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Tools of the Trade
| Tool | Function |
|---|---|
 Scalpel |
Used for cutting through flesh. Has three laser-augmented variants of differing quality, each with a percentage chance to create a bloodless incision instead. Improvised equivalents: PICT system  , bayonet , kitchen knife , or glass shard
|
 Incision Management System (IMS) |
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. Only functions as a scalpel in steps after the first. (Available in the surgical theatre on Solaris Ridge) |
 Hemostat |
Used to stop bleeding during an operation, or to remove foreign and undesirable objects from a patient's body. Also used to repair the brain by removing chips of bone from grey matter. Improvised equivalents: wirecutters  for all of the above uses, a kitchen fork  for removing objects and brain repair, or cable coil  if you are only trying to clamp bleeders during an operation.
|
 Bone Setter |
Used for setting bones back into place. If used on a bone that is not broken then you will break it. Improvised equivalents: wrench  or maintenance jack
|
 Bone Gel |
Used for repairing broken/shattered bones, both in case of fracture and resealing cut ribcages & skulls. Improvised equivalents: screwdriver  + 2 metal rods
|
 Retractor |
Used for widening incisions and re-arranging organs, and moving cut ribcages & skulls. Most scalpels and scalpel substitutes can widen incisions in place of a retractor or one of its substitutes, albeit at a much slower rate. When prying open bones, there is a small chance that the ribcage or skull will suffer a fracture even if this step is performed correctly. Improvised equivalents: crowbar  or maintenance jack
|
 Cautery |
Used for sealing incisions in a patients skin. Burns skin together. Improvised equivalents: cigarette  , lighter , or blowtorch
|
 Fix-O-Vein |
Used for repairing veins and arteries, treating internal bleeding in the process. Also used to repair hematoma in the brain, treating severe brain damage. Improvised equivalents: surgical line  , cable coil, or headband 
|
 Circular Saw |
Used for cutting through bones, particularly those in the ribcage and skull. Performing a bone cutting step on disarm intent will instantly complete the step at the cost of a guaranteed fracture to that region. Improvised equivalents: bayonet , hatchet , or machete
|
 Advanced Trauma Kit |
Used to repair all organs except for the brain and eyes. Improvised equivalents: roll of gauze 
|
Surgical Line |
Used to suture damaged flesh together, treating excessive brute damage. It can also be used to close incisions in place of a cautery. Improvised equivalents: Fix-O-Vein or cable coil
|
 Synth-Graft |
Used to graft severely burned flesh, treating excessive burn damage. No improvised equivalents. |
PICT System |
The Precision Incision and Cauterization Tool uses a high-frequency vibrating blade, laser cautery, and suction liquid control system to precisely sever target tissues while preventing all fluid leakage. Despite its troubled development program and horrifying pricetag, outside of complex experimental surgeries it isn't any better than an ordinary twenty-dollar scalpel and can't create a full-length incision bloodlessly.
Improvised equivalents: scalpel |
 Surgical Drill |
Used to open holes in the thoracic wall to access implant cavities, whether implanting a new object from scratch or removing a deeply-embedded foreign body (such as a monkey cube...)
Improvised equivalents: a pen or a metal rod |
- Improvised tools perform surgery slower compared to their ideal counterparts and apply a risk of failure mitigated by your surgical skill. The severity of the speed penalty scales on how unsuited the tool is. A bayonet is a much better substitute for a scalpel than a glass shard, for example.
- In addition to the speed penalty, an improvised PICT will spray acidic blood all over you and your patient, dealing burn damage to the patient's body as well as significant organ damage to the heart, lungs, and liver.
Preparing for Surgery
Tools
Before you begin to operate, you should make sure you have all the tools you will need. Occasionally a surgeon will accidentally pocket a tool, or a deploying field surgeon will grab tools out of an operating theatre.
Specifically designed surgical tools are the best, but there are a variety of substitutes; some tools can be used outside of their intended role, and others can be replaced with improvised substitutes.
- The equipment on the Almayer is adequate, but sometimes marines will find better tools while deployed. If someone asks if you'd like an Incision Management System, the correct answer is "yes please".
Surgical Surface
The second requirement is a place to work. Some surgeries can be performed on a standing patient, and it doesn't matter where you perform them. Most, however, need a decent surface to work on.
The patient doesn't necessarily need to be buckled - having them on the same tile will do. However the speed modifier is not applied if they aren't buckled. If a surface isn't ideal, the surgery will take longer - and possibly a lot longer.
Locations, namely medical tents, can also provide some benefits to the surgery speed and pain reduction required.
- The ideal surface for surgery is a proper operating table.
This is designed for surgery and has a built-in anesthetic system for patients buckled to it. This is the only surface that can be used for extracting xenomorph larvae.
- The next best thing is a portable surgical bed.
- The surfaces that are better than nothing are beds,
roller beds, 
tables, 
and window frames. 
- The worst surfaces are floors and Med-Evac stretchers,
which are not designed for surgery, and trying to work with their fittings in their way is as hard as no surface at all.
Surgery Failure Penalties
Improvised tools and poor working conditions contribute to a penalty system that increases the risk of failure, but this penalty is mitigated by your surgical skill.
| Tool Suitability | Penalty | Surface Suitability | Penalty | Skill Compensation | Penalty | Penalties | Chance of Failure | |||
|---|---|---|---|---|---|---|---|---|---|---|
| Ideal | 0 | Ideal | 0 | Novice | 0 | 0 | 0% | |||
| Suboptimal | 0 | Adequate | 0 | Trained | -1 | 1 | 5% | |||
| Subsitute | 0 | Unsuited | 1 | Expert | -3 | 2 | 25% | |||
| Bad Substitue | 1 | Awful | 2 | Max | -3 | 3+ | 50% | |||
| Awful | 2 |
For example, performing internal bleeding surgery, skipping clamp bleeders step, by a corpsman on a roller:
| Step | Tool Penalties | Surface Penalties | Skill Mitigation | Total Penalties | Chance of Failure |
|---|---|---|---|---|---|
| Knife - Incision (Pre-op) | 0 (Subsitute) | - (Lying not required) | 0 (Novice) | 0 | 0% |
| Knife - Expose (Pre-op) | 2 (Awful) | - (Lying not required) | 0 (Novice) | 2 | 25% |
| Surgical Line - Fix Vein (IB) | 0 (Subsitute) | 1 (Unsuited) | 0 (Novice) | 1 | 5% |
| Surgical Line - Suture (Post-op) | 0 (Ideal) | - (Lying not required) | 0 (Novice) | 0 | 0% |
For example, performing internal bleeding surgery, skipping clamp bleeders step, by a surgeon on a roller:
| Step | Tool Penalties | Surface Penalties | Skill Mitigation | Total Penalties | Chance of Failure |
|---|---|---|---|---|---|
| Shard - Incision (Pre-op) | 2 (Awful) | - (Lying not required) | -1 (Trained) | 1 | 5% |
| Shard - Expose (Pre-op) | 2 (Awful) | - (Lying not required) | -1 (Trained) | 1 | 5% |
| Surgical Line - Fix Vein (IB) | 0 (Subsitute) | 1 (Unsuited) | -1 (Trained) | 0 | 0% |
| Surgical Line - Suture (Post-op) | 0 (Ideal) | - (Lying not required) | -1 (Trained) | -1 | 0% |
Anesthetic
Surgery is a painful experience, and patients find it difficult to hold still while feeling someone cut into their flesh, which tends to frustrate everyone involved. There are two ways around this: an unconscious (or dead) patient, or powerful painkillers.
Anesthetic (with tank and mask or using the surgery table's integrated anesthesia setup) is a simple and reliable way to render your patient unconscious.
- if the patient's lungs are ruptured, they will occasionally not breath in the anesthetic. Depending on the damage to the lungs, they will either occasionally breath in the anesthetic or it won't work at all. Therefore, you will have to give the patient the anesthetic via Injection, until his lungs are not ruptured anymore.
Operating Table
If you are using an operating table, place your patient on the table (grab your patient, then click the table with your grabbing hand selected). Then buckle them to it to connect the anesthetic system (click hold and drag the patient to the operating table). After a short delay, your patient will be under general anesthetic, which will allow you to operate safely.
- The operating table must have an anesthetic tank attached to be able to put your patient to sleep.
- Click on the surgery table with an anasthetic tank in hand to insert one.
- Click on the table with an empty hand when no patient is buckled to it to remove an existing one.
- If the tank runs out, simply replace it with a new one.
Anesthetic Tank and Medical Mask
If there is no available operating table then you can make the patient wear an anesthetic tank and medical mask and turn on its internals. Encourage your patient to don and activate the tank and mask themselves, as this is much faster than doing it yourself.
- It is advisable to remove the anesthetic tank and medical mask during the cauterizing step for maximum efficiency; the anesthetic takes a few seconds to wear off.
Painkillers
If you don't have anesthetic equipment or you just want to save time, you can give your patients Tramadol or Oxycodone for quick surgeries without anesthetic. These painkillers wear off over time. Tramadol lasts twice as long compared to Oxycodone but Oxycodone has enough painkilling potency to perform Amputations and Alien Embryo Removal. Choose your painkiller wisely.
- Use your medical scanner to monitor your patient's painkiller levels and re-dose as necessary. Using painkillers instead of anesthetics can cause distress in the patient (screaming over the radio about getting operated on without anesthetics, standing up and trying to leave or fight back).
Now that the preparations are done, you can begin with the actual surgery.
Surgeries
Surgeries are simple processes 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.
To perform surgery on someone, you must Toggle the Surgery Mode to be On. This can be bound to a hotkey in preferences. 
This will toggle the Help-Intent Safety preference, if you didn't have it already, preventing you from accidentally hurting people with objects when on help intent. You will be forced on to
Help intent (top left, 1) 
, which allows you to perform any surgeries.
- The patient must not be wearing any armor.
- Only one surgery can be performed on a given aim-location at a time.
- Once you complete a step in a surgery, you must finish the surgery before you can begin a different one.
- Failing or cancelling the first attempted step doesn't injure the patient unless done deliberately.
- Some steps can be skipped, if the conditions are right, sometimes including the first step.
- If you are in a rush, attempting surgery steps on
Disarm intent (top right, 2) deliberately fails the step. For a handful of specific steps, this will quickly and violently complete the step at the expense of your patient's health. Useful when you need to do a critical surgery very quickly, or to save time if you're certain you know what you're doing. It isn't necessary to switch back to Help intent afterwards - that happens automatically. (You can use disarm intent to skip the widening incision with Scalpel or break the rib with Circular Saw)
Standing Patients and Self-Surgery
Some surgeries can be performed on a patient who's standing up. These surgeries aren't affected by the surface under the patient. These are marked as (STANDING).
Some surgeries can be performed on yourself. As you need to be able to hold tools while you work, this means they have to be able to be performed on a standing patient, since people who're lying down can't handle objects. These are marked as (SELF).
- If you're trying to work on a standing patient and can't begin a surgery that you know you should be able to, make sure that it doesn't need them to be lying down.
- Since it's difficult and awkward to work on your own body, self-surgery takes longer to do.
- You can't perform surgery on the same arm you're holding the tool with.
- Self-surgery requires you to use painkillers rather than anesthesia, since it's hard to work when unconscious.
Required Skills
Your character's training affects how quickly they can work and mitigates risk of failure due to improvised tool or unsuitable working condition penalties.
Some surgeries can be performed by anyone with any surgical training, but others need a more thorough education.
Medics, nurses, and pilot officers all have basic surgical training and can perform simple level 1 surgeries.
Doctors, chief medical officers, and synthetic units have more skills and can perform level 1 and level 2 surgeries.
You may occasionally see Professor DUMMY, the medical mannequin. This is a sophisticated training tool designed to realistically simulate any wound (Except alien parasite infections). Real patients are more difficult to perform surgery on - a medic may be able to set Professor DUMMY's broken ribs, but that doesn't mean they can do it on a real patient in the field. (You may contact your local CMO to vend the Professor DUMMY from their cabinet)
Level 1 Surgeries
(
) (optional)
| Surgery: | Description: |
|---|---|
| Suture Wound (Everywhere except mouth/eyes.) (STANDING - SELF) | Suture and tend a wound that has brute or burn damage on it. This will heal 10 brute on the targeted area when a surgical line is used, and will heal 10 burn if a synth graft is used. This will loop until half of all damage on the area has been fixed.
|
| Foreign Object (Everywhere except mouth/eyes.) | Removal of unknown objects, such as shrapnel or implants from the body.
|
| Sealing a Stump (Severed Arms and Legs) | Sealing a stump where the patient's arm or leg should have been.
|
| Autopsy (Only on Permanently Dead) | Helps find out how the person died. Displays wounds, possible causes, and detected chemicals in the body.
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| Internal Bleeding Surgery (Everywhere except mouth/eyes.) | This surgery mends the torn/ripped arteries and veins within the body to stop internal bleeding.
|
OR Open the incision. (
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)
Level 2 Surgeries
| Surgery: | Description: |
|---|---|
| Alien Embryo Removal | Removal of an alien embryo from the body.
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| Bone Repair Surgery (Everywhere except mouth/eyes.) | This surgery is used for mending broken bones and fractures.
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| Internal Organs Surgery (Groin, Chest.) | Mending broken internal organs such as the heart or appendix. Note that this surgery excludes the eyes and brain as they have their own surgeries respectively.
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| Monkey Cube Removal (Chest.) | Removing a monkey cube post-ingestion. This surgery is one of the few that require a surgical drill.
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| Eye Surgery (Eyes.) | Mending the eyes to cure blindness and eye damage.
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| Brain Damage Surgery (Head.) | Fixing up the brain.
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| Facial Reconstruction Surgery (Mouth.) | This surgery fixes facial deformities caused by severe damage to the head. I.E. "Unknown as (name)" when speaking.
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| Amputation (Limbs: Legs, Arms, Hands, Feet.) | Removal of a limb.
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| Limb Replacement Surgery (Limbs: Legs, Arms, Hands, Feet.) | The replacement of missing limbs with robotic ones. Robot arms and legs are used to replace hands and feet; there is no need to further amputate if that's all the patient has lost.
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| Synthetic Head Re-Attachment Surgery (Head.) | Re-attaching a decapitated synthetic head.
Note: There isn't a timer on defibbing a synthetic.
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) OR use (
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) (Use the Health Analyzer to double check)
/
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on the synthetic.The Autodoc System
The Autodoc system is located in the middle of the treatment center and is only usable by medical staff (and Squad Medics during Whiskey Outpost). Note that while the Autodoc is a useful machine in medical, it is limited in what surgeries it is able to perform, requiring upgrades from Research for procedures such as Bone Fracture Surgery, or Alien Embryo Removal.
| Manual: | Manual mode will fix everything of the selected surgery type once selected, and the procedures are done in the order they are selected, and will repeat itself if necessary (ex. multiple incisions are open)
Combining SurgeriesOften 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 time consuming when other marines may be waiting. The following procedures are examples of combining multiple procedures at once. It is possible to condense the previous surgery down to one in such a manner:
Well what about an infected marine with a broken chest, internal bleeding, and a ruptured lung? Here you will need to use medication from the vendors in Medbay in order to tackle the problems at hand.
Tips
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->
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) to make an incision.
Cut through the skull
Use the FixOVein and Trauma Kit to repair hematomas and damage to the brain and eyes if necessary
Use bone gel on the damaged bones in the skull
Piece together the broken or fractured skull
Seal up the incision
Begin cutting out the alien embryo