Patent Publication Number: US-2023157530-A1

Title: Devices and methods for treatment of body lumens

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of priority from U.S. Provisional Application No. 62/713,669, filed on Aug. 2, 2018, which is incorporated by reference herein in its entirety. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates generally to devices and methods for diagnosing and/or treating tissue using, for example, endoscopes, bronchoscopes, and ureteroscopes. More specifically, aspects of the present disclosure pertain to devices and methods for positioning and/or visualizing medical devices within body lumens of a subject. 
     BACKGROUND 
     Endoscopic, bronchoscopic, or ureteroscopic techniques may be used for diagnosing, treating, and/or monitoring conditions by advancing tools and other devices through body lumens. However, it may be difficult to perform procedures in certain body lumens due to a narrow diameter of the lumen. For example, it may be difficult to obtain a biopsy or to treat a nodule or lesion in the periphery of the lungs, due to an inability to visualize the periphery lumen using traditional endoscopes. Typical therapeutic and diagnostic endoscopes may be limited in how many generations of the bronchi they are able to navigate due to their relatively large outer diameter of approximately 6 mm or greater. Many current procedures for obtaining a biopsy of a nodule or lesion in the fifth or higher generation of the bronchi tend to be done blind because of the lack of an optics system compatible with biopsy devices and small enough to provide visualization of peripheral airways. A lack of visualization may lead to (a) low yields and/or (b) increased procedure time resulting from a user&#39;s needing to spend additional time to ensure that a tool is positioned in the correct location. 
     SUMMARY 
     Examples of the present disclosure relate to, among other things, devices and methods for positioning and/or visualizing medical devices within body lumens of a subject. Each of the examples disclosed herein may include one or more of the features described in connection with any of the other disclosed examples. 
     A medical device may comprise a handle portion; an insertion portion having a proximal end portion at the handle portion, wherein the insertion portion includes a lumen therein and a distal end having a distal opening in communication with the lumen; and a member disposed within the lumen, the member having a distal end portion with an imaging device. The member may be configured to transition between a first configuration and a second configuration. In the first configuration, the imaging device may face distally, and, in the second configuration, the imaging device may face proximally. Extending the distal end portion of the member distally past the distal opening may cause the member to transition from the first configuration to the second configuration. 
     Any medical device described herein may include one or more of the features described below. The member may include a flat shaft having a cross sectional width greater than a thickness and having at least one substantially planar outer surface. The shaft may be ribbon shaped. The imaging device may be disposed on a side surface of the member. On the first configuration, the distal end portion of the member may form approximately a right angle relative to a more proximal portion of the member. In the second configuration, the distal end portion of the member may form a curl shape. The member may be configured to transition between the first configuration and the second configuration by moving the member longitudinally relative to the lumen. A proximal portion of the member may be coupled to a hub. The hub may be configured to effect longitudinal movement of the member relative to the lumen as the hub translates relative to the handle portion. The lumen may be in communication with a first proximal opening in the handle portion and with a second proximal opening in the handle portion. A tool may be insertable into at least one of the first and second opening. A first proximal lumen and a second proximal lumen may join to form the lumen. The member may rest against a side surface of the lumen so that a tool may be disposed in the lumen along with the member. In the first configuration, a side surface of the lumen may engage a surface of the member. The member may transition from the first configuration to the second configuration due to a shape memory of the member. The insertion portion may further comprise a second lumen. 
     A method of treatment may comprise: advancing an insertion portion of a medical device in a body lumen of a subject; visualizing the body lumen using an imaging device of a member, wherein the member is disposed in a lumen of the insertion portion, and wherein the imaging device faces distally out of a distal opening of the lumen; moving the member longitudinally relative to the lumen, causing the imaging device to be located distally of the distal opening of the lumen and to face proximally; after moving the member, visualizing the body lumen using the imaging device; inserting a tool into the lumen of the insertion portion; and performing a procedure using the tool. 
     Any method described herein may include one or more of the features or steps described below. Moving the member may include sliding a hub at a proximal portion of the member, relative to a handle portion of the medical device. The member may include a flat shaft having a cross sectional width greater than a thickness and having at least one substantially planar outer surface. The shaft may be ribbon shaped. After moving the member, a distal end portion of the member may form a curl shape. A second tool may be inserted into a second lumen of the member. 
     A medical device may comprise: a member having a shaft, an imaging device, and an anchor member; a tool having a shaft; and a tether, comprising: a first surface, wherein the first surface is configured so as to slidably engage with the shaft of the member; and a second surface, wherein the second surface is configured so as to engage with the shaft of the tool to secure the tether to the tool as the tether slides relative to the member. 
     Any medical device described herein may include one or more of the features described below. The member may be configured to transition between a first configuration and a second configuration. In the first configuration, the imaging device may face distally. On the second configuration, the imaging device may face proximally. The first surface may define a first lumen for engaging the shaft of the member, and the second surface may define a second lumen for engaging the shaft of the tool. A surface of the tether may include an opening in communication with at least one of the first and second lumens. The anchor member may include at least one of the following: an inflatable member, a clip, and a coil. A steering mechanism may have a shaft. The second surface may be configured so as to engage with the steering mechanism to secure the tether to the steering mechanism as the tether slides relative to the member. 
     It may be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention, as claimed. As used herein, the terms “comprises,” “comprising,” or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements, but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. The term “exemplary” is used in the sense of “example,” rather than “ideal.” The term “endoscope” may be used herein but is not limiting. References to endoscopes may also include other medical devices, including, but not limited to, bronchoscopes and ureteroscopes. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate examples of the present disclosure and together with the description, serve to explain the principles of the disclosure. 
         FIG.  1    shows a schematic cross-section of an exemplary device in a first configuration. 
         FIG.  2    shows a schematic cross-section of an exemplary device in a second configuration. 
         FIG.  3    shows a schematic view of a distal portion of an exemplary device in a first configuration. 
         FIG.  4    shows a schematic view of a distal portion of an exemplary device in a second configuration. 
         FIG.  5    shows a schematic view of a distal portion of an exemplary device in a body lumen. 
         FIG.  6    shows a schematic view of a further exemplary device in a body lumen. 
         FIGS.  7 A- 7 C  show cross-sectional schematic views of exemplary tethering devices. 
         FIGS.  8 A- 8 B  show cross-sectional schematic views of a first exemplary anchoring mechanism. 
         FIGS.  9 A- 9 B  show cross-sectional schematic views of a second exemplary anchoring mechanism. 
         FIGS.  10 A- 10 B  show cross-sectional schematic views of a third exemplary anchoring mechanism. 
         FIGS.  11 A- 11 C  show exemplary steering mechanisms. 
     
    
    
     DETAILED DESCRIPTION 
     The present disclosure is drawn to devices, systems, and/or methods for diagnosing and/or treating tissue using, for example, endoscopes, bronchoscopes, and ureteroscopes. More specifically, aspects of the present disclosure pertain to devices and methods for positioning and/or visualizing tools and/or devices within body lumens of a subject. In particular, in at least some aspects, the devices and methods disclosed herein may provide for visualization of an area of interest in a narrow passageway such as a bronchus. The devices and methods disclosed herein may facilitate advancement of tools to a visualized area of interest. Although respiratory anatomy may be referenced herein, reference to respiratory anatomy should not be construed as limiting possible applications of the disclosed devices and methods. The disclosed devices and methods may be suitable for use in a variety of portions of a subject&#39;s body, including, for example, urological organs or the digestive system. 
       FIGS.  1 - 2    depict a medical device  10 , which may have an insertion portion  12  and a handle portion  14 . A proximal end portion of insertion portion  12  may be connected to a distal portion of handle portion  14 . Insertion portion  12  may be disposed distally of handle portion  14  relative to an operator of device  10 . Medical device  10  may be a device, such as an endoscope, ureteroscope, bronchoscope, or other type of scope, catheter, or sheath. Insertion portion  12  may be inserted into a subject. For example, insertion portion  12  may be inserted into a body lumen of a subject. Insertion portion  12  may be an elongate member such as a shaft and may have a longitudinal axis. Insertion portion  12  may be steerable by any suitable mechanism. 
     Insertion portion  12  may have a distal end portion  16 , including a distal end face  18 . A lumen  20  may be within insertion portion  12 . For example, lumen  20  may extend from a proximal portion of insertion portion  12  to distal end portion  16  of insertion portion  12 . A longitudinal axis of lumen  20  may be coaxial with or parallel to a longitudinal axis of insertion portion  12 . Lumen  20  may lead to a distally-facing opening  22  in distal end face  18 . Lumen  20  may also include a first proximal portion  24 , which may extend into handle portion  14 . Lumen  20  may also include a second proximal portion  26 . For example, lumen  20  may diverge into two proximal portions  24  and  26  at a y-shaped or otherwise shaped junction. Proximal portion  24  may lead to an opening  28  in handle portion  14 . Proximal portion  26  may lead to an opening  30  in handle portion  14 . Thus, lumen  20  may be bifurcated, with two separate access points (opening  28  and opening  30 ) providing access to lumen  20 . 
     Insertion portion  12  may also optionally include a second lumen  40 . Second lumen  40  may lead to a distal opening  42  in distal end face  18 . Second lumen  40  may also lead to an opening  44  in handle portion  14 . In addition or in an alternative, second lumen  40  may lead to openings  28  and/or  30 . 
     A member  50  may be inserted in lumen  20 . Member  50  may have an elongated shape. Member  50  may extend from proximal portion  24  of lumen  20  toward opening  22 . Member  50  may be flat or ribbon-shaped. In an alternative, member  50  may not be flat but may have a first flat surface and a second flat surface. Side surfaces connecting the flat surfaces may be short so that member  50  is substantially flat. In an alternative, member  50  may have a circular, polygonal, ovular, or other cross-section. Member  50  may be made at least partially from nitinol and may be made from a nitinol ribbon. Member  50  may exhibit shape memory. 
     Member  50  may include a distal portion  52 . Distal portion  52  of member  52  may include a camera portion  54 . Camera portion  54  may be disposed on a surface of distal portion  52  of member  50 . Signal cables may be operative to provide power to camera portion  54 , provide control signals to camera portion  54 , and/or retrieve images from camera portion  54 . Such signal cables may be adhered or otherwise attached to a surface of member  50  or embedded within member  50 . For example, signal cables may extend from a proximal portion of member  50  toward distal portion  52  of member  50 . Member  50  may also include other electronics, such as illumination components. For example, member  50  may include one or more light emitting diodes (LEDs) such as surface LEDs, printed LEDs, or other suitable devices. 
     A proximal portion of member  50  may be coupled to a hub  60 . Hub  60  may be formed of any suitable material, such as the same material comprising member  50  or a material comprising handle portion  14 . Hub  60  may be slidably disposed in a mating cavity  62  of handle portion  28 . Hub  60  may have a clearance fit with mating cavity  62 . One or more cables  70  may extend from a proximal portion of hub  60  and may provide power and/or control signals to camera portion  54  and/or transmit image data from camera portion  54 . Cables  70  may extend through or along hub  60  and along member  50  from a proximal portion of member  50  toward a distal portion  52  of member  50 . In addition or in an alternative, cables  70  may be electrically coupled to other cables which extend through or along hub  60  and/or along member  50 . 
     Sliding hub  60  relative to handle portion  14  and insertion portion  12  may cause movement of member  50  relative to handle portion  14  and/or insertion portion  12 . For example, sliding movement of hub  60  proximally or distally may cause member  50 , including distal portion  52  of member  50 , to move longitudinally (proximally or distally, respectively) relative to insertion portion  12 . Hub  60  may be connected to an actuator for effecting such sliding motion, or a user may effect a sliding motion via hub  60  alone. Longitudinal movement of member  50  via, e.g., hub  60 , may cause member  50  to transition from a first configuration ( FIG.  1   ) to a second configuration ( FIG.  2   ). In a first configuration ( FIG.  1   ), a distal portion  52  of member  50 , including camera portion  54 , may be located at or near opening  22  of lumen  20 . For example, distal portion  52  and/or camera portion  54  may be slightly longitudinally proximal to opening  22 , aligned with opening  22 , or slightly distal to opening  22 . In the first configuration, distal portion  54  may curve upward so that distal portion  54  forms roughly a right angle with respect to more proximal portions of member  50 , as shown in  FIG.  1   . In such a configuration, camera portion  54  may face distally away from distal face  18 , out of opening  22 . 
     In a second configuration ( FIG.  2   ), distal portion  52  of member  50 , including camera portion  54 , may be located distally of opening  22  of lumen  20 . In the second configuration, distal portion  52  of member  50  may be curved upward and backward (in the proximal direction). In either the first or the second configuration, member  50  may curve smoothly, so that no sharp angles are formed in member  50 . In an alternative, member  50  may include angled and/or hinged portions in distal portion  52 . In the second configuration, camera portion  54  may face proximally, toward handle  14 . A proximal orientation of camera portion  54  may also include other directional components. For example, in addition to facing proximally, camera portion  54  may also face an upward or downward direction (a direction transverse to the longitudinal axis of member  50 ). For example, in  FIG.  2   ., proximally-facing camera portion  54  also faces upward in a direction transverse to the axis. In the second configuration, member  50  may roll or curl back on itself by at least 180 degrees with camera portion  54  mounted on an outward-facing surface of member  50  near an end of the formed curl. 
     Member  50  may be biased to assume the shape of the second configuration or, in other words, member  50  may be biased so that camera portion  54  faces proximally. For example, member  50  may have shape memory. When member  50  is in the first configuration, the size and shape of lumen  20  may prevent member  50  from facing proximally. For example a portion of distal portion  52  may interact with an interior surface of lumen  20  and/or opening  22 . For example, a distal edge of member  50  may interact with a top surface, a bottom surface, and/or a side surface of lumen  20  and/or opening  20 . Movement of hub  60 , which may be connected to a proximal portion of member  50 , may cause member  50  to transition from the first configuration to the second configuration, and from the second configuration to the first configuration. When hub  60  is moved distally, member  50  may transition to the second configuration. For example, member  50  may transition due to removal of engagement of distal end portion  52  with one or more inner surfaces of lumen  20  and/or opening  22 . Member  50  may transition due to shape memory or other biasing of member  50 . When hub  60  is moved proximally, member  50  may transition to the first configuration. For example, proximal movement of member  50  may cause member  50  to partially unwind due to, for example, engagement of distal end portion  52  with one or more surfaces of lumen  20  and/or opening  22 . Hub  60  may be omitted, and another actuation mechanism may be used to transition member  50  from the first configuration to the second configuration and from the second configuration to the first configuration. 
       FIG.  3    shows a close-up of distal end portion  16  with member  50  in the first configuration. Distal end portion  52  of member  50  may be oriented so that camera portion  54  faces distally out of opening  22 . Distal end portion  52  may lie in a plane that is transverse to the longitudinal axis of insertion portion  12  and to the longitudinal axis of a proximal portion of member  50 . Distal end portion  52  may lie in a plane that is parallel or substantially parallel to a plane of opening  22 . As shown in  FIG.  3   , opening  42  of lumen  40  may be transverse to distal end face  18 . For example, opening  42  may be an elongate opening which is disposed both on a side surface of insertion portion  12  and on a distal end face  18 . For example, opening  42  may open to the side and distally. 
       FIG.  4    shows a close-up of distal end portion  16  in the second configuration. Distal end portion  52  of member  50  may be oriented so that camera portion  54  faces proximally and is extended distally of opening  22 . Proximally-facing camera portion  54  may also face to the side, in this case upwardly. As shown in  FIGS.  2  and  4   , when member  50  is in the second configuration, member  50  may occupy only a small portion of lumen  20  and opening  22  so that a tool  102  may be inserted in lumen  20  along with member  50 . For example, member  50  may lie along one side of lumen  20  such as a bottom side of lumen  20 . Tool  102  may be any of a variety of tools for use in a body lumen of a patient. For example, tool  102  may be a probe such as an ultrasound probe, radio frequency probe, and/or cryogenic probe. Tool  102  may also be a forceps, a snare, a basket, a tome, a suction device, or any other type of diagnostic or therapeutic tool. The examples above are not exclusive; any type of tool or accessory may be used. The fact that tool  102  may be inserted into lumen  20  along with member  50  may mean that a diameter of insertion portion  12  may be smaller than conventional scopes because one lumen can be used for both a member  50  including camera portion  54  and a tool  102 . A smaller diameter of insertion portion  12  may allow use of insertion portion  12  in narrower body lumens. For example, insertion portion  12  may be inserted into a subject&#39;s lungs, whereas other types of medical devices may be limited as to how far they can extend into a body lumen such as bronchial passages. In addition, because tool  102  and member  50  are narrower than insertion portion  12 , they may reach further into body passages than insertion portion  12  may reach. 
     As also shown in  FIG.  4   , another tool  104  may be inserted into lumen  40  and may extend out of opening  44 . Tool  104  may include any of the tools described in connection with tool  102 . Tool  104  may exit opening  40  at an angle transverse to a longitudinal axis of insertion portion  12 . Alternatively, tool  104  may exit opening  40  parallel to a longitudinal axis of insertion portion  12 . 
       FIG.  5    depicts medical device  10  in a body lumen. The body lumen shown in  FIG.  5    is a bronchial lumen; however, device  10  may be used in any body lumen. Device  10  may optionally be used in conjunction with an introduction device  150 . Introduction device  150  may be a scope, such as an endoscope, ureteroscope, bronchoscope, duodenoscope, or any other type of scope, catheter, or sheath. Introduction device  150  may have a larger diameter than device  10 . Introduction device  150  may include a lumen  152 . Lumen  152  may be sized so as to allow passage of medical device  10  through lumen  152 . Introduction device  150  may also include other lumens  154 ,  156  through which other devices may be passed. Introduction device  150  may be advanced to a certain portion of a body lumen. Introduction device  150  may reach a point in a body lumen where device  150  is too large in diameter to pass further into the body lumen. Insertion portion  12  may be further advanced into the lumen. The small diameter of insertion portion  12  may facilitate advancing insertion portion  12  into a further and/or narrower portion of a body lumen than other scopes could reach. For example, as described above with regard to  FIG.  4   , because tool  102  and member  50  may occupy the same lumen  20 , an outer diameter of insertion portion  12  may be smaller than if two separate lumens were required for tool  102  and member  50 . 
     When a distal end portion  16  of device  10  is proximal of an area of interest, member  50  may be advanced into the second configuration, as shown in  FIG.  5   . In the second configuration, camera portion  54  may be directed toward an area of interest in a body lumen. For example, as shown in  FIG.  5   , an area of interest may be located between a distal face  18  of insertion portion  12  and distal portion  52  of member  50 . Camera portion  54  may, for example, capture images of a side surface of a body lumen and/or of a central portion of a body lumen, proximal to a location of camera portion  54 . Tool  102  may be deployed toward the area of interest. Tool  104  ( FIG.  4   ) may also be deployed toward the area of interest. Tools  102  and/or  104  may be used to perform therapeutic and/or diagnostic procedures on an area of interest in a body lumen. 
       FIG.  6    shows another embodiment according to the present disclosure, which may be used in conjunction with or in an alternative to the aspects described above with regard to  FIGS.  1 - 5   . As shown in  FIG.  6   , a distal portion of a medical device  200  may include an insertion portion  210 . Insertion portion  210  may have any of the qualities of insertion portion  12  or introduction device  150 , described above. Insertion portion  210  may include a camera  212  to provide imaging of a body lumen of a subject. Insertion portion  210  may also include other features, such as illumination features (not shown). Insertion portion  212  may include a lumen  214 . Lumen  214  may have any of the qualities of, for example, lumen  152 . 
     A member  220  may be inserted through lumen  214  and may extend out of an opening at a distal end of lumen  214  and on a distal face of insertion portion  212 . Member  220  may have any of the qualities of member  50 , described above. In an alternative, member  220  may have differing qualities from member  50 . For example, member  220  may have a round cross-section. Member  220  may include a shaft  222 , which may extend from a proximal end (not shown) of insertion portion  210 , through insertion portion  210 , and out an end of insertion portion  210 . Member  220  may be steerable (see, e.g.,  FIGS.  11 A- 11 C , discussed in further detail below). For example, one or more steering mechanisms may be disposed within an inside lumen of member  220  or on an external surface of member  220 . Member  220  may have a distal portion  224 . Distal portion  224  may include an atraumatic tip. For example, an atraumatic tip may be formed from a soft durometer material, such as silicone, polyurethane, soft durometer pebax, or any other suitable material. 
     Distal portion  224  may include a camera portion  226  and/or an illumination portion. Camera portion  226  may be disposed in a lumen of distal portion  224  or on an exterior surface of distal portion  224 . Distal portion  224  may be formed at least partially of transparent material. Camera portion  226  may incorporate an illumination mechanism. Camera portion  226  may include components such as lenses and imagers. Camera portion  226  may be mounted at an angle between 0 degrees and 70 degrees relative to a longitudinal axis of member  220 . If camera portion  226  is mounted at an angle of 0 degrees, an end face of camera portion  226  (which, in one example, may include a planar surface of a cover, lens, or the like) may lie flat against the longitudinal axis of member  220 , or may lie parallel to the longitudinal axis of member  220 , such that the end face may face a sideways direction. The end face may, for example, face a direction perpendicular to the longitudinal axis of member  220 . If camera portion  226  is angled with respect to the longitudinal axis of member  220 , its end face may face either proximally (see, e.g.,  FIGS.  8 A and  8 B ) or distally (see, e.g.,  FIGS.  9 A,  10 A, and  10 B ). The end face may, for example, face a direction transverse to, but not perpendicular to, the longitudinal axis of member  220 . An angle of tilt may be measured between the end face of camera portion  226  and the longitudinal axis of member  220 . Camera portion  226  may be at least partially proximally facing so that camera portion  226  may view an area proximal of camera portion  226 . Camera portion  226  may also face in a lateral, or side, direction relative to member  220 . In an alternative, camera portion  226  may face distally so that camera portion  226  may view an area distal to camera portion  226 . Distal portion  224  may also include an anchor member  228 . Anchor member  228  may be used to secure distal portion  224  in a body lumen of a subject at a location of interest. While anchor member  228  is shown being located distally of camera portion  226  in  FIG.  6   , other configurations are also available. For example, camera portion  226  may be located distally of anchor member  228 . 
     A tether  240  may engage with shaft  222  of member  220 .  FIGS.  7 A- 7 C , discussed in further detail below, show potential configurations of tether  240 . Tether  240  may be slidable or otherwise longitudinally movable with respect to member  220 . For example, tether  240  may slide along shaft  222  of member  220 . Tether  240  may have a smaller cross-section than a cross-section of lumen  214 , so that tether  240  can fit within lumen  214 . Tether  240  may be capable of sliding proximally to a proximal portion of insertion member  210  and distally out of an opening of lumen  214 . Tether  240  may be prevented from sliding distally past distal portion  224  of member  220 . For example, distal portion  224  may be wide enough that tether  240  may not move past distal portion  224 . 
     A tool  250  may also be inserted through lumen  214  and may extend out of an opening on a distal face of insertion portion  212 . Tool  250  may include a shaft  252 . Tether  240  may also engage with shaft  252  of tool  250 . One or more surfaces of tether  240  may have an interference fit with one or more surfaces of tool  250 . Movement of tether  240  longitudinally with respect to member  220  therefore may result in longitudinal movement of tool  250  with respect to member  220 . Tool  250  may also have an atraumatic tip at a distal portion  254 . An atraumatic tip of tool  250  may have any of the qualities of an atraumatic tip of member  210 , discussed above. An atraumatic tip or other feature of tool  250  may prevent tether  240  from moving off of a distal end of tool  250 , so that tool  250  may be stationary relative to tether  240 . 
       FIGS.  7 A- 7 C  depict different exemplary cross-sectional configurations of tethers. As shown in  FIG.  7 A , an exterior surface  260  of tether  240  may have a circular cross-section. Such a circular cross-section is merely exemplary. Tether  240  may have any suitable cross-sectional shape. Tether  240  may have a lumen  262  formed therein. A shaft  222  of member  220  may be slidably disposed within lumen  262 . Lumen  262  and shaft  222  may be sized and shaped so as to allow for translational sliding of tether  240  along shaft  222  of member  220  while tether  240  is coupled to shaft  252  of tool  250 . For example, lumen  262  and shaft  222  may be sized and shaped so that there is a clearance fit between lumen  262  and shaft  222 . While lumen  262  and shaft  222  are shown in  FIG.  7 A  as having circular cross-sections, lumen  262  and shaft  222  may have any suitable shape and size. For example, shaft  222  may be keyed to lumen  262 . Shaft  222  and/or lumen  262  may have an ovular, polygonal, or other shape. For example, shaft  222  and/or lumen  262  may have a hexagonal or star shape. Alternatively, member  220  may have any of the properties of member  50 , described with regard to  FIGS.  1 - 5    above, and tether  240  may be configured to work in conjunction with such a member. For example, shaft  222  may have a substantially flat shape (width substantially greater than thickness), and lumen  262  may have a corresponding substantially flat rectangular shape. 
     Tether  240  may also have another lumen  264  formed therein. Shaft  252  of tool  250  may be disposed within lumen  264 . Shaft  252  and lumen  264  may be sized and shaped so as to have an interference fit or a slight interference fit with one another. The interference fit or slight interference fit may serve as a locking and/or mating mechanism between shaft  262  and lumen  264 , securing the two together during translational movement relative to shaft  222 . While lumen  264  and shaft  252  are shown in  FIG.  7 A  as having a circular cross-section, lumen  264  and shaft  252  may have any suitable shape and size. For example, shaft  252  may be keyed to lumen  264 . Shaft  252  and/or lumen  264  may have an ovular, polygonal, or other shape. One or both of shaft  252  and/or lumen  264  may additionally or alternatively have anchoring mechanisms which may prevent or limit translational movement between shaft  252  and lumen  264 . When tether  240  moves longitudinally with respect to member  220 , tool  250  may also move longitudinally with respect to member  220 . While lumen  262  is shown as having a smaller cross-sectional diameter than lumen  264 , lumen  262  may be larger than lumen  264 , or lumens  262  and  264  may be the same size. While  FIGS.  7 A- 7 C  depict shaft  222  as having a smaller diameter than shaft  252 , shaft  222  may be the same size as shaft  252  or may be larger than shaft  222 . 
       FIG.  7 B  depicts an alternative exemplary configuration of a tether denoted  240 ′. As shown in  FIG.  7 B , tether  240 ′ may have an outer surface  270  and lumens  272 ,  274 . Surface  270  may include side openings  276 ,  278  in communication with lumens  272 ,  274 . Openings  276 ,  278  may extend from a proximal portion of tether  240 ′ to a distal portion of tether  240 ′. Openings  276 ,  278  may be parallel to a longitudinal axis of tether  240 ′. Openings  276 ,  278  may be disposed approximately 180 degrees apart from one another. Alternatively, openings  276 ,  278  may be disposed at a smaller angle from one another. Opening  276  may have a width which is smaller than a diameter of shaft  222  of member  220 . Opening  278  may have a width that is smaller than a diameter of shaft  252  of tool  250 . 
     Shaft  222  of member  220  may be slidably disposed in lumen  272 . Lumen  272  may have any of the properties of lumen  252 , described above with regard to  FIG.  7 A . Tether  240  may have lip portions  280  at either side of opening  276 . Lip portions  280  may be deformable so that shaft  222  may be pressed and/or snapped into lumen  272  via opening  276 . Shaft  252  of tool  250  may be disposed within lumen  274 . Lumen  274  may have any of the properties of lumen  264 , described above with regard to  FIG.  7 A . Tether  240  may have lip portions  282  at either side of opening  278 . Lip portions  282  may be deformable so that shaft  252  may be pressed and/or snapped into lumen  274  via opening  278 . As described with regard to  FIG.  7 A , when tether  240  moves longitudinally with respect to member  220 , tool  250  may also move longitudinally with respect to member  220 . In an alternative, a tether may contain one lumen with an opening (for example, such as lumens  272  and  274 ) and one lumen without an opening (for example, such as lumens  262  and  264 ). 
       FIG.  7 C  depicts a further exemplary configuration of a tether  240 ″. As shown in  FIG.  7 C , tether  240 ″ may have a protruding surface  280  that is configured to engage with a broken lumen surface  282  of shaft  252  of tool  250 . Shaft surface  282  and tether surface  280  may be sized and shaped so as to have an interference fit with one another so as to lock and/or mate to one another, securing the two together as tether  240 ″ translates relative to member  220 . Tether surface  280  may be pressed and/or snapped into a lumen defined by shaft surface  282 . Shaft  252  may include surface  282  at only a distal portion  254  of tool  250 , or shaft  252  may include surface  282  along a greater portion of a length of shaft  252 , such as an entirety or a majority of shaft  252 . While shaft surface  282  and tether surface  280  are shown in  FIG.  7 C  as being rounded, shaft surface  282  and tether surface  280  may have any suitable shape and size. For example, shaft surface  282  may be keyed tether surface  280 . Shaft surface  282  and/or tether surface  280  may have an ovular, polygonal, teardrop, or other shape. For example, shaft surface  282  and/or tether surface  280  may have a hexagonal, a triangular, or a star shape. One or both of shaft surface  282  and/or tether surface  280  may additionally or alternatively have anchoring mechanisms which may prevent or limit translational movement between shaft surface  282  and tether surface  280 . 
     Tether  240 ″ may also have a lumen  284 . Lumen  284  may have any of the properties of lumens  262  and/or  272 , described above with regard to  FIGS.  7 A- 7 B . A surface of tether  240 ″ may include an opening  286  that is in communication with lumen  284 . In an alternative, tether  240 ″ may lack such opening  286  and lumen  284  may be similar to lumen  262 , described above. Tether  240  may have lip portions  288  at either side of opening  286 . Lip portions  288  may be deformable so that shaft  222  may be pressed and/or snapped into lumen  284  via opening  286 . As described with regard to  FIGS.  7 A- 7 B , when tether  240 ″ moves longitudinally with respect to member  220 , tool  250  may also move longitudinally with respect to member  220 . 
       FIGS.  8 A and  8 B  show exemplary distal portion  224  of member  220 . 
     Distal portion  224  may include a surface  302  defining a space that may contain camera portion  226 . Surface  302  may be transparent. In an alternative, camera portion  226  may be disposed on any outer surface of shaft  222 . Camera portion  226  may be connected to a cable  304  which may provide power and/or control signals to camera portion  226  and/or transmit images obtained by camera portion  226 . Cable  304  may be disposed in a lumen  306  of member  220 . 
     Anchor  228  may include an expandable member  310 .  FIG.  8 A  shows expandable member  310  in a collapsed configuration, and  FIG.  8 B  shows expandable member  310  in an expanded configuration. Expandable member  310  may be an inflatable member such as a balloon. The wall of shaft  222  of member  220  may include openings  312 ,  314  therethrough. Openings  312  and  314  may be in communication with an interior of expandable member  310  and with lumen  306 . Air, fluid, or another medium may be passed through lumen  306  and through openings  312  and  314  in order to expand expandable member  310 . When expandable member  310  is in an expanded configuration ( FIG.  8 B ), expandable member  310  may engage with walls of a body lumen, such as the body lumen shown in  FIG.  6   . Engagement of expandable member  310  with walls of a body lumen may serve to anchor member  220  in place so that member  220  may not be longitudinally movable when expandable member  310  is in an expanded configuration. 
     Expandable member  310  may have a variety of shapes and sizes. A longitudinal length of expandable member (along a longitudinal axis of member  220 ) as well as a radial width of expandable member (extending orthogonally from member  220 ) may be any suitable amount. For example, expandable member  310  may have a circular cross section having a diameter of approximately 4-5 mm. In an alternative, expandable member  310  may have a hexagonal cross section having a greatest width dimension of approximately 10 mm. Alternatively, expandable member  310  may have any other cross-sectional geometry and any diameter or cross-sectional size that is effective in anchoring member  220  to a body lumen in an expanded configuration. For example, a diameter or cross-sectional size of expandable member  310  may be approximately 2 mm-5 mm or 2 mm-6 mm. Expandable member  310  may be a non-compliant balloon formed of a semi-rigid material such as PEBAX, PET, or any other suitable material. Alternatively, expandable member  310  may be a compliant balloon formed of a soft durometer material such as silicone, polyurethane, or any other suitable material. 
       FIGS.  9 A- 9 B  show another exemplary distal portion  224 ′ of member  220 ′.  FIG.  9 A  shows a side view of distal portion  224 ′, and  FIG.  9 B  shows a top view of distal portion  224 ′ rotated 90 degrees relative to  FIG.  9 A . Distal portion  224 ′ may include a surface  320 , which along with surface  324  of member  220 ′, defines a lumen that may contain camera portion  226  and a cable  326 . Surface  320  may project radially outward to form a surface  322  near camera portion  226 . Surfaces  320  and/or  322  may be transparent. In addition or in an alternative, camera portion  226  may be disposed on a surface of shaft  222  (such as surface  324 ). Camera portion  226  may be connected to cable  326 , which may provide power and/or control signals to camera portion  226  and/or transmit images from camera portion  226 . Surface  320  may extend proximally from distal portion  224 ′ so that cable  326  passes through a lumen defined by surface  320  instead of a central lumen (such as lumen  333 ) of member  220 ′. In an alternative, cable  326  may pass through lumen  333 . 
     Anchor  228 ′ may include a clipping mechanism  330 . Clipping mechanism  330  may include a control member  332 . Control member  332  may be slidably disposed in a lumen  333  of shaft  222  so that control member  332  and other portions of clipping mechanism  330  may move longitudinally relative to shaft  222 . A distal portion of control member  332  may be fixed to a proximal portion of a pair of jaws  334 . Jaws  334  may include curved end portions  336 . End portions  336  may curve toward one another. Jaws  334  may be moved laterally relative to one another so that they may be opened and closed. Jaws  334  may be biased toward an open configuration. For example, a shape of jaws  334  may be such that jaws  334  are biased in an open configuration and/or jaws  334  may be made of material having shape memory. In a first configuration, control member  332  and jaws  334  may be disposed within a lumen of shaft  222 . In the first configuration, jaws  334  may be in a closed position resulting from pressure exerted by walls of lumen  333  on jaws  334 . In a closed position, tips  336  of jaws  334  may contact one another, may be near to one another, or may overlap one another. Control member  332  may be slid longitudinally relative to shaft  222  so that jaws  334  extend completely through a distal opening  338  of lumen  333  in a second configuration. After clipping mechanism  330  is moved into the second configuration, jaws  334  may be in an open position due to the bias of jaws  334  and the absence of pressure from the walls of lumen  333 . In an open configuration, there may be a gap (or a relatively larger gap) between tips  336 . 
     In order to achieve an anchoring function such as via clamping jaws  334 , control member  332  may be retracted into a third configuration so that a proximal end of jaws  334  is within lumen  333 . The pressure of the walls of lumen  333  and/or opening  338  on the proximal ends of jaws  334  may cause tips  336  of jaws  334  to move toward one another. Body tissue that is between tips  336  of jaws  334  when the clipping mechanism  330  is transitioned to the third configuration may be pinched by tips  336  and/or other portions of jaws  334  in the third configuration. Closing jaws  334  around tissue may result in anchoring of clipping mechanism  330  and member  220  to the tissue. Jaws  334  may angle away from a longitudinal axis of lumen  333  so that tips  336  extend past an exterior surface of shaft  220 , toward a side surface of a body lumen, as shown in  FIG.  9 A . Jaws  334  may each diverge from the longitudinal axis of lumen  333  so that jaws  334  are substantially parallel to one another. Angling of jaws  334  away from the longitudinal axis of lumen  333  may facilitate engagement of jaws  334  with tissue on a size surface of the body lumen. 
       FIGS.  10 A- 10 B  depict another exemplary distal portion  224 ″ of member  220 ″. The example of  FIGS.  10 A and  10 B  may be similar to the example of  FIGS.  9 A and  9 B , except with respect to the features described below. Anchor  228 ″ may include an auger member  340 . Auger member  340  may have an elongated control member  342  disposed within lumen  333  of shaft  222 . Control member  342  may be rotatable relative to shaft  222 . A distal portion of control member  342  may be attached to a coil  344 . Coil  344  may be a corkscrew-type coil that may have one, two, four, or any other suitable number of coils. A distal end of coil  344  may include a pointed tip  346  that may be sharp. Control member  342  may be longitudinally movable relative in lumen  333  relative to shaft  222  so that coil  344  may be retracted into lumen  333  and extended out of opening  338  in lumen  333 . Coil  344  may be made of a wire and may be made from, for example, stainless steel, elgiloy and other cobalt-containing alloys, nitinol, titanium, platinum or any other suitable material that may be formed into a coil shape and may have requisite stiffness to maintain the shape and to move through a tissue of a subject. Auger member  340  may be transitioned from a first configuration to a second configuration. In a first configuration ( FIG.  10 A ), coil  344  may be navigated to a target site within a lumen of a subject. Coil  344  then may rest against a wall  360  of a body lumen without engaging the tissue of the wall  360 . Auger  340  may be transitioned to a second configuration ( FIG.  10 B ) by rotating control member  342  about its own axis. Rotation of control member  342  may cause rotation of coil  344 . Pointed tip  346  of coil  344  may pierce a tissue surface of a wall  360  of the body lumen. Continued rotation of control member  342  may cause pointed tip  346  to pass through tissue before exiting into the body lumen again. Coil  344  may continue to pierce and/or pass through the tissue with continued rotation of control member  342 . Engagement of coil  344  with the tissue may cause member  220 ″ to be fixed in a desired location in the body lumen. 
       FIGS.  11 A- 11 C  depict exemplary steering mechanisms. As shown in  FIG.  11 A , member  220  (like member  220  in  FIG.  6   ) may be navigated to a desired location by a steering member  400 . Steering member  400  may be coupled to tether  240  (like tether  240  in  FIG.  6   ). For example, shaft  402  of steering member  400  may be inserted into a lumen of tether  240 . An end cap portion  404  of steering member  400  may restrain steering member  400  so that it remains coupled with tether  240 . Steering member  400  may have an interference fit with a lumen of tether  240 . Steering member  400  may have any of the properties of tool  252 , described above, including those described with regard to  FIGS.  7 A- 7 C . Tether  240  may also have any of the properties described above, including those described with regard to  FIGS.  7 A- 7 C . Steering member  400  may also have a steering mechanism  410  that may be disposed inside of steering member  400  (e.g., in a lumen of shaft  402 ) or outside of shaft  402 .  FIG.  11 A  depicts an exemplary embodiment wherein steering mechanism  410  is disposed within a lumen of shaft  402  for a portion of a length of shaft  402  and is disposed outside of shaft  402  at another portion of a length of shaft  402 . Steering mechanism  410  may exit shaft  402  via a hole near the distal end of shaft  402 . Steering mechanism  410  may be, for example, a wire or a cable or any other suitable mechanism. Member  220  may also be slidably secured to tether  240 , using any of the methods or mechanisms described above. 
     After steering member  400  and member  220  are coupled to tether  240 , steering member  400 , member  220 , and tether  240  may be advanced through a lumen  214  of an insertion portion  210 . Interaction between tether  240  and distal portion  224  of member  220  (e.g., the distal end of tether  240  abutting the proximal end of an enlarged portion of distal portion  224 ) may cause member  220  to be advanced along with tether  240  and steering member  400 . Steering member  400 , member  220 , and tether  240  may extend out of a distal opening of lumen  214  and advanced distally of insertion portion  210 . A relatively smaller size of tether  240 , steering member  400 , and member  220  may allow those components to reach narrower body lumens, such as bronchial lumens, than could be reached by insertion portion  210 . 
     Steering mechanism  410  may extend proximally through a lumen  214  of insertion portion  210  to a control device. Actuation of steering mechanism  410  may cause bending of a distal portion of steering member  400 , as shown in  FIG.  11 B . For example, actuation of steering mechanism  410  may cause a shortening of steering mechanism  410 . After steering member  400  is used to position member  220  in a desired location of a subject&#39;s body lumen, member  220  may be anchored using anchor member  228 . Steering member  400  and tether  240  may then be retracted through lumen  214  so that an operator may detach steering member  400  from tether  240 . A tool  250  may then be secured to tether  240  and advanced through lumen  214  of insertion portion  210 . Member  220  may act as a guidewire for tether  240  and tool  250 . Tether  240  may ride along shaft  222  of member  220  so that tool  250  can be transported to a location of interest, proximate to distal portion  224  of member  220 . Tool  250  may then be used to conduct a variety of diagnostic or treatment procedures on a subject. Tool  250  may eventually be retracted through lumen  214  and replaced by another tool  250 , using the method described above. The above process may be repeated any number of times. At the end of a procedure, anchor portion  228  may be disengaged so that member  220  is no longer secured to a body lumen of a subject. Member  220  may then be retracted through lumen  214 . 
       FIG.  11 C  shows an exemplary alternative configuration wherein member  220  includes a steering mechanism  450  such as a steering wire or cable or any other suitable mechanism. Steering mechanism  450  may have any of the properties of steering mechanism  410 , described above. Steering mechanism  450  may be disposed inside of member  220  (e.g., in a lumen of shaft  222 ) or outside of shaft  222 .  FIG.  11 C  depicts an exemplary embodiment wherein steering mechanism  450  is disposed within a lumen of shaft  222  for a portion of a length of shaft  222  and is disposed outside of shaft  222  at another portion of a length of shaft  402 . Actuation of steering mechanism  450  may cause bending of a distal portion of member  220 , as shown in  FIG.  11 C . For example, actuation of steering mechanism  450  cause a shortening of steering mechanism  450 . 
     In use, member  220  may be advanced toward a desired location of a subject&#39;s body lumen. Steering mechanism  450  may aid in such positioning. Member  220  may then be anchored using anchor member  228 . A tool  250  may then be secured to tether  240 . Tether  240  may be secured to member  220  if it is not already secured to member  220 . Tool  250  and tether  240  may then be advanced through lumen  214  of insertion portion  210 . Member  220  may act as a guidewire for tether  240  and tool  250 . Tether  240  may ride along shaft  222  of member  220  so that tool  250  can be transported to a location of interest, proximate to distal portion  224  of member  220 . Tool  250  may then be used to conduct a variety of diagnostic or treatment procedures on a subject. Tool  250  may eventually be retracted through lumen  214  and replaced by another tool  250 , using the method described above. The above process may be repeated any number of times. At the end of a procedure, anchor portion  228  may be disengaged so that member  220  is no longer secured to a body lumen of a subject. Member  220  may then be retracted through lumen  214 . 
     While principles of the present disclosure are described herein with reference to illustrative examples for particular applications, it should be understood that the disclosure is not limited thereto. Those having ordinary skill in the art and access to the teachings provided herein will recognize additional modifications, applications, and substitution of equivalents all fall within the scope of the examples described herein. Accordingly, the invention is not to be considered as limited by the foregoing description.