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The VISERA ELITE II Infrared Imaging System is intended to provide real-time endoscopic visible and near infrared fluorescence imaging. The VISERA ELITE II Infrared Imaging System enables surgeons to perform minimally invasive surgery using standard endoscopic visible light as well as visual assessment of vessels. blood flow and related tissue perfusion, and at least one of the major extra-hepatic bile duct, common bile duct and common hepatic duct), using near-infrared imaging. Fluorescence imaging of biliary ducts with the VISERA ELITE II Infrared Imaging System is intended for use with standard of care white light and, when indicated, intraoperative cholangiography. The device is not intended for standalone use for biliary duct visualization.

[VISERA ELITE II VIDEO SYSTEM CENTER OLYMPUS OTV-S200]
This video system center is intended to be used with OLYMPUS camera heads, endoscopes, monitors, EndoTherapy accessories, and other ancillary equipment for endoscopic diagnosis, treatment, and video observation.

[VISERA ELITE II XENON LIGHT SOURCE OLYMPUS CLV-S200-IR]
The light source has been designed to be used with Olympus endoscopes, video system centers, light guide cables, and other ancillary equipment for endoscopic observation through visible and near-infrared fluorescence imaging with fluorescence agent.

[HD 3CMOS AUTOCLAVABLE CAMERA HEAD OLYMPUS CH-S200-XZ-EA]
The camera head has been designed to be used with Olympus endoscopes, video system center, and other ancillary equipment for endoscopic diagnosis, treatment, and observation.

[HD 3CMOS CAMERA HEAD OLYMPUS CH-S200-XZ-EB]
The camera head has been designed to be used with Olympus endoscopes, video system center, and other ancillary equipment for endoscopic diagnosis, treatment, and observation.

[TELESCOPE IR/ULTRA WAIR500A,WAIR530A,WAIR100A,WAIR130A]
These endoscopes are intended to be used for endoscopic surgery within the thoracic and peritoneal cavities including the female reproductive organs. The device is also indication of transanal and transvaginal natural orifice surgery. In combination with a compatible infrared imaging system, the telescope allows for fluorescence imaging.

The subject devices OTV-S200, CH-S200-XZ-EA, and CH-S200-XZ-EB were cleared in 510(k) K190449. After clearances, no technological modification for the subject devices were made. Therefore, the above devices have been omitted from the device description in this pre-market notification.

CLV-S200-IR: This device consists of the source circuit, the control circuit, the illumination lamp, and the optical filter. The control circuit connects to the diaphragm to regulate the light intensity, the source circuit supplies the power to the illumination lamp, the operation panel and the rear panel. By switching on the illumination lamp, this device provides the light for endoscopic observation. This device regulates the endoscopic image brightness constantly from the video system center. The observation mode can be switched by the optical filter extracting the specific wavelengths.

WAIR100A, WAIR130A, WAIR500A, WAIR530A: The "IR" Telescopes are rigid endoscopes. An image relay system of rod lenses transmits the endoscopic image. A bundle of optical fibers transmits light from an external light source to illuminate the endoscopic image. The "IR" Telescopes are delivered non-sterile. They are reusable and fully autoclavable. Before the first and each subsequent use of the device, it must be inspected and reprocessed according to defined reprocessing methods in the Instructions for Use. The "IR" Telescopes are available with different directions of view to allow use for various applications in accordance with the intended use as submitted with this 510(k).

This document describes the VISERA ELITE II Infrared Imaging System components (Xenon Light Source, Telescopes, Video System Center, and Camera Heads). There is no explicit "device" (like an AI algorithm) for which acceptance criteria and a study proving the device meets those criteria are directly provided in the format you described.

The document is a 510(k) summary, which focuses on demonstrating substantial equivalence to predicate devices rather than proving a novel device meets specific performance acceptance criteria for a new function. Therefore, much of the requested information regarding an AI study or specific performance metrics linked to acceptance criteria is not present.

However, I can extract information related to the device's validation and compliance:

1. Table of Acceptance Criteria and Reported Device Performance:

The document mentions several types of performance testing and compliance with standards. It does not provide a table with quantitative acceptance criteria and corresponding reported performance values for a specific device feature that would typically be seen in an AI performance study (e.g., sensitivity, specificity for disease detection). Instead, it lists validation activities.

The subsequent points (2-9) are generally applicable to studies for AI/CADe devices and are not fully addressed by this document, which pertains to a general surgical imaging system rather than a specific AI-driven diagnostic or assistive tool.

2. Sample size used for the test set and the data provenance:

• Test Set Sample Size: Not applicable. The document describes an animal study but does not specify a "test set" in the context of an AI algorithm evaluation. For the animal study, it mentions "canines and swines" but does not give a specific number of animals.
• Data Provenance: The animal study involved "canines and swines." It's a prospective study as it involved taking videos to validate performance. Country of origin is not specified.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts:

• For the animal study videos, evaluation was done by an "independent Health Care Professional." The number of professionals and their specific qualifications (e.g., radiologist with X years of experience) are not detailed.

4. Adjudication method for the test set:

• Not specified. It only mentions evaluation by "an independent Health Care Professional."

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 or comparative effectiveness study involving human readers with and without AI assistance was described. This document is not for an AI-assisted device in that context.

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

• Not applicable. This device is an imaging system, not an AI algorithm. Its performance is demonstrated as an imaging tool used by surgeons.

7. The type of ground truth used:

• For the animal study, the "ground truth" for demonstrating substantial equivalence in IR observation was based on the performance observed and evaluated by a healthcare professional in a simulated body environment. This is closer to expert assessment/observation in a controlled animal setting, rather than pathology or outcomes data.

8. The sample size for the training set:

• Not applicable. This is not an AI algorithm.

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

• Not applicable. This is not an AI algorithm.

In summary:

This 510(k) pertains to an endoscopic imaging system. It demonstrates substantial equivalence to predicate devices through various engineering, safety, and limited performance tests (bench and animal study). It does not involve a software-based AI algorithm for image interpretation or diagnosis that would typically require validation against a test set with established ground truth by multiple experts. Therefore, many of the requested points related to AI device evaluation are not applicable or cannot be extracted from this document.

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The KARL STORZ ICG Imaging System is intended to provide real-time visible (VIS) and near-infrared (NIR) fluorescence imaging.

The KARL STORZ Endoscopic ICG System enables surgeons to perform minimally invasive surgery using standard endoscopic visible light as well as visual assessment of vessels, blood flow and related tissue perfusion, and at least one of the major extra-hepatic bile ducts (cystic duct, common bile duct and common hepatic duct), using near infrared imaging. Fluorescence imaging of biliary ducts with the KARL STORZ Endoscopic ICG System is intended for use with standard of care white light and, when indicated, intraoperative cholangiography. The device is not intended for standalone use for biliary duct visualization.

The KARL STORZ VITOM II ICG System is intended for capturing and viewing fluorescent images for the visual assessment of blood flow, as an adjunctive method for the evaluation of tissue perfusion, and related tissue-transfer circulation in tissue and free flaps used in plastic, micro- and reconstructive surgical procedures. The VITOM II ICG System is intended to provide a magnified view of the surgical field in standard white light.

The KARL STORZ ICG Imaging System is used to provide real-time high definition (HD) endoscopic or telescope images of visible (VIS) and near-infrared (NIR) indocyanine green (ICG) dye fluorescence during minimally invasive or open surgery. The system components are a HOPKINS ICG/NIR Endoscope and a VITOM II ICG/NIR Telescope for VIS and NIR illumination and imaging, a light source with foot switch for emission of VIS and NIR illumination, a color video camera head capable of capturing both VIS and NIR imaging, and KARL STORZ ICG Kit. Additional accessories used with the KARL STORZ ICG Imaging System include a standard fiber-optic light cable for transmission of VIS and NIR light and the Image1S Camera Control Unit (CCU). All components except for the VITOM II ICG/NIR Telescope were cleared in K152583. The KARL STORZ ICG Imaging System can be used with any medical grade HD monitor with a DVI-D or 3G-SDI input. The VITOM II ICG/NIR Telescope is a Class I device under 21 CFR 878.4700.

The provided text describes a 510(k) submission for the "KARL STORZ ICG Imaging System". This document focuses on demonstrating the substantial equivalence of the new device to previously cleared predicate devices, rather than proving that the device meets specific acceptance criteria through a standalone clinical or "algorithm only" study. Therefore, much of the requested information about acceptance criteria, detailed study design, ground truth establishment, and multi-reader multi-case studies is not present in the provided text.

Specifically, the document states: "Clinical testing was not required to demonstrate the substantial equivalence to the predicate devices. Non-clinical bench testing was sufficient to assess safety and effectiveness and to establish the substantial equivalence of the modifications."

This indicates that the submission relies on demonstrating comparable performance to predicate devices through non-clinical (bench and animal) testing, rather than establishing specific performance metrics against a predefined acceptance criterion in human clinical data.

However, I can extract information about the non-clinical testing performed and how it aims to demonstrate equivalence, which implicitly serves as the "study" proving the device's acceptable performance in the context of this 510(k).

Here's the information based on the provided text:

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

The document does not explicitly state quantitative "acceptance criteria" in the format of a table with specific metrics (e.g., minimum sensitivity, maximum false positive rate). Instead, the performance is demonstrated by showing that the new system is "as safe as and as effective as" the predicate devices in various non-clinical tests. The reported 'performance' is qualitative: the system "successfully tested for its functions and performance" and "enable a selective visualization of the ICG fluorescence signal."

While specific quantitative results are not provided, the conclusion states that these tests "demonstrated that the subject device is as safe as and as effective as the primary predicate device," implying satisfactory performance on these aspects. |
| Biocompatibility | Should not change from the previously cleared system. | "The addition of the VITOM II ICG Telescope to the system does not change the biocompatibility... conducted for the KARL STORZ Endoscopic ICG System cleared in K152583." |
| Electromagnetic Compatibility (EMC) | Should not change from the previously cleared system. | "The addition of the VITOM II ICG Telescope to the system does not change the ... electromagnetic compatibility... conducted for the KARL STORZ Endoscopic ICG System cleared in K152583." |
| Electrical Safety | Should not change from the previously cleared system. | "The addition of the VITOM II ICG Telescope to the system does not change the ... electrical safety... conducted for the KARL STORZ Endoscopic ICG System cleared in K152583." |
| Software Validations | Should not change from the previously cleared system. | "The addition of the VITOM II ICG Telescope to the system does not change the ... software validations conducted for the KARL STORZ Endoscopic ICG System cleared in K152583." |
| Cleaning & Sterilization | Validation for the new component (VITOM II ICG Telescope) is required. | "Cleaning method validation and sterilization validation were performed on the VITOM II ICG Telescope." |
| Animal Study Performance | Performance in animal model should be adequate for evaluation. | "a GLP animal study was successfully performed by the NAMSA testing facility to evaluate the performance of the KARL STORZ ICG Imaging System with the VITOM II ICG Telescope in the porcine open surgery laparoscopy model." |
| Compliance with Standards | Device must meet relevant safety standards. | The device (and its predicates) are listed as meeting IEC 60601-1-2 and IEC 60601-1. The Visionsense predicate also met IEC 60825-1. "Bench testing was performed per IEC 62471." |

2. Sample size used for the test set and the data provenance

• Sample Size: Not explicitly stated with numerical values. The document refers to "comparative testing" and a "GLP animal study" without specifying the number of samples or animals used.
• Data Provenance:
  • Bench Testing: Conducted in-house or by testing laboratories (e.g., "NAMSA testing facility"). The country of origin is not specified but implied to be within the scope of FDA regulations (likely USA or a country with recognized testing standards).
  • Animal Study: Performed by "NAMSA testing facility" using a "porcine open surgery laparoscopy model."
  • Retrospective/Prospective: All described tests are non-clinical and would be conducted prospectively as part of the device development and submission process.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

Not applicable. This was a non-clinical study for substantial equivalence. The "ground truth" was based on the physical and optical properties of the device and its ability to visualize ICG fluorescence as measured by established testing methods and verified by the testing facility. There's no mention of human experts establishing "ground truth" in the diagnostic sense for a test set.

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

Not applicable. This was a non-clinical study. Adjudication methods like 2+1 or 3+1 are typically used for establishing ground truth in clinical imaging studies involving multiple human readers.

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

Not applicable. No MRMC study was performed as this was a 510(k) submission based on non-clinical substantial equivalence. The device is an imaging system, not an AI-powered diagnostic tool, and the submission explicitly states "Clinical testing was not required."

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

This concept doesn't directly apply here. The device itself is an integrated imaging system (camera, endoscope/telescope, light source). Its "standalone performance" is demonstrated through its physical and optical characteristics (e.g., light transmission, spectral characteristics, visualization of ICG signal) as measured in bench and animal studies, rather than an "algorithm."

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

The "ground truth" for the non-clinical tests would have been based on:

• Physical measurements and optical properties: For tests like "spectral characteristics," "irradiance levels," and "depth dependency," the ground truth is derived from established physics principles and calibrated measurement equipment.
• Known ICG fluorescence: For "visualization of ICG signal," the ground truth is the known presence and location of the fluorescent dye.
• Biological outcomes (animal model): In the GLP animal study, the "performance" would have been evaluated based on the ability of the system to correctly visualize blood flow/perfusion and biliary ducts as expected in the porcine model, potentially against direct observation or other validated methods if used in the study.

8. The sample size for the training set

Not applicable. This is not an AI/machine learning device that requires a "training set."

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

Not applicable, as this is not an AI/machine learning device.

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