NOVATOME, MODEL: SU101-50

K072051 · Scholten Surgical Instruments, Inc. · DWZ · Oct 3, 2007 · Cardiovascular

Device Facts

• Record ID: K072051
• Device Name: NOVATOME, MODEL: SU101-50
• Applicant: Scholten Surgical Instruments, Inc.
• Product Code: DWZ · Cardiovascular
• Decision Date: Oct 3, 2007
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 870.4075
• Device Class: Class 2

Intended Use

The Scholten Novatome™ is a surgical device used to perform endomyocardial biopsies.

Device Story

Novatome is a manually operated, single-use surgical instrument for obtaining heart tissue samples. Input: manual operator force applied to a proximal handle. Transformation: handle actuation transmits force through an internal wire to a distal cutting jaw assembly; single-action jaw mechanism (one fixed, one movable) captures tissue. Output: excised endomyocardial biopsy sample. Used in clinical settings by physicians via percutaneous access (jugular, subclavian, or femoral). Device benefits include standardized, single-use sterile access for cardiac tissue sampling, reducing cross-contamination risks compared to reusable alternatives. Healthcare providers use the device to obtain tissue for diagnostic evaluation.

Clinical Evidence

No clinical data. Substantial equivalence established via non-clinical bench testing, including dimensional analysis, tensile testing, simulated biopsy yield, and cutting jaw force tests.

Technological Characteristics

Manual endomyocardial biopsy forceps. Components: stainless steel cutting jaws and actuation wire; polymer-coated flexible shaft (fluoropolymer tubing); high-performance polymer actuation handle. Sizes: 6, 7, 8, 9 French; lengths: 50, 70, 100 cm. Single-action jaw mechanism. Single-use, pre-sterilized.

Indications for Use

Indicated for patients requiring endomyocardial biopsy via percutaneous venous or arterial access (internal jugular, subclavian veins, or femoral artery).

Regulatory Classification

Identification

An endomyocardial biopsy device is a device used in a catheterization procedure to remove samples of tissue from the inner wall of the heart.

Predicate Devices

• Scholten Bioptome (Scholten Surgical Instruments Inc.)
• Ultra-CBX™ (Medcanica)

Submission Summary (Full Text)

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# SECTION 5 - SUMMARY

UCT 2 3 2007

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Scholten Surgical Instruments, Inc. 170 Commerce St. #101 Lodi, CA 95240 - USA

## 510k SUMMARY

Konzosi 510K Number:

Jim Van Andel, Chief Operations Officer Submitter: Scholten Surgical Instruments, Inc. 170 Commerce St. #101 Lodi, CA 95240 - USA Ph: 1-209-365-1393 Fax: [phone]

Establishment Registration Number: 2936330

Date Prepared: July 20, 2007

| Trade Name: | Novatome™ Endomyocardial Biopsy Forceps |
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| Common Name: | Endomyocardial Biopsy Forceps, Bioptome |
| Classification Name: | device, biopsy, endomyocardial (21 CFR<br>870.4075) |

Predicate Devices:

The Scholten Bioptome by Scholten Surgical Instruments Inc. and the Ultra-CBX™ by Medcanica

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### Device Description:

The Scholten Surgical Instruments, Inc. Novatome is a manually operated hand held surgical instrument designed to remove biopsy samples from the right or left ventricle of the Human Heart via percutaneous venous or arterial access. Specifically via the internal Jugular or subclavian veins or the femoral artery.

### Device Design:

The device consists of three main parts. The cutting jaws, a polymer coated flexible shaft, and an actuating handle. At the distal end of the forceps is a pair of jaws used to obtain the heart tissue samples. At the proximal end of the forceps is the actuation handle used to activate the jaws and steer the device

The device cutting jaws are single action in that one of the jaws is fixed and is attached to the end of the flexible shaft and the other jaw is movable and is attached to a link that is welded to the end of the actuation wire. The single moving jaw, the distance the jaws open, as well as the orientation of the jaw work in combination to control the amount of tissue obtained. These design characteristics are the identical to the Scholten Surgical Instruments, Inc. Scholten Bioptome.

The Novatome's actuation handle is made of an advanced high-performance polymer. The jaws, actuation wire, and other mechanical parts are made of stainless steel. The flexible shaft sheath material is Fluoropolymer tubing.

### Device physical properties:

The Novatome™ will be available in 9,8,7, and 6 French cutting jaw sizes, with flexible shaft lengths of 50, 70, and 100cm lengths. These lengths are standard in the industry for endomyocardial biopsy devices.

# Intended Use (Indications for use):

The Scholten Novatome™ is a surgical device used to perform endomyocardial biopsies.

# Comparison of technological characteristics:

The Novatome™ is designed with the same characteristics as the predicate devices. It, like the others, is designed for endomyocardial biopsy. The Scholten Surgical Instruments Novatome™ is a single use device as is the Ultra-CBX ™ by Medicanica. The Scholten Surgical Instruments Bioptome is reusable.

Additionally, the Novatome™ and the Scholten Bioptome both share a hemostat type finger ring actuating handle that is at a right angle to the flexible shaft. The Novatome™ actuating handle is constructed of a strong light weight,

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material that is injection molded yielding dimensionally consistent components as opposed to the Scholten Bioptome's stainless steel actuating handle constructed from forged components that are hand assembled and hand finished. The Bioptome and the Novatome actuation handles share virtually identical physical geometry. The Ultra-CBX ™ by Medicanica uses a 3 pullring style actuating handle.

Both the Scholten Bioptome and the Novatome™ share the same cutting head design as well as the same flexible shaft construction

One difference between the Novatome™ and the Scholten Bioptome is the device packaging. The Scholten Bioptome is sold non-sterile and is sterilized by autoclaving at the end user facility. The Novatome and the predicate Ultra-CBX TM by Medicanica are pre-packaged and sterilized

Non clinical test performed for determination of substantial equivalence are as follows:

Performance tests were conducted in several areas including, dimensional, tensile, simulated biopsy yield, cutting jaw force tests.

Discussion of Clinical test Performed:

Clinical studies were not conducted on the Novatome forceps.

Conclusion:

The Novatome™ was designed utilizing design control methods and is safe and effective for the application for which it is intended. Based on the comparison of the intended use, the design of the predicate devices, and the results of all testing performed, the proposed Novatome™ shows substantially equivalence to the predicate devices.

End of Summary

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Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

OCT 2 3 2007

Scholten Surgical Instruments, Inc. c/o Jim Van Andel Chief Operations Officer 170 Commerce St. #101 Lodi, CA 95240

Re: K072051

Novatome™ Endomyocardial Biopsy Forceps Regulation Number: 21 CFR 870.4075 Regulation Name: Endomyocardial Biopsy Device Regulatory Class: Class II (two) Product Code: DWZ Dated: July 20, 2007 Received: July 31, 2007

Dear Mr. Van Andel:

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. 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 (PMA), 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 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

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Page 2 - Mr. Van Andel

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); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. This letter will allow you to begin marketing your device as described in your Section 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), please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

lsse

For Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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# SECTION 4 - INDICATION FOR USE

#### Indications for Use

K072051 510(k) Number (if known):

Device Name: Novatome™ Endomyocardial Biopsy Forceps

Indications for Use: The Scholten Novatome™ is a surgical device used to perform endomyocardial biopsies.

Prescription Use (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use . (Per 21 CFR 801.109)

(Division Sign-Off)
Division of Cardiovascular Devices
Indications for Use Page 1 of 1
510(k) Number K072051

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