NEUROBLATE(TM) SYSTEM

K131955 · Monteris Medical, Inc. · GEX · Jul 30, 2013 · General, Plastic Surgery

Device Facts

• Record ID: K131955
• Device Name: NEUROBLATE(TM) SYSTEM
• Applicant: Monteris Medical, Inc.
• Product Code: GEX · General, Plastic Surgery
• Decision Date: Jul 30, 2013
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 878.4810
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Monteris Medical NeuroBlate™ System is indicated for use to ablate, necrotize, or coagulate soft tissue through interstitial irradiation or thermal therapy in medicine and surgery in the discipline of neurosurgery with 1064 nm lasers. The Monteris Medical NeuroBlate™ System is intended for planning and monitoring thermal therapies under MRI visualization. It provides MRI based trajectory planning assistance for the stereotaxic placement of MRI compatible (conditional) NeuroBlate™ Laser Delivery Probes. It also provides real-time thermographic analysis of selected MR1 images. When interpreted by a trained physician, this System provides information that may be useful in the determination or assessment of therapy. Patient management decisions should not be made solely on the basis of the NeuroBlate™ System analysis.

Device Story

NeuroBlate System provides MRI-guided laser thermal therapy for neurosurgery. Components: gas-cooled laser delivery probe; probe driver for stereotaxic positioning; electronics rack; control workstation with M Vision software. System integrates with 1.5T and 3.0T GE MRI scanners. Workflow: surgeon uses workstation to plan trajectories for probe placement; system provides real-time thermographic analysis of MRI images during procedure. Output: visual thermographic data for physician interpretation. Benefit: precision thermal ablation of soft tissue. Used in clinical settings by trained physicians. Decisions based on system analysis require physician oversight.

Clinical Evidence

Bench testing only. No clinical data presented. Testing demonstrated system compliance with labeling and performance expectations, confirming equivalent functionality across GE, Siemens, and IMRIS MRI platforms.

Technological Characteristics

MRI-compatible laser surgical system. Components: gas-cooled laser delivery probe, probe driver, electronics rack, control workstation. Energy source: 1064 nm laser. Connectivity: interfaces with 1.5T and 3.0T GE MRI systems. Software: M Vision software for planning and thermographic analysis. Materials: identical to predicate device.

Indications for Use

Indicated for ablation, necrosis, or coagulation of soft tissue via interstitial irradiation or thermal therapy in neurosurgery using 1064 nm lasers. Intended for use in patients requiring neurosurgical thermal therapy under MRI guidance.

Regulatory Classification

Identification

(1) A carbon dioxide laser for use in general surgery and in dermatology is a laser device intended to cut, destroy, or remove tissue by light energy emitted by carbon dioxide.(2) An argon laser for use in dermatology is a laser device intended to destroy or coagulate tissue by light energy emitted by argon.

Predicate Devices

• NeuroBlate™ System (K120561)

Submission Summary (Full Text)

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# K131955

NeuroBlate™ System – GE MRI Compatibility Special Premarket Notification

# Section 5: 510(k) Šummary

| Category | Comments |
|------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------|
| Sponsor: | Monteris Medical Corp.<br>16305 36th Ave. North, Suite 200<br>Plymouth, MN 55446<br>763-253-4710<br>Fax: [phone]<br>www.monteris.com<br>JUL 30 2013 |
| Correspondent Contact<br>Information: | Craig Coombs<br>Coombs Medical Device Consulting<br>1193 Sherman Street<br>Alameda, CA 94501<br>Tel: [phone]<br>Fax: [phone] |
| Device Common Name: | Magnetic Resonance Image Guided Laser<br>Thermal Therapy System |
| Device Classification Number: | 21 CFR 878.4810<br>Laser surgical instrument for use in general and<br>plastic surgery and in dermatology |
| | 21 CFR 882.4560<br>Stereotaxic instrument |
| Device Classification &<br>Product Code: | Class II, GEX<br>Class II, HAW |
| Device Proprietary Name: | Monteris Medical NeuroBlateTM System |

### a. Device Information:

## Predicate Device Information:

| Predicate Device: | NeuroBlate™ System |
|----------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Predicate Device Manufacturer: | Monteris Medical |
| Predicate Device Common Name: | Monteris NeuroBlate™ System |
| Predicate Device Premarket Notification # | K120561 |
| Predicate Device Regulation: | 21 CFR 878.4810<br>Laser surgical instrument for use in general<br>and plastic surgery and in dermatology<br><br>21 CFR 882.4560<br>Stereotaxic instrument |
| Predicate Device Classification &<br>Product Code: | Class II, GEX<br>Class II, HAW |

b. Date Summary Prepared 25 June 2013

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#### c. Description of Device

The Monteris NeuroBlate™ System is a unique collection of MRI-compatible laser devices and accessories that create an MRI guided delivery of precision thermal therapy. The NeuroBlate System components consist of:

- A gas-cooled Laser Delivery Probe (Probe) to deliver controlled energy to a target . zone:
- . A Probe Driver which allows the surgeon to precisely position, stabilize and manipulate a laser probe within the target zone;
- A System Electronics Rack and Components, which includes necessary . umbilicals, cables, penetration panels, and small hardware for system mechanical, electrical, and electronic operation; and
- A Control Workstation including the M Vision™ Software, which includes a user ● interface for procedure planning, interactive monitoring of NeuroBlate™ procedures, and interfaces to the MRI and hardware subsystems.

This submission clears the use of the NeuroBlate System with specific 1.5 & 3.0T General Electric Magnetic Resonance Imaging Systems.

#### d. Indications for Use

The Monteris Medical NeuroBlate™ System is indicated for use to ablate, necrotize, or coagulate soft tissue through interstitial irradiation or thermal therapy in medicine and surgery in the discipline of neurosurgery with 1064 nm lasers.

The Monteris Medical NeuroBlate™ System is intended for planning and monitoring thermal therapies under MRI visualization. It provides MRI based trajectory planning assistance for the stereotaxic placement of MRI compatible (conditional) NeuroBlate™ Laser Delivery Probes. It also provides real-time thermographic analysis of selected MR1 images.

When interpreted by a trained physician, this System provides information that may be useful in the determination or assessment of therapy. Patient management decisions should not be made solely on the basis of the NeuroBlate™ System analysis.

#### e. Comparison to Predicate Device

The application Monteris Medical NeuroBlate™ System (GE, Siemens, and IMRIS MRI compatible) is substantially equivalent to the predicate Monteris NeuroBlate™ System (Siemens, and IMRIS MRI compatible) in intended use, technology, design and physician use.

All patient contacting materials are identical in composition, source, and use with respect to the predicate device.

The technical modes of action and technical principles are materially the same the predicate devices.

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The application System is compatible with listed GE 1.5 and 3.0T MRI systems, along with the predicate Systems compatibility with listed Siemens and IMRIS 1.5 and 3.0 MRI Systems

Bench testing has demonstrated that the System is in compliance with the medical community's expectations and the product labeling.

As the modifications presented in the current device do not change the intended use, operating principles, or raise any unaddressed safety concerns, with respect to the predicate device, it can be concluded the application NeuroBlate™ System (GE, Siemens, and IMRIS MRI compatible) is substantially equivalent to the predicate NeuroBlate™ System (Siemens, and IMRIS MRI compatible).

#### f. Summary of Supporting Data

Software and bench testing has demonstrated that the System is in compliance with the medical community's expectations and the product labeling. It demonstrates that the NeuroBlate System works as well with the GE MRI's as it does with the Siemens and IMRIS MRI's.

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#### DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

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

July 30, 2013

Monteris Medical, Incorporated % Mr. Craig Coombs Coombs Medical Device Consulting, Incorporated 1193 Sherman Street, Alameda, California 94501

Re: K131955

Trade/Device Name: Monteris Medical NeuroBlate™ System Regulation Number: 21 CFR 878.4810 Regulation Name: Laser surgical instrument for use in general and plastic surgery and in dermatology Regulatory Class: Class II Product Code: GEX, HAW Dated: June 26, 2013 Received: July 01, 2013

Dear Mr. Coombs:

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. 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

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Page 2 - Mr. Coombs

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 contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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.

# Mark N. Melkerson -S

Mark N. Melkerson Acting Director Division of Surgical Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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#### Section 4: Indications for Use

510(k) Number (if known): K131955

Device Name: Monteris Medical NeuroBlate™ System

#### Indications for Use:

The Monteris Medical NeuroBlate™ System is indicated for use to ablate, necrotize, or coagulate soft tissue through interstitial irradiation or thermal therapy in medicine and surgery in the discipline of neurosurgery with 1064 nm lasers.

The Monteris Medical NeuroBlate™ System is intended for planning and monitoring thermal therapies under MRI visualization. It provides MRI based trajectory planning assistance for the stereotaxic placement of MRI compatible (conditional) NeuroBlate™ Laser Delivery Probes. It also provides real time thermographic analysis of selected MRI images.

When interpreted by a trained physician, this System provides information that may be useful in the determination or assessment of thermal therapy. Patient management decisions should not be made solely on the basis of the NeuroBlate™ System analysis.

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

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)

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Neil R Ogden 2013.07.29 09:27:30 -04'00' (Division Sign-off) for MxM Division of Surgical Devices 510(k) Number