A miniaturized ultrasonic scalpel based on the Acoustic Black Hole (ABH) and Moonie transducer structures is proposed in this paper, aiming to effectively address the vibration performance degradation of the ultrasonic scalpel during miniaturization by leveraging the energy local aggregation effect of the ABH structure and the displacement amplification characteristics of the Moonie transducer. The scalpel consists of a metal end cap with an ABH profile, operating blade and a longitudinally polarized piezoelectric ring, achieving multiple vibration mode conversions. An analytical theoretical model for the multi-modal coupled vibration of the ABH-Moonie type scalpel was established using the equivalent circuit method, enabling rapid frequency prediction. The coupled vibration characteristics of the ABH-Moonie type scalpel were analyzed using the finite element method, and the effects of ABH parameters and load on vibration performance were investigated. Compared to the conventional Moonie-structured scalpel (m<2), the ABH-Moonie type scalpel demonstrates a significant improvement in maximum amplitude output. Under load conditions, the scalpel maintains good vibration performance, including minimal frequency drift and vibration attenuation. Finally, a scalpel prototype was fabricated and experimentally tested. The results show that the designed mode of the scalpel can be effectively excited, with a frequency error of only 1.5%, fully validating the feasibility of the ABH-Moonie composite enhancement structure and the accuracy of the analytical theoretical model. This study provides a novel perspective for the design and optimization of miniaturized high-performance piezoelectric devices.