Surgery

Tools of the Trade

Image	Name	Function	Improvised Equivalents
	Scalpel	Used for cutting through flesh.	or
	Laser Scalpel	Used for cutting through flesh, skips bleeder clamping. Basically acts as both a scalpel and a hemostat in one step during the initial incision. Can fail due to experimental nature.	N/A
	Incision Management System	Used for cutting through flesh, skips bleeder clamping and organ rearranging. Basically acts as a scalpel, hemostat, and retractor in one step during the initial incision, then acts as a faster retractor afterwards. Failure proof unless patient is not under anesthetic.	N/A
	Hemostat	Used to stop bleeding during an operation, or to remove foreign and undesirable objects from a patient's body.	or
	Bone Setter	Used for setting bones back into place. If used on a bone that is not broken then you will break it.
	Bone-Gel	Used for repairing broken/shattered bones.
	Retractor	Used for re-arranging organs, and moving cut ribcages & skulls.
	Cautery	Used for sealing incisions in a patients skin. Burns skin together.	or or
File:1Vixovein.png	Fix-o-Vein	Used for repairing veins and arteries.
	Circular Saw	Used for cutting through bones.
	Advanced Trauma Kit	Used to patch all organs except for the brain and eyes.	N/A

Surgeries

Surgery is a simple process with a series of steps. Once these steps are memorized it should become effortless and routine to perform. Keep in mind that once you have mastery over the basics, it's a good idea to aim to be as fast and efficient as possible due to the importance of recycling casualties back into the fight, or even preventing them from dying in the case of Foreign Object/Alien Embryo Removal

The first step is either applying anesthetic to the patient via the anesthetic tank and medical mask and turning on its internals (encourage your patient to put on the tank and mask, and turn the internals on as this is fastest and allows you to proceed with step two immediately), or using powerful painkillers like Oxycodone (recommended only for experienced surgeons). If you use painkillers, you must be careful to make sure that they aren't metabolized/depleted mid-surgery; use your medical scanner to monitor your patient's painkiller levels and redose as necessary. Note that even the most powerful painkillers feature a failure chance for steps taken during the actual surgery.

The second step is to prevent infection: wash your hands, spray yourself with Space Cleaner, or best of all, inject your patient with Spaceacillin effectively immunizing him from infection while it remains in his system (which will be awhile).

The third step is to place your patient on the surgical table (grab your patient, then click the table with your grabbing hand selected). If you must, you can improvise with a roller bed or even a table, but these improvised surfaces add a failure chance to each surgical step (a table's failure chance is higher).

Now that the preparations are done, you can begin with the actual surgery.

Most surgeries begin with a surgical incision into the tissue. The hemostat step can be saved for later in the surgery or skipped entirely at the cost of damaging your patient over time.

• Open the incision.
  (->->)

Some surgeries require access to the organs behind the skull or ribcage.

• Open the skull or ribcage.
  (->)
• Close the skull or ribcage.
  (->)

All surgeries that begin with an incision must end in its cauterization.

• Close the incision.
  ()

Surgery:	Description:	How to:	Target Zones:
Bone Repair Surgery	This surgery is used for mending broken bones and fractures. Keep applying bonegel on the bonegel step until it's refused, Once you can't keep applying it, move on to the next step.	Incision Management System. Note: You can skip the "Open the Incision" step below if you use the incision management system instead. Open the incision. (->->) Repair the bone. (-> Close the incision. ()	Everywhere except mouth/eyes.
Internal Bleeding Surgery	This surgery mends the torn/ripped arteries and veins within the body to stop internal bleeding.	Incision Management System. Note: You can skip the "Open the Incision" step below if you use the incision management system instead. Open the incision. (->->) Mend the artery. (Fix-o-Vein) Close the incision. ()	Everywhere except mouth/eyes.
Foreign Object/Alien Embryo Removal	Removal of unknown objects, such as shrapnel, implants, or alien embryos from the body. Alien embryos will always be in the chest behind the ribcage. Time is of the essence when removing them, and you must complete this surgery as quickly as possible; your patient will die instantly when it finishes gestating, resulting in the birth of an alien larva.	Incision Management System. Note: You can skip the "Open the Incision" step below if you use the incision management system instead. Open the incision. (->->) Open the skull or ribcage if necessary . (->) Fish out the foreign object. () Close the skull or ribcage if necessary. (->). Close the incision ()	Everywhere except mouth/eyes.
Internal Organs Surgery	Mending broken internal organs, excluding the eyes and brain. Healing biological organs with peridaxon is usually faster than this surgery.	Incision Management System. Note: You can skip the "Open the Incision" step below if you use the incision management system instead. Open the incision. (->->) Open the skull or ribcage if necessary. (->) Repair the biological organ with a Trauma Kit, or the robotic organ with Nanopaste. (/) Close the skull or ribcage if necessary. (->) Close the incision. ()	Groin, Chest.
Necrosis Treatment Surgery	Treating necrosis by cutting away the necrotic tissues and treating the affected area.	Incision Management System. Note: You can skip the "Open the Incision" step below if you use the incision management system instead. Open the incision. (->->) Excise necrotic tissue and heal the area. (->) Close the incision. ()	Limbs: Legs, Arms, Hands, Feet.
Organ Removal/Transplantation Surgery	Removing an organ from the body and transplanting a new organ.	Incision Management System. Note: You can skip the "Open the Incision" step below if you use the incision management system instead. Open the incision. (->->) Open the skull or ribcage if necessary. (->). Remove the old organ (->) Add and attach the new organ. Use the Trauma kit if biological, or the Nanopaste if robotic. (New Organ ->Fix-O-Vein->/) Close the skull or ribcage if necessary. (->) Close the incision. ()	Groin, Chest, Head.
Brain Damage Surgery	Fixing up the brain. Using peridaxon or alkysine is usually faster than this surgery.	Incision Management System. Note: You can skip the "Open the Incision" step below if you use the incision management system instead. Open the incision. (->->) Open the skull. (->) Extract embedded bone chips from the brain until they are all removed. () Repair severe brain damage, if any. (Fix-O-Vein) Close the skull. (->) Close the incision. ()	Head.
Facial Reconstruction Surgery	This surgery fixes facial deformities caused by severe damage to the head. I.E. "Unknown as (name)" when speaking. This surgery is of minimal priority and should only be done if you have literally nothing better to do. This is a combat operation, cosmetic surgery can wait.	Incision Management System. Note: You can skip the Scalepl, Hemostat and Retractor step below if you use the incision management system instead. Fix the facial deformities. (->->->)	Mouth.
Amputation	Removal of a limb.	Saw through the limb. ()	Limbs: Legs, Arms, Hands, Feet.
Limb Replacement Surgery	The replacement of missing limbs with robotic ones. You can also reattach a robotic limb to just a hand or foot stump.	Seal the stump. (->->) Attach the robotic limb. (Robotic Limb)	Limbs: Legs, Arms, Hands, Feet.
Eye Surgery	Mending the eyes to cure blindness and eye damage. Using peridaxon or imidazoline is usually faster than this surgery.	Mend the eyes (->->->).	Eyes.

Combining Surgeries

Very often people will come in with multiple problems at once. For instance, you might have a patient who has a fractured skull, brain damage, and shrapnel in their head. Performing three separate surgeries is very time consuming when other marines may be waiting. It is possible to condense the surgery down to one in such a manner:

• Broken skull, brain damage, and head shrapnel removal surgery

1. Cut an incision while aiming with 'Help' intent at the head
2. Stop bleeders in the head
3. Open up the incision for further surgery
4. Cut through the skull
5. Open up the skull
6. Here it gets a bit tricky, use a hemostat repeatedly to pull out bone chips and shrapnel until you get a message that nothing more can be found in the brain. Both types of removal can take several rounds or attempts.
7. Fix-O-Vein Use the FixOVein and Trauma Kit to repair hematomas and damage to the brain and eyes if necessary
8. Use the Health Analyzer to check that the patient does not have brain damage! If the patient still has brain damage go back and use the hemostat and FixOVein more until the Analyzer shows no brain damage.
9. Close the skull back up
10. Use bone gel on the damaged bones in the skull
11. Piece together the broken or fractured skull
12. Add bone gel once more
13. Seal up the incision
14. Use the Health Analyzer again to see if the patient needs antibiotics or anti-toxins and administer them as needed

What about an infected marine with a broken chest, internal bleeding, and a ruptured lung? Here you'll want to use medication from the vendors in medbay in order to tackle the problems at hand.

• Alien embryo removal, ruptured lung, and broken chest surgery (with a side of internal bleeding)

1. First use one Quick-clot and one Dexalin Plus injectors to stop internal bleeding and to halt suffocation damage from the ruptured lung. While you can stop internal bleeding surgically, in the vast majority of cases a quick jab with Quick-clot is preferable. Keep a couple of Dex+ injector on hand to keep the patient from dying from the ruptured lung.
2. Make an incision quickly
3. Ignore bleeders and rearrange organs. Removing the larva ASAP is the top priority right now
4. Cut open the rib cage
5. Separate the rib cage
6. Begin pulling out the alien embryo
7. Repair the ruptured lungs and any other damaged organs, note that a mechanical heart requires to fix
8. Now stem the bleeders with the hemostat
9. Close up the rib cage
10. One application of bone gel for the cut rib cage. Cut rib cages and skulls require one application of bone gel after they've been pushed back together.
11. Set the broken bones in the chest
12. An application for the set bones. In general remember that fixing a broken bone requires one application of bone gel before the setting and one after.
13. Cauterize the incision, your patient should be recovering nicely now
14. Again, use the Health Analyzer to double-check your work and to dispense spaceacillin or dylovene as needed

General Tips

• Wash your hands to help reduce infection chance. A space cleaner bottle on yourself works too. Note that you can inject your patient with 5U of Spaceacillin to reliably immunize him from infection (until it is fully metabolized) and circumvent the need to wash your hands.
• Anesthesia is important to successful surgery, make sure to put a mask on the patient's face, an anesthesia tank on their back, and turn their internals on.
• If in a rush, you can give your patients 20U of Oxycodone for quick surgeries without anesthesia. You need to work quick though. A combination of Tramadol or Paracetamol and Inaprovaline can work well too while giving you more time. 5U of Chloral Hydrate is highly effective and fast. Do not use Chloral Hydrate excessively as it is toxic. Note that every form of anesthetic other than the anesthetic tank has a chance of causing your patient to flinch during the surgery.
• Patients can often times tell you where they need surgery if an advance scanner is not available.
• Triage cases properly, alien embryo cases and lung ruptures take priority over brain damage cases which in turn take priority over simple bone fractures in limbs.
• Use the Health Analyzer to check for brain damage during brain surgery to confirm that you've fixed everything.
• Use the Health Analyzer to confirm that a patient's bone fractures are all gone after performing all required bone repair surgeries.
• Use the Health Analyzer to check for post-op infection that should be treated with spaceacillin.
• If no other options are available, roller beds and tables can be used to perform surgery. These cause surgical steps to have a failure chance unfortunately.
• A prototype medical device known as an incision management system or IMS, can often be found planetside; have the marines retrieve it if you can. The IMS acts to create and spread an incision and clamp bleeders simultaneously.
• Infected wound detected in subject [Insert Location Here]. Disinfection of wounds recommended means that the patient has a infected wound that needs to be treated with gauze/advanced brute kit, surgery and spaceacillin won't work at all.
• If you don't have proper surgical tools on hand you can use their ghetto/improvised equivalents per the table above if necessary. Improvised tools generally have a fairly high failure chance starting at about 25%.