Teslatome Bipolar Sphincterotome; Tesla BiCord Active Cord

K243568 · Wilson-Cook Medical, Inc. · KNS · Jan 17, 2025 · Gastroenterology, Urology

Device Facts

• Record ID: K243568
• Device Name: Teslatome Bipolar Sphincterotome; Tesla BiCord Active Cord
• Applicant: Wilson-Cook Medical, Inc.
• Product Code: KNS · Gastroenterology, Urology
• Decision Date: Jan 17, 2025
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 876.4300
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

This device is used for cannulation of the ductal system and for sphincterotomy. If preloaded, the device also aids in bridging difficult strictures during ERCP. Also indicated for sphincterotome-aided, wire-quided selective cannulation of the biliary ducts. Tesla BiCord Active Cord: This device is used to connect the Teslatome Bipolar Sphincterotome to compatible electrosurgical generators.

Device Story

Teslatome Bipolar Sphincterotome is an endoscopic accessory used during ERCP; consists of three-ring handle, tri-lumen catheter, and cutting wire. Device passes through duodenoscope to access biliary tract; distal tip positions at major papilla for cannulation. Electrosurgical current, delivered via Tesla BiCord Active Cord from compatible generator, applied to cutting wire to perform sphincterotomy. Multi-lumen design allows contrast injection and passage over pre-positioned wire guide. Used by gastroenterologists in clinical settings. Output is incision of papilla; facilitates biliary access and stricture management. Benefits include improved procedural access and therapeutic intervention capabilities.

Clinical Evidence

Bench testing only. No clinical data provided. Testing included seal strength, functional testing after simulated distribution, current carrying capacity, device burnout, neutral electrode thermal performance, and force of device pushability.

Technological Characteristics

Endoscopic electrosurgical accessory. Features three-ring handle, tri-lumen catheter, and cutting wire. Bipolar electrosurgical principle of operation. Connects to external electrosurgical generator via Tesla BiCord Active Cord. Designed for use with duodenoscopes.

Indications for Use

Indicated for patients undergoing ERCP requiring cannulation of the ductal system, sphincterotomy, or sphincterotome-aided wire-guided selective cannulation of biliary ducts. Includes use for bridging difficult strictures if preloaded.

Regulatory Classification

Identification

An endoscopic electrosurgical unit and accessories is a device used to perform electrosurgical procedures through an endoscope. This generic type of device includes the electrosurgical generator, patient plate, electric biopsy forceps, electrode, flexible snare, electrosurgical alarm system, electrosurgical power supply unit, electrical clamp, self-opening rigid snare, flexible suction coagulator electrode, patient return wristlet, contact jelly, adaptor to the cord for transurethral surgical instruments, the electric cord for transurethral surgical instruments, and the transurethral desiccator.

Predicate Devices

• TeslaTome Bipolar Sphincterotome, Tesla Bipolar Active Cord (K192339)

Submission Summary (Full Text)

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January 17, 2025

Wilson-Cook Medical Inc. Lindsey Ebke Regulatory Scientist 4900 Bethania Station Road Winston Salem, North Carolina 27105

Re: K243568

Trade/Device Name: Teslatome Bipolar Sphincterotome; Tesla BiCord Active Cord Regulation Number: 21 CFR 876.4300 Regulation Name: Endoscopic Electrosurgical Unit And Accessories Regulatory Class: Class II Product Code: KNS Dated: December 19, 2024 Received: December 19, 2024

Dear Lindsey Ebke:

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 (the 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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database available at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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.

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device"

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(https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30. Design controls; 21 CFR 820.90. Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review. the OS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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); medical device reporting of medical device-related adverse events) (21 CFR Part 803) for devices or postmarketing safety reporting (21 CFR Part 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

All medical devices, including Class I and unclassified devices and combination product device constituent parts are required to be in compliance with the final Unique Device Identification System rule ("UDI Rue"). The UDI Rule requires, among other things, that a device bear a unique device identifier (UDI) on its label and package (21 CFR 801.20(a)) unless an exception or alternative applies (21 CFR 801.20(b)) and that the dates on the device label be formatted in accordance with 21 CFR 801.18. The UDI Rule (21 CFR 830.300(a) and 830.320(b)) also requires that certain information be submitted to the Global Unique Device Identification Database (GUDID) (21 CFR Part 830 Subpart E). For additional information on these requirements, please see the UDI System webpage at https://www.fda.gov/medical-device-advicecomprehensive-regulatory-assistance/unique-device-identification-system-udi-system.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See

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the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

# Anthony Lee -S

Anthony Lee, PhD, MBA Assistant Director DHT3A: Division of Renal, Gastrointestinal, Obesity, and Transplant Devices OHT3: Office of Gastrorenal, ObGyn, General Hospital, and Urology Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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#### Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: 07/31/2026 See PRA Statement below.

Submission Number (if known)

K243568

Device Name

Teslatome Bipolar Sphincterotome;

Tesla BiCord Active Cord (TESLA-B-ACU)

Indications for Use (Describe)

This device is used for cannulation of the ductal system and for sphincterotomy. If preloaded, the device also aids in bridging difficult strictures during ERCP. Also indicated for sphincterotome-aided, wire-quided selective cannulation of the biliary ducts.

Tesla BiCord Active Cord:

This device is used to connect the Teslatome Bipolar Sphincterotome to compatible electrosurgical generators.

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)

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| 510(k) #: | K243568 | 510(k) Summary | Prepared on: 2025-01-07 |
|-----------|---------|----------------|-------------------------|
|-----------|---------|----------------|-------------------------|

| Contact Details | 21 CFR 807.92(a)(1) |
|-----------------------------|-----------------------------------------------------------------|
| Applicant Name | Wilson-Cook Medical Inc. |
| Applicant Address | 4900 Bethania Station Road Winston Salem NC 27105 United States |
| Applicant Contact Telephone | 567-236-0650 |
| Applicant Contact | Dr. Lindsey Ebke |
| Applicant Contact Email | [e-mail] |

| Device Name | 21 CFR 807.92(a)(2) |
|---------------------|-----------------------------------------------------------------------------|
| Device Trade Name | Teslatome Bipolar Sphincterotome;<br>Tesla BiCord Active Cord (TESLA-B-ACU) |
| Common Name | Endoscopic electrosurgical unit and accessories |
| Classification Name | Unit, Electrosurgical, Endoscopic (With Or Without Accessories) |
| Regulation Number | 876.4300 |
| Product Code(s) | KNS |

| Legally Marketed Predicate Devices | 21 CFR 807.92(a)(3) |
|------------------------------------|---------------------|
|------------------------------------|---------------------|

| Predicate # | Predicate Trade Name (Primary Predicate is listed first) | Product Code |
|-------------|-------------------------------------------------------------|--------------|
| K192339 | TeslaTome Bipolar Sphincterotome, Tesla Bipolar Active Cord | KNS |

| Device Description Summary | 21 CFR 807.92(a)(4) |
|----------------------------|---------------------|
|----------------------------|---------------------|

ln a sphincterotomy, access to the biliary tract is gained by passing a sphincterotome through a duodenoscope and positioning the distal tip adjacent to the major papilla is cannulated using the tip of the sphincterotome. The papilla is then incised using an electrosurgical current applied to the cutting wire by an electrosurgical generator that is connected to the sphincterotome by an active cord.

The Teslatome consists of a three-ring handle, tri-lumen catheter, and cutting wire with a connection to an electrosurgical generator via the Tesla BiCord active cord. The connection delivers a current to the cutting wire that is exposed at the device. A multilumen catheter allows for the injection of contrast and/or the passage over a prepositioned wire guide using the proximal end of the device.

21 CFR 807.92(a)(5)

21 CFR 807.92(a)(5)

## Intended Use/Indications for Use

This device is used for cannulation of the ductal system and for sphincterotomy. If preloaded, the device also in bridging difficult strictures during ERCP. Also indicated for sphincterotome-aided selective cannulation of the biliary ducts.

Tesla BiCord Active Cord:

This device is used to connect the Teslatome Bipolar Sphincterotome to compatible electrosurgical generators.

### Indications for Use Comparison

The intended uses for the subject devices were updated to improve clarity and readability. The subject and predicate intended uses are functionally identical, and the change does not raise any new questions of safety or effectiveness.

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The Teslatome Bipolar Sphincterotome and BiCord active cord have the same technological characteristics of the predicate devices K192339.

## Non-Clinical and/or Clinical Tests Summary & Conclusions 21 CFR 807.92(b)

The non-clinical tests for seal strength, functional testing after simulated distribution, current carrying capacity, device burnout, neutral electrode thermal performance, and force of device pushability demonstrate adherence to the quality design and risk management systems of the manufacturer. The Teslatome and BiCord active cord are substantially equivalent to the currently cleared predicate devices.