SISS REPROCESSED HOT BIOPSY FORCEPS, LAPAROSCOPIC, ENDOSCOPIC AND ELECTROSURGICAL SURGICAL INSTRUMENTS AND ACCESSORIES

K024011 · Surgical Instruments Service and Savings, Inc. · NLU · Dec 19, 2002 · Gastroenterology, Urology

Device Facts

• Record ID: K024011
• Device Name: SISS REPROCESSED HOT BIOPSY FORCEPS, LAPAROSCOPIC, ENDOSCOPIC AND ELECTROSURGICAL SURGICAL INSTRUMENTS AND ACCESSORIES
• Applicant: Surgical Instruments Service and Savings, Inc.
• Product Code: NLU · Gastroenterology, Urology
• Decision Date: Dec 19, 2002
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 876.4300
• Device Class: Class 2
• Attributes: Therapeutic, 3rd-Party Reviewed

Intended Use

The MediSISS Reprocessed Hot Biopsy Forceps and accessories are intended to be used endoscopically to obtain tissue specimens, remove polyps, and cauterize tissue.

Device Story

MediSISS Reprocessed Hot Biopsy Forceps are reprocessed single-use endoscopic instruments. Device functions by delivering electrosurgical energy to tissue via forceps jaws to facilitate biopsy, polyp removal, and cauterization. Used by clinicians in endoscopic procedures. Reprocessing restores device to original functional specifications, allowing reuse. Benefit includes cost-effective access to standard endoscopic surgical tools.

Clinical Evidence

No clinical data provided. Substantial equivalence established via supplemental validation data for reprocessed single-use devices.

Technological Characteristics

Electrosurgical forceps for endoscopic use. Reprocessed single-use device. Energy source: external electrosurgical generator. Materials and dimensions consistent with original predicate device specifications.

Indications for Use

Indicated for endoscopic tissue specimen collection, polyp removal, and tissue cauterization in patients requiring such procedures.

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

• Microvasive/Boston Scientific 1550 (K024011)
• Wilson-Cook HDS-2.5-230 (K024011)
• Ballard Medical 60110 (K024011)

Submission Summary (Full Text)

{0}------------------------------------------------

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized caduceus symbol, which is a staff with two snakes coiled around it. The logo also includes the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged in a circular fashion around the caduceus symbol. The image is in black and white.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

NOV 1 2004

Ms. Brandi James Regulatory Affairs Specialist MediSISS, Inc. 2747 SW 6th St. REDMOND OR 97756

Re: K024011 - Supplemental Validation Submission Trade Name: See Enclosed List Regulation Number: 876.4300 Regulation Name: Endoscopic electrosurgical unit and accessories Regulatory Class: II Product Code: 78 NLU Dated: December 2, 2002 Received: December 4, 2002

Dear Ms. James:

The above-referenced premarket notification (510(k)) was cleared by the Office of Device Evaluation (ODE) on December 19, 2002. We have received your supplemental validation data as required for reprocessed single-use devices by the Medical Device User Fee and Modernization Act of 2002. After reviewing your supplemental validation data, we have determined the devices listed in the enclosure accompanying this letter are 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 these devices, 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 devices are classified (see above) into either class II (Special Controls) or class III (PMA) they 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 devices in the Federal Register.

{1}------------------------------------------------

Page 2 - Ms. Brandi James

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your devices comply 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 applicable 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.

The FDA finding of substantial equivalence of your devices to legally marketed predicate devices results in classification for your devices and thus, permits you to legally market the devices. This letter will allow you to continue marketing the devices listed in the enclosure accompanying this letter.

If you desire specific advice for your devices 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/dsma/dsmamain.html.

Sincerely yours,

Nancy C. Brogdon

Nancy C. Brogdon Director, Division of Reproductive, Abdominal and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

{2}------------------------------------------------

## MediSISS Reprocessed Hot Biopsy Forceps K024011 -Substantially Equivalent (SE)

:

| Manufacturer | Model Number |
|-----------------------------------|--------------|
| Microvasive/<br>Boston Scientific | 1550 |
| Wilson-Cook | HDS-2.5-230 |
| Ballard Medical | 60110 |

:

.

.

:

:

.

・

.

{3}------------------------------------------------

## Indications for Use

510(k) Number (if known):

K024011

Device Name:

Indications For Use:

MediSISS Reprocessed Hot Biopsy Forceps

The MediSISS Reprocessed Hot Biopsy Forceps and accessories are intended to be used endoscopically to obtain tissue specimens, remove polyps, and cauterize tissue.

Prescription Use (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (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)

Nancy C. Brogdon

Page 1 of ____________________________________________________________________________________________________________________________________________________________________

Division Sian Division of Reproo and Radiologic 510(k) Numb