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A Guide to Surgery

A full set of surgery tools can be found in each Operating Theatre locker at the start of the round, though they are often moved into a bag near the operating table by surgeons. Once a surgery has been initiated, the nearby operating computer will give you a hint towards the next step. For Synthetic surgery, see Here.

Surgical Tools

Every operating theatre is equipped with a full suite of surgical tools. In the event that surgical tools go missing, you can either have them manufactured at an autolathe or order them from Cargo.

The following are the standard surgical tools most doctors will need:

• Scalpel: Creates incisions.
• Hemostat: Ties bleeders, and removes objects.
• Retractors: Opens incisions and cavities.
• Bone Setter: Sets broken bones in place.
• Bone Gel: Mends broken bones back together.
• Cautery: Cauterizes incisions and debrides.
• FixOVein: Mends ruptured arteries and veins.
• Circular Saw: Saws through bone and amputates limbs.
• Surgical Drill: Creates cavity spaces for implants.
• MMI: Provides storage for brains.
• Autopsy Scanner: Provides autopsy results.
• Anesthetic Tank: Anesthetizes patients.
• Sterile Mask: Prevents infections.
• Latex Gloves: Prevents infections.

While not available without research, these tools can be very useful to have once available.

• Advanced Laser Scalpel: A scalpel that can also serve as a cautery and hemostat for clamping bleeders.
• Incision Management System: A scalpel, hemostat, retractor, and cautery all in one. Retractor function takes precedence over hemostat in certain situations.

Ghetto Surgery

Surgery can also be performed with other tools if proper surgical implements are not readily available. Use of these tools dramatically decreases the likelihood of successfully completing a step and often causes collateral damage, especially when attempting to make the initial incision. Furthermore, surgical procedures can be performed on tables and rollerbeds as well, with a 66% and 33% additional chance of failure respectively.

The following is a list of non-standard surgical tools for ghetto surgery:

Each Percentage represents the chance of success

• Scalpel: Kitchen Knife (90%), File:Glass Shard Medium.png Glass Shard (60%), Scissors (12%), Claymore (6%), Energy Axe (6%), Energy Dagger (6%), Chainsaw (1%)
• Hemostat: Cable Coil (90%), Mouse Trap (25%)
• Retractors: Crowbar (90%), Fork (60%)
• Bone Gel: Screwdriver (90%).
• Bone Setter: Wrench (90%).
• Cautery: Cigarette (90%), Lighter (60%), Welding Tool (30%)
• FixOVein: Cable Coil (90%).
• Circular Saw: Hatchet (90%), Armblade (75%) (Amputation Only)
• Surgical Drill: Pen (90%) (Cavity Only), Exosuit Drill (60%) (Dental Only), Mining Drill (60%) (Dental Only), Metal Rods (60%) (Cavity Only), Screwdriver (20%) (Dental Only)

Notable exceptions:

• Debridement: Use a Kitchen Knife or a File:Glass Shard Medium.png Glass Shard to remove a dead tissue.
• Facial Reconstruction: Use a Kitchen Knife or a File:Glass Shard Medium.png Glass Shard to make an incision.
• Implant Removal: Use a Crowbar to extract an implant.
• Internal Damage Repair: Use a Plasmacutter to fix burn damage.
• Open/Close Hatch: Use a Retractor or any kitchen utensil to open or close the hatch.
• Organ Removal: Use a Fork to extract an organ, then a Crowbar to continue.
• Unscrew Hatch: Use a Screwdriver, a Kitchen Knife or a Coin to open the hatch.

Infection

Infections can be caused by a myriad of sources, from untreated burns to uncleanly surgical tools. The following factors contribute to the likelihood of a surgical procedure causing infection: unhygienic surroundings (including blood and debris), dirty surgical tools, unwashed hands, improper/absent usage of sterile gloves, improper/absent usage of sterile masks, improper storage of transplantable limbs/organs, and multiple people in a single operating theatre.

Failure to keep an operating theatre and its tools clean, along with adequate use of protective equipment (gloves, masks) will result in infection. It is paramount that every surgeon practices adequate hygiene and safety precautions, limits the active number of patients in their theatre to one, washes their hands between every surgery, and keeps the operating theatre sterile.

If a patient manages to contract - or is presently suffering from - an infection administer spaceacillin. In lieu of spaceacillin, compounds containing high levels of ethanol (preferably straight ethanol) can be used to disinfect organs during the organ manipulation surgery.

Prepping for Surgery

Now that you understand the basics of both surgical tools and infections it's time to prep for performing the surgery itself. Make sure you diagnose what's wrong with the patient prior to attempting surgery via the use of the Advanced Body Scanner. There are also a few caveats to surgical prep work such as:

• If anyone is pulling on the patient, the surgery will not work properly. Make sure no one is pulling the patient.

• The patient needs to be healed as much as possible prior to surgical intervention, as many surgeries won't take when performed on severely injured persons.

• All patients require some form of anesthetic, such as the anesthetic tank, ether, or hydrdocodone. Failure to use anesthetic will increase the chance of failure on each step.

• If the patient is Vox or Plasmaman do not administer tank-based anesthetic. In the case of Vox and Plasmamen, removing their internals can be fatal.

The following is a list of steps to prep for surgical procedures. Please ensure you diagnose your patient prior to prepping for surgical intervention.

1. Find a suitable operating table. In absence of an operating table, a rollerbed or table may be used (with a higher likelihood of surgical errors).
2. Make sure you're wearing latex gloves and a sterile mask.
3. Use a sink to wash your hands. Unclean hands can result in infections.
4. Click+drag the person to the operating table to lay them down on it.
5. Check to ensure whether or not your patient is able to be safely anesthetized. Species such as Plasmamen and Vox can not be anesthetized and will optionally require ether, morphine (addictive), salicylic acid, or hydrocodone.
6. Pick up a medical mask and anesthetic tank.
7. Click+drag their body onto yours to view their inventory. Click on the link beside "Mask" to remove their mask if they have one. Do the same for the link beside "Back" to remove their backpack.
8. With the medical mask in your active hand click on the "Nothing" link at the top beside "Head (Mask)". In a few seconds, you will equip them with the medical mask.
9. Place the anesthetic tank in your active hand, then click the "Nothing" link in their inventory window beside "Back" to equip it on their back.
10. A new link will appear beside the sleeping agent called "Set internals". Click on it to turn on the gas. It will force them asleep in about 5 seconds. You are now ready to proceed with surgery.
11. Make sure you're set on the Help intent.

Basic Surgery List

While there are a number of surgical procedures one can perform, the following are some of the most common procedures that every surgeon should familiarize themselves with.

• To stop a surgery at any point in time, hold the scalpel tool in your active hand and a cautery in your off-hand. You can also switch intents prior to making the first incision.

• Cybernetic Implant Surgery falls under Organ Manipulation Surgery.

Bone Repair Surgery

The mending of broken bones and fractures

1. (Optional) Complete Prepping for Surgery.
2. Ensure the patient has been healed first, or the bones will break as soon as you fix them.
3. Aim for the afflicted limb in the Damage Zone.
4. Use the Scalpel to select the "Bone Repair" Surgery.
5. Use the Scalpel again to begin the incision
6. Use the Hemostat to stop any potential bleeding.
7. Use your Retractors to lift up the skin.
8. Apply Bone Gel to the broken bone.
9. Use the Bone Setter to put the bone in place.
10. Apply more Bone Gel.
11. Use the Cautery to seal the incision.

Internal Bleeding Surgery

Repairing damaged arteries and veins within the body to stop internal bleeding.

1. (Optional) Complete Prepping for Surgery.
2. Aim for the afflicted limb in the Damage Zone.
3. Use the Scalpel to select the "Internal Bleeding" Surgery.
4. Use the Scalpel again to begin the incision
5. Use the Hemostat to stop any potential bleeding.
6. Use your Retractors to lift up the skin.
7. Use the FixOVein to repair the damaged blood vessels.
8. Use the Cautery to seal the incision.

Amputation

Removal of limbs or head.

1. Aim for the target limb using the Damage Zone.
2. Use the Scalpel or Circular Saw to select the "Limb Attachment" Surgery.
3. Use the Circular Saw to Amputate the limb.

Limb Attachment Surgery

Re-attaching severed limbs

1. Aim for the patient's affected (missing) limb using the Damage Zone.
2. Use the Scalpel to select the "Limb Attachment" Surgery.
3. Attach the appropriate missing limb (theirs or someone elses).
4. Use the Hemostat to reconnect the nerves and muscles and finish. This step isn't needed for IPC limbs.

You can use the severed limbs of most humanoid mobs for this procedure.

Internal Organ Manipulation (Non-Synthetics)

Mending, inserting, and removing internal organs and cybernetic implants. Also fixes bones, and is used to remove xenomorph larva or terror spider eggs.

1. (Optional) Complete Prepping for Surgery.
2. Aim for the correct Damage Zone.
3. Use the Scalpel to select the "Organ Manipulation" Surgery.
4. Use the Scalpel again to begin the incision
5. Use the Hemostat to stop any potential bleeding.
6. Use the Retractors to lift up the skin.
7. Use the Circular Saw to open the the ribcage/skull [CHEST/HEAD ONLY].
8. Use the Retractor to pull their ribcage/skull open [CHEST/HEAD ONLY].
9. Here, you can manipulate the organs, by either using the Hemostat to remove them, Trauma Kit or Nanopaste to heal them, a reagent container filled with an alcoholic reagent to disinfect them, or simply transferring new organs inside.

In the case of replacing "Fleshy mess" from a victim of an abductor make sure to have a spare heart and a defibrillator ready.

1. When finished:Use the Retractor to close the ribcage/skull/skin.
2. Apply Bone Gel to help mend the ribcage/skull [CHEST/HEAD ONLY].
3. Use the Bone Setter to finish mending the ribcage/skull [CHEST/HEAD ONLY].
4. Apply Bone Gel to help mend the ribcage/skull [CHEST/HEAD ONLY].
5. Use the Cautery to seal the incision.

Plastic Surgery

Fixing facial Disfigurement and changing Identity.

1. (Optional) Complete Prepping for Surgery.
2. Aim for the patient's head in the Damage Zone.
3. Use the Scalpel to select the "Plastic Surgery" Surgery.
4. Use the Scalpel again to begin the incision.
5. Use your Retractor to lift up the skin.
6. Use the Scalpel to reshape the face and vocal chords.
7. Use the Cautery to seal the incision.

• Performing the surgery on a Disfigured face will repair, on a Normal face will give a list of random, species-appropriate names to change identity.
• Note that this does not repair "husked" appearance as the result of excessive Burn damage.
• Any ID cards on the patient or surgeon will also have their registered name added to the available names list.

Infection Treatment

Removing infections.

1. Complete Prepping for Surgery.
2. Aim for the affected body part location on the Damage Zone.
3. Use the Scalpel to select the "External Infection Treatment/Autopsy" Surgery.
4. Use the Scalpel again to begin the incision
5. Use the Cautery to seal the incision.

• If an organ is infected you will have to administer spaceacillin or douse it in alcohol with a high ethanol content. If the organ is septic, it will require transplantation.

Debridement and Limb Revival

Reviving dead limbs

1. (Optional) Complete Prepping for Surgery.
2. Aim for the afflicted limb in the Damage Zone.
3. Use the Scalpel to select the "Debridement" Surgery.
4. Use the Scalpel again to begin the incision
5. Use the Hemostat to stop any potential bleeding.
6. Use your Retractors to lift up the skin.
7. Use the Scalpel to debride the necrotic tissue.
8. Apply mitocholide using a container* to the organ to regenerate the removed tissue.
9. Use the Cautery to seal the incision.

• While bottles and buckets may be used, droppers are more effective (can not fail). The container must have mitocholide in it.

Advanced Surgery List

There's also a bevy of other surgeries that, whilst uncommon, can be extremely useful under certain circumstances.

Limb Augmentation

Augment limb with robotic part.

1. Aim for the chest or limbs in the Damage Zone.
2. Use the Scalpel to select the "Augment Limb" Surgery.
3. Use the Scalpel again to begin the incision.
4. Use the Hemostat to stop any potential bleeding.
5. Use the Retractorto lift up the skin.
6. While holding a cyborg arm, leg, or chest; Insert the item inside.

Cavity Surgery

Implanting a variety of objects into an artificial body cavity.

Maxiumum size of item that fits inside:

• Head - tiny (i.e. pen, paper)
• Abdomen - pocket-size (i.e. most surgical tools)
• Chest - small (i.e. bone saw, revolver)

1. Aim for the chest, abdomen or head in the Damage Zone.
2. Use the Scalpel to select the "Cavity Implant/Removal" Surgery.
3. Use the Scalpel again to begin the incision
4. Use the Hemostat to stop any potential bleeding.
5. Use your Retractors to lift up the skin.
6. [HEAD AND CHEST ONLY] Use the Circular Saw to cut through the bone.
7. [HEAD AND CHEST ONLY] Use the Retractor to pull back the bone.
8. [GROIN ONLY] Use the Scalpel to make an internal incision into the abdominal wall.
9. Use the Surgical Drill to prepare the cavity.
10. While holding an Item:Insert the item inside. If it caused internal bleeding, use FixOVein internal bleeding surgery to fix it.
11. With an open hand: Click the patient to check for items inside the cavity.
12. When done use Cautery twice to mend cavity wall.
13. [HEAD AND CHEST ONLY] Use the Retractors to close their ribcage.
14. [HEAD AND CHEST ONLY] Apply Bone Gel to mend the cut ribcage.
15. [HEAD AND CHEST ONLY] Use the Bone Setter to mend the ribcage.
16. [HEAD AND CHEST ONLY] Apply Bone Gel to mend the cut ribcage.
17. Use the Cautery to seal the incision.

Dental Implant Surgery

Putting pills in your teeth.

1. (Optional) Complete Prepping for Surgery.
2. Aim for the mouth Damage Zone.
3. Use the Scalpel (or other surgery starter) to select the "Dental Implant" Surgery.
4. Use the Surgical Drill to prepare the tooth.
5. Insert the desired pill in the tooth.

Embedded Object Removal (Non-Synthetics)

Removing embedded objects, typically bullets, from the body.

1. (Optional) Complete Prepping for Surgery.
2. Aim for the embeded object location on the Damage Zone.
3. Use the Scalpel to select the "Removal of Embedded Objects" Surgery.
4. Use the Scalpel again to begin the incision
5. Use your Hemostat to stop any potential bleeding.
6. Use your Retractors to lift up the skin.
7. Use the Circular Saw to open the ribcage/skull. [CHEST/HEAD ONLY]
8. Use the Retractor to pull their ribcage/skull open. [CHEST/HEAD ONLY]
9. With an empty hand: Click the patient to remove the embedded object.
10. Use the Retractor to close their ribcage/skull. [CHEST/HEAD ONLY]
11. Apply Bone Gel to mend the cut ribcage/skull. [CHEST/HEAD ONLY]
12. Use the Bone Setter to finish mending the ribcage/skull. [CHEST/HEAD ONLY]
13. Apply Bone Gel to mend the cut ribcage/skull. [CHEST/HEAD ONLY]
14. Use the Cautery to seal the incision.

Implant Removal (Non-Synthetics)

Removing Implants such as mindshields, death alarms, mindslaves, and other implants from the body.

1. (Optional) Complete Prepping for Surgery.
2. Aim for the chest on the Damage Zone.
3. Use the Scalpel to select the "Implant Removal" Surgery.
4. Use the Scalpel again to begin the incision
5. Use your Hemostat to stop any potential bleeding.
6. Use your Retractors to lift up the skin. Hold a Implant Case in your other hand for the next step to put the implant into a case.
7. Use your Hemostat to extract the implant.
8. Use the Cautery to seal the incision.

Autopsy

Examination of cadavers to find cause of death. See autopsy prodedures for more information.

1. Place cadaver onto the operating table.
2. Scan the cadaver with a Health Analyer to find injured locations.
3. Aim for the patient's affected area in the Damage Zone.
4. Use the autopsy scanner to scan the area.
5. Repeat scan procedure for all affected areas.
6. Right click the autopsy scanner to print out autopsy data.

Organ Removal (Decapitated Head)

Removing the eyes and brain of a decapitated head for transplant to a full body or man-machine interface.

1. With the head in your hand, use the Scalpel to make an incision.
2. Use your Retractors to peel the skin open.
3. Use the Bone Setter or Circular Saw to crack the head open.
4. Use the Hemostat to remove the eyes/brain.

Alien Organ Manipulation

Extracting or manipulating the organs of a Xenomorph.

1. Aim for the chest, head, groin, eyes, or mouth in the Damage Zone.
2. Use the Scalpel or the Circular Saw to select the "Alien Organ Manipulation" Surgery.
3. Use the Circular Saw to saw its carapace.
4. Use the Scalpel to cut its carapace.
5. Use the Retractor to retract its carapace.
6. Here, you can manipulate the organs, by either using the Hemostat to remove them, Trauma Kit to heal them, a reagent container filled with an alcoholic reagent to disinfect them, or simply transferring new organs inside.

Synthetic Surgery List

There are are also a number of procedures that can be performed on IPCs. IPCs don't feel pain and can't get infections, so don't worry about administering anesthetics or washing your hands.

Internal Cybernetic Manipulation

Mending, removal, and insertion of posibrains, microbatteries, optical sensors, and implants.

1. Aim for the patient's correct Damage Zone.
2. Use the screwdriver to select the "Internal Cybernetic Manipulation" Surgery.
3. Use a screwdriver to unlock the hatch on the limb;
4. Use a crowbar to open the hatch on the limb;
5. [REMOVAL Option] Use a multitool to Remove the organ.
6. [REMOVAL] Dispose of the organ. For Borgification simply place the Posibrain in an empty cyborg exoskeleton, or give the posibrain to a Roboticist.
7. [TRANSPLANTATION Option] Use the organ you intend to transplant on the patient.
8. [HEALING Option] Repair the affected organ with Nanopaste.
9. Use a crowbar to close the hatch on the limb

Implant Removal (Synthethics)

Removing implants from the body. Also removal of things from body cavities.

1. Aim for the implant location on the Damage Zone.
2. Use the screwdriver to select the "Implant Removal" Surgery.
3. Use a screwdriver to unlock the hatch on the limb;
4. Use a crowbar to open the hatch on the limb;
5. Use your hemostat to extract the implant. This may take several goes.
6. Use a crowbar to close the hatch on the limb

Robotic Limb Repair

Fixing mechanical arms, legs, hands and feet. Also performs facial reconstruction if aiming for head.

1. Use the screwdriver to select the "Cybernetic Repair" Surgery.
2. Use a screwdriver to unlock the hatch on the limb;
3. Use a crowbar to open the hatch on the limb;
4. Use a welding tool to repair Brute damage then cable coil to repair burn damage;
5. Use a crowbar to close the hatch on the limb

Robotic Limb Amputation

Amputating or otherwise removing mechanical limbs for the purposes of replacement, or simple cruelty.

1. Use the screwdriver to select the "Robotic Limb Amputation" Surgery.
2. Use a multitool to remove the targeted limb.