Rule2026-18429
Medical Devices; Ear, Nose, and Throat Devices; Classification of the Cooperative Powered Surgical Assist Device for ENT Surgery
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Published
September 10, 2026
Effective
September 10, 2026
Issuing agencies
Health and Human Services DepartmentFood and Drug Administration
Abstract
The Food and Drug Administration (FDA) is classifying the cooperative powered surgical assist device for ear, nose, and throat (ENT) surgery into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for classification of the cooperative powered surgical assist device for ENT surgery. We are taking this action because we have determined that classifying the device into class II will provide a reasonable assurance of the safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.
Full Text
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<title>Federal Register, Volume 91 Issue 174 (Thursday, September 10, 2026)</title>
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[Federal Register Volume 91, Number 174 (Thursday, September 10, 2026)]
[Rules and Regulations]
[Pages 57502-57504]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-18429]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
21 CFR Part 874
[Docket No. FDA-2026-N-9902]
Medical Devices; Ear, Nose, and Throat Devices; Classification of
the Cooperative Powered Surgical Assist Device for ENT Surgery
AGENCY: Food and Drug Administration, HHS.
ACTION: Final amendment; final order.
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SUMMARY: The Food and Drug Administration (FDA) is classifying the
cooperative powered surgical assist device for ear, nose, and throat
(ENT) surgery into class II (special controls). The special controls
that apply to the device type are identified in this order and will be
part of the codified language for classification of the cooperative
powered surgical assist device for ENT surgery. We are taking this
action because we have determined that classifying the device into
class II will provide a reasonable assurance of the safety and
effectiveness of the device. We believe this action will also enhance
patients' access to beneficial innovative devices, in part by reducing
regulatory burdens.
DATES: This order is effective September 10, 2026. The classification
was applicable on July 19, 2023.
FOR FURTHER INFORMATION CONTACT: Vasant Dasika, Center for Devices and
Radiological Health, Food and Drug Administration, 10903 New Hampshire
Ave., Bldg. 66, Rm. 1206, Silver Spring, MD 20993-0002, 301-796-5365,
<a href="/cdn-cgi/l/email-protection#96c0f7e5f7f8e2b8d2f7e5fffdf7d6f0f2f7b8fefee5b8f1f9e0"><span class="__cf_email__" data-cfemail="1a4c7b697b746e345e7b6973717b5a7c7e7b34727269347d756c">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION:
I. Background
Upon request, FDA (the Agency or we) has classified the cooperative
powered surgical assist device for ENT surgery into class II (special
controls), which we have determined will provide a reasonable assurance
of the safety and effectiveness of the device. In addition, we believe
this action will enhance patients' access to beneficial innovation, in
part by reducing regulatory burdens by placing the device into a lower
device class than the automatic class III assignment.
The automatic assignment of class III occurs by operation of law
and without any action by FDA, regardless of the level of risk posed by
the new device. Any device that was not in commercial distribution
before May 28, 1976, is automatically classified into, and remains
within, class III and requires premarket approval unless and until FDA
takes an action to classify or reclassify the device (21 U.S.C.
360c(f)(1)). We refer to these devices as ``postamendments devices''
because they were not in commercial distribution prior to the date of
enactment of the Medical Device Amendments of 1976, which amended the
Federal Food, Drug, and Cosmetic Act (FD&C Act).
FDA may take a variety of actions in appropriate circumstances to
classify or reclassify a device into class I or II. We may issue an
order finding a new device to be substantially equivalent under section
513(i) of the FD&C Act (21 U.S.C. 360c(i)) to a predicate device that
does not require premarket approval. We determine whether a new device
is
[[Page 57503]]
substantially equivalent to a predicate device by means of the
procedures for premarket notification under section 510(k) of the FD&C
Act (21 U.S.C. 360(k)) and part 807 (21 CFR part 807).
FDA may also classify a device through ``De Novo'' classification,
a common name for the process authorized under section 513(f)(2) of the
FD&C Act (see also part 860, subpart D (21 CFR part 860, subpart D)).
Section 207 of the Food and Drug Administration Modernization Act of
1997 (Pub. L. 105-115) established the first procedure for De Novo
classification. Section 607 of the Food and Drug Administration Safety
and Innovation Act (Pub. L. 112-144) modified the De Novo
classification process by adding a second procedure. A device sponsor
may utilize either procedure for De Novo classification.
Under the first procedure, the person submits a premarket
notification (510(k)) for a device that has not previously been
classified. After receiving an order from FDA classifying the device
into class III under section 513(f)(1) of the FD&C Act, the person then
requests a classification under section 513(f)(2).
Under the second procedure, rather than first submitting a 510(k)
and then a request for classification, if the person determines that
there is no legally marketed device upon which to base a determination
of substantial equivalence, that person requests a classification under
section 513(f)(2) of the FD&C Act.
Under either procedure for De Novo classification, FDA is required
to classify the device by written order within 120 days. The
classification will be according to the criteria under section
513(a)(1) of the FD&C Act. Although the device was automatically placed
within class III, the De Novo classification is considered to be the
initial classification of the device.
We believe this De Novo classification will enhance patients'
access to beneficial innovation, in part by reducing regulatory
burdens. When FDA classifies a device into class I or II via the De
Novo process, the device can serve as a predicate for future devices of
that type, including for 510(k)s (see section 513(f)(2)(B)(i) of the
FD&C Act). As a result, other device sponsors do not have to submit a
De Novo request or premarket approval application to market a
substantially equivalent device (see section 513(i) of the FD&C Act,
defining ``substantial equivalence''). Instead, sponsors can use the
less burdensome 510(k) process, when necessary, to market their device.
II. De Novo Classification
On July 22, 2022, FDA received Galen Robotics' request for De Novo
classification of the Galen ES Robotic Surgical Assistant Platform. FDA
reviewed the request in order to classify the device under the criteria
for classification set forth in section 513(a)(1) of the FD&C Act.
We classify devices into class II if general controls by themselves
are insufficient to provide reasonable assurance of the safety and
effectiveness of the device, but there is sufficient information to
establish special controls that, in combination with the general
controls, provide reasonable assurance of the safety and effectiveness
of the device for its intended use (see section 513(a)(1)(B) of the
FD&C Act). After review of the information submitted in the request, we
determined that the device can be classified into class II with the
establishment of special controls. FDA has determined that these
special controls, in addition to the general controls, will provide
reasonable assurance of the safety and effectiveness of the device.
Therefore, on July 19, 2023, FDA issued an order to the requester
classifying the device into class II. In this final order, FDA is
codifying the classification of the device by adding 21 CFR
874.4460.\1\ We have named the generic type of device ``cooperative
powered surgical assist device for ENT surgery,'' and it is identified
as a device that facilitates ENT surgical procedures, including
instrument placement. The device works in conjunction with the
surgeon's movements to assist with precise and stable positioning of an
instrument while maintaining the surgeon's direct physical control of
the instrument.
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\1\ FDA notes that the ``ACTION'' caption for this final order
is styled as ``Final amendment; final order,'' rather than ``Final
order.'' Beginning in December 2019, this editorial change was made
to indicate that the document ``amends'' the Code of Federal
Regulations. The change was made in accordance with the Office of
Federal Register's (OFR) interpretations of the Federal Register Act
(44 U.S.C. chapter 15), its implementing regulations (1 CFR 5.9 and
parts 21 and 22), and the Document Drafting Handbook.
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FDA has identified the risks to health associated with this type of
device and the measures required to mitigate these risks in table 1.
Table 1--Risks to Health and Mitigation Measures for Cooperative Powered
Surgical Assist Devices for ENT Surgery
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Identified risks to health Mitigation measures
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Injury to anatomic structures resulting Simulated use testing; Human
in bleeding or loss of function. factors evaluation; Non-
clinical performance testing;
Software verification,
validation, and hazard
analysis; Labeling;
Electromagnetic compatibility
testing; Electrical safety
testing; Thermal safety
testing; and Biocompatibility
evaluation.
Inability to remove the device Simulated use testing; Non-
expeditiously (e.g., if device becomes clinical performance testing;
sluggish or frozen) resulting in: Software verification,
<bullet> Lack of sufficient control of validation, and hazard
bleeding. analysis; Labeling;
<bullet> Prolonged time for removal and Electromagnetic compatibility
delayed access to critical structures. testing; and Electrical safety
testing.
Infection.............................. Labeling; Simulated-use
testing; Sterilization
validation; and Shelf-life
testing.
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FDA has determined that special controls, in combination with the
general controls, address these risks to health and provide reasonable
assurance of the safety and effectiveness of the device. For a device
to fall within this classification, and thus avoid automatic
classification in class III, it would have to comply with the special
controls named in this final order. The necessary special controls
appear in the regulation codified by this final order.
Under the FD&C Act, submission of a premarket notification under
section 510(k) is required to reasonably assure the safety and
effectiveness of class II devices unless FDA determines that the device
type should be exempt under
[[Page 57504]]
section 510(m) of the FD&C Act. At this time FDA has not made this
determination for cooperative powered surgical assist devices for ENT
surgery. This device is therefore subject to premarket notification
requirements under section 510(k) of the FD&C Act.
III. Analysis of Environmental Impact
The Agency has determined under 21 CFR 25.34(b) that this action is
of a type that does not normally have a significant effect on the human
environment. Therefore, neither an environmental assessment nor an
environmental impact statement is required.
IV. Paperwork Reduction Act of 1995
This final order establishes special controls that refer to
previously approved collections of information found in other FDA
regulations and guidance. These collections of information are subject
to review by the Office of Management and Budget (OMB) under the
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521). The collections
of information in part 860, subpart D, regarding De Novo classification
have been approved under OMB control number 0910-0844; the collections
of information in 21 CFR part 814, subparts A through E, regarding
premarket approval have been approved under OMB control number 0910-
0231; the collections of information in part 807, subpart E, regarding
premarket notification submissions have been approved under OMB control
number 0910-0120; the collections of information in 21 CFR part 820
regarding quality management system regulation have been approved under
OMB control number 0910-0073; and the collections of information in 21
CFR part 801 regarding labeling have been approved under OMB control
number 0910-0485.
List of Subjects in 21 CFR Part 874
Medical devices.
Therefore, under the Federal Food, Drug, and Cosmetic Act and under
authority delegated to the Commissioner of Food and Drugs, 21 CFR part
874 is amended as follows:
PART 874--EAR, NOSE, AND THROAT DEVICES
0
1. The authority citation for part 874 continues to read as follows:
Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371.
0
2. Add Sec. 874.4460 to subpart E to read as follows:
Sec. 874.4460 Cooperative powered surgical assist device for ENT
surgery.
(a) Identification. A cooperative powered surgical assist device
for ear, nose, and throat (ENT) surgery is a device that facilitates
ENT surgical procedures, including instrument placement. The device
works in conjunction with the surgeon's movements to assist with
precise and stable positioning of an instrument while maintaining the
surgeon's direct physical control of the instrument.
(b) Classification. Class II (special controls). The special
controls for this device are:
(1) Simulated-use testing must demonstrate that the device performs
as intended under anticipated conditions of use to successfully assist
in the indicated surgery, including:
(i) Testing in a simulated hospital environment with an
anatomically relevant model;
(ii) Compatibility testing of all indicated instruments;
(iii) Human factors/usability evaluation; and
(iv) Validation of device use by surgeons, including:
(A) The user interface and controller(s);
(B) Compatibility with the ranges of surgeon-applied forces,
torques, speeds, and motion; and
(C) Time required for emergency removal of the device and
associated instruments in the event of power loss or device failure.
(2) Non-clinical performance testing must demonstrate hardware and
system verification, including verification of critical parameters
(including minimum and maximum forces, torques, speeds, and range of
motion).
(3) Software verification, validation, and hazard analysis must be
performed for any software components of the device.
(4) Performance testing must demonstrate the electromagnetic
compatibility, electrical safety, and thermal safety of the device.
(5) All parts or components of the device that enter the sterile
field must be demonstrated to be sterile.
(6) Performance testing must support the shelf life of device
components provided sterile by demonstrating continued sterility,
package integrity, and device functionality over the labeled shelf
life.
(7) All patient-contacting components of the device must be
demonstrated to be biocompatible.
(8) Labeling must include:
(i) Identification of compatible instruments;
(ii) A statement about any training needed prior to use of the
device;
(iii) A summary of all relevant performance testing, including
simulated-use testing; and
(iv) Reprocessing instructions for reusable device components.
Grace R. Graham,
Deputy Commissioner for Policy, Legislation, and International Affairs.
[FR Doc. 2026-18429 Filed 9-9-26; 8:45 am]
BILLING CODE 4164-01-P
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</html>Indexed from Federal Register on September 10, 2026.
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