A hydraulically actuated medical instrument includes an elongated shaft having proximal and distal ends, a hydraulically actuated end effector at the distal end of the shaft and a fluid flow path extending through the shaft to the end effector. The shaft may be capable of an angled configuration where at least a portion of the shaft is manually movable to a direction in which it extends at an angle to another portion of the shaft. The end effector is not limited to a linear configuration and at least a portion of an elongated end effector extends at an angle relative to another portion of the end effector as is needed or desirable for the particular procedure to be performed.