Matrix LS-40 CO2 Laser System

K161356 · Shanghai Wonderful Opto-Electrics Tech.Co.,Ltd · GEX · Sep 9, 2016 · General, Plastic Surgery

Device Facts

• Record ID: K161356
• Device Name: Matrix LS-40 CO2 Laser System
• Applicant: Shanghai Wonderful Opto-Electrics Tech.Co.,Ltd
• Product Code: GEX · General, Plastic Surgery
• Decision Date: Sep 9, 2016
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.4810
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

It is indicated for incision, excision, ablation, vaporization and coagulation of body soft tissues in medical specialties including aesthetic (dermatology and plastic surgery), podiatry, otolaryngology (ENT), gynecology, neurosurgery, orthopaedics, general and thorasic surgery (including open and endoscopic), dental and oral surgery and genitourinary surgery. The use with the scanning unit is indicated for ablative skin resurfacing. The CO2 System is intended for use in surgical applications requiring the ablation, vaporization, excision, incision, and coagulation of soft tissue in dermatology and plastic surgery, general surgery. Dermatology, Plastic Surgery and General Surgery procedures: - Laser skin resurfacing. - Treatment of furrows and wrinkles. •Removal of skin taqs, actinic keratosis, acne scars, keloids, tattoos, telangiectasia, squamous and basal cell carcinoma, warts and uneven pigmentation. - Treatment of cysts, abscesses, hemorrhoids and other soft tissue applications. - · Blepharoplasty. - · Site preparation for hair transplants. - The fractional scanner is for skin resurfacing.

Device Story

Matrix LS-40 CO2 Laser System; delivers 10,600nm wavelength laser energy via 7-joint articulated arm; activated by footswitch. Used in office/clinic settings by physicians for soft tissue surgery (incision, ablation, coagulation) and skin resurfacing. Device transforms electrical power into CO2 laser output; operates in Continuous Wave, Pulse, and Super Pulse modes. Healthcare providers use LCD touch screen interface to control parameters; output affects tissue via thermal ablation/vaporization. Benefits include precise tissue removal and resurfacing capabilities.

Clinical Evidence

Bench testing only. Compliance with IEC 60601-1, IEC 60601-1-2, IEC 60601-2-22, and IEC 60825-1 standards for electrical, electromagnetic, and radiation safety.

Technological Characteristics

Sealed CO2 laser tube; 10,600nm wavelength; 0.5-40W power output; 7-joint articulated arm; closed-loop liquid cooling; LCD touch screen interface. Standards: IEC 60601-1:2005, IEC 60601-1-2:2007, IEC 60601-2-22:1995, IEC 60825-1:2007. Power input: 110-120 VAC, 50-60 Hz.

Indications for Use

Indicated for incision, excision, ablation, vaporization, and coagulation of soft tissues in patients requiring surgical intervention in dermatology, plastic surgery, general surgery, podiatry, ENT, gynecology, neurosurgery, orthopaedics, thoracic surgery, dental/oral surgery, and genitourinary surgery. Includes ablative skin resurfacing via scanning unit.

Regulatory Classification

Identification

(1) A carbon dioxide laser for use in general surgery and in dermatology is a laser device intended to cut, destroy, or remove tissue by light energy emitted by carbon dioxide.(2) An argon laser for use in dermatology is a laser device intended to destroy or coagulate tissue by light energy emitted by argon.

Predicate Devices

• Cortex Laser System (K150587)

Submission Summary (Full Text)

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Image /page/0/Picture/1 description: The image shows the seal of the U.S. Department of Health and Human Services. The seal features the department's name in a circular arrangement around an emblem. The emblem consists of a stylized representation of three human profiles facing right, stacked on top of each other.

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

September 9, 2016

Shanghai Wonderful Opto-Electrics Tech. Co., Ltd. Mr. Jonathan Hu Medwheat (Shanghai) Medical Technology Co., Ltd. Yangpu District Liaoyuan East Road Shuangyang First Suite No. 33 Room 303 Shanghai, Shanghai China 200093

Re: K161356

Trade/Device Name: Matrix LS-40 CO2 Laser System Regulation Number: 21 CFR 878.4810 Regulation Name: Laser surgical instrument for use in general and plastic surgery and in dermatology Regulatory Class: Class II Product Code: GEX Dated: July 25, 2016 Received: August 3, 2016

Dear Mr. Hu:

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

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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 Part 803); 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 Parts 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/Resourcesfor You/Industry/default.htm. 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/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.

# Christopher J. Ronk -S

For Binita S. Ashar, M.D., M.B.A., F.A.C.S. Director Division of Surgical Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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## Indications for Use

510(k) Number (if known) K161356

#### Device Name Powered Laser Surgical Instrument

#### Indications for Use (Describe)

It is indicated for incision, ablation, vaporization and coagulation of body soft tissues in medical specialties including aesthetic (dermatology and plastic surgery), podiatry, otolaryngology (ENT), gynecology, neurosurgery, orthopaedics, general and thorasic surgery (including open and endoscopic), dental and oral surgery and genitourinary surgery. The use with the scanning unit is indicated for ablative skin resurfacing.

The CO2 System is intended for use in surgical applications requiring the ablation, vaporization, and coagulation of soft tissue in dermatology and plastic surgery, general surgery.

Dermatology, Plastic Surgery and General Surgery procedures:

- · Laser skin resurfacing.
- Treatment of furrows and wrinkles.

· Removal of skin tags, actinic keratosis, acne scars, keloids, tattoos, telangiectasia, squamous and basal cell carcinoma, warts and uneven pigmentation.

- · Treatment of cysts, abscesses, hemorrhoids and other soft tissue applications.
- · Blepharoplasty.
- · Site preparation for hair transplants.
- · The fractional scanner is for skin resurfacing.

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

| <div> <span> <span style="text-decoration: overline;">X</span> Prescription Use (Part 21 CFR 801 Subpart D) </span> </div> | <div> <span> Over-The-Counter Use (21 CFR 801 Subpart C) </span> </div> |
|------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------|
|------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------|

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Image /page/3/Picture/1 description: The image shows the logo for SWOT. The logo is blue and features the word "SWOT" in a stylized font. There are two lines above and below the word "SWOT". The logo also includes the registered trademark symbol.

# 002_510(k) Summary

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Image /page/4/Picture/1 description: The image shows the logo for SWOT. The logo is blue and white, and it features the word "SWOT" in a stylized font. The letters are connected by a horizontal line. There is a registered trademark symbol in the upper right corner of the logo.

Date Prepared:September 9, 2016

# 510(k) Summary

[As required by 21 CFR 807.92]

# 1. Submitter's Information

| Name of Sponsor: | Shanghai Wonderful Opto-Electrics Tech. Co., Ltd. |
|------------------|--------------------------------------------------------------------------|
| Address: | 2F, Building 3, Lane 561, Nujiang Road (North),Shanghai<br>200333, China |
| Contact Name: | Amy Lee |
| Telephone No.: | 0086-021-62642623 |
| Fax No.: | 0086-021-52827988 |
| Email Address: | [e-mail] |

# 2. Correspondent's Information

| CompanyName: | Med-wheat Shanghai |
|---------------------|--------------------------|
| Correspondent Name: | Jonathan Hu |
| Telephone No.: | 0086-021-65181421 |
| Email Address: | [e-mail] |

# 3. Trade Name, Common Name, Classification

| Trade Name: | Matrix LS-40 CO2 Laser System |
|---------------------------|-----------------------------------|
| Common Name: | Medical Laser System |
| Mode Name: | Matrix LS-40 |
| Regulation Classification | Powered Laser Surgical Instrument |
| Product Code: | GEX |
| Classification Panel: | General and Plastic Surgery |
| Device Class: | II |

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Image /page/5/Picture/1 description: The image shows the logo for SWOT. The logo is blue and features the word "SWOT" in a stylized font. There are two lines above and below the word "SWOT". To the left of the word is a design that looks like two letter "S"s stacked on top of each other with a line going through them. There is a registered trademark symbol in the upper right corner of the image.

# 4. Identification of Predicate Device(s)

The identified predicatedevice within this submission is as follows:

TheCortex Laser System of Cynosure, Inc. dbaEllmanhas been cleared by FDA through 510(k) No.K150587 (Decision Date - July 21, 2015).

## 5. Description of the Device

The MATRIX LS-40 CO2 Surgical laser System incorporating a permanently articulated arm that delivers CO2 laser power in a wavelength of 10,600nm in its normal operations. The device is activated by means of a footswitch.

The Laser System is designed for use in an office or a clinic, which shall be a clean, dry and well-ventilated room with a door.

# 6. Indication for Use

It is indicated for incision, excision, ablation, vaporization and coagulation of body soft tissues in medical specialties including aesthetic (dermatology and plastic surgery), podiatry, otolaryngology (ENT), gynecology, neurosurgery, orthopaedics, general and thorasic surgery (including open and endoscopic), dental and oral surgery and genitourinary surgery. The use with the scanning unit is indicated for ablative skin resurfacing.

The CO2 System is intended for use in surgical applications requiring the ablation, vaporization, excision, incision, and coagulation of soft tissue in dermatology and plastic surgery, general surgery.

Dermatology, Plastic Surgery and General Surgery procedures:

- Laser skin resurfacing.
- Treatment of furrows and wrinkles.

•Removal of skin taqs, actinic keratosis, acne scars, keloids, tattoos, telangiectasia, squamous and basal cell carcinoma, warts and uneven pigmentation.

- Treatment of cysts, abscesses, hemorrhoids and other soft tissue applications.
- · Blepharoplasty.
- · Site preparation for hair transplants.
- The fractional scanner is for skin resurfacing.

## 510(k) Summary

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# 7. Technological Characteristics

The subject device in this 510(k) uses the same technology that is utilized in the predicate device. A comparison of technological characteristics is provided in the following table:

| Items | Matrix LS-40<br>CO2Laser System | Cortex Laser System<br>in K150587 | |
|----------------------------|----------------------------------------------------------------|----------------------------------------------------------------|----------|
| Technology Characteristics | | | |
| Laser Type | Sealed CO2 Laser Tube | Sealed CO2 Laser Tube | |
| Wavelength | 10.6 micron (10,600nm) | 10.6 micron (10,600nm) | |
| Laser Operation<br>Mode | Continuous Wave (CW), Blend<br>(PW), Super Pulse (SP) | Continuous Wave, Blend (PW),<br>Super Pulse | |
| Power to<br>Tissue | CW | 0.5-40W | 0.5-40W |
| | PW | 0.5-30W | 0.5-30W |
| | SP | 0.5-15W | 0.5-15W |
| Frequency<br>Range | CW | N/A | N/A |
| | PW | 30Hz | 30Hz |
| | SP | 20-240Hz | 20-240Hz |
| Peak Power | 200W | 200W | |
| Repetition Rate | 1-8 Hz/240 Hz Super Pulse | 1-8 Hz/240 Hz Super Pulse | |
| SuperPulse Duration | 10-1000ms | 10-1000ms | |
| Aiming Beam | 3mW (650nm diode) adjustable | 3mW (650nm diode) adjustable | |
| Spot Size | 100µm for surgical handpiece<br>150µm for fractional handpiece | 100µm for surgical handpiece<br>150µm for fractional handpiece | |
| Articulated Arm | 7-joint articulated arm | 7-joint articulated arm | |
| Cooling Type | Closed Loop Liquid | Closed Loop Liquid | |
| User Interface | LCD Touch Screen | LCD Touch Screen | |
| Dimension | 34cm*46cm*96cm | 150cm*46cm* 31cm | |
| Weight | 46.5Kg | 60kg | |
| Power Input | 110 - 120 VAC, 10 A, 50-60 Hz | 110 - 120 VAC, 10 A, 50-60 Hz | |

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Image /page/7/Picture/1 description: The image is a logo for SWOT. The logo is blue and white. The word "SWOT" is written in blue letters, with a blue line underneath. There is a blue oval shape to the left of the word "SWOT" with the letters "S" written twice inside the oval. There is a registered trademark symbol in the upper right corner of the logo.

# 8. Discussion of Non-clinical Testing

The Matrix LS-40 CO2 Laser System has been conducted related non-clinical tests to identify the substantial equivalence from the predicate device. The tests include the concerning of electrical safety, EMC and the requirements of radiation safety, which contains the standards including IEC 60601-1:2005/COR1:2006/COR2:2007, IEC 60601-1-2:2007, IEC 60601-2-22:1995 and IEC 60825-1:2007.

## 9. Conclusions

In accordance with the Federal Food, Drug and Cosmetic Act, 21 CFR Part 807, it is concluded, basing on performance testing, indication for use, and technology, the subject device is substantially equivalent to the predicate device K150587.