Steerable endoscopic needle

Abstract

The invention relates to a device comprising a needle, a cable and a handle. The needle has a proximal section and a distal section. The distal section is more flexible than the proximal section. The needle also includes a channel extending within a wall thereof. Each of the channels extends from a proximal end of the needle to a distal channel end within the distal section. The needle is insertable into a living body via an insertion instrument. Each of the cables is received within a corresponding one of the channels. A distal end of each of the cables is coupled to a distal channel end of a corresponding channel. During use, the handle is retained outside the body. The handle portion includes an actuator coupled to the cable. Operation of the actuator away from a neutral position places at least one of the cables under tension conditions to bend the distal section of the needle.

Description

INVENTOR: DI PAK KUMAR SHARMA CLAIM OF PRIORITY

[0001] The present disclosure claims priority to U.S. Provisional Patent Application Serial No. 63 / 517,699, filed August 4, 2023; the disclosure of which is hereby incorporated by reference in its entirety. TECHNICAL FIELD

[0002] The present disclosure relates to an endoscopic needle, and in particular to an endoscopic ultrasound (EUS) guided puncture needle. BACKGROUND

[0003] Hollow needles can be used in EUS guided procedures to puncture a target anatomical structure (e.g., a bile duct) and introduce a guide wire through the needle lumen into the target anatomical structure, for example, to guide a stent implantation, to remove an obstruction, etc. In certain procedures, a user can not be able to align an insertion device (e.g., an endoscope) with a desired path of the needle to the target anatomical structure. SUMMARY

[0004] The present disclosure relates to a device for treating tissue. The device includes a needle having a proximal section and a distal section. The distal section is more flexible than the proximal section. The needle also includes a plurality of channels extending within a wall thereof. Each of the channels extends from a proximal end of the needle to a distal channel end within the distal section. The needle is configured to be inserted into a living body via an insertion instrument.

[0005] The device also includes a plurality of cables. Each of the cables is received within a corresponding one of the channels. A distal end of each of the cables is coupled to the distal channel end of the corresponding channel.

[0006] Further, the device includes a handle. The handle is held outside of the body during use. The handle includes actuators coupled to the cables. Operation of the actuators away from a neutral position places at least one of the cables under tension to cause the distal section of the needle to bend.

[0007] In one embodiment, the needle is hollow and the channels extend through the length of the needle in a wall surrounding a lumen of the needle.

[0008] In one embodiment, the channels extend to a distal end of the needle.

[0009] In one embodiment, the needle includes a first pair of channels on a first side of the needle and a second pair of channels on a second side of the needle opposite the first side, and wherein the device includes a first pair of cables and a second pair of cables, the first pair of cables extending through the first pair of channels, the second pair of cables extending through the second pair of channels, proximal ends of the cables of the first pair of cables and the second pair of cables connected to the actuator, such that when the actuator is operated in a first direction, the cables of the first pair of cables are tensioned and the cables of the second pair of cables are loosened, causing the distal section of the needle to bend toward the first side of the needle.

[0010] In one embodiment, the cables are formed of nitinol and have a diameter between 0.1 mm and 0.2 mm.

[0011] In one embodiment, the distal section of the needle includes a plurality of cuts into a wall of the needle, a first portion of the cuts arranged in a first group, the first group extending along a first side of the distal section of the needle.

[0012] In one embodiment, a second portion of the cuts is arranged in a second group, the second group extending along a second side of the distal section of the needle.

[0013] In one embodiment, the cuts of the first group are of a size and distributed along a length of the distal section of the needle substantially similar to the cuts of the second group.

[0014] In one embodiment, at least one of a pitch and a size of the cuts of the first group varies along a length of the first group.

[0015] In one embodiment, at least one of a pitch and a size of the cuts of the second group varies along a length of the second group.

[0016] In one embodiment, the needle is configured such that actuation of the actuator allows bending of the distal section of the needle in only a predetermined plane.

[0017] Further, the present disclosure relates to a device for treating tissue. The device includes a needle having a flexible distal section. The needle includes a plurality of channels extending within a wall thereof. Each of the channels extends from a proximal end of the needle to a distal channel end within the distal section. The needle is configured to be inserted into a living body via an insertion instrument.

[0018] The device also includes a first cable received within a first one of the channels, wherein a distal end of the first cable is coupled to a distal channel end of the first channel. Further, the device includes a second cable received within a second one of the channels, wherein a distal end of the second cable is coupled to a distal channel end of the second channel. The second cable is on a second side of the needle opposite a first side of the needle on which the first cable is located. The first and second cables extend to a user-accessible location that remains outside of the patient's body during use of the device, such that the user can tension the first cable to bend the distal section of the needle toward the first side.

[0019] In one embodiment, the device also includes a handle that remains outside of the body during use. The handle includes an actuator coupled to the first and second cables, the actuator configured such that operation of the actuator in a first direction away from a neutral position places the first cable in tension to bend the distal section of the needle toward the first side of the needle, and operation of the actuator in a second direction away from the neutral position places the second cable in tension to bend the distal section of the needle toward the second side of the needle.

[0020] Further, the present disclosure is directed to a method of treating tissue. The method includes inserting an insertion device to a target site within a living body; inserting, by the insertion device, a needle having a proximal section and a distal section, wherein the distal section is more flexible than the proximal section; extending the distal section of the needle distally away from the insertion device to enter a target anatomical structure; and tensioning at least one cable extending through a wall of the needle to pull the needle into a curved configuration within the target anatomical structure to achieve a desired orientation and positioning of the needle within the target anatomical structure.

[0021] In one embodiment, the method also includes operating a handle to orient the needle such that, prior to tensioning the at least one cable, a plane within which the distal section of the needle bends is at a desired orientation relative to the target anatomical structure.

[0022] In one embodiment, the target anatomical structure is a bile duct. The method also includes positioning the entire distal section within the bile duct.

[0023] In one embodiment, the distal section of the needle includes a plurality of cuts into a wall of the needle; a first portion of the cuts are arranged in a first set that extends along a first side of the distal section of the needle; the distal section of the needle also includes a lumen that supplies a liquid to the needle such that the liquid is supplied to the bile duct via the first set of cuts.

[0024] In one embodiment, a second portion of the cuts are arranged in a second set that extends along a second side of the distal section of the needle, and wherein a plane within which the distal section of the needle bends extends through midpoints of the cuts in the first set of cuts and the second set of cuts.

[0025] In one embodiment, at least one cable is tensioned via an actuator of an operating handle connected to a needle.

[0026] In one embodiment, the actuator includes a ball joint between two segments of the shank. Attached Figure Description

[0027] Figure 1 A perspective view of a steerable needle device according to a first embodiment is shown, wherein the needle is in a first configuration.

[0028] Figure 2 It shows Figure 1 A perspective view of the device, in which the needle extends distally from the distal end of the protective sheath in a second form.

[0029] Figure 3 It shows Figure 1 A three-dimensional view of the device, in which the needle extends distally from the distal end of the protective sheath in a third form.

[0030] Figure 4A It shows Figure 1 A three-dimensional view of the distal portion of the needle in the device.

[0031] Figure 4B It shows Figure 4A A perspective view of the distal end of the needle.

[0032] Figure 5 It shows Figure 1 A perspective view of the device's steering joint. Detailed Implementation This disclosure can be further understood with reference to the following description and accompanying drawings, wherein similar elements are designated by the same reference numerals. An exemplary embodiment describes a steerable needle device that facilitates the insertion of a needle into a target anatomical structure.

[0033] In this application, the terms distal and proximal refer to directions away from (distal) and towards (proximal) the user of the device. Thus, for a device according to the described embodiment (which is used with an insertion device (e.g., an endoscope), the proximal end of the device is typically kept outside the body accessible to the user, while the distal end is inserted through the insertion device (e.g., within the working channel of the insertion device) and extends distally away from the distal end of the insertion device into the target anatomical structure. Those skilled in the art will understand that while the devices according to various embodiments are described as being used with flexible endoscopes to puncture the bile duct, these devices can be used with a wide variety of flexible or rigid insertion devices (e.g., ureteroscopes, lithotripters, laparoscopes, etc.) to facilitate needle insertion into any desired anatomical structure. As those skilled in the art will understand, the needles according to the disclosed embodiments are typically formed of a single material (e.g., nitinol) along their length and include a tissue puncture tip at their distal end. Those skilled in the art will also understand that nitinol increases the needle's column strength, making it easier to push the needle through the insertion device, even when the insertion device defines a tortuous path. The material also enhances torque transmission along the needle, improves the stiffness of the proximal portion of the needle, while allowing for a more flexible distal segment cut by laser for easy steering. Therefore, the steerable needles described herein can have diameters as small as 0.3 mm.

[0034] like Figures 1 to 5 As seen, the device 100 according to an exemplary embodiment includes a handle 102 extending to a distal end 104, the distal end 104 including a coupling 106 configured to engage with a proximal end of an insertion device. For example, in this embodiment, the coupling 106 is configured to be threadedly connected to a corresponding coupling (not shown) at the proximal end of the insertion device. As will be described in more detail below, the coupling 106 of this embodiment is configured such that the distal end 104 of the handle 102 is rotatable relative to the coupling 106, such that the handle 102 is rotatable relative to the coupling 106, while the connection between the handle 102 and the insertion device is not loosened or tightened. The handle 102 of this embodiment includes a proximal segment 105, which engages with a distal segment 107 at a connector 109.

[0035] The device 100 of this embodiment includes an insertion section 108 that extends distally from the handle 102 and is configured to be slidably inserted into the insertion device. In this embodiment, as the device 100 is configurable for use with a flexible insertion device (e.g., a flexible endoscope), the insertion segment 108 is sufficiently flexible to be inserted through the insertion device, even when the insertion device has been inserted into a target site in the living body along a tortuous path (e.g., a path defined by a natural body lumen into which the insertion device has been inserted via a natural body orifice), and the insertion segment 108 has a length selected such that when the connector 106 is connected to the proximal end of the insertion device, the distal end 110 of the insertion segment 108 extends distally away from the distal end of the insertion device by a desired distance (e.g., this distance is at least equal to the distance from the distal end of the insertion device when the insertion device is in the target position (adjacent to the position where the insertion segment 108 will puncture the target anatomical structure), plus the distance that the distal end 110 of the insertion segment 108 will extend into the target anatomical structure).

[0036] Furthermore, the shank 102 includes an insertion port 111 in fluid communication with the central lumen 120 of the needle 112, such that fluid introduced into the insertion port 111 is supplied to tissue surrounding the distal segment 114 of the needle 112. The needle 112 may be formed, for example, of a biocompatible metal such as nitinol (e.g., nitinol hypo tube), stainless steel, or a plastic such as PEEK or Delrin.

[0037] The handle 102 also includes a length adjustment mechanism 103, which includes a slider 117 mounted on the proximal section 105 with a locking nut 119. The locking nut 119 is loose to allow the slider to slide longitudinally on the proximal section 105 to a desired position, so that the length of the needle 112 can be adjusted relative to the length of the insertion device, such that when the connector 106 is connected to the insertion device as needed, the desired length of the needle 112 extends distally from the insertion device.

[0038] like Figure 4A and Figure 4B As shown, the flexible distal segment 114 of the needle 112 extends distally from the lower flexible proximal segment 116 to the distal end 115 of the needle 112. The needle 112 of this embodiment includes an outer wall 118 surrounding and defining a central lumen 120 configured for, for example, introducing or withdrawing a therapeutic fluid from a target anatomical structure. A plurality of cable lumens 122 (four cable lumens 122 in this embodiment) extend through the wall 118 of the needle 112, wherein each of the cable lumens 122 extends from a proximal end adjacent to the connector 109 to a distal end adjacent to the distal end 115 of the needle 112.

[0039] The needle 112 includes a plurality of steering cables 124. Each of the cables 124 is secured at a distal end 115 to a wall 118 of the needle 112 and extends through a corresponding one in a cable lumen 122 to a proximal end 125, which is coupled to a connector 109, as will be described in more detail below. Specifically, the cables 124 are configured such that when a first pair of cables 124a is pulled proximally and a second pair of cables 124b is allowed to extend further distally, the tension applied to one side of the needle 112 causes the needle 112 to bend toward the side through which the first pair of cables 124a extends. That is, the distal end 115 of the needle 112 will deflect away from the longitudinal axis L of the needle 112, such that the distal segment 114 of the needle 112 forms an arc with a bending radius that gradually decreases as the amount of the first pair of cables 124a is pulled proximally.

[0040] Those skilled in the art will understand that the extent to which the curvature imparted to the needle 112 extends into the proximal segment 116 of the needle 112 will depend, respectively (as described in more detail below) on the relative flexibility of the proximal segment 116 and the distal segment 114, and the length by which the needle 112 extends distally beyond the distal end of the insertion device. Those skilled in the art will understand that the cable 124 may be formed of, for example, nitinol. This allows the use of a cable 124 with a cross-sectional diameter between 0.1 mm and 0.2 mm to deliver the required tensile force to bend the needle 112 over a length of 1 mm to 4.5 mm. Such a small diameter may be necessary, for example, because the thickness of the wall 118 of the needle 112 may be between 0.01 inches and 0.03 inches.

[0041] like Figure 4A As shown, the flexibility of the distal segment 114 is enhanced by providing a plurality of slits 126 distributed along the length of the distal segment 114 on the wall 118 of the distal segment 114. In this embodiment, the slits 126 are distributed in two independent longitudinal groups. The first group 126a of this embodiment extends along a first side of the needle 112, which corresponds to the path of the cable lumen 122 through which the first pair of cables 124a extends; while the second group 126b extends along a second side of the needle 112 (opposite to the first side), which corresponds to the path of the cable lumen 122 through which the second pair of cables 124b extends.

[0042] In this embodiment, the cuts 126 are shown to be substantially equal in length along the distal segment 114 and substantially equally spaced from each other, wherein the circumferential length of each of the first set of cuts 126a is substantially equal to that of each of the second set of cuts 126b. However, those skilled in the art will understand that any or all of the spacing, width (along axis L), or circumferential length of the cuts 126 may be varied along the length of the distal segment 114, and may be varied between the first set 126a and the second set 126b; and the length of the distal segment 114 may also be varied to achieve any desired bending of the needle 112.

[0043] For example, the distal portion of the distal segment 114 (e.g., the farthest 60% to 80% of the length of the distal segment 114) may be made more flexible than the proximal portion of the distal segment 114. As those skilled in the art will understand, this can be achieved by increasing one or both of the width and circumferential length of the cut 126, by increasing the number of cuts per unit length, or by reducing the thickness of the wall 118 in the more flexible portion of the distal segment 114, etc.

[0044] Furthermore, as those skilled in the art will understand, the distribution of the cuts 126 in this embodiment configures the distal segment 114 of the needle 112 to bend in a pre-selected plane. For example, the distal segment 114 in this embodiment is configured to bend in a plane P (based on the manipulation of the cable 124) that passes through the midpoint M between the cable lumens 122 of the first pair of cables 124a and the cable lumens 122 of the second pair of cables 124b. Furthermore, those skilled in the art will understand that the cuts 126 will enhance the visibility of the distal segment 114 of the needle 112 under ultrasonic conditions because the edges of the cuts 126 enhance the reflection of ultrasonic energy.

[0045] As previously indicated, the proximal end 125 of cable 124 is coupled to connector 109, allowing a user to apply tension to a desired pair of cables 124a or 124b by manipulating the proximal end 105 of handle 102 relative to the distal end 107, thereby causing the distal end 114 of needle 112 to bend in a desired direction within plane P. Specifically, connector 109 includes a ball 130 formed at the distal end of proximal end 105, rotatably received within a correspondingly shaped cavity 132 formed in the proximal end of distal end 107.

[0046] As those skilled in the art will understand, in this embodiment, the connector is formed such that the ball 130 can rotate within the cavity 132 only in the plane corresponding to the distribution of the points where the first pair of cables 124a are connected to the ball 130 and the points where the second pair of cables 124b are connected to the ball 130. More specifically, the proximal portion of each of the cables 124 passes through the ball 130, wherein a crimp 136 at the proximal end of each of the cables 124 prevents the proximal end of the cable 124 from being pulled distally through the ball 130. Thus, when the proximal section 105 of the handle 102 rotates relative to the distal section 107, the cable 124 of one of the first pair 124a and the second pair 124b is tensioned and pulled proximally through the needle 112; while the other pair of cables 124 is correspondingly loosened, such that the distal end of the needle 112 is pulled toward the side of the needle 112 where the tensioned pair of cables 124 resides.

[0047] In other words, the connector 109 of this embodiment is formed such that the user can only apply tension to one pair of the first pair of cables 124a or the second pair of cables 124b, and cannot simultaneously apply tension to, for example, one of the first pair of cables 124a and one of the second pair of cables 124b. This ensures that the distal segment 114 of the needle 112 bends only within the plane P. However, since the distal segment 107 of the shank 102 is rotatable relative to the connector 106 (and therefore relative to the insertion device to which it is attached), the user can deflect the distal segment 114 of the needle 112 in any desired plane by rotating the distal segment 107 relative to the insertion device, and thus rotating the needle 112 relative to the insertion device. That is, the needle 112 of this embodiment is fixed to the distal segment 107 of the shank 102 such that rotation of the distal segment 107 of the shank 102 causes rotation of the needle 112, and this in turn causes rotation of the plane P within the body (i.e., relative to the target anatomical structure).

[0048] For example, such as Figure 2 As shown, the proximal segment 105 rotates in a first direction A, which tensions the first pair of cables 124a, thereby bending the distal end 115 of the needle 112 toward a side portion of the needle 112, which includes a first set of cuts 126a; and as Figure 3 As shown, the proximal segment 105 rotates in the second direction B, which tensions the second pair of cables 124b, causing the distal end 115 of the needle 112 to bend toward a side portion of the needle 112, which includes a second set of cuts 126b. Those skilled in the art will understand that the further the proximal segment 105 rotates relative to the distal segment 107 (e.g., from a neutral position, where the longitudinal axis of the proximal segment 105 is aligned with the longitudinal axis of the distal segment 107), the greater the degree of bending of the distal segment 114 of the needle 112 (i.e., the bending radius of the distal end 114 will decrease).

[0049] In use, the user first adjusts the position of the length adjustment mechanism 103 on the proximal section 105 of the handle 102 to the insertion position (e.g., insertion / retraction mode). In this insertion position, the length of the needle 112 is selected such that the distal end 115 of the needle 112 remains within the working channel of the insertion device (e.g., so that the needle 112 does not protrude from the insertion device because the insertion device is inserted into the target location within the body). The user then inserts the needle 112 through the working channel of the insertion device (e.g., an endoscope) and connects the connector 106 to the corresponding connector on the proximal end of the insertion device.

[0050] The insertion device, containing the needle 112 (e.g., through a natural orifice and cavity), is then inserted into the body to a target site adjacent to the anatomical structure to which the needle will puncture. The user then readjusts the position of the length adjustment mechanism 103 (e.g., to an operable configuration defined by the length of the insertion device in use) such that the desired length of the needle 112 (e.g., including at least the distal segment 114) protrudes from the distal end of the insertion device, sufficient to allow the needle 112 to penetrate the target anatomical structure as needed. Those skilled in the art will understand that, if desired, after the distal end of the insertion device has been positioned relative to the target anatomical structure as needed, the needle 112 can be inserted into and coupled to the working channel of the insertion device.

[0051] In this configuration, the length adjustment mechanism 103 can be easily set into an operable state, and the connector 106 is then attached to the insertion device. The user can utilize the combination of the insertion device's directional capability (if present) and the manipulation of the proximal segment 105 relative to the distal segment 107 of the handle 102 to bend the distal segment 114 of the needle 112 to any desired curvature, which can be considered helpful in inserting the needle 112 into the target anatomical structure. As those skilled in the art will understand, bending the needle 112 can be helpful in cases where the user loses access to the target anatomical structure during surgery. For example, if the needle 112 slips out of the bile duct, the user can bend the distal segment 114 of the needle 112 as needed to facilitate reinsertion of the needle 112 into the bile duct.

[0052] The needle 112 can be inserted into the target anatomical structure in the same manner as conventional needles. If, for example, the target anatomical structure is the bile duct, then using the visual system of this insertion device and additionally utilizing ultrasound imaging, the user can insert the insertion device to the target location within the small intestine, advancing the distal end 115 of the needle 112 distally until it extends beyond the insertion device until the distal end 115 of the needle 112 (which may include, for example, a tissue puncture tip) penetrates the target site on the wall of the small intestine, and then penetrates the wall of the bile duct to enter it. At this point, since the distal end 115 of the needle 112 cannot be observed through the endoscopic visual system, using ultrasound imaging, the user can bend the distal end 114 of the needle 112 as needed by moving the proximal segment 105 relative to the distal segment 107 in either direction A or B.

[0053] For example, if the user wants to point the distal end 115 of the needle 112 upstream within the bile duct, the user will first position the handle 102... Figure 3 The user rotates the distal segment 107 relative to the longitudinal axis of the insertion device in the direction C shown until, based on observation of the incision 126, the user determines that plane P is aligned to substantially encompass the longitudinal axis of the bile duct. Alternatively, the user may slightly bend the distal segment 114 and adjust the rotation of the distal segment 107 until the curvature of the distal segment 114 is substantially aligned with the axis of the bile duct. Once the user has bent the distal segment 114 as needed, the user may also extend the needle 112 distally, advancing the bent distal segment into the bile duct in the desired direction. Once the needle 112 is positioned as needed, the user can perform any other desired procedure in the same manner as with conventional needles.

[0054] For example, the user can pass a guidewire through the insertion port 111 and advance the guidewire through the needle into the bile duct, allowing other devices to be inserted into the bile duct along the guidewire. Furthermore, the lengths of the first set 126a and the second set 126b can be selected such that all incisions 126 are within the bile duct (or other target anatomical structures) when the needle 112 is positioned as needed. Therefore, fluid supplied to the needle 112 via the insertion port 111 will travel through the entire proximal segment 116 (which does not have an opening through the wall 118) until it reaches the incision 126 and flows out into the bile duct. Finally, those skilled in the art will recognize that by controlling the amount of deflection of the proximal segment 105 relative to the distal segment 107, the user can bend the distal segment 114 to any desired amount, making the degree of bend controllable better than that provided, for example, by a needle with a pre-shaped J-tip.

[0055] Then, when the procedure is complete, the user can disengage the connector 106 from the insertion device and completely withdraw the needle 112 from it (e.g., leaving the guidewire in place), so that the working channel of the insertion device can then be used to insert other devices into the bile duct via the guidewire. Alternatively, the user can easily adjust the length adjustment mechanism 103 to return the needle 112 to the insertion / retraction position, in which the needle 112 is fully contained within the insertion device. The insertion device can then be withdrawn from the body along with the needle 112.

[0056] It will be apparent to those skilled in the art that various modifications can be made to this disclosure without departing from its scope. Furthermore, those skilled in the art will understand that features of any of the various embodiments can be combined in any manner that does not contradict the description and / or function of these embodiments. For example, those skilled in the art will understand that any number of cables (two or more) can be used to achieve the desired curvature of the distal segment of the needle. Additionally, any of a variety of known mechanisms can be employed to tension one or more cables, such as a slider or knob on a handle, which allows the cable to be wound or unwound upon rotation, and such mechanisms can be used in any desired manner to facilitate bending of the distal segment of the needle by the user.

Claims

1. A device for treating tissue, the device comprising: A needle having a proximal portion and a distal portion, wherein the distal portion is more flexible than the proximal portion, the needle further including a plurality of channels extending within its wall, each of the channels extending from a proximal end of the needle to a distal channel end within the distal portion, the needle being configured for insertion into a living body via an insertion instrument; Multiple cables, wherein each of the cables is received within a corresponding one of the channels, and the distal end of each of the cables is coupled to the distal channel end of the corresponding channel; and The handle, which remains outside the body during use, includes an actuator coupled to the cable, the operation of which away from the neutral position places at least one of the cables under tension to bend the distal segment of the needle.

2. The apparatus according to claim 1, wherein, The needle is hollow, and the channel extends through the length of the needle in the wall of the lumen surrounding the needle.

3. The apparatus according to claim 2, wherein, The channel extends to the distal end of the needle.

4. The apparatus according to any one of claims 1 to 3, wherein, The needle includes a first pair of channels on a first side of the needle and a second pair of channels on a second side of the needle opposite to the first side, and wherein the device includes a first pair of cables and a second pair of cables, the first pair of cables extending through the first pair of channels and the second pair of cables extending through the second pair of channels, the proximal ends of the first pair of cables and the second pair of cables being connected to the actuator such that when the actuator is operated in a first direction, the cables of the first pair of cables are tensioned and the cables of the second pair of cables are loosened, causing the distal segment of the needle to bend toward the first side of the needle.

5. The apparatus according to any one of claims 1 to 4, wherein, The cable is made of nitinol and has a diameter between 0.1 mm and 0.2 mm.

6. The apparatus according to claim 4, wherein, The distal portion of the needle includes a plurality of incisions that enter into the wall of the needle, the first portion of which is arranged in a first group that extends along the first side of the distal portion of the needle.

7. The apparatus according to claim 6, wherein, The second portion of the incision is arranged in a second group, which extends along the second side of the distal segment of the needle.

8. The apparatus according to claim 7, wherein, The size of the incisions in the first group and the distribution of the length along the distal segment of the needle are substantially similar to the incisions in the second group.

9. The apparatus according to claim 7, wherein, At least one of the spacing and size of the cuts in the first group varies along the length of the first group.

10. The apparatus according to claim 9, wherein, At least one of the spacing and size of the cuts in the second group changes along the length of the second group.

11. The apparatus according to any one of claims 1 to 10, wherein, The needle is configured such that actuation of the actuator allows the distal segment of the needle to bend only in a predetermined plane.

12. An apparatus for treating tissue, the apparatus comprising: A needle having a flexible distal portion, the needle including a plurality of channels extending within its wall, each of the channels extending from a proximal end of the needle to a distal channel end within the distal portion, the needle being configured for insertion into a living body via an insertion instrument; A first cable, the first cable being received within a first portion of the channel, wherein the distal end of the first cable is connected to a distal end of the first channel. and A second cable is received within the second of the channels, wherein the distal end of the second cable is coupled to the distal channel end of the second channel, the second cable is located on a second side of the needle opposite to a first side of the needle, the first cable is located on the first side, and the first and second cables extend to a position accessible to a user outside the patient's body during use of the device, such that the user can tension the first cable to bend the distal segment of the needle toward the first side.

13. The apparatus of claim 12, further comprising: The handle, which remains outside the body during use, includes an actuator coupled to the first cable and the second cable. The actuator is configured such that operation of the actuator away from the neutral position in a first direction places the first cable under tension to bend the distal segment of the needle toward the first side of the needle, and operation of the actuator away from the neutral position in a second direction places the second cable under tension to bend the distal segment of the needle toward the second side of the needle.

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