Guide to Surgery

A Preface to Surgical Procedures

All surgical procedures are handled primarily by two different variables:

1. The Qualities a tool has. The higher the required quality a tool has, the more effective (fast) that tool will be.
2. Your Biology stat. The higher it is, the less likely you are to fail a surgical procedure. The same holds for procedures on prosthetics and robotic parts, but using the Mechanical stat instead.

Your Biology (or Mechanical for prosthetics/robotic parts) stat also affects diagnosis. If you do not meet the threshold, the Surgical UI shows a single "Diagnose" button. Click it to attempt to diagnose that bodypart; success reveals health, organ integrity, and conditions. If you fail, you can try again until you succeed—otherwise you cannot perform most procedures. At Expert level or above in the relevant stat, you diagnose immediately without a roll.

Only Medical Doctors and the Chief Biolab Overseer are qualified to perform advanced surgery (e.g. internal organ repair, facial restoration, bone grafting), but nothing bars Corpsmen or Roboticists from doing so when no Doctors (or ideal conditions) are available.
Ideally, all surgical procedures are done with proper Surgical Tools in the Operating Theatre, an Operating Table, and Anesthetics.

The patient must ALWAYS be sedated to perform surgery, both as ethical practice and to avoid the trauma of feeling the procedure. The ideal method is Anesthetics. If unavailable, Soporifics (NOT CHLORAL HYDRATE. SOPORIFIC.) are a viable alternative. If neither is available, at least numb pain with Tramadol or preferably Oxycodone.
The sole exceptions are Cht'mant (they do not feel pain and many prefer to remain conscious during surgery) and patients who have specified—verbally or in Medical Records—that they do not wish to be unconscious (preference, trauma, religion, etc.). For those who refuse sedation but must stay still, use strong pain relief (e.g. Oxycodone) and/or a paralytic such as Vecuronium Bromide so they cannot move during the procedure; the paralytic does not cause unconsciousness. Always respect the patient’s wishes; they have the right to refuse.
IF THE PATIENT IS *NOT* BUCKLED, YOU WILL HURT OR KILL THEM INSTEAD OF PERFORMING SURGERY STEPS!!

Field Surgery

Use this only when Medbay or operating rooms are unreachable (e.g. overrun, destroyed, or on an expedition) and surgery is needed immediately. Without a proper operating table, use a Roller bed when possible (lowest step failure outside proper surfaces). If that is not available, build a Bed from metal so long as the patient stays buckled to it.
If possible, remove their backpack, put an anesthetic tank on their back and a breathing mask on their face, turn it on, and proceed. Drag their sprite to yours, then click the corresponding equipment slots with empty hands.
Without anesthetic, use Tramadol or Oxycodone and ask them to look away.

AGAIN: ENSURE THEY ARE *BUCKLED* TO THE BED/ROLLER BED OR YOU WILL HURT THEM!!

Self Surgery

You can perform surgery on yourself (Self-Surgery) by buckling yourself to a chair instead of a bed. You cannot do this while unconscious, so use strong painkillers or Oxycodone first. You cannot operate on a hand with the tool held in that same hand (e.g. no incision on the right hand if the right hand holds the scalpel).

Surgical Tools

For easier classification we use Tool Qualities. Each surgical step needs a tool with a given quality; higher quality means faster, more reliable steps.

Qualities used in surgery:

• Cutting / Laser Cutting — Incisions and facial reconstruction. Laser cutting can make a clean incision that does not require a separate clamping step.
• Clamping — Stopping bleeding from incisions and extracting foreign objects or implants.
• Retracting — Opening the surgery interface after an incision (opens the Surgical UI window).
• Bone setting — Setting a broken bone back into place (does not repair integrity damage by itself).
• Sawing — Amputation of organic limbs.
• Cauterizing — Closing incisions and reattaching transplanted organic organs.
• Hammering — Deliberately breaking bones (e.g. for certain repairs).
• Screw driving — Opening prosthetic hatches and fixing robotic organs; also used to attach prosthetic organs after insertion.
• Bolt turning — Disconnecting (amputating) robotic limbs.
• Prying — Removing objects from robotic limbs.
• Bone grafting — Repairing integrity damage to bones (e.g. with Bone Gel).
• Drilling — Hardsuit removal (and similar procedures).
• Welding / Wire cutting — Repairing damage on robotic limbs and organs (with or without cable coils/nanopaste as alternatives where supported).

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Approved Surgical Tools:

• Scalpel
• Hemostat
• Retractors
• Circular saw
• Cautery
• Bone setter
• Bone gel
• Anesthetics
• Autopsy scanner
• Latex/Nitrile gloves
• Advanced Trauma Kit
• Advanced Burn Kit
• Nanopaste

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"Alternative" Tools:

• Cable Coil (see Robotic Limb Repair)
• Wire cutters (Retracting, Bone setting)
• Crowbar (Prying, Hammering)
• Welding Tool (Welding, Cauterizing)
• Screwdriver (Screw driving, Bone setting)
• Wrench (Bolt turning, Hammering)
• Any sharp object with Cutting quality
• Lighter or lit cigarette (Cauterizing)
• Any item with Sawing quality
• Bruise pack (as trauma kit)
• Ointment (as burn kit)
• Superglue (bone grafting)

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The Soteria Medical Omnitool is an excellent implant for Medical Doctors and Corpsmen. It acts as multiple surgical tools in one implant; use it on the bodypart (or the Surgery UI) to perform steps. It requires a battery to function.

Preventing Infections

ALWAYS wear Latex/Nitrile Gloves (or at least gloves) and wash your hands before AND AFTER every surgery. Otherwise you risk giving the patient an infection that can become very serious. Ensure both your hands AND your tools are free of blood BEFORE starting. A spray bottle of Sterilizine is useful for sanitizing tools and surfaces.

Preparing the Operating Theatre

• Open a locker in the room, take an Anesthetics tank and place it on the Medical Stand.
• Tighten the nut holding the tank with a Wrench from the locker by clicking the Medical Stand (with the tank attached) with the wrench.

Preparing a patient for surgery

1. Lay the patient on the Operating Table so they are buckled to it.
2. Click and hold the Medical Stand and drag it onto the patient. Ensure they are not wearing a mask, holding a cigarette, or anything in their mouth. If a Blood Pack is also on the Stand, you will be prompted to choose: Blood pack or Mask.
3. Click the Medical Stand with an empty hand and choose "Toggle Valve" to open the gas so they breathe anesthetics.
4. Right-click the patient and Examine them to confirm they are asleep.
5. Begin surgery.

If the patient is already dead, skip anesthetics. Remember to perform an Autopsy scan for research points where applicable.

Surgical Procedures List

The list below assumes the patient is buckled to a surgical table/bed/roller bed and properly sedated (unless exempt).

Opening a Surgical Incision

The first step for almost every surgical procedure.

1. Aim at the bodypart you want to operate on # With a Scalpel (or any tool with Cutting quality), click the patient to make the incision.
2. If you did not use a laser scalpel: with a Hemostat (or Clamping quality), click the patient to stop the bleeding.
3. With a Retractor (or Retracting quality), click the patient to open the Surgery UI.

The Surgery UI is your main way to work inside a bodypart. After retracting, it shows that bodypart’s internal organs, conditions (e.g. Bleeding, Necrosis, Disfigured face), and actions (e.g. Separate/Attach, Mend, Graft, Amputate, Insert). Unless stated otherwise, steps are done via this UI or by clicking the patient with the right tool.
NOTE: With a Laser Scalpel you may be offered a normal or laser-assisted incision. If you choose the laser option, you skip the Hemostat step (no separate clamping).
If you leave and the Surgery UI closes, Examine the patient or use the Retractor again on the same bodypart to reopen it.

Closing a Surgical Incision

The final step of ALL surgeries on that bodypart.

1. Aim at the bodypart that has an open incision.
2. Use a Cautery (or tool with Cauterizing quality) on the patient to seal it. The Surgery UI will close when the incision is closed.

IMPORTANT: Always Examine the patient to confirm no incisions are left open. An open bodypart will report something like "They have an open incision on their (limb)". Open incisions cause pain and infection risk.

Bone Setting and Repair

Setting broken bones and repairing their integrity. Bones are internal organs (e.g. skull, ribcage, pelvis, humerus, femur) and appear in the Surgery UI.

1. Open an incision on the bodypart with the damaged bone.
2. In the Surgery UI, select the bone for that bodypart. Use "Mend" with a Bone Setter (or Bone setting quality) if the bone is broken.
3. Use "Graft" with Bone Gel (or Bone grafting quality) to repair integrity damage to the bone.
4. Close the incision.

Tissue Reconstitution

Healing large Brute or Burn damage (e.g. to prepare a corpse for revival). Bodies with very high Burn damage may need Ryetalyn to unhusk before revival.

1. Aim at the Chest# Open an incision; retracting is optional if you are only applying kits to the body.
2. Click the patient’s body with a full Advanced Trauma Kit for Brute, or Advanced Burn Kit for Burn. Bruise Packs and Ointment can be used as weaker alternatives.
3. Scan with a Health Analyzer; if Brute/Burn is still high (e.g. above ~100), repeat until the patient is in a safe range.
4. Close the incision.

If the Trauma Kit or Burn Kit is not full when you perform this step, the surgery may use time but not heal.

THIS PROCEDURE CONSUMES USES OF THE KIT AND IS EXPENSIVE.

Internal Organ Repair

Repairing damaged internal organs (e.g. lungs, liver, kidneys, stomach, brain, muscles, nerves, blood vessels).

1. Open an incision on the bodypart that contains the damaged organ.
2. In the Surgery UI, select the damaged organ. To treat damage:
   • For organic organs: open Mods/Wounds on that organ and use Treat with an Advanced Trauma Kit or Bruise Pack (or use any Heal/Mend action shown for that organ with the same tools).
   • For synthetic/robotic organs: use Treat or the repair action with a Screwdriver or Nanopaste.
3. Close the incision.

Limb and Stump Amputation

Required before replacing a limb when the limb is a stump, or to replace it with a prosthetic.

1. Aim at the limb or stump.
2. Open an incision on it. If the patient has a stump on scans but you get "They're missing that limb!" when trying this, consider ahelp as it may be a bug.
3. In the Surgery UI, scroll to the red Amputate (or Disconnect for robotic limbs) button.
4. Click Amputate while holding a Surgical Saw (or Sawing quality). For a stump, bleeding is handled by this step.
5. You do not cauterize a missing limb; simply close the Surgery UI when done.

Limb Replacement

Replacing missing limbs (including the head).

If there is a stump, do Stump Removal first.

1. Aim at the correct zone: Chest for arm or head, Groin for leg.
2. Open an incision on that bodypart.
3. In the Surgery UI, click Insert with the desired limb in hand (organic or prosthetic).
4. Close the incision.

If the inserted limb was previously amputated and still has an open incision, close that incision as well.

Inserting Implants and Toolsets

"My vision is augmented."

1. Aim at the bodypart where the augmentation will go.
2. Open an incision. Some implants only fit certain bodyparts (e.g. Subdermal Armor on Chest, Mechanical Muscles on Legs, Embedded HUDs on Head).
3. In the Surgery UI, click Insert with the implant in hand.
4. Close the incision.

Foreign Object Removal

Removing embedded shrapnel, implants (e.g. Excelsior), and other objects that do not belong inside the body.

1. Scan the patient on the Body Scanner to find foreign objects (they may show as "Unknown body" on a bodypart). Printing the scan helps.
2. Aim at the relevant bodypart. Excelsior implants are often in the Head.
3. Open an incision.
4. In the Surgery UI, select the object and click Extract while holding a Hemostat (or Clamping quality). For shrapnel, you can use the Remove shrapnel option in the UI.
5. Close the incision.

Facial Reconstruction

When someone shows as "Unknown" or with a mangled face (e.g. "looks horribly mangled!" on Examine), or damaged vocal cords, this restores identity and speech.

1. Open an incision on the patient’s Head # In the Surgery UI, under Conditions, find "Disfigured face" (or damaged vocal cords) and click Restore with a Scalpel or tool with Cutting quality.
2. Close the incision.

Organ Extraction / Transplant

Removing and re-inserting organs.

Locating organs (by bodypart):

• Head — Brain, Eyes, Skull (bone)
• Chest — Heart, Lungs, Stomach, Ribcage (bone)
• Groin — Appendix, Kidneys, Liver, Pelvis (bone)
• Each bodypart also has muscles, nerves, blood vessels, and its corresponding bone (e.g. humerus, femur). All of these count as organs for extraction/transplant.

Extracting an organ:

1. Open an incision on the bodypart that contains the organ.
2. In the Surgery UI, select the organ:
   1. For bones: click Extract with a Hemostat (or Clamping quality).
   2. For other organs: click Separate with a Scalpel (or Cutting quality), then click Extract with the Hemostat.
3. Close the incision.

For borgification, place the brain in a Man-Machine Interface as soon as possible to preserve it.

Transplanting an organ:

1. Open an incision on the correct bodypart.
2. In the Surgery UI, click Insert with the organ in hand.
3. The new organ appears in the list. Select it and click Attach with a Cautery (or Cauterizing quality) for organic organs, or a Screwdriver (or Screw driving quality) for prosthetic organs.
4. Close the incision.

Purging Toxins / Fixing Neural Degradation

Removes toxin damage and can help with neural degradation from long death. Use when a body has high Toxin and/or "Excessive neural degeneration" blocks revival.

1. Aim at the Chest# Open an incision; retracting is optional.
2. Use Nanopaste (or Purging Ichor where available) on the patient’s body to reduce toxin damage and neural degradation.
3. Close the incision.

Autopsy

Examination of cadavers for cause of death. See autopsy procedures. Give a copy of scans to Science for research points.

1. Use a Scalpel (or Cutting quality) on every bodypart: Head, Chest, both arms, Groin, both legs.
2. Use a Hemostat (or Clamping quality) on each incised bodypart to stop bleeding (skip if you used a laser-assisted incision).
3. Use the Autopsy Scanner on each incised bodypart.
4. Cauterize each bodypart with a Cautery (or Cauterizing quality).
5. Use the Autopsy Scanner in hand (e.g. press Z or click it) to print an Autopsy Report.
6. Complete and hand in the report as in the autopsy procedures. Give a copy to Science for research points.

For maximum accuracy and research gain, cut and scan every bodypart. If Science is unmanned, you can use a Science Tool from R&D (Misc) to scan the report and add points at the R&D console.

Hardsuit Removal

Required to remove a hardsuit from a dead or unconscious person so you can perform surgery.

THIS USES THE MECHANICAL STAT. ROBOTICISTS OR ARTIFICER'S GUILD MEMBERS ARE PREFERRED; DOCTORS MAY FAIL REPEATEDLY.

1. Aim at the chest.
2. Use a surgical drill or tool with Drilling quality to cut through the support systems.
3. Drag the patient’s sprite to yours and remove the Hardsuit Module from their Back slot.

Bone Reinforcement (Bone Braces)

Installing Bone Braces as an organ modification on a bone to strengthen it (at the cost of some movement speed).

1. Aim at the bodypart whose bone you want to reinforce.
2. Open an incision and open the Surgery UI.
3. In the Surgery UI, click on the bone (e.g. ribcage, skull, femur) for that bodypart, then open Mods/Wounds to view that internal organ.
4. Click Attach and use Bone Braces in hand to install them as an organ modification on the bone.
5. Close the incision.

Bone Braces are an organ mod applied to the bone, not a separate “break then reinforce” procedure. They can be crafted or obtained from research/prosthesis designs.

Necrotic Tissue Excision (Sepsis Removal)

When infection is left untreated, a bodypart can become necrotic (dead tissue), causing toxin damage. This surgery removes the necrotic condition from that bodypart.

1. Use the Body Scanner to find the bodypart showing sepsis/necrosis.
2. Treat the underlying infection (e.g. inject 15–17 units of Spaceacillin) so germ levels can decrease.
3. Aim at the affected bodypart.
4. Open an incision.
5. In the Surgery UI, under Conditions, find Necrosis and click Treat with a Scalpel (or Cutting quality).
6. If necrosis reappears, the infection level may still be high; repeat infection treatment and/or surgery. Optionally spray the patient with Sterilizine to help reduce germs.
7. When necrosis no longer appears, close the incision.
8. Have the patient rest and monitor; give more Spaceacillin as needed until the infection is gone.

Necrosis appears when the bodypart reaches a high infection stage (e.g. severe germ accumulation). There is no in-game readout of exact germ count; use the Body Scanner and response to treatment to judge progress.

Prosthetic and Robotic Procedures

For FBP and robotic organ/limb repairs, see the Guide to Robotics.