1688 4K Camera Control Unit with Advanced Imaging Modality (1688010000), 1688 4K Pendulum Camera Head (1688310130)

K220895 · Stryker · GCJ · Apr 22, 2022 · Gastroenterology, Urology

Device Facts

• Record ID: K220895
• Device Name: 1688 4K Camera Control Unit with Advanced Imaging Modality (1688010000), 1688 4K Pendulum Camera Head (1688310130)
• Applicant: Stryker
• Product Code: GCJ · Gastroenterology, Urology
• Decision Date: Apr 22, 2022
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 876.1500
• Device Class: Class 2
• Attributes: Pediatric

Intended Use

Endoscopic white light and near-infrared illumination and imaging during endoscopic procedures.

Device Story

Endoscopic camera system capturing live surgical video; utilizes CMOS image sensors to acquire data in visible and near-infrared (NIR) spectrums; processes data via Camera Control Unit (CCU) for display; supports white light, NIR-fluorescence, and NIR-transillumination modes; used in OR by surgeons (general, pediatric, gynecological, cardiac, thoracic, plastic, orthopedic, ENT, neuro, urology); provides real-time visualization of surgical field; aids clinical decision-making through enhanced imaging modalities; benefits patients by facilitating minimally invasive endoscopic procedures.

Clinical Evidence

No clinical data provided. Substantial equivalence supported by bench testing, including software verification per IEC 62304:2015.

Technological Characteristics

Endoscopic camera system; CMOS image sensors; 4K resolution (3840 x 2160) at 60 fps; digital video output; modes include white light, NIR-fluorescence, and NIR-transillumination; components include CCU, camera head, and coupler; standards: IEC 60601-1, IEC 60601-1-6, IEC 60601-2-18, IEC 60601-1-2.

Indications for Use

Indicated for use in general laparoscopy, nasopharyngoscopy, ear endoscopy, sinuscopy, neurosurgery, and plastic surgery in adult and pediatric patients whenever a laparoscope/endoscope/arthroscope/sinuscope is indicated for use.

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

• 1688 4K Camera System with Advanced Imaging Modality (K211202)

Reference Devices

• AIM 4K Autoclave Camera Head and Coupler (K212511)

Submission Summary (Full Text)

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April 22, 2022

Stryker Marlene Fraga Sr. Staff, Regulatory Affairs Specialist, Software Interoperability 5900 Optical Court San Jose, California 95138

Re: K220895

Trade/Device Name: 1688 4K Camera Control Unit with Advanced Imaging Modality (1688010000), 1688 4K Pendulum Camera Head (1688310130) Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: Class II Product Code: GCJ, GWG

Dear Marlene Fraga:

The Food and Drug Administration (FDA) is sending this letter to notify you of an administrative change related to your previous substantial equivalence (SE) determination letter dated April 22, 2022. Specifically, FDA is updating this SE Letter to add a secondary product code as an administrative correction.

Please note that the 510(k) submission was not re-reviewed. For questions regarding this letter please contact Purva Pandya, OHT4: Office of Surgical and Infection Control Devices, at 240-402-9979, [e-mail].

Sincerely,

# Purva U. Pandya -S

Purva Pandya, D.Eng. 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

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April 22, 2022

Stryker Marlene Fraga Sr. Staff, Regulatory Affairs Specialist, Software Interoperability 5900 Optical Court San Jose, California 95138

Re: K220895

Trade/Device Name: 1688 4K Camera Control Unit with Advanced Imaging Modality (1688010000), 1688 4K Pendulum Camera Head (1688310130) Regulation Number: 21 CFR 21 C.F.R. §876.1500 Regulation Name: Laparoscope, General And Plastic Surgery Regulatory Class: Class II Product Code: GCJ

Dated: March 24, 2022 Received: March 28, 2022

Dear Marlene Fraga:

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); 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 (DICE(@fda.hhs.gov) or phone [phone] or 301-796-7100).

Sincerely,

Purva U. Pandya -S

Purva Pandya, D.Eng. 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)

#### K220895

Device Name

1688 4K Camera System with Advanced Imaging Modality (AIM)

#### Indications for Use (Describe)

The 1688 Video Camera is indicated for use in general laparoscopy, ear endoscopy, ear endoscopy, sinuscopy, neurosurgery and plastic surgery whenever a laparoscope/ arthroscope/ sinuscope/ sinuscope is indicated for use. The 1688 Video Camera is indicated for adults and pediatric patients.

A few examples of the more common endoscope surgeries are Laparoscopic cholecystectomy, Laparoscopic hernia repair, Laparoscopic appendectomy, Laparoscopic pelvic lymph node detection, Laparoscopically assisted hysterectomy, Laparoscopic and thorascopic anterior spinal fusion, Anterior cruciate ligament reconstruction, Knee arthroscopy, Small joint arthroscopy, Decompression fixation, Wedge resection, Lung biopsy, Dorsal sympathectomy, Pleurodesis. Internal mammary artery dissection for coronary artery bypass grafting where endoscopic visualization is indicated and Examination of the evacuated cardiac chamber during performance of valve replacement.

The users of the 1688 Video Camera are general and pediatric surgeons, gynecologists, cardiac surgeons, thoracic surgeons, plastic surgeons, orthopedic surgeons, neurosurgeons and urologists.

| Type of Use (Select one or both, as applicable) |
|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| <span style="font-family: Arial;"> <span style="font-size: 10pt;"> </span> </span> <span style="font-family: Symbol;"> <span style="font-size: 10pt;">☑</span> </span> <span style="font-family: Arial;"> <span style="font-size: 10pt;"> Prescription Use (Part 21 CFR 801 Subpart D)</span> </span> |
| <span style="font-family: Arial;"> <span style="font-size: 10pt;"> </span> </span> <span style="font-family: Symbol;"> <span style="font-size: 10pt;">☐</span> </span> <span style="font-family: Arial;"> <span style="font-size: 10pt;"> Over-The-Counter Use (21 CFR 801 Subpart C)</span> </span> |

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# stryker

## 510(k) Summary K220895

#### Submitter:

| Applicant: | Stryker Endoscopy<br>5900 Optical Court<br>San Jose, CA 95138 |
|-----------------|-------------------------------------------------------------------------------------------------------------------------|
| Contact Person: | Marlene Fraga<br>Sr. Staff Regulatory Affairs Specialist, Software Interoperability<br>Email: [e-mail] |
| Date Prepared: | March 24, 2022 |

#### Subject Device:

| Name of Device: | 1688 4K Camera System with Advanced Imaging Modality |
|-------------------------|-----------------------------------------------------------------------------------------------------------------|
| Common or<br>Usual Name | 3-chip Video Camera |
| Classification<br>Name: | Laparoscope, General and Plastic Surgery (21 C.F.R. §876.1500)<br>Endoscope, Neurological (21 C.F.R. §882.1480) |
| Regulatory Class: | II |
| Product Code: | GCJ<br>GWG |
| 510(k) Review<br>Panel: | General & Plastic Surgery<br>Neurology |

#### Predicate Device(s):

| 1688 4K Camera System with Advanced Imaging Modality | K211202 |
|------------------------------------------------------|---------|
|------------------------------------------------------|---------|

#### Device Description:

The 1688 4K Camera System with Advanced Imaging Modality is an endoscopic camera system that produces live video in the surgical field during surgical endoscopic procedures. The system is sensitive in the visible and infrared spectrum. The optical image is transferred from the surgical site to the camera head by a variety of rigid and flexible endoscopes, which are attached to the camera head. The 1688 4K Camera System consists of three main components: (1) a camera control unit (CCU); (2) a camera head with an integral cable that connects to the CCU; and (3) a coupler for attaching an endoscope to the camera head.

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# stryker

### Indications for Use:

| Subject Device | Predicate Device |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------|
| 1688 4K Camera System | 1688 4K Camera System |
| This Submission | (K211202) |
| Intended Use: | Intended Use: |
| Endoscopic white light and near-infrared illumination and imaging<br>during endoscopic procedures. | Same as subject device |
| Indications for Use: | Indications for Use: |
| The 1688 Video Camera is indicated for use in general laparoscopy,<br>nasopharyngoscopy, ear endoscopy, sinuscopy, neurosurgery and<br>plastic surgery whenever a laparoscope/ endoscope/ arthroscope/<br>sinuscope is indicated for use. The 1688 Video Camera is indicated<br>for adults and pediatric patients. | Same as subject device |
| A few examples of the more common endoscope surgeries are<br>Laparoscopic cholecystectomy, Laparoscopic hernia repair,<br>Laparoscopic appendectomy, Laparoscopic pelvic lymph node<br>detection, Laparoscopically assisted hysterectomy, Laparoscopic and<br>thorascopic anterior spinal fusion, Anterior cruciate ligament<br>reconstruction, Knee arthroscopy, Small joint arthroscopy,<br>Decompression fixation, Wedge resection, Lung biopsy, Pleural<br>biopsy, Dorsal sympathectomy, Pleurodesis, Internal mammary artery<br>dissection for coronary artery bypass, Coronary artery bypass grafting<br>where endoscopic visualization is indicated and Examination of the<br>evacuated cardiac chamber during performance of valve replacement. | |
| The users of the 1688 Video Camera are general and pediatric<br>surgeons, gynecologists, cardiac surgeons, thoracic surgeons, plastic<br>surgeons, orthopedic surgeons, ENT surgeons, neurosurgeons and<br>urologists. | |

### Comparison of Technological Characteristics with the Predicate Device:

| Item | Subject Device<br>1688 4K Camera System<br>(This Submission) | Predicate Device<br>1688 4K Camera System<br>(K211202) |
|--------------------------|-----------------------------------------------------------------------------------------------------|------------------------------------------------------------|
| Manufacturer | Stryker | Stryker |
| Imaging Modes | White Light<br>Near-infrared – fluorescence<br>Near-infrared – transillumination | Same as subject device |
| Camera System Components | Camera Control Unit | Camera Control Unit |
| | Camera Head(s) – Standard,<br>Integrated, Inline, Pendulum,<br>Autoclave1 | Camera Head(s) – Standard,<br>Integrated, Inline, Pendulum |
| | Coupler(s) – AIM 4K, AIM 4K<br>Autoclave1 | Coupler(s) – AIM 4K |
| Principles of Operations | Via an optical endoscope and<br>coupler, light is projected from a<br>light source onto one or more | Same as subject device |

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# stryke

| Item | Subject Device | Predicate Device |
|-----------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------|
| | 1688 4K Camera System<br>(This Submission) | 1688 4K Camera System<br>(K211202) |
| | complementary metal oxide<br>semiconductor image sensors which<br>acquire a continuous stream of image<br>data. The image data is processed to<br>provide a video stream that is then<br>sent to a display for viewing. | |
| Safety Standards | IEC 60601-1<br>IEC 60601-1-6<br>IEC 60601-2-18<br>IEC 60601-1-2 | Same as subject device |
| Modes of Operation | Alternate Frame processing<br>Simultaneous Frame processing | Same as subject device |
| Image Sensor | CMOS image sensor | Same as subject device |
| Image Processing/ Video<br>Output | Digital | Same as subject device |
| Resolution | 4K (up to 3840 x 2160) | Same as subject device |
| Frame Rate | 60 frames per second | Same as subject device |
| Camera Control Unit<br>Software | Version: 4.0.19 | Version: 4.0.18 |

¹ AIM 4K Autoclave Camera Head and Coupler were previously cleared under K212511 on November 4, 2021 as part of the 1688 4K Camera System.

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#### Performance Data:

The following performance data were provided in support of the substantial equivalence determination:

| Test | Method | Result |
|-----------------------|----------------|--------|
| Software Verification | IEC 62304:2015 | Pass |

NOTE: The 1688 4K Camera System is not patient contacting; therefore, biocompatibility testing was not required to support the determination of substantial equivalence. Additionally, the device modifications to the 1688 4K Camera System do not require clinical studies to support the determination of substantial equivalence.

#### Conclusions:

The 1688 4K Camera System is substantially equivalent in design, intended use, principles of operation, technological characteristics and safety features to the predicate devices. There are no different issues of safety and/or effectiveness introduced by the 1688 4K Camera System.