Cleared Traditional

K921103 - RETRACTION INSTRUMENT

K921103 is an FDA 510(k) clearance for RETRACTION INSTRUMENT, manufactured by Origin Medsystems, Inc.. The device is a Class 2 General & Plastic Surgery device with product code GCJ cleared through the Traditional 510(k) pathway after a 549-day FDA review.

K921103 · Origin Medsystems, Inc. · General & Plastic Surgery device
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Sep 1993
Decision
549d
Days
Class 2
Risk

K921103 is an FDA 510(k) clearance for the RETRACTION INSTRUMENT. Classified as Laparoscope, General & Plastic Surgery (product code GCJ), Class II - Special Controls.

Submitted by Origin Medsystems, Inc. (San Carlos, US). The FDA issued a Cleared decision on September 9, 1993 after a review of 549 days - an unusually long review period, suggesting complex equivalence evaluation.

This device falls under the General & Plastic Surgery FDA review panel, regulated under 21 CFR 876.1500 - the FDA general and plastic surgery device framework. The Traditional 510(k) pathway establishes clearance through substantial equivalence to a legally marketed predicate device, without requiring clinical trial data.

Device pattern: High-complexity regulatory submission. Elevated predicate reliance profile. The extended review timeline suggests the FDA required additional documentation before confirming substantial equivalence - a pattern common in complex or first-of-kind General & Plastic Surgery submissions.

View all Origin Medsystems, Inc. devices

FDA 510(k) Submission Details - K921103

510(k) Number K921103 FDA.gov
FDA Decision Cleared Substantially Equivalent - Traditional 510(k) (SESE)
Date Received March 09, 1992
Decision Date September 09, 1993
Days to Decision 549 days
Submission Type Traditional
Review Panel General & Plastic Surgery (SU)
Summary Statement
Third-party Review No - reviewed directly by FDA
Combination Product No
PCCP Authorized No
Regulatory Context
Review time vs. panel average
434d slower than avg
Panel avg: 115d · This submission: 549d
Pathway characteristics
Predicate-based equivalence. No clinical trials required.

GCJ Device Classification - Class 2, Special Controls

Product Code GCJ Laparoscope, General & Plastic Surgery
Device Class Class 2 - Special Controls
CFR Regulation 21 CFR 876.1500
Definition Validated Reprocessing Instructions And Reprocessing Validation Data For This Device Type Must Be Included In A 510(k) Submission If The Device Is Reusable And Has Specific Design Features (please Refer To Table 2 Of 82 Fr 26807, Available At Https://www.gpo.gov/fdsys/pkg/fr-2017-06-09/pdf/2017-12007.pdf).
What this classification means

Class II devices require demonstration of substantial equivalence to a legally marketed predicate device. This pathway does not require clinical trials - it relies on engineering equivalence and performance data. Most General & Plastic Surgery devices follow this clearance model.

Regulatory Peers - GCJ Laparoscope, General & Plastic Surgery

All 723
Devices cleared under the same product code (GCJ) and FDA review panel - the closest regulatory comparables to K921103.
SURGICAL TROCAR AND CANNULA
K932995 · Applied Medical Resources · Sep 1993
ONE-HANDED ENDOPOUCH SPECIMEN RETRIEVAL BAG
K933104 · Ethicon, Inc. · Sep 1993
AESCULAP MANUAL ENDOSCOPIC INSTRUMENTS
K933076 · Aesculap, Inc. · Sep 1993
LOCKING PIVOTAL THORACOPORT
K930463 · Surgical Technologies, Inc. · Sep 1993
ENDOSCOPE ACCESSORY
K931895 · Applied Medical Resources · Sep 1993
CABOT MEDICAL OPTIMA HAND INSTRUMENTS
K932976 · Cabot Medical Corp. · Sep 1993