VESOCCLUDE LIGATING CLIP

K091060 · Vesocclude Medical, LLC · FZP · Sep 23, 2009 · General, Plastic Surgery

Device Facts

• Record ID: K091060
• Device Name: VESOCCLUDE LIGATING CLIP
• Applicant: Vesocclude Medical, LLC
• Product Code: FZP · General, Plastic Surgery
• Decision Date: Sep 23, 2009
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.4300
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Vesocclude ligating clips are intended for use in procedures involving vessels or anatomic structures for which the user determines ligating clips are the best choice. Users should select the size and amount of the clips based on upon their experience, judgment, and needs.

Device Story

Vesocclude ligating clips are permanent, non-absorbable, titanium surgical clips. Used in surgical procedures to ligate vessels or anatomic structures. Operated by surgeons using compatible reusable stainless steel appliers. Clips are loaded from a plastic cartridge carrier into the applier jaw. Application technique is identical to predicate devices. Provides mechanical occlusion of vessels/structures based on surgeon judgment of size and quantity required. Benefits include reliable hemostasis or structure ligation.

Clinical Evidence

Bench testing only. Metallurgical comparative analysis performed to demonstrate equivalence in safety and performance to predicate devices.

Technological Characteristics

Implantable grade Titanium; Chevron-shaped clip; available in multiple sizes; compatible with reusable stainless steel appliers; non-absorbable; sterile.

Indications for Use

Indicated for ligation of vessels or anatomic structures in surgical procedures. Contraindicated for contraceptive tubal occlusion and renal artery ligation during laparoscopic donor nephrectomies.

Regulatory Classification

Identification

An implantable clip is a clip-like device intended to connect internal tissues to aid healing. It is not absorbable.

Predicate Devices

• Teleflex Medical Horizon Ligating Clips (K901303, K982313)
• Teleflex Medical Hemoclip Ligating Clips (K841547, K841548, K841549)
• Teleflex Medical Atrauclip Ligating Clips (K861992)

Submission Summary (Full Text)

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K091060
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# SECTION 5 - 510(k) Summary

#### Name, Address, Phone and Fax Number of Applicant

Owner: Stephen Holmes Address: Vesocclude Medical, LLC Durham, NC Phone: [phone]

#### Contact Person

| Name: | Diane Peper |
|------------|----------------------------------------------------------------------------------|
| Telephone: | 919-570-9605 |
| E-mail: | [e-mail] |
| Address: | Triangle Quality Solutions, Inc.<br>10419 Stallings Road<br>Spring Hope NC 27882 |

Date Prepared: March 16th 2009

### A. Device Name

| Trade Name: | Vesocclude Ligating Clip |
|----------------------|--------------------------------|
| Common Name: | Hemostatic Clip, Ligating Clip |
| Classification Name: | Vascular Clip |

### B. Predicate Device

Teleflex Medical Horizon Ligating Clips (510ks; K901303. K982313) Teleflex Medical Hemoclip Ligating Clips (510ks; K841547, K841548, K841549) Teleflex Medical Atrauclip Ligating Clips (510k; K861992)

#### C. Device Description

Vesocclude ligating clips are permanent implant, non-absorbable, sterile, surgical clips made from an implantable grade of Titanium and are available in multiple sizes.

#### Indications for Use

Vesocclude ligating clips are intended for use in procedures involving vessels or anatomic structures for which the user determines ligating clips are the best choice. Users should select the size and amount of the clips based on upon their experience. judgment, and needs.

#### Contraindications

This product is not intended for use as a contraceptive tubal occlusion device. This product is contraindicated for use in ligating the renal artery during laparoscopic donor nephrectomies.

## D. Characteristic Comparison to Predicate Device Equivalence

The Vesocclude ligating clips are substantially equivalent to the predicate device in design (Chevron shaped clip), material (Titanium), performance characteristics and intended use. The Vesocclude ligating clips are specifically designed to be used with both the Teleflex Medical Horizon ligating clip and Vesocclude ligating clip appliers.

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The technique used to transfer both the Vesocclude and Teleflex Medical Horizon ligating clip from plastic cartridge carrier into the jaw of the reusable stainless steel applier is the same. See Appendix 7 for photographs. Clip application to the ligation site is identical to the predicate device.

## E. Summary of Non-clinical Performance Data

Vesocclude ligating clips are made of an implantable grade of Titanium with similar dimensions and metallurgical characteristics as the Teleflex Medical Horizon ligating clips. A metallurgical comparative analysis demonstrates that the Vesocclude ligating clips are as safe, as effective and perform as well as the predicate device. See Appendix 4 for additional details.

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## DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the Department of Health & Human Services - USA. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is an emblem featuring a stylized depiction of an eagle or bird-like figure with three wing-like extensions. The emblem is black, and the text is also in a dark color, likely black or a dark shade of gray.

Food and Drug Administration 10903 New Hampshire Avenue Document Mail Center - WO66-G609 Silver Spring, MD 20993-0002

## SEP 2 3 2009

Vesocclude Medical, LLC % Triangle Quality Solutions, Inc. Ms. Diane Pepers 10419 Stallings Roadn Spring Hope, North Carolina 27882

Re: K091060

Trade/Device Name: Vesocclude Ligating Clip Regulation Number: 21 CFR 878.4300 Regulation Name: Implantable clip Regulatory Class: Class II Product Code: FZP Dated: September 1, 2009 Received: September 4, 2009

## Dear Ms. Pepers:

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 device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set

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Page 2 - Ms. Diane Pepers

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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.

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/ucch1 1 5809.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 fire [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours.

for Nolo

N.A

Mark N. Melkerson Director Division of Surgical, Orthopedic and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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# SECTION 4 - Indications for Use

510(k) Number:

Device Name: Vesocclude Ligating Clip

Indications For Use: Vesocclude ligating clips are intended for use in procedures involving vessels or anatomic structures for which the user determines ligating clips are the best choice. Users should select the size and amount of the clips based on upon their experience, judgment, and needs.

Contraindications: This product is not intended for use as a contraceptive tubal occlusion device. This product is contraindicated for use in ligating the renal artery during laparoscopic donor nephrectomies.

Prescription Use Yes

AND/OR

Over-The-Counter Use

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Ned RP Opher forman

vision Sign-Off) ( Division of Surgical, Orthopedic, and Restorative Devices

1091060 510(k) Number.

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