A medical observation device that includes a microscope that images a surgical site, a holding section that holds the microscope, a base section to which the holding section is connected, and an operation section that receives operating input, the operation section being provided at the base section, the holding section being configured as a balance arm provided with a counterweight, when the base section is viewed from an upper side of the medical observation device, the base section having a first area inside a movable range of the counterweight and a second area outside the movable range of the counterweight, the base end of the holding section being connected to the base section at a location in the first area, and the operation section being arranged at another location in the second area.