INTUITIVE SURGICAL ENDOSCOPIC INSTRUMENT CONTROL SYSTEMS, MODELS IS1200, IS2000 AND IS3000

Q: Who is the manufacturer of INTUITIVE SURGICAL ENDOSCOPIC INSTRUMENT CONTROL SYSTEMS, MODELS IS1200, IS2000 AND IS3000?

Intuitive Surgical, Inc. filed the 510(k) submission for INTUITIVE SURGICAL ENDOSCOPIC INSTRUMENT CONTROL SYSTEMS, MODELS IS1200, IS2000 AND IS3000 (K090993).

Q: What is the FDA product code for INTUITIVE SURGICAL ENDOSCOPIC INSTRUMENT CONTROL SYSTEMS, MODELS IS1200, IS2000 AND IS3000?

NAY. It is classified under 21 CFR 876.1500 as a Class 2 device in the Gastroenterology, Urology panel.

Q: What is the regulatory pathway for INTUITIVE SURGICAL ENDOSCOPIC INSTRUMENT CONTROL SYSTEMS, MODELS IS1200, IS2000 AND IS3000?

510(k) clearance (submission type: Traditional).

Q: Who can help prepare an FDA 510(k) submission like INTUITIVE SURGICAL ENDOSCOPIC INSTRUMENT CONTROL SYSTEMS, MODELS IS1200, IS2000 AND IS3000?

Innolitics — a medical-device software consultancy — provides regulatory and engineering support for FDA 510(k) submissions. See https://innolitics.com/services/510ks/ or contact https://innolitics.com/contact.

K090993 · Intuitive Surgical, Inc. · NAY · Dec 16, 2009 · Gastroenterology, Urology

Device Facts

Record ID	K090993
Device Name	INTUITIVE SURGICAL ENDOSCOPIC INSTRUMENT CONTROL SYSTEMS, MODELS IS1200, IS2000 AND IS3000
Applicant	Intuitive Surgical, Inc.
Product Code	NAY · Gastroenterology, Urology
Decision Date	Dec 16, 2009
Decision	SESE
Submission Type	Traditional
Regulation	21 CFR 876.1500
Device Class	Class 2
Attributes	Therapeutic, Pediatric

Intended Use

The Intuitive Surgical Endoscopic Instrument Control Systems (da Vinci, da Vinci S, and da Vinci Si Surgical Systems Models IS1200, IS2000, IS3000) are intended to assist in the accurate control of Intuitive Surgical EndoWrist Instruments and Accessories including rigid endoscopes, blunt and sharp endoscopic dissectors, scissors, scalpels, ultrasonic/harmonic shears, forceps/pick-ups, needle holders, endoscopic retractors, stabilizers, electrocautery and accessories for endoscopic manipulation of tissue, including grasping, cutting, blunt and sharp dissection, approximation, ligation, electrocautery, suturing, delivery and placement of microwave ablation probes and accessories, during urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, transoral otolaryngology surgical procedures restricted to benign and malignant tumors classified as T1 and T2, general thoracoscopic surgical procedures, and thoracoscopically assisted cardiotomy procedures. The system can also be employed with adjunctive mediastinotomy to perform coronary anastomosis during cardiac revascularization. The system is indicated for adult and pediatric use (except for transoral otolaryngology surgical procedures). It is intended for use by trained physicians in an operating room environment in accordance with the representative, specific procedures set forth in the Professional Instructions for Use.

Device Story

Robotic-assisted surgical system comprising Surgeon Console and Patient Side Cart (PSC). Surgeon at console controls endoscopic instruments and camera via Master Tool Manipulators (MTM). PSC holds instruments and endoscope via Patient Side Manipulators (PSM) and Endoscope Camera Manipulator (ECM). Insite Vision System provides 3D or 2D stereo images to surgeon. System facilitates tissue manipulation (grasping, cutting, dissection, suturing, etc.) during minimally invasive procedures. Surgeon commands relayed via cables to PSC; assistant at PSC performs instrument/endoscope changes. Enables precise control of EndoWrist instruments, enhancing surgical dexterity and visualization. Used in OR by trained physicians.

Clinical Evidence

Multicenter retrospective clinical study conducted to assess feasibility, efficacy, and safety in transoral otolaryngology procedures. Historical controls used to demonstrate substantial equivalence of robotic-assisted transoral procedures to alternative methods including open surgery, transoral surgery, and chemoradiation.

Technological Characteristics

Computer-controlled endoscopic instrument system. Components: Surgeon Console, Patient Side Cart, stereo endoscope, endoscopic camera, light source, and EndoWrist instruments. Connectivity via cables between console and cart. No changes in materials or technology from predicate.

Indications for Use

Indicated for adult and pediatric patients (excluding transoral otolaryngology) undergoing urologic, general laparoscopic, gynecologic laparoscopic, general thoracoscopic, and thoracoscopically assisted cardiotomy procedures. Also indicated for transoral otolaryngology procedures restricted to T1 and T2 benign and malignant tumors. Used by trained physicians in operating rooms.

Regulatory Classification

Identification

An endoscope and accessories is a device used to provide access, illumination, and allow observation or manipulation of body cavities, hollow organs, and canals. The device consists of various rigid or flexible instruments that are inserted into body spaces and may include an optical system for conveying an image to the user's eye and their accessories may assist in gaining access or increase the versatility and augment the capabilities of the devices. Examples of devices that are within this generic type of device include cleaning accessories for endoscopes, photographic accessories for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes, flexible or rigid choledochoscopes, colonoscopes, diagnostic cystoscopes, cystourethroscopes, enteroscopes, esophagogastroduodenoscopes, rigid esophagoscopes, fiberoptic illuminators for endoscopes, incandescent endoscope lamps, biliary pancreatoscopes, proctoscopes, resectoscopes, nephroscopes, sigmoidoscopes, ureteroscopes, urethroscopes, endomagnetic retrievers, cytology brushes for endoscopes, and lubricating jelly for transurethral surgical instruments. This section does not apply to endoscopes that have specialized uses in other medical specialty areas and that are covered by classification regulations in other parts of the device classification regulations.

Special Controls

*Classification* —(1)*Class II (special controls).* The device, when it is an endoscope disinfectant basin, which consists solely of a container that holds disinfectant and endoscopes and accessories; an endoscopic magnetic retriever intended for single use; sterile scissors for cystoscope intended for single use; a disposable, non-powered endoscopic grasping/cutting instrument intended for single use; a diagnostic incandescent light source; a fiberoptic photographic light source; a routine fiberoptic light source; an endoscopic sponge carrier; a xenon arc endoscope light source; an endoscope transformer; an LED light source; or a gastroenterology-urology endoscopic guidewire, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.(2) Class I for the photographic accessories for endoscope, miscellaneous bulb adapter for endoscope, binocular attachment for endoscope, eyepiece attachment for prescription lens, teaching attachment, inflation bulb, measuring device for panendoscope, photographic equipment for physiologic function monitor, special lens instrument for endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope, and cleaning brush for endoscope. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807of this chapter, subject to the limitations in § 876.9.

Predicate Devices

Intuitive Surgical da Vinci Surgical Systems (Models IS1200, IS2000, IS3000) and EndoWrist Instruments and Accessories (K990144, K002489, K011002, K011281, K012833, K013416, K021036, K022574, K040237, K040948, K042855, K043153, K043288, K050005, K050369, K050404, K050802, K060391, K061260, K063220, K081137)

Related Devices

K043288 — MODIFICATION TO INTUITIVE SURGICAL DA VINCI SURGICAL SYSTEM AND ENDOSCOPIC INSTRUMENTS · Intuitive Surgical, Inc. · Mar 3, 2005
K050802 — MODIFICATION TO INTUITIVE SURGICAL DA VINCI SURGICAL SYSTEM AND ENDOSCOPIC INSTRUMENTS · Intuitive Surgical, Inc. · Jun 29, 2005
K050369 — INTUITIVE SURGICAL DA VINCI SURGICAL SYSTEM, MODEL IS2000 · Intuitive Surgical, Inc. · Apr 29, 2005
K081137 — INTUITIVE SURGICAL DA VINCI SI SURGICAL SYSTEM: MODEL IS3000 · Intuitive Surgical, Inc. · Feb 18, 2009
K021036 — INTUITIVE SURGICAL DA VINCI SURGICAL SYSTEM, MODEL IS1000 · Intuitive Surgical, Inc. · Jun 26, 2002

Submission Summary (Full Text)

{0}------------------------------------------------ K090993 ## Section II - 510(k) Summary This summary of 510(k) safety and effectiveness information is submitted in accordance with the requirements of SMDA 1990 and 21 CFR 807.92. ## 510(k) Number: | Date | December 14, 2009 | |--------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Submitter | Intuitive Surgical, Inc. 1266 Kifer Road Sunnyvale, CA 94086 | | ER Number | 2955842 | | Contact | Karen Uyesugi VP, Clinical and Regulatory Affairs Telephone: (408) 523 - 8918 Fax: (408) 523 - 1390 e-mail:karen.uyesugi@intusurg.com | | Subject Device | Name: Intuitive Surgical® da Vinci, da Vinci S® and da Vinci Si® Surgical Systems and EndoWrist Instruments and Accessories. | | | Classification Name: System, Surgical, Computer Controlled Instrument (21 CFR 876.1500). | | | Common Name: Endoscopic Instrument Control System, Endoscopic Instruments and Accessories | | Predicate Devices | Intuitive Surgical da Vinci Surgical Systems (Models IS1200, IS2000, IS3000) and EndoWrist Instruments and Accessories (legally marketed under: K990144 / K002489 / K011002 / K011281 / K012833 / K013416 / K021036 / K022574 / K040237 / K040948 / K042855 / K043153 / K043288 / K050005 / K050369 / K050404 / K050802 / K060391 / K061260 / K063220 / K081137). | | Device Description | This 510(k) is being submitted to request an expansion of the Indications for Use to include transoral otolaryngology surgical procedures. There are no changes in the design, technology, materials, manufacturing, performance, specifications, or method of use for the da Vinci Surgical Systems, EndoWrist Instruments and Accessories associated with this pre-market notification. The da Vinci Surgical Systems (Models IS1200, IS2000, IS3000) | | | consists of two integrated sub-systems as follows: | | Device | A Surgeon Console and a Patient Side Cart. While seated at the Surgeon Console, the surgeon controls critical aspects of the | \$\rho.1/3\$ {1}------------------------------------------------ | Description (continued) | procedure, including movement of the endoscopic instruments and endoscope within the operative field. The endoscopic instrument and camera movements are controlled by the surgeon through use of the Master Tool Manipulators (MTM); two hand-operated mechanisms residing within the Surgeon Console. The endoscopic instruments are held in a fixed position with respect to the patient by either two (or optionally three) unique arms known as Patient Side Manipulators (PSM), which are located on the Patient Side Cart (PSC). The endoscope is also held in a fixed position (with respect to the patient) by another arm, similar to the PSM, known as the Endoscope Camera Manipulator (ECM), which is also located on the PSC. Commands from the Surgeon Console are relayed to the PSC, which is located immediately adjacent to the patient, via cables. Instrument and endoscope changes are performed by another individual positioned adjacent to the PSC. | |-------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Intuitive Surgical Stereo View Endoscopic System: The | endoscopic vision system used with the da Vinci Surgical Systems, also known as Intuitive Surgical Insite® Vision System, consists of a stereo endoscope, endoscopic camera, and various accessories, including a light source and light guides. The Insite Vision System provides two independent images that are relayed to the surgeon located at the Surgeon Console, where they are fused to form a 3-D (or alternatively a 2-D image) image of the surgical field. | | Intended Use | The Intuitive Surgical Endoscopic Instrument Control Systems (da Vinci, da Vinci S, and da Vinci Si Surgical Systems Models IS1200, IS2000, IS3000) are intended to assist in the accurate control of Intuitive Surgical EndoWrist Instruments and Accessories including rigid endoscopes, blunt and sharp endoscopic dissectors, scissors, scalpels, ultrasonic/harmonic shears, forceps/pick-ups, needle holders, endoscopic retractors, stabilizers, electrocautery and accessories for endoscopic manipulation of tissue, including grasping, cutting, blunt and sharp dissection, approximation, ligation, electrocautery, suturing, delivery and placement of microwave ablation probes and accessories, during urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, transoral otolaryngology surgical procedures restricted to benign and malignant tumors classified as T1 and T2, general thoracoscopic surgical procedures, and thoracoscopically assisted cardiotomy procedures. The system can also be employed with adjunctive mediastinotomy to perform coronary anastomosis during cardiac revascularization. The system is indicated for adult and pediatric use (except for transoral otolaryngology surgical procedures). It is intended for use by | - P. 2/3 {2}------------------------------------------------ trained physicians in an operating room environment Intended Use accordance with the representative, specific procedures set forth (continued) in the Professional Instructions for Use. Comparison to Predicate Device There are no changes in the design, technology, materials, manufacturing, performance, specifications, and method of use for the Intuitive Surgical Endoscopic Instrument Control Systems. The expansion of the labeling to include transoral otolaryngology surgical procedures is based on the da Vinci, da Vinci S Surgical Systems (Models IS1200, IS2000, IS3000) and EndoWrist instruments and accessories being currently cleared for performing a full array of surgical tasks across multidisciplinary surgical specialties, and on a comparison of surgical tasks performed in cleared procedures to those performed in transoral otolaryngology surgical procedures. The technological characteristics of the subject device are the Technological same as for the predicate device cleared to performed similar Characteristics surgical tasks in other specialties. A list of surgical tasks involved in completing the typical array of transoral otolaryngology surgical procedures confirms there are no new tasks above and beyond those for which the da Vinci Surgical System (IS1200, IS2000, IS3000) is currently used. A multicenter retrospective clinical study has been conducted to Clinical Data confirm the feasibility, efficacy, safety and functional assessment undergoing transoral otolaryngology surgical patients in Historical controls demonstrate substantial procedures. equivalence of robotic assisted transoral procedures to alternative methods of treatment (Open surgery, transoral surgery and chemoradiation treatment). - upon the information provided in this pre-market Conclusion Based notification, the Intuitive Surgical Endoscopic Instrument Control Systems' (Models IS1200, IS2000, IS3000) use in transoral otolaryngology surgical procedures is substantially equivalent to existing treatment methods of otolaryngology procedures (Open and transoral surgery). The use of the da Vinci Surgical Systems do not raise any new issues of safety or effectiveness. P. 3/3 in {3}------------------------------------------------ Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" arranged around the perimeter. Inside the circle is a stylized image of a bird or eagle with its wings spread, possibly representing freedom or protection. Food and Drug Administration 10903 New Hampshire Avenue Document Control Room W-O66-0609 Silver Spring, MD 20993-0002 Intuitive Surgical, Inc. % Ms. Usha S. Kreaden Senior Director, Clinical Affairs 1266 Kifer Road Sunnyvale, California 94086 ## DEC 1 6 2009 Re: K090993 Trade/Device Name: Intuitive Surgical® Endoscopic Instrument Control Systems Regulation Number: 21 CFR 876-1500 Regulation Name: Endoscope and accessories Regulatory Class: Class II Product Code: NAY Dated: December 01, 2009 Received: December 02, 2009 Dear Ms. Kreaden: 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 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); medical device reporting (reporting of medical {4}------------------------------------------------ Page 2 - Ms. Usha S. Kreaden device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to http://www.fda.gov/cdrh/mdr/ for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance. 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 (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html. Sincerely yours. For N. Melkerson Mark N. Melkerson Director Division of Surgical, Orthopedic and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure {5}------------------------------------------------ ## Section III - Indications for Use 510(k) Number (if known): K090993 Intuitive Surgical® Endoscopic Instrument Control Systems Device Name: Indications for Use: The Intuitive Surgical Endoscopic Instrument Control Systems (da Vinci, da Vinci S and da Vinci Si Surgical Systems Models IS1200, IS3000) are intended to assist in the accurate control of Intuitive Surgiçal Endoscopic EndoWrist Instruments and Accessories including rigid endoscopes, blunt and sharp endoscopic dissectors, scissors, scalpels, ultrasonic/harmonic shears, forceps/pick-ups, needle holders, endoscopic retractors, stabilizers, electrocautery and accessories for endoscopic manipulation of tissue, including grasping, cutting, blunt and sharp dissection, approximation, ligation, electrocautery, suturing, and delivery and placement of microwave ablation probes and accessories, during urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, transoral otolaryngology surgical procedures restricted to benign and malignant tumors classified as T1 and T2. general thoracoscopic surgical procedures, and thoracoscopically assisted cardiotomy procedures. The system can also be employed with adjunctive mediastinotomy to perform coronary anastomosis during cardiac revascularization. The system is indicated for adult and pediatric use (except for transoral otolaryngology surgical procedures). It is intended for use by trained physicians in an operating room environment in accordance with the representative, specific procedures set forth in the Professional Instructions for Use. Prescription Use × (Part 21 CFR ,801 Subpart D) AND/OR Over-The-Counter Use (21 CFR 807 Subpart C) (PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE) Neil Kldal for xxx Division of Surgical, Orthopedic, and Restorative Devices 510(k) Number K090993