Air Bubble Based Infuser (ABBI)

K143415 · CooperSurgical, Inc. · LKF · Feb 26, 2015 · Obstetrics/Gynecology

Device Facts

• Record ID: K143415
• Device Name: Air Bubble Based Infuser (ABBI)
• Applicant: CooperSurgical, Inc.
• Product Code: LKF · Obstetrics/Gynecology
• Decision Date: Feb 26, 2015
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 884.4530
• Device Class: Class 2

Intended Use

The ABBI (Air Bubble Based Infuser) is indicated for the following: - Instillation of a consistent alternating pattern of saline and air as a continuous stream of contrast media into the uterus and fallopian tubes to be used in conjunction with an intrauterine catheter for performance of sono-hysterosalpingogram (SonoHSG). - Instillation of saline as a continuous stream of contrast media into the used in conjunction with an intrauterine catheter for performance of saline infusion sonography (SIS).

Device Story

ABBI is a dual-barrel syringe; connects to intrauterine infusion catheter; enables manual instillation of saline-air mixture or saline-only contrast media. User-operated selector valve toggles between saline-air (for SonoHSG) and saline-only (for SIS). Used in healthcare facilities/hospitals by clinicians. Device facilitates visualization of uterus and fallopian tubes during ultrasound procedures; aids in diagnosis of uterine or tubal pathology. Single-use; sterile.

Clinical Evidence

Bench testing only. Performance evaluated via filling/infusion tests, volume capacity, pressure/vacuum, torque, steam deformation, feature evaluation, summative usability, multi-fill performance, and cadaver device evaluation. Biocompatibility confirmed via ISO 10993-5 (cytotoxicity) and ISO 10993-10 (vaginal irritation, sensitization). Accelerated aging study supports 1-year shelf life.

Technological Characteristics

Dual-barrel syringe with selector valve. Materials tested per ISO 10993-5 and ISO 10993-10. Sterile (ethylene oxide). Single-use. Manual operation; no electronic components or software.

Indications for Use

Indicated for patients undergoing sono-hysterosalpingogram (SonoHSG) or saline infusion sonography (SIS) for evaluation of the uterus and/or fallopian tubes.

Regulatory Classification

Identification

An obstetric-gynecologic specialized manual instrument is one of a group of devices used during obstetric-gynecologic procedures to perform manipulative diagnostic and surgical functions (e.g., dilating, grasping, measuring, and scraping), where structural integrity is the chief criterion of device performance. This type of device consists of the following:(1) An amniotome is an instrument used to rupture the fetal membranes. (2) A circumcision clamp is an instrument used to compress the foreskin of the penis during circumcision of a male infant. (3) An umbilical clamp is an instrument used to compress the umbilical cord. (4) A uterine curette is an instrument used to scrape and remove material from the uterus. (5) A fixed-size cervical dilator is any of a series of bougies of various sizes used to dilate the cervical os by stretching the cervix. (6) A uterine elevator is an instrument inserted into the uterus used to lift and manipulate the uterus. (7) A gynecological surgical forceps is an instrument with two blades and handles used to pull, grasp, or compress during gynecological examination. (8) A cervical cone knife is a cutting instrument used to excise and remove tissue from the cervix. (9) A gynecological cerclage needle is a looplike instrument used to suture the cervix. (10) A hook-type contraceptive intrauterine device (IUD) remover is an instrument used to remove an IUD from the uterus. (11) A gynecological fibroid screw is an instrument used to hold onto a fibroid. (12) A uterine sound is an instrument used to determine the depth of the uterus by inserting it into the uterine cavity. (13) A cytological cervical spatula is a blunt instrument used to scrape and remove cytological material from the surface of the cervix or vagina. (14) A gynecological biopsy forceps is an instrument with two blades and handles used for gynecological biopsy procedures. (15) A uterine tenaculum is a hooklike instrument used to seize and hold the cervix or fundus. (16) An internal pelvimeter is an instrument used within the vagina to measure the diameter and capacity of the pelvis. (17) A nonmetal vaginal speculum is a nonmetal instrument used to expose the interior of the vagina. (18) A fiberoptic nonmetal vaginal speculum is a nonmetal instrument, with fiberoptic light, used to expose and illuminate the interior of the vagina.

Special Controls

*Classification.* (1) Class II (special controls). The device, when it is an umbilical clamp with or without a cutter, a uterine tenaculum which is sterile and does not use suction and is intended for single use, a nonmetal vaginal speculum, or a fiberoptic nonmetal vaginal speculum, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 884.9.(2) Class I for the amniotome, uterine curette, cervical dilator (fixed-size bougies), cerclage needle, IUD remover, uterine sound, and gynecological biopsy forceps. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 884.9.

Predicate Devices

• FemVue Saline-Air Device (K110288)

Reference Devices

• H/S Elliptosphere Catheter Set (K013972)

Submission Summary (Full Text)

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

February 26, 2015

Cooper Surgical, Inc. James Keller VP Regulatory Affairs & Quality 95 Corporate Drive Trumbull, CT 06611

Re: K143415 Trade/Device Name: Air Bubble Based Infuser (ABBI™) Regulation Number: unclassified Regulation Name: unclassified Regulatory Class: unclassified Product Code: LKF Dated: November 19, 2014 Received: November 28, 2014

Dear James Keller,

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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 devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in

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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 contact the Division of Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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/MedicalDevices/Safety/ReportaProblem/default.htm 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 Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

# Herbert P. Lerner -S

for Benjamin R. Fisher, Ph.D. Director Division of Reproductive, Gastro-Renal, and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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## Indications for Use

510(k) Number (if known)

#### K143415

Device Name Air Bubble-Based Infuser (ABBI^TM)

Indications for Use (Describe)

The ABBI (Air Bubble Based Infuser) is indicated for the following:

- Instillation of a consistent alternating pattern of saline and air as a continuous stream of contrast media into the uterus and fallopian tubes to be used in conjunction with an intrauterine catheter for performance of sono-hysterosalpingogram (SonoHSG).

- Instillation of saline as a continuous stream of contrast media into the used in conjunction with an intrauterine catheter for performance of saline infusion sonography (SIS).

Type of Use (Select one or both, as applicable)

| <div><span style="font-family: Arial;"> <span style="font-size: 10pt;">☑</span> Prescription Use (Part 21 CFR 801 Subpart D)</span></div> | <div><span style="font-family: Arial;"> □ Over-The-Counter Use (21 CFR 801 Subpart C)</span></div> |
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# K143415 – 510(k) Summary

| Date Prepared: | February 24, 2015 |
|----------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 510k submitter and<br>Primary Contact: | James Keller<br>VP Regulatory Affairs & Quality<br>CooperSurgical, Inc.<br>95 Corporate Dr.<br>Trumbull, CT 06611<br>Phone: [phone]<br>Email: [e-mail] |

#### Device Name:

| Proprietary<br>Name | Common Name | Classification Name | Product<br>Code |
|---------------------|----------------------------------------------|---------------------|-----------------|
| ABBITM | Cannula,<br>Manipulator/Injector,<br>Uterine | Unclassified | LKF |

#### Predicate Information:

FemVue Saline-Air Device (Femasys, Inc.) - K110288

## Device Description:

The Air Bubble-Based Infuser (ABBI™) is a dual-barrel syringe that can be connected to an intrauterine infusion catheter to instill a saline-air mixture as contrast media during sono-hysterosalpingogram (Sono HSG) procedures and saline only during hysterosonography (SIS) procedures. The device has a selector valve that allows the user to select infusion of a saline-air mixture for a Sono HSG procedure or saline alone for a SIS procedure. These procedures are used for the evaluation of the fallopian tube(s) selectively and/or the uterus.

The ABBI™ is labeled for use with the H/S Elliptosphere Catheter Set (K013972).

The device is a single use only and provided sterile using an ethylene oxide sterilization method. The device is intended to be used in a healthcare facility or hospital.

#### Indications for Use:

The ABBI (Air Bubble Based Infuser) is indicated for the following:

- -Instillation of a consistent alternating pattern of saline and air as a continuous stream of contrast media into the uterus and fallopian tubes to be used in

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conjunction with an intrauterine catheter for performance of sonohysterosalpingogram (SonoHSG).

- Instillation of saline as a continuous stream of contrast media into the uterus to be used in conjunction with an intrauterine catheter for performance of saline infusion sonography (SIS).
## Technological Characteristics:

The technological characteristics of the device are equivalent to the predicate, with the exception of (1) the added feature that allows the ABBT™ to infuse saline only in the performance of SIS (as opposed to only infusing saline-air) and (2) differences in materials between the predicate and the ABBI™

## Performance Data:

The ABBI™ was tested by the following non-clinical methods to demonstrate substantial equivalence to the predicate device:

- Filling and Infusion Test ●
- Volume Capacity ●
- Pressure and Vacuum
- Torque Test ●
- Steam Deformation Test
- Feature Evaluation
- Summative Usability Assessment ●
- Multi-Fill Performance Test ●
- Cadaver Device Evaluation Study .

The protocol and results of the following biocompatibility studies demonstrate that the ABBI™ is non-cytotoxic, non-irritating, and non-sensitizing, respectively.

- Cytotoxicity - MEM Elution (ISO 10993-5:2009)
- Irritation Vaginal Irritation Study (ISO 10993-10:2010) ●
- Sensitization Guinea Pig Maximization (ISO 10993-10:2010) ●

The results of an accelerated aging study evaluating functional characteristics and package integrity support a 1-year shelf life for the ABBI™

## Conclusion:

The performance testing demonstrates that the ABBI™ is substantially equivalent to the proposed predicate device.