The introduction of the microscope in the operating room necessitated the research, development and production of multiple, new or simply smaller and finer surgical instruments. It expanded the boundaries of the specialty, it improved patient outcomes and it made the creation of subspecialties, such as vascular and skull base neurosurgery, feasible. The microscope serves two main functions such as operative field magnification and illumination. There should be a proper understanding of the tools used for the surgery along with its outcome. The chapter gives a review about the use of operating microscope, mechanics of various surgical microinstruments, monopolar and bipolar electrocautery, and techniques to use needle drivers, suturing material, dissectors, vascular clips and clip appliers.