| Catalog Number |
60-5274-132 |
| Medical Device Problem Code |
Detachment of Device or Device Component (2907)
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| Health Effect - Clinical Code |
No Clinical Signs, Symptoms or Conditions (4582)
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| Date of Event |
09/30/2024
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Type of Reportable Event
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Malfunction
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Additional Manufacturer Narrative
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The reported device is being returned to conmed for evaluation.A supplemental and final report will be filed following the completion of the device evaluation and complaint investigation.We will continue to monitor for trends through the complaint system to assure patient safety.
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Event or Problem Description
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Conmed japan reported on behalf of their customer that the device, 60-5274-132, laparoscopic electrode with eschar-resistant coating was being used on (b)(6) 2024 during a laparoscopic cholecystectomy and ¿during use, the electrode tip came off.The part that fell into the body was retrieved.In the first device, the electrode came off while being wiped outside the body.Therefore, the facility replaced it to the same new device.However, the replaced electrode came off inside the patient's body while it was being replaced and used.The detached electrode was retrieved with forceps.¿.The procedure was completed with an alternate same device.This report is being raised due to the reported malfunction with potential for injury upon reoccurrence.
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Event or Problem Description
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Conmed japan reported on behalf of their customer that the device, 60-5274-132, laparoscopic electrode with eschar-resistant coating was being used on (b)(6) 2024 during a laparoscopic cholecystectomy and ¿during use, the electrode tip came off.The part that fell into the body was retrieved.In the first device, the electrode came off while being wiped outside the body.Therefore, the facility replaced it to the same new device.However, the replaced electrode came off inside the patient's body while it was being replaced and used.The detached electrode was retrieved with forceps.¿ the procedure was completed with an alternate same device.This report is being raised due to the reported malfunction with potential for injury upon reoccurrence.
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Additional Manufacturer Narrative
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Received two 60-5274-132 in opened original packaging.Lot number was verified.Performed a visual inspection, the tips are missing from the devices and were returned separately.There is evidence on the electrodes of soldering.A root cause cannot be determined, however, based upon the evaluation of the device and the photos, a likely cause may be due to excessive force being used during removal of eschar from the tip.A two-year lot history review shows a total of 3 devices for this lot number and failure mode.The manufacturing documents from the device history record have been reviewed with special attention to the manufacturing and inspection of the product.The product released for distribution was found to have met all specifications prior to shipment.A two-year review of complaint history revealed there has been a total of 28 reports, regarding 29 devices, for this device family and failure mode.During this same time frame (b)(4) devices have been manufactured and shipped worldwide.Should all the complaint devices have been found confirmed for this reported failure, the rate of failure would be (b)(4).Per the instructions for use, the user is advised the following: to avoid potential damage to trocar seals and to the electrosurgical tip, always slide the tip shield in the covered and locked position during insertion into the trocar cannula.Misuse of this or any other electrosurgical device can result in a patient injury.Read and become familiar with all instructions and directions before using this device.During trocar insertion, always have the electrode tip covered to avoid potential damage to trocar seals and the electrode tip.We will continue to monitor for trends through the complaint system to assure patient safety.
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Search Alerts/Recalls
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