FLEXIBLE VIDEO CYSTOSCOPE/CHOLEDOCHOSCOPE, MODELS 7308.061 AND 7308.066

K051176 · Richard Wolf Medical Instruments Corp. · FAJ · Oct 5, 2005 · Gastroenterology, Urology

Device Facts

Record IDK051176
Device NameFLEXIBLE VIDEO CYSTOSCOPE/CHOLEDOCHOSCOPE, MODELS 7308.061 AND 7308.066
ApplicantRichard Wolf Medical Instruments Corp.
Product CodeFAJ · Gastroenterology, Urology
Decision DateOct 5, 2005
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 876.1500
Device ClassClass 2
AttributesTherapeutic

Indications for Use

The Flexible Video Cystoscope is used for visualizing body cavities and organs via natural and surgically generated passages. For examination, diagnosis and/or therapy in conjunction with endoscopic accessories/auxiliary instruments through the scope's working channel. The scope is used in the medical disciplines of Urology ( urogential tract, cystoscopy, nephroscopy) and Surgery (choiedochoscopy).

Device Story

Flexible video cystoscope/choledochoscope (models 7308.061, 7308.066) utilizes CCD video image sensor at distal tip to capture images; replaces traditional fiber-optic light guide. Device connects to Richard Wolf 5520 camera system for image processing and display. Operated by physicians in clinical settings for urological and surgical procedures. Features include ergonomic handle with remote control buttons for camera functions, removable adapter with instrument port, irrigation/drain stopcocks, and biopsy valve. Control lever allows tip deflection (up/down) to facilitate insertion. Output provides real-time visualization of body cavities to assist in diagnosis and therapeutic interventions.

Clinical Evidence

No clinical data; bench testing only. Device performance verified against IEC601-1/UL2601-1 and IEC601-1-2 safety standards.

Technological Characteristics

Flexible endoscope with distal CCD video sensor; control lever for tip deflection; ergonomic handle with remote camera control buttons; removable adapter with instrument port, irrigation/drain stopcocks, and biopsy valve. Connectivity via cable to external camera controller (5520 system). Designed to meet IEC601-1/UL2601-1 and IEC601-1-2 standards.

Indications for Use

Indicated for visualization of body cavities and organs via natural passages for examination, diagnosis, and therapy in urology (urogenital tract, cystoscopy, nephroscopy) and surgery (choledochoscopy) using endoscopic accessories.

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}------------------------------------------------ K051176 Pg 1 of 2 OCT 5 - 2005 353 Corporate Woods Parkway Vernon Hills, IL 60061-3110 Phone: 847-913-1113 Customer Service: 800-323-WOLF (9653) www.richardwolfusa.com # 12.0 510(k) Summary of Safety and Effectiveness | Submitter: | | |---------------------------------------------------------------------|----------------------------------------------------------------------| | Company / Institution name: | RICHARD WOLF MEDICAL INSTRUMENTS CORP. | | Division name (if applicable): | N.A. | | Street address: | 353 Corporate Woods Parkway | | City: | Vernon Hills | | State/Province: | Illinois | | Country: | USA | | ZIP / Postal Code: | IL 60061 | | Contact name: | Mr. Robert L. Casarsa | | Contact title: | Quality Assurance Manager | | Date of Preparation: | May 4, 2005 | | FDA establishment registration number: | 14 184 79 | | Phone number (include area code): | ( 847 ) 913 1113 | | FAX number (include area code): | ( 847 ) 913 0924 | | Product Information: | | | Trade name: | Flexible Video-Endoscope | | Model number: | 7308.061, 7308.066 | | Common name: | Flexible Video Cystoscope /<br>Choledochoscope | | Classification name: | Cystoscope / Nephroscope<br>/Choledochoscope | | Information on devices to which substantial equivalence is claimed: | | | 510(k) Number | Trade or proprietary or model name | | | Manufacturer | | 1 K980401 | 1 Flexible Fiberscopes and Accessories | | | 1 Richard Wolf | | 2 K 021074 | 2 Cysto-Videoscope VISERA CYF-V,<br>CYF-VA | | | 2 Olympus | | 3 K30960 | 3 Digital Flexible Cysto-Videoscope DCN | | | 3 ACMI | | 4 K023659 | 4 1 CCD Endocam 5520 System | | | 4 Richard Wolf | | 5 K983279 | 5 1 CCD Multi Endocam 5502 with<br>Electronic CCD Endoscope 4934.551 | | | 5 Richard Wolf | Medical Instruments Corporation {1}------------------------------------------------ K o51176-P2 % ## 1.0 Description RICHARD WOLF MEDICAL INSTRUMENTS CORPORATION Image /page/1/Picture/3 description: The image contains text describing flexible video cystoscopes and choledochoscopes. The submitted flexible video cystoscopes and choledochoscopes are a modification of the Richard Wolf flexible fiber-cystoscopes. The flexible video cystoscopes have a CCD video image sensor for generating a video image with a camera controller instead of an image fiber light guide. The video cystoscopes connect to the Richard Wolf camera system 5520. #### Intended Use 2.0 The Flexible Video Cystoscope is used for visualizing body cavities and organs via natural and surgically generated passages. For examination, diagnosis and/or therapy in conjunction with endoscopic accessories/auxiliary instruments through the scope's working channel. The scope is used in the medical disciplines of Urology ( urogential tract, cystoscopy, nephroscopy) and Surgery (choiedochoscopy). ### Technological Characteristics 3.0 The videoscopes have similar dimensions, working channels and design as the Richard Wolf flexible fiber-cystoscopes. Both cystoscopes are designed with a control lever for locking the tip in any angled position. Two different control directions are available, is . the endoscope is deflected either upward or downward upon activating the control lever proximally or distally. The tips are angled approximately 45° and angled. This makes the insertion into the urethra easier and more comfortable for male patients. The adapter with instrument port, irrigation and drain stopcocks and optional biopsy valve is removable. The new style ergonomic handle is equipped with two remote control buttons that control the camera function. ### 4.0 Substantial Equivalence The submitted devices pose the same type of questions about safety or effectiveness as existing devices and the new technological characteristics have not diminished safety or effectiveness. The submitted devices are substantially equivalent to existing 510(k) devices sold by Richard Wolf, Olympus and ACMI. #### 5.0 Performance Data The flexible videoscopes 7301.061 / 7301.066 are designed to meet the standards IEC601-1/ UL2601-1 and IEC601-1-2. #### 6.0 Clinical Tests By: No special clinical tests performed. #### 7.0 Conclusions Drawn These devices are designed and tested to guarantee the safety and effectiveness, when used according to the instructions manual. Robert L. Casare Robert L. Casarsa Quality Assurance Manager Date: May 4, 2005 {2}------------------------------------------------ rublic Health Service Image /page/2/Picture/1 description: The image shows a logo with a stylized depiction of three figures in motion, possibly dancing or running. The figures are rendered in black and have a fluid, dynamic appearance. To the left of the figures, there is some text arranged in a semi-circular fashion, also in black. The text appears to be part of the logo, possibly the name of an organization or brand. OCT 5 - 2005 Food and Drug Administration 9200 Corporate Boulevard Rockville MI) 20050 Mr. Robert L. Casarsa Quality Assurance Manager Richard Wolf Medical Instruments Corporations 353 Corporate Woods Parkway VERNON HILLS IL 60061-3110 Re: K051176 Trade/Device Name: Flexible Video Cystoscope / Choledochoscope (Models 7308.061 and 7308.066) Regulation Number: 21 CFR §876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Codes: FBN and FAJ Dated: September 7, 2005 Received: September 9, 2005 Dear Mr. Casarsa: We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially of the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to reclassified in accordence with the 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 premarks 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, abbeling, 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 898. In addition, FDA may publish further announcements concerning your device in the Federal Register. 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 sounces. 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. {3}------------------------------------------------ This letter will allow you to begin marketing your device as described in your Section 510(k) prematket 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 one of the following numbers, based on the regulation number at the top of this letter: | 21 CFR 876.xxxx | (Gastroenterology/Renal/Urology) | 240-276-0115 | |-----------------|----------------------------------|--------------| | 21 CFR 884.xxxx | (Obstetrics/Gynecology) | 240-276-0115 | | 21 CFR 892.xxxx | (Radiology) | 240-276-0120 | | Other | | 240-276-0100 | Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html. Sincerely yours, Nancy C. Hogdon Nancy C. Brogdon Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure 。 『 {4}------------------------------------------------ # 5.0 Indications for Use # 4 05 1176 510(k) Number: Device Name: Flexible Video Cystoscope / Choledochoscope Indications For Use: The Flexible Video Cystoscope is used for visualizing body cavities and organs via natural passages. For examination, diagnosis and/or therapy in conjunction with endoscopic accessories/ auxiliary instruments through in scone's working should co scope's working channel. The scope is used in the medical disciplines of · Urology (urogenital tract, cystoscopy, nephroscopy), · Surgery (choledochoscopy) Prescription Use (Part 21 CFR 801 Subpart D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AND/OR Over-The Counter (Part 21 CFR 807 Subpart C) (PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH Office of Device Evaluation (ODE) David A. Logemann (Division Sign-Off) Division of Reproductive, Abdominal, and Radiological Device 510(k) Number Page _1_ of _1
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