A medical device includes a lever with an applied force position, a load position, and a fulcrum position. A first cable extends from the applied force position of the lever to a first capstan, the first cable wrapping around the first capstan. A second cable extends from the applied force position of the lever to a second capstan, the second cable wrapping around the second capstan. A rod couples the load position of the lever and a surgical end effector. The first and second capstans may be fixed to an axle. The axle may receive a rotational input from a rotary actuator. A hand wheel may be coupled to the axle. There may be a spring between a support structure and the lever to bias the lever to rotate about the fulcrum position of the lever.