Importance
Few gynecologic surgeons understand the mechanism by which surgical instruments are approved for human use and marketing or do they appreciate the central role they play in postmarket surveillance and reporting after instruments have come to market.
Objective
Using the experience with the uterine morcellator, this review will detail the Food and Drug Administration (FDA) system for approving surgical instruments and the potential pitfalls of this process.
Evidence Acquisition
Literature review and public documents from the FDA.
Results
The FDA 510(k) approval process for surgical instruments relies largely on postmarket surveillance as exemplified by the uterine power morcellator, which was approved before sufficient evidence was available regarding its potential harms.
Conclusions
The current system currently transfers the responsibility of ensuring safety and efficacy to the public, patients, and providers. To minimize potential harm, the FDA needs to incorporate a greater standard of evidence into its framework for the approval and regulation of medical devices. The burden of these requirements should be borne at least in part by the companies bringing equipment to market.
Relevance
It is incumbent on all surgeons to be vigilant in their objective critical assessment of new instrumentation and report their outcomes after they come to market.
Target Audience
Obstetricians and gynecologists, family physicians
Learning Objectives
Physicians should be better able to: Identify the challenges associated with the current 510(k) process; Distinguish between the roles of the initial approval and postmarketing surveillance of surgical products and their safety; and Evaluate the efficacy of new surgical modalities and products.
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