In various embodiments, a surgical instrument for operation in an aqueous environment is provided. In at least one embodiment, the surgical instrument may include a hollow sheath and a blade disposed at least partially within the sheath. Coupled to the blade may be at least one ultrasonic transducer, which, in turn, may be coupled to a drive system. The drive system may be configured to deliver gross axial motions to the blade such that the blade translates with respect to the hollow sheath when the drive system is activated. Accordingly, tissue may be cut by the blade with gross axial movement of the blade and/or ultrasonic vibrational motion provided by the ultrasonic transducer(s). In alternative embodiments, the blade may be rotated axially instead of translated with respect to the hollow sheath.