inforMED
MalfunctionDWQ

TRIVEX SYSTEM RESECTOR HANDPIECE

Received Oct 24, 2019 · Event occurred Sep 24, 2019

Report 1220948-2019-00145 · MDR key 9235123

Device

Generic name

Handpiece

Catalog number

7210387

Product problems

  • Power Problem
  • Power Problem

Patient

Not reported

  • No Known Impact Or Consequence To Patient
  • No Known Impact Or Consequence To Patient

Narrative

Additional Manufacturer Narrative

WE HAVE RECEIVED THE COMPLAINT DEVICE FOR EVALUATION. HOWEVER, WE WERE UNABLE TO CONFIRM THE REPORTED INCIDENT. WE HAVE INSPECTED THE HOUSING AND POWERCABLE OF THE HANDPIECE AND FOUND THEM TO BE ACCEPTABLE. DEVICE OPERATED PROPERLY ON ALL SETTINGS AND FUNCTIONS. HOWEVER, UPON DISASSEMBLY, WE OBSERVED MOISTURE INSIDE THE CORE TUBE THAT HAD PENETRATED INTO THE ADHESIVE OF THE PC BOARD. WE ALSO OBSERVED CORROSION ON THE HEAT SINK AND MOTOR. WE HAVE IMPLEMENTED A CORRECTIVE AND PREVENTIVE ACTION (CAPA) TO ADDRESS THIS ISSUE. BASED ON OUR INVESTIGATION, WE HAVE UPDATED THE DESIGN OF THE HANDPIECE WATER SEALS, WHICH WILL BETTER PREVENT WATER AND STEAM FROM ENTERING INTO THE INNER COMPONENTS OF THE HANDPIECE. THERE WAS NO INJURY TO THE PATIENT AS THE RESULT OF THIS INCIDENT. SURGEON REPLACED THE HANDPIECE TO COMPLETE THE REMAINING PROCEDURE.

Description of Event or Problem

DURING PROCEDURE, THE RESECTOR OF THE HANDPIECE STOPPED SPINNING. HOWEVER, AFTER FEW ATTEMPTS, SURGEON WAS ABLE TO GET THE DEVICE TO WORK PROPERLY.