Conventional medical devices are manufactured using standard techniques such as injection molding and CNC. Conventional instruments usually consist of many individual parts based on standard components, such as pulleys, that are used in other technical fields in much larger dimensions. Squeezing down these components into miniature dimensions and fitting everything together, requires elaborate manufacturing and assembly, increasing costs and limiting further size decrease. This chapter deals with the benefits of bio-inspiration, applying smart working principles from nature within innovative medical devices, combined with the incredible manufacturing possibilities of additive manufacturing or 3D printing, enabling the manufacture of prototypes that are much simpler and with higher functionality than conventional tools. The chapter also deals with the limitations of 3D printing at small dimensions, requiring new design approaches and clever ways to merge sterilization with the 3D printing process, to realize broad acceptance for use in the future OR.