The Delta™ 2000 Series of Extracorporeal Lithotripter is intended to fragment urinary stones in the kidney (renal pelvis and renal calyces) and ureter (upper, middle, and lower ureter).
Device Story
Delta™ 2000 Series Lithotripter is an extracorporeal shock wave lithotripter used in hospitals by clinicians. It utilizes spark gap technology to generate shock waves; electrical discharge between two electrodes submerged in water causes rapid vapor expansion. This shock wave is focused by an ellipsoidal reflector. The device is positioned so the second focal point of the reflector aligns with the patient's kidney or ureteral stone. Repeated shock wave impacts cause stone disintegration. The system operates via 120 VAC power. Clinicians use the device to non-invasively treat urinary calculi, potentially benefiting patients by avoiding invasive surgery.
Clinical Evidence
No clinical data provided. Substantial equivalence is based on technological characteristics, bench testing, and compliance with recognized safety standards (UL-2601, IEC 60601-2-36, IEC 61846).
Indicated for patients requiring fragmentation of urinary stones located in the kidney (renal pelvis and renal calyces) or ureter (upper, middle, and lower).
Regulatory Classification
Identification
An extracorporeal shock wave lithotripter is a device that focuses ultrasonic shock waves into the body to noninvasively fragment urinary calculi within the kidney or ureter. The primary components of the device are a shock wave generator, high voltage generator, control console, imaging/localization system, and patient table. Prior to treatment, the urinary stone is targeted using either an integral or stand-alone localization/imaging system. Shock waves are typically generated using electrostatic spark discharge (spark gap), electromagnetically repelled membranes, or piezoelectric crystal arrays, and focused onto the stone with either a specially designed reflector, dish, or acoustic lens. The shock waves are created under water within the shock wave generator, and are transferred to the patient's body using an appropriate acoustic interface. After the stone has been fragmented by the focused shock waves, the fragments pass out of the body with the patient's urine.
Special Controls
*Classification.* Class II (special controls) (FDA guidance document: “Guidance for the Content of Premarket Notifications (510(k)'s) for Extracorporeal Shock Wave Lithotripters Indicated for the Fragmentation of Kidney and Ureteral Calculi.”)
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# APR 2 9 2002
K013471
PAGE / UF 2
## EXHIBIT 2 510(k) Summary of Safety and Effectiveness E.S.W.L. Products, Inc. 1542 Barclay Blvd. Buffalo Grove, IL 60089 USA Tel 1+847-419-6844 Fax 1+847-419-6881 Contact: Christopher Nowacki, President
October 17, 2001
- 1. Identification of the Device: Proprietary-Trade Name: "Delta™ 2000" Series Lithotripter. Classification Name/Product Code: 78 LNS Common/Usual Name: Extracorporeal Shock Wave Lithotripter
- 2. Equivalent legally marketed devices: Dornier Compact Alpha Lithotripter, K002929; EDAP Technomed Sonolith Praktis, K003529; Storz Modulith Lithotripter Model SLK, K010340.
- Indications for Use (intended use) The Delta™ 2000 Series Lithotripter is intended 3. to fragment urinary stones in the kidney (renal pelvis and renal calyces) and ureter (upper, middle, and lower ureter).
- 4. Description of the Device: The DELTA lithotripter utilizes well known spark gap technology. To generate a shock wave utilizing this method, an electrical discharge is created between two electrodes submerged in water. This sudden discharge of the enormous amount of energy lasts less than 1 microsecond. During this time an evaporation of water surrounding the gap between the electrodes occurs. The evaporation causes an instant expansion of vapor which produces a shock wave. In an extracorporeal lithotripter, the two wire electrodes are embedded in a plastic tube filled with insulating material. On one end of the tube the tips of the wire are bent towards each other with a small gap between them. A source of electrical energy is connected to each wire on the other end of this tubular structure. This electrode assembly is placed inside an ellipsoidal reflector in such a way that the gap between the two conductors coincides with the first focal point of the reflector. The reflector is filled with water and covered with a thin elastic membrane. After discharging the energy, reflected shock waves are transmitted to the second focal point through noncompressible medium, such as water in the reflector and in human tissue. The energy generated at the first focal point is recaptured at the second focal point of the ellipsoidal reflector with only minimal losses. When the second focal point is positioned on the treatment area such as the kidney stone inside the body, the repeated impact of the shock waves on the stone, at various energy levels, causes its disintegration.
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K013471
PAGE 2 OF 2
| Comparison Areas | EDAP Technomed Sonolith | "Delta™ 2000" Series |
|----------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------|
| | Praktis, K003529 | Lithotripter |
| Indications for use | Intended to fragment urinary<br>stones in the kidney (renal<br>pelvis and renal calyces) and<br>ureter (upper, middle, and<br>lower ureter). | SAME |
| Where used | Hospitals | SAME |
| Standards compliance | a. UL-2601 and IEC 60601<br>b. IEC 60601-2-36, "Medical<br>electrical equipment - Part 2:<br>Particular requirements for the<br>safety of equipment for<br>extracorporeally induced<br>lithotripsy" (1997).<br>c. IEC 61846, "Ultrasonics -<br>Pressure pulse lithotripters -<br>Characteristics of fields" (1998).<br>d. EMC: Compliance with IEC<br>60601-1-2 will be maintained,<br>except during the triggering and<br>generation cycle of the<br>PRESSURE PULSE release | SAME |
| Technology | Extracorporeal shock wave,<br>spark. | SAME. |
| Power Source | 120 VAC 50-60~ 15 amp<br>outlet | SAME |
- 5. Safety and Effectiveness, comparison to predicate device:
- Conclusion: In all material respects, the "Delta™ 2000" Series Lithotripter is 6. substantially equivalent to one or more products of similar description. Testing, certifications, and clinical experience demonstrates that the device is equivalent to the EDAP Technomed Sonolith Praktis, K003529, currently on the market. The "Delta™ 2000" Series Lithotripter meets the requirements of Guidance for the Content of Premarket Notifications (510(k)s) for Extracorporeal Shock Wave Lithotripters Indicated for the Fragmentation of Kidney and Ureteral Calculi, Document issued on August 9, 2000
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### DEPARTMENT OF HEALTH & HUMAN SERVICES
Rockville MD 20850
E.S.W.L. Products, Inc. c/o Daniel Kamm, P.E. Regulatory Engineer Kamm & Associates, Inc. P.O. Box 7007 DEERFIELD IL 60015
Re: K013471
Trade/Device Name: Delta™ 2000 Series Extracorporeal Lithotripter Regulation Number: 21 CFR 876.5990 Regulation Name: Extracorporeal shock wave lithotripter Regulatory Class: II Product Code: 78 LNS Dated: February 20, 2002 Received: February 21, 2002
Dear Mr. Kamm:
We have reviewed your Section 510(k) premarket notification of intent to market the device we nave reviewed your becaon 3 re(x) presidentially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate for use stated in the encrosure) to regars actment date of the Medical Device Amendments, or to conniter co pror to may 20, 1978, the ecordance with the provisions of the Federal Food, Drug, devices that have been receasined in assee approval of a premarket approval application (PMA). and Cosmetic (110-) that to novice, subject to the general controls provisions of the Act. The r ou may, aference, manner of the Act include requirements for annual registration, listing of general controls provisions of tactice, 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 additional controls. Existing major regulations affecting your device can be It may be subject to additional come of the 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 I loase of advised that I Dris issum that your device complies with other requirements of the Act that I DA has made a dolorimiations administered by other Federal agencies. You must of any I ederal statures than ogenements, including, but not limited to: registration and listing comply with an the Hel Frequirement Bart 801); good manufacturing practice requirements as set (21 CFR Part 007), advening (21 CFR Part 820); and if applicable, the electronic forth in the quant) by events (sections 531-542 of the Act); 21 CFR 1000-1050.
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This letter will allow you to begin marketing your device as described in your 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 If you desire specific ac at one of the following numbers, based on the regulation number at the top of this letter:
| 8xx.1xxx | (301) 594-4591 |
|----------------------------------|----------------|
| 876.2xxx, 3xxx, 4xxx, 5xxx | (301) 594-4616 |
| 884.2xxx, 3xxx, 4xxx, 5xxx, 6xxx | (301) 594-4616 |
| 892.2xxx, 3xxx, 4xxx, 5xxx | (301) 594-4654 |
| Other | (301) 594-4692 |
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" (21 CFR Part 807.97). Other general information on by rolerence to premiumed 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,
Nancy Brogdon
Nancy C. Brogdon Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health
Enclosure
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## 10. Indications for Use
K013471 510((k) Number________________________________________________________________________________________________________________________________________________________________
The Delta™ 2000 Series of Extracorporeal Lithotripter is intended to fragment urinary stones in the kidney (renal pelvis and renal calyces) and ureter (upper, middle, and lower ureter).
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| | Concurrence of CDRH, Office of Device Evaluation (ODE) |
|--|--------------------------------------------------------|
|--|--------------------------------------------------------|
| Prescription Use | |
|------------------|--|
|------------------|--|
OR
| Over the Counter Use | |
|----------------------|----------------------|
| | (Per 21 CFR 801.109) |
Nancy Brogdon
(Division Sign-Off)
Division of Reproductive, Abdominal,
and Radiological Devices
| 510(k) Number | K013471 |
|---------------|---------|
|---------------|---------|
8
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