REPROCESSED SURGICAL SCISSORS AND GRASPERS

K033592 · Clearmedical, Inc. · GEI · Jul 27, 2004 · General, Plastic Surgery

Device Facts

• Record ID: K033592
• Device Name: REPROCESSED SURGICAL SCISSORS AND GRASPERS
• Applicant: Clearmedical, Inc.
• Product Code: GEI · General, Plastic Surgery
• Decision Date: Jul 27, 2004
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.4400
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The ClearMedical Reprocessed Used, Disposable Endoscopic Scissors and Graspers have application in a variety of minimally invasive procedures to facilitate grasping, mobilization, dissection, and transaction of tissue.

Device Story

Reprocessed, sterile, single-patient-use endoscopic instruments (scissors and graspers) for minimally invasive surgery. Features rotating insulated shaft (360-degree rotation via handle knob); some models include monopolar cautery connector for electrosurgery when attached to standard generators/cables; others feature ratchet handles for jaw locking. Jaws/blades activated by manual compression/release of ring handles. Used in clinical/OR settings by surgeons. Device provides mechanical tissue manipulation and electrosurgical capability, aiding in tissue dissection and transaction.

Clinical Evidence

No clinical data; bench testing only.

Technological Characteristics

Manual endoscopic surgical instruments with rotating insulated shaft. Materials and design are equivalent to predicate. Sterilization method: Ethylene Oxide (EtO).

Indications for Use

Indicated for use in minimally invasive surgical procedures requiring grasping, mobilization, dissection, and transaction of tissue.

Regulatory Classification

Identification

An electrosurgical cutting and coagulation device and accessories is a device intended to remove tissue and control bleeding by use of high-frequency electrical current.

Predicate Devices

• Ethicon Endoscopic Surgical Instruments (K930933)

Submission Summary (Full Text)

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# JUL 27 2004 033592 510(k) SUMMARY OF SAFETY & EFFECTIVENESS

This 510(k) Summary details sufficient information to provide an understanding of the This of othy Cammary actalle causes antilal equivalence. For convenience, the summary is formatted pursuant to 21 CFR §807.92. This section may be used, as presented, to romide a substantial equivalence summary to anyone requesting it from the Agency.

#### 21 CFR §807.92 a (1)

| <br>Submitter: |
|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| FALL PROPERTY LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAS |

ClearMedical, Inc 1776 136 Place NE Bellevue, Washington 98005 Contact person: Mike Kovacs Ph: 425-460-2718 Fax: [phone]

Date prepared: 29 June 2004

#### 21 CFR §807.92 a (2)

Trade name:

Reprocessed Used, Disposable Endoscopic Scissors and Graspers

| Common name: | | Laparoscopic/Endoscopic Surgical Instruments |
|----------------------|--|-------------------------------------------------|
| Classification name: | | 79GCJ, Manual Laparoscopic Surgical Instruments |
| | | 79GEI, Endoscopic Electrosurgical Instruments |

### 21 CFR §807.92 a (3)

Identification of predicate(s): Substantial equivalence for the Reprocessed Used, Disposable Endoscopic Scissors and Graspers is based on its similarities to the predicate devices, Ethicon Endoscopic Surgical Instruments (K930933) 22 June 2003. The Reprocessed Used, Disposable Endoscopic Scissors and Graspers is substantially equivalent to the predicates in intended use, material, design, performance, and physical characteristics.

## 21 CFR §807.92 a (4)

Device Description-parts and function/concept: The Reprocessed SUD (Reprocessed Used, Disposable Endoscopic Scissors and Graspers) is a sterilized SUD. The reprocessed Endopath endoscopic instruments are sterile, single patient use instruments that have a rotating insulated shaft and are designed for use through appropriate surgical trocars. The rotation knob located on the handle rotates the shaft 360 degrees in either direction. Some instruments have a monopolar cautery connector extending from the top of the handle and can be used for electosurgery when properly attached to standard cautery cables and appropriate generators. Other instruments have rachet handles, which allow the instrument jaws to be locked in place. The instrument jaws or scissor blades are activated by compression and release of the ring handles. See instructions for complete mode of operation

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details. The Reprocessed SUD (Reprocessed Used, Disposable Endoscopic details. The Reprosesses Coasted using EtO sterilization.

#### 21 CFR §807.92 a (5)

21 CFR §807.92 a (5)
Intended use and relationship to predicate(s): The Reprocessed Used, Disposable Intended use and relationship to predicated for use in a variety of minimally invasive
Endoscopic Scissors and Graspers is indicated for use in a variety of tissue Endoscopic Scissols and Graspers is indication, dissection, and transaction of tissue.

#### CFR §807.92 a (6)

Of IX 9601:52 a (0) Lechnological characteristics and follations on Scissors and Graspers is similar in
The Reprocessed Used, Disposable Endoscopic Scissors and Graspers is similar in The Reprocessed Osed, Disposable Endooseph Solors
design, material, intended use and technological characteristics to the predicate devices.

#### 21 CFR §807.92 b

21 CFR §807.92 b
This substantial equivalence is based on similarities to the predicate devices in terms of This Substantial oquivalor oquivalism characteristics.

#### 21 CFR §807.92 c

21 CFR 8007.32 €
In accordance with the specifications of this subsection, this summary in accordance with the speomsations of a learly identified as such.

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Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of an eagle with three lines representing its wings and three wavy lines representing its body.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUL 27 2004

Mr. Mike Kovacs Vice President, Engineering and Production ClearMedical, Inc. 1776 136th Place, NE Bellevue, Washington 98005

Re: K033592

Trade/Device Name: Reprocessed Used, Disposable Endoscopic Scissors Regulation Number: 21 CFR 878.4400 Regulation Name: Electrosurgical cutting and coagulation device and accessories Regulatory Class: II Product Code: GEI Dated: June 29, 2004 Received: June 30, 2004

Dear Mr. Kovacs:

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. Mike Kovacs

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]. 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 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 yours,

Miriam C. Provost

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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# Indication Statement

Page _ 1 _ of __ 1__

510(k) Number (if known): K033592

Device Name: Reprocessed Used, Disposable Endoscopic Scissors

# Indications for Use

The ClearMedical Reprocessed Used, Disposable Endoscopic Scissors The CleanMedical Neprocessou Good, Displantinally invasive procedures
and Graspers have application in a variety of minimaly in a finance and Graspers have application in a varies)
to facilitate grasping, mobilization, dissection, and transaction of tissue...

Prescription Use (Per 21 CFR 801.109)

OR

Over-The-Counter Use Optional Format 1-

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

uriam C. Provost

(Division Sign-Off Division of General, Restorative, and Neurological Devices

510(k) Number K033592

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