VASOVIEW BALLOON DISSECTION SYSTEM

K964171 · Origin Medsystems, Inc. · GCJ · Feb 14, 1997 · Gastroenterology, Urology

Device Facts

Record IDK964171
Device NameVASOVIEW BALLOON DISSECTION SYSTEM
ApplicantOrigin Medsystems, Inc.
Product CodeGCJ · Gastroenterology, Urology
Decision DateFeb 14, 1997
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 876.1500
Device ClassClass 2
AttributesTherapeutic

Indications for Use

The VasoView™ Balloon Dissection System has applications in minimally invasive surgery. It is indicated when endoscopic surgery is indicated and may be used to form elongated working cavities during thoracoscopic procedures involving exposure and dissection of structures external to the parietal pleura, including, nerves, blood vessels and other tissues of the chest wall. The VasoView™ Balloon Dissection System is not intended for use except as indicated. In addition, it is not intended for use when endoscopic surgery is contraindicated.

Device Story

VasoView™ Balloon Dissection System is a single-use, sterile dissection cannula used in minimally invasive thoracoscopic surgery. Device consists of a tubular body with a distal transparent conical tapered tip, an elastomeric balloon, luer extension, and syringe. Physician inserts a 5mm rigid endoscope through the tapered tip for visualization. Device is advanced along anatomic tracts; sequential balloon inflation creates an elongated working cavity to isolate structures like nerves and blood vessels external to the parietal pleura. Facilitates surgical access and visualization for the clinician.

Clinical Evidence

Bench testing only. Biocompatibility and effectiveness established via comparison to predicate device materials and design.

Technological Characteristics

Single-use dissection cannula. Materials: Polycarbonate (cannula), Silicon Latex Rubber (balloon), Loctite™ (adhesive). Features: distal transparent conical tapered tip, elastomeric balloon, luer extension, syringe. Designed for 5mm rigid endoscope integration. Sterile, non-powered, mechanical device.

Indications for Use

Indicated for patients undergoing thoracoscopic surgery requiring formation of elongated working cavities for exposure and dissection of structures external to the parietal pleura (nerves, blood vessels, chest wall tissues). Contraindicated when endoscopic surgery is contraindicated.

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.

In combination with the general controls of the FD&C Act, the integrated operating table-electromechanical surgical system is subject to the following special controls: 1. (1) Premarket clinical performance testing, or a combination of premarket clinical performance testing and postmarket surveillance (in accordance with special control (2)), must include the following: 1. (i) Objective performance measures (e.g., rate and number of conversions to other surgical modalities, rate of device related adverse events (including tissue injury, hematoma, and increased blood loss), and their severity, cause, and outcomes) must be reported with relevant descriptive comparator performance measures. 2. (ii) The data must demonstrate the performance of the device for providing accurate and precise control of attached surgical instruments in range of clinical conditions relevant to the device's intended use. 3. (iii) The test dataset must include data collected from a patient population representative of the intended patient population under anticipated conditions of use. 2. (2) Data obtained from postmarket surveillance must demonstrate, in consideration of the premarket data obtained in accordance with special control (1), that the device performs in accordance with special control (1), unless FDA determines, based on the totality of the premarket data, that data from postmarket surveillance is not required to demonstrate that the device performs as intended. Such postmarket surveillance must be conducted per a protocol determined appropriate by FDA to demonstrate that the device performs as intended (in consideration of the premarket data obtained in accordance with special control (1)), and must include initiation, enrollment, and reporting requirements to ensure timely periodic updates to FDA on post-market surveillance progress and outcomes. 3. (3) Animal performance testing must evaluate the extent of port site trauma due to repositioning of table during surgical procedures when utilizing robotic minimally invasive and laparoscopic approaches 4. (4) The device manufacturer must develop, and update as necessary, a device-specific use training program that ensures proper device setup/use/shutdown, accurate control of instruments to perform the intended surgical procedures, troubleshooting and handling during unexpected events or emergencies, and safe practices to mitigate use error. 5. (5) The device manufacturer may only distribute the device to facilities that implement and maintain the device-specific use training program and ensure that users of the device have completed the device-specific use training program. (6) Human factors assessment must demonstrate that the user can correctly use the device system across all intended use environments with the provided instructions and training materials, including patient access during normal operating conditions and emergency situations, and effects arising from the integrated nature of the operating table and robotic surgical arms. (7) Labeling must include: (i) A detailed summary of clinical performance testing conducted with the device, including study population, results, adverse events, and comparisons to any comparator groups identified; (ii) A statement in the labeling that the safety and effectiveness for the representative specific procedures was based on evaluation of the device as a surgical tool and did not include evaluation of outcomes related to the treatment of the patient's underlying disease or condition, unless FDA determines that it can be removed or modified based on clinical performance data submitted to FDA; (iii) Identification of compatible devices; (iv) The list of surgical procedures for which the device has been determined to be safe with clinical justification; (v) Reprocessing instructions for reusable components; (vi) A shelf life for any sterile components; (vii) A description of the device-specific use training program; (viii) A statement that the device is only for distribution to facilities that implement and maintain the device-specific use training program and ensure that users of the device have completed the device-specific use training program; and (ix) A summary of any completed postmarket surveillance data collected as required by special control (2), including updated labeling to accurately reflect outcomes observed in postmarket surveillance. (8) Non-clinical performance testing must demonstrate that the device performs as intended under anticipated conditions of use and must include: (i) Device motion accuracy and repeatability; (ii) System testing; (iii) Instrument reliability; (iv) Crosstalk; (v) Table motion control; (vi) Thermal effects on tissue; (vii) User-device interface performance; (viii) Workspace access testing; and (ix) Performance testing with compatible devices. (9) Software verification, validation, and hazard analysis must be performed. (10) Electromagnetic compatibility and electrical, thermal, and mechanical safety testing must be performed. (11) Performance data must demonstrate the sterility of all patient-contacting device components. (12) Performance data must support the shelf life of the device components provided sterile by demonstrating continued sterility and package integrity over the labeled shelf life. (13) Performance data must validate the reprocessing instructions for the reusable components of the device. (14) Performance data must demonstrate that all patient-contacting components of the device are biocompatible. (15) Performance data must demonstrate that all patient-contacting components of the device are non-pyrogenic. (16) The device manufacturer must submit a report to the FDA annually on the anniversary of initial marketing authorization for the device, until such time as FDA may terminate such reporting, which comprises the following information: (i) Cumulative summary, by year, of complaints and adverse events since date of initial marketing authorization; and (ii) Identification and rationale for changes made to the device, labeling, or device specific use training program, which did not require submission of a premarket notification during the reporting period.

Predicate Devices

Submission Summary (Full Text)

{0} FEB 14 '997 ORIGIN Medsystems, Inc. PREMARKET NOTIFICATION VasoView™ Balloon Dissection System K964171 Class II # 510(k) SUMMARY OF SAFETY & EFFECTIVENESS This 510(k) Summary details sufficient information to provide an understanding of the basis for a determination of substantial equivalence. For convenience, the summary is formatted pursuant to 21 CFR §807.92. This section may be used, as presented, to provide a substantial equivalence summary to anyone requesting it from the Agency. ## 21 CFR §807.92 a(1) Submitter: ORIGIN® Medsystems, Inc. 135 Constitution Avenue Menlo Park, CA 94025 (415) 617-5142 contact person: Anthony Durso date prepared: October 3, 1996 ## 21 CFR §807.92 a(2) Trade name: VasoView™ Balloon Dissection System Common name: Dissection Cannula Classification name: Distention Balloon ## 21 CFR §807.92 a(3) Identification of predicate(s): Substantial equivalence for the VasoView™ Balloon Dissection System is based on its similarities to predicate device: the ORIGIN Tapered Tip Balloon Dissection Cannula. It shares the identical material, and technological characteristics as the predicate device. VasoView™ Balloon Dissection System is also similar in intended use. ## 21 CFR §807.92 a(4) Device Description-parts and function/concept: The VasoView™ Balloon Dissection System is a single-use device which consists of a, tubular body with a distal transparent conical tapered tip, an elastomeric balloon adjacent to the tapered tip, luer extension, and syringe. It is designed to accept a 5mm diameter rigid endoscope for visualization through the tapered tip. The VasoView™ Balloon Dissection System is provided sterile. This dissection cannula is used to advance along specific anatomic tracts to isolate structures. After the cannula advancement, sequential balloon inflation forms an elongated cavity in the desired location. Page 6 {1} ORIGIN Medsystems, Inc. PREMARKET NOTIFICATION VasoView™ Balloon Dissection System Class II Device Description-materials/physical properties: a table of the patient contact components, with their respective materials, is provided below. | Component Name | Patient Contact | Material | Predicate | | --- | --- | --- | --- | | Cannula | yes | Polycarbonate | Tapered Tip Balloon Dissection Cannula k953377 | | Balloon | yes | Silicon Latex Rubber | Tapered Tip Balloon Dissection Cannula k953377 | | Adhesive | yes | Loctite™ | Tapered Tip Balloon Dissection Cannula k953377 | The listed parts are currently being used in existing ORIGIN products, and therefore have been cleared for biocompatibility (safety) and effectiveness. ## 21 CFR §807.92 a(5) Intended use and relationship to predicate(s): The VasoView™ Balloon Dissection System has applications in minimally invasive surgery. It is indicated when endoscopic surgery is indicated and may be used to form elongated working cavities during thoracoscopic procedures involving exposure and dissection of structures external to the parietal pleura, including, nerves, blood vessels and other tissues of the chest wall. The predicate device (Tapered Tip Balloon Dissection Cannula) has applications in minimally invasive surgery and is primarily indicated for patients undergoing laparoscopic surgery requiring tissue separation of the extraperitoneal space or extremities. The VasoView™ Balloon Dissection System is not intended for use except as indicated. In addition, it is not intended for use when endoscopic surgery is contraindicated. Page 7 {2} ORIGIN Medsystems, Inc. PREMARKET NOTIFICATION VasoView™ Balloon Dissection System Class II # CFR §807.92 a(6) Technological characteristics and relationship to predicate(s): The VasoView™ Balloon Dissection System is substantially equivalent to the Tapered Tip Balloon Dissection Cannula previously cleared product. The VasoView™ Balloon Dissection System shares the identical function, technological characteristics and materials as the predicate device. # 21 CFR §807.92 b This submission’s determination of substantial equivalence is based on similarities to the predicate devices in terms of intended uses, materials, and technological characteristics. # 21 CFR §807.92 c In accordance with the specifications of this subsection, this summary (3 pages) is its own section, and has been clearly identified as such. Page 8
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