FDA Adverse Event Malfunction Summary report: N

VISIONPORT SYSTEM

MDR report key: 16895161 · Received May 8, 2023

Report

Report Number
MW5117394
Event Type
Malfunction
Date Received
May 8, 2023
Date of Event
February 28, 2023
Report Date
May 4, 2023
Manufacturer
NEW VIEW SURGICAL INC.
Product Code
GCJ
Product Problem
Yes
Report Source
Voluntary report
Reporter Location
MA, US
Reporter Occupation
RISK MANAGER
Health Professional
N

Narratives

Description of Event or Problem · 0

THIS 40-YEAR OLD FEMALE PATIENT PRESENTED TO THE EMERGENCY DEPARTMENT ON (B)(6), 2023 AT 11:31 AM WITH COMPLAINT OF ABDOMINAL PAIN SINCE SATURDAY. A CT OF THE ABDOMEN AND PELVIS WITH CONTRAST REVEALED SUSPECTED NONCOMPLICATED EARLY APPENDICITIS. A LAPAROSCOPIC APPENDECTOMY WAS PERFORMED ON (B)(6) 2023 AT (B)(6) HOSPITAL USING THE VISION PORT DEVICE FROM NEW VIEW SURGICAL. THE PATIENT TOLERATED THE PROCEDURE WELL AND WAS DISCHARGED HOME ON (B)(6) 2023. ON (B)(6) 2023, THE OPERATING PHYSICIAN WAS CONTACTED BY A MEMBER OF THE NEW VIEW SURGICAL ENGINEERING TEAM. THEY IDENTIFIED THAT A RETAINED FOREIGN OBJECT, SPECIFICALLY A SILICONE SEAL (P-473, SIZE 3/8 X 3/16 X 1/32) FROM THE OBTURATOR OF THE DEVICE WAS LEFT BEHIND IN THE PATIENT'S OMENTUM AFTER REVIEWING DEVICE PERFORMANCE DATA. THE IDENTIFIED LOT OF THE DEVICE WAS 26053244 (MANUFACTURER DATE OF (B)(6) 2022). THIS SILICONE SEAL IS DESIGNED TO PROTECT THE CAMERA WHEN THE DEVICE IS IN THE CLOSED POSITION AND IS GLUED IN POSITION IN THE OBTURATOR. AS IT IS NOW MORE THAN 1-MONTH POST SURGERY, THE OMENTUM TISSUE HAS LIKELY SURROUNDED AND INCORPORATED THE RETAINED FOREIGN OBJECT (SILICONE SEAL). AS SUCH THE RISK OF REMOVAL WOULD OUTWEIGH THE BENEFITS TO THE PATIENT PER DISCUSSION WITH THE OPERATING PHYSICIAN. THE PATIENT WAS NOTIFIED BY THE OPERATING PHYSICIAN OF THE RETAINED FOREIGN OBJECT ON (B)(6) 2023. THE PHYSICIAN ALSO INFORMED THE PATIENT THAT HE WOULD CONTINUE TO MONITOR THEM.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
686734 VISIONPORT SYSTEM LAPAROSCOPE, GENERAL & PLASTIC SURGERY GCJ NEW VIEW SURGICAL INC. NVSV001 26053244

Patients

Seq Age Sex Outcome Treatment
1 40 YR Female