NIH grant: Improved Surgical Visibility and Navigation during Endoscopic Treatment of Upper Tract Urothelial Carcinoma (1R37CA304606-01A1)

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NIH grant 1R37CA304606-01A1: Improved Surgical Visibility and Navigation during Endoscopic Treatment of Upper Tract Urothelial Carcinoma
Institute: {'code': 'CA', 'abbreviation': 'NCI', 'name': 'National Cancer Institute', 'admin_org_id': '12500008', 'admin_funding_url': ''}. PI: Nicholas L Kavoussi. Award: $603714.
Start: 2026-06-18T00:00:00.
Project Summary
The importance of localizing and treating all upper tract urothelial cancer (UTUC) tumors during a renal sparing,
endoscopic treatment is emphasized by the high risk of cancer progression from inadequate tumor treatment.
Insufficient treatment necessitates kidney and ureteral removal (i.e., nephroureterectomy). Nephroureterectomy
permanently compromises renal function, and increases morbidity and mortality, while negatively impacting a
patient’s quality of life. In contrast, endoscopic treatment (i.e., using a laser to ablate only the tumors) improves
long-term outcomes by sparing healthy kidney tissue. However, endoscopic treatment is underutilized compared
to nephroureterectomy because it is difficult to accomplish. Successful endoscopic treatment is dependent on
the surgeon’s ability to create a mental 3D map of the branched, intrarenal endoscopic anatomy intraoperatively
from preoperative 2D imaging, which is extremely difficult. Since mental mapping relies on hand-eye
coordination, memory, and spatial reasoning, it is inherently imprecise and its impact on accuracy and tumor
treatment is dependent on the surgeon’s experience. To make matters worse, even when tumors are successfully
visualized, the surgeon often cannot accurately assess the location of tumor margins or infer pathologic grade
due to the limited field of view and depth of field (10mm and 6mm on average, respectively) of current scopes.
The scopes only provide visualization of a small part of the surgical field at any instant. These inherent challenges
prevent many surgeons from attempting endoscopic tumor treatment since incomplete treatment leads to a
devastating, oncologic outcome.
Our overall goal is to create an enhanced visualization and navigational system that makes endoscopic UTUC
tumor treatment easier and more accurate for all surgeons, enabling wider utilization. Toward this goal, our
specific objective in this proposal is to test the hypothesis that our system can make endoscopic UTUC surgery
more accurate and efficient. To test this hypothesis, we propose three Specific Aims: Aim 1 involves the
development of an automatic, real-time segmentation and grading system of UTUC tumors during endoscopic
treatment. Aim 2 integrates a 3D navigational map of collecting system anatomy, which includes tumor and
endoscope location, during endoscopic surgery. Aim 3 evaluates the system in patients, with zero risk to the
human subjects. The endpoint of this R01 will be a fully validated enhanced visualization and navigational system
for endoscopic UTUC surgery, which would provide the necessary experimental data towards a large-scale,
multi-center clinical trial and future FDA approval. As our system would require only software integration to
current endoscopic surgical cameras, all existing endoscopic surgical systems could in principle immediately
benefit from the results of this project. In this way, we believe the success of our project will facilitate improved
UTUC treatment and mitigate progression to a higher risk extirpative surgery.

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