KARL STORZ DIRECT COUPLED CAMERA HEAD

K973252 · Karl Storz Imaging, Inc. · FET · Nov 24, 1997 · Gastroenterology, Urology

Device Facts

Record IDK973252
Device NameKARL STORZ DIRECT COUPLED CAMERA HEAD
ApplicantKarl Storz Imaging, Inc.
Product CodeFET · Gastroenterology, Urology
Decision DateNov 24, 1997
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 876.1500
Device ClassClass 2

Indications for Use

The Karl Storz Imaging (KSI) Direct Coupled (DCC) Camera Head is a color, television camera head designed for attachment to a Karl Storz Tuttlingen (KST) DCC endoscopic visioning system. The KSI DCC camera head is compatible with the currently marketed KSI Telecam SL (Super Luxury) video processor and the KSI Telecam SL with IPM (Image Processing Module) video processor. The camera head is suitable for attachment to any KST DCC rigid or flexible endoscope, including, but not limited to sinoscopes, colonoscopes, sigmoidoscopes, bronchoscopes, gastroscopes, laparoscopes, choledoscopes, ureteroscopes, hysteroscopes and arthroscopes. The camera head is coupled to the endoscope by directly pressing the endoscope onto the front of the DCC camera head until it locks into place. An optional adapter allows DCC camera head attachment to non-DCC rigid and flexible endoscopes. The endoscopic image can be displayed on any standard operating room video monitor.

Device Story

Color television camera head for endoscopic visualization; attaches to KST DCC rigid/flexible endoscopes via direct coupling or optional adapter; compatible with KSI Telecam SL and Telecam SL with IPM video processors. Features two programmable function buttons for accessory/port control and two focus buttons; light cable connects to rear; rotatable head for image orientation. Used in operating rooms by physicians; output displayed on standard OR video monitors to assist in surgical/diagnostic visualization.

Clinical Evidence

No clinical data provided; substantial equivalence based on technological characteristics and design similarities to predicate devices.

Technological Characteristics

Color television camera head; includes programmable function buttons and focus controls; direct coupling mechanism for endoscopes; compatible with existing KSI video processors; standard OR video monitor output.

Indications for Use

Indicated for use with Karl Storz Tuttlingen (KST) DCC endoscopic visioning systems for visualization during endoscopic procedures, including sinoscopy, colonoscopy, sigmoidoscopy, gastroscopy, bronchoscopy, laparoscopy, choledoscopy, ureteroscopy, hysteroscopy, and arthroscopy.

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}------------------------------------------------ K973252 Nov.24,1997 ## 510(k) Summary of Safety and Effectiveness This summary of premarket notification safety and effectiveness information is being submitted in CEP This Sunninal y or premarker notheaton safety and offees Act (SMDA) of 1990 and 21 CFR 807.92. | Application: | Karl Storz Imaging, Incorporated<br>175 Cremona Drive<br>Goleta, California 93117 | |---------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Contact: | Mr. Terry Fernandez | | Registration: | 2027009 | | Device Name: | Proprietary Name -- Karl Storz Imaging Direct Coupled Camera Head<br>Common Name -- Color Television Camera Head<br>Classification Name -- Camera, Television, Endoscopic | | Intended Use: | The Karl Storz Imaging (KSI) Direct Coupled (DCC) Camera Head is a<br>color, television camera head designed for attachment to a Karl Storz Tuttlingen<br>(KST) DCC endoscopic visioning system. The KSI DCC camera head is<br>compatible with the currently marketed KSI Telecam SL (Super Luxury) video<br>processor and the KSI Telecam SL with IPM (Image Processing Module) video<br>processor. | | | The camera head is suitable for attachment to any KST DCC rigid or flexible<br>endoscope, including, but not limited to sinoscopes, colonoscopes,<br>sigmoidoscopes, bronchoscopes, gastroscopes, laparoscopes, choledoscopes,<br>ureteroscopes, hysteroscopes and arthroscopes. The camera head is coupled to<br>the endoscope by directly pressing the endoscope onto the front of the DCC<br>camera head until it locks into place. An optional adapter allows DCC camera<br>head attachment to non-DCC rigid and flexible endoscopes. The endoscopic<br>image can be displayed on any standard operating room video monitor. | | Device Description: | The KSI DCC incorporates two programmable function buttons (to select an<br>accessory port(s) and to control the port output) and two focus buttons.<br>The light cable is connected directly to the back of the camera head. The camera<br>is designed to allow the user to directionally rotate the camera head to maintain<br>proper image orientation on the monitor. | {1}------------------------------------------------ Substantial Equivalence: KSI believes that its proposed new device, the Direct Coupled Camera Head, is substantially equivalent to several other camera heads currently in commercial distribution including the camera head in the KŠI Tricam Color Endoscopic Television Camera System (K950862) and the camera head in the KSI Telecam Color Endoscopic Television Camera System (K883943). The proposed new KSI camera head is unique only in that it incorporates into one camera head variations of several features found in similar, earlier camera head models. Signed: Terry Fernandez Date: 08/27/97 Image /page/1/Picture/6 description: The image shows a close-up of a signature. The signature is illegible and appears to be a series of overlapping loops and lines. The lines are dark and thick, and the overall impression is one of a quick, stylized mark. {2}------------------------------------------------ Image /page/2/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. In the center of the circle is an abstract image of an eagle. Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850 NOV 2 4 1997 Terry Fernandez Director, Regulatory and Standards Compliance Karl Storz Imaging, Inc. 175 Cremona Drive Goleta, California 93117 Re: K973252 Karl Stortz Direct Coupled Camera Head Dated: August 27, 1997 Received: August 29, 1997 Regulatory class: II 21 CFR §876.1500/Product code: 78KOG and GCJ Dear Mr. Fernandez: We have reviewed your Section 510(k) notification of intent to market the device and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act). You may, therefore, market the device, subject to the general controls provisions of the Act. 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. If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirement, as set forth in the Quality System Regulation (OS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic OS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations. This letter will allow you to begin marketing your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market. If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4613. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsmamain.html". Sincerely yours. Lillian Yin, Ph.D. Director, Division of Reproductive, Abdominal, Ear. Nose and Throat. and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure {3}------------------------------------------------ 510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________ Device Name: KSI DIRECT COUPLED CAMERA SYSTEM Indication for Use: The Karl Storz Imaging (KSI) Direct Coupled (DCC) Camera Head is a color, television camera head The Kall Storz maging (Kor) Diroce Couptlingen (KST) DCC endoscopic visioning system. The KST designed for attachment to a Karl Storz Tuttlingen (KST) DCC endoscopic visionin designed for attachinent to a hear its the currently marketed KSI Telecam SL (Super Luxury) and the KSI Telecam SL with IPM (Image Processing Module) video processors. The camera head is suitable for attachment to any KST DCC rigid or flexible endoscope, including, but I no valiford to sinoscopes, colonoscopes, sigmoidoscopes, gastroscopes, gastroscopes, laparoscopes, choledoscopes, ureteroscopes, hysteroscopes and arthroscopes. The camera head is coupled to the endoscope by directly pressing the endoscope onto the front of the DCC camera head until it locks into place. The endoscopic image can be displayed on any standard operating room video monitor. (PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED.) Concurrence of CDRH, Office of Device Evaluation (ODE) (Division Sign-Off) ﮯ ﺑ 510(k) Number _ L Prescription Use (Per 21 CFR 801.109) OR Over-The-Counter Use_________ Pobut D (Division Sign-Off) and Radiological Devices Division of Reproductive, Abdominal, ENT, 510(k) Number_1973252 (Optional Format 1-2-96)
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