Other examples include tissue and/or organ retractors or clamps, e.g., a suction cup with detachable suction tubing; an activatable clamp; a needle or other device to pierces or transfix a tissue; an anchoring system that is deployed within the targeted tissue, e.g., a T-fastener, a cross, a ring or an inflatable balloon configuration; a suturing, staple or clipping type of NOTES tool.