ArtiSential Trocar

K212500 · Livsmed, Inc. · GCJ · Dec 3, 2021 · Gastroenterology, Urology

Device Facts

Record IDK212500
Device NameArtiSential Trocar
ApplicantLivsmed, Inc.
Product CodeGCJ · Gastroenterology, Urology
Decision DateDec 3, 2021
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 876.1500
Device ClassClass 2

Indications for Use

ArtiSential Trocar has an application in general, abdominal, thoracic, and gynecologic minimally invasive procedures to establish a path of entry for endoscopic instruments.

Device Story

ArtiSential Trocar is a sterile, single-use surgical instrument used in minimally invasive procedures (general, abdominal, thoracic, gynecologic) to create access for endoscopic instruments. The device consists of a main body, cannula, and obturator. An optical element in the obturator allows visualization of tissue layers during insertion when used with an endoscope. A funnel serves as an insertion guide for passive multi-joint surgical instruments. Used by surgeons in clinical settings to establish pneumoperitoneum and provide a conduit for instruments. The device facilitates surgical access and instrument manipulation, potentially reducing trauma and improving procedural efficiency compared to manual entry methods.

Clinical Evidence

Bench testing and animal studies (micro pig) were conducted. Bench tests compared appearance, dimensions, leak testing, tensile strength, pneumoperitoneum maintenance, and instrument manipulation against the predicate. Animal testing evaluated tissue insertion/retention forces, intra-abdominal pressure, and obturator integrity. All tests passed, demonstrating performance equivalent to the predicate.

Technological Characteristics

Materials: Polycarbonate (PC) cannula and obturator. Dimensions: 8mm diameter, 100mm length. Sterilization: Ethylene Oxide (EO) per ISO 11135. Biocompatibility: Tested per ISO 10993-1. Packaging/Shelf-life: Tested per ASTM F88/F88M-15, ASTM F1929, and ISO 11737-2.

Indications for Use

Indicated for patients undergoing general, abdominal, thoracic, or gynecologic minimally invasive procedures requiring a path of entry for endoscopic instruments.

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}------------------------------------------------ Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: on the left, there is a symbol representing the Department of Health & Human Services - USA, and on the right, there is the text "FDA U.S. FOOD & DRUG ADMINISTRATION" in blue. The word "FDA" is in a larger, bolder font than the rest of the text. The overall design is clean and professional, reflecting the FDA's role in regulating food and drugs in the United States. December 3, 2021 LivsMed Inc. Dong Wook Lee Quality Management Representative #304, D-dong, 700, Pangyo-ro, Bundang-gu, 13516 Seongnam-si, Gyeonggi-do Republic of Korea Re: K212500 Trade/Device Name: ArtiSential Trocar Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: Class II Product Code: GCJ Dated: October 18, 2021 Received: October 19,2021 Dear Dong Wook Lee: 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/cfpm/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. {1}------------------------------------------------ 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 and Part 809); medical device reporting (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 (QS) 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 medical devices and radiation-emitting products, including information about labeling regulations, please see Device (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, Long Chen, Ph.D. Assistant Director DHT4A: Division of General Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Ouality Center for Devices and Radiological Health Enclosure {2}------------------------------------------------ # Indications for Use 510(k) Number (if known) K212500 Device Name ArtiSential Trocar Indications for Use (Describe) ArtiSential Trocar has an application in general, abdominal, thoracic, and gynecologic minimally invasive procedures to establish a path of entry for endoscopic instruments. | 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}------------------------------------------------ # 510(k) Summary # 1. General Information | Applicant/Submitter: | LivsMed Inc. | |----------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Address: | #304, D-dong, 700, Pangyo-ro, Bundang-gu, 13516<br>Seongnam-si, Gyeonggi-do, Republic of Korea<br>Tel) +82-70-4282-7652<br>Fax) +82-31-706-3211 | | Contact Person: | Dong Wook Lee / QMR<br>(Quality Management Representative) | | Address: | #304, D-dong, 700, Pangyo-ro, Bundang-gu, 13516<br>Seongnam-si, Gyeonggi-do, Republic of Korea<br>Tel) +82-70-7709-4993<br>Fax) +82-31-706-3211<br>Email) dongwook.livsmed@gmail.com | | Preparation Date: | 11-19-2021 | # 2. Device Name and Code | Device Trade Name | ArtiSential Trocar | |---------------------|----------------------------------------| | Common Name | Sterile Trocars for Endoscopic surgery | | Classification Name | Endoscope and accessories | | Product Code | GCJ | | Regulation Number | 21 CFR 876.1500 | | Classification | Class II | | Review Panel | General & Plastic Surgery | # 3. Predicate Devices ArtiSential Trocar is the same or similar to the device in Table 3.1. - 3.1 Subject Device Description ArtiSential Trocar is for use during endoscopic minimally invasive procedures or to gain access potential spaces for endoscopic instruments. This device is a sterile, single-use instruments consisting of a main body, cannula, obturator. An optical element, which when used with an endoscope, provides visibility of individual tissue layers during insertion. And a funnel serves as an instrument insertion guide and aids in the insertion of a passive multijoint surgical instrument into the cannula. {4}------------------------------------------------ The device falls within Section 876.1500 Endoscope and accessories and is a prescription use only. Table 3.1 Predicate device | Applicant | Device Name | 510(k) Number | |------------------------------------|-----------------------|---------------| | Applied Medical Resources<br>Corp. | Modular Trocar System | K060096 | # 4. Indications for Use - 4.1 Indications for use ArtiSential Trocar has an application in general, abdominal, thoracic, and gynecologic minimally invasive procedures to establish a path of entry for endoscopic instruments. # 5. Technical Characteristics in Comparison to Predicate Devices Table 5.1 Comparison of Proposed device and predicate device | | Proposed<br>device | Predicate<br>device | Substantial<br>Equivalence<br>Assessment | |--------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | 510(K) Number | K212500 | K060096 | N/A | | Manufacture | LivsMed, Inc. | Applied Medical<br>Resources Corp. | N/A | | Device Name | ArtiSential Trocar | Modular Trocar System | N/A | | Clearance Date | N/A | 01-24-2006 | N/A | | Classification /<br>Regulation | Class 2 / 876.1500 | Class 2 / 876.1500 | Same | | Product Code | GCJ | GCJ | Same | | Intended for | Prescription Use | Prescription Use | Same | | Indications for<br>Use | ArtiSential Trocar has an<br>application in general,<br>abdominal, thoracic, and<br>gynecologic minimally<br>invasive procedures to<br>establish a path of entry for<br>endoscopic instruments. | The Applied Medical<br>Modular Trocar System<br>is a sterile single use<br>device, or may be used<br>with a reusable stainless<br>steel or reusable<br>DuraGold® cannula and<br>is intended for use in<br>conjunction with<br>Applied's currently<br>marketed trocar<br>products to establish a<br>path of entry for<br>endoscopic instruments<br>for use during general,<br>abdominal, | Same | | | | | | | | | thoracic minimally<br>invasive procedures or<br>to gain access through<br>tissue planes and/or<br>potential spaces for<br>endoscopic instruments.<br>If utilizing the Applied<br>Medical Optical<br>Separator Obturator<br>with the Modular Trocar<br>System it may be used<br>with or without<br>visualization for primary<br>and secondary<br>insertions. | | | Description | ArtiSential Trocar is for<br>use during endoscopic<br>minimally invasive<br>procedures or to gain<br>access potential spaces for<br>endoscopic instruments.<br>This device is a sterile,<br>single-use instruments<br>consisting of a main body,<br>cannula, obturator. An<br>optical element, which<br>when used with an<br>endoscope, provides<br>visibility of individual<br>tissue layers during<br>insertion.<br>And a funnel serves as an<br>instrument insertion guide<br>and aids in the insertion of<br>a passive multi-joint<br>surgical instrument into the<br>cannula. | The Modular Trocar<br>System is a sterile single<br>use device, intended for<br>use in conjunction with<br>Applied's currently<br>marketed Trocar products.<br>A standard trocar assembly<br>consists of an obturator, a<br>seal and a cannula system.<br>The Modular Trocar<br>System will be available<br>in sizes of 5mm, 8mm,<br>11mm, 12mm and<br>15mm diameter in<br>lengths ranging from<br>55mm to 150mm. | Similar: The<br>description of<br>the proposed<br>ArtiSential<br>Trocar is as<br>same as the<br>predicate<br>devices except<br>for the function<br>of the funnel<br>part, which is an<br>optional feature<br>that the user<br>selects. Also,<br>given the<br>technological<br>characteristics<br>of the proposed<br>ArtiSential<br>Trocar are<br>identical to the<br>predicate<br>products.<br>Design<br>verification and<br>validation<br>testing of the<br>proposed Trocar<br>have provided<br>reasonable<br>assurance that<br>the proposed<br>ArtiSential<br>Trocar are<br>appropriate for<br>the proposed<br>indications for<br>use and can be<br>as safely and<br>effectively used | | | | | as predicate<br>devices. | | Principles of<br>operation | This product is a sterile,<br>single-use product<br>which is composed of<br>main body, cannula,<br>obturator that is<br>generally used in<br>invasive surgery to<br>create passageways for<br>surgery in the abdomen,<br>gynecology, chest,<br>access through tissues,<br>or to make space for<br>endoscopic instruments.<br>The obturator has an<br>optical element applied<br>to visualize the tissue<br>layer during insertion<br>into the body, and a<br>funnel serves as an<br>instrument insertion<br>guide and aids in the<br>insertion of a passive<br>multi-joint surgical<br>instrument into the<br>cannula. | This product consists of<br>a sleeve and an<br>obturator that are<br>generally used in<br>minimally invasive<br>surgery to create a<br>passageway for surgery<br>in the abdomen,<br>gynecology, chest,<br>access through tissue, or<br>to make space for<br>endoscopic instruments.<br>It is a sterile disposable<br>product.<br>The optical type uses a<br>separate obturator with<br>optical elements applied to<br>visualize the tissue layer<br>during insertion, and the<br>shielded bladed type<br>includes a blade. | Similar: The<br>operation<br>principle of the<br>proposed<br>ArtiSential<br>Trocar is as<br>same as the<br>predicate<br>devices except<br>for the function<br>of the funnel<br>part, which is an<br>optional feature<br>that the user<br>selects. Also,<br>given the<br>technological<br>characteristics<br>of the proposed<br>ArtiSential<br>Trocar are<br>identical to the<br>predicate<br>products.<br>Design<br>verification and<br>validation<br>testing of the<br>proposed Trocar<br>have provided<br>reasonable<br>assurance that<br>the proposed<br>ArtiSential<br>Trocar are<br>appropriate for<br>the proposed<br>indications for<br>use and can be<br>as safely and<br>effectively used<br>as predicate<br>devices. | | Physical<br>dimensions and<br>design<br>(diameter, length<br>of Cannula) | -Diameter: 8mm<br>-Length: 100mm | -Diameter: 8mm<br>-Length: 100mm | Same | | Raw Materials | | | Similar | | | -Cannula: Polycarbonate (PC) | -Cannula: Copolyester | : Raw materials | | | -Obturator: Polycarbonate (PC) | -Obturator: Polycarbonate (PC) | of the proposed | | | | | ArtiSential | | | | | Trocar are same | | | | | as the predicate | | | | | device(K060096 | | | | | ), except | | | | | Copolyester of | | | | | the predicate | | | | | device's raw | | | | | material. All | | | | | patient | | | | | contacting | | | | | materials of | | | | | proposed | | | | | ArtiSential | | | | | Trocar have | | | | | been tested per | | | | | the same | | | | | standards of | |…
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