LINA-BAG, MODELS LB-60, LB-100

K030422 · Lina Medical Cml Aps · GCJ · Apr 14, 2003 · Gastroenterology, Urology

Device Facts

Record IDK030422
Device NameLINA-BAG, MODELS LB-60, LB-100
ApplicantLina Medical Cml Aps
Product CodeGCJ · Gastroenterology, Urology
Decision DateApr 14, 2003
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 876.1500
Device ClassClass 2

Indications for Use

The LiNA-Bag is a sterile, single-use bag designed to contain tissue, small organic matter temporarily in order to facilitate the removal of this matter without wound contamination during laparoscopic procedures.

Device Story

LiNA-Bag is a sterile, single-use laparoscopic specimen retrieval device. It consists of a collapsible pouch attached to a long, slender, multi-part tube. The device is introduced into the patient through a laparoscopic trocar. The surgeon operates the device manually using a push-pull motion on the tube, which activates an attached nylon drawstring to open or close the pouch. The pouch contains tissue or organic matter during extraction to prevent wound contamination. It is used by surgeons in clinical laparoscopic settings.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

Laparoscopic specimen retrieval device; consists of a collapsible pouch and a multi-part tube with a nylon drawstring mechanism. Manual operation via push-pull motion. Sterile, single-use. No electronic components or software.

Indications for Use

Indicated for use in laparoscopic surgery to temporarily contain and facilitate removal of organs, stones, or tissue structures, including appendix, ectopic pregnancy, gallbladder, gallstones, lymph nodes, ovaries, fibroid tumors, and small sections of bowel, without wound contamination.

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}------------------------------------------------ K030422 APR 1 4 2003 # 510(K) Summary as required by 21 CFR section 807.92 for LiNA-BAG Prepared February 7, 2003 | Submitted by: | LiNA Medical CML ApS<br>Formervangen 5<br>Glostrup<br>Denmark DK-2600 | |--------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Contact Person:<br>Device Trade Name:<br>Common Name:<br>Classification: | Mr. Niels Kornerup, President<br>LiNA-Bag<br>Laparoscopic Specimen Retrieval Device<br>Laparoscopic, General & Plastic Surgery, 876.1500 Class II | | Predicate Devices: | Patton Endo-bag (K0122150), distributed by Patton Medical,<br>1000 Westbank Drive, Suite 5A200, Austin, TX 78746<br>ENDOPOUCH Specimen Retrieval Bag (K933104), manufactured by Ethicon,<br>Inc., P.O. Box 151, Somerville, NJ 08876<br>Auto Suture ENDO CATCH Single Use Specimen Pouch<br>(K922123), manufactured by U.S. Surgical, Division of TYCO, 150 Glover Ave.,<br>Norwalk, CT 06856 | ### Description of Device: The LiNA-Bag is a laparoscopic instrument consisting of a collapsible pouch attached and placed within a long slender multi-part tube allowing for introduction of said pouch through a laparoscopic trocar. Opening and closing of the pouch is activated by manual manipulation in a push and pull motion of the attached tube that has a corresponding nylon drawstring attached to the pouch. ### Intended Use of Device: The LiNA-Bag is a sterile, single-use bag designed to contain tissue, small organic matter temporarily in order to facilitate the removal of this matter without wound contamination during laparoscopic procedures. ### Substantial Equivalence to Predicate Device: The LiNA-Bag is substantially equivalent to the Patton Endo-bag (K0122150), distributed by Patton Medical, 1000 Westback Drive, Suite 5A200, Austin, TX 78746 and the ENDOPOUCH Specimen Retrieval Bag (K933104), manufactured by Ethicon, Inc., P.O. Box 151, Somerville, NJ 08876 and the Auto Suture ENDO CATCH Single Use Specimen Pouch (K922123), manufactured by U.S. Surgical, Division of TYCO, 150 Glover Ave, Norwalk, CT 06856. {1}------------------------------------------------ Image /page/1/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features a stylized image of three human profiles facing right, stacked on top of each other. The profiles are connected by a flowing, ribbon-like shape at the bottom. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the image. Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850 APR 1 4 2003 Mr. Niels Kornerup President LiNa Medical CML ApS Formervangen 5 Glostrup, Denmark DK-2600 Re: K030422 Trade/Device Name: LiNa-Bag Regulation Number: 21 CFR 876.1500 Regulation Names: Endoscope and accessories Regulatory Class: II Product Codes: GCJ Dated: February 7, 2003 Received: February 10, 2003 Dear Mr. Kornerup: 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. Iisting 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. 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. {2}------------------------------------------------ Page 2 - Mr. Niels Kornerup 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 (301) 594-4659. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. 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 may be obtained 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/dsma/dsmamain.html Sincerely yours. Sincerely yours, Mark N Millkern Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure {3}------------------------------------------------ NR. 999 S. 3 Indications for Use 13.5 - Found sures I ruy 1 diministration ar Jos Destens and Radiological Health CDRH Home | Search | A-Z Index | Feedback Page 1 of 1 Side I af 2 510(k) Number (if known): K030422 LiNA-Bag, model LB-60 & LB-100 Device Name: Indications for Use: A single use retrieval bag designed to temporarily contain organs or stones and facilitate their removal from the patient without contamination during laparoscopic surgery such as the appendix, an ectopic pregnancy, gallbladder, gallstones, lymph nodes, ovaries, fibroid tumors, small sections of bowel and other tissue structures. ## (PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE OF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE) Mark R. Milleson (Division Sign-Off) Restorative Divis anc 510(k) Number K030926 http://www.fda.gov/cdrh/ode/indicate.html 21-03-03
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