Surgery

Tools of the Trade

Tool	Function
Scalpel	Used for cutting through flesh. Improvised Equivalents: Kitchen Knife, Glass Shard, or Survival Knife (survival knife not for Necrosis Treatment Surgery)
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.
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.
Hemostat	Used to stop bleeding during an operation, or to remove foreign and undesirable objects from a patient's body. Improvised Equivalents: Wirecutters or Cable Coil
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
Bone-Gel	Used for repairing broken/shattered bones. Improvised Equivalents: Screwdriver
Retractor	Used for re-arranging organs, and moving cut ribcages & skulls. Improvised Equivalents: Crowbar
Cautery	Used for sealing incisions in a patients skin. Burns skin together. Improvised Equivalents: Cigarette or Lighter or Blowtorch
File:1Vixovein.png Fix-o-Vein	Used for repairing veins and arteries. Improvised Equivalents: Cable Coil
Circular Saw	Used for cutting through bones. Improvised Equivalents: Hatchet or Machete
Advanced Trauma Kit	Used to patch all organs except for the brain and eyes.

• Improvised tools generally have a fairly high failure chance starting at about 25%.

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.

Anesthetic

There are two ways of doing this, anesthetic (with mask or using the surgery table) and powerful painkillers.

Inserting an Anesthetic Tank into the Surgery Table

Firstly click on the surgery table with an anesthetic tank in hand, then lay your patient on the surgery table and lastly buckle (click and drag their sprite onto the surgery table) them to the surgery table and they will be put under anesthetic until you unbuckle them (click on the surgery table with an empty hand.).

Anesthetic tank and medical mask

The first step is 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). It is advisable to remove the anesthetic tank and medical mask during the cautery step for maximum efficiency.

Painkillers

If in a rush, or you just want to do things quickly, you can give your patients Oxycodone for quick surgeries without anesthetic (15-20U recommended). You need to work quick though. Note that every form of anesthetic other than the anesthetic tank has a chance of causing your patient to flinch during the surgery, you can supplement the oxycodone with Tramadol, Inaprovaline or Paracetamol to eliminate any flinch chance. Use your medical scanner to monitor your patient's painkiller levels and redose as necessary. Using painkillers can cause distress in the patient (screaming over the radio about getting operated on without anaesthetics, standing up and trying to leave or fight back).

Disinfection

The second step is to wash your hands to help reduce infection chance. Using space cleaner on yourself works too, if you're wearing gloves. 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.

Surgical table

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.

Different surgeries

Surgery:	Description:
Bone Repair Surgery (Everywhere except mouth/eyes.)	This surgery is used for mending broken bones and fractures. Note that a repaired bone will rebreak if your patient has more than 50 brute damage. Incision Management System. OR Open the incision. (->->) Repair the bone. (->) (Use the Health Analyzer to double check) Close the incision. ()
Internal Bleeding Surgery (Everywhere except mouth/eyes.)	This surgery mends the torn/ripped arteries and veins within the body to stop internal bleeding. Incision Management System. OR Open the incision. (->->) Open the skull or ribcage if necessary. (->) Mend the artery. (Fix-o-Vein) Close the skull or ribcage if necessary.(->). Close the incision. ()
Foreign Object/Alien Embryo Removal (Everywhere except mouth/eyes.)	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. OR Open the incision. (->->) Open the skull or ribcage if necessary. (->) Fish out the foreign objects until they are all removed.. () Close the skull or ribcage if necessary.(->). Close the incision ()
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. Peridaxon does not heal organ damage. This is the only way to heal organs in the chest and groin. Incision Management System. OR Open the incision. (->->) Open the ribcage if necessary. (->) Repair the biological organ with a Trauma Kit, or the robotic organ with Nanopaste.(/) Close the ribcage if necessary. (->) Close the incision. ()
Necrosis Treatment Surgery (Limbs: Legs, Arms, Hands, Feet.)	Treating necrosis by cutting away the necrotic tissues and treating the affected area. Incision Management System. OR Open the incision. (->->) Excise necrotic tissue and heal the area.(->) Close the incision. ()
Organ Removal/Transplantation Surgery (Groin, Chest, Head.) Currently disabled and not performable.	Removing an organ from the body and transplanting a new organ. Incision Management System. OR Open the incision. (->->) Open the skull or ribcage if necessary. (->). Remove the old organ (->) Attach the new organ. Use Trauma kit (biological) or Nanopaste (robotic). (New Organ ->Fix-O-Vein->/) Close the skull or ribcage if necessary. (->) Close the incision. ()
Brain Damage Surgery (Head.)	Fixing up the brain. Using alkysine is usually faster than this surgery. Incision Management System. OR Open the incision. (->->) Open the skull.(->) Repair severe brain damage, if any. (Fix-O-Vein) Extract embedded bone chips until they are all removed. () (Use Health Analyzer to double check) Close the skull. (->) Close the incision. ()
Facial Reconstruction Surgery (Mouth.)	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. Fix the facial deformities. (->->) Close the incision. ()
Amputation (Limbs: Legs, Arms, Hands, Feet.)	Removal of a limb. Saw through the limb. ()
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. Seal the stump. (->->) Attach the robotic limb. (Robotic Limb) Inform the patient that the robotic limb can be repaired with Blowtorch (brute) and Cable coils(burn).
Eye Surgery (Eyes.)	Mending the eyes to cure blindness and eye damage. Using imidazoline is usually faster than this surgery. Mend the eyes. (->->->).
Synthetic Head Re-Attachment Surgery (Head.)	Re-attaching a decapitated synthetic head. Mend the torn silicone tissue. (->Fix-O-Vein->->). Attach the synthetic head. Use a Defibrillator on the synthetic. Note: There isn't a timer on defibbing a synthetic.

The Autodoc System

The Autodoc system is located in the south surgery hallway and is only useable by the medical staff. Note that while the autodoc is an extremely useful machine in medical it cannot conduct larva removal surgery.

Operating Modes:

Automatic:

First you scan a patient in the body scanner then put them in the autodoc and press start to fix everything wrong with the person. Keep in mind that the automatic mode is slower then manual mode.

Manual:

Manual mode will fix everything of the selected surgery type, for example selecting broken bone surgery will fix all broken bones one by one. Note that the autodoc cannot remove larva as, narratively, a removal procedure for this has not yet been programmed. Manual Surgery List: Eye Surgery: Treats and repairs eye damage and vision problems. Facial Surgery: Treats and repairs facial deformities (typically from physical damage) so the patient can be clearly identified and doesn't look like an uggo. Surgical Brute Treatment: Treats and removes brute damage from the patient. Surgical Burn Treatment: Treats and removes burn damage from the patient. Toxin Damage Chelation (Kelation): Removes toxin damage. Dialysis: Purges chemicals from the patient's blood stream; use with toxin damage chelation to treat poisoning and overdoses. Blood Transfer: Transfers blood into the patient. The autodoc has an internal reservoir of O- blood that it refills as needed. Organ Infection Treatment: Injects 30U of Spaceacillin. Surgical Organ Treatment: Repairs any damage to organs the patient has other than the eyes. Internal Bleeding Surgery: Repairs any internal bleeding the patient has. Broken Bone Surgery: Repairs any broken bones the patient has. Limb Replacement Surgery: Replaces any missing limbs the patient has with robotic prosthetics. Necrosis Removal Surgery: Physically removes necrotic and infected tissue. Does not treat infections with antibiotics; use the appropriate Organ Infection Treatment and Limb Disinfection Procedure options for this. Shrapnel Removal Surgery: Removes all instances of shrapnel from the patient. Limb Disinfection Procedure: Injects 15U of Spaceacillin. Close Open Incision: Closes all open surgical incisions on the patient.

Combining Surgeries

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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

Tips

• Patients can often tell you where they need surgery if an advance scanner is not available.
• The hemostat step can be saved for later in the surgery or skipped entirely at the cost of damaging your patient over time.
• If there is "Infected wound detected in subject [Insert Location Here]. Disinfection of wounds recommended", it means that the patient has an infected wound that needs to be treated with ointment, advanced brute kit (stage 1) or antibiotics (stage 3), surgery and spaceacillin won't work at all. See Antibiotics