SOLTIVE™ Laser System(SOLTIVE™ Pro SuperPulsed Laser, SOLTIVE™ Premium SuperPulsed Laser, SOLTIVE™Laser Fibers, and Accessories)

{0}------------------------------------------------ Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue. Olympus Surgical Technologies America Jon Gilbert Senior Specialist, Regulatory Affairs 136 Turnpike Road Southborough, Massachusetts 01772-2104 August 10, 2019 Re: K183647 Trade/Device Name: SOLTIVE™ Laser System (SOLTIVE™ Pro SuperPulsed Laser, SOLTIVE™ Premium SuperPulsed Laser, SOLTIVE™ Laser Fibers, and Accessories). 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 Dated: July 4, 2019 Received: July 9, 2019 Dear Jon Gilbert: 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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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 {1}------------------------------------------------ requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems. For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100). Sincerely, Neil R.P. Ogden, MS Assistant Director, THT4A4 DHT4A: Division of General Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health Enclosure {2}------------------------------------------------ ## Indications for Use ### 510(k) Number (if known) ### Device Name SOLTIVE™ Laser System (SOLTIVE™ Pro SuperPulsed Laser, SOLTIVE™ Premium SuperPulsed Laser, SOLTIVE™ Laser Fibers, and Accessories). #### Indications for Use (Describe) The SOLTIVE™ Laser System (SOLTIVE™ Pro SuperPulsed Laser, SOLTIVE™ Premium SuperPulsed Laser, SOLTIVE™ Laser Fibers, and Accessories) is incision, excision, resection, ablation, coagulation, hemostasis, and vaporization of soft tissue, with or without an endoscope, in the following indications: urology, lithotripsy, gastroenterological surgery and gynecological surgery. ### Urology · Ablation of Benign Prostatic Hypertrophy (BPH) · Laser Resection of the Prostrate (LRP · Laser Enucleation of the Prostate (LEP) • Laser Ablation of the Prostate (LAP) • Transurethral Incision of the Prostate (TUIP) • Condylomas · Urethral strictures · Lesions of external genitalia · Bladder neck incisions (BNI) • Ablation and resection of bladder tumors, urethral tumors, and ureteral tumors• Endoscopic fragmentation of urethral, ureteral, bladder, and renal calculi • Treatment of distal impacted fragments remaining in the ureters following lithotripsy. ### Lithotripsy and Percutaneous Urinary Lithotripsy Indications · Endoscopic fragmentation of ureteral, bladder and renal calculi including cystine, calcium oxalate, monohydrate and calcium oxalate dehydrate stones• Endoscopic fragmentation of renal calculi• Treatment of distal impacted fragments of steinstrasse when guide wire cannot be passed. Type of Use (Select one or both, as applicable) X Prescription Use (Part 21 CFR 801 Subpart D) Over-The-Counter Use (21 CFR 801 Subpart C) ### CONTINUE ON A SEPARATE PAGE IF NEEDED. This section applies only to requirements of the Paperwork Reduction Act of 1995. ### *DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.* The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to: > Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov "An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number." {3}------------------------------------------------ ## Gastroenterology Open and endoscopic gastroenterology surgery (incision, excision, ablation, vaporization, coagulation and haemostasis) including: - · Appendectomy - Polyps - Biopsv - Gall Bladder calculi - Biliary/Bile duct calculi - · Ulcers - Gastric ulcers - Duodenal ulcers - · Non Bleeding Ulcers - · Pancreatitis - Haemorrhoids - Cholecystectomy - · Benign and Malignant Neoplasm - Gynecology Open and laparoscopic gynecological surgery (incision, resection, ablation, vaporization, coagulation and hemostasis) of soft tissue. Type of Use (Select one or both, as applicable) iption Use (Part 21 CFR 801 Subpart D) ter Use (21 CFR 801 Subpart C) ## CONTINUE ON A SEPARATE PAGE IF NI This section applies only to reguirements of the Paperwork Reduction ## ID YOUR COMPLETED FORM TO THE PRA S The burden time for this collection of information is estimated to avera time to review instructions, search existing data sources, gather and and review the collection of information. Send comments regard of this information collection, including suggestions Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov "An agency may not conduct or sponsor, and a person is r respond to, a collection of information unless it displays a curre - Angiodysplasia - Colorectal cancer - · Telangiectasias - · Telangiectasias of the Osler-Weber-Renu disease - Vascular Malformation - · Gastritis - · Esophagitis - Esophageal ulcers - · Varices - · Colitis - · Mallory-Weiss tear - Gastric Erosions {4}------------------------------------------------ ## 510(k) Summary SOLTIVE™ Laser System (SOLTIVE™ Pro SuperPulsed Laser, SOLTIVE™ Premium SuperPulsed Laser, SOLTIVE™ Laser Fibers, and Accessories) | General Information | IPG Medical<br>50 Old Webster Road,<br>Oxford, MA 01540, USA<br>Phone: (508) 373-1100 | |------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------| | Contract Manufacturer: | | | 510(k) Submitter: | Gyrus ACMI, Inc. 136<br>Turnpike Rd.<br>Southborough, MA 01772-2104<br>Phone: 508-804-2600<br>Fax: 508-804-2624 | | Establishment Registration Number: | 3003790304 | | Contact Person: | Jon Gilbert, consultant fbo<br>Christina Flores<br>Senior Specialist, Regulatory Affairs<br>508-804-2776<br>Christina.Flores@olympus-osta.com | | Date Prepared: | August 8, 2019 | | Device Description | | | Classification Name: | Laser Instrument, Surgical, Powered | | CFR Citation Number: | 21 CFR 878.4810 | | Product Code: | GEX | | Classification: | Class II | | Review Panel | Gastroenterology/Urology | | Trade Name: | SOLTIVETTM Laser System (SOLTIVETTM<br>Pro SuperPulsed Laser, SOLTIVETTM<br>Premium SuperPulsed Laser, SOLTIVETM<br>Laser Fibers, and Accessories) | Laser Instrument for Use in General Surgery K170121 K103654 ## Generic/Common Name: ## Predicate Devices Lumenis P120 StarMedTec, vela XL {5}------------------------------------------------ ## Product Description The SOLTIVE™ Laser System (SOLTIVE™ Pro SuperPulsed Laser, SOLTIVE™ Premium SuperPulsed Laser, SOLTIVE™ Laser Fibers, and Accessories) is a thulium laser, producing a pulsed beam of coherent near-infrared light (1940 nm) upon activation by a footswitch. The beam is then directed to the treatment zone by means of an optical fiber coupled to a handpiece. An integrated touch screen gives the user control over the necessary laser system LED parameters. The URSUS Laser System is equipped with a 550 nm aiming beam. The SOLTIVE Laser System is produced in two models, the SOLTIVE™ Premium SuperPulsed Laser and SOLTIVE™ Pro SuperPulsed Laser. The Premium has a maximum power output of 60 Watts and a maximum Frequency output of 2400 Hz. A secondary, foldable screen is provided. The Pro can operate at a maximum power of 35 Watts and Frequency limited to 100Hz. Both systems are operated with a wireless footswitch or wired footswitch, and both systems can utilize an auxiliary video monitor to display operating parameters. The Premium and Pro Laser must be used with a SOLTIVE Laser Fiber, offered in diameters from 150 - 940 microns. The system includes: - Laser console - Laser fibers - sterile single use and reusable - Foot pedal, wireless or wired - Accessories power cord, HDMI cable, safety goggles/glasses, fiber cutter, fiber cleaver, fiber gripper, sterilization tray, cart The devices do not incorporate medicinal substances, tissues, or blood products. The laser fibers are single-use and reusable, and both single-use and reusable are initially sterilized by Ethylene Oxide. Fibers are compatible with the Olympus endoscope models as listed on the IFU. ## Indications For Use The SOLTIVE™ Laser System (SOLTIVE™ Pro SuperPulsed Laser, SOLTIVE™ Premium SuperPulsed Laser, SOLTIVETM Laser Fibers, and Accessories) is intended for incision, excision, resection, ablation, coagulation, hemostasis, and vaporization of soft tissue, with or without an endoscope, in the following indications: urology, lithotripsy, gastroenterological surgery and gynecological surgery. ## Urology - · Ablation of Benign Prostatic Hyperplasia (Hypertrophy) [BPH] - · Laser Resection of the Prostrate (LRP) - · Laser Enucleation of the Prostate (LEP) - · Laser Ablation of the Prostate (LAP) - · Transurethral Incision of the Prostate (TUIP) - Condylomas - Urethral strictures {6}------------------------------------------------ - Lesions of external genitalia - · Bladder neck incisions (BNI) - · Ablation and resection of bladder tumors, urethral tumors, and ureteral tumors - · Endoscopic fragmentation of urethral, ureteral, bladder, and renal calculi - · Treatment of distal impacted fragments remaining in the ureters following lithotripsy # Lithotripsy and Percutaneous Urinary Lithotripsy Indications · Endoscopic fragmentation of urethral, ureteral, bladder and renal calculi including cystine, calcium oxalate, monohydrate and calcium oxalate dehydrate stones - · Endoscopic fragmentation of calculi - · Treatment of distal impacted fragments of steinstrasse when guide wire cannot be passed # Gastroenterology Open and endoscopic gastroenterology surgery (incision, excision, resection, ablation, vaporization, coagulation and haemostasis) including: - Appendectomy • Gall Bladder calculi • Biliary/Bile duct calculi - Polyps • Ulcers - Biopsv · Gastric ulcers · Pancreatitis · Haemorrhoids • Duodenal ulcers - · Angiodysplasia - Colorectal cancer - · Telangiectasias - · Telangiectasias of the Osler-Weber-Renu disease - Vascular Malformation - Gastritis - · Esophagitis - Esophageal ulcers - · Varices - · Colitis - Mallory-Weiss tear - · Cholecystectomy • Non Bleeding Ulcers - - Benign and Malignant Neoplasm - · Gastric Erosions {7}------------------------------------------------ ## Gynecology Open and laparoscopic gynecological surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis) of soft tissue ## SUBSTANTIAL EQUIVALENCE The intended use and indications for use of the SOLTIVE™ Laser System (SOLTIVE™ Pro SuperPulsed Laser, SOLTIVE™ Premium SuperPulsed Laser, SOLTIVE™ Laser Fibers, and Accessories) are equivalent to the intended use and indications for use of the predicate Lumenis Pulse 120H. In addition, similar technological characteristics and principles of operation apply for both laser systems. The subject device components share the same fundamental technology as the cleared systems. As with the cleared systems the subject devices enable control of the pulse duration. Performance testing was conducted and demonstrated that technological differences in optical and energy outputs of the laser do not alter the safety and effectiveness when compared to the optical and energy outputs of the predicate laser system in bench testing and animal testing/tissue analyses. Given the similarities in technology to predicate laser systems, and considering a) verification testing results that show statistical equivalence to the predicate. b) efficacious and safe use in animal studies by independent surgeons, and c) effective and safe operation as shown through usability studies, it is determined that the subject SOLTIVE™ Laser System is substantially equivalent to the predicate devices. {8}------------------------------------------------ In summary, no different questions of safety and effectiveness have been raised due to the design, manufacturing, or intended use. Test results indicated that the subject SOLTIVE™ Laser System performs in accordance with its requirements and specifications, similar to its predicate device. ## Summary of Non-Clinical Testing Risk analysis activities. in compliance with the requirements of ISO 14971: 2007 Medical devices - Application of Risk Management to Medical Devices Electrical and laser safety and electromagnetic compatibility tests, in compliance with: AAMI / ANSI ES60601-1:2005/(R)2012 and A1:2012. C1:2009/(R)2012 and A2:2010/(R)2012 Medical electrical equipment - Part 1: General requirements for basic safety and essential performance (IEC 60601-1:2005, MOD) IEC60601-1-2 Edition3:2007:Medical electrical equipment-Part1-2:General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests 60601-2-22 Edition 3.1 2012-10: Medical electrical equipment - Part 2-22: Particular requirements for basic safety and essential performance of surgical, cosmetic, therapeutic and diagnostic laser equipment IEC60825-1Edition2.02007-03:Safety of laser products-Part1:Equipment classification, and requirements [Including: Technical Corrigendum 1 (2008), Interpretation Sheet 1 (2007), Interpretation Sheet 2 (2007)] - Software verification and validations, in compliance with FDA Guidance for the Premarket Submissions for Software Contained in Medical Devices (issue on 2005). The tests verified that the subject device performs according to its specifications. - Biocompatibility in compliance with ISO 10993-1:2009/(R)2013: Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process. - Sterilization validation in compliance with and ISO 11135 2nd ed.: 2014 Sterilization of health-care products - Ethylene oxide - Requirements for the development, validation and routine control of a sterilization process for medical devices. - ex-vivo and the in-vivo set ups demonstrate comparable tissue response and device performance. ## Conclusion: In summary, the SOLTIVE™ Laser System (SOLTIVE™ Pro SuperPulsed Laser, SOLTIVE™ Premium SuperPulsed Laser, SOLTIVE™ Laser Fibers, and Accessories) is substantially equivalent to the predicate devices and presents no new questions of safety or effectiveness.