Exilis XP II

K163176 · BTL Industries, Inc. · PBX · Jan 12, 2017 · General, Plastic Surgery

Device Facts

• Record ID: K163176
• Device Name: Exilis XP II
• Applicant: BTL Industries, Inc.
• Product Code: PBX · General, Plastic Surgery
• Decision Date: Jan 12, 2017
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.4400
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Exilis XP II RF device is intended to provide heating for the purpose of elevating tissue temperature for selected medical conditions such as temporary relief of pain, muscle spasms, and increase in local circulation. The Exilis XP II massage device is intended to provide a temporary reduction in the appearance of cellulite.

Device Story

Exilis XP II is a radiofrequency (RF) system for non-invasive tissue heating and massage; utilizes high-frequency electromagnetic energy to elevate tissue temperature (40-45°C). System comprises a microprocessor-driven control unit with 8.4" color touch screen, RF generator, and handpiece with exchangeable applicator tips. Operator uses touch screen to follow therapy guidance; handpiece buttons allow control during treatment; illuminated tip indicates energy flow quality. Contact quality monitoring system tracks electrode interface. Used in clinical settings by trained operators. Device provides therapeutic heating for pain/spasm relief and local circulation; massage function targets cellulite appearance. Benefits include improved ergonomics and hygiene via single-use/exchangeable tips compared to predecessor.

Clinical Evidence

No clinical data. Substantial equivalence is based on non-clinical performance testing and comparison of technical characteristics to the predicate device.

Technological Characteristics

Monopolar RF energy source (3.25 MHz); 120 W max output. Class II, BF electrical protection. 8.4" color touch screen interface. Exchangeable applicator tips. Complies with ISO 14971 (risk management), IEC 62304 (software lifecycle), IEC 60601-1 (safety), IEC 60601-1-2 (EMC), IEC 60601-2-2 (HF surgery equipment), and ISO 10993-1/5/10 (biocompatibility).

Indications for Use

Indicated for patients requiring tissue heating for temporary relief of pain, muscle spasms, and increased local circulation, or for temporary reduction in the appearance of cellulite.

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

• Exilis XP (K143040)

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

January 12, 2017

BTL Industries, Inc. Mr. David Chmel 47 Loring Drive Framingham, Massachusetts 01702

Re: K163176

Trade/Device Name: Exilis XP II Regulation Number: 21 CFR 878.4400 Regulation Name: Electrosurgical cutting and coagulation device and accessories Regulatory Class: Class II Product Code: PBX Dated: December 19, 2016 Received: December 22, 2016

Dear Mr. Chmel:

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 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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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,

# Jennifer R. Stevenson -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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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

#### Indications for Use

510(k) Number (if known)

K163176

Device Name Exilis XP II

Indications for Use (Describe)

The Exilis XP II RF device is intended to provide heating for the purpose of elevating tissue temperature for selected medical conditions such as temporary relief of pain, muscle spasms, and increase in local circulation. The Exilis XP II massage device is intended to provide a temporary reduction in the appearance of cellulite.

| <span> <span style="font-size: 16px;">☑</span> Prescription Use (Part 21 CFR 801 Subpart D) </span> | <span>☐ Over-The-Counter Use (21 CFR 801 Subpart C)</span> |
|-----------------------------------------------------------------------------------------------------------------|------------------------------------------------------------|
|-----------------------------------------------------------------------------------------------------------------|------------------------------------------------------------|

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

Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement below.

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Tel: [phone]

# 510(k) Summary

### General Information

| Sponsor: | BTL Industries, Inc.<br>47 Loring Drive<br>Framingham, MA 01702<br>Tel: [phone]<br>Fax: [phone] |
|------------|-----------------------------------------------------------------------------------------------------------------|
| Applicant: | BTL Industries, Inc.<br>47 Loring Drive<br>Framingham, MA 01702 |

| | Fax: [phone] |
|-----------------|---------------------------------------------------------|
| Contact Person: | David Chmel<br>BTL Industries, Inc.<br>[e-mail] |

Summary Preparation 27 October 2016 Date:

#### Device Names

| Trade/Proprietary Name: | Exilis XP II |
|------------------------------|------------------------------------------------|
| Primary Classification Name: | Massager, Vacuum, Radio Frequency Induced Heat |
| Classification Regulation: | 878.4400 |
| Product Code: | PBX |

### Legally Marketed Predicate Devices

The Exilis XP II system is a state-of-the-art high-frequency energy device with accessories, and is substantially equivalent to the current product that is already cleared for USA distribution under the following 510(k) Premarket Notification number:

- . Exilis XP (K143040)
### Product Description

Subject of the submission is approval of design changes, improvement of the device ergonomics, hygiene and cleaning through addition of exchangeable and single use applicator tips.

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Image /page/4/Picture/0 description: The image shows the logo for BTL Industries. The logo consists of three blue squares, each containing a letter from the company's name. The squares are arranged in a triangular pattern, with the "B" square at the top, the "T" square on the left, and the "L" square on the right. To the right of the logo is the company name, "BTL Industries", in a gray, sans-serif font.

The Exilis XP II is a state-of-the-art radiofrequency device that enables the application of therapy by a non-invasive. high-frequency field.

The control unit of the system is fitted with a color touch screen, to facilitate use of the device. The on-screen information quides the operator through the entire therapy. For easier control, the handpiece is equipped with buttons, enabling operation of the device during therapy. Quality of the energy flow is indicated by the illuminated treatment tip.

Exilis XP II comes with the opportunity of exchangeable tips for patients greater convenience when treating various body parts.

Contact quality monitoring system is present for monitoring of the contact quality under the patch electrode. An easy-to-read handpiece display shows the selected treatment parameters.

The Exilis XP II consists of the following main components:

- microprocessor-driven control unit
- . high-frequency electromagnetic energy generator
- . user interface with 8.4" color touch screen
- applicator for an application of radiofrequency .
- . exchangeable applicator tips to treat various body parts

#### Indications for Use

The Exilis XP II RF device is intended to provide heating for the purpose of elevating tissue temperature for selected medical conditions such as temporary relief of pain, muscle spasms, and increase in local circulation.

The Exilis XP II massage device is intended to provide a temporary reduction in the appearance of cellulite.

### Non-clinical Testing

The Exilis XP II device has been thoroughly evaluated for electrical safety. The Exilis XP II has been found to conform with applicable medical device safety standards. The system complies with the following standards:

ISO 14971 - Medical devices - Application of risk management to medical devices IEC 62304 - Medical Device Software - Software Life Cycle Processes

Medical Electrical Equipment

IEC 60601-1 General requirements for safety IEC 60601-1-2 Electromagnetic compatibility-Requirements and Tests

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- IEC 60601-2-2 Particular requirements for the basic safety and essential performance of high frequency surgery equipment and high frequency surgical accessories
- Evaluation and testing within a risk management process ISO 10993-1
- ISO 10993-5 Biological Evaluation of Medical Devices-Tests for In Vitro toxicity
- ISO 10993-10 Biological Evaluation of Medical Devices-Test for Irritation and Skin Sensitization

### Clinical testing

The substantial equivalence determination for the Exilis XP II system is not based upon clinical performance testing. The device safety and efficacy was demonstrated by comparison of technical characteristics between the Exilis XP II and compared to the predicate device.

### Summary of Clinical and Non-clinical testing

Non-clinical test have been conducted to evaluate the Exilis SP II performance, and results confirm that the device performs as intended and in a similar manner compared to the predicate. Thus, the Exilis XP II is substantially equivalent to the predicate devices.

| Device Name | Exilis XP II | Exilis XP |
|------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Manufacturer | BTL Industries, Inc. | BTL Industries, Inc. |
| 510(k) Number | Current Submission | K143040 |
| Product Code | General & Plastic Surgery<br>21 CFR 878.4400 | General & Plastic Surgery<br>21 CFR 878.4400 |
| Regulation | • PBX, Electrosurgical, Cutting &<br>Coagulation & Accessories | • PBX, Massager, Vacuum, Radio<br>Frequency Induced Heat |
| Indications for<br>Use | The Exilis XP II RF device is<br>intended to provide heating for the<br>purpose of elevating tissue<br>temperature for selected medical<br>conditions such as temporary<br>relief of pain, muscle spasms, and<br>increase in local circulation. The<br>Exilis XP II massage device is<br>intended to provide a temporary<br>reduction in the appearance of<br>cellulite. | The Exilis XP RF device is<br>intended to provide heating for the<br>purpose of elevating tissue<br>temperature for selected medical<br>conditions such as temporary relief<br>of pain, muscle spasms, and<br>increase in local circulation. The<br>Exilis XP massage device is<br>intended to provide a temporary<br>reduction in the appearance of<br>cellulite. |

### Comparison with the Predicate Device

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| Device Name | Exilis XP II | Exilis XP |
|----------------------------------------------|------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------|
| Manufacturer | BTL Industries, Inc. | BTL Industries, Inc. |
| 510(k) Number | Current Submission | K143040 |
| Device<br>Technologies | Application of the heat to the<br>tissue via RF energy. Massaging<br>of body<br>parts with<br>massage<br>device. | Application of the heat to the<br>tissue via RF energy. Massaging<br>of body<br>parts with<br>massage<br>device. |
| Electrical<br>Protection | Class II, BF | Class II, BF |
| Color Touch<br>Screen | 8.4" (21.5cm)/640x480 pixel | 8.4" (21.5cm)/640x480 pixel |
| Exchangeable<br>Applicator<br>Tips Available | Yes | No |
| Maximum<br>Output<br>Power | 120 W | 120 W |
| Effective<br>Treatment<br>Temperature | 40 - 45 °C | 40 - 45 °C |
| Modes of<br>Operation | Monopolar | Monopolar |
| Output<br>Frequency | 3.25 MHz | 3.25 MHz |
| Energy Source | 100 - 240 VAC, max 4A, 50-60 Hz | 100 - 240 VAC, max 4A, 50-60 Hz |
| Dimensions<br>(W x H x D) | 16" x 10.6" x 11.9"<br>(41 cm x 22 cm x 18 cm) | 16" x 10.6" x 11.9"<br>(41 cm x 22 cm x 18 cm) |
| Weight | 16 lb (7.3 kg) | 16 lb (7.3 kg) |

### Substantial Equivalence

Based upon the intended use and technical information provided in this pre-market notification, the Exilis XP II device has been shown to be substantially equivalent to currently marketed predicate device.

### Conclusion

Based on the aforementioned information, the changes in Exilis XP II do not raise any new questions of safety and effectivity and the device is substantially equivalent to the identified predicate device.