-Max chain over 50 - 1000
-Completed with 180 left - 500
-No mistakes - 500
You'll be fighting Kyriaki here again. The operation is conducted exactly the same way as before, so you shouldn't have too many problems. The one possible problem you can have is not being able to hit the 50 chain required for the XS. To do this, you'll want to stall a bit at the start so that the huge lacerations develop additional blood pools for you. After getting inside the patient, you'll want to treat all of the small lacerations first except for one. Then stall by injecting a bit of stabilizer until you see additional blood pools form on the big lacerations. This is your cue to get to work on treating them.
The only difference between this operation is that the organ is a little bigger, but this changes nothing. Other than that, the Kyriaki will tend to make lacerations in directions that might make it difficult for you to suture and get COOLs. Don't worry too much though, because it's not the end of the world if you get a few GOODs here and there. You can still get the XS anyway.
Try to concentrate most of your ultrasounds around the center of the organ unless you've gone 2-3 ultrasounds without finding anything. Usually you'll be able to make the Kyriaki appear by spamming it near the center though.
As soon as you can see the Kyriaki, immediately switch to the scalpel and make an incision on him, then very quickly change to the laser and burn it. It's weak so it won't require much to kill it. You'll want to immediately switch to the sutures and take care of the laceration it made, then switch to the gel and treat the wound caused by your incision. Then, switch to the sutures and keep them as a pre-emptive measure for the laceration the next wave of Kyriaki will make. All this should be done as the original one is dying and before the next ones appear.
The next wave will be two Kyriaki. They will make a laceration each. But before they do, there's a very small window which you can use to inject a bit of stabilizer if you managed to take care of the lacerations and incision wounds very quickly. Once the two Kyriaki appear, take care of both lacerations quickly. Now what we want to do here is find one with the ultrasound, cut it out, then find the other and cut that one out as well while the first one is running around out in the open. Then, when both of them are outside at the same time, use the laser to incinerate them both one right after the other. After that's done, very quickly suture the lacerations made by them and gel the two wounds you just caused with the scalpel. If you do this very fast, there will be a VERY tiny window of opportunity to inject a bit of stabilizer before the boss Kyriaki appears. The window is really small though so if you don't feel like injecting, it's not a big deal. Just have your sutures ready instead.
After both little ones the boss Kyriaki will appear and create his trademark triple laceration pattern. Take care of these before you start looking for him. Remember to make many passes to get the COOLs. Now, unlike the little ones, the boss Kyriaki has 3 HP. So we'll be repeating the procedure on him thrice. When the wounds have been treated, start spamming the ultrasound near the center. He's big so he should be easy to spot. Cut him up with the scalpel and then laser him. He requires VERY little lasering before he burrows back inside the organ, so don't bother keeping the laser on him for very long. Just a few microseconds is fine. As he's burrowing, immediately switch to the sutures, treat the lacerations and the wound you made with the gel. Then switch back to the ultrasound and repeat the exact same procedure two more times until you've defeated him.
Now it's time to finish up. Vitals are probably ridiculously low at this point, so what we're going to do is start pumping stabilizer before making the final suture. Keep using the syringe until you see the first signs of it getting red, then make the suture. Make sure not to get a BAD because it will break your chain. Then apply gel over the bandage area, and then switch back to the syringe which should have recovered enough by now, and raise vitals up until max. Then simply apply the bandage making sure you don't get a BAD, and you're done.