DEKA LipoAI

K212270 · El.En Electronic Engineering Spa · GEX · Oct 21, 2021 · General, Plastic Surgery

Device Facts

• Record ID: K212270
• Device Name: DEKA LipoAI
• Applicant: El.En Electronic Engineering Spa
• Product Code: GEX · General, Plastic Surgery
• Decision Date: Oct 21, 2021
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.4810
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The LipoAI is indicated for the surgical incision, excision, vaporization, ablation, and coagulation of soft tissue. All soft tissue is included, such as skin, cutaneous tissue, subcutaneous tissue, striated and smooth tissue, muscle, cartilage meniscus, mucous membrane, lymph vessels and nodes, organs and glands. The LipoAI is further indicated for laser assisted lipolysis.

Device Story

DEKA LipoAI is a powered laser surgical instrument utilizing a 1444 nm Nd:YAG laser source. It delivers laser energy via a 600 µm optical fiber housed within a stainless-steel cannula (max 1.4mm). The system includes an AC/DC power supply, CPU controller, cooling system, and LCD touch screen interface. Operated by a physician in a clinical setting, the device is activated via footswitch. The laser energy is used for incision, excision, vaporization, ablation, and coagulation of soft tissue, as well as laser-assisted lipolysis. The aiming beam uses red and green laser diodes to assist the physician in targeting tissue. The device provides controlled thermal energy to soft tissue to achieve the desired surgical effect, potentially benefiting patients through precise tissue interaction during surgical and lipolysis procedures.

Clinical Evidence

No clinical data provided. Bench testing only.

Technological Characteristics

1444 nm pulsed Nd:YAG laser; 600 µm optical fiber delivery; stainless-steel cannula (max 1.4mm); 12W max output power; 5-40 Hz pulse repetition rate; 300 mJ max pulse energy. Complies with ANSI AAMI ES60601-1, IEC 60601-1-2, IEC 60601-2-22, and IEC 60825-1. Includes CPU controller, cooling system, and LCD touch screen interface. Powered by 200-240V AC/DC supply.

Indications for Use

Indicated for surgical incision, excision, vaporization, ablation, and coagulation of soft tissue (skin, cutaneous, subcutaneous, striated/smooth muscle, cartilage, mucous membrane, lymph vessels/nodes, organs, glands) and laser-assisted lipolysis in patients requiring these surgical procedures.

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

• Lutronic AccuSculpt II Laser system (K101573)

Submission Summary (Full Text)

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October 21, 2021

EL.EN Electronic Engineering Spa Paolo Peruzzi Regulatory Affairs Manager VIA Baldanzese 17 Calenzano, Firenze 50041 Italy

Re: K212270

Trade/Device Name: DEKA LipoAI 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 15, 2021 Received: July 20, 2021

Dear Paolo Peruzzi:

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.

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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 and Part 809: 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 mediation-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.

Purva Pandya 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) K212270

Device Name DEKA LipoAI

Indications for Use (Describe)

The LipoAI is indicated for the surgical incision, vaporization, ablation, and coagulation of soft tissue. All soft tissue is included, such as skin, cutaneous tissue, striated and smooth tissue, muscle, cartilage meniscus, mucous membrane, lymph vessels and nodes, organs and glands. The LipoAI is further indicated for laser assisted lipolysis.

| Type of Use (Select one or both, as applicable) | |
|---------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------|
| <div> <span> <span style="font-size: 20px;">☑</span> Prescription Use (Part 21 CFR 801 Subpart D) </span> </div> | <div> <span> <span style="font-size: 20px;">☐</span> Over-The-Counter Use (21 CFR 801 Subpart C) </span> </div> |

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# 510(k) Summary

# DEKA LIPOAI

## Submitter:

El.En. S.p.A. Via Baldanzese, 17 50041 Calenzano (FI), Italy

# Contact:

Paolo Peruzzi Regulatory Affairs Manager & Official Correspondent Phone: [phone] E-mail: [e-mail]

# Date Summary Prepared:

September 17, 2021

### Device Trade Name:

DEKA LIPOAI

### Common Name:

Powered Laser Surgical Instrument

### Classification Name:

Laser Surgical Instrument for use in General and Plastic Surgery and in Dermatology

### Product Code:

GEX

# Regulatory Class:

Class II

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## Classification Number:

21 CFR 878.4810

# Predicate Device:

Lutronic AccuSculpt II Laser system (K101573)

# Device Description:

The LipoAl is medical laser equipped with a short pulse 1444 nm Nd:YAG laser source.

The device delivers the laser energy through a 600 um optical fiber. The fiber is protected by a small stainless-steel cannula (max. 1.4mm) and is inserted in the tissue through a small aperture in the skin.

The DEKA LipoAl device consists of:

- An AC/DC power supply unit
- CPU controller
- . LASER source
- Cooling system
- . User interface with LCD touch screen
- . Beam delivery system

Laser activation is controlled by footswitch.

Electrical specifications are:

200-240V ~ single phase, 50/60 Hz, Absorbed electric power 3200 VA (max)

### Indications for Use:

The LipoAl is indicated for the surgical incision, excision, vaporization, and coagulation of soft tissue. All soft tissue is included, such as skin, cutaneous tissue, subcutaneous tissue, striated and smooth tissue, muscle, cartilage meniscus, mucous membrane, lymph vessels and nodes, organs and glands. The LipoAl is further indicated for laser assisted lipolysis.

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# Comparison with The Predicate Device:

The DEKA LIPOAI is substantially equivalent to the AccuSculpt II Laser system (K101573):

| Device Trade | Proposed Device | Predicate Device | comment |
|--------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------|
| Name | DEKA LipoAI | Lutronic AccuSculpt II<br>(K101573) | |
| Indications for<br>Use | The LipoAl is indicated for<br>the surgical incision,<br>excision, vaporization,<br>ablation, and coagulation of<br>soft tissue. All soft tissue is<br>included, such as skin,<br>cutaneous tissue,<br>subcutaneous tissue,<br>striated and smooth tissue,<br>muscle, cartilage meniscus,<br>mucous membrane, lymph<br>vessels and nodes, organs<br>and glands. The LipoAl is<br>further indicated for laser<br>assisted lipolysis. | The AccuSculpt II Laser<br>System is indicated for the<br>surgical incision, excision,<br>vaporization, ablation, and<br>coagulation of soft tissue.<br>All soft tissue is included,<br>such as skin, cutaneous<br>tissue, subcutaneous tissue,<br>striated and smooth tissue,<br>muscle, cartilage meniscus,<br>mucous membrane, lymph<br>vessels and nodes, organs<br>and glands. The AccuSculpt<br>II is further indicated for<br>laser assisted lipolysis. | Identical |
| Regulation<br>number | 21 CFR 878.4810 Laser<br>surgical instrument for use<br>in general and plastic<br>surgery and in dermatology | 21 CFR 878.4810 Laser<br>surgical instrument for use<br>in general and plastic<br>surgery and in dermatology | Identical |
| Product Code | GEX | GEX | Identical |
| Laser type | • Pulsed Nd:YAG | • Pulsed Nd:YAG | Identical |
| Wavelength | 1444 nm | 1444 nm | Identical |
| Max Pulse Energy | 300 mJ | 300 mJ | Identical |
| Transmission<br>system | 600 µm Optical fiber | 600 µm Optical fiber | Identical |
| Pulse width | Up to 100 µs | Up to 100 µs | Identical |
| Device Trade<br>Name | Proposed Device | Predicate Device | comment |
| | DEKA LipoAI | Lutronic AccuSculpt II<br>(K101573) | |
| Pulse repetition<br>rate | 5-40 Hz | 5-40 Hz | Identical |
| Aiming beam | Red and Green visible laser<br>diode | Red visible laser diode | Difference does not<br>affect safety and<br>effectiveness of the<br>device |
| Max Output<br>power | 12W | 12 W | Identical |

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# Clinical Performance Data:

None

# Non-Clinical Performance Data:

### Electrical safety and electromagnetic compatibility (EMC)

Electrical safety and EMC testing were conducted on the LipoAl device, according to the following standards:

- . ANSI AAMI ES60601-1Medical electrical equipment - Part 1: General requirements for basic safety and essential performance.
. IEC 60601-1-2 Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral Standard: Electromagnetic disturbances -Requirements and tests.

### Software Validation and Verification Testing

Software verification and validation testing were conducted and documented as recommended by FDA's Guidance for Industry and FDA Staff, "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices."

### Additional non-clinical testing conducted

Additional tests were conducted on the LipoAl device, according to the following standards:

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# K212270

. IEC 60601-2-22: Medical electrical equipment - Part 2-22: Particular requirements for basic safety and essential performance of surgical, cosmetic, therapeutic and diagnostic laser equipment

- . IEC 60825-1: Safety of laser products - Part 1: Equipment classification and requirements.
### Conclusion:

On the basis of the comparison with the predicate device and on the non-clinical performance data , we can conclude that DEKA LIPOAI is as safe, as effective, and performs as well as the legally marketed predicate device (K101573).

### Additional Information:

None.