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510(k) Data Aggregation

    K Number
    K200035
    Date Cleared
    2020-05-04

    (117 days)

    Product Code
    Regulation Number
    878.5050
    Reference & Predicate Devices
    Why did this record match?
    Device Name :

    Ultravision Visual Field Clearing System

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Ultravision™ Visual Field Clearing System is indicated for the clearance of smoke and other particulate matter that is created during surgery, including laparoscopic surgery. The Ultravision™ 5mm Trocar component establishes a path of entry for instruments used in laparoscopic surgery.

    Device Description

    The Ultravision™ Visual Clearing System removes surgical smoke and particulates from the visual field by means of electrostatic precipitation. The System consists of the Ultravision Generator, the Ionwand Sterile Pack, and the Ultravision 5mm Trocar. The Ionwand is connected to the energy source and is then introduced into the body cavity near the smoke generating electrosurgical device. The Ultravision™ 5mm Trocar is intended for use only with the Ultravision™M Visual Field Clearing System to introduce the Ionwand while providing a pathway for laparoscopic instruments through one 5 mm trocar incision. The trocar may be used with or without the Ionwand component of the system. The system is powered using a rechargeable battery or through mains power. Accessories include the rechargeable battery, battery recharging station, mains converter power supply, mains converter, power supply unit, and patient return adaptor.

    AI/ML Overview

    The Ultravision Visual Field Clearing System is a surgical smoke precipitator. The study described in the provided text focuses on demonstrating the substantial equivalence of the updated Ultravision system to its predicate device, particularly concerning the addition of a new indication for use in open surgical procedures.

    Here's an analysis of the acceptance criteria and study details based on the provided text:

    1. Table of Acceptance Criteria and Reported Device Performance

    Name of the TestPurposeAcceptance CriteriaResults
    Cytotoxicity (ISO 10993-5)To analyze the potential of the test article to induce a cytotoxic effect.Must not cause cell lysis or toxicity greater than a grade of 2 (mild reactivity).Reactivity of grade 1 was observed - Pass.
    Intracutaneous Irritation (ISO 10993-10)To analyze the potential of the test article to induce a local irritation response.No evidence of significant intracutaneous irritation.No evidence of intracutaneous irritation - Pass.
    Systemic Toxicity (ISO 10993-11)To analyze the potential of the test article to induce a systemic response.No evidence of significant systemic toxicity or mortality after test article extracts injection.No evidence of systemic toxicity - Pass.
    Maximization Sensitization (ISO 10993-10)To analyze the potential of the test article to induce a sensitization or allergic response.No evidence of induced delayed sensitization.Not a sensitizer - Pass.
    Performance Test 1: Simulated UseComparison of smoke clearing characteristics of Ultravision versus other smoke clearing devices for open procedures.Must be considered at least equivalent to comparators.Results of the evaluation demonstrated that Ultravision was at least equivalent to the comparator devices - Pass. (Specifically, in terms of surgical workflow, ease of use, and risks, the Ultravision system was considered equivalent to the reference device.)
    Performance Test 2: Risk Assessment (Ozone, Tissue Damage)Evaluation of device use in an oxygen-rich (open) environment considering ozone generation and tissue damage, including empirical testing on ozone generation.The risks associated with the use of Ultravision in an open procedure must not be greater than those for a laparoscopic procedure. Ozone generation must comply with 21 CFR [specific part not specified but implied standard].There were no new risks associated with the use of Ultravision in an open procedure; risks were found to be lower. The time-weighted average for ozone production was below acceptable limits - Pass.

    2. Sample Size Used for the Test Set and Data Provenance

    • Biocompatibility Tests (Cytotoxicity, Intracutaneous Irritation, Systemic Toxicity, Maximization Sensitization): The sample sizes for these tests are not explicitly stated in the provided text. These are typically standard tests conducted according to ISO 10993 guidelines, which would specify the number of samples/animals required. The provenance is likely laboratory-based testing.
    • Performance Test 1 (Simulated Use): The text states a "human factors evaluation was also conducted during simulated surgery by actual users (surgeons)." The number of surgeons or simulated cases is not specified. The data provenance is from simulated surgical conditions.
    • Performance Test 2 (Risk Assessment/Ozone Generation): This involved "empirical testing on ozone generation" in a "worst-case model." The specific sample size for these empirical tests (e.g., number of test runs, duration of tests) is not provided. The data provenance is laboratory testing.

    3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts

    • Biocompatibility Tests: Ground truth for these tests is established by standardized laboratory procedures and scientific assessment against predefined biological endpoints. No "experts" in the sense of clinical specialists establishing ground truth are mentioned.
    • Performance Test 1 (Simulated Use): "Actual users (surgeons)" provided feedback to compare the Ultravision device to reference devices. The number of surgeons is not specified, nor are their specific qualifications (e.g., years of experience, subspecialty), beyond being "surgeons." Their feedback likely served as the "ground truth" for perceived performance metrics like workflow, ease of use, and risks in the simulated environment.
    • Performance Test 2 (Risk Assessment): The ground truth for ozone generation is established by analytical measurements against regulatory limits (implied by "21 CFR"). The risk assessment for tissue damage risks was conducted internally by the manufacturer, comparing risks across different environments. The specific experts involved in designing or executing this risk assessment are not detailed, but it would involve experts in medical device safety, engineering, and possibly toxicology.

    4. Adjudication Method for the Test Set

    • Biocompatibility Tests: Adjudication is based on objective measurements and adherence to ISO 10993 standards and criteria.
    • Performance Test 1 (Simulated Use): Feedback from "actual users (surgeons)" was synthesized to conclude equivalence. The method of synthesizing this feedback (e.g., individual reports, consensus meeting, voting) is not specified. It's unclear if a formal adjudication process beyond simple aggregation of feedback was used.
    • Performance Test 2 (Risk Assessment): The risk assessment involves internal evaluation against predefined criteria and regulatory standards (for ozone). This is typically an internal process, so a specific external adjudication method is unlikely to have been used in the sense of a clinical read.

    5. If a Multi Reader Multi Case (MRMC) Comparative Effectiveness Study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

    • No MRMC comparative effectiveness study was done. This device is a surgical smoke precipitator, not an AI diagnostic tool. The "Performance Test 1" involved human factors evaluation by surgeons, but it was not an MRMC study and did not involve AI.

    6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

    • This device is a physical medical device (surgical smoke precipitator) and not an algorithm or AI-powered tool. Therefore, a standalone algorithm performance study is not applicable. The device's performance is intrinsically linked to its physical operation.

    7. The Type of Ground Truth Used

    • Biocompatibility Tests: Ground truth is established by standardized laboratory test results adhering to ISO 10993, which provide objective measurements of biological response (e.g., cell viability, irritation scores, systemic effects, sensitization).
    • Performance Test 1 (Simulated Use): Ground truth is based on subjective feedback and comparative assessment from "actual users (surgeons)" regarding workflow, ease of use, and perceived risks in a simulated environment.
    • Performance Test 2 (Risk Assessment): Ground truth for ozone generation is based on empirical measurement data compared against regulatory limits (21 CFR). For tissue damage assessment, it's based on an internal risk assessment methodology comparing scenarios.

    8. The Sample Size for the Training Set

    • Not applicable. This is a physical medical device, not an AI/machine learning model that requires a training set. The device was previously cleared (K182053), and the current submission is for an expanded indication, so the "development" or "training" of the device happened prior to or as part of the predicate device's clearance.

    9. How the Ground Truth for the Training Set was Established

    • Not applicable, as no training set for an AI/ML model is involved.
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    K Number
    K182053
    Date Cleared
    2018-09-07

    (38 days)

    Product Code
    Regulation Number
    878.5050
    Reference & Predicate Devices
    Why did this record match?
    Device Name :

    Ultravision™ Visual Field Clearing System

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Ultravision™ Visual Field Clearing System is indicated for the clearance of smoke and other particulate matter that is created during laparoscopic surgery.

    The Ultravision™ 5mm Trocar component also establishes a path of entry for instruments used in laparoscopic surgery.

    Device Description

    The Ultravision™ Visual Clearing System removes surgical smoke from the visual field during laparoscopic surgery by means of electrostatic precipitation. The System consists of the Ultravision™ Generator, the Ionwand Sterile Pack, and the Ionwand 5mm Trocar. The Ionwand is connected to the energy source and is then introduced into the body cavity near the smoke generating electrosurgical device. The Ultravision™ 5mm Trocar is intended for use only with the Ultravision™ Visual Field Clearing System to introduce the Ionwand while providing a pathway for laparoscopic instruments through one 5 mm trocar incision. The Ultravision™ 5mm Trocar provides an alternative to the currently available Ultravision™ Visual Field Clearing System Ionwand™ Sterile Pack for introduction of the Ionwand. The trocar may be used with or without the Ionwand component of the system. The system is powered using a rechargeable battery or through mains power. Accessories include the rechargeable battery, battery recharging station, mains converter power supply, mains converter, power supply unit, and patient return adaptor.

    AI/ML Overview

    This request is about a medical device called the "Ultravision™ Visual Field Clearing System," which is a surgical smoke precipitator. The provided text is an FDA 510(k) summary, which focuses on demonstrating substantial equivalence to a predicate device, rather than detailed clinical performance studies or acceptance criteria for AI/ML performance.

    Therefore, based on the provided document, the device does not employ Artificial Intelligence or Machine Learning, and thus, none of the requested information regarding AI/ML acceptance criteria and performance evaluation is available.

    The document describes a modification to an existing mechanical device (adding a mains power option), and the safety and effectiveness are established by comparing it to a previously cleared version of the same device. The "Nonclinical Performance Data" section mentions electromagnetic compatibility and electrical safety standards, which are typical for medical devices but distinct from AI/ML performance evaluation.

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    K Number
    K170178
    Date Cleared
    2017-05-26

    (127 days)

    Product Code
    Regulation Number
    878.5050
    Reference & Predicate Devices
    Why did this record match?
    Device Name :

    Ultravision Visual Field Clearing System

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Ultravision™ Visual Field Clearing System is indicated for the clearance of smoke and other particulate matter that is created during laparoscopic surgery.

    The Ultravision 5mm Trocar component also establishes a path of entry for instruments used in laparoscopic surgery.

    Device Description

    The Ultravision™ Visual Clearing System removes surgical smoke from the visual field during laparoscopic surgery by means of electrostatic precipitation. The System consists of the Ultravision Generator, the Ionwand Sterile Pack, and the Ionwand 5mm Trocar. The Ionwand is connected to the energy source and is then introduced into the body cavity near the smoke generating electrosurgical device. The Ultravision™ 5mm Trocar is a new accessory device intended for use only with the Ultravision™ Visual Field Clearing System to introduce the Ionwand while providing a pathway for laparoscopic instruments through one 5 mm trocar incision. The Ultravision™ 5mm Trocar provides an alternative to the currently available Ultravision™ Visual Field Clearing System Ionwand™ Sterile Pack for introduction of the Ionwand. The Ultravision™ 5mm Trocar is a standard dilating laparoscopic trocar compatible for use with 5mm instruments. The trocar design includes a discrete lumen that is positioned separate from the main trocar channel and which accepts the Ionwand component of the system. The trocar design allows the distal tip of the Ionwand to exit the trocar some 12mm from its distal point and at an angle to the trocar body that positions the Ionwand at a point close to but not interfering with the 5mm energy instruments that are intended to be accommodated by the trocar. The Ultravision™ 5mm trocar and Ionwand are provided packaged together in the same sterile barrier packaging. The trocar may be used with or without the Ionwand component of the system.

    AI/ML Overview

    The provided text describes the regulatory clearance (510(k) submission) for the Ultravision™ Visual Field Clearing System, specifically focusing on the new 5mm Trocar component. It details the device's function, comparison to predicate devices, and the nonclinical testing performed to demonstrate substantial equivalence.

    Based on the provided information, the device is not an AI/ML medical device. It's a surgical device for clearing smoke during laparoscopic surgery. Therefore, many of the typical acceptance criteria and study components associated with AI/ML devices (like MRMC studies, expert consensus for ground truth on training data, etc.) are not applicable here.

    However, I can extract the acceptance criteria and the study (nonclinical testing) that proves the device meets them from the provided text, interpreting them in the context of a physical medical device.

    Here's the information as requested, with "N/A" for sections not applicable to this type of device or not explicitly mentioned in the document:


    Acceptance Criteria and Device Performance for Ultravision™ Visual Field Clearing System (K170178)

    1. Table of Acceptance Criteria and Reported Device Performance

    The acceptance criteria are implicitly defined by the successful results of the specified nonclinical tests, demonstrating equivalence to predicate devices. The reported device performance is that it "Pass"-ed all these tests and was found "Equivalent" to the predicate.

    Acceptance Criteria (Test)Description of TestReported Device Performance (Result)
    Performance of the system to clear the visual field of smoke and particulate matterPerformance comparison to the predicate device under simulated use conditionsEquivalent to predicate - Pass
    UsabilityComplexity of use compared to the predicate and reference deviceEquivalent to predicate and reference - Pass
    Ionwand removal and reinsertionRepeated insertions/removals performed and forces both quantitative and qualitative evaluations performedEquivalent to predicate and reference - Pass
    Leak resistance and sealing, maintenance of pneumoperitoneum during usePressure tests under high and low pressures with and without instruments or Ionwand inserted, including multiple cycles of useEquivalent to predicate or reference - Pass
    Strength, resistance to bendingTensile or pressure forces applied to shaft, trocar, and connectionsEquivalent to predicate or reference - Pass
    Dimensional VerificationConfirmation of dimensional characteristics by dimensional evaluationPass
    Luer fittingConfirmation of compliance with industry standard luer fittingPass
    Electrical SafetyDielectric breakdown, radio-frequency applied parts, capacitive couplingPass
    Biocompatibility per ISO 10993Appropriate biocompatibility based on tissue contact and durationPass
    Sterilization and shelf life studiesValidated sterilization cycle according to industry standard, shelf life studies on accelerated aging conditions including product and package evaluationsPass

    2. Sample Size Used for the Test Set and Data Provenance

    • Sample Size:
      • The document does not explicitly state the numerical sample sizes for each nonclinical test (e.g., how many units were tested for strength, how many cycles for reinsertion). It describes the type of tests performed.
    • Data Provenance:
      • Country of Origin: Not specified, but the applicant (Alesi Surgical Ltd) is based in Cardiff, GB (United Kingdom). The tests were presumably conducted internally or by a contracted lab.
      • Retrospective or Prospective: These are laboratory/benchtop tests and simulated use conditions, not clinical studies on patients. Therefore, the terms "retrospective" or "prospective" as typically applied to patient data are not directly applicable. These were newly conducted tests to support the 510(k) submission.

    3. Number of Experts Used to Establish Ground Truth for the Test Set and Qualifications of Those Experts

    • Number of Experts: N/A. Ground truth in this context (performance of a physical device) typically relies on engineering specifications, physical measurements, and standardized testing protocols rather than expert consensus on subjective interpretations.
    • Qualifications of Experts: N/A. The qualification of personnel performing the tests would be governed by internal quality systems and standards for medical device manufacturing and testing, but not explicitly stated as "experts" for ground truth establishment in the way it's done for AI models interpreting medical images.

    4. Adjudication Method for the Test Set

    • Adjudication Method: N/A. Adjudication methods (like 2+1 or 3+1) are typically used for establishing ground truth from multiple human readers in image interpretation tasks. For physical device testing, results are typically objective measurements against predefined acceptance criteria.

    5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was Done

    • MRMC Study: No. This device is not an AI/ML system or diagnostic imaging tool that would benefit from an MRMC study. Its function is direct surgical smoke clearance and trocar access, not interpretation by human readers.
    • Effect Size of Human Readers Improvement: N/A, as no MRMC study was conducted or relevant for this device.

    6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) was Done

    • Standalone Performance: N/A. This is a physical medical device, not an algorithm. Its "performance" is its physical and functional operation.

    7. The Type of Ground Truth Used

    • Type of Ground Truth: The "ground truth" for this device's performance is established by:
      • Predicate Device Performance: Demonstrating "equivalence" to the legally marketed predicate device (Ultravision™ Visual Field Clearing System, DEN150022) under simulated use conditions.
      • Industry Standards and Specifications: Adherence to standards like ISO 10993 for biocompatibility, industry standards for luer fittings, and general engineering principles for strength, sealing, etc.
      • Established Methods for Sterilization and Shelf-Life Validation: Following recognized protocols for these critical aspects.
      • Objective Measurements: Dimensional verification, pressure tests, electrical safety measurements provide objective data points.

    8. The Sample Size for the Training Set

    • Sample Size for Training Set: N/A. This device is not an AI/ML system that requires a "training set" in the computational sense. Device design and development are based on engineering principles and iterative testing, not statistical training on a data set.

    9. How the Ground Truth for the Training Set was Established

    • Ground Truth for Training Set Establishment: N/A. As there is no training set as understood in AI/ML, there is no method for establishing ground truth for it. The development and refinement of the device would involve engineering design, prototyping, and testing against functional requirements and safety standards.
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