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510(k) Data Aggregation

    K Number
    K162411
    Date Cleared
    2016-09-21

    (23 days)

    Product Code
    Regulation Number
    876.1500
    Reference & Predicate Devices
    Predicate For
    N/A
    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Intuitive Surgical Endo Wrist® Stapler 45, Stapler 45 Reloads and other Stapler Accessories are intended to be used with the da Vinci® Surgical System (Model 1S4000) for resection, transection and/or creation of anastomoses in General, Thoracic, Gynecologic and Urologic surgery. The device can be used with staple line or tissue buttressing material (natural or synthetic).

    Device Description

    The da Vinci Xi 12 - 8 mm Reducer is a sterile, single use hollow cylinder with an integrated seal that is inserted into the da Vinci Xi 12 mm & Stapler Cannula/Cannula Seal assembly to support the use of da Vinci Xi 8 mm instruments and endoscopes.

    The Reducer consists of three components - a tube, handle, and an integrated seal to allow a da Vinci Xi 8 mm instrument or endoscope to be used with a 12 mm & Stapler Cannula while maintaining pneumoperitoneum. The latch on the Reducer snaps onto the da Vinci Xi Stapler Cannula Seal by a molded-in latch flexure on the device.

    AI/ML Overview

    The provided document describes the da Vinci Xi 12 - 8 mm Reducer and its substantial equivalence to a predicate device. It does not contain information about the performance of a software-driven or AI-based medical device. Therefore, many of the requested fields related to AI performance, ground truth, expert consensus, and reader studies are not applicable or cannot be extracted from this document.

    However, I can extract information related to the device's functional performance and the testing conducted to ensure its safety and effectiveness.

    Here's the closest possible answer based on the provided text, recognizing that it's for a mechanical medical device, not an AI system:

    1. A table of acceptance criteria and the reported device performance

    Acceptance Criteria CategorySpecific TestReported Performance / Outcome (Pass/Fail)
    MechanicalInsertion forceTested & Verified
    Retraction forceTested & Verified
    Insertion frictionTested & Verified
    Latch disengagement forceTested & Verified
    Insertion axis range of motionTested & Verified
    FunctionalInternal seal leak rateTested & Verified
    Maintains pneumoperitoneumConfirmed (with compatible components)
    CompatibilityCompatibility with cannulasConfirmed
    Compatibility with cannula sealsConfirmed
    Compatibility with size-compatible endoscopesConfirmed
    Compatibility with size-compatible instrumentsConfirmed
    DimensionalDimensional requirementsTested & Verified
    LabelingAdequacy of labeling for compatibilityTested & Verified
    OverallIntended Use FunctionalityConfirmed in animal model
    Met Design Input RequirementsConfirmed
    Safe and Effective for Intended UseConfirmed

    2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

    • Sample Size for Test Set: Not explicitly stated for each test. The document mentions "tests with an animal model" but does not give a specific number of animals or trials. For bench tests, it's implied that sufficient samples were tested to verify the requirements, but no numbers are provided.
    • Data Provenance: Not specified, but tests were conducted by Intuitive Surgical, Inc. (Sunnyvale, CA, USA).
    • Retrospective or Prospective: Testing appears to be prospective as it's part of design verification and validation for a new/modified device.

    3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)

    • This information is not applicable and not provided as this is a mechanical device, not an AI system that requires expert interpretation for ground truth.

    4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

    • This information is not applicable and not provided. Adjudication methods are typically relevant for subjective assessments, particularly in clinical studies or AI performance evaluation. The tests described are objective engineering and functional verifications.

    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

    • This information is not applicable and not provided. This is for a mechanical reducer, not an AI-assisted diagnostic tool.

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

    • This information is not applicable and not provided. This pertains to an algorithm's performance, not a mechanical device.

    7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

    • For the functional and mechanical tests, the "ground truth" (or reference standard) was established by engineering specifications and design input requirements. For the animal model, the ground truth was the intended functional outcome (e.g., maintaining insufflation, proper instrument use) as observed and measured against predefined criteria.

    8. The sample size for the training set

    • This information is not applicable and not provided. This refers to AI/machine learning models, which are not described here.

    9. How the ground truth for the training set was established

    • This information is not applicable and not provided. This refers to AI/machine learning models, which are not described here.
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