A motion-compensated cutting system includes a hand-held tool body, and an actuator connected to the tool body. A shaft of the actuator is movable relative to the tool body so that a distal end of a cutting implement attached to the shaft is axially movable relative to the tool body. An optical coherence tomography system includes an optical fiber with a distal end fixed relative to the distal end of the cutting implement. The system includes a control unit that can determine a position of the distal end of the cutting implement relative to a reference surface based on input from the optical coherence tomography system. The control unit can control the cutting implement to compensate for relative motion between the tool body and the reference surface, and can maintain a predetermined depth of the distal end of the cutting implement with respect to the reference surface.
