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510(k) Data Aggregation

    K Number
    K193539
    Date Cleared
    2020-05-28

    (160 days)

    Product Code
    Regulation Number
    878.5040
    Reference & Predicate Devices
    Why did this record match?
    Reference Devices :

    K163647

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

    REVOLVE ENVI™ 600 System is used for aspiration, harvesting, filtering, and transferring of autologous adipose tissue for aesthetic body contouring. The system should be used with a legally marketed vacuum or aspirator as a source of suction. If harvested fat is to be re-implanted, the harvested fat is only to be used without any additional manipulation.

    REVOLVE ENVI™ 600 System is intended for use in the following surgical specialties when the aspiration of soft tissue is desired: plastic and reconstructive surgery, gastrointestinal and affiliated organ surgery, general surgery, orthopedic surgery, gynecological surgery, thoracic surgery, and laparoscopic surgery.

    Device Description

    REVOLVE ENVI™ 600 Advanced Adipose System (REVOLVE ENVI 600 System) consists of a sterile, single-use canister and components intended to be used for harvesting, filtering and transferring of autologous adipose tissue. Such products have been classified by FDA as Class II devices under 21 CFR §878.5040. Suction Lipoplasty System. and assigned product code MUU. The subject device should be used with a legally marketed vacuum or aspirator apparatus as a source of suction. The adipose tissue is harvested from the patient using liposuction tubing and cannula that are supplied by the user or the institution. The harvested tissue is collected inside the device which contains an inner basket with 200 um mesh filter that can process up to 600 mL of collected tissue. A manual stirring assembly allows the user to mix the tissue and Lactated Ringer's during the washing step. The processed adipose tissue is removed from the device via an extraction port located on the bottom of the device using a syringe.

    The REVOLVE ENVI 600 System is comprised of the following components, intended to be used only as a system:

    • Canister (including mesh filter)
    • Syringe Adapter
    • Temperature Strip
    • Lactated Ringer's Tubing Set
    • Vacuum Tubing Set

    The device is offered in a single size, is packaged in a thermoformed tray and Tyvek® lidding and is sterilized via gamma irradiation. The device is a single-use device to be used in a healthcare facility.

    AI/ML Overview

    Here's an analysis of the provided text regarding the REVOLVE ENVI 600 Advanced Adipose System, structured according to your request. However, it's important to note that this document is a 510(k) summary for a medical device and not a detailed study report for an AI/ML powered device. Therefore, many of your requested criteria, particularly those related to AI algorithm performance (like sample sizes for test/training sets, ground truth establishment methods, expert qualifications, MRMC studies, and standalone performance metrics), are unlikely to be found. This document focuses on demonstrating substantial equivalence to a predicate device through non-clinical performance testing.

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

    The document does not explicitly state "acceptance criteria" in the typical sense of quantitative targets for each test in a table format. Instead, it states that the tests were performed "to support substantial equivalence" and that "data demonstrate that the device is biocompatible" and "is comparable to the predicate REVOLVE System in product performance characteristics relevant to the intended use of the device."

    Below is a table summarizing the types of performance tests conducted. The specific quantitative results or acceptance thresholds for each test are not provided in this summary.

    Test/AssessmentReported Device Performance
    Gross and microscopic assessments of adipose samplesPerformed to support substantial equivalence.
    Adipose tissue viability (via Lactate Dehydrogenase assessment)Performed to support substantial equivalence.
    System fluid leakPerformed to support substantial equivalence.
    System vacuum leakPerformed to support substantial equivalence.
    Tubing connection tensile strengthPerformed to support substantial equivalence.
    Hose collapseConforms to ISO 10079-1:2015(E) Medical Suction Equipment Part 1, Section 6.3.1 and Annex A.4
    Implosion testConforms to ISO 10079-1:2015(E) Medical Suction Equipment Part 1, Section 6.1.3 and Annex A.3
    BiocompatibilityData demonstrates the device is biocompatible (classified as Externally Communicating Device, Tissue, Limited Contact (≤ 24 hours) as per ISO 10993-1:2018).
    SterilizationValidated in accordance with ISO 11137-2:2013 to provide a SAL of 10^-6.

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

    This information is not provided in the 510(k) summary. The document describes bench testing, which typically uses laboratory samples or device units, not patient data in the context of AI.

    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/provided. The performance evaluation described is for a physical medical device (lipoplasty system) through bench testing and biocompatibility assessments, not an AI/ML algorithm that requires expert-established ground truth from images or clinical data.

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

    This information is not applicable/provided. Adjudication methods are typically used in clinical studies or for establishing ground truth for AI algorithms, which is not the focus of the performance tests described here.

    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. An MRMC study is relevant for AI-assisted diagnostic or interpretive devices. This 510(k) is for a physical surgical system for adipose tissue processing and does not involve AI assistance for human readers.

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

    This information is not applicable. The device is a physical system, not an algorithm.

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

    This information is not applicable/provided. The ground truth for this device would be established through engineering specifications, material properties, and standardized test methods (e.g., ISO standards for hose collapse, implosion, and sterilization).

    8. The sample size for the training set

    This information is not applicable/provided as the device is not an AI/ML algorithm.

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

    This information is not applicable/provided as the device is not an AI/ML algorithm.

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