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The Evolution Spine navigation instruments are indicated for use during the preparation and placement of Whistler Modular Pedicle Screw System polyaxial screws or Stowe Pedicle Screw System polyaxial screws during spinal surgery to assist the surgeon in precisely locating anatomical structures in either open or minimally invasive procedures. The navigation instruments are intended to be used with the Medtronic® StealthStation® S8 Navigation System (Software Version 1.3.0)., which is indicated for any medical condition in which the use of stereotactic surgery may be appropriate and where reference to a rigid anatomical structure such as a vertebra can be identified relative to a CT or MR based model, fluoroscopy images, or digitized landmarks of the anatomy.

The Evolution Spine Navigation Instruments are reusable surgical instruments for use with the Medtronic® StealthStation® S8 Navigation System. The system is designed to assist surgeons in the precise localization of anatomical structures, preparation and placement of pedicle screw implants during spinal procedures.

The Evolution Spine navigation Instruments include awls, probes, taps and drivers. The navigated instruments are to be used with Whistler Modular Pedicle Screw System (K182478) and Stowe Pedicle Screw System (K181554).

All instruments are made of stainless steel per ASTM F899. The Evolution Spine navigation Instruments are not compatible with implants from other manufacturers and are designed for use only with Medtronic® StealthStation® S8 Navigation System hardware and software.

The provided FDA 510(k) clearance letter for the Evolution Spine Navigation Instruments focuses on establishing substantial equivalence to predicate devices, primarily through non-clinical performance testing. It indicates that clinical testing was not performed. Therefore, a multi-reader multi-case (MRMC) comparative effectiveness study was not conducted to assess human reader improvement with AI assistance, nor was a standalone algorithm performance study performed as part of this submission for establishing substantial equivalence.

The submission relies on a non-clinical test to demonstrate performance, specifically focusing on positional accuracy of the instruments when used with a specific navigation system.

Here's an analysis of the acceptance criteria and the study that proves the device meets them, based on the provided text:

Acceptance Criteria and Reported Device Performance

Note: The exact numerical values for positional accuracy criteria from ASTM F2554-18 and Rampimura et al. are not explicitly stated in the provided text. The document only confirms that the device "meets and exceeds" these established benchmarks.

Study Details

1. Sample Size Used for the Test Set and Data Provenance:

   • Sample Size: The document does not specify a numerical "sample size" in terms of cases or patients. Instead, it refers to "the worst-case instruments constructs" being tested. This implies a limited number of physical instrument configurations were chosen for rigorous testing, representing the most challenging scenarios for accuracy.
   • Data Provenance: The study described is a non-clinical, laboratory-based performance test. This means the "data" is derived from controlled measurements in a lab setting, not from human subjects or clinical data. Therefore, concepts like "country of origin" or "retrospective/prospective" do not apply in the typical sense; it's an engineering test.

2. Number of Experts Used to Establish Ground Truth for the Test Set and Qualifications of those Experts:

   • This is a non-clinical performance test of a physical device's accuracy. "Ground truth" in this context refers to the engineering specifications and established test methods (ASTM F2554-18 and Rampimura et al. reference values) for positional accuracy. No human experts (e.g., radiologists) were used to establish the ground truth for this performance test. The "truth" is an objective, measurable accuracy.

3. Adjudication Method for the Test Set:

   • Not applicable as this was a non-clinical instrument performance test, not a subjective assessment requiring human adjudication. The results are quantitative measurements against established engineering standards.

4. If a multi-reader multi-case (MRMC) comparative effectiveness study was done:

   • No. The document explicitly states: "Clinical testing was not necessary to demonstrate the substantial equivalence of the subject devices." This implies that an MRMC study involving human readers and AI assistance was not performed or submitted for this specific clearance.

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

   • No. The device is a set of "navigation instruments" used with a navigation system (Medtronic® StealthStation® S8). It's a physical instrument, not an AI algorithm. Its performance is evaluated in conjunction with the navigation system, but the focus is on the instrument's mechanical and tracking accuracy.

6. The Type of Ground Truth Used:

   • Engineering Specifications / Established Test Standards: The ground truth for this non-clinical study was defined by the performance criteria established in:
     • ASTM F2554-18, "Standard Practice for Measurement of Positional Accuracy of Computer Assisted Surgical Systems"
     • Rampimura et al: "Accurate pedicle screw insertion under the control of a computer-assisted guiding system: Laboratory test and clinical study"
   • These are recognized industry standards and published research that define acceptable accuracy limits for such devices.

7. The Sample Size for the Training Set:

   • Not applicable. This is a physical medical device (surgical instruments), not an AI/machine learning algorithm that requires a "training set" of data.

8. How the Ground Truth for the Training Set was Established:

   • Not applicable, as there is no "training set" for this type of device.

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OptiVu™ Shoulder is intended for use during stereotaxic surgery to aid the surgeon in locating anatomical structures (humerus and scapula), humerus resection, and aligning the endoprosthesis with the anatomical structures, provided that the required anatomical landmarks can be identified on the patient's preoperative CT scan.

OptiVu™ Shoulder utilizes pre-operative planning files provided by the Zimmer CAS Signature ONE™ System. OptiVu™ Shoulder is compatible with any humeral implants that are supported by the Signature ONE™ System.

OptiVu™ Shoulder is specifically indicated for total shoulder arthroplasty using the Zimmer Biomet Alliance® Glenoid system or reverse shoulder arthroplasty using the Comprehensive® Reverse Shoulder system, to aid the surgeon in locating anatomical structures (humerus and scapula), humerus resection, and aligning the glenoid component with the anatomical structures.

OptiVu Shoulder includes an augmented reality (AR) head-mounted display (HMD) (OptiVu Tilt with HoloLens 2) and trackers to register and optically track anatomical landmarks and surgical instruments in real-time during the procedure. The HMD should not be relied upon solely and should always be used in conjunction with traditional methods.

OptiVu Shoulder is a stereotaxic surgical navigation system designed to aid surgeons in locating anatomical structures and aligning the endoprosthesis in total or reverse shoulder arthroplasty procedures. The system includes an augmented reality (AR) head-mounted display (HMD) (OptiVu Tilt with HoloLens 2) and mixed reality trackers to register and optically track anatomical landmarks and surgical instruments in real-time during the procedure.

The OptiVu Shoulder system is intended to be used specifically with the Zimmer Biomet Alliance® Glenoid or Comprehensive® Reverse Shoulder system for total or reverse shoulder arthroplasty, respectively.

The OptiVu Shoulder system also utilizes pre-operative planning files provided by the Zimmer CAS Signature ONE™ System.

The intended users of the system are surgeons who are trained in performing shoulder arthroplasty procedures.

This 510(k) clearance letter pertains to a Special 510(k) submission for the OptiVu™ Shoulder system. A Special 510(k) is used when changes to a previously cleared device do not alter its fundamental scientific technology or indications for use, but rather involve specific modifications. In this case, the modifications are explicitly stated to be updates to packaging parameters and the site for contract sterilization, not changes to the software, functionality, or performance of the navigation system itself.

Therefore, the provided document does not contain the information requested about the acceptance criteria and study proving the device meets those criteria for the AI/software performance, as this type of study would have been part of the original 510(k) clearance for OptiVu™ Shoulder (K250108), not this Special 510(k) (K252170). The validation testing performed for this submission is limited to sterilization efficacy and packaging safety.

This document explicitly states:

• "The purpose of this Special 510(k) submission is to update both the packaging parameters for the instruments and the site for contract sterilization."
• "There are no differences in technological characteristics that raise questions of safety and efficacy."
• "With the updated packaging and sterilization parameters presented in this submission, there are no technological or design changes in the subcomponents of the OptiVu Shoulder system instruments themselves."
• "Validation testing was conducted according to written protocols with acceptance criteria that were based on established standards. This submission includes or references the following tests in support of a substantial equivalence determination:
  • Sterilization validation testing to confirm that there is no impact to the sterilization efficacy of the system
  • Packaging validation to confirm that the packaging of OptiVu Shoulder system is safe and effective"

Conclusion based on the provided document:

The provided 510(k) clearance letter for K252170 (OptiVu™ Shoulder) is a Special 510(k), which addresses changes only to the packaging and sterilization of the device, not its core functionality or software performance. As such, the document does not contain any information about acceptance criteria or performance studies related to the artificial intelligence/software accuracy, clinical effectiveness, human reader improvement with AI assistance, or the establishment of ground truth for such studies. This type of information would have been part of the original 510(k) submission (K250108) for the device's fundamental technology.

Therefore, I cannot populate the requested table or answer the specific questions about AI/software performance, ground truth, and study parameters based solely on the provided text.

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The NextAR Spine platform is intended as an aid for precisely locating anatomical structures in either open/mini-open or percutaneous spine procedures. It is indicated for any medical condition in which the use of stereotaxic surgery may be appropriate, when reference to a rigid anatomical structure, such as vertebrae or pelvis, can be identified relative to images of the anatomy. This can include posterior approach spinal procedures, such as:

• Pedicle Screw Placement (Thoracic and Lumbosacral spine)
• Sacro-Iliac Screw Placement

NextAR Spine is also intended to provide planning tools for measuring and selecting the fixation rod for the thoracic and lumbosacral spine.

The NextAR Spine platform is intended to be used in combination with NextAR™ Stereotaxic instruments and / or Medacta preoperative planning. In the case of pre-operative planning, surgical planning software is used pre-operatively to plan the surgical placement of pedicle screws based upon radiological images of the patient. As an optional display, the NextAR Smart Glasses can be used auxiliary to the NextAR Spine Platform to view stereotaxic information as presented by the NextAR Spine Platform. The NextAR Smart Glasses should not be relied upon solely and should always be used in conjunction with the primary computer display.

NextAR Spine sterile drill and pins

The sterile drills, pins and iliac pins are part of the NextAR Spine platform which is intended as an aid for precisely locating anatomical structures in either open / mini open or percutaneous spine procedures. The NextAR Spine sterile drills pins and iliac pins are intended for use with the NextAR Spine platform according to its approved indications for use. All the drills are motorized. Pins may be used either motorized or manually. Iliac pins are manual.

The NextAR™ Spine platform is a CT based computer-assisted surgical navigation platform used in either open/mini open or percutaneous spine surgery procedure and includes the following components:

• Navigation software which displays information to the surgeon
• Augmented Reality glasses
• Optical tracking system
• PC based hardware platform
• Fiducial Block
• Surgical instruments for spine surgery procedures

The system operates on the common principle of stereotaxic technology in which markers are mounted on the bones and an infrared camera is used to monitor the spatial location of the instruments. Tracking sensors attached to the bones enable the surgeon to view the position and orientation of the instrumentation relative to the intra-operative data in real-time while performing the surgical procedure. The tracking sensors, the fiducial block, and a group of pins and drills are provided sterile.

NextAR™ Spine aids the surgeon in executing the surgical plan by visualizing all the information in real time in a screen monitor. The platform uses the information of either an intra-operative scan or pre-operative CT in combination with an intra-operative 3D scan in order to register the spine to navigation elements. The registration can be performed with one of the following approaches: 1) Direct 3D: based on the use of an intra-operative 3D scan, or 2) 3D-3D: based on the use of a pre-operative CT scan and an intra-operative 3D scan.

Where the Direct 3D approach is utilized, NextAR™ Spine allows for planning of screw positioning on the patient's intraoperative DICOM images just before system setup. The application allows for navigating the spine with a screw planning superimposed on the acquired scan.

The NextAR™ Spine platform also includes the rod planning tool, which gives the surgeon information about the length and the rod type to best fit the spine anatomy and to perform the desired curvature correction.

The system's navigation technology is based on an active infrared camera coupled with an active tracker (Target). These elements allow, by means of the different registration approaches and use of compatible instruments, to accurately prepare trajectories in the vertebrae and/or to implant screws while visualizing information in real time on a screen monitor.

The FDA 510(k) clearance letter for NextAR™ Spine (K250477) provides limited details on a comprehensive study proving acceptance criteria. However, based on the provided text, we can infer some aspects of the performance data and the methods used to demonstrate the device's substantial equivalence.

Here's an attempt to structure the information based on your request, highlighting what is explicitly stated and what can be inferred or is missing from this document:

1. Table of Acceptance Criteria and Reported Device Performance

The FDA 510(k) summary does not explicitly list acceptance criteria in a quantitative table format nor does it provide numerical performance metrics. Instead, it relies on comparative evaluations and qualitative assessments to demonstrate substantial equivalence to predicate devices. The "Performance Data" section primarily focuses on non-clinical studies.

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

• Sample Size for Test Set: Not explicitly stated in terms of number of cases or subjects. "Cadaver workshops" imply surgical procedures performed on anatomical models (cadavers), but the number is not provided.
• Data Provenance: The document does not specify the country of origin for the cadaver studies or the software testing. The studies were non-clinical. The studies were likely prospective in nature, as they were "performed in support of a substantial equivalence determination."

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

• Number of Experts: Not specified.
• Qualifications of Experts: Not specified. However, the mention of "Cadaver workshops" suggests that surgeons or other qualified medical professionals would have been involved to assess the adequacy of the instruments and system for surgical use.

4. Adjudication Method for the Test Set

• Adjudication Method: Not explicitly stated. Given that these were "cadaver workshops" to demonstrate adequacy, it's likely qualitative assessments by the participating surgeons, rather than a formal, multi-reader quantitative adjudication process.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

• MRMC Study: No. The document explicitly states: "No clinical studies were conducted." This indicates that no MRMC study comparing human readers with and without AI assistance was performed. The device, NextAR™ Spine, is a surgical navigation platform, not an AI-assisted diagnostic imaging device that would typically undergo MRMC studies for reader performance improvement (e.g., radiologists interpreting images).

6. Standalone (Algorithm Only Without Human-in-the-Loop Performance) Study

• Standalone Study: Not explicitly detailed with performance metrics. The "Software testing" and "Comparative evaluations" could be considered forms of standalone assessment of the algorithmic components and instrument performance, but no specific quantitative standalone performance (e.g., accuracy, precision) of the navigation algorithms themselves is provided in this summary. The device's primary function is as a navigation aid where a human surgeon is always in the loop.

7. Type of Ground Truth Used

• Type of Ground Truth:
  • For instrument performance, the ground truth would likely be established through engineering specifications and comparative measurements against predicate instruments.
  • For the cadaver workshops, the ground truth was likely surgical outcomes/adequacy as determined by the participating surgeons in a realistic (cadaveric) surgical environment. This is a form of expert assessment of functional performance. It is not pathology, or clinical outcomes data, as no clinical studies were performed.

8. Sample Size for the Training Set

• Sample Size for Training Set: Not applicable. The document describes a traditional medical device (navigation system) with software components, not an AI/Machine Learning device that undergoes a train-test split methodology with large datasets for model training. The software functionality and instrument performance are verified through testing and comparative evaluation, not
  ML model training on patient data.

9. How Ground Truth for the Training Set Was Established

• Ground Truth for Training Set: Not applicable, as this is not an AI/ML system requiring a dedicated training set with established ground truth in the typical sense for image interpretation or diagnosis. The "ground truth" for the device's functionality would stem from its design specifications, engineering principles, and the known anatomical relationships it aims to navigate.

In summary, the FDA 510(k) summary for NextAR™ Spine focuses on demonstrating substantial equivalence through non-clinical performance data, primarily through comparative evaluations with predicate devices and cadaveric workshops, rather than extensive clinical studies or AI model performance metrics.

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The CORUS™ Navigation System-GX for use with the CORUS™ Spinal System is intended to be used during spinal surgery to assist the surgeon in locating and preparing facet joints in either open, or minimally invasive procedures. The CORUS™ Navigation System-GX is specifically designed for use with the Globus Medical ExcelsiusGPS™ which is intended for use as an aid for precisely locating anatomical structures and for the spatial positioning and orientation of an instrument holder or guide tube to be used by surgeons for navigating and/or guiding compatible surgical instruments in open or percutaneous procedures provided that the required fiducial markers and rigid patient anatomy can be identified on CT scans or fluoroscopy.

The CORUS™ Navigation System-GX disposable instruments are used during the preparation and usage of CORUS™ Spinal System during spinal surgery to assist the surgeon in locating anatomical structures, such as the facet joint, in either open or minimally invasive procedures. The Navigation Access Chisel-G and Navigation Chisel Rasp-G are specifically designed for use with Globus Medical ExcelsiusGPS™ for navigation of the instruments to the facet joint. The instrument set provides access to the posterior spinal facet joint and decortication for bone preparation.

The provided FDA Clearance Letter and 510(k) Summary for the CORUS™ Navigation System-GX (K251060) do not contain detailed information about specific acceptance criteria, study methodologies (like sample sizes for test/training sets, data provenance, ground truth establishment, or expert involvement), or the results of a multi-reader multi-case (MRMC) comparative effectiveness study.

The document states that the device was evaluated through "an engineering analysis and geometric comparison to predicate devices to establish the safety and efficacy for accuracy performance." It also mentions "a functional assessment was conducted to evaluate compatibility and simulated use testing." However, it does not provide the quantitative acceptance criteria or the specific performance metrics achieved in these evaluations.

Therefore, based solely on the provided text, I cannot complete many sections of your request. I will indicate where the information is not present.

Here's a breakdown of the available information:

Acceptance Criteria and Device Performance

Due to the lack of quantitative performance data in the provided document, I cannot create a table of acceptance criteria and reported device performance. The document states:

• "The CORUS™ Navigation System-GX instruments have been evaluated through an engineering analysis and geometric comparison to predicate devices to establish the safety and efficacy for accuracy performance."
• "A functional assessment was conducted to evaluate compatibility and simulated use testing."
• "The results of these engineering analysis and evaluations show that the subject is substantially equivalent to the cleared predicate."

This language indicates that the device met the necessary performance for clearance by demonstrating substantial equivalence, but it does not disclose the specific numerical thresholds or achieved performance metrics.

Study Information Based on Provided Text:

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

Not Available in the Provided Text. The document generally states that "engineering analysis and evaluations show that the subject is substantially equivalent to the cleared predicate," implying that performance criteria were met, but does not list specific criteria or results.

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

Not Available in the Provided Text for "accuracy performance" or "functional assessment" studies. The document mentions "engineering analysis and geometric comparison" and "functional assessment" and "simulated use testing," but it does not specify sample sizes or data provenance (e.g., retrospective/prospective, country of origin).

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

Not Applicable/Not Available. The device is a "Stereotaxic Instrument" intended to assist surgeons in locating anatomical structures. The described evaluations ("engineering analysis," "geometric comparison," "functional assessment," and "simulated use testing") suggest a focus on mechanical accuracy, compatibility, and functionality rather than diagnostic interpretation requiring human expert ground truth. Therefore, the concept of "experts establishing ground truth for a test set" in the context of image interpretation is not directly applicable here. The ground truth might be defined by engineering specifications or physical measurements.

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

Not Applicable/Not Available. Given the nature of the device and the described evaluations, an adjudication method for image interpretation or diagnosis is not relevant.

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. The document does not indicate that a multi-reader multi-case (MRMC) comparative effectiveness study was performed. This device is a navigation system instrument, not an AI-assisted diagnostic tool that would typically undergo such a study.

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

Partially Applicable / Inferred. The evaluations described ("engineering analysis and geometric comparison," "functional assessment," "simulated use testing") would inherently involve testing the device's performance in a standalone or controlled environment, ensuring its mechanical and functional specifications are met, independent of a specific surgical procedure on a live patient. The device "does not include its own navigation platform" but works with the Globus Medical ExcelsiusGPS™. The testing would focus on the navigation instruments' accuracy and compatibility with this platform.

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

Inferred to be Engineering/Physical Specifications. For a stereotaxic instrument, the ground truth for "accuracy performance" would typically be derived from engineering specifications, physical measurements using highly precise measurement tools, or established anatomical models/phantoms. It is not expert consensus on images, pathology, or outcomes data.

8. The sample size for the training set

Not Applicable / Not Available. The document describes "engineering analysis and geometric comparison" and "functional assessment," and "simulated use testing." This type of evaluation is typically for mechanical devices and does not describe a machine learning algorithm that would require a "training set" in the conventional sense.

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

Not Applicable. See point 8.

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The Innovasis Navigation Instruments are intended to be used in the preparation and placement of Innovasis pedicle screws during non-cervical spinal surgery to assist the surgeon in precisely locating anatomical structures in either open or minimally invasive procedures for skeletally mature patients. These instruments are designed for use with the Globus ExcelsiusGPS System, which is indicated for any medical condition in which the use of stereotactic surgery may be appropriate, and where reference to a rigid anatomical structure, such as vertebra, can be identified relative to a CT or MR based model, fluoroscopy images, or digitized landmarks of the anatomy.

The Innovasis Navigation Instruments (Vector G-E Navigation Instruments and the Excella G-E Navigation Instruments) are non-sterile, reusable instruments including taps and drivers that can be operated manually. These instruments are intended to be used with the Globus Medical ExcelsiusGPS® Robotic Navigation Platform to aid in implantation of the Innovasis pedicle screw system (Vector Pedicle Screw System and Excella Spinal System) implants. The instruments are manufactured from medical grade stainless steels and plastic.

The provided FDA clearance letter concerns the Innovasis Navigation Instruments (Vector G-E Navigation Instruments and the Excella G-E Navigation Instruments). This letter primarily focuses on demonstrating substantial equivalence to predicate devices based on technological characteristics and engineering analysis rather than a human reader study or AI performance evaluation.

Therefore, many of the requested details, such as those pertaining to AI model training, human reader studies (MRMC), or a comprehensive standalone algorithm performance, are not explicitly available within this document. The device in question is a set of surgical instruments, not an AI or imaging device requiring such detailed performance evaluation in the context of this 510(k) submission.

However, based on the provided text, we can extract information regarding the performance data used to demonstrate safety and effectiveness for these specific instruments.

Acceptance Criteria and Reported Device Performance

The letter states that the instruments were evaluated for their accuracy performance and their ability to register with the navigation system and fit within the guide tube of the end-effector.

Study Details (Based on available information)

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

   • Test Set Sample Size: Not explicitly stated as a numerical sample size of "cases" or "patients" in the context of a clinical study. The evaluation appears to be primarily an engineering analysis and verification testing on the instruments themselves.
   • Data Provenance: The study described is a technical evaluation of the instruments, not a clinical trial with patient data. It is an "engineering analysis and geometric comparison to predicate devices," and "pass/fail verification testing." The location of this engineering and testing work is not specified, but the applicant (Innovasis, Inc.) is based in Salt Lake City, Utah, and their regulatory consultant in Colorado Springs, Colorado, suggesting a U.S.-based context for the submission. The information implies a retrospective approach in terms of comparing to existing designs and prospective in terms of conducting new verification tests on the manufactured instruments.

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

   • Not Applicable. This submission does not describe a study involving expert readers or medical professionals establishing ground truth for diagnostic interpretation. The "ground truth" for this device relates to its physical and functional specifications (e.g., dimensions, fit, compatibility with the navigation system), established through engineering methods.

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

   • Not Applicable. Adjudication methods are typically used in studies where human experts are interpreting medical images or data and discrepancies need to be resolved. This study is an engineering and verification test.

4. 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. This device is a surgical instrument set and the submission does not mention an MRMC study or any AI component that would assist human readers in image interpretation or diagnosis.

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

   • No. This device is not an algorithm. The "performance data" refers to the instrument's mechanical and functional compatibility.

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

   • Engineering Specifications and Functional Compatibility. The ground truth for this device's performance is based on established engineering principles, design specifications, and the functional requirements for compatibility with the predicate navigation system (Globus ExcelsiusGPS). This includes geometric tolerances, material properties, and successful registration/fit with the navigation platform.

7. The sample size for the training set:

   • Not Applicable. This is not an AI/machine learning device requiring a training set.

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

   • Not Applicable. As above, this is not an AI/machine learning device. The "ground truth" for the device's design and function would be based on engineering design principles and specifications, tested through verification.

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OptiVu Shoulder is intended for use during stereotaxic surgery to aid the surgeon in locating anatomical structures (humerus and scapula), humerus resection, and aligning the endoprosthesis with the anatomical structures, provided that the required anatomical landmarks can be identified on the patient's preoperative CT scan.

OptiVu Shoulder utilizes pre-operative planning files provided by the Zimmer CAS Signature ONE™ System. OptiVu Shoulder is compatible with any humeral implants that are supported by the Signature ONE™ System.

OptiVu Shoulder is specifically indicated for total shoulder arthroplasty using the Zimmer Biomet Alliance® Glenoid system or reverse shoulder arthroplasty using the Comprehensive® Reverse Shoulder system, to aid the surgeon in locating anatomical structures (humerus and scapula), humerus resection, and aligning the glenoid component with the anatomical structures.

OptiVu Shoulder includes an augmented reality (AR) head-mounted display (HMD) (OptiVu Tilt with HoloLens 2) and trackers to register and optically track anatomical landmarks and surgical instruments in real-time during the procedure. The HMD should not be relied upon solely and should always be used in conjunction with traditional methods.

OptiVu Shoulder is a stereotaxic surgical navigation system designed to aid surgeons in locating anatomical structures and aligning the endoprosthesis in total or reverse shoulder arthroplasty procedures. The system includes an augmented reality (AR) head-mounted display (HMD) (OptiVu Tilt with HoloLens 2) and mixed reality trackers to register and optically track anatomical landmarks and surgical instruments in real-time during the procedure.

The OptiVu Shoulder system is intended to be used specifically with the Zimmer Biomet Alliance® Glenoid or Comprehensive® Reverse Shoulder system for total or reverse shoulder arthroplasty, respectively.

The OptiVu Shoulder system also utilizes pre-operative planning files provided by the Zimmer CAS Signature ONE™ System.

The intended users of the system are surgeons who are trained in performing shoulder arthroplasty procedures.

The provided FDA 510(k) clearance letter for OptiVu™ Shoulder describes the device and its intended use, but it does not contain the detailed information necessary to fully answer your request regarding acceptance criteria and the specific study that proves the device meets those criteria.

The document states that non-clinical testing was conducted to demonstrate safety and effectiveness, including "Performance tests to ensure the performance of the implemented features and verify related design inputs" and "Validation lab to validate that the OptiVu Shoulder system is safe and effective and performance of the system is acceptable under full simulated use on cadaveric specimens." However, the specific acceptance criteria values and the quantitative results of these tests are not provided in this public clearance letter. This type of detailed performance data is typically found within the full 510(k) submission, which is a confidential document.

Therefore, I cannot populate the table or provide specific values for most of your questions. I can only infer what kind of studies would have been conducted based on the mention of "Validation lab" with "cadaveric specimens" and "Performance tests."

Here's what I can extract and infer from the provided text, along with clear indications of what information is missing:

While the complete details of the acceptance criteria and the specific study proving the device meets them are not fully contained within the provided FDA 510(k) clearance letter, the document does refer to non-clinical testing that was conducted to demonstrate safety and effectiveness.

The clearance letter mentions:

• "Performance tests to ensure the performance of the implemented features and verify related design inputs"
• "Validation lab to validate that the OptiVu Shoulder system is safe and effective and performance of the system is acceptable under full simulated use on cadaveric specimens"

Based on the nature of a stereotaxic surgical navigation system for shoulder arthroplasty, the acceptance criteria would typically revolve around the accuracy and precision of anatomical structure localization, humerus resection, and endoprosthesis alignment. The "Validation lab" study on cadaveric specimens strongly suggests a performance study was conducted to quantify these aspects.

However, the specific numerical acceptance criteria (e.g., target accuracy in mm and degrees) and the quantitative results (reported device performance) are not provided in this public document.

1. Table of Acceptance Criteria and Reported Device Performance

Note: The specific numerical acceptance criteria and reported performance values are not present in the provided document. The table below represents typical acceptance criteria for such a device, and the "Reported Device Performance" column cannot be filled with concrete data from this document.

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

• Test Set Sample Size: Not specified in the provided document. The document mentions "full simulated use on cadaveric specimens," implying a test set that included multiple cadaveric specimens, but the exact number is missing.
• Data Provenance: The document explicitly states "cadaveric specimens." The geographic origin (country) is not specified. The study was likely prospective as it involved simulated use of the device for testing purposes.

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

• Number of Experts: Not specified in the provided document.
• Qualifications of Experts: Not specified in the provided document. For a device used in surgical navigation, these would typically be experienced orthopedic surgeons familiar with shoulder arthroplasty.

4. Adjudication Method for the Test Set

• Adjudication Method: Not specified in the provided document. Given the nature of a cadaveric study for surgical navigation accuracy, adjudication might refer to the method used to establish the "true" surgical plan or the "true" anatomical alignment against which the device performance is measured (e.g., independent measurements by a metrology expert, or consensus among multiple surgeons on the optimal plan).

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

• MRMC Study: No, a multi-reader multi-case (MRMC) comparative effectiveness study was NOT mentioned or described in the provided document. This type of study typically assesses the impact of an AI algorithm on human reader performance (e.g., radiologists interpreting images). OptiVu™ Shoulder is a surgical navigation system with an Augmented Reality (AR) HMD for real-time guidance, not primarily an image interpretation AI tool. Its effectiveness study would focus on its guidance accuracy during simulated surgery, rather than assisting human readers in diagnostic interpretation.
• Effect Size of Human Reader Improvement: Not applicable, as an MRMC study was not described.

6. Standalone (Algorithm Only) Performance

• Standalone Performance: The document describes "Performance tests" and "Validation lab" studies. While the results are not quantified, these studies would inherently evaluate the "standalone" or "algorithm-only" performance of the navigation system (e.g., its accuracy in tracking, registration, and guidance output) in a controlled environment without active human intervention beyond operating the system as intended. The "HMD should not be relied upon solely and should always be used in conjunction with traditional methods" indicates that the device is intended for human-in-the-loop use, but its core performance metrics (accuracy of localization, resection, alignment) would be evaluated in a standalone manner.

7. Type of Ground Truth Used

• Type of Ground Truth: The document explicitly states "full simulated use on cadaveric specimens." Therefore, the ground truth would likely be established through:
  • Pre-operative CT scan planning: The "true" surgical plan (e.g., desired resection angles, implant position) is derived from the pre-operative CT scan using the Zimmer CAS Signature ONE™ System.
  • Post-hoc metrology/physical measurements: After using the OptiVu™ Shoulder system on the cadaver, the actual resections and implant placements would be measured using highly accurate metrology tools (e.g., CMM, industrial CT scanning) and compared against the planned values derived from the pre-operative CT. This comparison would quantify the accuracy of the device's guidance.

8. Sample Size for the Training Set

• Training Set Sample Size: Not specified in the provided document. The 510(k) clearance process primarily focuses on the safety and effectiveness of the final device, including its performance characteristics, rather than the details of the training data used for its development (unless it's a specific AI/ML medical device where the training data directly impacts performance).

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

• Training Set Ground Truth Establishment: Not specified in the provided document. As mentioned above, the details of the training process and data are typically not disclosed in the public 510(k) clearance letter.

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Phasor EZ-Fiducials is intended to provide fixed reference point(s) in patients requiring stereotactic surgery in conjunction with CT imaging with the included screws placed using the included EZ-Driver (electric screwdriver) or manual screwdriver exclusively for each.

Phasor EZ-FIDUCIALS™ provide fixed reference points during neurosurgical procedures. The device is composed of 3 items, all single-use, provided gamma-sterilized, and placed within the same primary packaging (sealed Tyvek tray within a shelf carton):

1. Screws: Each of the four provided titanium screws is identical, with specific dimensions of each EZ-Fiducials screw as follows: screwhead circular shape screwhead with square-shaped engagement, non-threaded shaft diameter 2.9mm and length 15mm, threaded shaft diameter (major threads) 1.98mm, thread length 5mm; no protective caps are provided, and the screws should exclusively be utilized in conjunction with the screwdrivers (manual or EZ-Driver) provided together in the same tray (and with no other screwdriver);

2. Manual Screwdriver: handheld, to be solely used with the screws provided, not intended for use with any other screws;

3. EZ-driver: (electric, handheld, non-rechargeable battery-operated screwdriver, without software, single-use for solely tightening or loosening the provided screws exclusively, not intended for use with any other screws).

The provided FDA 510(k) clearance letter and summary for EZ-Fiducials focuses primarily on substantial equivalence to predicate devices based on technological characteristics and bench testing, rather than a clinical study with acceptance criteria based on human-in-the-loop performance or algorithm-only performance against a defined ground truth.

Therefore, for aspects related to "device performance," "acceptance criteria," "sample size," "expert ground truth," "adjudication methods," "MRMC studies," "standalone performance," and "ground truth for training/test sets," the available document does not provide this information. The submission relies on bench testing to demonstrate equivalence.

Here's an analysis of what information is provided and what explicitly is not provided based on your request:

Acceptance Criteria and Device Performance (Based on Available Information)

The document does not present a table of acceptance criteria and reported device performance in the manner typically seen for clinical or AI/algorithm performance studies (e.g., sensitivity, specificity, accuracy). Instead, it relies on demonstrating compliance with an ASTM standard and general performance adequacy, often by comparison to predicate devices' known characteristics.

Table of Acceptance Criteria and Reported Device Performance (as inferred from the document):

Study Proving Device Meets Acceptance Criteria

The study proving the device meets acceptance criteria is primarily bench testing. No clinical study data is presented.

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

• See table above. This is inferred from the discussion of performance testing. Explicit quantitative acceptance criteria (e.g., "deflection must be less than X mm") are not detailed, but compliance with ASTM F543-23 and "adequate performance" are stated.

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

• Sample Size: Not explicitly stated for bench testing. The testing refers to "bone simulant" but the quantity of fiducials, screws, or instances tested is not specified.
• Data Provenance: Not applicable in terms of patient data. The testing is bench testing using "bone simulant." There is no indication of retrospective or prospective data or country of origin, as it's not a clinical study.

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 bench study, not a study requiring expert ground truth for clinical cases. The "ground truth" for the bench testing would be physical measurements and compliance with engineering standards.

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

• Not applicable. There was no human interpretation or subjective assessment of clinical data that would require adjudication.

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. An MRMC study was not done. The device is a physical fiducial system and an electric screwdriver, not an AI or software device that assists human readers.

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

• Not applicable. This is not an AI algorithm. The device performance here refers to the physical characteristics and functionality of the fiducials and screwdriver.

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

• Bench Testing Data/Engineering Standards. The ground truth for this submission's performance assessment is the physical performance and measurements of the device (deflection) and compliance with industry standards (ASTM F543-23).

8. The sample size for the training set:

• Not applicable. This device does not use machine learning or AI, so there is no training set.

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

• Not applicable. As above, no training set.

Summary of the Study:

The "study" referenced in the 510(k) for EZ-Fiducials is a series of bench tests focusing on:

• Biocompatibility of materials.
• Sterility validation.
• Packaging integrity.
• Performance of the screws (e.g., deflection characteristics, compliance with ASTM F543-23 when inserted into bone simulant).
• Performance of the electric screwdriver (its ability to drive screws adequately).

The clearance is based on the argument that these bench tests demonstrate the device's substantial equivalence in terms of safety and effectiveness to the predicate device (Medtronic Navigus Unibody Fiducial Marker System) and a reference device (OsteoMed Pinnacle Driver), even with some technological differences (e.g., screwdriver speed, sterilization method). The document explicitly states: "No clinical testing was needed or performed otherwise." The predicate device was also "cleared based upon bench testing alone."

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ExcelsiusXR™, when used in conjunction with ExcelsiusHub™ and/or ExcelsiusGPS®, is intended for use as an aid for precisely locating anatomical structures to be used by surgeons for navigating and/or guiding compatible surgical instruments in open or percutaneous procedures provided that the required fiducial markers and rigid patient anatomy can be identified on CT scans or fluoroscopy. This system is indicated for the placement of spinal and orthopedic (Sacroiliac, Ulna, and Tibia) bone screws, and interbody fusion devices.

The ExcelsiusXR™ Headset displays 2D stereotactic images and 3D virtual anatomy images, and displays the virtual instrument location in relation to the virtual anatomy to assist in percutaneous visualization and trajectory planning. This headset should not be relied upon solely for absolute positional information and should always be used in conjunction with the primary stereotactic display.

ExcelsiusXR™ is a head-mounted navigation device, or headset, that is used in conjunction with ExcelsiusHub, and ExcelsiusGPS if robotic guidance is desired, as an aid for precisely locating anatomical structures in open or percutaneous procedures, and for precisely positioning compatible surgical instruments or implants (screws and interbody devices) during surgery. ExcelsiusXR™ includes hardware and software that enables real-time surgical visualization using radiological patient images (preoperative CT, intraoperative CT, and fluoroscopy), provides tracking and planning capabilities for a series of compatible instruments, and contains hand tracking cameras for manipulation of the head-mounted display by the user. The Headset displays 2D stereotactic images and provides a 3D visual, or virtual image, of the patient anatomy in the lower region. The 2D data and 3D model, along with tracking information, are projected to the surgeon's retina from the transparent near-eye-display Headset, allowing the surgeon to look at the patient and the navigation data at the same time.

The provided FDA 510(k) Clearance Letter for ExcelsiusXR™ describes performance testing in a general manner but does not contain the specific details required to fully address all parts of your request for acceptance criteria and the study that proves the device meets them.

Here's a breakdown of what can be extracted and what information is missing based on the provided text:

1. Table of Acceptance Criteria and Reported Device Performance

The document does not provide a specific table with numerical acceptance criteria and corresponding performance metrics. It generally states that "Verification and validation testing were conducted on ExcelsiusXR™ to confirm that the device meets performance requirements under the indications for use and to ensure safety and efficacy of the system."

It mentions the types of tests performed:

• Non-clinical system, software, and instrument verification and validation – demonstrated compliance with user needs and corresponding design inputs
• Surgical simulations conducted on phantom models
• Qualitative and quantitative validation to confirm intended use and accuracy
• Optical bench testing to evaluate the image quality characteristics of the head mounted display
• Electrical Safety and Electromagnetic Compatibility (compliance with standards)
• Software Verification and Validation Testing (compliance with FDA guidance)

Without specific numeric thresholds or results, a detailed table cannot be created. However, generally, for a navigation system like this, key performance metrics and their associated acceptance criteria would typically include:

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

• Sample Size: The document does not specify the sample size used for any of the performance tests (e.g., number of phantom models, number of tests, number of unique cases).
• Data Provenance: The document does not specify the country of origin of the data or whether the data was retrospective or prospective. Phantom studies are typically prospective tests under controlled lab conditions.

3. Number of Experts and Qualifications for Ground Truth

• The document does not mention the number of experts used to establish ground truth or their specific qualifications (e.g., "Radiologist with 10 years of experience").
• Given that "surgical simulations conducted on phantom models" were performed, the "ground truth" would likely be established by the physical measurements taken from the phantom and the known ideal trajectory/placement, often assessed by engineers and potentially verified by clinically experienced personnel.

4. Adjudication Method for the Test Set

• The document does not mention any specific adjudication method (e.g., 2+1, 3+1) for establishing ground truth or evaluating performance. This is generally more relevant for studies involving human interpretation of medical images. For phantom studies, ground truth is typically precisely measured rather than adjudicated in the same way.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

• The document does not mention a Multi-Reader Multi-Case (MRMC) comparative effectiveness study.
• There is no information provided on the effect size of how much human readers improve with AI vs. without AI assistance. This type of study would typically be done if the device were primarily an AI-driven diagnostic or interpretative tool, which this navigation system is not. Its primary function is to aid surgical guidance.

6. Standalone (Algorithm Only Without Human-in-the-Loop) Performance

• The document describes the device as "an aid for precisely locating anatomical structures to be used by surgeons for navigating and/or guiding compatible surgical instruments." It also states "This headset should not be relied upon solely for absolute positional information and should always be used in conjunction with the primary stereotactic display."
• This strongly indicates that the device is intended for human-in-the-loop use, assisting the surgeon.
• While there are "software verification and validation testing" and "surgical simulations on phantom models," these would assess the algorithm's performance within the system context, but the document does not present a standalone, algorithm-only performance metric separate from its intended use as a surgeon's aid. The emphasis is on the system's performance when used by surgeons.

7. Type of Ground Truth Used

• Based on "surgical simulations conducted on phantom models" and "qualitative and quantitative validation," the ground truth was likely established through physical measurements and known anatomical references on the phantom models. This is a form of objective, fabricated ground truth suitable for evaluating a navigation system's precision and accuracy in a controlled environment. It is not expert consensus, pathology, or outcomes data in the traditional sense, though expert surgical opinion would guide the design and interpretation of phantom studies.

8. The Sample Size for the Training Set

• The document does not provide any information regarding the training set size. The FDA 510(k) summary focuses on the "performance testing" (verification and validation), which relates to the test set that demonstrates the device's capabilities post-development. Information about model training (if applicable for any AI components involved in image processing or tracking) is typically not included in such summaries unless it's a primary AI/ML device where the training data directly impacts the cleared function.

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

• Since no information about a training set is provided, there is no information on how its ground truth was established.

In summary, the 510(k) summary provides a high-level overview of the types of performance tests conducted (phantom models, software V&V, electrical safety), but it lacks the detailed quantitative data, sample sizes, and specific methodologies for ground truth establishment that would be found in a full study report. This level of detail is typically contained in the more comprehensive "Basis for Substantial Equivalence" documentation submitted to the FDA, which is not fully replicated in the public 510(k) summary letter.

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Navient is a computerized surgical navigation system intended as an aid for precisely locating anatomical structures. The Navient system is indicated for any medical condition in which the use of stereotactic surgery may be appropriate, and where reference to a rigid anatomical structure, such as the skull, can be identified relative to a CT, MR-based anatomy model.

Indications:

Example procedures include but are not limited to:

ENT Procedures:

• Transsphenoidal procedures
• Maxillary antrostomies
• Ethmoidectomies
• sphenoidotomies
• Sphenoid explorations
• Turbinate resections
• Frontal sinusotomies
• Intranasal procedures
• Intranasal tumor resections
• All ENT related skull base surgery

Navient is an image guided navigational system intended to assist with preoperative planning and real-time positioning of surgical tools during stereotaxic procedures via optical tracking technology. The system is essentially composed of a computerized main unit (computer), a Navient IR CameraBox, Navient cart, Navient navigation software, and corresponding accessory set.

Navient's guidance function is based on the patient images acquired prior to the procedure, combined with optical measurements of the pose of navigated instruments relative to the patient's anatomy. To enable navigation, the reference instrument/accessory is attached to the patient to enable tracking of the patient's anatomy. The patient images are then spatially registered with the patient's anatomy by matching landmark locations marked on both the image and the patient, followed by matching a path traced by the user on the patient's anatomy with a model of patient's anatomical surface automatically generated from the image data.

The provided FDA 510(k) clearance letter and summary for the Navient Image Guided Navigation System (ENT) do not contain information about the study design or acceptance criteria for AI/algorithm-based performance evaluations. Instead, the document focuses on the system's accuracy, software validation, electrical safety, biocompatibility, and reprocessing validation, all typical for traditional medical devices rather than AI/ML-powered ones.

The document states: "Full system accuracy bench testing: Navient has been validated to the positional accuracy of ≤ 2.0 mm (mean=1.52 mm, STD=0.93 mm, 99% confidence interval of 3.68 mm), with the angular error of ≤ 2.0 deg (mean=1.13 deg, STD=0.43 deg, 99% confidence interval of 2.13 deg). This performance was determined using representative phantoms with system components that are deemed the worst-case in the Navient clinical applications."

This validation refers to the physical navigation system's accuracy in positioning, not the performance of an AI algorithm in tasks like image interpretation or diagnosis. Therefore, I cannot generate the requested table and study details related to AI acceptance criteria and performance based on the specific content provided in this 510(k) document.

The "Navient navigation software" mentioned is described as having a workflow for loading images, planning, setting up, registration, and navigation. This suggests a traditional software interface for guiding the user, rather than an AI/ML algorithm performing diagnostic or predictive functions that would require a ground truth, expert consensus, or MRMC studies.

If we were to hypothetically extract the closest equivalent to "acceptance criteria" for this device, it would be its spatial accuracy, which is a key performance metric for image-guided navigation systems.

Here's a hypothetical structure based on the provided spatial accuracy data, while acknowledging it's not AI-specific:

Hypothetical Acceptance Criteria and System Performance (based on provided spatial accuracy)

Recognizing that the provided document details a traditional image-guided navigation system and not an AI-powered diagnostic/interpretive device, the "acceptance criteria" presented here refer to the system's demonstrated physical accuracy.

1. Table of Acceptance Criteria and Reported Device Performance

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

• Test set sample size: Not explicitly stated as a "test set" in the context of an AI model. The performance data is derived from "Full system accuracy bench testing" using "representative phantoms." The number of measurements or phantom tests isn't specified.
• Data provenance: Not directly applicable as it's a bench test on phantoms, not clinical patient data. The testing was conducted internally by ClaroNav.

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

• Not applicable. The ground truth for positional and angular accuracy in bench testing is defined by precision measurement equipment and physical phantoms, not human experts.

4. Adjudication method for the test set:

• Not applicable. Bench testing does not involve human adjudication.

5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done:

• No. This type of study (MRMC) is typically performed for AI devices that aid human interpretation (e.g., radiologists reading images with AI assistance). The Navient system is a guidance system, not an interpretive AI.

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

• The "Full system accuracy bench testing" represents the standalone performance of the navigation system's hardware and software integration in terms of its ability to track instruments accurately relative to images. It's not an AI algorithm performing a task without human input in the sense of a diagnostic or predictive AI.

7. The type of ground truth used:

• The ground truth for the positional and angular accuracy was established through precise measurements on representative phantoms using calibrated equipment, which is standard for validating the accuracy of surgical navigation systems.

8. The sample size for the training set:

• Not applicable. This is not an AI/ML device that undergoes a training phase on a dataset of examples. Its software processes sensor data and medical images according to deterministic algorithms.

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

• Not applicable, as there is no training set in the context of AI/ML for this device's reported validation.

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The TMINI® Miniature Robotic System is indicated as a stereotaxic instrumentation system for total knee replacement (TKA) surgery. It is to assist the surgeon by providing software-defined spatial boundaries for orientation and reference information to identifiable anatomical structures for the accurate placement of knee implant components.

The robotic device placement is performed relative to anatomical landmarks as recorded using the system intraoperatively and based on a surgical plan determined preoperatively using CT based surgical planning tools.

The targeted population has the same characteristics as the population that is suitable for the implant(s) compatible with the TMINI® Miniature Robotic System.

The TMINI® Miniature Robotic System is to be used with the following knee replacement system(s) in accordance with the indications and contraindications:

• Enovis™ EMPOWR Knee System®
• Ortho Development BKS® and BKS TriMax® Knee System
• Total Joint Orthopedics Klassic® Knee System
• United U2™ Knee Total Knee System
• Medacta® GMK® Sphere / SpheriKA Knee Systems
• Zimmer Biomet Anterior & Posterior Referencing Persona® Knee
• b-ONE MOBIO® Total Knee System
• Maxx Orthopedics Freedom® Total & Titan Knee
• LINK® LinkSymphoKnee System

The TMINI® Miniature Robotic System consists of three primary components: a three-dimensional, graphical, Preoperative Planning Workstation (TPLAN® Planning Station) including THINK Case Manager (TCM) the web-based method for surgeons to review, approve and download approved surgical plans, an Optical Tracking Navigation Console (TNav) and a robotically controlled hand-held tool (TMINI Robot) that assists the surgeon in preparing the bone for implantation of TKA components.

The TPLAN Planning Station uses preoperative CT scans of the operative leg to create 3D surface models for case templating and intraoperative registration purposes. The Planning Workstation contains a library of 510(k) cleared knee replacement implant(s) available for use with the system. The surgeon can select an implant model from this library. The planner/surgeon can manipulate the 3D representation of the implant in relation to the bone model to place the implant. The surgeon reviews and approves the case plan using either TPLAN or the TCM web-based application once the surgeon is satisfied with the implant selection, location and orientation. The data from the approved plan is written to a file that is used to guide the robotically controlled hand-held tool.

The hand-held robotic tool is optically tracked relative to optical markers placed in both the femur and tibia and articulates in two degrees-of-freedom, allowing the user to place bone pins in a planar manner in both bones. Mechanical guides are clamped to the bone pins, resulting in subsequent placement of cut slots and drill guide holes such that the distal femoral and proximal tibial cuts can be made in the pre-planned positions and orientations, and such that the implant manufacturer's multi-planer cutting block can be placed relative to drilled distal femoral pilot holes. If the surgeon needs to change the plan during surgery, it can be changed intraoperatively using TNav.

The provided FDA 510(k) clearance letter pertains to the TMINI Miniature Robotic System, a device used to assist surgeons in total knee replacement (TKA) surgery. The submission describes modifications to the system, primarily software enhancements to improve tibial registration performance, along with data logging updates, open-source software report updates, and cybersecurity updates. The application claims substantial equivalence to a previously cleared predicate device (K243481) and focuses on demonstrating that these modifications do not alter the intended use, safety, or effectiveness of the device.

Based on the provided document, here's a breakdown of the acceptance criteria and the study details:

1. Table of Acceptance Criteria and Reported Device Performance

The document does not explicitly present a table of numerical acceptance criteria for performance metrics (e.g., specific thresholds for accuracy, precision). Instead, it states that "Testing to verify the function of the subject device was conducted following the same test methods and acceptance criteria as those used for the predicate device. The testing demonstrated that the TMINI® Miniature Robotic System met all test criteria and specifications."

The performance tests conducted and their qualitative results are summarized in Table 2: Substantial Equivalence, under the "Performance Testing" section.

* *Note: For Pin & Block Placement Accuracy, System Gap Balance Accuracy, User Needs Validation Testing, and Usability Testing, the document explicitly states "**Passed" and clarifies in a footnote, "These tests did not need to be repeated as a result of the changes to the software included in this submission." This implies that the acceptance criteria were met by the previous testing on the predicate device, and the current modifications did not necessitate re-testing these specific performance aspects.

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

The document does not explicitly state the sample size used for the performance testing. For tests like "Cadaver Lab Validation Testing," while it mentions "Reanalyzed data passed," it does not specify the number of cadavers or cases.

The document does not provide information on the data provenance (e.g., country of origin, retrospective or prospective) for the test sets.

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

The document does not provide information on the number of experts used or their qualifications for establishing ground truth for the test set. Given the nature of a robotic surgical system, ground truth would typically refer to highly accurate measurements obtained from advanced imaging or physical measurements in a controlled environment, likely assisted by surgical and engineering expertise.

4. Adjudication Method for the Test Set

The document does not specify any adjudication method (e.g., 2+1, 3+1, none) used for the test set.

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

No, an MRMC comparative effectiveness study was not done or reported. This type of study is more common for diagnostic AI algorithms where human interpretation is a key component. The TMINI Miniature Robotic System is a surgical assistance robot, and the study focuses on its performance and accuracy rather than its impact on human reader performance.

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

The performance tests listed, such as "Pin & Block Placement Accuracy," "Cadaver Lab Validation Testing," and "System Gap Balance Accuracy," directly assess the standalone performance of the robotic system in achieving its intended surgical accuracies. While a surgeon operates the system, these accuracy measurements inherent to the robot's capabilities would constitute standalone performance in a sense, as they evaluate the robot's ability to execute pre-planned actions with precision. However, it's important to note that the system is intended to assist the surgeon, so "standalone" in the context of a robotic surgical system usually refers to the accuracy and precision of the robotic movements and tool positioning, which appear to have been tested.

7. The Type of Ground Truth Used

The document implicitly suggests that the ground truth for surgical accuracy tests (e.g., "Pin & Block Placement Accuracy," "System Gap Balance Accuracy") would be established through highly precise measurement techniques in a controlled lab or cadaveric setting, likely using CMM (Coordinate Measuring Machine) data, optical tracking references, or other metrology tools to determine the true positions and orientations relative to the planned surgical targets. For the "Cadaver Lab Validation Testing," the ground truth would be based on anatomical measurements in those cadavers after the robotic intervention.

8. The Sample Size for the Training Set

The document does not provide any information on the sample size for a training set. This submission is for modifications to a previously cleared device, and the focus is on verification and validation of those specific changes rather than the initial development and training of a new AI model for the core robotic functions. While "software enhancements to improve tibial registration performance" are mentioned, it's not specified if this involved a machine learning model that required a distinct training set.

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

As no training set information is provided, there is no information on how ground truth for a training set was established.

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