Advancing system and method of use thereof

1. An advancing system comprising:

an endoscope having a proximal portion, a distal portion, a working channel extending from the proximal portion to the distal portion, an aperture disposed at the distal portion and in communication with the working channel, and a port disposed at the proximal portion and in communication with the working channel;

a flexible tether comprising a first portion extending external the endoscope from the proximal portion of the endoscope to the aperture, the tether further comprising a second portion extending through the working channel from the aperture to the proximal portion of the endoscope, wherein the first portion of the tether comprises a coupling element configured to be coupled to a medical device and apply a pulling force thereto; and

a guiding device configured to be movably advanced through the working channel of the endoscope and alongside the second portion of the tether, the guiding device comprising an elongate shaft having a shaft proximal portion and a shaft distal portion, the guiding device further comprising a fulcrum disposed at the shaft distal portion and configured to movably receive the tether there through at a location distal of and spaced apart from the distal portion of the endoscope.

2. The advancing system of claim 1 , wherein the coupling element comprises a closed loop structure, releasable or breakable sutures, temporary or dissolvable bonds, adhesives, magnets, or a combination thereof.

3. The advancing system of claim 1 , wherein the tether comprises a hydrophilic or lubricious coating.

4. The advancing system of claim 1 , wherein the tether is selected from the group consisting of a wire, a strap, a thread, or a suture.

5. The advancing system of claim 1 further comprising at least one guide ring disposed on an external surface of the endoscope and configured to guide the tether alongside the endoscope from the proximal portion to the distal portion.

6. The advancing system of claim 1 ,

wherein the elongate shaft comprises a variable stiffness cable comprising:

a helical spring extending from the shaft proximal portion to the shaft distal portion;

a wire extending through the spring, the wire operatively connected to the spring at the shaft distal portion; and

an actuator operatively connected to the wire and disposed proximal to the shaft proximal portion, wherein actuation of the actuator causes the spring to be compressed.

7. The advancing system of claim 1 , wherein the fulcrum consists of one of a single looped structure, a double looped structure, or a cylindrical structure.

8. The advancing system of claim 1 , wherein the elongate shaft includes a hydrophilic or lubricious coating.

9. An advancing system configured for use with an endoscope having a proximal portion, a distal portion, a working channel extending from the proximal portion to the distal portion, an aperture disposed at the distal portion and in communication with the working channel, and a port disposed at the proximal portion and in communication with the working channel, the advancing system comprising:

a flexible tether comprising a first portion extending external the endoscope from the proximal portion of the endoscope to the aperture, the first portion of the tether comprising a coupling element configured to be coupled to a medical device and apply a pulling force thereto, the tether further comprising a second portion extending through the working channel from the aperture to the proximal portion of the endoscope; and

a guiding device configured to be movably advanced through the working channel of the endoscope and alongside of the second portion of the tether, the guiding device comprising:

an elongate shaft having a shaft proximal portion and a shaft distal portion;

a fulcrum disposed at the shaft distal portion and configured to movably receive the tether there through;

a variable stiffness cable disposed through the elongate shaft, comprising a helical spring extending from the shaft proximal portion to the shaft distal portion, and a wire extending through the spring, the wire operatively connected to the spring at the shaft distal portion; and

an actuator operatively connected to the wire and disposed proximal to the shaft proximal portion.

10. The advancing system of claim 9 , wherein the fulcrum comprises one of a single looped structure, a double looped structure, or a cylindrical structure.

11. The advancing system of claim 9 , wherein the elongate shaft comprises a first aperture at the shaft distal portion and in communication with a second aperture disposed proximal to the first aperture and located at the shaft distal portion.

12. The advancing system of claim 9 , wherein at least a portion of the elongate shaft comprises a hydrophilic or lubricious material.

13. The advancing system of claim 9 , wherein the fulcrum has a diameter ranging from about 1 mm to about 3 mm.

14. The advancing system of claim 9 , wherein the elongate shaft includes a hydrophilic or lubricious coating.

15. The advancing system of claim 9 , wherein the tether is selected from the group consisting of a wire, a strap, a thread, or a suture.

16. The advancing system of claim 9 , wherein the tether comprises a hydrophilic or lubricious coating.