Abstract Surgical instruments were the earliest products of biomedical engineering. Principal knowledge of the surgical tools used in classical (open) surgery is a precondition to understand the mode of action and design of even more sophisticated instruments as used in flexible endoscopy, laparoscopy, or NOTES. In this chapter, the most important items, such as forceps, clamps, scissors, retractors, and needle holders are explained. The therapeutic use of electrosurgery is described as well as new tissue dissection techniques like ultrasound and water jet dissection. A detailed description of stapling devices is followed by an overview upon suture materials and meshes.