Disclosed are systems, devices, and methods that allow a surgeon to both cut an implanted microsurgical device and also to simultaneously retain the cut-off piece using a single tool and a single motion. In various embodiments, this is achieved by a microsurgical cutting and grasping instrument that may include a piston assembly including a piston, a cap, an outer shell housing the piston and a tension member in operative engagement with the piston and the cap, a cannula connected to the piston, a rod axially disposed in the cannula which is moved in an axial direction by the piston when the outer shell and the piston are squeezed together, a cutter assembly disposed at a distal end of the rod and configured to perform both an inline cutting action and a grasping action on a target.