Patent Publication Number: US-2021177530-A1

Title: Multi-stage robot for anatomical structure interventions

Description:
FIELD OF THE INVENTION 
     The present disclosure generally relates to robots for performing various interventional procedures (e.g., aortic valve displacements and mitral valve repairs). The present disclosure specifically relates to a multi-stage robot attachable to a wall of an anatomical structure (e.g., a heart, a stomach, an intestine and a bladder) for facilitating a target positioning of an end-effector within the anatomical structure. 
     BACKGROUND OF THE INVENTION 
     In minimally invasive structural heart disease interventions, the surgeons deploy valves or other devices that correct heart pathologies using X-ray and/or ultrasound guidance. The access to the deployment site is either trans-catheter or trans-apical and the deployment accuracy is very important for the procedure&#39;s success. For example, if an aortic valve is placed too “high”, then the aortic valve may obstruct the coronary arteries. By further example, when a mitral clip used to correct mitral valve regurgitation is deployed, the surgeon has to ensure that the clip catches properly the mitral valve leaflets in order for it to be effective. The challenges of these procedures is to obtain a full imagery of the anatomy and/or to acquire full three-dimensional (“3D”) information and physiological motion of the anatomy (the anatomy is moving with the heart beat and the respiratory cycle). 
     The current minimally invasive approach to treat structural heart diseases relies on manual guidance using fluoroscopy and ultrasound feedback. However, the delineation of the anatomy in such image modalities is hard to identify and is subject to physiological motion of the anatomy. Additionally, a position of the therapy delivery device with respect to the anatomy has to be inferred in real time by the surgeon from available images, and there is no automatic registration of the therapy device to the anatomy or imaging dataset. Furthermore, positioning of the therapy device may be challenging as the conventional approach is to use catheters in a trans-catheter approach or straight sheath in a trans-apical approach. 
     More particularly, in an aortic valve replacement using a trans-apical approach, the surgeon uses a straight sheath for valve delivery. During the intervention, the surgeon has to align the chest incision with the apex of the heart and with the aortic valve. This may be challenging and if repositioning is required, this may apply a stress on the heart&#39;s apex. 
     Using a small slender robot that has sensing at the end-effector has proven to provide positioning accuracy and feedback that is required in such procedures. The sensors on the end-effector will allow for the automatic registration of the robot with respect to the anatomy segmented from preoperative or intraoperative imaging of the robot. Additionally, the robot will allow for automatic adjustment of the device position with respect to the anatomy of interest. These two features allow for more accurate treatment delivery and faster procedures. 
     SUMMARY OF THE INVENTION 
     As an improvement to robots for interventional procedures on anatomical structures (e.g., a heart, a stomach, an intestine and a bladder), the present disclosure describes a multi-stage robot including a non-actuatable positioning stage and an actuatable positioning stage whereby a junction of the two (2) stages is attachable to an incision into the anatomical structure for facilitating a target positioning of an end-effector within the anatomical structure. 
     One embodiment of the inventions of the present disclosure is a multi-stage robot for a target positioning of an intervention tool within an anatomical structure (e.g., a heart). The multi-stage robot comprises a sequential series arrangement of a flexible robot arm, a robot platform, an snake robot arm and an end-effector. In operation, the flexible robot arm, the robot platform, the snake robot arm and the end-effector are introduced through an incision or an anatomical opening into an anatomical region enclosing an anatomical structure (e.g., an incision into a thoracic pericardial cavity enclosing a heart), and the snake robot arm and the end-effector are further introduced through an incision into the anatomical structure (e.g., an incision into the heart). The robot platform is thereafter attached to the incision or the anatomical opening of the anatomical structure to facilitate an actuation of the snake robot arm relative to the robot platform to thereby target position the end-effector within the anatomical structure. 
     A second embodiment of the inventions of the present disclosure is the multi-stage robot further comprising a robot base at the proximal end of the multi-stage robot and attachable to the incision or the anatomical opening into the anatomical region. 
     For purposes of describing and claiming the inventions of the present disclosure: 
     (1) terms of the art of the present disclosure are to be interpreted as known in the art of the present disclosure and exemplary described and/or further defined in the present disclosure. Examples of the terms of the present disclosure include, but not limited to, interventional procedure, intervention tool, anatomical region, anatomical structure, anatomical opening, incision, markers, shape sensors, motion sensors, distance sensors and end-effector; 
     (2) the term “interventional procedure” broadly encompasses all interventional procedures, as known in the art of the present disclosure or hereinafter conceived, for an imaging, a diagnosis and/or a treatment of a patient anatomy; 
     (3) the term “intervention space” broadly encompasses a coordinate space enclosing the interventional procedure as exemplary described in the present disclosure; 
     (4) the term “intervention tool” broadly encompasses, as understood in the art of the present disclosure and hereinafter conceived, a tool, an instrument, a device or the like for conducting an imaging, a diagnosis and/or a treatment of a patient anatomy. Examples of intervention tools include, but are not limited to, scalpels, cauterizers, ablation devices, balloons, stents, endografts, atherectomy devices, clips, needles, forceps, and endoscopes; 
     (5) the term “sequential series arrangement” broadly encompasses an sequential arrangement of components in a series extending from a proximal end of multi-stage robot to a distal end of multi-stage robot as exemplary described herein. Examples of a sequential series arrangement of the present disclosure include (proximal end) flexible robot arm-robot platform-snake robot arm-end-effector (distal end), and (proximal end) robot base-flexible robot arm-robot platform-snake robot arm-end-effector (distal end); 
     (6) the term “robot base” broadly encompasses all intervention accessories or intervention devices, as known in the art of the present disclosure and hereinafter conceived, structured for establishing a proximal point of origin for the multi-stage robot. Examples of robot bases include, but are not limited to, a general purpose positioning robot, a passive positioning arm and a fixture; 
     (7) the term “flexible robot arm” broadly encompasses all flexible cylindrical medical devices utilized in interventional procedures as known in the art of the present disclosure and hereinafter conceived. Examples of flexible robot arms include, but are not limited to, a catheter and passive snake-like robots; 
     (8) the term “robot platform” broadly encompasses all intervention accessories or intervention devices, as known in the art of the present disclosure and hereinafter conceived, structured for attachment to an incision into an anatomical structure. Examples of robot bases include, but are not limited to, a cuff of a flexible robot arm and clips mounted on the flexible robot; 
     (9) the term “snake robot arm” broadly encompasses all robotic arms, as known in the art of the present disclosure and hereinafter conceived, structured for actuating a translation, a rotation, and/or pivoting of an end-effector relative to a robot platform. Examples of snake robot arms include, but are not limited to, serial articulated robot arms structures similar with the ones employed by the da Vinci® Robotic System, the Medrobotics Flex® Robotic System, the Magellan™ Robotic System, and the CorePath® Robotic System; 
     (10) the term “end-effector” broadly encompasses all accessory devices, as known in the art of the present disclosure and hereinafter conceived, for attachment to a snake robot arm for facilitating a performance of a task by the multi-stage robot in support of an intervention procedure within an anatomical structure; 
     (11) the term “target position” broadly encompasses a position for an end-effector within an anatomical structure that facilitates a delivery of an interventional tool by the end-effector within the anatomical structure. 
     (12) the term “target positioning” broadly encompasses all techniques, as known in the art of the present disclosure and hereinafter conceived, for actuating a snake robot arm to position the end-effector at the target position within the anatomical structure. Examples of such techniques include, but are not limited to, image-based guidance of a snake robot arm, image based feedback position control, and image based real time target tracking; 
     (13) the term “adjoined” and any tense thereof broadly encompasses a detachable or a permanent coupling, connection, affixation, clamping, mounting, etc. of components; 
     (14) the term “controller” broadly encompasses all structural configurations, as understood in the art of the present disclosure and as exemplary described in the present disclosure, of an application specific main board or an application specific integrated circuit for controlling an application of various inventive principles of the present disclosure as subsequently described in the present disclosure. The structural configuration of the controller may include, but is not limited to, processor(s), computer-usable/computer readable storage medium(s), an operating system, application module(s), peripheral device controller(s), slot(s) and port(s). A controller may be housed within or linked to a workstation. Examples of a “workstation” include, but are not limited to, an assembly of one or more computing devices, a display/monitor, and one or more input devices (e.g., a keyboard, joysticks and mouse) in the form of a standalone computing system, a client computer of a server system, a desktop or a tablet; 
     (15) the descriptive labels for term “controller” herein facilitates a distinction between controllers as described and claimed herein without specifying or implying any additional limitation to the term “controller”; 
     (16) the term “application module” broadly encompasses an application incorporated within or accessible by a controller consisting of an electronic circuit and/or an executable program (e.g., executable software stored on non-transitory computer readable medium(s) and/or firmware) for executing a specific application; 
     (17) the terms “signal”, “data” and “command” broadly encompasses all forms of a detectable physical quantity or impulse (e.g., voltage, current, or magnetic field strength) as understood in the art of the present disclosure and as exemplary described in the present disclosure for transmitting information and/or instructions in support of applying various inventive principles of the present disclosure as subsequently described in the present disclosure. Signal/data/command communication between components of a coaxial robotic system of the present disclosure may involve any communication method as known in the art of the present disclosure including, but not limited to, signal/data/command transmission/reception over any type of wired or wireless datalink and a reading of signal/data/commands uploaded to a computer-usable/computer readable storage medium; and 
     (18) the descriptive labels for terms “signal”, “data” and “commands” herein facilitates a distinction between signals/data/commands as described and claimed herein without specifying or implying any additional limitation to the terms “signal”, “data” and “command”. 
     The foregoing embodiments and other embodiments of the inventions of the present disclosure as well as various features and advantages of the present disclosure will become further apparent from the following detailed description of various embodiments of the inventions of the present disclosure read in conjunction with the accompanying drawings. The detailed description and drawings are merely illustrative of the inventions of the present disclosure rather than limiting, the scope of the inventions of present disclosure being defined by the appended claims and equivalents thereof. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  illustrates exemplary embodiments of a multi-stage robot and a control network in accordance with the inventive principles of the present disclosure. 
         FIG. 2  illustrates an exemplary embodiment of the multi-stage robot of  FIG. 1  in accordance with the inventive principles of the present disclosure. 
         FIG. 3  illustrates an exemplary embodiment of an intervention system employing the multi-stage robot of  FIG. 2  in accordance with the inventive principles of the present disclosure. 
         FIG. 4  illustrates a flowchart representative of an exemplary embodiment of an intervention method executable by the control network of  FIG. 1  in accordance with the inventive principles of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     To facilitate an understanding of the inventions of the present disclosure, the following description of  FIGS. 1 and 2  teaches basic inventive principles of exemplary embodiments of a multi-stage robot and a control network of the present disclosure. From this description, those having ordinary skill in the art will appreciate how to apply the inventive principles of the present disclosure to making and using numerous and varied embodiments of a multi-stage robot and control network of the present disclosure. 
     Referring to  FIG. 1 , a multi-stage robot  10  of the present disclosure employs a robot base  20 , a flexible robot arm  30 , a robot platform  40 , a snake robot arm  50  and an end-effector  60  for performing an interventional procedure involving an imaging, a diagnosis and/or treatment of an anatomical structure (e.g., a heart, a lung, a stomach, an intestine and a bladder) via a target positioning of end-effector  60  within the anatomical structure. 
     Robot base  20  implements a robot position tracking stage of robot  10  involving robot base  20  serving as a point of origin for a position tracking of robot  10  relative to an imaging modality to thereby facilitate a visualization of end-effector  60  within interventional images of the anatomical structure generated by the imaging modality and/or facilitate an autonomous control by an intervention controller  70  of the target positioning of end-effector  60  within the anatomical structure. 
     In practice, robot base  20  may have a fixed position or a variable position within an intervention space of the interventional procedure. 
     In one embodiment, robot base  20  is affixed to or fixedly positioned relative to the imaging modality within the intervention space as will be further exemplary described in the present disclosure. 
     In a second embodiment, robot base  20  is structured to be attachable to an incision or an anatomical opening into an anatomical region (i.e., a thoracic region, a cranial region, an abdominal region, etc.) enclosing the anatomical structure as will be further exemplary described in the present disclosure. For example, robot base  20  may be attached to an incision into a thoracic pericardial cavity enclosing a heart, an incision into a thoracic pleural cavity enclosing lungs, an incision into an abdominopelvic abdominal cavity enclosing a stomach or an incision into an abdominopelvic pelvic cavity enclosing a bladder. 
     Further in practice, robot base  20  may have a channel  21  for delivery of an intervention tool to end-effector  60  as will be further exemplary described in the present disclosure. 
     Further in practice, robot base  20  may include one or more markers  22  to facilitate an identification of the fixed position or the variable position of robot base  20  within the intervention space. For example, robot base  20  may include marker  22  in the form of an optical marker identifiable within the intervention space by an optical tracker as known in the art of the present disclosure. By further example, robot base  20  may include marker  22  in the form of a fluoroscopic marker identifiable within the intervention space by a fluoroscopic imaging modality as known in the art of the present disclosure. 
     Further in practice, robot base  20  may be omitted from robot  10  whereby any reference within the intervention space may serve as an origin for position tracking robot  10 . 
     Still referring to  FIG. 1 , robot platform  40  implements an end-effector target positioning stage of robot  10  involving robot platform  40  serving as a point of origin for a target positioning of end-effector  60  within the anatomical structure to thereby further facilitate a visualization of end-effector  60  within interventional images of the anatomical structure generated by an imaging modality and/or facilitate an autonomous control by intervention controller  70  of the target positioning of end-effector  60  within the anatomical structure. 
     In practice, robot platform  40  represents a junction between flexible robot arm  30  and snake robot arm  50  and is structured to be attachable to an incision or an anatomical opening into the anatomical structure, whereby flexible robot arm  30  is positioned within the anatomical region external to the anatomical structure and snake robot arm  50  is positioned within the anatomical structure as will be further exemplary described in the present disclosure. 
     Further in practice, robot platform  40  may have a channel  41  for delivery of an intervention tool to end-effector  60  as will be further exemplary described in the present disclosure. 
     Further in practice, robot platform  40  may include one or more motion sensors  42  to facilitate a detection of any physiological motion of the anatomical structure. For example, robot platform  40  may include motion sensors  42  in the form of accelerometers for a detection of any physiological motion of the anatomical structure as known in the art of the present disclosure. 
     Still referring to  FIG. 1 , flexible robot arm  30  implements a non-actuatable positioning stage of robot  10  involving a portion or an entirety of flexible robot arm  30  within the anatomical region extending from an incision or an anatomical opening into the anatomical region to an incision into the anatomical structure. 
     In practice, flexible robot arm  30  is structured for facilitating the attachment of robot platform  40  to the incision into the anatomical structure and has a material composition for following any physiological motion of the anatomical structure as will be further exemplary described in the present disclosure. 
     Further in practice, flexible robot arm  30  may have a channel  31  for delivery of an intervention tool to end-effector  60  as will be further exemplary described in the present disclosure. 
     Further in practice, flexible robot arm  30  includes one or more shape sensors  32  for tracking a shape of flexible robot arm  30  that is representative of a distance between robot base  20  and robot platform  40 , particularly in view of any physiological motion of the anatomical structure. For example, flexible robot arm  30  includes one or more shape sensors  32  in the form of optical shape sensor(s) for tracking a shape of flexible robot arm  30  as known in the art of the present disclosure. 
     In one embodiment, flexible robot arm  30  is an optical shape sensing catheter as will be further exemplary described in the present disclosure. 
     Still referring to  FIG. 1 , snake robot arm  50  implements an actuatable positioning stage of robot  10  involving an actuation of snake robot arm  50  for target positioning end-effector  60  within the anatomical structure for delivery of an intervention tool within the anatomical structure. 
     In practice, snake robot arm  50  may be any type of snake robot arm as known in the art of the present disclosure. 
     In one embodiment, snake robot arm  50  includes a proximal linkage, a distal linkage and optionally including one or more intermediate linkages. Snake robot arm  50  further includes actuator joint(s)  52  interconnecting the linkages in a serial arrangement. Examples of an actuator joint include, but are not limited to, a translational actuator joint, a ball and socket actuator joint, a hinge actuator joint, a condyloid actuator joint, a saddle actuator joint and a rotary actuator joint. 
     Further in practice, snake robot arm  50  may have a channel  51  for delivery of an intervention tool to end-effector  60  as will be further exemplary described in the present disclosure. 
     Further in practice, actuator joints  52  of snake robot arm  50  may be actuatable by any technique known in the art of the present disclosure. 
     In one embodiment, each actuator joint  52  is actuatable by an actuation controller  54  via actuation signals for controlling a location and orientation of each linkage relative to robot platform  40 , and each actuator joint  52  includes a pose sensor of any type (e.g., an encoder) for generating a pose signal informative of the location and orientation of each linkage relative to a robot platform  40 . 
     In a second embodiment, each actuator joint  52  is tendon driven by an operator of robot  10  for controlling an actuation of each linkage, and each actuator joint  52  again includes a pose sensor of any type (e.g., an encoder) for generating a pose signal informative of the location and orientation of each linkage relative to a robot platform  40 . 
     Still referring to  FIG. 1 , end-effector  60  implements a tool delivery stage of robot  10  involving a delivery of an intervention tool from a target location of end-effector within the anatomical structure to conduct an imaging, a diagnosis and/or a treatment of the anatomical structure in accordance with an interventional procedure as known in the art of the present disclosure. 
     In practice, end-effector  60  has a structural form suitable for delivery of one or more particular intervention tools to the target location within the anatomical structure. 
     In one embodiment, end-effector  60  may have a channel  61  for directing the intervention tool within the anatomical structure as known in the art of the present disclosure. For this embodiment, end-effector  60  may be actuatable to translate, rotate and/or pivot channel  61  relative to a distal end of snake robot arm  50  as known in the art of the present disclosure. 
     In a second embodiment, end-effector  60  may have the intervention tool detachably supported by end-effector  60 . For this embodiment, end-effector  60  again may be actuatable to translate, rotate and/or pivot channel  61  relative to a distal end of snake robot arm  50  as known in the art of the present disclosure. 
     Further in practice, end-effector  60  may include one or more distance sensors  62  for measuring distance(s) of end-effector  60  from one or more walls of the anatomical structure to thereby further facilitate a target positioning of end-effector  60  within the anatomical structure. 
     In one embodiment, end-effector  60  includes a distance sensor  62  in the form of a ring ultrasound array for generating a “looking forward” ultrasound image of an interior of the anatomical structure as known in the art of the present disclosure whereby the ultrasound image generated by the ring ultrasound array facilitates the target positioning of end-effector  60  within the anatomical structure and further may be fused with an image of the anatomical structure segmented from pre-operative and/or intraoperative interventional images as known in the art of the present disclosure. 
     In a second embodiment, end-effector  60  includes distance device  62  in the form of a set of one-dimensional forward looking ultrasound probes for generating an image line emanating from end-effector  60  whereby the image line generated by the ultrasound probes also facilitates the target positioning of end-effector  60  within the anatomical structure and further may also be fused with the image of the anatomical structure segmented from pre-operative and/or intraoperative interventional images as known in the art of the present disclosure. More particularly, a dense ultrasound image of the interior of the anatomical structure may be formed from multiple generated image lines as end-effector  60  is moved within the anatomical structure. 
     Still referring to  FIG. 1 , multi-stage robot  10  has a sequential serial arrangement of components  20 ,  30 ,  40  and  50  with (1) robot base  20  being adjoined to a proximal end of flexible robot arm  30 , (2) end-effector  60  being adjoined to a distal end of snake robot arm  50 , and (3) robot platform  40  being adjoined to a distal end of flexible robot arm  30  and/or a proximal end of snake robot arm  50 . With this serial arrangement of components  20 ,  30 ,  40  and  50 , if applicable, channels  21 ,  31 ,  41  and  51  are axially aligned, preferably co-axially aligned, to form a robot channel extending from a proximal end  11  of robot  10  towards a distal end  12  of robot  10  whereby an intervention tool may be extended through the robot channel to end-effector  60 . 
     In practice, components  20 ,  30 ,  40  and  50  of robot  10  may be adjoined in any manner suitable for introducing the robot  10  into the anatomical structure and for implementing each stage of robot  10  as previously described in the present disclosure. 
     In one embodiment, a distal end  27  of robot base  20  is detachably coupled or permanently affixed to a proximal end  36  of flexible robot arm  30 . 
     In a second embodiment, proximal end  36  of flexible robot arm  30  extends into or through channel  21  of robot base  20 , which is clamped to or integrated with flexible robot arm  30 . 
     In a third embodiment, a proximal end of robot platform  40  is detachably connected or permanently affixed to a distal end  37  of flexible robot arm  30  and a distal end  47  of robot platform  40  is detachably connected or permanently affixed to a proximal end  56  of snake robot arm  50  to thereby couple proximal end  37  of flexible robot arm  30  to a distal end  56  of snake robot arm  50 . 
     In a fourth embodiment, distal end  37  of flexible robot arm  30  extends into or through channel  41  of robot platform  40 , which is clamped to or integrated with flexible robot arm  30 , and distal end  37  of flexible robot arm  30  is further detachably connected or permanently affixed to proximal end  56  of snake robot  50 . 
     In a fifth embodiment, proximal end  56  of snake robot arm  50  extends into or through channel  41  of robot platform  40 , which is clamped to or integrated with snake robot arm  50 , and distal end  37  of flexible robot arm  30  further detachably connected or permanently affixed to proximal end  56  of snake robot  50 . 
     In a sixth embodiment, distal end  37  of flexible robot arm  30  is further detachably connected or permanently affixed to proximal end  56  of snake robot  50  within channel  41  of robot platform  40 , which is clamped to the flexible robot arm  30  and the snake robot arm  50 . 
     End-effector  60  is adjoined to snake robot arm  50  in a manner suitable for delivery of the intervention tool as known in the art of the present disclosure. 
     Still referring to  FIG. 1 , a control network for robot  10  includes a shape controller  34 , actuation controller  54  and intervention controller  70 , and may further include a registration controller  24  (applicable if robot base  20  incorporates marker(s)  22 ), a motion controller  44  (applicable if robot platform  40  incorporates motion sensor(s)  42 ) and a tracking controller  64  (applicable if end-effector  60  incorporates distance sensor(s)  62 ). 
     If applicable, an interaction  23  between marker(s)  22  and registration controller  24  is established via a tracking machine (e.g., an optical tracker or an electromagnetic tracker) whereby registration controller  24  controls an operation of the tracking machine for implementing one or more registration techniques as known in the art of the present disclosure involving an identification of marker(s)  22  within the intervention space and a generation by registration controller  24  of registration data  25  informative of a positioning of robot base  20  relative to the imaging modality (e.g., X-ray machine). 
     For example, as previously described, optical markers may be affixed to robot base  20  and the imaging modality whereby registration controller  24  controls an operation of an optical tracker having registration controller  24  installed therein or linked thereto to thereby identify the optical markers within the intervention space and generate the registration data  25 . 
     An interaction  33  between shape sensor(s)  32  and shape controller  34  is established via a shape sensing machine (i.e., an optical integrator for optical shape sensor(s)) and shape controller  34  controls an operation of the shape sensing machine as installed therein or linked thereto for implementing one or more shape sensing techniques as known in the art of the present disclosure involving a determination of a shape of flexible robot arm  30 . 
     For example, for embodiments having shape sensor(s)  32  in the form of optical shape sensor(s) (e.g., optical fiber(s) including Fiber Bragg gratings or a Raleigh scattering), shape controller  34  controls an optical integrator supplying light to the optical shape sensors to thereby determine a shape of flexible robot arm  30  via light transmitted through or reflected back from the optical shape sensors. For this example, the optical shape sensor is integrated into the flexible robot arm  30  as known in the art and extends through or along robot base  20  to the optical integrator, which is connected to a workstation having intervention controller  70  installed therein. 
     If applicable, a wired connection  43  is established between motion sensor(s) and motion controller  44  whereby motion controller  44  receives signals from motion sensor(s)  42  informative of any physiological motion of the incision into the anatomical structure. For this embodiment, the wired connection  43  extends from robot platform  40  sequentially through or along flexible robot arm  30  and robot base  20  to a workstation having motion controller  44  installed therein. 
     A wired connection  53  is established between actuated joints  52  and actuation controller  54  whereby actuation controller  54  receives pose signals informative of a pose (i.e., orientation and/or location) of each linkage of snake robot arm  50  relative to robot platform  40  as known in the art of the present disclosure and generates pose data  55  from the pose signals. Additionally, actuation controller  54  may control an operation of actuated joints  52  via wired connection  53 . For this embodiment, the wired connection  53  extends from snake robot arm  50  sequentially through or along robot platform  40 , flexible robot arm  30  and robot base  20  to a workstation having actuation controller  54  installed therein. 
     If applicable, an interface  63  between distance devices  62  and tracking controller  64  is established via an ultrasound machine whereby tracking controller  64  controls an operation of distance sensors  62  via the ultrasound machine to thereby generate tracking data  65  informative of a position of end-effector  60  within the interior of the anatomical structure. For example, as previously discussed, distance sensor(s)  62  may in the form of a ring ultrasound array or a set of 1D ultrasound probes whereby tracking controller  64  energies the ultrasound elements via the ultrasound machine to thereby generate tracking data  65  in the form of ultrasound images. For this embodiment, the wired connection  63  extends from end-effector  60  sequentially through or along snake robot arm  50 , robot platform  40 , flexible robot arm  30  and robot base  20  to a workstation having tracking controller  64  installed therein. 
     Intervention controller  70  implements the interventional procedure by controlling a display of preoperative and/or interoperative intervention images  80  (e.g., X-ray, CT, MRI, etc.) of the anatomical structure in accordance with a preoperative plan for a target positioning end-effector  60  within the anatomical structure as known in the art of the present disclosure, which may include a fusion of any generated ultrasound image of the interior of the anatomical structure. 
     In one embodiment, intervention controller  70  displays a position of end-effector  60  within intervention images  80  of the anatomical structure as indicated from all of the data. 
     In a second embodiment, intervention controller generates an overlay of end-effector  60  (and a portion or an entirety of snake robot arm  50 ) onto intervention images  80  as indicated from all of the data. 
     Intervention controller  70  may further control an actuation of snake robot arm  50  as known in the art of present disclosure via actuation commands  72  derived from a conformance or any deviation in accordance with a preoperative plan of a target positioning on end-effector  60  within the anatomical structure as indicated by all the data. 
     In practice, all of the controllers of  FIG. 1  may be installed on a same workstation, or distributed in any manner among a plurality of workstations. 
     Further in practice, all of the controllers of  FIG. 1  may be segregated as shown, or two (2) or more of the controllers may be fully or partially integrated. 
     To further understand multi-stage robot  10 ,  FIG. 2  illustrates an embodiment  110  of robot  10  as introduced into a left ventricle chamber LV of a heart to perform an aortic valve replacement of aortic valve AV. 
     Referring to  FIG. 2 , robot  110  includes a robot base  120 , a flexible robot arm  130  in the form of an optical shape sensing catheter, a robot platform  140 , a snake robot arm  150  and an end-effector  160 . 
     Robot base  120  is a proximal cuff of flexible robot arm  130  and is attached to an incision of a chest wall CW of a thoracic pericardial cavity TPC via a suture. Alternatively, robot base  120  may be a launch device for the optical shape sensing catheter that is affixed externally to the thoracic pericardial cavity TPC to a reference point in the intervention space whereby flexible robot arm extends into the entry of the chest wall CW of the thoracic pericardial cavity TPC. 
     Robot platform  130  is a distal cuff of flexible robot arm  130  and is attached to an incision into the left ventricle chamber LV of the heart via a suture. 
     Flexible robot arm  130  flexibly extends within the thoracic pericardial cavity between robot base  120  and robot platform  140 . 
     Snake robot arm  150  is adjoined to robot platform  130  and extends into the left ventricle chamber LV of the heart. 
     End-effector  160  is adjoined to snake robot arm  150  and actuatable to be translated and/or pivoted relative to snake robot arm  150 . 
     A position of end-effector  160  within the left ventricle chamber LV of the heart is derived from (1) a registration of robot base  120  to a corresponding imaging modality, (2) a sensed shape of flexible robot arm  130 , (3) a sensed physiological motion of the left ventricle chamber LV (if applicable), (4) a pose of each linkage of snake robot arm  150  relative to robot platform  140 , and (5) an ultrasound imaging of the interior of the left ventricle chamber LV (if applicable). 
     As such, snake robot arm  150  may be actuated, manually or via intervention controller  70  ( FIG. 1 ), as needed for a target positioning of end-effector  160  relative to the aortic valve AV via a preoperative plan to thereby deliver the valve replacement via a balloon as known in the art of the present disclosure. 
     In practice, robot base  120  may be omitted whereby flexible robot arm  130  is sutured to the incision into the chest wall CW of the thoracic pericardial cavity and proximally extends to a reference within the intervention space. 
     To facilitate a further understanding of the inventions of the present disclosure, the following description of  FIGS. 3 and 4  teaches basic inventive principles of exemplary embodiments of an intervention system and an intervention method incorporating a multi-stage robot and a control network of the present disclosure. From this description, those having ordinary skill in the art will appreciate how to apply the inventive principles of the present disclosure to making and using numerous and varied embodiments of an intervention system and an intervention method incorporating a multi-stage robot and a control network of the present disclosure. 
     Referring to  FIG. 3 , an intervention system  15  is provided to perform an interventional procedure on a heart  202  of a patient  201  resting on an operating table  200 . To this end, intervention system  15  incorporates multi-stage robot  110  as previously presented in the description of  FIG. 2 . Intervention system  15  further incorporates a control network  310  including registration controller  24 , shape controller  34 , motion controller  44 , actuation controller  54 , tracking controller  64  and intervention controller  74  as previously presented in the description of  FIG. 1 . 
     In practice, control network  310  may be distributed throughout intervention system  15 . 
     In one embodiment, control network  310  is operated by a workstation  300  including an arrangement of a monitor  301 , a keyboard  302  and a computer  303  as known in the art of the present disclosure. 
     As installed on computer  303 , control network  310  includes processor(s), memory, a user interface, a network interface, and a storage interconnected via one or more system buses. 
     Each processor may be any hardware device, as known in the art of the present disclosure or hereinafter conceived, capable of executing instructions stored in memory or storage or otherwise processing data. In a non-limiting example, the processor may include a microprocessor, field programmable gate array (FPGA), application-specific integrated circuit (ASIC), or other similar devices. 
     The memory may include various memories, as known in the art of the present disclosure or hereinafter conceived, including, but not limited to, L1, L2, or L3 cache or system memory. In a non-limiting example, the memory may include static random access memory (SRAM), dynamic RAM (DRAM), flash memory, read only memory (ROM), or other similar memory devices. 
     The user interface may include one or more devices, as known in the art of the present disclosure or hereinafter conceived, for enabling communication with a user such as an administrator. In a non-limiting example, the user interface may include a command line interface or graphical user interface that may be presented to a remote terminal via the network interface. 
     The network interface may include one or more devices, as known in the art of the present disclosure or hereinafter conceived, for enabling communication with other hardware devices. In an non-limiting example, the network interface may include a network interface card (NIC) configured to communicate according to the Ethernet protocol. Additionally, the network interface may implement a TCP/IP stack for communication according to the TCP/IP protocols. Various alternative or additional hardware or configurations for the network interface will be apparent\ 
     The storage may include one or more machine-readable storage media, as known in the art of the present disclosure or hereinafter conceived, including, but not limited to, read-only memory (ROM), random-access memory (RAM), magnetic disk storage media, optical storage media, flash-memory devices, or similar storage media. In various non-limiting embodiments, the storage may store instructions for execution by the processor or data upon with the processor may operate. For example, the storage may store a base operating system for controlling various basic operations of the hardware. The storage stores one or more application modules in the form of executable software/firmware for implementing the various functions of control network  310  as previously presented in the description of  FIG. 1 . 
     In practice, the controllers of control network  310  may be partially or wholly integrated within computer  303 . 
     Still referring to  FIG. 3 , in a second embodiment, a controller of control network  310  may be installed on a different workstation/machine of intervention system  15 . 
     For example, intervention system  15  may include an imaging modality  400  for generating preoperative and/or intraoperative intervention images of heart  202 , and intervention controller  70  may be partially or fully installed within a workstation of imaging modality  400  for controlling an operation of imaging modality  400 . Examples of imaging modality  400  include, but are not limited to, a stand-alone x-ray imaging system, a mobile x-ray imaging system, an ultrasound imaging system (e.g., TEE, TTE, IVUS, ICE), computed tomography (“CT”) imaging system, positron emission tomography (“PET”) imaging system, and magnetic resonance imaging (“MRI”) system. 
     By further example, intervention system  15  may include a position tracker  410  for identifying the markers of the robot base  120  of robot  110  and imaging modality  400 , and registration controller  24  may be partially or fully installed within a workstation of position tracker  410  for controlling an operation of position tracker  410 . 
     By further example, intervention system  15  may include an optical integrator  430  for sensing a shape of the flexible robot arm  130  of robot  110 , and shape controller  34  may be partially or fully installed within a workstation of optical integrator  430  for controlling an operation of optical integrator  430 . 
     By further example, intervention system  15  may include an ultrasound apparatus  440  for energizing any ultrasound sensors of the end-effector of robot  110 , and tracking controller  64  may be partially or fully installed a workstation of ultrasound apparatus  440  for controlling an operation of ultrasound apparatus  440 . 
     Still referring to  FIG. 3 , via a connection to the robot base of robot  110 , a cable connector  320  may be utilized to connect the sensors, actuators and/or encoders of robot  110  to computer  303 , imaging modality  400 , position tracker  410 , optical integrator  430  and ultrasound apparatus  440  as needed. 
       FIG. 4  illustrates a flowchart  500  representative of an intervention method executed by control network  310  (FIG.) for implementing the interventional procedure. 
     Referring to  FIGS. 3 and 4 , a stage S 502  of flowchart  500  is directed to preparation acts by control network  310  necessary for implementing the interventional procedure. 
     In one embodiment of S 502 , registration controller  24  as commanded by intervention controller  70  or via an operator of position tracker  410  controls an execution of a registration of imaging modality  400  and robot base  120  of multi-stage robot  110 . For example, registration controller  24  operates position tracker  410  to identify a position of marker(s) affixed to imaging modality  400  and robot base  120  of robot  110  whereby registration controller  24  or intervention controller  70  execute a registration technique as known in the art of the present disclosure. 
     Additionally, if end-effector  160  of robot  110  includes ultrasound capability, tracking controller  74  as commanded by intervention controller  70  or via an operator of ultrasound machine  440  controls an execution of an ultrasound imaging of the left ventricle chamber of heart  202 . For example, tracking controller  74  operates ultrasound machine  440  to energize the ultrasound transducers of end-effector  160  of robot  110  whereby tracking controller  74  or intervention controller  70  execute a generation of ultrasound images of the left ventricle chamber of heart  202  as known in the art of the present disclosure and to further execute an image based registration of an interventional images of the left ventricle chamber of heart  202  generated by imaging modality  400  and the ultrasound images of the left ventricle chamber of heart  202  generating by the ultrasound transducers of end-effector  160 . 
     Still referring to  FIGS. 3 and 4 , a stage S 504  of flowchart  500  is directed to interoperative acts by control network  310  necessary for implementing the interventional procedure. 
     In one embodiment of stage S 504 , intervention controller  70  processes data received from all of the sensors and encoders of robot  110  to determine an initial position of end-effector  160  of robot  110  within the left ventricle chamber of heart  202 . More particularly, a position of end-effector  160  within the left ventricle chamber LV of the heart may be derived from (1) a registration of robot base  120  to a corresponding imaging modality, (2) a sensed shape of flexible robot arm  130 , (3) a sensed physiological motion of the left ventricle chamber LV (if applicable), (4) a pose of each linkage of snake robot arm  150  relative to robot platform  140 , and (5) an ultrasound imaging of the interior of the left ventricle chamber LV (if applicable). 
     From the initial position determination of end-effector  160  of robot  110 , intervention controller  70  controls a display of an intervention image  304  of the left ventricle chamber of heart  202 . In practice, intervention image  304  may be a preoperative or an intraoperative image whereby an overlay of robot  110  may be provided on image  304  based on a position of end-effector  160  of robot  110  within the left ventricle chamber of heart  202  determined by intervention controller  70 . Alternatively, intervention image  304  may be an intraoperative image whereby intervention controller  70  provides an indication of a position of end-effector  160  of robot  110  within the left ventricle chamber of heart  202  determined by intervention controller  70 . Concurrently, an ultrasound image generated from any ultrasound transducers of end-effector  160  may be fused with intervention image  304  of the left ventricle chamber of heart  202 . 
     At this point, there are two (2) general modes of snake robot arm actuation. 
     The first mode involves intervention controller  70  controlling an actuation of snake robot arm  150  of robot  110  to position end-effector  160  at or relative to a target position for an intervention tool within the left ventricle chamber of heart  202  in accordance with a preoperative plan as known in the art of the present disclosure. 
     The second mode involves an operator of workstation  300  manually actuating snake robot arm  150  of robot  110  to position end-effector  160  at or relative to a target position for an intervention tool within the left ventricle chamber of heart  202  in accordance with a preoperative plan as known in the art of the present disclosure. 
     For either mode, intervention controller  70  facilitates any adjustments to the preoperative plan via intervention controller  70  or the operator as necessary for end-effector  160  at or relative to an original target position or new target position for an intervention tool within the left ventricle chamber of heart  202 . 
     Upon end-effector  160  reaching the target position, the aortic valve replacement is delivered for treatment of the aortic valve as known in the art of the present disclosure. 
     While  FIGS. 3 and 4  were described in terms of an aortic valve replacement by a robot  110  ( FIG. 2 ), those having ordinary skill in the art will appreciate how to apply the inventive principles of the present disclosure to robot  110  and additional embodiments of a multi-stage robot of the present disclosure for implementing an aortic valve replacement or any other type of interventional procedure for an anatomical structure. 
     Referring to  FIGS. 1-4 , those having ordinary skill in the art of the present disclosure will appreciate numerous benefits of the inventions of the present disclosure including, but not limited to, a multi-stage robot facilitating an accurate registration of an end-effector within an anatomical structure that improves upon an efficient of imaging, diagnostic and/or treatment delivery of an intervention tool to the anatomical structure. 
     Furthermore, as one having ordinary skill in the art will appreciate in view of the teachings provided herein, features, elements, components, etc. described in the present disclosure/specification and/or depicted in the Figures may be implemented in various combinations of electronic components/circuitry, hardware, executable software and executable firmware and provide functions which may be combined in a single element or multiple elements. For example, the functions of the various features, elements, components, etc. shown/illustrated/depicted in the Figures can be provided through the use of dedicated hardware as well as hardware capable of executing software in association with appropriate software. When provided by a processor, the functions can be provided by a single dedicated processor, by a single shared processor, or by a plurality of individual processors, some of which can be shared and/or multiplexed. Moreover, explicit use of the term “processor” should not be construed to refer exclusively to hardware capable of executing software, and can implicitly include, without limitation, digital signal processor (“DSP”) hardware, memory (e.g., read only memory (“ROM”) for storing software, random access memory (“RAM”), non-volatile storage, etc.) and virtually any means and/or machine (including hardware, software, firmware, circuitry, combinations thereof, etc.) which is capable of (and/or configurable) to perform and/or control a process. 
     Moreover, all statements herein reciting principles, aspects, and embodiments of the invention, as well as specific examples thereof, are intended to encompass both structural and functional equivalents thereof. Additionally, it is intended that such equivalents include both currently known equivalents as well as equivalents developed in the future (e.g., any elements developed that can perform the same or substantially similar function, regardless of structure). Thus, for example, it will be appreciated by one having ordinary skill in the art in view of the teachings provided herein that any block diagrams presented herein can represent conceptual views of illustrative system components and/or circuitry embodying the principles of the invention. Similarly, one having ordinary skill in the art should appreciate in view of the teachings provided herein that any flow charts, flow diagrams and the like can represent various processes which can be substantially represented in computer readable storage media and so executed by a computer, processor or other device with processing capabilities, whether or not such computer or processor is explicitly shown. 
     Furthermore, exemplary embodiments of the present disclosure can take the form of a computer program product or application module accessible from a computer-usable and/or computer-readable storage medium providing program code and/or instructions for use by or in connection with, e.g., a computer or any instruction execution system. In accordance with the present disclosure, a computer-usable or computer readable storage medium can be any apparatus that can, e.g., include, store, communicate, propagate or transport the program for use by or in connection with the instruction execution system, apparatus or device. Such exemplary medium can be, e.g., an electronic, magnetic, optical, electromagnetic, infrared or semiconductor system (or apparatus or device) or a propagation medium. Examples of a computer-readable medium include, e.g., a semiconductor or solid state memory, magnetic tape, a removable computer diskette, a random access memory (RAM), a read-only memory (ROM), flash (drive), a rigid magnetic disk and an optical disk. Current examples of optical disks include compact disk-read only memory (CD-ROM), compact disk-read/write (CD-R/W) and DVD. Further, it should be understood that any new computer-readable medium which may hereafter be developed should also be considered as computer-readable medium as may be used or referred to in accordance with exemplary embodiments of the present disclosure and disclosure. 
     Having described preferred and exemplary embodiments of novel and inventive multi-stage robots (which embodiments are intended to be illustrative and not limiting), it is noted that modifications and variations can be made by persons having ordinary skill in the art in light of the teachings provided herein, including the Figures. It is therefore to be understood that changes can be made in/to the preferred and exemplary embodiments of the present disclosure which are within the scope of the embodiments disclosed herein. 
     Moreover, it is contemplated that corresponding and/or related systems incorporating and/or implementing the device or such as may be used/implemented in a device in accordance with the present disclosure are also contemplated and considered to be within the scope of the present disclosure. Further, corresponding and/or related method for manufacturing and/or using a device and/or system in accordance with the present disclosure are also contemplated and considered to be within the scope of the present disclosure.