NAVIX ACCESS DEVICE

K093279 · Xlumena · GCJ · Apr 7, 2010 · Gastroenterology, Urology

Device Facts

Record IDK093279
Device NameNAVIX ACCESS DEVICE
ApplicantXlumena
Product CodeGCJ · Gastroenterology, Urology
Decision DateApr 7, 2010
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 876.1500
Device ClassClass 2
AttributesTherapeutic

Indications for Use

The NAVIX Access Device is intended for use as an accessory to cannulate the transgastric or transduodenal wall into a pancreatic pseudocyst, when it is visibly bulging into the gastrointestinal tract during endoscopic procedures.

Device Story

Multi-lumen catheter device; enables creation and dilation of access tract through adjacent tissues. Includes trocar, anchor balloon, and dilation balloon. Exchange-free design allows delivery of multiple tools without guidewire exchange. Used by trained endoscopists during endoscopic procedures. Physician operates device to access pancreatic pseudocysts bulging into gastrointestinal tract. Facilitates therapeutic access; benefits patient by streamlining procedure and reducing need for tool exchanges.

Clinical Evidence

No clinical data. Performance validated via laboratory design durability testing and animal studies in a simulated clinical environment to verify performance to design specifications.

Technological Characteristics

Multi-lumen catheter system comprising a trocar, anchor balloon, and dilation balloon. Exchange-free mechanism. Mechanical device; no energy source or software described.

Indications for Use

Indicated for use by trained endoscopists to cannulate the transgastric or transduodenal wall into a pancreatic pseudocyst that is visibly bulging into the gastrointestinal tract during endoscopic procedures.

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}------------------------------------------------ ## 5. 510(K) SUMMARY Proprietary Name: NAVIX Access Device APR - 7 2010 1693279 Classification Name: KOG - endoscope and/or accessories Common Name: Access Device Manufacturer: Xlumena, Inc. 453 Ravendale Drive, Suite H Mountain View, California 94117 - Contact: Witney McKiernan, RN, MSN Director of Business & Clinical Affairs Xlumena, Inc. 453 Ravendale Drive, Suite H Mountain View, California 94117 (650) 961-9900 x225 Fax: (650) 961-9900 wmckiernan@xlumena.com Preparation Date: October 16, 2009 #### Predicate Devices: The NAVIX Access Device is substantially equivalent to the following currently marketed predicate devices: - (1) Electrocautery Dilation Balloon - K082114 Approved December 19, 2008 Apollo Endosurgery, Inc. Product Code: KNS Regulation: Sec.876.4300 Endoscopic electrosurgical unit and accessories - (2) Wilson-Cook Cystotome - K022595 Approved October 17, 2002 Wilson-Cook Medical Inc. Product Code: KNS Regulation: Sec.876.4300 Endoscopic electrosurgical unit and accessories {1}------------------------------------------------ ### Device Description: The NAVIX Access Device is a multi-lumen catheter device that enables the physician to create and dilate an access tract through adjacent tissues. The NAVIX Access Device is exchange-free in that it delivers multiple tools without the need to exchange these tools over a guidewire. The NAVIX Access Device includes a trocar, an anchor balloon, and a dilation balloon, #### Intended Use: The NAVIX Access Device is intended for use as an accessory to cannulate the transgastic or transcluodenal wall and this a panereally osseudowst, when it is visibly bulging into the gastrointestinalytract during endoscopto procedures ## Technological Characteristics of Substantial Equivalence: The NAVIX Access Device is substantially equivalent to the: - (1) Electrocautery Dilation Balloon - K082114 Approved December 19, 2008 Apollo Endosurgery, Inc. Product Code: KNS Regulation: Sec.876.4300 Endoscopic electrosurgical unit and accessories - (2) Wilson-Cook Cystotome K022595 Approved October 17, 2002 Wilson-Cook Medical Inc. Product Code: KNS Regulation: Sec.876.4300 Endoscopic electrosurgical unit and accessories with regard to materials, safety and efficacy. #### Performance Data: Xlumena performed an analysis of key characteristics of predicates in comparison to key characteristics of the NAVIX Access Device. This analysis has shown that the NAVIX Access Device is substantionally equivalent in characteristics and uses to our predicate devices in combination. Design durability was tested in the laboratory, and animal studies were used to validate performance of the system in a simulated clinical environment as well as verify the performance to design specifications. #### Conclusion: The NAVIX Access Device has the same intended use and utilizes the same fundamental scientific technology as that of the referenced predicate devices. CONFIDENTIAL {2}------------------------------------------------ Image /page/2/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" around the perimeter. Inside the circle is an eagle-like symbol with three talon-like shapes extending from the body. ## DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Food and Drug Administration 10903 New Hampshire Avenue Document Control Room - WO66-G609 Silver Spring, MD 20993-0002 # APR - 7 2010 Ms. Witney Mckiernan, RN, MSN Director of Business and Clinical Affairs Xlumena ----------------------------------------------------------------------------------------------453 Ravendale Drive, Suite H MOUNTAIN VIEW CALIFORNIA 94043 Re: K093279 Trade/Device Name: NAVIX Access Device Regulation Number: 21 CFR §876.1500 · Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: GCJ Dated: March 24, 2010 Received: March 29, 2010 Dear Ms. Mckiernan: 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. 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 {3}------------------------------------------------ Page 2 - 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 go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. 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 (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Sincerely yours, Janine M. Morris Acting Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure {4}------------------------------------------------ # 4. INDICATIONS FOR USE STATEMENT 510(k) Number (if known): ____Not known at this time___ × Device Name: NAVIX Access Device Indications for Use: The XIumena NAVIX Access IDevice is intended for useras an accessory to cannulate the transgastric or transduodenal wall into a pancreativ oseudocyst. When it is visibly bulging into the gastrointestinal tractic furing endoscopic procedures Prescription Use Over-The-Counter Use X 100 AND/OR the trained endoscopis (21 CFR 801 Subpart C) only (Part 21 CFR 801 Subpart D) (PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE) Page of (POSTED NOVEMBER 13, 2003) Signature (Division Sign-Off) Division of Reproductive, Abdominal, and Radiological Devices 510(k) Number. CONFIDENTIAL
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