ENDOSCOPE SET FOR MAGNETIC RESONANCE (MR), MODELS 8767.412, 8767.121 & 8767.452

K022198 · Richard Wolf Medical Instruments Corp. · GWG · Mar 21, 2003 · Neurology

Device Facts

• Record ID: K022198
• Device Name: ENDOSCOPE SET FOR MAGNETIC RESONANCE (MR), MODELS 8767.412, 8767.121 & 8767.452
• Applicant: Richard Wolf Medical Instruments Corp.
• Product Code: GWG · Neurology
• Decision Date: Mar 21, 2003
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 882.1480
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The MR Endoscope by Tronnier (Magnetic Resonance) allows visual observation of the operating site with simultaneous utilization of the working, supply and drain channels. The Obturator is used for atraumatic insertion of the endoscope. The MR Endoscope is specially designed for use in open nuclear magnetic resonance tomographs for examination, diagnosis and therapy in neurosurgery in conjunction with endoscopic accessories during intracranial procedures, such as: the fenestration of cysts, the removal of cysts, biopsies of lesions, coagulation of intraventricular lesions, etc.

Device Story

Rigid endoscope set designed for neurosurgical procedures within open nuclear magnetic resonance (MR) tomographs. Device features working, supply, and drain channels for visual observation and surgical access. Includes an obturator for atraumatic insertion. Replaces standard ferromagnetic materials with nickel silver or titanium to ensure compatibility with MR environments. Operated by neurosurgeons in clinical settings to perform intracranial interventions like cyst management and biopsies. Provides direct visualization of the operating site to guide surgical accessories.

Clinical Evidence

No clinical tests performed.

Technological Characteristics

Rigid endoscope; materials: nickel silver or titanium; MR-compatible design; includes working, supply, and drain channels; conforms to IEC 601-1 and IEC 601-2-18 standards.

Indications for Use

Indicated for neurosurgical examination, diagnosis, and therapy during intracranial procedures, including cyst fenestration, cyst removal, lesion biopsy, and coagulation of intraventricular lesions, specifically for use in open nuclear magnetic resonance tomographs.

Regulatory Classification

Identification

A neurological endoscope is an instrument with a light source used to view the inside of the ventricles of the brain.

Predicate Devices

• Neurological Endoscope Set (K970162)
• Endoscopic Spine System (K973405)

Submission Summary (Full Text)

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MAR 2 1 2003

15022198

# 12.0 510(k) Summary of Safety and Effectiveness

| Submitter: | | |
|---------------------------------------------------------------------|-------------------------------------------|----------------|
| Company / Institution name: | RICHARD WOLF MEDICAL INSTRUMENTS CORP. | |
| Division name (if applicable): | N.A. | |
| Street address: | 353 Corporate Woods Parkway | |
| City: | Vernon Hills | |
| State/Province: | Illinois | |
| Country: | USA | |
| ZIP / Postal Code: | IL 60061 | |
| Contact name: | Mr. Robert L. Casarsa | |
| Contact title: | Quality Assurance Manager | |
| Date of Preparation: | July 1, 2002 | |
| FDA establishment registration number: | 14 184 79 | |
| Phone number (include area code): | ( 847 ) 913 1113 | |
| FAX number (include area code): | ( 847 ) 913 0924 | |
| Product Information: | | |
| Trade name: | Endoscope set for magnetic resonance (MR) | |
| Model number: | 8767.412, 8767.121, 8767.452 | |
| Common name: | Endoscopes, rigid | |
| Classification name: | Endoscopes, neurological | |
| Information on devices to which substantial equivalence is claimed: | | |
| 510(k) Number | Trade or proprietary or model name | Manufacturer |
| 1 K970162 | 1 Neurological Endoscope Set | 1 Richard Wolf |
| 2 K973405 | 2 Endoscopic Spine System | 2 Richard Wolf |

### 1.0 Description

The submitted endoscope set is equivalent to standard endoscopes with a working channel, but for the use in magnetic resonance applications.

# 2.0 Intended Use

The MR Endoscope by Tronnier (Magnetic Resonance) allows visual observation of the operating site with simultaneous utilization of the working, supply and drain channels.

The Obturator is used for atraumatic insertion of the endoscope.

The MR Endoscope is specially designed for use in open nuclear magnetic resonance tomographs for examination, diagnosis and therapy in neurosurgery in conjunction with endoscopic accessories during intracranial procedures, such as: the fenestration of cysts, the removal of cysts, biopsies of lesions, coagulation of intraventricular lesions, etc.

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## 3.0 Technological Characteristics

The ferromagnetic device materials are replaced by nickel silver or titanium

#### 4.0 Substantial Equivalence

The submitted devices pose the same type of questions about safety or effectiveness as the compared devices and the new technological characteristics have not diminished safety or effectiveness. The submitted devices are substantially equivalent to existing devices sold by Richard Wolf.

#### 5.0 Performance Data

The devices are conforming to the international standards IEC 601-1 and IEC 601-2-18. Thermal heat rise has been verified to be within acceptable levels.

#### 6.0 Clinical Tests

No clinical tests performed.

#### 7.0 Conclusions Drawn

These devices are designed and tested to guarantee the safety and effectiveness, when used according to the instructions manual.

By: Robert J. Casares

Robert L. Casarsa Quality Assurance Manager

Date: July 1, 2002

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Image /page/2/Picture/1 description: The image shows the logo for the Department of Health & Human Services - USA. The logo features a stylized image of an eagle with its wings spread, formed by three curved lines that resemble human profiles. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the eagle symbol.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAR 2 1 2003

Mr. Robert L. Casarsa Quality Assurance Manager Richard Wolf Medical Instruments Corp. 353 Corporate Woods Parkway Vernon Hills. Illinois 60061

Re: K022198

Trade/Device Name: Rigid Endoscopes Regulation Number: 21 CFR 882.1480 Regulation Name: Neurological endoscope Regulatory Class: II Product Code: GWG Dated: December 20, 2003 Received: December 23, 2003

Dear Mr. Casarsa:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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Page 2 - Mr. Robert L. Casarsa

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at [phone]. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR Part 807.97) you may obtain. Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely vours.

Mark n Millenn

Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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# 5.0 INDICATIONS FOR USE

510(k) Number (if known): --

- Rigid Endoscopes Device Name:
- The MR Endoscope by Tronnier (Magnetic Resonance) allows visual Intended use: observation of the operating site with simultaneous utilization of the working, supply and drain channels.

The Obturator is used for atraumatic insertion of the endoscope.

Indications and field of use: For examination, diagnosis and therapy in neurosurgery in conjunction with endoscopic accessories during intracranial procedures, such as: the fenestration of cysts, the removal of cysts, biopsies of lesions, coagulation of intraventricular lesions, etc.

> NOTE: The MR Endoscope is specially designed for use in open nuclear magnetic resonance tomographs.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)
Concurrence of CDRH Office of Device Evaluation (ODE)
(Division Sign-Off)
Division of General, Restorative and Neurological Devices

| 510(k) Number | K022198 |
|---------------|---------|
|---------------|---------|

| Prescription Use<br>Per 21 CFR 801.109 | <img alt="checkbox" src="checkbox.png"/> | OR | Over-The Counter |
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