Disposable Trocar

K202931 · Wuxi Shukang Medical Appliance Co., Ltd. · GCJ · Nov 17, 2020 · Gastroenterology, Urology

Device Facts

• Record ID: K202931
• Device Name: Disposable Trocar
• Applicant: Wuxi Shukang Medical Appliance Co., Ltd.
• Product Code: GCJ · Gastroenterology, Urology
• Decision Date: Nov 17, 2020
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 876.1500
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Disposable Trocar has applications in endoscopic procedures to provide a port of entry for endoscopic instruments.

Device Story

Disposable trocar used in minimally invasive abdominal, thoracic, and gynecologic surgery; establishes port of entry for endoscopic instruments. Device consists of obturator with bladeless tip, outer seal release lever, and stability sleeve. Surgeon manually inserts obturator through abdominal wall to create incision; trocar sleeve follows to maintain access; allows gas insufflation into cavity. Used in OR by surgeons. Provides stable access channel for endoscopic tools; facilitates minimally invasive approach; reduces trauma compared to open surgery.

Clinical Evidence

No clinical data. Substantial equivalence supported by bench performance testing (visual inspection, insertion/removal force, leakage, penetration force, retention force) and biocompatibility testing (ISO 10993-5, -10, -11).

Technological Characteristics

Materials: PC, ABS. Principle: Bladeless obturator for incision expansion and sleeve insertion. Dimensions: 3-15mm diameter, 80-150mm length. Sterilization: Gamma irradiation. Connectivity: None (mechanical device).

Indications for Use

Indicated for patients undergoing abdominal, thoracic, or gynecologic minimally invasive endoscopic procedures requiring a port of entry for instruments.

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

• U-IGNITE Bladeless Trocar (K162387)

Submission Summary (Full Text)

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November 17, 2020

Wuxi Shukang Medical Appliance Co., Ltd. Xiaoqing Yuan Sales Manager No.83, Haitang West Road, Zhakou, Heqiao Town Yixing, Jiangsu 214216 China

Re: K202931

Trade/Device Name: Disposable Trocar Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and Accessories Regulatory Class: Class II Product Code: GCJ Dated: September 10, 2020 Received: September 29, 2020

Dear Xiaoqing Yuan:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

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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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

Long Chen, Ph.D. Assistant Director DHT4A: Division of General Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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### Indications for Use

510(k) Number (if known) K202931

Device Name Disposable Trocar

Indications for Use (Describe)

The Disposable Trocar has applications in endoscopic procedures to provide a port of entry for endoscopic instruments.

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

X Prescription Use (Part 21 CFR 801 Subpart D)

| Over-The-Counter Use (21 CFR 801 Subpart C)

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## 510(k) Summary

#### 1. Contact Information

#### 1.1. Applicant

Applicant Name: Wuxi Shukang Medical Appliance Co., Ltd. Address: No. 83, Haitang West Road, Zhakou Heqiao Town, Yixing, Jiangsu, 214216 China Contact Person: Xiaoqing Yuan Title: Sales Manager Telephone: [phone] E-mail: [e-mail]

#### 1.2. Designated Submission Correspondent

Company: Sinow Medical AS Address: Vestre Fantoft åen 44, 5072, Bergen, Norway Contact Person: Huifang Zhao Telephone: [phone] Email: [e-mail]

### 2. Device information

Trade Name: Disposable Trocar Common Name: Disposable Surgical Trocar Classification: II Product Code: GCJ Regulation: 21 CFR 876.1500

#### 3. Legally Marketed Primary Predicate Device

Product name: U-IGNITE Bladeless Trocar 510K Number: K162387 Product Code: GCJ Manufacture: Tianjin UWell Medical Device Manufacturing Co., Ltd.

## 4. Device Description

The disposable Trocar has application in abdominal, thoracic and gynecologic minimally invasive surgical procedures to establish a path of entry for endoscopic instruments. The trocar may be used with or without visualization for primary and secondary insertions.

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The Disposable trocar is mainly composed of Obturator with bladeless tip, Outer Seal Release Lever, Trocar Stability Sleeve, Obturator Locking Button, etc.

## 5. Indication for use:

The Disposable Trocar has applications in endoscopic procedures to provide a port of entry for endoscopic instruments.

# 6. Substantially Equivalent (SE) Comparison

| Item | Proposed Device | Primary Predicate Device | Reference Device |
|------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------|
| Product Code | GCJ | GCJ | GCJ |
| Regulation<br>Number | 21 CFR 876.1500 | 21 CFR 876.1500 | 21 CFR 876.1500 |
| Indication for<br>use | The Disposable Trocar has<br>applications in endoscopic<br>procedures to<br>provide a port of entry for<br>endoscopic instruments. | The U-IGNITE Bladeless<br>Trocar has applications in<br>endoscopic procedures to<br>provide a port of entry for<br>endoscopic instruments. | Applicate in a variety<br>of endoscopic<br>procedures to provide<br>a port of entry for<br>endoscopic<br>instruments. |
| Models | SHTA, SHTB,<br>SHTC ,SHTD and SHTE<br>which is bladeless without<br>Endo-Assistant Part. | Bladeless without<br>Endo-Assistant Part (BIG &<br>IG models) | Bladeless Trocar |
| Dimension | Diameter: 3-15mm<br>Length:80-150mm | Diameter: 5-12mm<br>Length:75-150 mm | Diameter: 3-15mm<br>Length:65-150mm |
| Principles of<br>operation | During the operation, the<br>trocar sleeve and the obturator<br>are used together. The surgeon<br>uses the obturator to expand<br>the incision of the abdomen<br>and penetrates the trocar<br>sleeve through the abdominal<br>surface of the human body into<br>the abdominal cavity, thereby<br>delivering gas to the<br>abdominal cavity and<br>establishing a path of entry for | During the operation, the<br>trocar sleeve and the obturator<br>are used together. The surgeon<br>uses the obturator to expand<br>the incision of the abdomen<br>and penetrates the trocar<br>sleeve through the abdominal<br>surface of the human body into<br>the abdominal cavity, thereby<br>delivering gas to the<br>abdominal cavity and<br>establishing a path of entry for | / |
| | endoscopic instruments. | endoscopic instruments. | |
| Main<br>Components | Obturator, Sleeve | Cannula Sleeve; Obturator | Cannula<br>Tip of obturator |
| Patient<br>Contacting<br>Structure | Obturator<br>Trocar Sleeve | Obturator<br>Cannula Sleeve | / |
| Patient<br>Contacting<br>Material | PC, ABS | PC, ABS | / |
| Sterilization | Gamma sterilization | Gamma sterilization | EO Sterilized |

Table 1 Comparison of Technology Characteristics

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#### 7. Non-Clinical Test conclusion

Non clinical tests were conducted to verify that the proposed device met all design specifications as was Substantially Equivalent (SE) to the predicate device. The test results demonstrated that the proposed device complies with the following standards:

(1) Bench Performance test:

Performance test was conducted to demonstrate the proposed Disposable Trocar is substantially equivalent to the predicate devices. The performance tests include the following tests:

- · Visual Inspection
- · Insertion and Removal Force using obturator
- · Leakage
- · In Vitro Penetration Force
- · In Vitro Retention Force

(2) Biocompatibility evaluation and test

Biocompatibility evaluation conducted in accordance with the FDA's 2016 guidance and ISO10993-1:2018 supports that the subject devices are biocompatible. The biocompatibility test includes the following tests:

In Vitro Cytotoxicity Test (ISO 10993-5: 2009 )

Skin Sensitization Test (ISO 10993-10:2010)

Intracutaneous reactivity Test (ISO 10993-10:2010 )

Acute Systemic Toxicity (ISO 10993-11:2017)

Pyrogen Test (ISO 10993-11:2017)

(3) Sterilization and Shelf Life Accelerated Aging Test

Aging test report for product performance:

Validation report for the sterilization by Gamma irradiation process (ISO 11737-2:2019) Test of Sterile Barrier System 3 Years Shelf Life.

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# 8. Clinical Test Conclusion

No clinical study is included in this submission.

# 9. Conclusion

Based on the comparison and analysis above, the proposed device is determined to be Substantially Equivalent (SE) to the predicate device.