ENSIZOR ENDOSCOPIC SCISSORS

K141058 · Slater Endoscopy, LLC · OCZ · Aug 1, 2014 · Gastroenterology, Urology

Device Facts

• Record ID: K141058
• Device Name: ENSIZOR ENDOSCOPIC SCISSORS
• Applicant: Slater Endoscopy, LLC
• Product Code: OCZ · Gastroenterology, Urology
• Decision Date: Aug 1, 2014
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 876.1500
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Slater Endoscopy Ensizor Endoscopic Scissors are designed to cut and dissect tissue during flexible endoscopic procedures.

Device Story

Ensizor Endoscopic Scissors are sterile, single-use, non-electrocautery mechanical instruments for soft tissue dissection during flexible endoscopic procedures. Device consists of an actuation handle, a flexible shaft, and distal cutting blades. Compatible with flexible endoscopes having a minimum 2.8 mm channel diameter. Operated by a physician during endoscopic procedures; handle actuation opens and closes the distal blades to mechanically cut tissue or sutures. Device functions similarly to standard scissors. Benefits include mechanical tissue dissection without the risks associated with electrocautery. Used in clinical settings where flexible endoscopy is performed.

Clinical Evidence

Bench testing only. Testing included operation in tortuosity (simulating flexible endoscope use) and sample cutting (LDPE polyethylene sheet). Ensizor devices (n=15 per configuration) were tested at baseline, post-accelerated aging, and post-transportation/distribution. Results showed all units passed tortuosity and cutting tests, performing as well as or better than the predicate device, which exhibited difficulty opening/closing in the tortuous configuration.

Technological Characteristics

Mechanical, non-electrocautery endoscopic instrument. Consists of an actuation handle and flexible shaft terminating in cutting blades. Available in 165 cm and 235 cm working lengths; compatible with 2.8 mm minimum endoscope channels. Sterile, single-use. No software or electronic components.

Indications for Use

Indicated for patients undergoing flexible endoscopic procedures requiring tissue cutting and dissection. No specific age or gender restrictions provided. Contraindicated for use where electrocautery is required.

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

• Apollo Endosurgery Endoscopic Scissors (K090583)

Submission Summary (Full Text)

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Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

August 1, 2014

Slater Endoscopy, LLC % Craig Pagan Regulatory Consultant C2C Development, LLC 1135 W NASA Blvd., Suite 500 Melbourne, FL 32901

Re: K141058

> Trade/Device Name: Slater Endoscopy Ensizor Endoscopic Scissors Regulation Number: 21 CFR§ 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: OCZ Dated: June 23, 2014 Received: June 25, 2014

Dear Craig Pagan,

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. 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.

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.

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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 (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours.

# Herbert P. Lerner -S

for

Benjamin R. Fisher, Ph.D. Director Division of Reproductive, Gastro-Renal, and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement below.

| 510(k) Number (if known) | |
|--------------------------|--|
|--------------------------|--|

# K141058

Device Name

Slater Endoscopy Ensizor Endoscopic Scissors

Indications for Use (Describe)

Slater Endoscopy Ensizor Endoscopic Scissors are designed to cut and dissect tissue during flexible endoscopic procedures.

Type of Use (Select one or both, as applicable)

Prescription Use (Part 21 CFR 801 Subpart D)

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

# PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.

## FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

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."

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# 510(k) Summary

#### Submitter's name, address, telephone number, a contact person and date (1) summary was prepared:

Slater Endoscopy, LLC 14000 NW 58 Ct. Miami Lakes, FL 33014 Telephone: [phone] Contact: Charles Slater July 17, 2014

#### Name(s) of device: (2)

| Proprietary/Trade Name: | Ensizor™ Endoscopic Scissors |
|-------------------------|---------------------------------------------|
| Common Name: | Endoscope and/or Accessories |
| Classification Name: | Endoscope and Accessories (21 CFR 876.1500) |
| Classification Panel: | Gastroenterology/Urology |
| Product Code: | OCZ |
| Regulatory Class: | II |

#### Legally Marked Predicate Device to which the submitter claims substantial (3) equivalence:

The Ensizor"14 Endoscopic Scissor is substantially equivalent to the Apollo Endosurgery Endoscopic Scissors (K090583).

#### Description of device(s): (4)

Ensizor™ Endoscopic Scissor

- Cat # ES-26165 2.6 mm Endoscopic Scissors x 165cm working length ●
- Cat # ES-26235 2.6 mm Endoscopic Scissors x 235cm working length ●

The above referenced Endoscopic Scissors are sterile, single use, non-electrocautery devices for soft tissue dissection during flexible endoscopic procedures. The devices are compatible with flexible endoscopes with a minimum channel diameter of 2.8 mm. The device cuts and dissects tissue during flexible endoscopic procedures. The device consists principally of an actuation handle and a flexible shaft body terminating in a pair of cutting scissors. The scissor blades function as standard scissors for mechanical cutting of sutures and tissue.

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#### Statement of intended use: (5)

Slater Endoscopy Ensizor Endoscopic Scissors are designed to cut and dissect tissue during flexible endoscopic procedures.

#### Comparison of Technological Characteristics to Predicate Device: (6)

The Ensizor™ Endoscopic Scissors have the same technological characteristics as the predicate devices as described below:

- devices are designed to cut and dissect tissue during endoscopic procedures ●
- . devices consists principally of an actuation handle and a flexible shaft body terminating in a pair of cutting Scissors
- scissors function just like standard scissors for mechanical cutting. . Bv operating the handle, the Scissors open and close.

# Differences:

The main difference between the Ensizor™ Endoscopic Scissor and the predicate device - Apollo Endosurgery Endoscopic Scissor (K090583) is that the Ensizor™ Endoscopic Scissors do not have an electrocautery function.

#### (7) Performance Data:

The following nonclinical testing was performed in order to evaluate the substantial equivalence of the Ensizor™ Scissors to the predicate devices:

- Operation in Tortuosity each device shall open and close with the distal ● shaft of the device is formed into approximately a 20 cm or 8 in diameter circle.
This test simulated operation of the device in a flexible endoscope. The results of the tests shows that the Ensizor™ Endoscopic Scissor is substantially equivalent to the predicate devices tested as they actuated as good as or better than the predicate devices in a tortuous path.

- Sample Cutting Each device shall cut at least 10 times each of the ● following sample material:
- o LDPE Polyethylene Sheet

The sample cutting test simulated the functionality of the Ensizor™ Endoscopic Scissor in cutting material. The results of the tests shows that the Ensizor "10 Endoscopic Scissor is substantially equivalent to the predicate devices tested as they cut the materials tested as good as or better than the predicate devices.

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| | EnsizorTM<br>Endoscopic<br>Scissors<br>Baseline | EnsizorTM<br>Endoscopic<br>Scissors<br>Post 1 year<br>Accelerated<br>Aging | EnsizorTM<br>Endoscopic<br>Scissors<br>Post 1<br>Transportation<br>& Distribution<br>Testing | Apollo<br>Endosurgery<br>Endoscopic<br>Monopolar<br>Scissors |
|-------------------------------------------------|-------------------------------------------------|----------------------------------------------------------------------------|----------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------|
| Test | EnsizorTM<br>Endoscopic<br>Scissors<br>Baseline | EnsizorTM<br>Endoscopic<br>Scissors<br>Post 1 year<br>Accelerated<br>Aging | EnsizorTM<br>Endoscopic<br>Scissors<br>Post 1<br>Transportation<br>& Distribution<br>Testing | Apollo<br>Endosurgery<br>Endoscopic<br>Monopolar<br>Scissors |
| Sample Size | 15 – 235 cm<br>15 – 165 cm | 15 – 235 cm<br>15 – 165 cm | 15 – 235 cm<br>15 – 165 cm | 1 – 235 cm |
| Operation in<br>Tortuosity | All units<br>passed | All units<br>passed | All units<br>passed | Unit had<br>difficulty<br>opening and<br>closing in the<br>tortuous<br>configuration |
| Sample Cutting<br>LDPE<br>Polyethylene<br>Sheet | All units<br>Passed | All units<br>Passed | All units<br>Passed | Passed |

Table 3 510(k) Summary - Testing Summary

#### Conclusions: (8)

Based on the non-clinical performance data performed comparing the Ensizor™ Endoscopic Scissors to the predicate device, it is concluded that the device is as safe, as effective, and performs as well as or better than the predicate device.