Camera System (Camera Control Unit, Camera Head to be coupled to a fiberoptic scope), NIR FI Light Source

Q: Who is the manufacturer of Camera System (Camera Control Unit, Camera Head to be coupled to a fiberoptic scope), NIR FI Light Source?

Schoelly Fiberoptic GmbH filed the 510(k) submission for Camera System (Camera Control Unit, Camera Head to be coupled to a fiberoptic scope), NIR FI Light Source (K221591).

Q: What is the FDA product code for Camera System (Camera Control Unit, Camera Head to be coupled to a fiberoptic scope), NIR FI Light Source?

GCJ. It is classified under 21 CFR 876.1500 as a Class 2 device in the Gastroenterology, Urology panel.

Q: What is the regulatory pathway for Camera System (Camera Control Unit, Camera Head to be coupled to a fiberoptic scope), NIR FI Light Source?

510(k) clearance (submission type: Traditional).

Q: What are the predicate devices for Camera System (Camera Control Unit, Camera Head to be coupled to a fiberoptic scope), NIR FI Light Source?

Stryker AIM (Advanced Imaging Modality) System (K182160).

Q: Who can help prepare an FDA 510(k) submission like Camera System (Camera Control Unit, Camera Head to be coupled to a fiberoptic scope), NIR FI Light Source?

Innolitics — a medical-device software consultancy — provides regulatory and engineering support for FDA 510(k) submissions. See https://innolitics.com/services/510ks/ or contact https://innolitics.com/contact.

K221591 · Schoelly Fiberoptic GmbH · GCJ · Feb 23, 2023 · Gastroenterology, Urology

Device Facts

Record ID	K221591
Device Name	Camera System (Camera Control Unit, Camera Head to be coupled to a fiberoptic scope), NIR FI Light Source
Applicant	Schoelly Fiberoptic GmbH
Product Code	GCJ · Gastroenterology, Urology
Decision Date	Feb 23, 2023
Decision	SESE
Submission Type	Traditional
Regulation	21 CFR 876.1500
Device Class	Class 2

Intended Use

Camera System: The Camera System is indicated for use in general laparoscopy, nasopharyngoscopy, ear endoscopy, sinuscopy, and plastic surgery whenever a laparoscope/ endoscope/ arthroscope is indicated for use. 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, Pleural biopsy, Dorsal sympathectomy, Pleurodesis, Internal mammary artery dissection for coronary artery bypass, 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 Camera System are general surgeons, gynecologists, cardiac surgeons, thoracic surgeons, plastic surgeons, orthopedic surgeons, ENT surgeons and urologists. NIR FI Light Source: The NIR FI Light Source and NIR FI Light Guide are indicated for use to provide real-time endoscopic visible and near-infrared fluorescence imaging. The NIR FI Light Source and NIR FI Light Guide enable surgeons to perform minimally invasive surgery using standard endoscope visual light as well as visual assessment of vessels, blood flow and related tissue perfusion, and at least one of the major extra-hepatic bile ducts (cystic duct, common bile duct and common hepatic duct), using near-infrared imaging. Fluorescence imaging of biliary ducts with the NIR FI Light Source and NIR FI Light Guide is intended for use with standard-of-care white light and, when indicated, intraoperative cholangiography. The devices are not intended for standalone use for biliary duct visualization.

Device Story

System provides real-time endoscopic white light (WLI) and near-infrared (NIR) fluorescence imaging (FI) using ICG. Components: Camera Control Unit (CCU), Camera Head, NIR FI Light Source, Light Guide, and fiberoptic laparoscope. Operation: Light from LEDs/laser diode projected through fiberoptic scope to tissue; optical signals converted to electrical signals by CMOS sensors; processed for display. Used in OR by surgeons for visualization of anatomy and tissue perfusion. Output: Real-time video on display; aids surgical decision-making by highlighting vessels and biliary ducts. Benefits: Enhanced visualization during minimally invasive procedures.

Clinical Evidence

Bench testing only. No clinical data provided. Performance testing included reprocessing validation (cleaning/sterilization per AAMI TIR12/TIR30/ISO 17665), electrical safety (IEC 60601-1, IEC 60601-2-18), and electromagnetic compatibility (IEC 60601-1-2). Non-clinical performance testing confirmed design outputs meet requirements for endoscopic white light and NIR fluorescence imaging.

Technological Characteristics

System components: CCU, Camera Head, NIR FI Light Source, Light Guide. Materials: Reusable medical device components. Sensing: CMOS image sensor. Energy: RGB LEDs and near-infrared laser diode. Connectivity: USB/remote storage. Sterilization: Moist heat (autoclave). Software: Moderate level of concern, managed per IEC 62304.

Indications for Use

Indicated for patients undergoing general laparoscopy, nasopharyngoscopy, ear endoscopy, sinuscopy, and plastic surgery. Used by general, gynecological, cardiac, thoracic, plastic, orthopedic, ENT, and urological surgeons for visualization and assessment of vessels, blood flow, tissue perfusion, and biliary ducts (cystic, common bile, common hepatic) during minimally invasive surgery. Not for standalone biliary duct visualization.

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

Stryker AIM (Advanced Imaging Modality) System (K182160)

Reference Devices

SCHOELLY TipVision Videoscope System (K201617)
SCHOELLY Laparoscope (K143221)

Related Devices

K223759 — Arthrex SynergyID Endoscopic Imaging System · Arthex, Inc. · Feb 24, 2023
K142310 — Stryker Infrared Fluorescence (IRF) Imaging System · Stryker Endoscopy · Dec 2, 2014
K250728 — Arthrex Synergy Vision Endoscopic Imaging System · Arthrex, Inc. · May 5, 2025
K213943 — SmartSurgN Visualization System · Smartsurgn Incorporated · Nov 29, 2022
K233333 — KARL STORZ ICG Imaging System, KARL STORZ Image1S Camera Control Unit · Karl Storz SE & CO. KG · Nov 21, 2023

Submission Summary (Full Text)

{0}------------------------------------------------ Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue. February 23, 2023 Schoelly Fiberoptic GmbH % Pamela Papineau Regulatory Affairs Consultant (Alternate Application Contact) Delphi Medical Device Consulting, Inc. 5 Whitcomb Avenue Ayer, Massachusetts 01432 Re: K221591 Trade/Device Name: Camera System (Camera Control Unit, Camera Head to be coupled to a fiberoptic scope), NIR FI Light Source Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope And Accessories Regulatory Class: Class II Product Code: GCJ, FET, OWN, FCW Dated: January 24, 2023 Received: January 27, 2023 Dear Pamela Papineau: 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. {1}------------------------------------------------ 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 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 (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100). Sincerely. # Jianting Wang -S Jianting Wang Acting 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 {2}------------------------------------------------ # Indications for Use 510(k) Number (if known) K221591 #### Device Name Near-Infrared (NIR) Fluorescence Imaging (FI) System: Camera Control Unit, Camera Head to be coupled to a fiberoptic scope); NIR FI Light Source #### Indications for Use (Describe) #### Camera System: The Camera System is indicated for use in general laparoscopy, ear endoscopy, ear endoscopy, sinuscopy, and plastic surgery whenever a laparoscope/ endoscope/ arthroscope is indicated for use. 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, Decompression fixation, Wedge resection, Lung biopsy, Pleural 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 Camera System are general surgeons, gynecologists, cardiac surgeons, plastic surgeons, orthopedic surgeons, ENT surgeons and urologists. ## NIR FI Light Source: The NIR FI Light Source and NIR FI Light Guide are indicated for use to provide real-time endoscopic visible and nearinfrared fluorescence imaging. The NIR FI Light Source and NIR FI Light Guide enable surgeons to perform minimally invasive surgery using standard endoscope visual light as well as visual assessment of vessels, blood flow and related tissue perfusion, and at least one of the major extra-hepatic bile duct, common bile duct and common hepatic duct), using near-infrared imaging. Fluorescence imaging of biliary ducts with the NIR FI Light Source and NIR FI Light Guide is intended for use with standard-of-care white light and, when indicated, intraoperative cholangiography. The devices are not intended for standalone use for biliary duct visualization. | Type of Use (Select one or both, as applicable) | | |------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------| | <div style="display:inline-block;">☒</div> Prescription Use (Part 21 CFR 801 Subpart D) | <div style="display:inline-block;">☐</div> Over-The-Counter Use (21 CFR 801 Subpart C) | CONTINUE ON A SEPARATE PAGE IF NEEDED. This section applies only to requirements of the Paperwork Reduction Act of 1995. ***DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.*** The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to: Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov *"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."* FORM FDA 3881 (6/20) {3}------------------------------------------------ 23 May 2022 NIR FI System # 005 510(k) Summary - K221591 # A. GENERAL INFORMATION | 510(k) Sponsor: | Schoelly Fiberoptic GmbH | |--------------------------|--------------------------------------------------------| | Address: | Robert-Bosch-Str. 1 – 3 79211 Denzlingen Germany | | FDA Registration Number: | 8043903 | | Telephone Number: | +49-7666-980-0 | | Fax Number: | +49-7666-908-380 | | Contact Person: | Dr. Sandra Baumann | | Date Prepared: | 23 May 2022 | # B. DEVICE IDENTIFICATION The subject device is the SCHOELL Y Near-Infrared (NIR) Fluorescence Imaging (FI) System that is specifically comprised of the flowing components: | Trade Name | Camera System (Camera Control Unit, Camera Head to be coupled to a fiberoptic scope) | |------------------------------|------------------------------------------------------------------------------------------------------------------| | Common Name | Video Camera (Camera Control Unit, Camera Head to be coupled to a fiberoptic scope) | | Classification Name | Laparoscope, General & Plastic Surgery Endoscopic Video Imaging System/Component, Gastroenterology-Urology | | Product Code | GCJ FET | | Regulation Number | 21 CFR 876.1500 | | Regulation Name | Endoscope and accessories | | Device Classification | Class II | | Regulation Medical Specialty | Gastroenterology/Urology | | Review Panels | General & Plastic Surgery Gastroenterology/Urology | | Trade Name | NIR FI Light Source | |---------------------|---------------------------| | Common Name | Light Source, Illuminator | | Classification Name | Confocal Optical Imaging1 | {4}------------------------------------------------ | | Light Source, Fiberoptic, Routine2 | |------------------------------|------------------------------------| | Product Code | OWN1 | | | FCW2 | | Regulation Number | 21 CFR 876.1500 | | Regulation Name | Endoscope and accessories | | Device Classification | Class II | | Regulation Medical Specialty | Gastroenterology/Urology | | Review Panels | General & Plastic Surgery1 | | | Gastroenterology/Urology2 | 1 when used for assessment of vessels, blood flow and related tissue perfusion, and at least one of the major extrahepatic bile ducts (cystic duct, common bile duct and common hepatic duct), using NIR Fluorescence Imaging 2 when used to emit light in the visible range of the spectrum to support standard endoscopic imaging ## Indications for Use ## Camera System The Camera System is indicated for use in general laparoscopy, nasopharyngoscopy, ear endoscopy, sinuscopy, and plastic surgery whenever a laparoscope/ endoscope/ arthroscope is indicated for use. 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, Pleural biopsy, Dorsal sympathectomy, Pleurodesis, Internal mammary artery dissection for coronary artery bypass, 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 Camera System are general surgeons, gynecologists, cardiac surgeons, thoracic surgeons, plastic surgeons, orthopedic surgeons, ENT surgeons and urologists. ## NIR FI Light Source The NIR FI Light Source and NIR FI Light Guide are indicated for use to provide real-time endoscopic visible and near-infrared fluorescence imaging. The NIR FI Light Source and NIR FI Light Guide enable surgeons to perform minimally invasive surgery using standard endoscope visual light as well as visual assessment of vessels, blood flow and related tissue perfusion, and at least one of the major extra-hepatic bile ducts (cystic duct, common bile duct and common hepatic duct), using near-infrared imaging. Fluorescence imaging of biliary ducts with the NIR FI Light Source and NIR FI Light Guide is intended for use with standard-of-care white light and, when indicated, intraoperative {5}------------------------------------------------ cholangiography. The devices are not intended for standalone use for biliary duct visualization. # C. PREDICATE DEVICE The predicate device is the STRYKER AIM (Advanced Imaging Modality) System: | 510(k) Sponsor: | Stryker Endoscopy | |-----------------|-------------------| | 510(k) Number: | K182160 | The predicate device is specifically comprised of the flowing components: | Trade Name | 1688 4k Camera System (1688 Camera Control Unit; 1688 AIM 4K Camera Head, C-Mount; 1688 AIM 4K Camera Head with Integrated Coupler; AIM 4K Coupler, 20mm, C-Mount) | |------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Common Name | 3-Chip Video Camera (Camera Control Unit, Camera Head and accessories to be coupled to a fiberoptic scope) | | Classification Name | Laparoscope, General & Plastic Surgery | | Product Code | GCJ | | Regulation Number | 21 CFR 876.1500 | | Regulation Name | Endoscope and accessories | | Device Classification | Class II | | Regulation Medical Specialty | Gastroenterology/Urology | | Review Panels | General & Plastic Surgery | | Trade Name | L11 LED Light Source with Advanced Imaging Modality | |---------------------|--------------------------------------------------------------------------------------------------------| | Common Name | Light Source, Illuminator | | Classification Name | Confocal Optical Imaging1 Light Source, Fiberoptic, Routine2 Fiberoptic light ureteral catheter3 | | Product Code | OWN1 FCW2 FCS3 | | Regulation Number | 21 CFR 876.15001 21 CFR 876.40202,3 | | Regulation Name | Endoscope and accessories | {6}------------------------------------------------ | Device Classification | Class II | |------------------------------|------------------------------------------------------------| | Regulation Medical Specialty | Gastroenterology/Urology | | Review Panels | General & Plastic Surgery1 Gastroenterology/Urology2, 3 | ## Indications for Use # 1688 4K Camera System with Advance Imaging Modality The 1688 Video Camera is indicated for use in general laparoscopy, nasopharyngoscopy, ear endoscopy, sinuscopy, and plastic surgery whenever a laparoscope/ endoscope/ arthroscope is indicated for use. A few examples of the more common endoscope surgeries are Laparoscopic cholecystectomy, Laparoscopic hernia repair, Laparoscopic appendectomy, Laparoscopic pelvic lymph node detection, Laparoscopically assisted hysterectorny, Laparoscopic and thorascopic anterior spinal fusion, Anterior cruciate ligament reconstruction, Knee arthroscopy, Small joint arthroscopy, Decompression fixation, Wedge resection, Lung biopsy, Pleural biopsy, Dorsal sympathectomy, Pleurodesis, Internal mammary artery dissection for coronary artery bypass, 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 surgeons, gynecologists, cardiac surgeons, thoracic surgeons, plastic surgeons, orthopedic surgeons, ENT surgeons and urologists. # L11 LED Light Source with Advanced Imaging Modality The L11 AIM Light Source and SafeLight™ Cable are indicated for use to provide real-time endoscopic visible and near-infrared fluorescence imaging. The L11 AIM Light Source and SafeLight Cable enable surgeons to perform minimally invasive surgery using standard endoscope visual light as well as visual assessment of vessels, blood flow and related tissue perfusion, and at least one of the major extra-hepatic bile ducts (cystic duct, common bile duct and common hepatic duct), using near-infrared imaging. Fluorescence imaging of biliary ducts with the L11 AIM Light Source and SafeLight Cable is intended for use with standard-of-care white light and, when indicated, intraoperative cholangiography. The devices are not intended for standalone use for biliary duct visualization. The L11 AIM Light Source is also intended to transilluminate the ureter during open or laparoscopic surgical procedures. {7}------------------------------------------------ # D. REFERENCE DEVICE SCHOELLY's TipVision™ Videoscope System serves as a reference device in this submission: | 510(k) Sponsor: | Schoelly Fiberoptic GmbH | |-----------------|--------------------------| | 510(k) Number: | K201617 | The reference device is specifically comprised of the flowing components: | Trade Name | EleVision™ HD 2 Camera Control Unit | |------------------------------|-------------------------------------------| | Common Name | Camera Control Unit | | Classification Names | Endoscopic Video Imaging System/Component | | Product Codes | FET | | Regulation Numbers | 21 CFR 876.1500 | | Regulation Name | Endoscope and accessories | | Device Classification | Class II | | Regulation Medical Specialty | Gastroenterology/Urology | | Review Panels | Gastroenterology/Urology | | Trade Name | TipVision™ Videoscope | |------------------------------|--------------------------------------------------------------------------------------| | Common Name | Video Laparoscope (Camera Head) | | Classification Names | Laparoscope, Gynecologic (and Accessories) Laparoscope, General & Plastic Surgery | | Product Codes | HET, GCJ | | Regulation Numbers | 21 CFR 884.1720 21 CFR 876.1500 | | Regulation Name | Endoscope and accessories | | Device Classification | Class II | | Regulation Medical Specialty | Obstetrics/Gynecology Gastroenterology/Urology | | Review Panels | Obstetrics / Gynecology General & Plastic Surgery | {8}------------------------------------------------ ## Indications for Use: The TipVision™ 0°/30° Videoscopes and the other EleVision™ / TipVision™ components are indicated for visualization during general laparoscopy, gynecological laparoscopy, urological laparoscopy, and video-assisted minimally invasive thoracic surgical procedures. SCHOELLY's Schoelly Laparoscope serves as a further reference device in this submission: | 510(k) Sponsor: | Schoelly Fiberoptic GmbH | |-----------------|--------------------------| | 510(k) Number: | K143221 | | Trade Name | Schoelly Laparoscope | |------------------------------|----------------------------------------| | Common Name | Laparoscope | | Classification Names | Laparoscope, General & Plastic Surgery | | Product Codes | GCJ | | Regulation Numbers | 21 CFR 876.1500 | | Regulation Name | Endoscope and accessories | | Device Classification | Class II | | Regulation Medical Specialty | Gastroenterology/Urology | | Review Panels | General & Plastic Surgery | ## Indications for Use: The Schoelly Laparoscope is indicated for examination of body cavities, hollow organs, and canals, and using additional accessories, to perform various diagnostic and therapeutic procedures. # E. DEVICE DESCRIPTION The individual components of the subject device, SCHOELL Y's NIR FI System, form a system to provide real-time endoscopic visible imaging (wight light imaging, WLI) and near-infrared (NIR) illumination and imaging (fluorescence imaging, FI) using indocyanine green (ICG): - Camera System suitable for processing and recordings visible light images as well as NIR images. The Camera System consists of a Camera Control Unit (CCU) and a Camera Head for connection to a fiberoptic scope; - . Light Source and Light Guide for use with a fiberoptic scope for emitting light within the visible spectrum as well as in the NIR spectrum to cause fluorescence; - . Fiberoptic Laparoscope suitable for visible light and NIR light illumination and imaging; The imaging agent (ICG) is not provided by SCHOELLY as part of the subject system. {9}------------------------------------------------ # F. INDICATIONS FOR USE ## Camera System: The Camera System is indicated for use in general laparoscopy, nasopharyngoscopy, ear endoscopy, sinuscopy, and plastic surgery whenever a laparoscope/ arthroscope/ arthroscope is indicated for use. A few examples of the more common endoscope surgeries are Laparoscopic cholecystectorny, 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, Pleural biopsy, Dorsal sympathectomy, Pleurodesis, Internal mammary artery dissection for coronary artery bypass, 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 Camera System are general surgeons, gynecologists, cardiac surgeons, thoracic surgeons, plastic surgeons, orthopedic surgeons, ENT surgeons and urologists. # NIR FI Light Source: The NIR FI Light Source and NIR FI Light Guide are indicated for use to provide real-time endoscopic visible and near-infrared fluorescence imaging. The NIR FI Light Source and NIR FI Light Guide enable surgeons to perform minimally invasive surgery using standard endoscope visual light as well as visual assessment of vessels, blood flow and related tissue perfusion, and at least one of the major extra-hepatic bile ducts (cystic duct, common bile duct and common hepatic duct), using near-infrared imaging. Fluorescence imaging of biliary ducts with the NIR FI Light Source and NIR FI Light Guide is intended for use with standard-of-care white light and, when indicated, intraoperative cholangiography. The devices are not intended for standalone use for biliary duct visualization. # G. COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH THE PREDICATE DEVICE Styrker's predicate device, the AIM (Advanced Imaging Modality) System, was cleared in K182160. A detailed comparison of the proposed and predicate system is provided in the substantial equivalence table below. SCHOELLY's TipVision™ Videoscope System cleared in K201617 is cited as a reference device in this submission because it represents an example of a camera system with Product Code FET (endoscopic video imaging system/component) for use in different application fields (not just laparoscopy) and relying on basically the same image processing options for real-time endoscopic visible imaging as the Camera System of the subject device does. The TipVision™ Videoscope System does not include near-infrared fluorescence imaging capability and features an integrated camera head (Videoscope) instead of a camera head connected to a fiberoptic scope. {10}------------------------------------------------ | Attribute | Proposed System SCHOELLY's NIR FI System (current submission) | Predicate System Styrker's AIM (Advanced Imaging Modality) System (K182160) | Similarities and Differences | |---------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Intended Use | Endoscopic visible and near-infrared light illumination and imaging | Endoscopic visible and near-infrared light illumination and imaging | Same | | Indications for Use | NOTE 1 | NOTE 2 | Camera System: Same Light Source: Same; Light source of subject device comprises a subset of the indications for use of the predicate device since subject device is not intended to transilluminate the ureter during open or laparoscopic surgical procedures | | Imaging Modes | White Light NIR - fluorescence | White Light NIR – fluorescence NIR - transillumination | Same; Subject device comprises a subset of imaging modes as compared to predicate device since subject device is not intended to transilluminate the ureter during open or laparoscopic surgical procedures | | Safety Standards | IEC 60601-1 IEC 60601-2-18 IEC 60601-1-2 IEC 60825-1 | IEC 60601-1 IEC 60601-2-18 IEC 60601-1-2 IEC 60825-1 | Same | | System Components | Camera System, Light Source and Light Guide, Laparoscopes | Camera System; Light Source and SafeLight Cable; Laparoscope; IRIS Ureteral Kit; Imaging Agent Kits | Same; Subject system comprises a subset of components as compared to predicate system since imaging agents kits are not within the scope of delivery of the subject system | | Use Environment | Hospital, Operating room | Hospital, Operating room | Same | | Camera System | | | | | Principles of Operation | Via an optical scope, light is transferred to imaging sensors of the camera system and the optical signal is transferred into an electrical signal. Imaging sensors acquire a continuous stream of image data which is further processed for proper viewing on displays. | Via an optical scope and coupler, light is transferred to imaging sensors of the camera system and the optical signal is transferred into an electrical signal. Imaging sensors acquire a continuous stream of image data which is further processed for proper viewing on displays. | Same | | Image Sensor | CMOS image sensor | CMOS image sensor | Same | | Image Processing / Video Output | Digital | Digital | Same | | Data record and storage | Capture images and video recordings to USB or recordings to remote device | Capture images and video recordings to remote device | Similar | | Resolution | up to 3840 x 2160 | up to 3840 x 2160 | Same | | Resprocessing | Camera head released for manual or automated cleaning and sterilization | Camera head released for manual or automated cleaning and sterilization | Same | | Light Source | | | | | Principles of Operation | An electronic driver controls Red/Green/Blue LEDs & a near-infrared laser diode which are combined through. dichroic mirrors and projected onto an output light collimator. A fiber output bundle can be inserted into the light source to couple light to the distal end and into an endoscope. | An electronic driver controls Red/Green/Blue LEDs & a near-infrared laser diode which are combined through. dichroic mirrors and projected onto an output light collimator. A fiber output bundle can be inserted into the light source to couple light to the distal end and into an endoscope. | Same | | Light Source / Laser | RGB LEDs Infrared Laser | RGB LEDs Infrared Laser | Same | | Automatic light control | yes | yes | Same | # Table 15.1: Technological Characteristics Comparison Table {11}------------------------------------------------ {12}------------------------------------------------ #### NOTE 1: #### Camera System: The Camera System is indicated for use in general laparoscopy, ear endoscopy, ear endoscopy, simuscopy, and plastic surgery whenever a laparoscope/ arthroscope is indicated for use. A few examples of the more common endoscope surgeries are Laparoscopic cholecystectomy, Laparoscopic hernia repair, Laparoscopic appendectorny, Laparoscopic pelvic lymph node detection, Laparoscopically assisted hysterectorny, Laparoscopic and thorascopic anterior spinal fusion, Anterior cruciate ligament reconstruction, Knee arthroscopy, Small joint arthroscopy, Decompression fixation, Wedge resection, Lung biopsy, Pleural biopsy, Dorsal sympathectorny, Pleurodesis, Internal mammary artery dissection for coronary artery bypass, 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 Camera System are general surgeons, gynecologists, cardiac surgeons, plastic surgeons, orthopedic surgeons, ENT surgeons and urologists. #### NIR FI Light Source: The NIR FI Light Source and NIR FI Light Guide are indicated for use to provide real-time endoscopic visible and nearinfrared fluorescence imaging. The NIR FI Light Source and NIR FI Light Guide enable surgeons to perform minimally invasive surgery using standard endoscope visual light as well as visual assessment of vessels, blood flow and related tissue perfusion, and at least one of the major extra-hepatic bile ducts (cystic duct, common bile duct and common hepatic duct), using near-infrared imaging. Fluorescence imaging of biliary ducts with the NIR FI Light Guide is intended for use with standard-of-care white light and, when indicated, intraoperative cholangiography. The devices are not intended for standalone use for biliary duct visualization. ### NOTE 2: #### 1688 4K Camera System with Advance Imaging Modality: The 1688 Video Camera is indicated for use in general laparoscopy, ear endoscopy, ear endoscopy, sinuscopy, and plastic surgery whenever a laparoscope/ arthroscope is indicated for use. A few examples of the more common endoscope surgeries are Laparoscopic cholecystectomy, Laparoscopic hernia repair, Laparoscopic appendectorny, Laparoscopic pelvic lymph node detection, Laparoscopically assisted hysterectorny, Laparoscopic and thorascopic anterior spinal fusion, Anterior cruciate ligament reconstruction, Knee arthroscopy, Small joint arthroscopy, Decompression fixation, Wedge resection, Lung biopsy, Pleural biopsy, Dorsal sympathectomy, Pleurodesis, Internal mammary artery dissection for coronary artery bypass, 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 surgeons, gynecologists, cardiac surgeons, plastic surgeons, orthopedic surgeons, ENT surgeons and urologists. #### L11 LED Light Source with Advanced Imaging Modality: The L11 AIM Light Source and SafeLightTM Cable are indicated for use to provide real-time endoscopic visible and near-infrared fluorescence imaging. The L11 AIM Light Source and SafeLight Cable enable surgeons to perform minimally invasive surgery using standard endoscope visual light as well as visual assessment of vessels, blood flow and related tissue perfusion, and at least one of the major extra-hepatic bile ducts (cystic duct, common bile duct and common hepatic duct), using near-infrared imaging. Fluorescence imaging of biliary ducts with the L11 AIM Light Source and SafeLight Cable is intended for use with standard-of-care white light and, when indicated, intraoperative cholangiography. The devices are not intended for standalone use for biliary duct visualization. {13}------------------------------------------------ The L11 AIM Light Source is also intended to transilluminate the ureter during open or laparoscopic surgical procedures. Differences in technological characteristics do not raise different questions of safety and effectiveness. # H. PERFORMANCE DATA The following performance testing has been performed for the subject device: # Reprocessing validation Reprocessing validations were designed and conducted in accordance with FDA's 2015 guidance (including Appendix E revised June 2017) Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling. Cleaning studies were designed and performed in accordance with AAMI TIR12:2010 Designing, Testing and Labeling Reusable Medical Devices for Reprocessing in Health Care Facilities: A Guide for Device Manufacturers, AAMI TIR30:2011(R)2016 A compendium of processes, materials, test methods, and acceptance criteria for cleaning reusable devices. Sterilization studies were designed and performed in accordance with AAMI TIR12:2010 Designing, Testing and Labeling Reusable Medical Devices for Reprocessing in Health Care Facilities: A Guide for Device Manufacturers, and ANSVAAMI/ISO 17665-1:2006 (R)2013 Sterilization of health care products - Moist heat - Part 1: Requirements for the development, validation and routine control of a sterilization process for medical devices. Cleaning and sterilization processes are defined in the device labeling per ISO 17664:2017 Processing of health care products – Information to be provided by the medical device manufacturer for the processing of medical devices. These tests demonstrated that the device successfully passed cleaning, drying and sterilization validations according to the instructions in the user manual. ## Software Documentation Software documentation for a MODERATE Level of Concern device is provided in support of the proposed device per FDA's 2005 Guidance for the Content of Premarket Submissions for Software Contained in Medical Device. The software lifecycle, including software documentation and validation, is managed in accordance with IEC 62304:2006/A1:2016 Medical Device Software -Software Life Cycle Processes. # Electrical Safety Testing The NIR FI System was assessed for conformity with, and was found to comply with, the relevant requirements of IEC 60601-1:2005 + CORR. 1:2006 + CORR. 2:2007 + AM1:2012 (ed. 3.1, including the US deviations) Medical Electrical Equipment, Part 1: General Requirements for Basic Safety and Essential Performance. {14}------------------------------------------------ The NIR FI System was assessed for conformity with, and was found to comply with, the relevant requirements of IEC 60601-2-18:2009 (ed. 3): Medical Electrical Equipment, Part 2: Particular Requirements for the Basic Safety and Essential Performance of Endoscopic Equipment. # Electromagnetic Compatibility Testing The NIR FI System was assessed for conformity with, and was found to comply with, the relevant requirements of IEC 60601-1-2:2014 (ed. 4) Medical Electrical Equipment, Part 1-2: General Requirements for Safety – Collateral standard: Electromagnetic Compatibility – Requirements and Tests. # Non-Clinical Performance Testing Non-Clinical performance test data demonstrate that the proposed NIR FI System performs substantially equivalent to the Stryker predicate AIM System and that the design output meets the design input requirements for endoscopic white light and near-infrared fluorescence imaging. #### CONCLUSION I. Based on a comparison of the proposed SCHOELLY NIR FI System and the Stryker predicate AIM System in terms of indications for use, physical and technological characteristics, and performance specifications the SCHOELLY NIR FI System raises no new issues of safety and effectiveness and is substantially equivalent to the predicate device.