Can medical institutions make their own medical devices, such as developing their own surgical tools?

It is possible, but it is not formal.

Formal research and development of medical devices depends on the company's business license or production license.

Whether there is research and development, in areas with strict medical device management, it must be strictly implemented in accordance with registration.

Of course, some areas are not well managed, so they secretly transform them themselves. But there is no formal document approval.