This is a complete guide on XSing every operation in Trauma Center: Second Opinion.

 
 
 

Should you need to return to this table of contents at any time, click the page title. – that don’t work no mo’. Scroll up. -Shep

Table of Contents
Introduction
How to make more effective use of your tools
General tips

Chapter 1 – Derek Stiles
1.1 – Standard Procedure
1.2 – Learning the Ropes
1.3 – A Farewell
1.5 – Singing the Blues
1.6 – A Real Doctor
1.8 – Life or Death
Z.1 – From Overseas

Chapter 2 – The Healing Touch
2.1 – Dormant Ability
2.3 – Striving For Asclepius
2.4 – Awakening
2.6 – Just Let Me Die
2.9 – Please Let Me Live
2.11 – For The Greater Good
Z.2 – Miracle

Chapter 3 – Caduceus
3.2 – GUILT
3.4 – Something Precious
3.6 – An Explosive Patient
3.8 – Caduceus On A Plane
3.10 – Pandora’s Box
Z.3 – Pursuit

Chapter 4 – Bio Terror
4.2 – Race For The Cure
4.4 – Stepping Up
4.6 – The First Step
4.7 – Medical Research
4.8 – The Next Step
4.9 – Progress
4.10 – Prolonged Struggle
Z.4 – Transplant

Chapter 5 – It Never Ends
5.2 – Under The Knife
5.3 – Shifting GUILT
5.4 – GUILT Evolves
5.6 – Infection
5.8 – A Devil
5.9 – Death Awaits All
Z.5 – Sayonara

Chapter 6 – Dark Gospel
6.3 – Relapse
6.4 – Second Opinion
6.6 – The Future Of GUILT
6.7 – Fallen Heroes
6.8 – Vulnerability

Chapter X – Confidential Operations
X.1 – Kyriaki (Derek)
X.1 – Kyriaki (Naomi)
X.2 – Deftera (Derek)
X.2 – Deftera (Naomi)
X.3 – Triti (Derek)
X.3 – Triti (Naomi)
X.4 – Tetarti (Derek)
X.4 – Tetarti (Naomi)
X.5 – Pempti (Derek)
X.5 – Pempti (Naomi)
X.6 – Paraskevi (Derek)
X.6 – Paraskevi (Naomi)
X.7 – Savato (Derek)
X.7 – Savato (Naomi)

Conclusion
Conclusion

Introduction

Hey there. I’ve decided to make this XS guide for Trauma Center: Second Opinion because this game is awesome and the best thing that will probably ever grace the Wii. I thought, hey, if I’m going to replay it, might as well write a guide while I’m at it. Yeah, I know the game is old but fuck you, I’m a renegade. And hey, if at least one person reads this and is helped in some way, it’ll be worth it. And you know what? Even if no one is helped by this it’ll still be worth it because I want to do it, so shut up already. That being said, the purpose of this guide is still to help people, regardless of whether or not it succeeds in doing so. Because of this, I’ll try to change my tone a bit in the interest of being more helpful. XSing this game isn’t an easy thing to do, and the last thing you want is your guide being a jackass to you, right?

Ahem. Right. Anyway. The reason this is called an XS guide is because getting XS rank in every operation is the only way to play the game and truly appreciate it. This guide is written assuming that you’re playing on Hard mode, because this is the only mode where you can get the XS rank. It also assumes that you know how to play at least a little. You can use this guide as a more general walkthrough if you so desire, but a lot of the tips given throughout might be a bit of… overkill for simply passing the operations.

Anyway, I’m no legendary surgeon. I’m just an average player who happens to love this game. Because of this, my firm belief is that, if I can XS the operations in this game, anyone can. I’m not saying it’s easy to do. It takes a good amount of effort and skill. But it’s doable.

The aim of this guide isn’t to show you “how the pros do it”, or blazing fast speed, or “perfect execution of every procedure”. The aim of this guide is to help other players who might want to XS the game in their journey with very detailed (sometimes maybe too detailed) tips on how to do it. I will try to always make these tips as reasonable as possible. I will aim to never give you tips and manuevers that an average player couldn’t execute. Like I said, I’m no pro, so I probably couldn’t give you ridiculous tips anyway. Obviously there are many different ways to play the game and to do things. I don’t claim my methods to be the best, the easiest, the cheapest, or the most effective. But they are the methods that worked for me and this is all I can give you.

XS isn’t perfection. Oftentimes the game gives you quite a bit of leeway so that you can do things a little imperfectly from time to time, and still get the XS. I reiterate that the aim of this guide isn’t perfection. Throughout the guide you will doubtless see me make less than perfect moves, or see manuevers that could have clearly gone a bit better. I opted to leave these things as they are, firstly to further drive the point that the purpose of this guide is simply to obtain the XS rank, not to achieve perfection Secondly, because the tips take into account the leeway the game gives you. Thirdly, because I believe videos that are more “down to earth” are more helpful as a guide than unreasonably perfect blazing fast videos that are the culmination of countless retries.

So I think that’s about it for my introduction. Welcome to my Second Opinion XS guide. I do sincerely hope I can help you even a little.

How to make more effective use of your tools

Antibiotic Gel

This is possibly the easiest tool to use. You can’t get any misses with it, and there’s not a whole lot to it. However, I will say this: when using the gel, make sure to be constantly pressing the button consecutively. You need to do this because if you simply hold it down, the gel will only spread a little bit and then stop completely.

When gelling the incision area before the lobectomy, a single pass with the gel is enough. Just make sure you don’t do it TOO fast or you might not get it on all the dots. When gelling the incision area before applying the bandage, you need to gel throughout the entire line and make several passes. This one you can do quickly, just make sure you do many passes with the gel until you get the OK.

Syringe

The syringe might not seem all that complicated, but it is actually one of the hardest tools to use. Possibly the hardest one. The reason is that, when injecting something that isn’t stabilizer, if you miss the spot where you’re supposed to inject by a little bit, you will get a miss. This single-handedly destroys your chance of getting the XS in an operation no matter what you have done up to this point, so as you can see, it is a very dangerous tool that should be used with care.

When injecting stabilizer you don’t have to worry about getting misses. Generally speaking it doesn’t matter where you inject it. Oftentimes you’ll want to inject repeatedly as fast as you can. In my experience it seems that the more you fill up the syringe before injecting, the better. This isn’t so easy to do, however, since you generally want to inject so fast that you might tend to jump the gun a bit and not fill it up completely every now and then. Don’t worry so much though. In the grand scheme of things it isn’t all that important if you fill your syringe completely or 3/4s of the way sometimes.

There is a trick that you can do when using the syringe, which I call warping. When filling the syringe or injecting with it, you may notice that, as long as you have the button pressed, and as long as the syringe hasn’t finished filling up/emptying out, you can move the wiimote as much as you want and the cursor won’t move. But as soon as the syringe is done filling/emptying, the cursor will appear where you are currently pointing the remote. Using this trick, you can save some time. For example, when treating inflammations, you can move the remote over to the anti-inflammatory bottle while the syringe is injecting, and when it’s done you can immediately fill it up again. It works the same the other way. While it’s filling up you can move over to an inflammation and inject it immediately.

When dealing with inflammations and injecting other things that aren’t stabilizer my recommendation is to be very careful so as to avoid a miss. When doing this, your first instinct might be to concentrate on what you’re trying to inject, but in my experience, it’s actually better to concentrate your gaze on the wiimote’s cursor, and relegate the object you’re trying to inject to your peripheral vision. I find that this makes it easier to make sure that the cursor is over the object before pressing the button.

Sutures

The sutures aren’t that hard to use, and they won’t get you a miss if you fail other than when you’re closing up a patient. However, if you get a BAD your chain will break, which is undesirable. The interesting thing about the sutures is that the motions required to get a COOL vary depending on the wound or opening. There tends to be little way to know exactly what the game will accept as a COOL for a particular wound until you try. Generally speaking though, when dealing with lacerations a good rule is to make many passes. For small ones 4-5 passes tends to be enough, for long ones, double that amount. For huge ones around 15.

It’s important that you learn to suture very quickly. The easiest lacerations to take care of are the ones that are more or less vertical. Do it by snapping your wrist left to right as you move your arm top to bottom. The ones that are horizontal are harder since snapping your wrist up and down doesn’t feel quite as natural as to the sides. Generally speaking I tend to do these lacerations a little bit slower since I have to actually move my arm both up and down and to the side.

Drain

Ok I lied. The antibiotic gel isn’t the easiest tool to use. It’s probably this one. To use the drain just place it over something and hold down the button. Easy. There’s not a whole lot to it. Though I will say to remember that it has an area of effect. Oftentimes if there are two things you need to drain and they are near each other, it’s more effective to place the drain between them. They will both be drained at the same time. This way you can drain things twice as fast. Also remember to keep it steady when draining something that takes a while.

Blue Lazor

The problem with the blue laser is that 1) it tends to wear out quickly and 2) it can damage organ tissue. Therefore, it’s usually a good idea to use it moderately. Most things you use the laser on can be burned with just a momentary prick, so there’s rarely a need to keep it activated for a long time. Also, remember that, like the drain, it also has an area of effect. If there are two things near each other, you can laser between them and they’ll both get burned.

Red Laser

The red laser which you use when fighting Pempti works exactly the same as the blue one except it never wears out, so unlike the other one you should keep this one activated 24/7.

Ultrasound

This is another tool with not much to it. When trying to locate moving bodies it’s a good idea to spam it near the center of the organ. When trying to find stationary bodies it’s also a good idea to start near the center and slowly widen your searching area as you go. Remember that sometimes you might momentarily pick up something with the fringes of the ultrasound but it might disappear and you’ll have to scan it again with the center of the tool.

Magnification Tool

The magnification tool is used in a few operations near the start of the game and then is promptly forgotten. The only advice I will give here is to remember that it sits in the same position as the ultrasound and that you need to press A to activate it. B will not work.

Scalpel

The scalpel reduces vitals at around the same rate that the gel raises them. There’s not really much I can tell you about using this tool. It’s pretty straightforward. I will say that when you’re cutting along a dotted line, it’s usually better to make the motion relatively slow so that you’re more precise rather than to rush and miss some dots and having to go back.

Forceps

The forceps are almost the sole reason why I made this section. My recommendation when using these guys is to realize that you are not actually using a real forceps. It is NOT necessary to press both A and B at the same time to grab something and let go of them to place it somewhere.

Instead, when using the forceps, ALWAYS have the A button pressed. Put your thumb on top of it and grip the wiimote firmly with it. When grabbing something, simply press the B button (the A button should already be pressed, and indeed, should be at all time), and when placing something simply let go of the B button. Not both buttons.

This little trick works well and gives you much, much greater control and precision with the forceps.

Healing Touch

The Healing Touch is a bit of a strange beast in this game. Mainly because it’s not very well implemented compared to the Healing Touch in, say, New Blood. Truth is, you NEVER need it. The only operations in which you’re forced to activate the Healing Touch are Striving For Asclepius and the Savato battle.

You will never see me use the Healing Touch in any of my videos when it’s not necessary. In fact, I will rarely even acknowledge its existence. None of my strategies depend on it. If you want to use it, that’s up to you.

If you want my advice on learning to draw a star and the video demonstration, go to operation 2.3 – Striving For Asclepius.

General Tips

The golden rule when it comes to XSing this game is practice, practice, practice. This guide aims to help you in this endeavor, but like most action games, no amount of tips and no amount of knowledge can ever substitute actual experience. So get in there and do stuff. Get comfortable with the tools, with the wiimote, with the nuances of the game. You should be so used to it that you can switch between tools without even thinking.

Generally speaking, I recommend using the B button in favor of the A button. In fact, you should never press the A button unless you’re using the forceps. Do not use the wiimote jacket or any other accessory of that kind. If you’re doing something that requires precision, hold the wiimote near the top part rather than the bottom, place your thumb around the area to the left, slightly bottom-left of the d-pad and upper left of the A button and grip firmly with it. In my experience this affords greater control. You should grip with the tip of your thumb so that you’re not actually pressing the A button, but if you have to, you can simply bring the rest of it down and easily press it with the joint between the proximal and distal phalanges while still maintaining the grip.

When using tools, sometimes it’s a good idea to keep the control stick HELD DOWN in the position you want. This not only makes it so that you switch to that tool instantly as soon as people are done talking/a transition ends, but it also makes it less likely that it slips when moving back to the neutral position. Obviously this shouldn’t be done if you’re going to use a certain tool for an extended period of time, but it certainly helps when you’re quickly switching between different ones.

If this is your first Trauma Center, XSing this game will not be an easy task. While this guide should make things easier for you than if you had to figure everything out, don’t expect a smooth ride all around. Expect to be challenged. Sometimes, a new operation might seem so difficult that you can’t imagine being able to XS it. But don’t despair. I can guarantee that each and every single operation is not only possible but also balanced, reasonable, and fair. Once you’ve mastered them and go back, you’ll see that you can XS them consistently and almost effortlessly. Always the mark of a good action game.

One of the beautiful things about this game is that very few things are out of your control. Whereas in more traditional action games there are a lot of things happening, not all of which you might see, such as the classic fireball of doom from offscreen, in Second Opinion everything happens onscreen. You can see everything. When you fail, try to see what you did wrong. Try to see where it is that you can improve. Look at my videos and try to see what you’re doing differently and how this can affect the outcome.

Always try your best to stay calm. This is the most beneficial state in which you can play the game. Getting agigated or angry will only lower your skill. The problem is that adrenaline, or epinephrine, is a fight or flight hormone. Basically it prepares the entire body including the muscles for emergency actions such as running or fighting. But it does not prepare the muscles for precision work of the kind you need to succeed in this game. Quite the opposite. It gives you what I call the jitters.

This is why keeping a calm mind is so important. There are many methods you can use to help calm you. When you feel overwhelmed, take a small break, just a few minutes is fine, stand up, walk around a little, stare out the window. Surf the net, read a little. The benefits of doing this are actually two-fold: not only does it help calm your mind, but also your wrist. It’s no secret that prolonged use of the wiimote causes quite a bit of wrist pain. Even more if you suffer from carpal tunnel syndrome. Resting for a few minutes in between retries does wonders to help prepare you for the next operation. In a related note, it’s also possible that your hands can get deathly cold while playing the game, especially if you live in a cold place. This can hamper you a little, so I recommend washing them in hot water every now and then. This might only be a temporary solution but it helps and gives you an excuse to take a quick break.

Sometimes there are some operations that are so long that your wrist can get very tired before they’re over. In these situations, pausing the game and resting for a few seconds or minutes isn’t a bad idea.

If you are very tired or need sleep, it’s probably also a good idea to do so, as it can negatively affect your performance. You want to be calm, but you also want to be alert. You don’t want to lean too far to either side.

When you fail, try not to blame outside forces. This is a psychological defense mechanism that manifests in a surprising amount of people. It might make you feel better, but it tends to hinder improvement. As I said before, I can guarantee that everything in this game is fair, balanced, and reasonable. So don’t blame your failures on the game. Don’t say “The hit detection is off,” or “It’s random,” or “The wiimote isn’t good enough”. Instead say “My hand slipped,” “I wasn’t fast enough,” or “I haven’t practiced enough”. Only by accepting responsibility can you strive to change what has gone wrong before.

1.1

Special Bonus

-No mistakes – 1000
-Vitals stayed above 75 – 500
-Completed with 275 left – 300
-6 COOLs earned – 200

This being your first operation, it’s almost criminally easy. Because of that, there’s really not much to say. You have almost no freedom when it comes to tools so just quickly do what you’re told to. Make sure you get COOLs in as many things as you can. When suturing, I’d recommend doing many quick and wide passes over the lacerations.

When extracting glass shards, a good rule is to always be slow and careful. Normally this is what I’d tell you, but this operation is so short and easy that you can afford to just go crazy and try to do everything fast if you want.

1.2

Special Bonus

-No mistakes – 1000
-Completed with 260 left – 300
-3 COOLs earned – 700

Like the last one, this operation is also too easy. First of all, you’re going to have to press the skip button quite a few times throughout the operation as the game likes to deactivate it for you here. Also like the previous operation, you have no freedom here when it comes to tools. The only thing I’ll make a note of, is that when the screen is in the middle of the transition after the lobectomy, press the skip button and keep the control stick in the upper-right position. That way you can use the stabilizer immediately. Make absolutely sure that you fill the syringe completely before injecting, otherwise you’ll be forced to inject a second time and waste time.

After this you’ll have to take care of a single tumor. Normally we wouldn’t use the ultrasound to find it, but like I said, you have no freedom in this operation. Therefore, just go with the flow and find the tumor immediately with the ultrasound. It’s just one tumor, so there’s really not much to say here when it comes to procedure. Just take care of it.

When you’re finishing up the patient, make sure you get COOLs in the final suture and the bandage. Otherwise you won’t get the XS. The operation is short and easy so it’s not a big deal if you have to restart it, but it doesn’t hurt to be careful.

1.3

Special Bonus

-No mistakes – 1000
-Completed with 240 left – 300
-3 COOLs earned – 700

Now it starts to get a tiny bit harder but we’re still in the drop dead easy phase here. You can use all of your tools here from the getgo so when the operation starts keep the control stick firmly on the up position so you can gel the incision area as soon as you can. Don’t worry about hitting the skip button at this point since it’ll just reset. Wait until after you’ve made the incision and hit the skip button while you’re going inside the patient. I didn’t do that in the video ’cause I suck and forgot, but just because I suck doesn’t mean you have to!

Anyway, once you’re inside, there’ll be a couple inflammations to take care of. These tend to be a pain but since they’re only two and the operation just started, you can afford to be fast with those injections. Now after that’s done, it’s time to treat the tumors. To get COOLs when you’re extracting the tumors you need to find them without the help of the ultrasound like in the video. However this isn’t actually necessary for the XS in this operation, so if you’d like to use the ultrasound, go ahead. Once you’ve cut them with the scalpel, you’ll want to drain two or three of them right after the other, and use the scalpel to excise them. Don’t use the forceps to remove them until all of them are ready so you can remove all three and place the membranes in all of them without having to switch tools. Otherwise it takes too much time. If you check the video, you’ll see that I drained all 3 tumors before using the scalpel. This is good, but the time limit is a bit strict for that, and it’s easy for the third tumor to build cytoplasm again before you get a chance to excise it. This will cause you to forfeit the COOL for that particular tumor. To avoid this, you can just drain 2 of the tumors and excise them, and then drain the third one afterwards. This is easier to do and works just as well. However, if you still want to do all 3 at once, I would recommend to use relatively slow and calculated motions with the scalpel rather than moving it quickly. The lines are in a bit of a funky formation, and swift motions seem to miss dots frequently. Check the vid to see just how slow. Once the tumors are done with it’s pretty much smooth sailing, but make absolutely sure that you use the syringe to raise vitals to 99 before you finish up.

1.5

Special Bonus

-No mistakes – 1000
-Fewer than 6 blood pools – 500
-Completed with 210 left – 300
-3 COOLs earned – 200

Get inside the patient. Remember not to hit the skip button until the moment when the screen is actually transitioning after you’ve made the incision. Keep the control stick firmly on down-left position so you can magnify the polyps immediately. Remember to magnify with the A button. The B button will not work. After that, quickly change to the drain and drain the blood pool, then switch to the laser and start burning them. If you notice, the laser has a bit of an area of effect, so if you can position it correctly between polyps that are in a cluster, you can burn off several at a time instead of one by one. This helps to make things a bit faster.

After the first few burned polyps, another blood pool will automatically form. This is the only time that one should form after you’ve drained the inital pool. Drain it and continue using the laser. Try to only keep the laser activated just enough to burn the polyps so you don’t cause any additional damage and don’t keep the button pressed too much when you’re going from cluster to cluster. Don’t worry too much though because it’s actually not that easy to cause additional damage or blood pools. Wait until all of the polyps have been burned to apply the antibiotic gel. Otherwise it takes too much time.

Now after you’re done with those initial polyps, a second wave will appear at the bottom. What is going to happen here is that after you treat a group of polyps, another group will appear, then another, and another, and so on. The waves will always alternate between the top of the pharynx and the bottom, so what you want to do is right after you’ve applied the gel, very quickly change to the magnification tool, demagnify, and then magnify on the general area where the next wave will appear. You want to do this quickly enough so that it’s before they actually appear. That way you’re ready to drain that initial blood pool immediately. Keep doing this procedure a few times, and that’ll be it

Now it’s time to finish up, but here you’ll want to be a bit careful. The problem is that you absolutely MUST get COOLs on the final suture and the bandage. Otherwise you will not get the XS. If you’ve done everything correctly up to now, you should have plenty of time, so be careful and don’t rush. Try to make the suture lines much wider than the actual opening like I do in the video. Be slow when applying the bandage because the pharynx is a bit small and awkward for this. Don’t worry so much about the time. Just take your time and make sure you place is correctly.

1.6

Special Bonus

-No mistakes – 1000
-Vitals stayed above 25 – 500
-Completed with 210 left – 300
-3 COOLs earned – 200

When you go inside the patient you’ll see a truckload of inflammations. These are going to constantly be draining his vitals so let’s take care of them first. First of all, remember to be fast but also to be very careful. If you inject the anti-inflammatory into a part of the patient that isn’t an inflammation, you will get a miss and forfeit the entire operation. That being said, don’t worry too much because you’ve just started. If you have to restart it’s not as big of a deal as if you were doing this at the end of an operation. Remember that a full syringe will have enough to treat 4 small inflammations and 2 big ones. Use this to plan ahead and save yourself a few seconds if you wish.

You’ll want to keep watch on the patients vitals with your peripheral vision as you work on the inflammations. You do not want vitals to drop below 25, or you won’t get the XS. Therefore, when you notice vitals begin to change to a reddish hue, stop for a bit to inject stabilizer and bring him back up to 80 (which is the max). This should only happen once about halfway through treating the inflammations, and a second time after they’re all gone.

Once you’ve pumped him back up to 80, it’s time to start looking for the tumors. You don’t necessarily have to get COOLs for these, but it helps, so try to memorize the locations of the tumors (either through practice or looking at the video) and make cuts with the scalpel where you think they are. It doesn’t matter if it takes several tries. The tumors in this operation are smaller than the ones in 1.3 and thus easier, so it’s not too hard to drain all 4 of them one right after the other and use the scalpel in time before the 4th’s cytoplasm reappears. Make sure to raise vitals to about 55-60 after you’ve used the scalpel and before you extract them with the forceps.

After they’re all treated, there’s a lull of about 5 seconds where nothing’s happening but you can still use your tools, so use this opportunity to raise the patient’s vitals to max, then switch to the ultrasound before the lull is over. Once it is, Angie will force you waste time and check around with it. Just press the button as fast as you can and use the ultrasound around the patient. Doesn’t really matter where you use it as there’s nothing to find. After some seconds of indulging her, it’ll be time to close up the patient. The final suture in this one is very lenient so you can afford to be fast/careless and still get a COOL, and if you got COOLs from the tumors you also don’t have to worry about getting one on the bandage.

1.8

Special Bonus

-No mistakes – 1000
-Completed with 240 left – 300
-10 COOLs earned – 700

This one is pretty standard as far as operations go but it’s actually the hardest one so far. The reason being that you can get all the special bonuses and still only get S rank. To get the XS you need to score above 6000 points. To do this you will need to get as many COOLs as you can. You don’t actually need to get a COOL on everything you do, but make sure you get the COOLs for the final suture and the bandage, as those are the most important ones.

So let’s get this started. First of all, hit skip so you can go directly into using the defibrillator. Try to get the patient revived in as few uses as possible, but don’t worry too much about it as time isn’t all that important here. What is important is getting COOLs, so don’t rush too much. Take things slow and steady and make sure you do it right. The lacerations are pretty much free COOLs, and so is the lobectomy. Once you’re inside it’s time to extract some glass shards after telling Angie to shut the fuck up. Try your best to get COOLs in as many of these as possible, but don’t worry if you get GOODs in a few. My recommendation for the extraction of these shards is first of all, to take it slow. Second of all, rather than watching the glass shard, instead focus on the remote’s cursor. Make sure that when extracting, the cursor moves in as straight a line as possible perpendicular to the wound the glass is being extracted from. Remember, what needs to move in a straight line is the cursor and not necessarily the glass shard. I find that this is the best way to get COOLs here.

After you’ve dealt with the glass, the patient will undergo cardiac arrest a second time and you’ll have to use the defibrillator again. Again, don’t worry too much about this. Still, try to have both your hands close to your body before the patient flatlines, that way when you thrust them forward the sensor bar will more easily register the motion.

After that’s done the mother of all shards will appear. Just extract it as usual and suture the wound. It’s easy. Once that’s done there’ll be a slight lull and Derek will activate the Healing Touch automatically. There’s nothing special to do here. Just suture the wound that appears. It’s a long one so do lots of quick and wide passes.

Now when it’s time to finish up, I recommend taking it slow. Like I said before, the final suture and bandage are critical in pushing you over 6000 points. The suture isn’t very hard to get right as it’s pretty lenient, but the bandage can be easily botched if you’re rushing. Unless you’re some kind of legendary surgeon, I would recommend waiting until the gel has disappeared to apply the bandage, otherwise it blocks your view and could mean missing the COOL.

Z.1

Special Bonus

-Max chain over 28 – 300
-No mistakes – 700
-Completed with 225 left – 500
-3 COOLs earned – 500

This operation is a pain when you don’t know what to do, but once you do it’s not much of a problem. Try to remember to hit the skip button as you’re diving into the patient so you don’t get interrupted when you’re about to align the ulna back into place.

Start by draining the blood pools. Remember that one of them has a minor wound beneath it which can be treated quickly with the antibiotic gel. After that’s done, you’ll extract the bone fragments. You can do this very fast since it’s almost impossible to botch. I’d recommend getting them from right to left but it’s up to you. Moving the ulna back into place is very frustrating when you don’t know exactly how you should place it, as you’ll constantly keep getting misses. But basically what you want to do is grab it from the tip and move it so that it’s pointing towards the broken bone on the bottom. Not the one on the right, but the leftmost one. There’s no need to do this quickly. Just make sure that when you let go of the forceps it is pointing in the right direction, otherwise you’ll get a miss.

When that’s out of the way, it’s time to reform the broken bone with the fragments you picked up. Because you’re going for the XS, this means that you’re going to want to memorize exactly where and how each bone fragment goes. This can be done either through sheer repetition or by carefully watching the video. It’s your choice. I’m not going to describe in detail where and how to place each piece as that would be too tedious. It’s much faster and helpful if you just watch their placement in the video. The order in which you originally picked up the fragments dictates the order in which they’ll be given to you when it comes time to reform the bone, so my recommendation is to always pick the fragments in the same order. That way you’ll know where each one goes ahead of time.

The main thing here is that you don’t want to have to think about where to place the fragments. You must know through memorization. Remember that you don’t have to rotate them to an exact position. The game gives you a little bit of slack in that regard. As a general rule, after you’ve placed a piece and before you grab the next one, remember to rotate your wrist back to the neutral position. You don’t want to get caught with a piece on your hand and unable to rotate your wrist further. If you want to go one step ahead, though, anticipate the direction in which you’ll rotate the next piece before you grab it, and rotate your wrist towards the OTHER direction. That way when you do grab it and rotate it, your wrist will be in the neutral position, giving you greater control.

After you’ve successfully placed all the available pieces, there will still be one missing. It’s always hiding in the same place, so there’s no need to use the ultrasound to find it. Simply make an incision with the scalpel in that general area, grab it, and place it. This last one is easy since there’s no two places where you can put it. Unless you decide to place it on top of another one, but why would you do that? In any case, gel over both bones quickly and several times. After you do that, there’s a slight lull where nothing’s happening but you still have control of your tools. It isn’t necessary, but this is a good time to inject some stabilizer. It’s better than doing nothing, anyway.

Now once you’re out of the patient, be very careful. This last part is critical. It’s absolutely essential that you get COOLs in both the final suture and the bandage. If you don’t, you will not get the XS. There’s no reason to rush, and it could very well mean you have to do everything all over again, so unless you’re some kind of legendary surgeon, take it slow. As always, the suture is lenient and thus easy. As always, try to do many quick passes that are wider than the actual opening. The bandage can be easily botched, so wait until the gel completely disappears so your view isn’t blocked, and apply it slowly. You can afford to lose a few seconds, but you cannot afford to miss the COOL on this one.

2.1

Special Bonus

-No mistakes – 800
-Fewer than 2 thrombi passed through – 700
-Completed with 240 left – 300
-3 COOLs earned – 200

Get inside the patient and hit skip when the screen is in the middle of the transition. There are five blood vessels here. At the start, one thrombus will come from each one. You can see them without using the ultrasound if you concentrate, but you cannot treat them without using it. What we want to do here is ultrasound the first 3 thrombi and stop them with the forceps. I’m going to recommend that you leave the other 2 alone until after you’ve treated the first 3, because treating all 5 within the allotted time is impractical. Maybe even impossible. You can stop those 2 to buy yourself time if you wish, but by the time you’ve finished treating the first 3, those 2 will have started moving again and that means you will only get GOODs when you treat them rather than COOLs. It doesn’t really matter for the XS if you get GOODs on those, but it’s not that hard to treat the first ones before those two get past, so you might as well.

From left to right, the first thrombi that will appear will come from blood vessel #1, #3, and #4. So we’re going to choose those as the first ones to treat. As soon as you’ve magnified, switch to the ultrasound and use it on the ends of those three blood vessels until you’ve located the three thrombi. Once that’s done, quickly pinch them with the forceps one right after the other, and then switch to the scalpel to make an incision in each one. I like to pinch them from right to left, and then go back from left to right cutting them. You’ll want to do this very quickly on all 3. Once they’re all cut, switch to the drain. We’re going to drain all 3 of them before they get a chance to start moving again. What you want to do is start by draining the FIRST thrombus that you cut. If you cut them up like me, that will be the leftmost one. Then you want to quickly move the drain to the second one that you cut, and so forth. You must drain all 3 of them before they start moving again. It’s not too hard, but if you screw up I suggest restarting. Don’t use the gel just yet. Leave the cuts as they are.

By the time you’ve finished treating those thrombi, the two that we left alone should be close to the bottleneck near the top of the screen. Fortunately for us, the bottleneck causes them to slow down somewhat. Quickly use the ultrasound on them and stop them with the forceps. Treat them the same way that you treated the first three. There’s a very good chance that by the time you stop them, they’ll be so close together that you will be able to drain both at the same time. This saves you a bit of time and makes things easier on you.

After you’re done with those, it’s time to spread antibiotic gel all over the 5 cuts. But be careful, as soon as you gel the first one and Angie remarks “Treatment complete!”, five very fast thrombi will come up from each vessel. Concentrate and try to see them without the ultrasound. They move very fast but there is an area near the bottleneck in which they will slow down somewhat. Do not use the scalpel until you’ve stopped all 5 thrombi. The first one that will reach the bottleneck is the thrombus from vessel #2, and this will be the first one you want to stop. After that, use the ultrasound on the area where vessels #4 and #5 converge. You should spot both thrombi from these vessels here and be able to stop them. Then, go back and use the ultrasound near where you stopped the first thrombus. The one from vessel #1 should be around here. Finally, stop the one coming from the central vessel, as this one happens to be the slowest. The main thing here is that you want to use your ultrasound on the areas where the blood vessels converge.

Once all 5 of them are stopped, switch to your scalpel and make an incision. As soon as you do, Derek will automatically activate his Healing Touch. Once this happens you’re pretty much home free. Cut up all 5 thrombi at once. With the power of the Healing Touch you have plenty of time to drain all 5 of them before they start moving again. Gel the cuts after you’ve drained. When you’re done with that, 2 very slow thrombi will come up from blood vessels #1 and #4. Again, with the Healing Touch these are absolutely no problem. Take care of them as usual. After you gel the incision areas, you’ll be done.

The opening in this patient is very strange, so to get the COOL in the final suture you’re going to have to do it a bit differently. The opening is really big and unlike the other times where you’d make the lines wider than the opening, here you’ll want to actually make the lines narrower than the opening. Check the video to see what I mean. Finally, if you’ve done everything correctly there will be no need to use stabilizer. Simply apply the bandage and you’re done.

2.3

Special Bonus

-Healing Touch activated successfully – 1200
-4 skilled Healing Touches – 550
-1 passable Healing Touches – 250

This operation is ridiculously easy. All you have to do is keep using the Healing Touch. That is to say, keep drawing a star. Remember back in kindergarten when all the girls had discovered how to draw stars and were drawing them all over the place and you wanted to draw stars too but didn’t know how, so you went crying to your mom and she taught you how to do it? Well now that is going to come in handy because it’s done in exactly the same way. What? You mean that only happened to me? Well whatever, fuck you. It was kindergarten ok? And I didn’t actually cry so get off my back!

Ahem. Right. In any case, the Healing Touch is very easy to use because the game is super lenient on what it accepts as a good star. There are different ways that you can draw one, but I’m going to show you the way I do it, which works very well for me. I’m not going to describe it with words because that would be too tedious. It would be much more helpful to simply show you.

You can do this operation as fast or as slow as you want. I’m going to show you two videos. A slow one to show you how to draw the star, and a fast one to show you that it doesn’t matter if the star looks ugly or is slanted to one side or what have you.

If you need help learning to draw the star, I recommend getting a piece of scratch paper and a pen, and start drawing as many stars as you can on it so that your muscle memory gets used to the motions necessary for it. You don’t want to have to think about drawing the star. It should be something that you can do naturally. I know that drawing a tiny star on a piece of paper might not seem the same as doing it with the wiimote, but trust me, it’s really the same thing.

This is my slow video:

This is my fast video:

2.6

Special Bonus

-Max chain over 50 – 500
-No aneurysms ruptured – 700
-Completed with 150 left -200
-8 COOLs earned – 600

Get inside the patient as usual. An important thing throughout this operation will be to memorize the general area of where each set of aneurysms is going to appear. That way you can maginify on this area before they come out and be ready to inject them immediately.

When you start there’ll be a single aneurysm. You will first need to use the magnification tool to get close, otherwise the game won’t let you treat it. Treat this one as you would. The scalpel lines are small and circular so they are very easy to excise. Something you should keep in mind throughout this operation is that when you’ve removed the aneurysm, drained the blood, and performed the anastomosis, but before you suture the blood vessel, you can use this time to raise vitals without having to worry about the next set of aneurysms appearing.

In any case, after you’ve treated the first one, very quickly demagnify and magnify on the left side of the organ. This is where the next one will appear. There will be a slight lull before it does, however, and you should use this moment to raise vitals. Don’t bother filling the syringe with sedative pre-emptively on this one, since it’ll just reset to empty after the aneurysm appears. Treat it like normal, then demagnify, and this time magnify on the bottom right of the organ.

Fill your syringe up with sedative before the aneurysms appear here. What you want to do here is inject the sedative on one of them, refill, then inject on the other. Then quickly change to the scalpel and cut the one that you injected FIRST. Then cut the one you injected second. After that remove both of them with the forceps, then drain BOTH pools of blood, then connect both blood vessels. Do every step to both aneurysms right after the other. Don’t treat one completely and then do the other.

After that’s done, the next set will appear absolutely immediately. You will have no time to do things pre-emptively, so just magnify on the area and treat them the exact same way you did the last couple. However, this time, after you’ve done the anastomosis, suture only one of them, and leave the other. Raise vitals to max here, and only suture that second blood vessel after vitals are at 80.

When you suture that one, demagnify, and magnify on the right-center of the organ. 4 aneurysms all ready to burst are about to appear here. At this point, you can activate your Healing Touch if you want. This makes them extremely easy to take care of and no tips are needed. However, if, like me, you hate Angie and want to give her the finger, you can also treat the aneurysms without the Healing Touch. It’s not too hard to do. First of all, fill up your syringe with sedative before they appear. When they do, the one you’ll want to inject first is the one on the far left. This is the one closest to bursting. Inject it completely, then quickly fill the syringe up again and inject the one in the middle completely. Now, quickly fill up the syringe to full again. This time, what you want to do is inject the one on the right only halfway, and then the one on the top also only halfway. If you try to inject fully, there’s a very high chance that the other one will burst. Fill the syringe up again, and this time inject those same two aneurysms fully. You should be able to get the scalpel lines to appear on both of them with that single full syringe without having to refill. At this point, the sedative on the aneurysm on the far left will have worn off, but don’t worry about it yet. Quickly use the scalpel on those two aneurysms so you can stop worrying about them, then very quickly fill up the syringe again and inject sedative on the left aneurysm completely. This should make the scalpel lines appear again. Refill, and do the same on the other one. Now cut them like the other two. Once that’s done, you’ll want to remove all 4 aneurysms one right after the other, drain all 4 blood pools, and connect all 4 blood vessels. However, the time limit on this can be a bit strict, so if you want, you can choose to remove only two aneurysms, drain and reconnect those two, then do the same with the other two afterwards. This is much easier to do, has less risk of making a mistake, and works just as well. It’s your choice.

To get COOLs on the blood vessel suturing, make sure that you make lines much wider than the blood vessel. Check the video to see what I mean. To me, the biggest danger in this operation is the anastomosis. If your hand slips a little, you’ll get a miss and forfeit the entire operation. Therefore, it’s not a bad idea to take things slow. Remember to relax. I know it’s not as easy thing to do, but if you’re nervous the chances of your hand trembling are much higher. When dealing with these aneurysms, my recommendation is to drain the blood with the A button, then, KEEP THE A BUTTON PRESSED, and switch to the forceps. Now grab the aneurysms simply by pressing and letting go of the B button. It is not actually necessary to do it as if you were using real forceps. There is no need to press and let go of both the A and B buttons. By keeping the A button pressed and only pressing and letting go of the B button, you are afforded a much higher degree of control on the wiimote.

You shouldn’t have to worry too much about the final suture and bandage if you got COOLs on all of the blood vessels. Raise vitals to max and finish up.

2.6

Special Bonus

-Max chain over 20 – 600
-Less than 1 hemorrages – 200
-Wound did not reopen – 200
-7 COOLs earned – 1000

This operation is really short, and may seem really easy. But once you do it you’ll see it’s actually not quite as easy as it might seem. The main problem in this operation is that Angie, like ALWAYS, is trying to make things harder for you. Don’t listen to that bitch. Listen to me instead.

First of all, when the operation starts, ignore Angie telling you there isn’t much time. You have plenty of time. In fact, there is no time special bonus in this operation. Before you perform the lobectomy, take the time to use the stabilizer and raise Linda’s vitals to max. That’s 65. Once that’s done, go inside her.

There will be 4 normal lacerations and 2 big ones. Angie will tell you to treat the big ones first, but the trick of this operation is that if you do that, you will not get the XS. Angie is only trying to keep you from becoming a good surgeon, like always. So what we’ll do here is ignore her and instead first treat the normal lacerations. It’s crucial that you get COOLs in all of them. You’ve done this before so it shouldn’t be a problem. Remember, lots of passes that are much wider than the laceration.

Now, after that’s done, we’re going to move on to the big lacerations. The reason we left them alone is because we want them to accumulate more blood pools. You want to have to drain more blood pools to push yourself over chain 20 and get the special bonus. If you treat the large lacerations immediately, they will not have as much blood on them, and your max chain will only go up to 19. In any case, first drain the blood on the bottom one, use the forceps to bring the opening together. Now, you want to get a COOL on each of these, but they are a little bit different than the normal lacerations. The trick to getting a COOL on these big lacerations is many MANY passes along the ENTIRE length of the laceration. The passes should be wider than it but not by much. Check the video to see what I mean.

Before you move on to the other big laceration, make absolutely sure that it has accumulated an extra set of blood pools. If it hasn’t, WAIT. Stall for time by injecting stabilizer or whatever you want. Don’t start working on it until that second set of blood pools has formed.

Once that’s done it’ll be time to finish up. You want to get COOLs on the final suture and the bandage as well. If you got COOLs on every single thing you did, you will most definitely get the XS. However, you can actually get a single GOOD in something and still manage to get the XS, so don’t lose heart if you get a GOOD somewhere. My recommendation, though, is to get COOLs in all of the sutures, because from my experience it’s very easy to botch the final bandage.

2.9

Special Bonus

-Max chain over 50 – 500
-Completed with 180 left – 500
-Wound did not reopen – 300
-No mistakes – 700

Yay, the first GUILT! This operation is actually not that hard to XS because the lacerations caused by the Kyriaki give you a lot of points and opportunities for COOLs.

When the operation starts, I recommend you start pumping stabilizer into Linda until her vitals have reached 99. Only after she’s at max should you make the lobectomy. Once you’re inside, my recommendation is to first suture all the small lacerations except one. Then start working on the big ones. This is pretty much the only part where you can feasibly get a miss, by your hand slipping when bringing both sides of the big lacerations together. You can take it slow here if you want, though the operation just started so restarting isn’t too big of a deal. Take care of the big lacerations in the same way that you did on the last operation. Getting COOLs in this operation is actually not as important as in the last. You can get away with a bunch of GOODs and still get the XS. That being said, COOLs don’t hurt, so try to get them anyway.

Once the big lacerations are taken care of, don’t suture the one small laceration you left just yet. Take the time to pump vitals back up to max. We’re going to treat Kyriaki without raising vitals much throughout the operation, so it’s a good idea to start at max. Once you suture that wound, Kyriaki will appear. It will create a single laceration. Ignore what Angie says and suture that wound before you start looking for it. When that’s done, switch to the ultrasound and begin using it. Try to concentrate most of your ultrasounds around the center of the lung 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. If you’re very fast, you can suture the laceration caused by the first one before the second one is made like in the video. However this is very hard to do because your “assistant” will start talking almost immediately after the first laceration is made and keep you from using your tools. Don’t worry though, if you can’t suture the first one like that, simply wait until you can use your tools again and suture both of them right after the other. Now, there are two Kyriaki running around in the lung. 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.

As soon as you do this, 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 lung, 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 you can finish up. Don’t worry so much about the final suture and bandage since it’s very easy to get the XS even if you get GOODs on them if you got enough points on the operation itself. Besides, the suture is ridiculously lenient on what it accepts as a COOL. Just look at the video. Your vitals should be around 30 or so at this point, so grab the syringe and raise them to 99 before applying the bandage. After that you’re done.

2.11

Special Bonus

-Max chain over 16 – 500
-Fibrillation occured less than 3 times – 700
-Completed with 240 left – 400
-No mistakes – 400

We’re not going to worry about vitals at all throughout this operation until the very end. Get inside the patient. On her heart there will be another scalpel line so spread gel over it. As soon as you do this and switch to your scalpel, she’ll start going into ventrical fibrillation. There will be a pause of a few seconds while she’s fibrillating. Don’t use any of your tools at this point, and instead use this pause to prepare for the incoming heart resuscitation. What I recommend you do here is to bring back both of your arms so that your hands are touching your torso. This gives you the greatest amount of distance covered when you move your arms forward without having to move the rest of your body so that the sensor bar can register the movement.

Try to get her resuscitatated in as few uses as possible but don’t worry too much as it’s not all that important in this operation. Once that’s done, we’re going to open up her heart. Here you’ll see the valve. First drain the blood, then the scalpel lines will appear. We’re going to make all three cuts in one single motion. Start near the top and move counterclockwise. When you get to the last dot, a new line will appear, but the dots start exactly where your scalpel should be, so don’t stop and continue going counterclockwise. After you cut the last dot in that, a final completely circular scalpel line will appear. Don’t ever let go of the button, simply continue going counterclockwise for one last pass. Remember not to rush. You want to get every dot without having to go back. You want to be constantly moving forward. It’s not a big deal if you have to go back if you’re fast enough, but my recommendation is to make a slow calculated path around the valve like in the video so you don’t have to.

Now very quickly switch to your forceps, grab the valve and put it in the tray. Now STOP. Don’t do anything. There’s a very high chance the patient will go into fibrillation again at this point. Just sit tight for a few seconds and wait for it. Use the defibrillator in the same way you did the last time. There’s actually a very small chance that the irregular heart beats are only a false alarm and the patient will stabilize on her own. If this happens just continue the operation as normal. The chances are too low to bank on though, so it’s better to expect that fibrillation.

Now, that should be the last time you use the defibrillator here. You’ll want to finish the operation before the heart gets a chance to stop beating again. Very quickly switch to your forceps and grab the new synthethic valve. We’re going to place it where the old one was. But be extremely careful here. You need to place it exactly in the hole in the center. If you’re off by even a little, you’ll get a miss and forfeit the entire operation. It’s true that you need to be fast before the heart starts causing problems again, but you have enough time that you can take it relatively slow and make sure the valve is placed correctly before letting go of the forceps. Now we’re going to suture the valve in place and then suture the heart. These two sutures are new so you might not know how to get COOLs on them. For the valve, I recommend relatively narrow passes from left to right. Start at the left side of the valve and finish on the right side. Don’t go over too much. For the heart, the opening is ridiculously big, but to get the COOL here, you want to actually make VERY narrow passes throughout the length of the opening. They should be much narrower than it. In any case, check the video to see what I’m talking about. Getting COOLs here isn’t actually necessary for the XS, so if you don’t feel like bothering or if you took too much time placing the new valve, you can go ahead and suture very quickly and not worry if you get GOODs.

When that’s done, it’ll be time to finish up. Make the final suture. Now it’s time to raise vitals to max. Start pumping stabilizer into her before gelling. Her vitals are so low that your syringe will not hold out up to 99. When you see it start to get red, switch to the gel and start applying it over the bandage area. By the time you’re done with this the syringe should have recovered a little. Enough to get vitals to max, at least, so switch back to it and inject a couple more times. This works well because by this time the gel has disappeared so you have a complete view of the area and can more easily get the COOL here.

Z.2

Special Bonus

-Tumors did not regenerate – 600
-Max chain over 100 – 400
-No mistakes – 600
-Completed with 180 left – 400

The trick to XSing this operation is to realize that if you work TOO well, you won’t give the tumors a chance to cause enough damage to get your chain over 100. So what you want to do is stall for a little bit so that just a few more tumors form than is necessary. We’ll do this on the first tumor since you can be more in control during that.

Open up the patient. There will be a single tumor in the center. There is no need to use the magnification tool this time. This tumor will be treated differently than the others so far. What you’re going to do first is drain it. Once that’s done you’ll use the scalpel to sever the three veins it’s connected to. To do this, keep the cursor near the center of each vein and keep the button pressed until you cut it off. There is no need to make any motions. Once you’ve severed all three veins, STOP for a second. This is where we’re going to stall so that the tumor can create a few more tiny tumors in the interest of getting our max chain past 100. Switch to the syringe and raise vitals while you wait. Right after you’ve severed the 3 veins, 3 small tumors should have formed. What you want to do is stall until an extra 2 have formed. Once they do, quickly switch to the forceps and remove the big tumor. Now, use the laser to burn off the small tumors. Sometimes this will cause a blood pool to form. This is to your advantage because it means you can get that chain up a little higher. Gel the holes, and switch back to your drain.

Two large tumors will appear. We’re not going to stall anymore from here on out, so treat them as quickly as you can. Use the drain on one right after the other, then switch to the scalpel and start severing the veins on the FIRST one you drained, then move on to the one you drained second. After both of their veins have been cut, pick them up with the forceps and put them on the tray. They should have formed many tiny tumors so take care of them the same way you did the others. However, this time, leave one hole alone and take the time to raise vitals to at least 40 just to stay safe. It should only take about a single injection. Once the patient is at 40, gel the last hole.

At this point 4 large tumors will appear. Don’t worry about it because Naomi will automatically activate her Healing Touch. Now you can relax because Naomi’s Healing Touch is absolutely ridiculous. Drain all 4 tumors right after the other, then scalpel all the veins right after the other. Again, don’t worry much about how you do it or how long you take, or even about vitals. The Healing Touch will take care of all that. Treat the tumors the same way, and then remove them all quickly. Once that’s done finish up by treating the tiny tumors. When you’re done the patients vitals should have automatically been raised to 99 by the Healing Touch. Simply finish up without raising vitals and remember to be careful and not break your chain by getting a BAD.

3.2

Special Bonus

-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.

3.4

Special Bonus

-Max chain over 60 – 800
-Completed with 150 left – 500
-No mistakes – 700

Alright, we’re on to the second strain of GUILT. We’re going to eliminate Deftera in two phases, first in the stomach, and then in the lung. That means that in the middle of the operation you’ll have to perform a closing suture and bandage.

The biggest problem with XSing this operation is getting the max chain of 60. If you work too efficiently and get too lucky (or unlucky depending on how you see it), you will kill Deftera without it causing enough damage to get your chain past 60. There’s a very slight element of luck here in that sometimes Deftera will cause huge amounts of tumors and take forever to become vulnerable, while other times it will become vulnerable without making hardly any tumors. Don’t worry though because you can always XS this even if you’re very unlucky by taking the right measures.

Now then, when you start, make the lobectomy and go inside Amy. Don’t raise vitals before you’re inside. Once you are, we’re going to stall for a bit and let the big tumors there create a few more tiny tumors to kickstart your chain. So bust out your syringe and start raising vitals. Because of the tumors, vitals will hardly go up at all. But don’t worry about that. Keep injecting the stabilizer until the syringe can take no more and becomes unusable. When that happens, it’s time to get to work on the tumors. They should have created a few extra tiny ones by now, so switch to your laser and burn them all. Once that’s done, switch back to the syringe which should be usable again, and raise vitals while you wait for Deftera to make its appearance.

Now the Deftera type A and type B are going to run around for a while and create tumors every now and then. Keep your laser on hand and burn them off immediately when they appear. Try not to give them a chance to create tiny ones in this phase or to stick around for too long since it hurts Amy’s vitals. After a little while (or a long while depending on your luck), the Deftera type A and type B will meet and begin eating each other. Now before you do anything, make sure that you’ve burned off any tumors that may have been created. Switch to your drain and keep it steady over the colliding Deftera. Keep the button pressed. You should do it fast enough that it takes a while for the drain to start working. Like I said, don’t drain the Deftera if there are still tumors around. This will cause the drainage to fail and it will just be wasted time.

You’ll need to drain the Deftera 3 times, so repeat the same procedure twice again. When you drain for the third time, quickly change to your scalpel. Circular scalpel lines will appear that will allow you to excise the Deftera. It gives you a little bit of time to get ready before the lines appear, so what I’d recommend is to start moving the scalpel where you THINK the lines will appear before they do so that you waste no time, and also so you’re already comfortably making the right motion. Don’t cut too fast because you want to get every dot on the first pass. If you do this fast enough the Deftera will only get a chance to create a single tumor. Burn this tumor off before you grab the Deftera with the forceps and place it on the tray. Then simply apply the synthetic membrane and gel over it. That’ll be it for the stomach. You’ll now have to close up the opening and put a bandage. Be very careful here though. You must make absolutely sure that you get at least a GOOD on the suture and the bandage, otherwise your chain will break and you will not get the XS. Raise vitals to 99 before applying the bandage.

Now we’re going to move up to Amy’s left lung. Perform the lobectomy and get inside. Here there will be two Deftera. That’s 2 type A’s and 2 type B’s. The procedure is basically the same as the last one, except, obviously, there’s going to be double the amount of tumors that you have to laser off, and her vitals will drop much quicker because when two of the same type meet they cause a nice bit of damage. Basically what you want to do here is, while the Deftera are moving around, burn off any tumors that get created immediately, and in between this, when there are no tumors present, be injecting stabilizer. The window of opportunity when there are no tumors present is very small so you’ll have to be fast with that syringe. The main thing here is that you should ALWAYS be: either burning off tumors, or injecting stabilizer. Never catch yourself doing nothing unless vitals are at 99. Since there are two Deftera, there is a chance that while you’re draining one, the other creates tumors which can screw you up. But don’t despair. Simply continue taking care of the tumors and wait for your chance when both pairs of types are eating each other.

After a while, a type A and type B should meet. When this happens, the chances of the other pair meeting are very, very high. So what you want to do is drain both of them one right after the other. But first make absolutely sure that there are no tumors present, otherwise it won’t work. Do this two more times, but on the third drain, don’t drain the second pair. Instead switch to the scalpel and excise the first Deftera like you did back in the stomach. Remove it, apply the synthetic membrane, and gel. By this time the other pair has probably separated and started moving again. This is fine. Keep working like you’ve been and take a look at your chain. If it’s close to 60, go ahead and defeat the remaining Deftera. If it’s not not close to 60, it’s a good idea to let it run amok for a while creating tumors to get your chain up.

In any case, once you’ve killed both Deftera it’ll be time to close Amy up for good. Vitals are probably quite low at this point so raise them to 99 like you always do. Make the final suture and bandage and make sure you get at least GOOD on them.

3.6

Special Bonus

-No Healing Touch – 1000
-Core reached faster than 80 – 700
-Did not approach MISS limit – 300

Alright, now we’re talkin’! This is probably the first very difficult operation. You’re probably going to require a few tries to XS this one, and the first two phases are probably impossible to get through on your first try unless you’re very lucky. Don’t worry though, once you know exactly what to do, those two phases will be the least of your problems.

We’re going to start by unscrewing the lid. There are four screw which you are going to unscrew with your scalpel. The problem is you don’t know which ones unscrew to the right and which ones to the left. Well except you do because I’m telling you. If you take a good look near the bottom right of the lid, some dumb person scratched the direction towards which you have to unscrew. So we’re going to use this. When the operation starts, I recommend not hitting the skip button immediately. This way the time limit won’t go down while you’re checking the scratch marks. Once you’re sure of which way you’re going to unscrew each of them, hit that skip button. The way you want to do this is to unscrew every bolt completely with a single twist of your wrist. To do this, switch to your scalpel and before you press the button, prepare yourself by twisting your wrist, arm, and even a little bit of your body towards the OPPOSITE direction which you’re going to unscrew the bolt in. Then, once you’re completely twisted in this direction as much as you can, put the cursor over the bolt, press the button, and twist yourself completely in the opposite direction. This should make the bolt go out in a single motion. I like to start with the upper left one. Once you’ve unscrewed that one, your wrist, arm, and body should be twisted completely in the right direction. STAY like this, move the cursor over to the bolt on the top right, and press the button. Because you’re already twisted all the way in the right direction, you don’t need to prep your body. Simply twist yourself completely in the other direction. Then, again, stay in this position, and move the cursor to the bolt on the bottom right. You’re already prepped for this one too, so hit the button and twist yourself again. Now move to the last bolt and do the same thing you’ve been doing. By doing this you’ll be able to unscrew all of the bolts very fast. If you’re sitting on a revolving chair (which you should be because they’re awesome), you can give yourself an added boost by rotating to the right when you’re twisting to the left and bringing your arm up above your head, and rotating to the left when you’re twisting to the left and bringing your elbow up as much as you can to the left. This is, of course, only if you’re using the wiimote on your right hand. If you’re not, just switch the directions. You should finish this phase in under 10 seconds this way. One final recommendation here is to not twist TOO fast, or the sensor bar will not register the motion.

Once the lid’s off, we’ll move on to the second phase. This one is almost impossible if you don’t know exactly what to do, but if you do, it’s the easiest one. Here, you’ll first grab the left plug with the forceps and place it on the top spot on the left side. Bring your arm back to get it off the slot and then move forward while keeping the cursor in the general vicinity of where you want to stick the plug. Don’t worry if you move the cursor a lot, this makes no difference. The only thing you have to worry about is to NOT let go of the forceps until the plug has gone inside the slot completely. Now grab the plug on the right side and stick it in the third hole from the top on the right side. That’s all you have to do here and you’re done with this phase. You should only take about 5 seconds to complete this one.

Now the next phase is a bit hard. You’re going to have to destroy every one of those panels with your laser, but if you touch the red panels the bomb will go off in your face. My recommendation here is to grab your wiimote, and hold your thumb very firmly above and slightly to the left of the A button, and use the B button to activate the laser. This gives you much greater control over the laser. First of all, don’t worry so much about the time because you have plenty. It’s more important to make sure you don’t hit any red panels. This isn’t all that easy to do but there’s a trick to the way the red panels move and it’s this: 1) When a red panel moves, it will ALWAYS move to a panel adjacent to it. This means that you can laser panels that have no adjacent red ones without fear of it suddenly becoming red. 2) The red panels will ALWAYS stay where they are for a few seconds right after they move. This means that you are free to laser panels adjacent to red ones immediately after you have seen the red ones change places. If it’s been a while since the red panels have moved, and you want to laser one adjacent to them, it’s better to play it safe and just wait it out until they move so you’re sure you won’t get a miss. Also be careful to always hit a panel with the laser, and not an empty space. Don’t worry so much about this though because you can actually get a miss from hitting an empty space and still get the XS. Now, I said not to rush because you have plenty of time, and you do if you followed my cool tips in the previous phases, but you must make absolutely sure that you destroy all of the panels before the time reaches 3:40. Otherwise you will not get the XS.

Once all the panels are gone, you’ll be in the final phase. Here, the time limit will immediately get reduced to 30. To finish this operation, you’ll have to laser the bomb’s core. But 3 rings of panels will start moving around it to protect it. If your laser so much as touches one of these rings, the bomb will explode in your face and you’ll lose the mission. Now here I want you to take things VERY slowly. There is no time bonus here that you have to hit. You can use as much of those 30 seconds as you wish and still get the XS. So your prime concern here should be to make sure that your laser doesn’t touch those rings. What I recommend here is to not concentrate on any one of the rings. Set your gaze at the center of the screen and instead gauge the rings’ movement with your peripheral vision. The human peripheral vision is bad at distinguishing color and shape, but it happens to be good at detecting motion. This is a feature that evolved to avoid predators. You probably won’t be avoiding predators any time soon, but this ability WILL instead help you to avoid those rings around the core. What you want to do is play it completely safe and laser the core in very small increments. As soon as you perceive a ring about to get close to the center of your vision, let go of the button, and wait patiently for your next opening. You should burn the core little by little in this way until the mission is finished. As a final aside, you may have to retry this operation several times to train your peripheral vision to more effectively detect the rings’ movement. Don’t worry about it. You will get it eventually. As a post-final aside, I need not remind you that alcohol and several other drugs cause tunnel vision. It’s probably a good idea to stay clean while attempting this operation and playing the game in general. You might also have trouble if you try this mission when you’re tired or need sleep, so if this is the case and you can’t seem to XS it, it might be a good idea to take a break and get some sleep.

3.8

Special Bonus

-No mistakes – 1000
-Operation complete before 5 jolts – 500
-Inflammation remained below 3 – 300
-Completed with 210 left – 200

After the hard bomb mission you get a slight breather with this operation which isn’t quite as hard. It still might present a few problems though. We’re operating on a plane here so there’s gonna be turbulence every now and then. When there is, you can’t do ANYTHING or it will result in a miss. That’s right, nothing. Not even things that have nothing to do with the patient like filling up the syringe. Or even trying to activate the Healing Touch. Every turbulence will be telegraphed ahead of time, and when these signals start, you have a few seconds before the big jolts start.

Anyway, get inside the patient. We’re going to be looking for places where fluids are concentrated and make incisions with the scalpel, drain the fluid, and repair the incision area with the gel. You can find these spots with the ultrasound, but to get COOLs on them you’ll have to make the incision without its help. Considering the locations are random, trying to find the spots by randomly picking with the scalpel is too difficult. The good news is that you can get nothing but GOODs throughout the entire operation and still get the XS. So we’re going to be using the ultrasound.

First of all, I recommend that you don’t use the Healing Touch, since all of the spots don’t spawn on the lung immediately. They actually get added after each jolt. So if you use the Healing Touch and find all of the spots in the lung quickly, you may be stuck with nothing to do for a long time while waiting for the turbulence.

Basically, what we want to do is find and treat 3 spots before each turbulence. Obviously this isn’t always possible. It depends on how quickly you can find each one. You need a tiny bit of luck so that your ultrasounds find the spots quickly. Not too much though. The ideal situation is this: you quickly find and treat all 3 spots before the turbulence starts, and you use the time you have before it actually starts to inject stabilizer. Like I said, this isn’t always possible, but don’t worry. Even if you only find two of them just keep going. There are 13 that you have to take care of in all, and you have to treat them before the 5th jolt to get the XS. This means that you’ll be working in 5 rounds. Therefore, you can get away with only finding 2 spots on 2 of the rounds.

Unlike in most other operations, here you’ll want to treat each fluid accumulation completely before moving on to the next one. The reason being that the patient’s vitals drop too quickly when the incision holes are left open, especially during turbulence.

In fact, vitals will drop very quickly throughout the entire operation as you make your incisions. As I said before, the ideal situation is that you find and treat 3 spots quickly and use the remaining time to raise vitals. However, if after finding 2 spots you use the ultrasound 2-3 times and seem to be unable to find the third one, I’d recommend giving it up for that round and just raising vitals before the jolt. Of course, once vitals are critical, raise them a little no matter what.

You must make sure that you’ve finished before the 5th jolt. Otherwise you will not get the XS. If you do this, you’ll be finished with the lung before the time limit, but it’s very likely that it’ll be very close, so make sure that you look at the time when you’re closing up the patient. You need to be done before it goes below 3:30. It’s also possible that the patient’s vitals are very low at this point. Your priority is hitting that time bonus, so if you see that the time is about to go below 3:30, forget about raising vitals and just end the operation. Generally speaking, the lowest you’ll want to go is 3:35 before going for the bandage. So if the time is above this, raise vitals as much as you can until it reaches this point. If you can’t raise vitals at all, don’t worry, as you could still get the XS even if the patient’s vitals are very low. You could also activate the Healing Touch when you’re closing up so that you have plenty of time to max vitals. It’s up to you.

As an aside, notice how Angie gets mad when the people in the plane applaud you for saving the patient. What a bitch. Just further proof of my theory that she doesn’t want you to succeed.

3.10

Special Bonus

-No Healing Touch – 1000
-Less than 2 membranes multiplied – 500
-Completed with 210 left – 300
-No mistakes – 200

Ahhh, Triti. This operation is an absolute nightmare when you first get to it. It is potentially the hardest operation in the entire game because it’s very difficult to figure out exactly how Triti works.

This is further exacerbated by the fact that the explanation Angie gives you is an outright, blatant lie. Probably because she secretly wants you to fail and wants the patient to die. What a bitch. I wish I could hate her to death. But don’t worry, I’ve got your back. So just ignore all of her malicious lies.

First of all I’m going to explain to you the way Triti works. But know that it can be a bit difficult to understand at first. This explanation will help you, but I recommend that you also get in there and actually see for yourself. It might take a while, but I guarantee that it will eventually become clear to you.

Triti is made up of two parts: membranes and thorns. What you want to do is remove all of the membranes from the pancreas. However, each membrane is embedded into the organ by three thorns in each corner. To remove a membrane, first you must remove all of the thorns surrounding it. The thorns also regenerate after a few seconds.

The big problem, of course, is the way the membranes multiply. First of all, notice that membranes only multiply based on what you do. Notice that if you don’t do anything, they will never multiply. This means that, while speed is still important, it’s also important to know what you are doing.

Notice that membranes can only multiply when you remove one with the forceps. Simply removing thorns does not allow them to. Now, the trick to Triti’s nightmarish multiplication is simply this: if there are two thorns adjacent to each other, and there is a free space next to them, a new membrane will appear there when you remove a membrane on any part of the organ. Therefore, the trick lies in looking at the thorns. What you want to do is only remove membranes when there are no adjacent thorns currently present. The exception is when there is no free space where two adjacent thorns can create a new membrane. This is either because there is already a membrane there, or because it’s the edge of the organ and there is no actual room for a membrane to appear.

You’re going to be using your forceps almost exclusively here. I recommend that you grab the wiimote in a specific way here: place your thumb over the A button and grip the remote firmly with it. That’s right, you’re going to have the A button constantly pressed throughout this operation. Never let go of it until you’re done. If you have the A button pressed, then you can simply use the B button to grab and let go of things with the forceps. There is no need to press and let go of both buttons. Using a single button affords much greater control over the remote. When pulling thorns in general, remember that they are embedded in the organ. You want to pull UPWARDS when grabbing them before placing them on the tray. If you simply pull to the right, you will get a miss and forfeit the entire operation. This is important, so always remember to pull in an upward motion.

Now what follows is the way to XS this specific operation. Understanding Triti and the meaning behind what you’re going to do is good, but if you follow these directions you can XS the operation without having to understand it:

When you’re inside the patient, hit the skip button, switch to your forceps and wait until Angie and Miller are done talking. Once they are, you’re going to very quickly remove 9 thorns. Starting from the bottom right, you’re going to remove all of the thorns EXCEPT for the 3 on the top left. When you’ve removed the ninth one, quickly go back to the bottom where you first started and begin removing all of the membranes. That’s 5 membranes: the 3 on the bottom and the two in the middle. It’s absolutely crucial that your remove the membranes quickly and in the same order that you first removed the thorns. If you do this correctly, NO membranes will multiply. There will now be only 3 of them left at the top. As soon as you remove the last of these 5 membranes, very quickly remove the single leftmost thorn of the 3 you originally left alone, then remove the membrane beneath it. Now there should be only 2 membranes left and zero new ones have been created. At this point, stop for a little. I want you to wait until the 4 thorns surrounding those two membranes have all regenerated. Use the time to inject stabilizer if you want. Then, when you see all 4 thorns there, very quickly remove ALL of them, then remove both membranes one right after the other. One of the thorns will probably turn into gas. IGNORE this gas until after you’ve removed both membranes. Then simply drain it. You can still drain the gas before removing the membranes if you’re fast, but it’s really better to just leave it until you’re done.

Now just close up the patient and that’ll be it. Check my video to see the demonstration of the directions I just gave you.

Z.3

Special Bonus

-Flash used 1 times or less – 800
-Max chain over 35 – 400
-No mistakes – 300
-Completed with 200 left – 500

This operation is going to be conducted in 3 phases. You’re going treat some wounds with limited information of where they are, so it’s important that you first try this operation many times to familarize yourself with the layout of the patient, where exactly each wound is located, etc. In short, you should memorize the general location of each wound. COOLs aren’t that important, but what is crucial is that you never get a BAD. This will break your chain and keep you from getting the XS.

For the first phase, no memorization is necessary. First, grab the penlight and shine it on the right side of the patient where the lacerations are. If you don’t do this you will not get access to your tools. Quickly suture these three lacerations. Once that’s done, grab the penlight again and move it to the bottom part where a huge laceration should be waiting for you. Drain the blood, close it up, and suture. Getting COOLs isn’t so important in this operation, but remember to make many wide passes through the entire length of the laceration. Now grab the light again and move to the center where a single glass shard is. Place the light slightly off to the right of the glass shard rather than dead center. This is important, so remember to do it. Remove the shard carefully. It’s only one so it shouldn’t be too hard. Don’t worry about getting the COOL. As long as you don’t get a BAD in anything there is no problem. Just make sure you do it carefully so you don’t get a miss. Once it’s pulled out, apply gel over the wound it was in, and continue applying it because a scalpel line will appear there. Once the incision area has been gelled, switch to your syringe and raise vitals all the way to 80. Now perform the lobectomy. You don’t need to be able to see the entirety of the scalpel line. As long as you can see the top part, just cut in a downward motion and you should get it.

Now we’re inside the patient. This phase will be the same as the previous one with one exception: I want you to leave the light where it is. That’s right, I want you to work this entire phase without ever moving the light. If you left it slightly off to the right of the glass shard in the previous phase, it should give you a decent view of everything you need to take care of in this phase. Right after making the lobectomy, watch carefully. If you placed the light correctly, as the screen is zooming in, you should be able to see the glass shard on the right. Once the screen is zoomed in completely you might not be able to see it anymore but it doesn’t matter. That glimpse should be all you need to know where it is and pull it out. But what we’re going to do first is suture the 3 lacerations on the left, because those are the ones that drain vitals the most. So keep the location of that glass shard in the back of your mind for now. You should be able to clearly see two of the lacerations on the left. Suture them quickly. Now the third one isn’t visible to you, but it’s right above the leftmost one of the two you just sutured. It’s a horizontal laceration, so make the suture lines accordingly. It helps if you’ve seen its position beforehand in another retry. Don’t worry if you can’t suture it immediately. Just keep trying. There is no penalty for missing sutures, after all. Once that’s done, we’ll move on to the huge laceration. You should be able to see the leftmost end of it. This is enough. Apply your drain back and forth over the length of it. Just judge the distance. It’s not too hard to do since you’ve already treated so many of these. Now bring the two ends together, and suture it like you did the previous one. Again, you’ve sutured tons of these already, so you should be familar with its length by now. Don’t worry if you don’t get a COOL. GOOD is fine. Now if you worked quickly, the location of the glass shard should still be fresh in your mind. Grab it. When you do, the shard will magically light up. This will make it easy to remove without getting a miss. Simply lift it upwards carefully. You’re almost done with this phase. Switch to your syringe and raise vitals all the way up to 80. This is very important. The next phase can easily kill the patient if vitals aren’t at max. When they are, gel the wound where the shard was.

This will bring us to the final phase. Here, the light will malfunction and plunge you into complete darkness. However, it takes about 1-2 seconds for it to go out, and you can use this to your advantage. If you left the light where I told you, you should be able to see 3 lacerations and a glass shard. As always, the lacerations are what damage the patient’s vitals the most, so we want to deal with those first. If you can suture very fast, you can actually suture 2 lacerations before the penlight goes out. I recommend suturing the vertical ones since those are the easiest. Don’t worry if you’re only fast enough to suture 1 of them though. The few seconds before the light went out should have given you enough information to suture them in the dark. Do it quickly, and once that’s done, press the camera button. It takes a little bit for the flash to go off. Use that time to inject stabilizer once. Then quickly switch to the sutures and fix the small laceration on the right, then use the drain on the huge one, clip it together, and suture it. All this should be done while the flash still illuminates everything. If you want extra time on the big laceration, you can also gauge the small laceration’s location and suture it in the dark before using the camera. In any case, once the big laceration’s taken care of, all that’s left is the glass shard. The combination of the penlight and the camera’s flash should have given you a good idea of where it’s at, so just remove it in the same way you did the previous shard. Gel the wound, and you’re done.

Now just raise vitals to max and close up the patient.

4.2

Special Bonus

-Max chain over 12 – 1000
-Toxins formed fewer than 3 times – 500
-Completed with 140 left – 300
-No mistakes – 200

This operation is stupidly easy. Because of that there isn’t a whole lot to say. All you have to do is inject the serum on the underdeveloped Tetarti and make sure you don’t get a miss. When it burrows just look around with your ultrasound. A good place to start looking is at the center. Once it’s visible just cut it up with the scalpel and quickly inject it again. Don’t gel the wound until it’s burrowing again. After the third injection it’ll start rampaging around. Just keep spreading gel over him, remember to press the button repeatedly rather than just holding it down. There’s really nothing to this operation. You can probably XS it with your eyes closed.

The opening in this patient is very thin. To get the COOL in the final suture I’d recommend doing lots of passes through the entire length of the incision area but keep them relatively narrow.

4.4

Special Bonus

-Max chain over 18 – 500
-3 or fewer diverticula formed – 500
-Completed with 180 left – 400
-No mistakes – 600

Tetarti is a pretty easy GUILT in this operation. The biggest danger you’re going to face is trying to make sure that you don’t miss the bodies when injecting the serum. This’ll cause a miss and will likely be the only thing that keeps you from getting the XS.

Perform the lobectomy and get inside Dr. Kasal. Angie tells you to use the Healing Touch but just ignore her. Like always it’s not necessary and since you can only go as fast as Tetarti bodies appear, it will only make you have to wait around while the next sets appear. Besides, since when has Angie ever given you good advice? That’s right, never.

Anyway, when you’re inside you’ll spot three diverticula. We’re going to take care of these as fast as possible. Inject the correct colored serum in each of them one right after the other. After the third injection, quickly switch to your scalpel and excise the FIRST one you injected, then move on to excise the second one you injected, and finally the last one. You need to do it in this order or else there’s a high chance that the serum will wear off on the first one before you get a chance to work on it. In any case, quickly take all 3 of them to the tray right after the other. This should net you a COOL on every one. Apply the synthetic membranes and gel them. By now Dr. Kasal’s vitals should be a bit on the low side. Don’t worry about this, you’ll have plenty of time to raise them. Still, if you’re fast you get a chance to inject stabilizer once while the gel is taking effect and before the Tetarti bodies appear.

Now we fight Tetarti proper. Before they appear, get ready by filling up your syringe with a serum. Doesn’t matter which. Once they come out, pay attention. Find the one which is the same color as the serum currently in your syringe. This is going to be the first one you inject. But at the same time, pay attention to a second body and keep its color in the back of your mind. This is because this one will be the second one you inject, and since their color disappears after the first second, you need to know it beforehand.

Now you’re going to inject the correct colored serum into each Tetarti body but it’s imperative that you be VERY careful when doing so. They move around a lot and like to make sharp turns that make it very easy for you to miss. First of all, relax. You’ll want to keep a steady hand throughout this operation. It’s true that the Tetarti burrow back after a while if you don’t inject them all fast enough, but you have more time than you might think so don’t rush. Generally speaking Tetarti will make sharp turns when it hits the edges of the organ or one of the other bodies. Usually when it makes a sharp turn it will not make another one immediately unless it hits something. Use this to your advantage. If you notice that it has just made a turn, you can be pretty confident that it will keep moving forward, which makes it easier to inject safely. If you see that it’s about to hit an edge or another one of the bodies, it’s probably a good idea to wait a little until after he’s made the turn just to be safe.

If you’re stupid like me and forget to check the second one’s color, it’s a good idea to wait a little until the remaining bodies expel their gas so you can be sure that you’re injecting the correct one. If you get the wrong color, just restart. After you’ve injected all 3 and as they’re dying, you have an opportunity to inject stabilizer twice and still have time to fill the syringe up with serum before the next wave appears. If you do this every time you defeat a wave, you’ll be at max vitals in no time.

In any case, that’s all you need to do. Just keep doing the same thing until all the Tetarti have been killed. Again, being very careful never to get a miss.

4.6

Special Bonus

-Max chain over 17 – 1000
-No mistakes – 600
-Finished 10 of Victor’s orders – 400

Another very easy operation. That is, if you know the trick to it. The trick is that to get the XS you must carry out 10 of Victor’s orders, but if you work TOO well he will only give you 9 orders. If you follow my directions you shouldn’t have any problem though. Especially because there is no time limit. Open up Mr. Anderson and get inside.

As soon as you’re in, switch to the scalpel and use it on the lung. Doesn’t really matter where. Just keep the button held down until you get the OK. Then switch to the laser and again, keep the button down until you get the OK. It also doesn’t matter where you use it. Next, do the same thing with the gel.

Now we’re going to start using the syringe. Locate the circle of Pempti cells. I like to wait until it disappears and reappears again, that way I can inject the blue serum and the pink one right after the other before it disappears. When injecting, make sure that you fill the syringe up completely. Otherwise you will have to inject more than once to get the full dosage in there. When it reappears again, inject the yellow serum. Very quickly go for the white serum now, fill it up completely and inject it. However, this won’t be enough. You’ll need to fill up the syringe a second time. But before you inject that second round of white serum, check out Anderson’s vitals. Make sure that they are below 70 before you inject that second time. If you did this correctly, Victor will tell you to raise his vitals with stabilizer. This is the order which you might not get if you work too well.

Next, you’re going to inject the blue serum and then the yellow one. You’ll want to inject them both before the circle disappears, so wait until it has disappeared and reappeared once before starting so that you have enough time. After that do the same thing but with the pink and white. You can also raise vitals while you’re waiting for the circle to reappear. Once that’s done, you just have to cut out the circle, and place it on the tray. Then finish up like always and that’ll be it for this operation. A very easy XS.

4.7

Special Bonus

-Finished faster than 5 – 2500

What is it with these easy operations lately? To XS this one you need to put the pieces of the puzzle in the correct places faster than 5 seconds. To do this you need to know where each piece goes ahead of time. You need to grab each piece and place it in its correct spot without even thinking. This isn’t very hard to do once you’ve tried it a few times.

To do this quickly, remember the forceps trick: Keep the A button held down at ALL times, and simply press and release the B button to grab and place things. This allows you to use the forceps much faster and with a much greater degree of control.

While the operation is starting, put your cursor over the piece on the top left and hold down the A and B buttons. This will allow you to grab it the very instant the hidden timer starts ticking. Place it on the top left spot. Then go for the top right piece and place it on the bottom left part. Next, pick up the bottom left piece and place it on the top right part. Finally place the remaining piece in the remaining spot. That’s it. Easiest XS ever. Obviously you’ll need to practice it a few times until you can do it fast enough but it’s really not hard at all.

4.8

Special Bonus

-Max chain over 70 – 600
-No mistakes – 600
-Completed with 210 left – 800

Next up on our marathon of drop-dead easy operations. Open the poor guy up again.

As soon as you’re in, fill up the syringe with the nanomachine and inject it in the circle. Fill up the syringe again. But now wait until it disappears. Once it reappears again, inject it a second time. It will create tumors on the upper part of the lung. But ignore those for now and instead inject the circle a third time before it has a chance to disappear. It will create a second set of tumors. Now you can quickly switch to your laser and start burning them off. Don’t worry about causing damage to the lung with the laser. You can hold the button down and just burn those tumors off as fast as you can. Gel up the holes. Now start burning the Pempti core with the laser. After a couple second you will get the OK. However, it will simply extend the gelatinous fluid back up the lung. Use the time while it’s doing this to raise vitals by injecting stabilizer on the right.

Now just repeat the procedure in exactly the same way. This time, after you burn the core, switch to your scalpel because it’ll be time to cut it out and place it on the tray. And that’ll be it for this operation. If you did everything like I told you, you should get the XS. There’s really not many places where you could make mistakes so it’s a pretty easy one.

4.9

Special Bonus

-Finished faster than 15 – 2500

This one is harder than the previous puzzle. Not only is it bigger but dere’s TWO off dem. Well, Ali, dere’s ONE off me.

Uhh right. Anyway. Because this one is so much more complicated, you’re going to need more memorization on your part. Like the other puzzle, you need to be able to do this one without thinking much. The only way to achieve this is to practice it many times. Let’s see if I can help you a little bit though.

You won’t be able to grab a piece immediately on this one because Angie will be mouthing off at the start. So after she’s done, you can start. Grab the piece on the right and place it on the far left side of the puzzle. It should go over Br. Next grab the green piece and place it on the bottom-left. Then grab the orange piece and place it on the bottom-right. That’s to the immediate right of the green one you just place. You should remember it this way: those two pieces are the same except one is upside down. They’re close to each other. They both go at the bottom of the puzzle next to each other, and if you’ve placed the light blue piece it should be easy to see where they go.

Once those two are in place, grab the huge pink piece at the bottom and place it on the top left. Then get the remaining piece on the bottom and place it on the top right. This one should be easy to remember because it looks EXACTLY like the top right corner. The last piece should be obvious.

Now we move on to the next puzzle. As soon as it starts grab the green piece on the right and place it on the far right side of the puzzle. This one should be very easy to remember because it goes in the exact same side you got it from. Next grab the yellow piece and place it on the bottom-left of the puzzle. This one should also be easy to remember because, like the previous piece, it also goes in the exact same side you got it from.

Now grab the pink piece. The way you’re going to remember where to place this one is this: it goes in the EXACT same place that the EXACT same pink piece went in the previous puzzle. Next grab the blue piece on the bottom. This one should be ridiculously obvious where it goes. It’s on the top-left. The last two pieces should be easy to place because if you’ve done what I told you, it happens to be impossible to place them incorrectly.

That’s pretty much it. Like I said before, you’ll need to practice a few times until you can do everything without thinking too much.

4.10

Special Bonus

-Max chain over 100 – 600
-Completed with 140 left – 800
-No mistakes – 600

Alright! Pempti! Now this is one fun operation. After the smorgasbord of criminally easy operations throughout this chapter, we finally get rewarded for our efforts by this beauty of a GUILT. Pempti is the hardest strain you’ve fought up till now by far. You’re going to be using Victor’s new laser here almost exclusively, and it happens to never run out, so it’s not a bad idea to keep the button held down when using it. A big problem with Pempti is that if you’re not on the ball, it’s very easy for it to overwhelm you. It has a very effective pressure strategy in that when something gets past you, rather than giving you a chance to repair your mistake, it doesn’t let up and continues fighting aggressively. This results in the odds stacking higher and higher against you because when you’re dealing with your mistakes, this is wasted time that you should have been using to prevent Pempti’s attacks in the first place. Basically, once you let something past you, the chances of the next attack causing damage are higher, then once that gets past you, the chances of the next one succeeding are even higher, and so on. Until you’re completely overwhelmed and there’s no more hope. But anyway…

This is the last time you’ll be operating on secretary Anderson. Open him up and go inside. Don’t worry about raising vitals yet. When you’re in, immediately fill up your syringe with the serum and inject it into the circle of Pempty cells before it disappears. After injecting once, switch to the stabilizer and raise vitals to max with a single injection on the right. Then switch back to the serum and inject the circle a second time. This will cause the Pempti core to reveal itself. Switch to your new laser now and begin burning the core.

Once you get the first OK it’ll be time to fight Pempti mano a mano. To kill it, you have to keep burning the core with the laser. But Pempti defends itself by sending out its minions to wreak havoc on the secretary’s lung. You can’t ignore the minions or they’ll kill Mr. Anderson in mere seconds. You have to kill them with the laser as well.

As a general rule, always, always, ALWAYS have your laser activated and right on the core when you’re not dealing with minions. This is because this is where they come out from. you don’t really know what Pempti will send out next, so having the laser activated and pointing on the core puts you in the best possible position to fight whatever it’s going to send out on the shortest notice.

Now Pempti has 3 kinds of minions that it likes to send out. The first type are red mini-cores that cause lacerations. These are the ones that can cause the most damage if you don’t take care of them, but they’re also not too hard to deal with. Pempti will send 5 of these, one right after the other. They will move from the center (that is, where the core is located) to one of 5 spots around it, then shoot upwards after a second and create a laceration on the lung. You don’t want this to happen. Your goal is to kill every one of these 5 small cores BEFORE they get a chance to create their laceration. This isn’t hard to do if you’re on the ball, but the timeframe from their creation to the laceration is a little bit strict so your laser NEEDS to be active and pointing at the core BEFORE it sends the first one out. Otherwise there’s a good chance that you won’t have enough time to kill it before it does damage. You can probably suture one or two lacerations if you’re fast enough, but ideally you don’t want to give Pempti a chance to create even ONE. The problem is that if you try to suture after all 5 of them have gone out, it’s probable that you will not be pointing the laser at the core when it sends out the next wave, meaning you will NOT have time to deal with it, and you will be even closer to being overwhelmed. So it’s in your best interest to kill these little guys immediately. To do this, as I’ve said before, have your laser burning the core before they come out. This makes it so that you start burning and causing damage to it as it’s coming out, and you can follow its path with the laser up to one of the 5 points where it preps to make the laceration, burning it the entire time. If you do this, you will kill it before it does the laceration. But you can’t relax because there’s still 4 more to come after that one, so very quickly go back to the center and repeat the same thing for all of them. Remember, don’t let even ONE of them get past.

The next type of Pempti minions are blue ones that cause tiny tumors. These are definitely the hardest ones to deal with. In fact, unless you’re some kind of legendary surgeon it’s very likely that you will not be able to kill all 5 of them before they create their tumors since they’re so ridiculously fast. The good news is that you actually DON’T want to kill all of them. Truth be told, if you work too well there’s a chance that you won’t get a high enough chain to get the XS. Therefore, what we actually want to do is let some of these guys live so that they can create some tumors to help boost our chain. Now if you’ll notice, the laser has an area of effect. This means that you can actually kill two of these little cores at the same time by pointing the laser BETWEEN them. If you’re good, you can theoretically consistently kill 4 of them every time by doing this. But this is very hard to do and not even all the desirable. Ideally, you want to leave 2 or 3 alive so they create a lot of tumors that you can quickly treat. What I recommend doing is, as soon as all 5 come out, move your laser a bit upwards, and place it in between two of the ones on the top part. You should very easily kill those two before they create their tumors. Then, move on to burning a third one. It’s very possible that you won’t kill that third one before they go out, but don’t worry about it. Like I said before, keeping them alive is actually to our benefit.

When the very short timeframe to kill them is up, they will spread upwards on the entire lung and place their tumors. You CANNOT actually kill them when they’re in the middle of this, so instead of wasting time trying to burn them at this point, ignore them and start burning the tumors instead. Do it fast and make sure you get all or most of them, then very quickly gel the wounds up. These minions wait around for a little while after their initial attack, so after you’ve gelled up those tumors you have a choice as to how to proceed:

1) if you feel that you’ve treated the tumors suitably fast (this will usually be when there are only 1 or 2 of them alive), you can take the time to inject stabilizer once (twice if you want to push your luck) before switching back to the laser and killing off the survivors. This is pretty much the only time when you can raise vitals safely. I don’t really recommend you raise vitals at any other time unless you’re sure you know what you’re doing.

2) if you feel that you haven’t treated the tumors suitably fast (this will usually be when there are 3 or 4 of them alive), I recommend you just kill the survivors as soon as possible and wait for another chance to raise vitals.

The third type of minion Pempti uses is the least dangerous one. They are 5 mini cores that slowly come out in a spiral and start spinning around and causing damage. The thing is, these pose absolutely NO problem if you’re pointing the laser at the core (which you should be). If you are, you don’t need to do anything. All 5 mini cores will die as they’re coming out before they have a chance to know what’s up. No sweat.

In any case, that’s how you fight Pempti. If you always keep the laser on the core you should be done before the time limit. Your only worry (other than dying), is your score. Do not break your chain at any time. And before you’re done, make absolutely SURE that your chain is over 170 (close to 200 just to be safe). It’s not enough to simply hit the 100 chain which gives you the special bonus. To get the XS you need to score over 6500 points. A chain below 170 has a low chance of netting you that much.

Z.4

Special Bonus

-Tumors did not regenerate – 800
-Finished before vasoconstrictor expired – 200
-No mistakes – 700
-Completed with 230 left – 300

The thing you need to be careful with in this operation is that the time limit is very, VERY strict if you’re a renegade and don’t use the Healing Touch.

When the operation starts, you may raise vitals before performing the lobectomy if you want a tiny bit of help in the next part, but it’s not necessary.

You’ll see two tumors of the nasty variety. What we’re going to do here is remove them both at once. You need to do it this way because if you treat one first and then the other, the first one will regenerate while you’re working on the second. However, you will need to be very fast and very precise when working here because the patient’s vitals are already dangerously low. It’s highly probable that by the time you’ve finished removing both tumors vitals will be at single digits. In any case, remember to keep the control stick pressed towards the bottom-right, have the B button also held down, and the cursor on top of one of the tumors as the screen is transitioning. This will allow you to start draining immediately. Drain the first one completely, then immediately move over and drain the second one. When that one’s drained, very quickly switch to the scalpel and start cutting off the veins of the FIRST one you drained. Remember to be very precise in where you place the cursor and to only keep the scalpel held down long enough to sever the vein. Otherwise the patient’s vitals drop too much. Once you’ve cut off all 3 of the first tumor’s veins, move on to do the same with the second one. When that one’s done, very quickly switch to the forceps and remove both tumors one right after the other. There is no need to apply synthetic membranes in this one. After you’ve removed them, there should be a few tiny tumors left over. Take a glance at the patient’s vitals. If he’s about to die, inject stabilizer a little before lasering the tumors. If his vitals are around 10 or so it might not be necessary. After lasering and gelling all the tiny tumors the vitals should definitely be critical, so now start injecting stabilizer and keep doing it until vitals are maxed at 50.

Now switch to the forceps, grab the kidney and place it where the tumors used to be. After this is done, change to the syringe and fill it up with the vasoconstrictor. First we’re going to inject it in the blue vein. Be careful here because you do not want to get a miss. Make sure the pointer is on the vein. It will require 2 injections before the scalpel line appears. Switch to your scalpel and make the incision, then drain the blood. We’re going to perform the anastomosis by bringing that blue vein the kidney has towards the incision we just made. Use the forceps and try to move the pointer in a relatively straight line towards the incision so that you don’t get a miss. Now you’ll have to suture the veins together. Getting all COOLs here isn’t absolutely imperative but it never hurts. I know that the place where the veins connect is very small and this might lead you to make the suture very small too, but to get the COOL, you want to make the suture much longer. Treat the vertical blue vein as a normal sized laceration and make the suture accordingly. When in doubt, make more and wider passes than you might think is necessary. Check the video to see what I mean.

Now we need to do the exact same thing but with the red vein. Just repeat the procedure. After that’s done, you’ll need to inject stabilizer once or twice because vitals will be dangerously low. Now switch to your scalpel and make an incision on the scalpel line that appeared at the bottom. No need to inject vasoconstrictor this time. Connect the green vein and make sure you bring the cursor over in a relatively straight line downwards. To get the COOL on this suture, do it the same as the others but this time treat it as a horizontal laceration.

After this, you’ll be almost done. There’ll be a very long lull where you can’t do anything. Not sure why. Use it to take a look at your time. It should be at around 4 minutes. You NEED to finish the operation before it goes below 3:50 or you will not get the XS. If you are at little over 4, you have time to raise vitals to max before finishing up, but if you’re not, it’s better to just finish before missing the time bonus and not worry about vitals if you don’t have the time.

5.2

Special Bonus

-Max chain over 200 – 800
-All 5 operations were completed – 600
-5 patients saved – 100
-No mistakes – 500

This is a pretty fun operation. It’s not that hard but it is very long so it’s a bit of an endurance test. You’re going to treat 5 patients back to back all infected with Kyriaki. Because it’s so long, it’s very likely that this is an operation which will cause you wrist pain. If you have carpal tunnel syndrome this operation is very likely to cause it to flare up. If you’re young you can try to take it and just hang in there. If you’re old I recommend taking it easy a little. Nevertheless, wrist pain does lower your ability, and if it’s particularly bad it can even cause mild hand paralysis and even muscle spasms. Therefore if you’re experiencing this I recommend taking short breaks in between retries. It doesn’t have to be more than a few minutes. Also, it helps a little to pause in between patients and rest for a few seconds if you feel your wrist too tensed up. Obviously I can’t do that in my video since people would get tired of watching nothing happen or I’d have to edit it which I’m completely against. You can though, and it’s not a bad idea.

The real trick to XSing this operation though is to realize that you have plenty of time. To realize that your number one priority isn’t to be fast; but rather to avoid breaking your chain or getting a miss. That’s what you should be striving for. This isn’t New Blood so you don’t actually have to get COOLs in every single thing you do. A few GOODs here and there are acceptable. But always be careful. Don’t rush. Make sure that you never get a BAD.

Perform the lobectomy as soon as you start. Once you’re inside the patient, my recommendation is to suture all of the normal lacerations except for one, then take care of the huge one. Remember to be reasonably careful when bringing the two ends together. If your hand slips you’ll get a miss and lose the XS. You should know how to get COOLs on all these lacerations by now. Remember that when in doubt, it’s better to make more passes than less. Before you suture the last small laceration, raise vitals to max. After that laceration is treated, the Kyriaki will start appearing. There is really no difference to the Kyriaki treatment here. You will be fighting it in the exact same way that you fought the last ones. The only difference is that there’s more of them.

Treat the lacerations the kyriaki makes as soon as you see them. Then switch to the ultrasound. 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. Remember that it takes two hits with the laser to kill the little Kyriaki. Use this knowledge to your advantage. As soon as you hit it the second time, you know that you have to switch to the sutures immediately.

You can actually raise vitals before treating the laceration and incision wound without fear of the next wave arriving until you do. This isn’t actually necessary though. The next wave will have more Kyriaki. Usually you’ll only fight two at a time but sometimes you can fight up to 3. I like to find and cut them all up then kill them at the same time rather than dealing with them one at a time.

After little ones are dead 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 several HP. So we’ll be repeating the procedure on him as many times as it takes. 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 until you’ve defeated him.

Obviously if vitals go into the critical zone you should raise them no matter what. Generally speaking, before fighting the boss Kyriaki vitals should be around 60 if you don’t want to raise them in the middle of the fight. Sometimes though, a little one will also be running around when the boss appears. You want to take care of this little one before dealing with the boss. And obviously vitals should be a bit higher than 60 if this is the case.

Like I said before, the most important part of this operation is being careful and making sure you don’t break your chain. Speed isn’t as important. When moving between patients don’t bother raising their vitals before you close them up. Except for the very last one, of course. Also be sure to take it slow and careful when applying the bandage after each one because you don’t want to get a BAD there.

5.3

Special Bonus

-No Healing Touch – 1000
-Less than 3 membranes multiplied – 500
-Completed with 190 left – 300
-No mistakes – 200

It’s Triti again! This one works exactly the same as the previous one you treated back in Africa. And just like the last one, if you follow my directions to the letter you can easily XS this without doing any actual work. Following directions isn’t as fun as actually doing it by yourself though, so let me paste the Triti explanation in case you missed it the first time:

First of all I’m going to explain to you the way Triti works. But know that it can be a bit difficult to understand at first. This explanation will help you, but I recommend that you also get in there and actually see for yourself. It might take a while, but I guarantee that it will eventually become clear to you.

Triti is made up of two parts: membranes and thorns. What you want to do is remove all of the membranes from the pancreas. However, each membrane is embedded into the organ by three thorns in each corner. To remove a membrane, first you must remove all of the thorns surrounding it. The thorns also regenerate after a few seconds.

The big problem, of course, is the way the membranes multiply. First of all, notice that membranes only multiply based on what you do. Notice that if you don’t do anything, they will never multiply. This means that, while speed is still important, it’s also important to know what you are doing.

Notice that membranes can only multiply when you remove one with the forceps. Simply removing thorns does not allow them to. Now, the trick to Triti’s nightmarish multiplication is simply this: if there are two thorns adjacent to each other, and there is a free space next to them, a new membrane will appear there when you remove a membrane on any part of the organ. Therefore, the trick lies in looking at the thorns. What you want to do is only remove membranes when there are no adjacent thorns currently present. The exception is when there is no free space where two adjacent thorns can create a new membrane. This is either because there is already a membrane there, or because it’s the edge of the organ and there is no actual room for a membrane to appear.

You’re going to be using your forceps almost exclusively here. I recommend that you grab the wiimote in a specific way here: place your thumb over the A button and grip the remote firmly with it. That’s right, you’re going to have the A button constantly pressed throughout this operation. Never let go of it until you’re done. If you have the A button pressed, then you can simply use the B button to grab and let go of things with the forceps. There is no need to press and let go of both buttons. Using a single button affords much greater control over the remote. When pulling thorns in general, remember that they are embedded in the organ. You want to pull UPWARDS when grabbing them before placing them on the tray. If you simply pull to the right, you will get a miss and forfeit the entire operation. This is important, so always remember to pull in an upward motion.

Now what follows is the way to XS this specific operation. Understanding Triti and the meaning behind what you’re going to do is good, but if you follow these directions you can XS the operation without having to understand it:

Open up the patient and go inside. You will see two separate clusters of membranes. They are identical in shape except one is upside down. They both consist of the same number of membranes (5) and thorns (8). Notice the pattern of the thorns. Look at the top-left cluster of membranes. You can see 6 thorns surrounding a single one in a hexagonal shape. We’re going to use this hexagon shape as a point of reference. The 8th thorn is the odd man out down at the bottom.

Anyway, we’ll start by quickly removing three thorns from the top-left cluster. Remove the the rightmost thorn in the hexagon, then the centermost thorn in that same hexagon, and finally the odd man out thorn. Now we’ll move on to the bottom- right membrane cluster. First remove the leftmost thorn of the hexagon, then the centermost thorn, then all three of the topmost thorns. After that, very quickly remove both of the topmost membranes of the bottom-right cluster. If you do this correctly, the bottom-right cluser will now only have 3 membranes and there will have been NO new ones created. If at any time one of the thorns turns into gas just quickly drain it.

At this point the thorns you removed on the left membrane cluster should be about to regenerate. Inject stabilizer a bit if you want while you wait for them to do so. Now, remove the same 3 thorns you removed from the left cluster last time. Then move over to the right cluser and remove the 3 leftmost thorns, then the leftmost membrane there. Now the right cluser should only have two membranes and again, none should have been created. Raise vitals again while you wait for the thorns to regenerate again. Now remove the SAME three thorns from the left cluster again, then move on to the right cluster and quickly remove all 4 thorns and then immediately remove both membranes one right after the other. If one of the thorns turns into gas, ignore it until you’ve removed both membranes. Again, no new membranes should have been created.

Now we’re almost done. We only have the left cluster to worry about. Wait until the thorns have regenerated while injecting stabilizer. Then, remove rightmost thorn of the hexagon followed by the centermost one and the three at the bottom. Remove both bottom membranes. Now there are only three left. Wait until the thorns have regenerated and remove the three rightmost ones. Now remove the right membrane. Only one more step to go now. Remember that absolutely zero membranes should have been created throughout this entire procedure. Let the thorns regenerate one last time, then very quickly remove all 4 and both membranes. Drain the gas that surely appeared and that’ll be it.

If you follow these directions correctly you will get the XS. Watch the video to see the demonstration.

5.4

Special Bonus

-Max chain over 30 – 600
-3 or fewer diverticula formed – 500
-Completed with 180 left – 400
-No mistakes – 500

Angie says this Tetarti is stronger than normal. If you ask me, it sounds like another of her many lies. Who knows though, it might take a few more injections before it dies but other than that it’s absolutely identical to the last one. There are zero changes from the normal procedure. If you XS’d the last Tetarti you should have no trouble XSing this one as well.

Tetarti is a pretty easy GUILT in this operation. The biggest danger you’re going to face is trying to make sure that you don’t miss the bodies when injecting the serum. This’ll cause a miss and will likely be the only thing that keeps you from getting the XS.

Anyway, when you’re inside you’ll spot three diverticula. We’re going to take care of these as fast as possible. Inject the correct colored serum in each of them one right after the other. After the third injection, quickly switch to your scalpel and excise the FIRST one you injected, then move on to excise the second one you injected, and finally the last one. You need to do it in this order or else there’s a high chance that the serum will wear off on the first one before you get a chance to work on it. In any case, quickly take all 3 of them to the tray right after the other. This should net you a COOL on every one. Apply the synthetic membranes and gel them. By now the patient’s vitals should be a bit on the low side. Don’t worry about this, you’ll have plenty of time to raise them.

Now we fight Tetarti proper. Before they appear, get ready by filling up your syringe with a serum. Doesn’t matter which. Once they come out, pay attention. Find the one which is the same color as the serum currently in your syringe. This is going to be the first one you inject. But at the same time, pay attention to a second body and keep its color in the back of your mind. This is because this one will be the second one you inject, and since their color disappears after the first second, you need to know it beforehand.

Now you’re going to inject the correct colored serum into each Tetarti body but it’s imperative that you be VERY careful when doing so. They move around a lot and like to make sharp turns that make it very easy for you to miss. First of all, relax. You’ll want to keep a steady hand throughout this operation. It’s true that the Tetarti burrow back after a while if you don’t inject them all fast enough, but you have more time than you might think so don’t rush. Generally speaking Tetarti will make sharp turns when it hits the edges of the organ or one of the other bodies. Usually when it makes a sharp turn it will not make another one immediately unless it hits something. Use this to your advantage. If you notice that it has just made a turn, you can be pretty confident that it will keep moving forward, which makes it easier to inject safely. If you see that it’s about to hit an edge or another one of the bodies, it’s probably a good idea to wait a little until after he’s made the turn just to be safe.

If you’re stupid like me and forget to check the second one’s color, it’s a good idea to wait a little until the remaining bodies expel their gas so you can be sure that you’re injecting the correct one. If you get the wrong color, just restart. After you’ve injected all 3 and as they’re dying, you have an opportunity to inject stabilizer twice and still have time to fill the syringe up with serum before the next wave appears. If you do this every time you defeat a wave, you’ll be at max vitals in no time.

In any case, that’s all you need to do. Just keep doing the same thing until all the Tetarti have been killed. Again, being very careful never to get a miss.

5.6

Special Bonus

-Max chain over 50 – 1000
-Paraskevi moved 1 time or less – 500
-Completed with 120 left – 300
-No mistakes – 200

Paraskevi’s a pretty fun GUILT because as you’re cutting him up into smaller pieces more and more of them get added and things can get pretty hectic for you if you’re not careful. Our strategy when operating on Paraskevi will be to avoid dealing with more bodies at any one time than is necessary. In other words, we want to keep things as easy and manageable for ourselves as possible.

When you first get inside Cybil, you will see two small lacerations. Just take care of these quickly. After they’re gone, you have a chance to raise vitals to max before Paraskevi makes its appearance. It’ll start as one big body. If you let it be for a while, it will eventually burrow and move on to another organ, then to another, and another and so on until it reaches the heart and kills the patient. You don’t want this to happen. If Paraskevi moves more than once, you will not get the XS. Use the laser on its tail to paralyze it temporarily. This keeps it from burrowing.

Pay attention to the tail. When it starts vibrating, it means it’s about to burrow, so quickly paralyze it before it gets the chance. Once it’s paralyzed, you’ll have to switch to the scalpel and slash it’s midsection to start killing it. Remember to slash along the MIDDLE. Any other part won’t work. Once you do, it will turn into two bodies and create two lacerations. Before dealing with the lacerations, it’s a good idea to paralyze the two bodies first so they don’t burrow while you’re busy suturing. Now, we’re going to repeat the procedure and slash one of the two bodies. This will have the same effect as the last time. It will divide in two and cause two lacerations. Now you have 3 bodies to worry about.

What you’re going to do from here on out is concentrate on slashing ONLY the smallest body currently present. You will do this so you can reduce the number of Paraskevi while keeping the number you have to worry about at one time down to the most manageable level. Therefore, other than periodically paralyzing them with the laser, you will ignore the larger bodies and only slash the smallest ones. You should keep working the same way as you go on, paralyze, slash, paralyze all, suture, paralyze again, slash etc. However, once you slash a body down to the smallest size, that is, to only a tail and head, what you’ll want to do is, instead of suturing the lacerations after paralzing everything, ignore them for a bit, and instead, pick up the two smallest bodies comprised of only the head and tail as soon as you paralyze them. Only after these two are gone should you suture the lacerations. The reason is that the smallest ones move too fast, plus by that point there will be a very large number of them, and if you can get rid of two that fast and easily, it’s better to get them out of the way first.

After that, move on to the smallest body currently present and start working that one down. Do everything exactly the same way until there are no more Paraskevi. Raise vitals whenever you want, but make sure that all the bodies are paralyzed when you do.

Alternatively, once you’ve slashed once and there are two large Paraskevis, you could choose to ignore one of them completely and let it move on to the next organ and treat it only once you’ve completely gotten rid of the other one. This might lighten the workload a bit since you’d have one less Paraskevi to worry about on the first organ. Still, I prefer to play it safe and not let any of them through on purpose.

Sometimes there may be too many Paraskevis moving around to paralyze all of them. This is when their signals come in handy. You can actually choose to let a body roam around as long as its tail isn’t vibrating. However, the ones whose tails ARE vibrating should be lasered as soon as possible. As a matter of fact, if you’re good at watching for those signals, it could be in your best interest to only paralyze bodies when absolutely necessary. This can certainly help to make things go faster for you.

Make sure to be careful when suturing so that you never get a BAD. Otherwise it’s probable that you won’t be able to hit the max chain bonus. If this happens you will not get the XS. Finally, be careful when picking up the smallest bodies. Firstly, make sure they’re paralyzed, and secondly, make sure that they aren’t near another body, because then you could accidentally pick up the wrong one and get a miss. If you paralyze a tiny Paraskevi and a larger one near each other, it might be best to let the paralysis wear off so they can get some distance from each other.

5.8

Special Bonus

-Max chain over 70 – 600
-Blue GUILT body did not appear – 900
-Completed with 230 left – 300
-No mistakes – 200

This is a very difficult operation if you’re a renegade and don’t use the Healing Touch. Once you realize the trick to it, though, it becomes much more reasonable.

Open up this son of a bitch and get inside. You’ll see 5 normal lacerations. Suture 4 of them, and raise vitals to max, then suture the last one. Once you do get ready because you’ll have to deal with wave after wave of Savatos. They will create a laceration, and then pour out from it to cause havoc. Now the hard part of this operation is that you MUST prevent the blue Savato from being formed. And the thing is, that if you don’t incinerate the majority of Savatos in the first 0.5 seconds after they pour out of the laceration, they WILL form the blue Savato and that’s goodbye XS rank.

If you think about it, 0.5 seconds isn’t a lot. In fact, 0.5 seconds isn’t that much more than an instant. Fortunately, there is a way: if you’ll notice, the location where each laceration gets made is actually FIXED. It is not random. You know what this means. You will have to memorize where each laceration will appear so that you can have the pointer on it and ready to burn the Savato BEFORE they actually appear. The problem is that, unless you’re some kind of legendary surgeon, it’s impossible to have fast enough reflexes to take care of the Savato without knowing where they will come out prior.

Anyway, there will be 8 waves of Savato that you have to kill. The first laceration will appear on the center of the organ slightly to the right, and the Savato will pour towards the right. Use this knowledge and your laser to burn them immediately. Then very quickly suture the laceration.

The second laceration will appear on the right. Do the same things you did on the last one. The third laceration will appear at the bottom, then the fourth a bit above the center. The fifth will be slightly left of center.

The sixth one will appear very near to the fifth. Now, at this point, you will need to STOP suturing the lacerations. The Savato have been accelerating and from here on out there is simply no time. After the sixth wave, the 7th will appear slightly bottom-right of the center. Be quick in burning them. Now be very careful with the final wave. This one will come SO fast that I actually recommend you don’t even let go of the button after burning the sixth one. Just keep the laser activated. This final wave will come out from dead center very near to the last one.

That’ll be it. Suture the 3 lacerations. If the blue Savato wasn’t formed, you will get the XS for sure. Unless, of course, you got a BAD somewhere. Don’t let this happen.

5.9

Special Bonus

-Completed with 240 left – 500
-No mistakes – 500
-Max chain over 120 – 600
-25 COOLs earned – 400

Alright, the completed form of Savato complete with decent boss music! This operation is actually not that hard. It’s only a little bit long. The main problem with it is that if you work TOO well it’s quite probable that you will only get an S rank. To get the XS you will have to stall and let the Savato cause a bit more damage so you can rack up points and a bigger chain. However, you must make absolutely sure that you finish before the clock goes below 4:00.

Get inside. You’ll be at the heart and spot the Savato plus a bunch of its webs. You’ll want to immediately switch to the scalpel and start severing those. Just put your cursor over a web and keep the button held down on it for a few seconds. However, your scalpel will melt each time you break one. It’s fine though, just put your cursor over the next web and keep the button held down. If you do this, once your scalpel is usable again it will start cutting off the next web immediately.

Be careful. When there’s only one web left, Savato will create a new one plus some minions. Obviously you want to burn these little guys with the laser but you should do that ONLY if your scalpel is currently unusable. As SOON as you can use your scalpel, ignore the mini-savatos and sever a web. Then go back to burning them with the laser as the scalpel is recovering. As soon as it is, cut off the last web. Savato will escape down to the bottom of the heart and create a bunch of new webs. You’ll have to repeat the same procedure to get rid of these, except this time he’ll start creating new ones and sending out minions earlier. Just remember the rule: only laser the minions if your scalpel is currently unusable.

Once those webs are taken care of, Savato will escape back to the top part of the heart and create a bunch more. You’ll have to repeat the same procedure a third time exactly the same way as before. If you’re having trouble because you kill him too fast and don’t like that whole stalling business, here you might want to try leaving a single minion alive when you cut off the last web. Savato will absorb the little guy and this will make him much more powerful, which means that it’ll take longer to kill him.

When that’s done you’ll move on to the next phase. Here you will have to keep using the laser to burn the Savato’s outer layer. Since he likes to dodge a lot, what I recommend here is that, instead of holding the button down, you try to prick him for a second with it, and when he dodges, follow him but WITHOUT holding the button down, and only use the laser when he’s reasonably immobile. Basically, you want to avoid wearing out the laser. One, because it’s actually less effective than using it moderately, and two because you want to keep it on hand in case he decides to send out minions.

Right, minions. That’s one of his two modes of attack. He’ll periodically create a long laceration from which little guys will pour out of. You’ll want to get them with laser immediately before they get a chance to disperse. Then suture the laceration before going back to the offensive.

The other mode of attack is simply to cause 3 normal lacerations. Just suture them as fast as you can before going back to the laser.

Remember to be moderately careful and not get a BAD because this will break your chain. You actually CAN break your chain in this way throughout the operation and still manage to get the XS, so if you were doing well and suddenly get a BAD near the end, don’t worry about it. Still, it’s best to be safe and not break that chain in the first place.

You should raise vitals frequently. In fact, it’s a good idea to strive for 99 vitals at all times. It’s simply best to raise them in small increments in between attacking rather than to wait until they’re critical and then waste a bunch of time getting them back up.

When you’ve laser’d off the outer layer, which you will know because Savato will start doing some crazy ninja dodging when you try to laser him some more, it’ll be time to switch to the scalpel and slash him once. He moves around a lot so be careful. When you do that, he’ll escape down to the bottom of the heart, and you’ll have to repeat the procedure again. When you’ve done everything here again, he’ll escape back to the top of the heart for one last round.

At this point it’s not a bad idea to take a look at the clock. You want to finish this round when it’s at around 4:30. If you let Savato absorb one little guy at the start you most likely won’t have to worry about finishing ahead of time. However, if you didn’t, it’s probably a good idea to stall and just let him do his thing until 4:30 and then apply the final blow. Slash him with the scalpel and then inject a full syringe of the black serum into him. This will cause Savato to go crazy and start making a ludicrous amount of lacerations. Vitals will automatically fall down to 30. Derek will automatically activate his Healing Touch here. Ignore the lacerations and quickly go for the syringe and start raising vitals. We’re going to let him cause a little bit more damage before we kill him. Keep raising vitals until your syringe gives out. By this time he should have created 2 or 3 more sets of lacerations. That’s about enough. Now activate the ultimate Healing Touch. This makes time stop completely. Now you’re pretty much home free. You can do this next part as slow as you want. Raise vitals to max, then start working on all those lacerations. Try to get COOLs on all of them. When they’re all gone switch back to your syringe and inject another full round of black serum into Savato. This will be enough to finally kill him.

Be very VERY careful when making the final suture and applying the bandage. Since the operation is so long, there’s a chance that your wrist has gotten very tired and so your hand may have started trembling like mine did in the video. This is dangerous because if you get a miss on the final suture or bandage all your previous work will have been for nothing. Try to go for at the very least GOODs or even BADs. Just don’t get a miss. Your chain at the end should be somewhere in the 300’s.

Z.5

Special Bonus

-Captured 3 blue GUILT bodies – 600
-Max chain over 50 – 200
-No mistakes – 400
-Completed with 140 left – 800

This operation is pretty easy. The main thing you have to watch out for is that you don’t kill any of the Savatos and 2, that you don’t get a BAD and thus break your chain. The other thing is that you need to score something like 9400 points or so for the XS. When I scored 9000 I only got an S. That means the XS is somewhere between 9000-9400. What this also means is that you must make sure to finish with the patient’s vitals at max, and also to finish quite a bit faster than the special bonus limit.

Perform the lobectomy immediately without raising vitals. You’ll spot 3 normal lacerations. Suture them all quickly. Don’t raise vitals at all. When that’s done, 3 Kyriaki will spawn. You’re going to deal with these as you always have. Suture the 3 lacerations they made, then start spamming the ultrasound on the center of the organ. Bring them all out with the scalpel then burn them with the laser. These happen to be a little stronger than normal. They will actually require 3 pricks with the laser before they die. You should not raise vitals at all throughout this. When they’re all dead, suture the lacerations and treat the remaining wounds.

When that’s done, 3 blue Savatos will spawn and bring vitals down to 36 automatically. This is why you shouldn’t raise vitals at all in the previous phase. It would have just been wasted time. Now the characters are going to talk for a while. Prepare to suture the laceration the Savatos made as soon as they’re done. Now 2 Kyriaki will appear. Suture both of the lacerations and take care of them like always. Be mildly careful here though, because you want to keep all 3 Savatos alive throughout this. If you kill one accidentally it’s over. It’s not too hard to avoid them though so don’t worry. What I’d recommend is, instead of holding the laser button down when fighting Kyriaki, just prick them once with it, let them move, follow them without having the laser activated, prick them again, let them move, etc. This works pretty well and reduces the chances of accidentally hitting a Savato.

After you’ve killed both Kyriaki, suture the lacerations but don’t gel the incision wounds just yet. The patient’s probably got one foot in the grave at this point so take the time to raise them to max (that’s 36). Now gel the wounds.

After little ones are dead 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 burrows after being hit with the laser. So we’ll be repeating the procedure on him as many times as it takes. 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 until you’ve defeated him. All this should be done without hitting any Savatos. Remember that max vitals is 36, so you will have to raise them a couple of times in between hitting the Kyriaki.

When he’s dead, Blackwell will give you a black serum to immobilize the Savato. Be mildly careful here. You don’t want to inject them when they’re moving or you could get a miss. Generally speaking, when a Savato stops moving, he will remain stationary for a few seconds before moving again. This is your chance to inject it. So to be safe, you want to wait until you’ve seen one stop moving. If you haven’t seen him stop, there’s a chance that he could be ready to start moving again at any moment, and if he does move while you’re in the middle of injecting the serum, you will get a miss. If the other ones are still moving after you’ve immobilized one, it’s not a bad idea to pick it up and place it on the tray. If you’ve seen another one stop though, go ahead and inject that one as well before you pick up the last one.

That will be it for the operation. Make the final suture. Now vitals are probably really low, and having them at 99 before you finish is imperative so switch to the syringe and start pumping stabilizer. When the syringe is about to give out, switch to the gel and disinfect the bandage area. This should give it some time to recuperate somewhat. Once you get the OK, switch back and continue raising them all the way to 99. Apply the bandage and you’re done.

6.3

Special Bonus

-Max chain over 10 – 900
-Completed with 210 left – 800
-1 or fewer diverticula formed – 300

This operation could have been hard, but they decided to pussify it and let you get misses without having to forfeit the XS. Here you’ll be fighting Tetarti, except now they move much faster than before. This would be a problem, but like I said, as long as you get up to chain 10, you can then get as many misses as you want and still get the XS. Of course, the other thing is that you can’t inject the serum into the wrong body. But no one was about to do that, right?

Tetarti works in pretty much the same way as before. The only difference is that it now burrows quicker, so you have to be faster with those injections. It’s good to remember that they only require a tiny dosage, so you don’t need to fill up your syringe completely, or even halfway for that matter.

Before the Tetarti bodies appear, get ready by filling up your syringe with a serum. Doesn’t matter which. Once they come out, pay attention. Find the one which is the same color as the serum currently in your syringe. This is going to be the first one you inject. But at the same time, pay attention to a second body and keep its color in the back of your mind. This is because this one will be the second one you inject, and since their color disappears after the first second, you need to know it beforehand. It’s more important to check the second one’s color out this time since they burrow quicker.

Normally I’d tell you to be careful, but like I said, you can get misses and still get the XS, so it’s not that important. All I’m going to say is to be careful until you get to chain 10, which should be after the third wave has been dealt with. Once you’re past chain 10 you can miss as much as you want throughout the entire operation and still get the XS. The first and third waves shouldn’t pose too much of a problem since they’re more or less the same Tetarti you’ve fought before. The second one is a much faster Tetarti that continuously spews gas. This means that you don’t need to worry about color, because it’s always there. All you need to worry about is hitting them with the injection. Since they’re much faster, their tendency for sharp turns becomes even more of a problem. The general rules from the normal Tetarti still pretty much apply to this one as well:

Generally speaking Tetarti will make sharp turns when it hits the edges of the organ or one of the other bodies. Usually when it makes a sharp turn it will not make another one immediately unless it hits something. Use this to your advantage. If you notice that it has just made a turn, you can be pretty confident that it will keep moving forward, which makes it easier to inject safely. If you see that it’s about to hit an edge or another one of the bodies, it’s probably a good idea to wait a little until after he’s made the turn just to be safe. The “trick” here is to only inject a body immediately after it has made a turn (and it’s not about to hit anything). These Tetarti will also not burrow after a while. They will only keep running around. The injection DOES wear off after a while so you still need to be reasonably fast. If you inject the third one and the first one’s has already worn off, just keep going. Go back to the first one and inject it again. If by this time the second one has worn off just keep going and inject it again as well.

You have time to inject a full round of stabilizer in between waves, and this should be enough to keep vitals in the clear.

In any case, it’s not too hard because once you’re past the third wave you’re pretty much home free.

The final suture in this operation is very weird. To get the COOL on it, you shouldn’t make the suture lines throughout the entire opening like you normally do, but instead, only make them in the very center. Check the video to see what I mean, although getting a COOL here isn’t really important.

6.4

Special Bonus

-Max chain over 60 – 500
-No mistakes – 800
-Completed with 120 left – 400
-30 COOLs earned – 300

Here you’ll be fighting Kyriaki and Paraskevi at the same time. Plus, you’ll already be at the heart from the start, so you can’t let Paraskevi burrow even once.

Now the way we’re going to approach this is that we will deal with the Paraskevi BEFORE the Kyriaki. There are two reasons for this: One, since it can instakill Derek, it’s the bigger danger. Two, by letting Kyriaki live longer, it can cause more damage which allows us to get more COOLs on the lacerations and thus more points.

So get inside Derek. You’ll see a number of lacerations. Suture them all except for one, then raise vitals all the way to max. When they’re at 99 suture the last one. Now Kyriaki and Paraskevi will appear. The Paraskevi are tiny so they can be picked up immediately. Laser them both and pick one up to get rid of it. Now suture the lacerations Kyriaki caused. Raise vitals to 99 again, then pick up the other Paraskevi. As soon as you do this, 3 more Kyriaki will spawn and create 3 lacerations, as well as 2 more Paraskevi. Quickly laser and pick up both Paraskevi. This will free you of them for the time being.

Now at this point there will 5 Kyriaki running around inside the heart. This is not a small number. They will cause a huge amount of lacerations, but this isn’t a bad thing. It’s actually what we want. Start suturing every one you see, and when there are none in sight, raise vitals. When vitals are at 99 start using the ultrasound and bring some Kyriaki to the surface. Since there are so many of them it might not be a good idea to cut them all up immediately. 3-4 of them is fine. Vitals will go down by a lot when you bring them out, and the others will surely cause even more lacerations. Keep an eye on the vitals. If they go down to critical you may have to inject some stabilizer before proceeding. If there are too many lacerations present very quickly suture some of them in between raising vitals. The reason we’re raising vitals and suturing instead of killing the Kyriaki as soon as possible is because 1) vitals might be too low and Derek could die while you’re lasering them and 2) we want them to cause a little bit more damage to rack up some more points and they can’t do that if they’re dead. As soon as vitals are at a reasonably comfortable level start lasering all the Kyriaki on the surface. Remember that these are a bit stronger and require 3 pricks with the laser each before they die. When all of the ones on the surface are dead suture any remaining lacerations. Now bring out the remaining ones and kill them. Before gelling the final incision wound raise vitals to 99 once again.

Remember to get COOLs in as many of these lacerations as possible. You need 30 of these for the special bonus. If you left the Kyriaki alive for as long as possible like I told you though, you should have plenty of opportunities.

Now the boss Kyriaki will make its appearance along with his trademark triple slash. A small kyriaki will also be escorting him, plus a couple of small (but not tiny) Paraskevis. We’re going to continue this in the same way. Let the Kyriaki be and concentrate on the Paraskevi. Paralyze them both and cut one with the scalpel, then laser both of the tiny resulting ones and put them on the tray. Then suture all of the lacerations including ones Kyriaki may have caused. Next, do the same thing for the other Paraskevi.

Now you only have Kyriaki to worry about. Suture all the lacerations and raise vitals to a reasonable level, then start fighting them as you always have. By this time you most likely have gotten enough points so you can go ahead and kill the small one first. If you want to let him live until after you kill the boss so you can suture even more it’s up to you though.

That’ll be it. By now you’ve probably gotten enough points that getting COOLs on the final suture and bandage isn’t imperative. Just make sure you don’t get a miss!

6.6

Special Bonus

-Max chain over 90 – 600
-Completed with 140 left – 800
-No mistakes – 600

Pempti works exactly the same way as he did last time except now he’s trying his hardest to keep you from getting the XS by being a complete pussy and making all his minions so slow that they all die before they can do anything.

So we’re going to approach this operation the same way as the last Pempti:

Go inside. Don’t worry about raising vitals yet. When you’re in, immediately fill up your syringe with the serum and inject it into the circle of Pempty cells before it disappears. After injecting once, switch to the stabilizer and raise vitals to max with a single injection on the right. Then switch back to the serum and inject the circle a second time. This will cause the Pempti core to reveal itself. Switch to your new laser now and begin burning the core.

Once you get the first OK it’ll be time to fight Pempti mano a mano. To kill it, you have to keep burning the core with the laser. But Pempti defends itself by sending out its minions to wreak havoc on the patient’s lung. You can’t ignore the minions or they’ll kill the poor guy in mere seconds. You have to kill them with the laser as well.

As a general rule, always, always, ALWAYS have your laser activated and right on the core when you’re not dealing with minions. This is because this is where they come out from. you don’t really know what Pempti will send out next, so having the laser activated and pointing on the core puts you in the best possible position to fight whatever it’s going to send out on the shortest notice.

Now Pempti has 3 kinds of minions that it likes to send out. The first type are red mini-cores that cause lacerations. These are the ones that can cause the most damage if you don’t take care of them, but they’re also not too hard to deal with. Pempti will send 5 of these, one right after the other. They will move from the center (that is, where the core is located) to one of 5 spots around it, then shoot upwards after a second and create a laceration on the lung. You don’t want this to happen. Your goal is to kill every one of these 5 small cores BEFORE they get a chance to create their laceration. This isn’t hard to do if you’re on the ball, but the timeframe from their creation to the laceration is a little bit strict so your laser NEEDS to be active and pointing at the core BEFORE it sends the first one out. Otherwise there’s a good chance that you won’t have enough time to kill it before it does damage. You can probably suture one or two lacerations if you’re fast enough, but ideally you don’t want to give Pempti a chance to create even ONE. The problem is that if you try to suture after all 5 of them have gone out, it’s probable that you will not be pointing the laser at the core when it sends out the next wave, meaning you will NOT have time to deal with it, and you will be even closer to being overwhelmed. So it’s in your best interest to kill these little guys immediately. To do this, as I’ve said before, have your laser burning the core before they come out. This makes it so that you start burning and causing damage to it as it’s coming out, and you can follow its path with the laser up to one of the 5 points where it preps to make the laceration, burning it the entire time. If you do this, you will kill it before it does the laceration. But you can’t relax because there’s still 4 more to come after that one, so very quickly go back to the center and repeat the same thing for all of them. Remember, don’t let even ONE of them get past.

The next type of Pempti minions are blue ones that cause tiny tumors. In the last operation these were so stupidly fast that it was nigh impossible to get them all before they caused damage. But this time around, it seems Pempti knows that you’re going for the XS and it’s hellbent on keeping it away from you by making these guys a lot slower. This time around it’s actually quite easy to kill them all before they create their tumors, but of course, you don’t want this because if you don’t let them, you won’t get a high enough score. Therefore, what we actually want to do is let some of these guys live so that they can create some tumors to help boost our chain. Now if you’ll notice, the laser has an area of effect. This means that you can actually kill two of these little cores at the same time by pointing the laser BETWEEN them. If you’re good, you can consistently kill all of them every time by doing this. But this is not really what you want. You want extra points. Ideally, you want to leave 2 or 3 alive so they create a lot of tumors that you can quickly treat. What I recommend doing is, as soon as all 5 come out, move your laser a bit upwards, and place it in between two of the ones on the top part. You should very easily kill those two before they create their tumors. Then, move on to burning a third one. Again, you should easily kill this one. Now leave the other two alone. Switch to the gel and start applying it on the part of the lung where they’re going to create their tumors. This will raise vitals a little bit plus prep you up for treating them. Once they move upwards and create them, quickly switch to your laser and start burning in that part before the gel disappears. The tumors will be gelled up as soon as you burn them. Obviously you can’t actually see the tumors because the gel is blocking your view, but just burn wildly around that part and you should get most of them. When the gel disappears quickly get the few strangler tumors you missed and gel them up, then burn the two little cores before they get a chance to create a second set.

Be careful because unless you’re some kind of legendary surgeon this doesn’t always go 100% smoothly. Pempti might get a chance to send out his first red core out and cause a laceration, for example. Don’t worry though, just keep going and suture it quickly after the 6th one’s killed.

The third type of minion Pempti uses is the least dangerous one. They are 5 mini cores that slowly come out in a spiral and start spinning around and causing damage. The thing is, these pose absolutely NO problem if you’re pointing the laser at the core (which you should be). If you are, you don’t need to do anything. All 5 mini cores will die as they’re coming out before they have a chance to know what’s up. No sweat. The only time that these guys can cause damage is if you took a bit too long to treat the tumors and kill the 2 little cores from the previous section. Don’t worry though, just laser them all. The patient’s vitals will take a bit of a hit but it shouldn’t be too much.

In any case, that’s how you fight Pempti. If you always keep the laser on the core you should be done before the time limit. Your only worry (other than dying), is your score. Do not break your chain at any time. You want to end with a chain of around 150.

6.7

Special Bonus

-Max chain over 150 – 500
-No mistakes – 500
-Completed with 200 left – 300
-Less than 5 membranes multiplied – 700

This is a fun operation. You’ll be fighting Triti, Kyriaki, Deftera and Paraskevi in that order. One right after the other. Your priorities in this operations are firstly to get no misses, and secondly to not break your chain. Thirdly, even if you do the operation perfectly you might still not get enough points for the XS. So we’ll have to do something about that. Read on.

Alright, the first patient has Triti. It works the same way as it always has:

Triti is made up of two parts: membranes and thorns. What you want to do is remove all of the membranes from the pancreas. However, each membrane is embedded into the organ by three thorns in each corner. To remove a membrane, first you must remove all of the thorns surrounding it. The thorns also regenerate after a few seconds.

The big problem, of course, is the way the membranes multiply. First of all, notice that membranes only multiply based on what you do. Notice that if you don’t do anything, they will never multiply. This means that, while speed is still important, it’s also important to know what you are doing.

Notice that membranes can only multiply when you remove one with the forceps. Simply removing thorns does not allow them to. Now, the trick to Triti’s nightmarish multiplication is simply this: if there are two thorns adjacent to each other, and there is a free space next to them, a new membrane will appear there when you remove a membrane on any part of the organ. Therefore, the trick lies in looking at the thorns. What you want to do is only remove membranes when there are no adjacent thorns currently present. The exception is when there is no free space where two adjacent thorns can create a new membrane. This is either because there is already a membrane there, or because it’s the edge of the organ and there is no actual room for a membrane to appear.

You’re going to be using your forceps almost exclusively here. I recommend that you grab the wiimote in a specific way here: place your thumb over the A button and grip the remote firmly with it. That’s right, you’re going to have the A button constantly pressed throughout this operation. Never let go of it until you’re done. If you have the A button pressed, then you can simply use the B button to grab and let go of things with the forceps. There is no need to press and let go of both buttons. Using a single button affords much greater control over the remote. When pulling thorns in general, remember that they are embedded in the organ. You want to pull UPWARDS when grabbing them before placing them on the tray. If you simply pull to the right, you will get a miss and forfeit the entire operation. This is important, so always remember to pull in an upward motion.

Now what follows is the way to XS this specific operation. Understanding Triti and the meaning behind what you’re going to do is good, but if you follow these directions you can XS the operation without having to understand it:

When you get inside there will be 10 membranes in a really funky pattern. Look at the thorns. What we’re going to use as a point of reference in these directions is the rows of thorns. When you start there will be 4 rows. From top to bottom the first row will have 2, the second will have 4, the third will have 5, and the last will have 4.

From top to bottom we’ll call these row 1, row 2, row 3 and row 4. Now, as soon as you can, I want you to remove the 3 middle thorns from row 3. Then quickly remove all of the thorns from row 1, and both middle thorns from row 2. Then remove the two membranes at the very top. Now you only have 8 membranes, and row 1 will be gone. No new membranes should have been created. Wait for all the thorns to regenerate while you inject some stabilizer.

Next, remove the left thorn from the top row, both left thorns from the middle row, and both left thorns from the bottom row. If a thorn turns into gas ignore it for now. Then remove the rightmost thorn from the top row, and the second thorn starting from the right on the middle row. Now very quickly remove the three leftmost membranes. Drain any gas. Now you’re down to 5 membranes and no new ones should have been created. Wait for the thorns to regenerate while you raise vitals.

Remove either of the thorns on the top row, then the two leftmost ones on the middle row, and the two leftmost ones on the bottom row. Remove both membranes on the bottom left. We’re down to 3 membranes. Again, wait for the thorns to regenerate.

Remove the three thorns holding down the left membrane and remove it. Only two membranes left. Wait for the thorns to renegerate, then quickly remove all 4 thorns holding them together and both membranes. Drain any gas after all membranes are gone. That’ll be it for this patient. Watch my video for the demonstration of these instructions. Make the final suture and apply the bandage, make sure not to get a miss. You should have finished this part in less than a minute.

Now we move on to the next one. Get inside. It’s Kyriaki. This one works exactly the same way as all the other Kyriakis so you should have no problems when dealing with it. However, remember that if you work too well and too quickly, Kyriaki won’t have a chance to cause many lacerations. It’s very easy to miss the mark on the score needed for the XS in this operation, and to avoid this we will approach this part in such a way that we will let Kyriaki cause more damage than we normally would.

When you get inside you’ll see a bunch of normal lacerations and a huge one. Take care of them all. Remember to get COOLs in as many as possible. Don’t raise vitals yet. I did raise them in the video because I suck and forgot, but just because I suck doesn’t mean you have to! After suturing them, two Kyriaki will appear. Suture the two lacerations, then find them with the ultrasound like always, and bring them up to the surface with the scalpel. Now wait a second. Don’t kill them immediately. Remember what we said. Suture all of the lacerations. What we’re going to do at this point is raise vitals to max while they’re running around, and hopefully they will create a few more lacerations that we can suture while we do that. Once vitals are maxed out, you can wait a few seconds and see if they want to make some more lacerations, but if you see that they stay passive for more than 5 seconds just kill them.

Now two more Kyriaki will spawn. Treat them exactly the same way as you did the last two. Remember to raise vitals when they’re running around so they can make a few more lacerations than normal.

Now the boss Kyriaki will spawn, escorted by a single small one. He will create his trademark triple slash. Treat the 3 lacerations as you always have. Now, normally you’d take care of the small Kyriaki first since it dies in one shot, but here you’re going to kill the boss first so that the little one can run around for a while making lacerations as you’re doing this. Once the boss is dead go ahead and kill the little guy. That’ll be it for this patient. By the time you’re done with this one I’d recommend your chain being above 100.

Next up we’ve got Deftera. This one’s going to work the same way as the last Deftera you treated, the only difference is this time random pools of blood will form that may obstruct you. You’ll have to drain them periodically. Along with Kyriaki, this is the other part where stall tactics could work to your benefit. Be careful when stalling with Deftera though, because it’s much more dangerous. Having too many tumors sitting at once can potentially destroy vitals before you even know what happened. If you’re lucky, Deftera will act so aggressively that you won’t have to stall too much on purpose. If you’re unlucky, both will be suicidal and hardly do anything.

Therefore, if you see that they’re acting aggressively, just laser off every tumor that appears as quickly as possible. If you see that they’re being too passive, it might be a good idea to let some tumors fester for a while and create additional tiny ones.

Go ahead and drain both pairs twice as fast as you can. Before the final drainage, however, use your judgement. If you feel that they’ve caused a good amount of trouble up till now, go for the kill. If you feel that they haven’t done much, stall for a bit and let them create some more tumors until you feel relatively satisfied. If you want some kind of meterstick to go by, I’d say you can start killing them once your chain is above 150.

Remember, don’t bother draining the Deftera if there are still tumors around. This will cause the drainage to fail and it will just be wasted time.

When you’re excising the Deftera, you know how it works already: It gives you a little bit of time to get ready before the lines appear, so what I’d recommend is to start moving the scalpel where you THINK the lines will appear before they do so that you waste no time, and also so you’re already comfortably making the right motion. Don’t cut too fast because you want to get every dot on the first pass. If you do this fast enough the Deftera will only get a chance to create a single tumor. Burn this tumor off before you grab the Deftera with the forceps and place it on the tray. Then simply apply the synthetic membrane and gel over it. If vitals are really high, you can let it create some more tumors during this part to get some more points. But if vitals are, say, below 50, it’s not really all that advisable.

Now it’s time to move on to the final patient. You should have finished Deftera before the clock goes below 6. But if it has gone a bit below that, don’t worry too much. You still have plenty of time. You have to finish before 3:20. This last part will be Paraskevi. It works exactly the same as the first Paraskevi you treated, except it’s already in the patient’s heart, so you have to be extra careful and not let it burrow even once. Stall tactics are useless here, so just finish it off as quickly as you can. Major dangers are 1) picking up the wrong body and getting a miss 2) picking up a body when it’s not paralyzed and obviously 3) letting a body burrow. So it’s important to be careful in this operation.

Other than that, it’s the same as the last time:

Pay attention to the tail. When it starts vibrating, it means it’s about to burrow, so quickly paralyze it before it gets the chance. Once it’s paralyzed, you’ll have to switch to the scalpel and slash it’s midsection to start killing it. Remember to slash along the MIDDLE. Any other part won’t work. Once you do, it will turn into two bodies and create two lacerations. Before dealing with the lacerations, it’s a good idea to paralyze the two bodies first so they don’t burrow while you’re busy suturing. Now, we’re going to repeat the procedure and slash one of the two bodies. This will have the same effect as the last time. It will divide in two and cause two lacerations. Now you have 3 bodies to worry about.

What you’re going to do from here on out is concentrate on slashing ONLY the smallest body currently present. You will do this so you can reduce the number of Paraskevi while keeping the number you have to worry about at one time down to the most manageable level. Therefore, other than periodically paralyzing them with the laser, you will ignore the larger bodies and only slash the smallest ones. You should keep working the same way as you go on, paralyze, slash, paralyze all, suture, paralyze again, slash etc. However, once you slash a body down to the smallest size, that is, to only a tail and head, what you’ll want to do is, instead of suturing the lacerations after paralzing everything, ignore them for a bit, and instead, pick up the two smallest bodies comprised of only the head and tail as soon as you paralyze them. Only after these two are gone should you suture the lacerations. The reason is that the smallest ones move too fast, plus by that point there will be a very large number of them, and if you can get rid of two that fast and easily, it’s better to get them out of the way first.

After that, move on to the smallest body currently present and start working that one down. Do everything exactly the same way until there are no more Paraskevi. Raise vitals whenever you want, but make sure that all the bodies are paralyzed when you do.

Sometimes there may be too many Paraskevis moving around to paralyze all of them. This is when their signals come in handy. You can actually choose to let a body roam around as long as its tail isn’t vibrating. However, the ones whose tails ARE vibrating should be lasered as soon as possible. As a matter of fact, if you’re good at watching for those signals, it could be in your best interest to only paralyze bodies when absolutely necessary. This can certainly help to make things go faster for you.Finally, be careful when picking up the smallest bodies. Firstly, make sure they’re paralyzed, and secondly, make sure that they aren’t near another body, because then you could accidentally pick up the wrong one and get a miss. If you paralyze a tiny Paraskevi and a larger one near each other, it might be best to let the paralysis wear off so they can get some distance from each other.

Remember to get COOLs in as many sutures as possible. Score is very, very important for the XS. If you get below 24000 points when it’s all over, you will only get an S. Lastly don’t forget to raise vitals to 99 on the last patient before you apply the bandage.

6.8

Special Bonus

-Max chain over 180 – 500
-No mistakes – 800
-Completed with 150 left – 200
-20 COOLs earned – 500

Shit man, the music in this one is so epic I could cry. Definitely a contender for the most fun operation in the game along with Pempti. This Savato works similarly to the one Blackwell had. Except it’s more badass. The biggest challenge in XSing this operation will be hitting the score you need. If you score too low, you will only get an S. And getting the score you need before the Healing Touch is much harder in this one than it was back in chapter 5. The other problem is that the operation is so long that after a while you’ll likely have some trademark Trauma Center jitters and wrist pain. It’s important to get a few minutes of rest in between retries. It’s also a good idea to pace yourself throughout the operation because as your wrist stamina gives out you’ll get worse and worse. Try to relax your grip a little when there’s a slight lull in the action. Be careful though, because if you’ve been gripping the wiimote for a long time and suddenly relax and then tense up again, there’s a chance you can get mild tendon spasms which can be a little offputting. You can also pause the game in the middle of the operation and rest for a few minutes. This is pretty effective in getting your wrist back in the game. Obviously I can’t do that in the video, which sucks, but you can.

Get inside. You’ll be at the heart and spot the Savato plus a bunch of its webs. You’ll want to immediately switch to the scalpel and start severing those. Just put your cursor over a web and keep the button held down on it for a few seconds. However, your scalpel will melt each time you break one. It’s fine though, just put your cursor over the next web and keep the button held down. If you do this, once your scalpel is usable again it will start cutting off the next web immediately.

Be careful. When there’s only one web left, Savato will create a new one plus some minions. Obviously you want to burn these little guys with the laser but you should do that ONLY if your scalpel is currently unusable. As SOON as you can use your scalpel, ignore the mini-savatos and sever a web. Then go back to burning them with the laser as the scalpel is recovering. As soon as it is, cut off the last web. Savato will escape down to the bottom of the heart and create a bunch of new webs. You’ll have to repeat the same procedure to get rid of these, except this time he’ll start creating new ones and sending out minions earlier. Just remember the rule: only laser the minions if your scalpel is currently unusable.

The transition from top to bottom and then to top again here is a great place to rest for a few seconds. It’s not much, I know, but every little bit helps. Relax and place your hand on your lap or wherever you feel comfortable until you can use your tools again.

Once those webs are taken care of, Savato will escape back to the top part of the heart and create a bunch more. You’ll have to repeat the same procedure a third time exactly the same way as before. Now, here, if this was the chapter 5 Savato I’d tell you to leave a minion alive when all the webs are gone so he can absorb it. But this Savato is powerful enough as it is, so I can’t really recommend it. Plus, you won’t be getting most of your point in that part.

When that’s done you’ll move on to the next phase. Here you will have to keep using the laser to burn the Savato’s outer layer. Since he likes to dodge a lot, what I recommend here is that, instead of holding the button down, you try to prick him for a second with it, and when he dodges, follow him but WITHOUT holding the button down, and only use the laser when he’s reasonably immobile. Basically, you want to avoid wearing out the laser. One, because it’s actually less effective than using it moderately, and two because you want to keep it on hand in case he decides to send out minions. Still, there are a few times where wearing out the laser completely could be good. For example, if it’s already in the red, and Savato has just sent out his minions and you’ve burned them all off. Wearing it off completely before suturing the laceration and then injecting stabilizer once could very well work in your favor.

The thing you have to watch out for with Savato here is that when he’s not being burned with the laser, his armor gradually gets tougher and tougher. This means that if you’re not constantly on his ass it’s only going to take you longer and longer to burn off that outer layer. If you’ve been particularly lenient on him it can take you forever to get back on track and it’s reasonably easy to lose all of your time like this. Therefore, as SOON as the last web is severed and you move on to the laser phase, begin burning him. That’s right, immediately. Your laser will probably be almost spent from the last phase but it doesn’t matter. Burn him immediately even if it’s only a little. Just don’t let his shields regenerate too much.

Right, minions. That’s one of his two modes of attack. He’ll periodically create a long laceration from which little guys will pour out of. You’ll want to get them with laser immediately before they get a chance to disperse. Then suture the laceration before going back to the offensive.

The other mode of attack is simply to cause 3 normal lacerations. Just suture them as fast as you can before going back to the laser.

The strategy I recommend here is to be very aggressive. If the laser is white, you should be burning Savato. ONLY give the laser a break when it’s yellow-red. Don’t let it sit there unused if it’s completely recovered. When it IS recovering you should be pumping stabilizer. That’s the strategy. Never let up. Even if vitals aren’t at max, if the laser is white forget about the syringe until it’s yellow. In fact, sometimes it can even be better to completely ignore vitals unless they’re really low and just try to get that shell off as soon as possible.

The exception to this, of course, is his attacks. Killing his minions and suturing lacerations always takes priority over everything else, in that order. And the exception to THIS is, of course, if Dr. Hoffman is about to die, ignore everything and concentrate on getting vitals out of the teens.

When you’ve laser’d off the outer layer, which you will know because Savato will start doing some crazy ninja dodging when you try to laser him some more, it’ll be time to switch to the scalpel and slash him once. He moves around a lot so be careful. When you do that, he’ll escape down to the bottom of the heart, and you’ll have to repeat the procedure again. If you’ve been very aggressive you can get him to move out to the bottom before the clock goes below 8. Repeat the procedure in the exact same way and make him move to the top again. Now this will be the final round. Here I’d recommend to be as aggressive as you’ve been up till now and get his outer layer off as soon as possible, then cut him up. Now he’ll be vulnerable. Raise vitals to higher than 30 if necessary, then inject the black serum into him. You may be tired by now. Be careful and make sure you don’t get a miss.

Now Savato will go balls out. Naomi will activate her god mode Healing Touch and Savato will start making a ridiculous amount of lacerations. This will be your chance to rack up some serious points before the operation is over. Do not activate your Healing Touch. Every time Savato slashes the heart vitals will drop like they’re hot, but since Naomi’s Healing Touch is so broken, you can suture lacerations as fast as you can and this will keep the vitals up. Just keep suturing. The longer you keep doing this, the better your chances of getting the XS. When the sutures start getting red, switch to your syringe and start raising vitals that way while they recover. Once they’re white again go back to suturing. When the time is at 2:45 or so, it’ll be time to finish up. I had to finish up earlier in my video because youtube has a video limit of 10 minutes, but you don’t have to. It’s really up to you. Anyway now go ahead and activate the ultimate Healing Touch. Now time will stop completely. Suture ALL of the remaining lacerations. When that’s done, inject a FULL syringe of serum into the Savato. Make sure it’s full. Otherwise it won’t work. That’ll be it. Vitals should already be at 99. Just do the final suture and apply the bandage. Be careful. Wouldn’t want to get a miss here.

X.1 (Derek)

Special Bonus

-No Healing Touch – 100
-Completed with 90 left – 600
-No mistakes – 900
-Max chain over 60 – 400

Alright, now we’re on to extreme mode! You’ll have to XS each operation twice here. Once with Derek and once with Naomi. Why? No reason other than because it shows both their ranks in the missions select screen. Also did I mention Adam is a cool assistant? He’s miles better than that bitch Angie.

Kyriaki isn’t a very hard operation. The key thing to remember here is that you want to stall for as long as possible (i.e: until just before the clock goes below 1:30) while racking up as many points as you can.

Get inside the patient. You’ll be greeted by 3 normal lacerations and 4 huge ones. First suture the small ones as fast as you can. Then move on to the big ones. You know how to deal with them by now. Drain the blood, bring both ends together with the forceps, and suture. Remember to make many, many passes along the entire length of the laceration to get the COOLs. Look at the video to see what I’m talking about. You can get away with some GOODs throughout the operation but make sure you get as many COOLs as possible just to be on the safe side. In any case, you should be able to treat all of the wounds without having to raise vitals in between. When you’ve sutured the last laceration, quickly switch to your syringe and inject stabilizer while you wait for the Kyriaki to spawn. They won’t take long. Probably less than a second. But you can get one injection in if you’re fast enough.

3 Kyriaki will spawn, causing 3 lacerations. Suture them. Now, remember that we do not want to kill them too fast. We want to stall but at the same time be doing something. That something will be 1) injecting stabilizer and 2) suturing lacerations. After you’ve sutured those first 3 start by raising vitals a bit. If lacerations get formed as you’re doing this, go ahead and suture them as they come, then go back to the syringe. Once vitals are over 60, we’re going to bring out the Kyriaki to the surface. If you’d like to stay on the safe side, go ahead and raise vitals even higher than that.

Spam the ultrasound near the center of the organ. This should reveal all of them without much trouble. Cut them all out to the surface with the scalpel. This is probably the single most dangerous part of the operation if you decided to do it with 60 vitals. Once you’ve cut them all vitals will have probably gone down to 20, and you will have quite a few lacerations to worry about, plus the Kyriaki will continue to make more. Suture as fast as you can, and if vitals drop into the teens, ignore everything else and get them out of there with the stabilizer, then go back to suturing. After a little bit of this all of the wounds will be treated and you should be back in control.

Vitals are still probably very low at this point. We’re going to raise them all the way to 99 here while we let the Kyriaki run around. They will cause damage as you’re doing this but don’t worry. It’s actually to your benefit. Suture any lacerations that come up as they appear and then go back to the syringe. Eventually you should be up to max vitals. When that happens, switch to the laser and kill two of the Kyriaki. Only two though! Leave the third one alive. When the second one kicks the bucket another pair of Kyriaki will spawn. Suture the two lacerations they create and then bring ’em up to the surface with the scalpel like you did last time. Treat all of the wounds. Now you’re going to let these three guys run amok while you raise vitals to 99 just like you did with the last 3. This time vitals won’t have been as low, so you should get back up to 99 pretty fast.

Take a look at the clock. We’re going to stall until it goes below 2:45, then we’ll kill them all with the laser. Now the boss Kyriaki will make his appearance escorted by a single small one. He will create his trademark triple slash pattern and the little one will also make one. Suture all of these immediately. I recommend many passes to get COOLs on these. Around 10. I also recommend that you first suture the diagonal one that goes from left to right, then the diagonal one that goes from right to left, and finally the middle one. In that order. I find that this helps so that the game doesn’t think I’m suturing the wrong one when I meant to suture another.

Bring the boss and the small one up to the surface with the scalpel. Let them run around and raise vitals for a little bit. Keep your eye on the clock. When it gets close to 2:00, start killing the boss. Not the other one. Leave the little one alone. The clock should be around 1:50 once the boss is dead. Now vitals will probably be low. Start raising them to 99 while the little guy runs around. Once vitals are at 99 OR the clock goes below 1:40, kill him.

Now you have 10 seconds to finish up. You need to finish before 1:30, so quickly make the final suture, gell, and apply the bandage. That’ll be it.

X.1 (Naomi)

Special Bonus

-No Healing Touch – 100
-Completed with 90 left – 600
-No mistakes – 900
-Max chain over 60 – 400

The operations with Naomi are pretty much identical to the ones with Derek. The only difference in this Kyriaki one is that the placement of the lacerations at the start is slightly altered. Doesn’t really matter though. I did them both because I felt like it. So there.

Kyriaki isn’t a very hard operation. The key thing to remember here is that you want to stall for as long as possible (i.e: until just before the clock goes below 1:30) while racking up as many points as you can.

Get inside the patient. You’ll be greeted by 3 normal lacerations and 4 huge ones. First suture the small ones as fast as you can. Then move on to the big ones. You know how to deal with them by now. Drain the blood, bring both ends together with the forceps, and suture. Remember to make many, many passes along the entire length of the laceration to get the COOLs. Look at the video to see what I’m talking about. You can get away with some GOODs throughout the operation but make sure you get as many COOLs as possible just to be on the safe side. In any case, you should be able to treat all of the wounds without having to raise vitals in between. When you’ve sutured the last laceration, quickly switch to your syringe and inject stabilizer while you wait for the Kyriaki to spawn. They won’t take long. Probably less than a second. But you can get one injection in if you’re fast enough.

3 Kyriaki will spawn, causing 3 lacerations. Suture them. Now, remember that we do not want to kill them too fast. We want to stall but at the same time be doing something. That something will be 1) injecting stabilizer and 2) suturing lacerations. After you’ve sutured those first 3 start by raising vitals a bit. If lacerations get formed as you’re doing this, go ahead and suture them as they come, then go back to the syringe. Once vitals are over 60, we’re going to bring out the Kyriaki to the surface. If you’d like to stay on the safe side, go ahead and raise vitals even higher than that.

Spam the ultrasound near the center of the organ. This should reveal all of them without much trouble. Cut them all out to the surface with the scalpel. This is probably the single most dangerous part of the operation if you decided to do it with 60 vitals. Once you’ve cut them all vitals will have probably gone down to 20, and you will have quite a few lacerations to worry about, plus the Kyriaki will continue to make more. Suture as fast as you can, and if vitals drop into the teens, ignore everything else and get them out of there with the stabilizer, then go back to suturing. After a little bit of this all of the wounds will be treated and you should be back in control.

Vitals are still probably very low at this point. We’re going to raise them all the way to 99 here while we let the Kyriaki run around. They will cause damage as you’re doing this but don’t worry. It’s actually to your benefit. Suture any lacerations that come up as they appear and then go back to the syringe. Eventually you should be up to max vitals. When that happens, switch to the laser and kill two of the Kyriaki. Only two though! Leave the third one alive. When the second one kicks the bucket another pair of Kyriaki will spawn. Suture the two lacerations they create and then bring ’em up to the surface with the scalpel like you did last time. Treat all of the wounds. Now you’re going to let these three guys run amok while you raise vitals to 99 just like you did with the last 3. This time vitals won’t have been as low, so you should get back up to 99 pretty fast.

Take a look at the clock. We’re going to stall until it goes below 2:45, then we’ll kill them all with the laser. Now the boss Kyriaki will make his appearance escorted by a single small one. He will create his trademark triple slash pattern and the little one will also make one. Suture all of these immediately. I recommend many passes to get COOLs on these. Around 10. I also recommend that you first suture the diagonal one that goes from left to right, then the diagonal one that goes from right to left, and finally the middle one. In that order. I find that this helps so that the game doesn’t think I’m suturing the wrong one when I meant to suture another.

Bring the boss and the small one up to the surface with the scalpel. Let them run around and raise vitals for a little bit. Keep your eye on the clock. When it gets close to 2:00, start killing the boss. Not the other one. Leave the little one alone. The clock should be around 1:50 once the boss is dead. Now vitals will probably be low. Start raising them to 99 while the little guy runs around. Once vitals are at 99 OR the clock goes below 1:40, kill him.

Now you have 10 seconds to finish up. You need to finish before 1:30, so quickly make the final suture, gell, and apply the bandage. That’ll be it.

X.2 (Derek)

Special Bonus

-No Healing Touch – 100
-Completed with 90 left – 500
-No mistakes – 900
-Max chain over 70 – 500

Interestingly enough, Deftera is one extreme operation in which stalling isn’t recommended. Because of this, XSing it isn’t very hard. All you have to do is kill it as fast as you can and you will most likely have the points needed for the rank. The points you need are close to 8000 though you can score a bit below that and still get the XS.

This operation will work in two parts. First the stomach with a single Deftera, and then in the lung with 2 Deftera.

When you get inside the patient’s stomach you’ll be greeted by 6 tumors. Laser them all quickly. If you do it fast enough they won’t have a chance to create little ones. Remember that we will never stall throughout this operation. The only possible exception is in the very unlikely scenario that you finish with less than a chain of 70. Don’t even worry about this though, since, like I said, it probably won’t happen.

Now the Deftera type A and type B are going to run around for a while and create tumors every now and then. Keep your laser on hand and burn them off immediately when they appear. Try not to give them a chance to create tiny ones or to stick around for too long since it hurts the patient’s vitals. After a little while (or a long while depending on your luck), the Deftera type A and type B will meet and begin eating each other. Now before you do anything, make sure that you’ve burned off any tumors that may have been created. Switch to your drain and keep it steady over the colliding Deftera. Keep the button pressed. You should do it fast enough that it takes a while for the drain to start working. Like I said, don’t drain the Deftera if there are still tumors around. This will cause the drainage to fail and it will just be wasted time. Pools of blood will form periodically so drain them when you get the chance. If you’re currently draining a Deftera or burning a tumor and a pool forms somewhere, just ignore it until you’re done. The only exception is if the pool is obstructing the tumor or the Deftera.

You’ll need to drain the Deftera 3 times, so repeat the same procedure twice again. When you drain for the third time, quickly change to your scalpel. Circular scalpel lines will appear that will allow you to excise the Deftera. It gives you a little bit of time to get ready before the lines appear, so what I’d recommend is to start moving the scalpel where you THINK the lines will appear before they do so that you waste no time, and also so you’re already comfortably making the right motion. Don’t cut too fast because you want to get every dot on the first pass. If you do this fast enough the Deftera will only get a chance to create a single tumor. Burn this tumor off before you grab the Deftera with the forceps and place it on the tray. Then simply apply the synthetic membrane and gel over it. If you’re fast you can inject a single round of stabilizer before the screen fades. It’s the same patient so vitals carry over. Make the suture and apply the bandage. Make sure you never break your chain even once.

Now we’ll move on to the lung. Be careful with the lobectomy here. It’s not a straight line. Once inside, you’ll have to deal with 2 Deftera.

The procedure is basically the same as the last one, except, obviously, there’s going to be double the amount of tumors that you have to laser off, and the vitals will drop much quicker because when two of the same type meet they cause a nice bit of damage. Basically what you want to do here is, while the Deftera are moving around, burn off any tumors that get created immediately, and in between this, when there are no tumors present, be draining off blood pools and injecting stabilizer. The window of opportunity when there are no tumors present is very small so you’ll have to be fast with that syringe. The main thing here is that you should ALWAYS be: either burning off tumors, or draining blood, or injecting stabilizer. Never catch yourself doing nothing unless vitals are at 99. Since there are two Deftera, there is a chance that while you’re draining one, the other creates tumors which can screw you up. But don’t despair. Simply continue taking care of the tumors and wait for your chance when both pairs of types are eating each other.

After a while, a type A and type B should meet. When this happens, the chances of the other pair meeting are very, very high. So what you want to do is drain both of them one right after the other. But first make absolutely sure that there are no tumors present, otherwise it won’t work. Do this two more times, but on the third drain, don’t drain the second pair. Instead switch to the scalpel and excise the first Deftera like you did back in the stomach. Remove it, apply the synthetic membrane, and gel. By this time the other pair has probably separated and started moving again. This is fine. Just keep working like you have up till now and when they meet, drain and excise them like normal. If all has gone well your chain should be above 70 and the clock should be around 3:00. This will net you the XS almost guaranteed.

X.2 (Naomi)

Special Bonus

-No Healing Touch – 100
-Completed with 90 left – 500
-No mistakes – 900
-Max chain over 70 – 500

The only difference between Naomi’s and Derek’s Deftera is that the number of tumors at the start and their locations are slightly altered. Doesn’t really matter though.

Interestingly enough, Deftera is one extreme operation in which stalling isn’t recommended. Because of this, XSing it isn’t very hard. All you have to do is kill it as fast as you can and you will most likely have the points needed for the rank. The points you need are close to 8000 though you can score a bit below that and still get the XS.

This operation will work in two parts. First the stomach with a single Deftera, and then in the lung with 2 Deftera.

When you get inside the patient’s stomach you’ll be greeted by 4 tumors. Laser them all quickly. If you do it fast enough they won’t have a chance to create little ones. Remember that we will never stall throughout this operation. The only possible exception is in the very unlikely scenario that you finish with less than a chain of 70. Don’t even worry about this though, since, like I said, it probably won’t happen.

Now the Deftera type A and type B are going to run around for a while and create tumors every now and then. Keep your laser on hand and burn them off immediately when they appear. Try not to give them a chance to create tiny ones or to stick around for too long since it hurts the patient’s vitals. After a little while (or a long while depending on your luck), the Deftera type A and type B will meet and begin eating each other. Now before you do anything, make sure that you’ve burned off any tumors that may have been created. Switch to your drain and keep it steady over the colliding Deftera. Keep the button pressed. You should do it fast enough that it takes a while for the drain to start working. Like I said, don’t drain the Deftera if there are still tumors around. This will cause the drainage to fail and it will just be wasted time. Pools of blood will form periodically so drain them when you get the chance. If you’re currently draining a Deftera or burning a tumor and a pool forms somewhere, just ignore it until you’re done. The only exception is if the pool is obstructing the tumor or the Deftera.

You’ll need to drain the Deftera 3 times, so repeat the same procedure twice again. When you drain for the third time, quickly change to your scalpel. Circular scalpel lines will appear that will allow you to excise the Deftera. It gives you a little bit of time to get ready before the lines appear, so what I’d recommend is to start moving the scalpel where you THINK the lines will appear before they do so that you waste no time, and also so you’re already comfortably making the right motion. Don’t cut too fast because you want to get every dot on the first pass. If you do this fast enough the Deftera will only get a chance to create a single tumor. Burn this tumor off before you grab the Deftera with the forceps and place it on the tray. Then simply apply the synthetic membrane and gel over it. If you’re fast you can inject a single round of stabilizer before the screen fades. It’s the same patient so vitals carry over. Make the suture and apply the bandage. Make sure you never break your chain even once.

Now we’ll move on to the lung. Be careful with the lobectomy here. It’s not a straight line. Once inside, you’ll have to deal with 2 Deftera.

The procedure is basically the same as the last one, except, obviously, there’s going to be double the amount of tumors that you have to laser off, and the vitals will drop much quicker because when two of the same type meet they cause a nice bit of damage. Basically what you want to do here is, while the Deftera are moving around, burn off any tumors that get created immediately, and in between this, when there are no tumors present, be draining off blood pools and injecting stabilizer. The window of opportunity when there are no tumors present is very small so you’ll have to be fast with that syringe. The main thing here is that you should ALWAYS be: either burning off tumors, or draining blood, or injecting stabilizer. Never catch yourself doing nothing unless vitals are at 99. Since there are two Deftera, there is a chance that while you’re draining one, the other creates tumors which can screw you up. But don’t despair. Simply continue taking care of the tumors and wait for your chance when both pairs of types are eating each other.

After a while, a type A and type B should meet. When this happens, the chances of the other pair meeting are very, very high. So what you want to do is drain both of them one right after the other. But first make absolutely sure that there are no tumors present, otherwise it won’t work. Do this two more times, but on the third drain, don’t drain the second pair. Instead switch to the scalpel and excise the first Deftera like you did back in the stomach. Remove it, apply the synthetic membrane, and gel. By this time the other pair has probably separated and started moving again. This is fine. Just keep working like you have up till now and when they meet, drain and excise them like normal. If all has gone well your chain should be above 70 and the clock should be around 3:00. This will net you the XS almost guaranteed.

X.3 (Derek)

Special Bonus

-No Healing Touch – 100
-Completed with 180 left – 700
-No mistakes – 900
-Less than 6 membranes multiplied – 300

This Triti can be a very hard operation because if you work too well and don’t let any membranes multiply, you will not get the points needed for the XS. The trick lies in looking at what exactly gives you points in this operation. There are two things that give you points. Removing membranes and draining gas. But draining gas gives many more. Therefore our strategy will consist in draining as much as possible. The score you need for XS is 6400 points. Read on to see how to do this.

In case you missed it the first 3 times, I’m going to paste the Triti explanation again:

Triti is made up of two parts: membranes and thorns. What you want to do is remove all of the membranes from the pancreas. However, each membrane is embedded into the organ by three thorns in each corner. To remove a membrane, first you must remove all of the thorns surrounding it. The thorns also regenerate after a few seconds.

The big problem, of course, is the way the membranes multiply. First of all, notice that membranes only multiply based on what you do. Notice that if you don’t do anything, they will never multiply. This means that, while speed is still important, it’s also important to know what you are doing.

Notice that membranes can only multiply when you remove one with the forceps. Simply removing thorns does not allow them to. Now, the trick to Triti’s nightmarish multiplication is simply this: if there are two thorns adjacent to each other, and there is a free space next to them, a new membrane will appear there when you remove a membrane on any part of the organ. Therefore, the trick lies in looking at the thorns. What you want to do is only remove membranes when there are no adjacent thorns currently present. The exception is when there is no free space where two adjacent thorns can create a new membrane. This is either because there is already a membrane there, or because it’s the edge of the organ and there is no actual room for a membrane to appear.

You’re going to be using your forceps almost exclusively here. I recommend that you grab the wiimote in a specific way here: place your thumb over the A button and grip the remote firmly with it. That’s right, you’re going to have the A button constantly pressed throughout this operation. Never let go of it until you’re done. If you have the A button pressed, then you can simply use the B button to grab and let go of things with the forceps. There is no need to press and let go of both buttons. Using a single button affords much greater control over the remote. When pulling thorns in general, remember that they are embedded in the organ. You want to pull UPWARDS when grabbing them before placing them on the tray. If you simply pull to the right, you will get a miss and forfeit the entire operation. This is important, so always remember to pull in an upward motion.

Now what follows is the way to XS this specific operation. Understanding Triti and the meaning behind what you’re going to do is good, but if you follow these directions you can XS the operation without having to understand it:

What we’re going to use as a point of reference here are the rows of thorns. If you look at them horizontally, there are 5 rows of them. From top to bottom, row 1 has four thorns, row 2 has three thorns, row 3 has two thorns, row 4 has three thorns, and row 5 has two thorns.

As soon as you can use your tools remove the two leftmost thorns of row 1, and the leftmost thorn of row 2. Then remove ALL of the thorns in row 4. Next, remove the two remaining thorns in row 2. It’s important that you remove them in that order. Now quickly remove the two membranes in the upper-left corner. No new membranes should have been created when you do. Now, don’t stop for a second and remove the two thorns at the very top. Then very quickly remove both of the membranes in the upper-right corner. Now you can drain any gas that may be floating around.

Now there should only be 5 membranes left and no new ones should have been created. Raise vitals for a bit and let the thorns regenerate. Now remove ALL of the thorns except for the two at the very bottom. Then pick up the two top membranes. Ignore the gas for a bit and quickly remove the thorn on the right, followed by the rightmost membrane. Drain the gas now.

Time should be around 4:30 and now there will only be a measly 2 membranes left. However, if you remove them both you will not get the XS. Therefore we’re going to use the following strategy: notice that draining gas gives you points! When you’ve gotten Triti down to 2 membranes, rather than letting it multiply, you can simply remove those 4 thorns over and over and over again, and there’s a very, very high chance that at least one of them will turn into gas every time. You can keep doing this as long as you want before going in for the kill. The longer you keep doing it, the higher your score will be. You don’t really need to do it that many times for the XS though. I’d say a bit less than 10. When your chain is at 60 you can probably go ahead and kill it.

Look at the video for the demonstration of the directions I gave you plus the draining strategy at the end.

X.3 (Naomi)

Special Bonus

-No Healing Touch – 100
-Completed with 180 left – 700
-No mistakes – 900
-Less than 6 membranes multiplied – 300

It would have been kind of cool if Naomi’s Triti was slightly different than Derek’s but alas, it’s identical.

This Triti can be a very hard operation because if you work too well and don’t let any membranes multiply, you will not get the points needed for the XS. The trick lies in looking at what exactly gives you points in this operation. There are two things that give you points. Removing membranes and draining gas. But draining gas gives many more. Therefore our strategy will consist in draining as much as possible. The score you need for XS is 6400 points. Read on to see how to do this.

In case you missed it the first 3 times, I’m going to paste the Triti explanation again:

Triti is made up of two parts: membranes and thorns. What you want to do is remove all of the membranes from the pancreas. However, each membrane is embedded into the organ by three thorns in each corner. To remove a membrane, first you must remove all of the thorns surrounding it. The thorns also regenerate after a few seconds.

The big problem, of course, is the way the membranes multiply. First of all, notice that membranes only multiply based on what you do. Notice that if you don’t do anything, they will never multiply. This means that, while speed is still important, it’s also important to know what you are doing.

Notice that membranes can only multiply when you remove one with the forceps. Simply removing thorns does not allow them to. Now, the trick to Triti’s nightmarish multiplication is simply this: if there are two thorns adjacent to each other, and there is a free space next to them, a new membrane will appear there when you remove a membrane on any part of the organ. Therefore, the trick lies in looking at the thorns. What you want to do is only remove membranes when there are no adjacent thorns currently present. The exception is when there is no free space where two adjacent thorns can create a new membrane. This is either because there is already a membrane there, or because it’s the edge of the organ and there is no actual room for a membrane to appear.

You’re going to be using your forceps almost exclusively here. I recommend that you grab the wiimote in a specific way here: place your thumb over the A button and grip the remote firmly with it. That’s right, you’re going to have the A button constantly pressed throughout this operation. Never let go of it until you’re done. If you have the A button pressed, then you can simply use the B button to grab and let go of things with the forceps. There is no need to press and let go of both buttons. Using a single button affords much greater control over the remote. When pulling thorns in general, remember that they are embedded in the organ. You want to pull UPWARDS when grabbing them before placing them on the tray. If you simply pull to the right, you will get a miss and forfeit the entire operation. This is important, so always remember to pull in an upward motion.

Now what follows is the way to XS this specific operation. Understanding Triti and the meaning behind what you’re going to do is good, but if you follow these directions you can XS the operation without having to understand it:

What we’re going to use as a point of reference here are the rows of thorns. If you look at them horizontally, there are 5 rows of them. From top to bottom, row 1 has four thorns, row 2 has three thorns, row 3 has two thorns, row 4 has three thorns, and row 5 has two thorns.

As soon as you can use your tools remove the two leftmost thorns of row 1, and the leftmost thorn of row 2. Then remove ALL of the thorns in row 4. Next, remove the two remaining thorns in row 2. It’s important that you remove them in that order. Now quickly remove the two membranes in the upper-left corner. No new membranes should have been created when you do. Now, don’t stop for a second and remove the two thorns at the very top. Then very quickly remove both of the membranes in the upper-right corner. Now you can drain any gas that may be floating around.

Now there should only be 5 membranes left and no new ones should have been created. Raise vitals for a bit and let the thorns regenerate. Now remove ALL of the thorns except for the two at the very bottom. Then pick up the two top membranes. Ignore the gas for a bit and quickly remove the thorn on the right, followed by the rightmost membrane. Drain the gas now.

Time should be around 4:30 and now there will only be a measly 2 membranes left. However, if you remove them both you will not get the XS. Therefore we’re going to use the following strategy: notice that draining gas gives you points! When you’ve gotten Triti down to 2 membranes, rather than letting it multiply, you can simply remove those 4 thorns over and over and over again, and there’s a very, very high chance that at least one of them will turn into gas every time. You can keep doing this as long as you want before going in for the kill. The longer you keep doing it, the higher your score will be. You don’t really need to do it that many times for the XS though. I’d say a bit less than 10. When your chain is at 60 you can probably go ahead and kill it.

Look at the video for the demonstration of the directions I gave you plus the draining strategy at the end.

X.4 (Derek)

Special Bonus

-No Healing Touch – 100
-Completed with 60 left – 900
-Max chain over 20 – 1000

This had the potential to be the hardest operation in the game, but they decided to pussify it and let you get misses and still get the XS. So as it is, it’s really easy and the only obstacle you have is reaching the max chain needed before you can start missing to your heart’s content.

When you get inside the patient, you’ll see three diverticula. Normally I’d tell you to inject them all one right after the other, but these ain’t yo momma’s diverticula. These are extreme diverticula. The effect of the serum wears off frighteningly fast. If you’re very fast you can inject and excise two of them at the same time like I did in the video, but if you want to be safe just take care of them one at a time. That is to say, inject the serum, cut it with the scalpel, move on to the second one, inject and cut, move to the third, inject and cut. Then remove all of them one right after the other like you’d normally do, apply the synthetic membranes and gel. Before the Tetarti appear you’ll get a chance to raise vitals to max, so do it.

By the time you’re done with all the tumors your chain should be at 17. That means that you only need to make sure you get past the first wave without missing, and then you can go crazy.

Most of the waves are the faster Tetarti that constantly spew gas. This means that you don’t need to worry about color, because it’s always there. All you need to worry about is hitting them with the injection. Since they’re much faster, their tendency for sharp turns becomes even more of a problem. The general rules from the normal Tetarti still pretty much apply to this one as well:

Generally speaking Tetarti will make sharp turns when it hits the edges of the organ or one of the other bodies. Usually when it makes a sharp turn it will not make another one immediately unless it hits something. Use this to your advantage. If you notice that it has just made a turn, you can be pretty confident that it will keep moving forward, which makes it easier to inject safely. If you see that it’s about to hit an edge or another one of the bodies, it’s probably a good idea to wait a little until after he’s made the turn just to be safe. The “trick” here is to only inject a body immediately after it has made a turn (and it’s not about to hit anything). These Tetarti will also not burrow after a while. They will only keep running around.

So if you don’t want to get misses here’s the deal: 1) keep a steady hand 2) don’t rush if you’re on a fast wave, because they never burrow and the effect of the serum lasts for much longer than you might realize 3)only inject immediately AFTER they have made a turn.

For the slow Tetarti, you have to watch for their color at the start. Injecting them is a bit easier since they’re slower, but you have to be quicker because they burrow after only a short while.

The longer Tetarti run around, the lower vitals go. But don’t worry too much. You get a chance to raise vitals a lot in between waves, and so you should. You can get as many as 3 full injections in between waves.

Alternatively, if you don’t want to avoid misses on even the first wave, you can get your chain all the way up to 20 on the diverticula alone. To do this, first inject all 3 of them with the right serum one right after the other. I recommend starting with the green one. Let the serum on each one wear off, then inject them a second time. This time cutting each one with the scalpel. Then proceed as normal. The thing is that by injecting them twice, instead of greeting the first wave with a chain of 17, you do it with a chain of 20. Thus you can start missing immediately without fear.

I’ve done the Derek video with no misses, and the Naomi video with many misses using the diverticula strategy in the above paragraph to show you how it can be done both ways.

The final suture in this operation is very weird. To get the COOL on it, you shouldn’t make the suture lines throughout the entire opening like you normally do, but instead, only make them in the very center. Check the video to see what I mean.

X.4 (Naomi)

Special Bonus

-No Healing Touch – 100
-Completed with 60 left – 900
-Max chain over 20 – 1000

This had the potential to be the hardest operation in the game, but they decided to pussify it and let you get misses and still get the XS. So as it is, it’s really easy and the only obstacle you have is reaching the max chain needed before you can start missing to your heart’s content.

When you get inside the patient, you’ll see three diverticula. Normally I’d tell you to inject them all one right after the other, but these ain’t yo momma’s diverticula. These are extreme diverticula. The effect of the serum wears off frighteningly fast. If you’re very fast you can inject and excise two of them at the same time like I did in the video, but if you want to be safe just take care of them one at a time. That is to say, inject the serum, cut it with the scalpel, move on to the second one, inject and cut, move to the third, inject and cut. Then remove all of them one right after the other like you’d normally do, apply the synthetic membranes and gel. Before the Tetarti appear you’ll get a chance to raise vitals to max, so do it.

By the time you’re done with all the tumors your chain should be at 17. That means that you only need to make sure you get past the first wave without missing, and then you can go crazy.

Most of the waves are the faster Tetarti that constantly spew gas. This means that you don’t need to worry about color, because it’s always there. All you need to worry about is hitting them with the injection. Since they’re much faster, their tendency for sharp turns becomes even more of a problem. The general rules from the normal Tetarti still pretty much apply to this one as well:

Generally speaking Tetarti will make sharp turns when it hits the edges of the organ or one of the other bodies. Usually when it makes a sharp turn it will not make another one immediately unless it hits something. Use this to your advantage. If you notice that it has just made a turn, you can be pretty confident that it will keep moving forward, which makes it easier to inject safely. If you see that it’s about to hit an edge or another one of the bodies, it’s probably a good idea to wait a little until after he’s made the turn just to be safe. The “trick” here is to only inject a body immediately after it has made a turn (and it’s not about to hit anything). These Tetarti will also not burrow after a while. They will only keep running around.

So if you don’t want to get misses here’s the deal: 1) keep a steady hand 2) don’t rush if you’re on a fast wave, because they never burrow and the effect of the serum lasts for much longer than you might realize 3)only inject immediately AFTER they have made a turn.

For the slow Tetarti, you have to watch for their color at the start. Injecting them is a bit easier since they’re slower, but you have to be quicker because they burrow after only a short while.

The longer Tetarti run around, the lower vitals go. But don’t worry too much. You get a chance to raise vitals a lot in between waves, and so you should. You can get as many as 3 full injections in between waves.

Alternatively, if you don’t want to avoid misses on even the first wave, you can get your chain all the way up to 20 on the diverticula alone. To do this, first inject all 3 of them with the right serum one right after the other. I recommend starting with the green one. Let the serum on each one wear off, then inject them a second time. This time cutting each one with the scalpel. Then proceed as normal. The thing is that by injecting them twice, instead of greeting the first wave with a chain of 17, you do it with a chain of 20. Thus you can start missing immediately without fear.

I’ve done the Derek video with no misses, and the Naomi video with many misses using the diverticula strategy in the above paragraph to show you how it can be done both ways.

The final suture in this operation is very weird. To get the COOL on it, you shouldn’t make the suture lines throughout the entire opening like you normally do, but instead, only make them in the very center. Check the video to see what I mean.

X.5 (Derek)

Special Bonus

-No Healing Touch – 100
-Completed with 120 left – 800
-No mistakes – 900
-Max chain over 100 – 200

You’d think extreme Pempti would be some kind of ruthless death-on-wheels speed demon. But turns out he’s actually very similar to the last one you fought. So we’re going to approach this operation the same way as the last Pempti:

Go inside. Don’t worry about raising vitals yet. When you’re in, immediately fill up your syringe with the serum and inject it into the circle of Pempti cells before it disappears. After injecting once, switch to the stabilizer and raise vitals to max with a single injection on the right. Then switch back to the serum and inject the circle a second time. This will cause the Pempti core to reveal itself. Switch to your new laser now and begin burning the core.

Once you get the first OK it’ll be time to fight Pempti mano a mano. To kill it, you have to keep burning the core with the laser. But Pempti defends itself by sending out its minions to wreak havoc on the patient’s lung. You can’t ignore the minions or they’ll kill the poor guy in mere seconds. You have to kill them with the laser as well.

As a general rule, always, always, ALWAYS have your laser activated and right on the core when you’re not dealing with minions. This is because this is where they come out from. you don’t really know what Pempti will send out next, so having the laser activated and pointing on the core puts you in the best possible position to fight whatever it’s going to send out on the shortest notice.

Now Pempti has 3 kinds of minions that it likes to send out. The first type are red mini-cores that cause lacerations. These are the ones that can cause the most damage if you don’t take care of them, but they’re also not too hard to deal with. Pempti will send 5 of these, one right after the other. They will move from the center (that is, where the core is located) to one of 5 spots around it, then shoot upwards after a second and create a laceration on the lung. You don’t want this to happen. Your goal is to kill every one of these 5 small cores BEFORE they get a chance to create their laceration. This isn’t hard to do if you’re on the ball, but the timeframe from their creation to the laceration is a little bit strict so your laser NEEDS to be active and pointing at the core BEFORE it sends the first one out. Otherwise there’s a good chance that you won’t have enough time to kill it before it does damage. You can probably suture one or two lacerations if you’re fast enough, but ideally you don’t want to give Pempti a chance to create even ONE. The problem is that if you try to suture after all 5 of them have gone out, it’s probable that you will not be pointing the laser at the core when it sends out the next wave, meaning you will NOT have time to deal with it, and you will be even closer to being overwhelmed. So it’s in your best interest to kill these little guys immediately. To do this, as I’ve said before, have your laser burning the core before they come out. This makes it so that you start burning and causing damage to it as it’s coming out, and you can follow its path with the laser up to one of the 5 points where it preps to make the laceration, burning it the entire time. If you do this, you will kill it before it does the laceration. But you can’t relax because there’s still 4 more to come after that one, so very quickly go back to the center and repeat the same thing for all of them. Remember, don’t let even ONE of them get past.

The next type of Pempti minions are blue ones that cause tiny tumors. Now if you’ll notice, the laser has an area of effect. This means that you can actually kill two of these little cores at the same time by pointing the laser BETWEEN them. If you’re good, you can consistently kill all of them every time by doing this. But this is not really what you want. You want extra points.

Believe it or not, extreme Pempti happens to be easier than the others in this regard. Since it has so much HP (thus the operation lasts longer), you actually only need to leave a single one of these blue mini cores alive each time and you will get the points you need. Therefore, the way you want to treat these little guys is as follows:

Your laser should always be pointing at the core. As soon as you see it send out these mini cores, bring your laser up a little bit and place it in between the two mini cores there. That should kill them both in one shot, then quickly move to the right and place the laser in between the two mini cores there. That should also kill them both in one shot. If you do this correctly, all the mini cores except for the single one on the far left should die before they can attack. Before the survivor attacks, switch to the gel and begin applying it over the part where you think it will create its tumors. Not only does this raise vitals slightly but it preps you up to treat them because if you laser them while the gel is still active the holes will be patched up instantly. Obviously if the gel hasn’t disappeared your view is blocked, so you kind of have to guess where the tumors are and do sweeping motions with the laser up and down that part. If you miss one or two, don’t worry, just treat them immediately before killing the survivor or quickly right afterwards. Since it’s only one guy, you shouldn’t have problems patching up the strangler tumors and killing it before it gets a chance to create a second set.

The third type of minion Pempti uses is the least dangerous one. They are 5 mini cores that slowly come out in a spiral and start spinning around and causing damage. The thing is, these pose absolutely NO problem if you’re pointing the laser at the core (which you should be). If you are, you don’t need to do anything. All 5 mini cores will die as they’re coming out before they have a chance to know what’s up. No sweat.

These guys are notable in that, right after killing all five, it’s a pretty good opportunity to raise vitals back up to max. I’d recommend doing only a quick half-injection before going back to lasering the core though. Vitals shouldn’t be dropping too much in this operation, so a half injection should be pretty much all you need to get them back up to 99. You can do a full injection if you want, though that might be pushing it a tiny bit.

In any case, that’s how you fight Pempti. If you keep the laser at the core you should finish before the time limit. You shouldn’t even have to raise vitals much or at all at the end.

X.5 (Naomi)

Special Bonus

-No Healing Touch – 100
-Completed with 120 left – 800
-No mistakes – 900
-Max chain over 100 – 200

There seems to be zero difference between Derek’s and Naomi’s Pempti. Oh well. I still made videos for both of them, so what are you gonna do about it.

You’d think extreme Pempti would be some kind of ruthless death-on-wheels speed demon. But turns out he’s actually very similar to the last one you fought. So we’re going to approach this operation the same way as the last Pempti:

Go inside. Don’t worry about raising vitals yet. When you’re in, immediately fill up your syringe with the serum and inject it into the circle of Pempti cells before it disappears. After injecting once, switch to the stabilizer and raise vitals to max with a single injection on the right. Then switch back to the serum and inject the circle a second time. This will cause the Pempti core to reveal itself. Switch to your new laser now and begin burning the core.

Once you get the first OK it’ll be time to fight Pempti mano a mano. To kill it, you have to keep burning the core with the laser. But Pempti defends itself by sending out its minions to wreak havoc on the patient’s lung. You can’t ignore the minions or they’ll kill the poor guy in mere seconds. You have to kill them with the laser as well.

As a general rule, always, always, ALWAYS have your laser activated and right on the core when you’re not dealing with minions. This is because this is where they come out from. you don’t really know what Pempti will send out next, so having the laser activated and pointing on the core puts you in the best possible position to fight whatever it’s going to send out on the shortest notice.

Now Pempti has 3 kinds of minions that it likes to send out. The first type are red mini-cores that cause lacerations. These are the ones that can cause the most damage if you don’t take care of them, but they’re also not too hard to deal with. Pempti will send 5 of these, one right after the other. They will move from the center (that is, where the core is located) to one of 5 spots around it, then shoot upwards after a second and create a laceration on the lung. You don’t want this to happen. Your goal is to kill every one of these 5 small cores BEFORE they get a chance to create their laceration. This isn’t hard to do if you’re on the ball, but the timeframe from their creation to the laceration is a little bit strict so your laser NEEDS to be active and pointing at the core BEFORE it sends the first one out. Otherwise there’s a good chance that you won’t have enough time to kill it before it does damage. You can probably suture one or two lacerations if you’re fast enough, but ideally you don’t want to give Pempti a chance to create even ONE. The problem is that if you try to suture after all 5 of them have gone out, it’s probable that you will not be pointing the laser at the core when it sends out the next wave, meaning you will NOT have time to deal with it, and you will be even closer to being overwhelmed. So it’s in your best interest to kill these little guys immediately. To do this, as I’ve said before, have your laser burning the core before they come out. This makes it so that you start burning and causing damage to it as it’s coming out, and you can follow its path with the laser up to one of the 5 points where it preps to make the laceration, burning it the entire time. If you do this, you will kill it before it does the laceration. But you can’t relax because there’s still 4 more to come after that one, so very quickly go back to the center and repeat the same thing for all of them. Remember, don’t let even ONE of them get past.

The next type of Pempti minions are blue ones that cause tiny tumors. Now if you’ll notice, the laser has an area of effect. This means that you can actually kill two of these little cores at the same time by pointing the laser BETWEEN them. If you’re good, you can consistently kill all of them every time by doing this. But this is not really what you want. You want extra points.

Believe it or not, extreme Pempti happens to be easier than the others in this regard. Since it has so much HP (thus the operation lasts longer), you actually only need to leave a single one of these blue mini cores alive each time and you will get the points you need. Therefore, the way you want to treat these little guys is as follows:

Your laser should always be pointing at the core. As soon as you see it send out these mini cores, bring your laser up a little bit and place it in between the two mini cores there. That should kill them both in one shot, then quickly move to the right and place the laser in between the two mini cores there. That should also kill them both in one shot. If you do this correctly, all the mini cores except for the single one on the far left should die before they can attack. Before the survivor attacks, switch to the gel and begin applying it over the part where you think it will create its tumors. Not only does this raise vitals slightly but it preps you up to treat them because if you laser them while the gel is still active the holes will be patched up instantly. Obviously if the gel hasn’t disappeared your view is blocked, so you kind of have to guess where the tumors are and do sweeping motions with the laser up and down that part. If you miss one or two, don’t worry, just treat them immediately before killing the survivor or quickly right afterwards. Since it’s only one guy, you shouldn’t have problems patching up the strangler tumors and killing it before it gets a chance to create a second set.

The third type of minion Pempti uses is the least dangerous one. They are 5 mini cores that slowly come out in a spiral and start spinning around and causing damage. The thing is, these pose absolutely NO problem if you’re pointing the laser at the core (which you should be). If you are, you don’t need to do anything. All 5 mini cores will die as they’re coming out before they have a chance to know what’s up. No sweat.

These guys are notable in that, right after killing all five, it’s a pretty good opportunity to raise vitals back up to max. I’d recommend doing only a quick half-injection before going back to lasering the core though. Vitals shouldn’t be dropping too much in this operation, so a half injection should be pretty much all you need to get them back up to 99. You can do a full injection if you want, though that might be pushing it a tiny bit.

In any case, that’s how you fight Pempti. If you keep the laser at the core you should finish before the time limit. You shouldn’t even have to raise vitals much or at all at the end.

X.6 (Derek)

Special Bonus

-No Healing Touch – 100
-Completed with 90 left – 800
-No mistakes – 900
-Max chain over 50 – 200

Now this is more like it! Paraskevi is actually mildly hard. The tricky part about this operation is that the patient’s vitals cap at 50, and cutting Paraskevi depletes almost all of it. Therefore you have to raise vitals back up to max after cut. Not only that, but extreme Paraskevi is actually bigger than normal so it’s gonna take longer to kill it. Plus, it happens to be much more burrow-happy so you have to laser it constantly. These three things make it so that finishing before the time limit is up can be challenging.

The key to finishing this operation quickly is to realize that there is no penalty for letting Paraskevi burrow and move on to another organ (as long as it doesn’t burrow into the heart). You don’t have to laser all of the bodies you see. You CAN kill them all in the first organ and still get the XS if you’re good, but it tends to be easier to let some of the bodies run away so that you lose less time lasering constantly. Generally speaking the ones you should let run away are the bigger ones.

When you get inside the patient you’ll find 3 small lacerations. Suture them before doing anything else, then raise vitals up to 50 before Paraskevi appears.

You’ll be treating it more or less as you always have:

Laser the tail to paralyze the Paraskevi. Once it’s paralyzed, you’ll have to switch to the scalpel and slash its midsection to start killing it. Remember to slash along the MIDDLE. Any other part won’t work. Once you do, it will turn into two bodies and create two lacerations. Suture these quickly. Vitals will now be critical, so you’ll have to raise them back up to 50. You will have to do this each and every single time you slash a body. Now here, it’s probably a good idea to let one of those two bodies burrow so that you have one less thing to worry about and can do everything faster. The time limit of 1:30 is a bit strict.

In any case, scalpel one of the 2 bodies now moving around. What you’re going to do from here on out is concentrate on slashing ONLY the smallest body currently present. You will do this so you can reduce the number of Paraskevi while keeping the number you have to worry about at one time down to the most manageable level. Therefore, other than periodically paralyzing them with the laser, you will ignore the larger bodies and only slash the smallest ones. You should keep working the same way as you go on, paralyze, slash, paralyze all, suture, paralyze again, slash etc. However, once you slash a body down to the smallest size, that is, to only a tail and head, what you’ll want to do is, instead of suturing the lacerations after paralzing everything, ignore them for a bit, and instead, pick up the two smallest bodies comprised of only the head and tail as soon as you paralyze them.

Well. That’s not really a hard and fast rule here. Truth is the vitals are dangerously low right after slashing a body, and the lacerations have the potential to bring it down to 0. Use your judgement. For example, if you can’t pick up the 2 tiny bodies quickly and see vitals in the single digits, it’s probably a better idea to suture them/inject stabilizer before picking them up rather than risk dying.

Always slash a single Paraskevi body. If you paralyze two near each other, it’s probably better to let them get some distance from each other. If you accidentally get two at the same time, it will definitely kill the patient. So take it easy and just deal with them one at a time, raising vitals to max before every slash.

Sometimes there may be too many Paraskevis moving around to paralyze all of them. This is when their signals come in handy. You can actually choose to let a body roam around as long as its tail isn’t vibrating. However, the ones whose tails ARE vibrating should be lasered as soon as possible. As a matter of fact, if you’re good at watching for those signals, it could be in your best interest to only paralyze bodies when absolutely necessary. This can certainly help to make things go faster for you.Finally, be careful when picking up the smallest bodies. Firstly, make sure they’re paralyzed, and secondly, make sure that they aren’t near another body, because then you could accidentally pick up the wrong one and get a miss. If you paralyze a tiny Paraskevi and a larger one near each other, it might be best to let the paralysis wear off so they can get some distance from each other.

When you’re done with an organ, remember to suture everything quickly and wait until you’re at the next organ before raising vitals. Paraskevi take a while to appear after the transition from one organ to the next and if you already maxed out vitals you’d be stuck doing nothing but waiting, which isn’t good considering how strict the time limit is. I recommend only letting it move one organ.

When you’re done there’s a chance that you might be cutting it really close on the clock. Ideally you should be finished with over 1:40 so that you can raise vitals to max before finishing up, but if you have less than that, just make sure you finish before it’s below 1:30. You MIGHT not get the XS because those few points do make a difference, but at least there’s a chance. Whereas if you miss the time special bonus there is no chance of getting the XS. If something like the patient’s vitals makes such a difference then it follows that getting COOLs also makes quite a difference. At this stage you should be pretty good at suturing, so it’s not much of a problem.

X.6 (Naomi)

Special Bonus

-No Healing Touch – 100
-Completed with 90 left – 800
-No mistakes – 900
-Max chain over 50 – 200

The only difference between Derek’s and Naomi’s Paraskevi is that the positions of the lacerations at the start are slightly altered. Doesn’t really matter. Other than that it’s the same.

Now this is more like it! Paraskevi is actually mildly hard. The tricky part about this operation is that the patient’s vitals cap at 50, and cutting Paraskevi depletes almost all of it. Therefore you have to raise vitals back up to max after cut. Not only that, but extreme Paraskevi is actually bigger than normal so it’s gonna take longer to kill it. Plus, it happens to be much more burrow-happy so you have to laser it constantly. These three things make it so that finishing before the time limit is up can be challenging.

The key to finishing this operation quickly is to realize that there is no penalty for letting Paraskevi burrow and move on to another organ (as long as it doesn’t burrow into the heart). You don’t have to laser all of the bodies you see. You CAN kill them all in the first organ and still get the XS if you’re good, but it tends to be easier to let some of the bodies run away so that you lose less time lasering constantly. Generally speaking the ones you should let run away are the bigger ones.

When you get inside the patient you’ll find 3 small lacerations. Suture them before doing anything else, then raise vitals up to 50 before Paraskevi appears.

You’ll be treating it more or less as you always have:

Laser the tail to paralyze the Paraskevi. Once it’s paralyzed, you’ll have to switch to the scalpel and slash its midsection to start killing it. Remember to slash along the MIDDLE. Any other part won’t work. Once you do, it will turn into two bodies and create two lacerations. Suture these quickly. Vitals will now be critical, so you’ll have to raise them back up to 50. You will have to do this each and every single time you slash a body. Now here, it’s probably a good idea to let one of those two bodies burrow so that you have one less thing to worry about and can do everything faster. The time limit of 1:30 is a bit strict.

In any case, scalpel one of the 2 bodies now moving around. What you’re going to do from here on out is concentrate on slashing ONLY the smallest body currently present. You will do this so you can reduce the number of Paraskevi while keeping the number you have to worry about at one time down to the most manageable level. Therefore, other than periodically paralyzing them with the laser, you will ignore the larger bodies and only slash the smallest ones. You should keep working the same way as you go on, paralyze, slash, paralyze all, suture, paralyze again, slash etc. However, once you slash a body down to the smallest size, that is, to only a tail and head, what you’ll want to do is, instead of suturing the lacerations after paralzing everything, ignore them for a bit, and instead, pick up the two smallest bodies comprised of only the head and tail as soon as you paralyze them.

Well. That’s not really a hard and fast rule here. Truth is the vitals are dangerously low right after slashing a body, and the lacerations have the potential to bring it down to 0. Use your judgement. For example, if you can’t pick up the 2 tiny bodies quickly and see vitals in the single digits, it’s probably a better idea to suture them/inject stabilizer before picking them up rather than risk dying.

Always slash a single Paraskevi body. If you paralyze two near each other, it’s probably better to let them get some distance from each other. If you accidentally get two at the same time, it will definitely kill the patient. So take it easy and just deal with them one at a time, raising vitals to max before every slash.

Sometimes there may be too many Paraskevis moving around to paralyze all of them. This is when their signals come in handy. You can actually choose to let a body roam around as long as its tail isn’t vibrating. However, the ones whose tails ARE vibrating should be lasered as soon as possible. As a matter of fact, if you’re good at watching for those signals, it could be in your best interest to only paralyze bodies when absolutely necessary. This can certainly help to make things go faster for you.Finally, be careful when picking up the smallest bodies. Firstly, make sure they’re paralyzed, and secondly, make sure that they aren’t near another body, because then you could accidentally pick up the wrong one and get a miss. If you paralyze a tiny Paraskevi and a larger one near each other, it might be best to let the paralysis wear off so they can get some distance from each other.

When you’re done with an organ, remember to suture everything quickly and wait until you’re at the next organ before raising vitals. Paraskevi take a while to appear after the transition from one organ to the next and if you already maxed out vitals you’d be stuck doing nothing but waiting, which isn’t good considering how strict the time limit is. I recommend only letting it move one organ.

When you’re done there’s a chance that you might be cutting it really close on the clock. Ideally you should be finished with over 1:40 so that you can raise vitals to max before finishing up, but if you have less than that, just make sure you finish before it’s below 1:30. You MIGHT not get the XS because those few points do make a difference, but at least there’s a chance. Whereas if you miss the time special bonus there is no chance of getting the XS. If something like the patient’s vitals makes such a difference then it follows that getting COOLs also makes quite a difference. At this stage you should be pretty good at suturing, so it’s not much of a problem.

X.7 (Derek)

Special Bonus

-Completed with 90 left – 500
-No mistakes – 1000
-Max chain over 200 – 500

This is the last operation in the game. They’ve even given you the awesome final boss music so enjoy it!

The difference between Derek and Naomi here is substantial compared to the other operations, but we’ll get to that later. For both of them, your objective will be to get Savato down to its knees as fast as you can.

A problem with this operation is that it’s so long that after a while you’ll likely have some trademark Trauma Center jitters and wrist pain. It’s important to get a few minutes of rest in between retries. It’s also a good idea to pace yourself throughout the operation because as your wrist stamina gives out you’ll get worse and worse. Try to relax your grip a little when there’s a slight lull in the action. Be careful though, because if you’ve been gripping the wiimote for a long time and suddenly relax and then tense up again, there’s a chance you can get mild tendon spasms which can be a little offputting. You can also pause the game in the middle of the operation and rest for a few minutes. This is pretty effective in getting your wrist back in the game. Obviously I can’t do that in the video, which sucks and it really shows at the end. Hell, I even botched the final suture on Derek and got a GOOD. But oh well what can ya do. Not all of us can be legendary surgeons with wrists of steel.

Get inside. You’ll be at the heart and spot the Savato plus a bunch of its webs. You’ll want to immediately switch to the scalpel and start severing those. Just put your cursor over a web and keep the button held down on it for a few seconds. However, your scalpel will melt each time you break one. A nice thing to do here to get through these webs fast is this: use your scalpel on the places where two strands intersect. This will make it so that you cut one, and severely weaken the other. Then, while the scalpel is recovering, put the cursor over the strand you weakened and alternate between pressing the Z button and the B button quickly. This will activate the scalpel in very, very short bursts even though it’s unusable. However, since the strand has already been weakened so much, this short burst is all you need to cut it. With this tactic you can cut two webs per scalpel. In fact, since the first web only has 4 strands, you can sever them all before Savato has a chance to create new ones or bring out minions.

Once they’re all severed Savato will move on to the bottom of the heart and create more webs. You’ll have to keep severing them in the same way. Now here, he may create either 5 webs, or 4. I’m not really sure what the deciding factor on how many he makes here is. It seems to be random. However, if he only makes 4 you luck out because you can sever them all before he gets a chance to create a new one just like in the first web. If he makes 5 you’ll have to deal with one new strand and some minions before you can scalpel the last one.

Obviously you want to burn these little guys with the laser but you should do that ONLY if your scalpel is currently unusable. As SOON as you can use your scalpel, ignore the mini-savatos and sever a web. Then go back to burning them with the laser as the scalpel is recovering. As soon as it is, cut off the last one. Savato will escape again to the top of the heart and create a bunch of new webs. You’ll have to repeat the same procedure to get rid of these, except this time there’ll be more so he’ll get a chance to make new ones and minions. Just remember the rule: only laser the minions if your scalpel is currently unusable.

The transition from top to bottom and then to top again here is a great place to rest for a few seconds. It’s not much, I know, but every little bit helps. Relax and place your hand on your lap or wherever you feel comfortable until you can use your tools again.

Make sure all the mini-savatos are dead before you cut off the last strand. When that’s done you’ll move on to the next phase. Here you will have to keep using the laser to burn the Savato’s outer layer. Since he likes to dodge a lot, what I recommend here is that, instead of holding the button down, you try to prick him for a second with it, and when he dodges, follow him but WITHOUT holding the button down, and only use the laser when he’s reasonably immobile. Basically, you want to avoid wearing out the laser. One, because it’s actually less effective than using it moderately, and two because you want to keep it on hand in case he decides to send out minions. Still, there are a few times where wearing out the laser completely could be good. For example, if it’s already in the red, and Savato has just sent out his minions and you’ve burned them all off. Wearing it off completely before suturing the laceration and then injecting stabilizer once could very well work in your favor.

Right, minions. That’s one of his two modes of attack. He’ll periodically create a long laceration from which little guys will pour out of. You’ll want to get them with laser immediately before they get a chance to disperse. Then suture the laceration before going back to the offensive.

The other mode of attack is simply to cause 3 normal lacerations. Just suture them as fast as you can before going back to the laser.

The strategy I recommend here is to be very aggressive. If the laser is white, you should be burning Savato. ONLY give the laser a break when it’s yellow-red. Don’t let it sit there unused if it’s completely recovered. When it IS recovering you should be pumping stabilizer. That’s the strategy. Never let up. Even if vitals aren’t at max, if the laser is white forget about the syringe until it’s yellow. In fact, sometimes it can even be better to completely ignore vitals unless they’re really low and just try to get that shell off as soon as possible.

The exception to this, of course, is his attacks. Killing his minions and suturing lacerations always takes priority over everything else, in that order. And the exception to THIS is, of course, if the patient is about to die, ignore everything and concentrate on getting vitals out of the teens.

Be mildly careful when suturing lacerations in this phase. Remember that you need a chain of 200 for the XS, so try not to get a BAD before that.

When you’ve laser’d off the outer layer, which you will know because Savato will start doing some crazy ninja dodging when you try to laser him some more, it’ll be time to switch to the scalpel and slash him once. He moves around a lot so be careful. When you do that, he’ll escape down to the bottom of the heart, and you’ll have to repeat the procedure again. If you’ve been very aggressive you can get him to move out to the bottom before the clock goes below 8. Of course this also depends a little on how aggressive HE is acting. Sometimes he attacks so much that you can’t help but take longer. Don’t worry about it. Repeat the procedure in the exact same way and make him move to the top again. Now this will be the final round. Here I’d recommend to be as aggressive as you’ve been up till now and get his outer layer off as soon as possible, then cut him up. Now he’ll be vulnerable. In a best case scenario the clock should be over 6:30. But the actual time limit is 1:30, so if you took a couple minutes longer, don’t sweat it. Raise vitals to higher than 30 if necessary, then inject the black serum into him. You may be tired by now. Be careful and make sure you don’t get a miss.

Now Savato will go balls out. This is the phase in which you’re going to stall to rack up points for the XS. Right after you inject the serum, he’ll create 8 lacerations and automatically bring down vitals to 30. Here Derek will automatically activate his Healing Touch. If you’re fast, though, you can inject almost a full syringe of stabilizer before it gets activated.

Now Derek’s Healing Touch might not be as broken as Naomi’s since it doesn’t heal automatically. However, it slows down time more so he can definitely hold his own. What this means is that Savato will create lacerations at a much slower pace than if he were under the influence of Naomi’s Healing Touch. What you’re going to do is start suturing lacerations as fast as you can. You should already be over chain 200 so don’t worry too much if you get a couple BADs here and there. Since Derek’s Healing Touch doesn’t heal, the only way to raise vitals is by injecting stabilizer. Therefore, you’ll want to inject a round or two in between Savato’s attacks. I recommend suturing lacerations while he’s in the middle of his attack, and only inject stabilizer after his attack animation has ended. The reason is because it seems the syringe gets slowed down if you use it during the animation, but the sutures do not.

If you suture reasonably fast, then you should be treating the lacerations faster than Savato can create them. Therefore, after a little while, you will have more time to inject stabilizer. This means that you can slowly raise vitals all the way up to 99 during this part. How long should you keep stalling in this phase? It’s up to you. The longer you keep doing this, the higher your score will be. The time limit is 1:30, so if you wanted to get the highest score possible you’d stall until around 1:45 or so. Of course, this is far from necessary. If you want to end a little sooner feel free to do so. I had no choice but to end sooner myself, since youtube has a video limit of 10 minutes. In any case, once you’re satisfied, simply activate the ultimate Healing Touch. Now time will stop completely. Suture ALL of the remaining lacerations. When that’s done, inject a FULL syringe of serum into the Savato. Make sure it’s full. Otherwise it won’t work. That’ll be it. Vitals should already be at 99.

All that’ll be left is the final suture and bandage. Chances are your wrist is very tired by now. I know mine was. Just look at that sorry excuse for a final suture. It might be a good idea to pause the game for a second here to get your bearings back, not to mention get the feeling back in your wrist. The final suture here is actually a little weird. Normally you’d make the lines wider than the opening, but that seems to only net you a GOOD here. To get the cool you actually have to make very narrow lines. Narrower than the opening. Check my Naomi vid to see what I mean. Not the Derek one though because I suck and got a GOOD there. Still, it doesn’t actually matter if you get GOODs or BADs here, as you should have way more points than you need. However, if you get a miss you can forget about getting the XS.

X.7 (Naomi)

Special Bonus

-Completed with 90 left – 500
-No mistakes – 1000
-Max chain over 200 – 500

This is the last operation in the game. They’ve even given you the awesome final boss music so enjoy it!

The difference between Derek and Naomi here is substantial compared to the other operations, but we’ll get to that later. For both of them, your objective will be to get Savato down to its knees as fast as you can.

A problem with this operation is that it’s so long that after a while you’ll likely have some trademark Trauma Center jitters and wrist pain. It’s important to get a few minutes of rest in between retries. It’s also a good idea to pace yourself throughout the operation because as your wrist stamina gives out you’ll get worse and worse. Try to relax your grip a little when there’s a slight lull in the action. Be careful though, because if you’ve been gripping the wiimote for a long time and suddenly relax and then tense up again, there’s a chance you can get mild tendon spasms which can be a little offputting. You can also pause the game in the middle of the operation and rest for a few minutes. This is pretty effective in getting your wrist back in the game. Obviously I can’t do that in the video, which sucks and it really shows at the end. Hell, I even botched the final suture on Derek and got a GOOD. But oh well what can ya do. Not all of us can be legendary surgeons with wrists of steel.

Get inside. You’ll be at the heart and spot the Savato plus a bunch of its webs. You’ll want to immediately switch to the scalpel and start severing those. Just put your cursor over a web and keep the button held down on it for a few seconds. However, your scalpel will melt each time you break one. A nice thing to do here to get through these webs fast is this: use your scalpel on the places where two strands intersect. This will make it so that you cut one, and severely weaken the other. Then, while the scalpel is recovering, put the cursor over the strand you weakened and alternate between pressing the Z button and the B button quickly. This will activate the scalpel in very, very short bursts even though it’s unusable. However, since the strand has already been weakened so much, this short burst is all you need to cut it. With this tactic you can cut two webs per scalpel. In fact, since the first web only has 4 strands, you can sever them all before Savato has a chance to create new ones or bring out minions.

Once they’re all severed Savato will move on to the bottom of the heart and create more webs. You’ll have to keep severing them in the same way. Now here, he may create either 5 webs, or 4. I’m not really sure what the deciding factor on how many he makes here is. It seems to be random. However, if he only makes 4 you luck out because you can sever them all before he gets a chance to create a new one just like in the first web. If he makes 5 you’ll have to deal with one new strand and some minions before you can scalpel the last one.

Obviously you want to burn these little guys with the laser but you should do that ONLY if your scalpel is currently unusable. As SOON as you can use your scalpel, ignore the mini-savatos and sever a web. Then go back to burning them with the laser as the scalpel is recovering. As soon as it is, cut off the last one. Savato will escape again to the top of the heart and create a bunch of new webs. You’ll have to repeat the same procedure to get rid of these, except this time there’ll be more so he’ll get a chance to make new ones and minions. Just remember the rule: only laser the minions if your scalpel is currently unusable.

The transition from top to bottom and then to top again here is a great place to rest for a few seconds. It’s not much, I know, but every little bit helps. Relax and place your hand on your lap or wherever you feel comfortable until you can use your tools again.

Make sure all the mini-savatos are dead before you cut off the last strand. When that’s done you’ll move on to the next phase. Here you will have to keep using the laser to burn the Savato’s outer layer. Since he likes to dodge a lot, what I recommend here is that, instead of holding the button down, you try to prick him for a second with it, and when he dodges, follow him but WITHOUT holding the button down, and only use the laser when he’s reasonably immobile. Basically, you want to avoid wearing out the laser. One, because it’s actually less effective than using it moderately, and two because you want to keep it on hand in case he decides to send out minions. Still, there are a few times where wearing out the laser completely could be good. For example, if it’s already in the red, and Savato has just sent out his minions and you’ve burned them all off. Wearing it off completely before suturing the laceration and then injecting stabilizer once could very well work in your favor.

Right, minions. That’s one of his two modes of attack. He’ll periodically create a long laceration from which little guys will pour out of. You’ll want to get them with laser immediately before they get a chance to disperse. Then suture the laceration before going back to the offensive.

The other mode of attack is simply to cause 3 normal lacerations. Just suture them as fast as you can before going back to the laser.

The strategy I recommend here is to be very aggressive. If the laser is white, you should be burning Savato. ONLY give the laser a break when it’s yellow-red. Don’t let it sit there unused if it’s completely recovered. When it IS recovering you should be pumping stabilizer. That’s the strategy. Never let up. Even if vitals aren’t at max, if the laser is white forget about the syringe until it’s yellow. In fact, sometimes it can even be better to completely ignore vitals unless they’re really low and just try to get that shell off as soon as possible.

The exception to this, of course, is his attacks. Killing his minions and suturing lacerations always takes priority over everything else, in that order. And the exception to THIS is, of course, if the patient is about to die, ignore everything and concentrate on getting vitals out of the teens.

Be mildly careful when suturing lacerations in this phase. Remember that you need a chain of 200 for the XS, so try not to get a BAD before that.

When you’ve laser’d off the outer layer, which you will know because Savato will start doing some crazy ninja dodging when you try to laser him some more, it’ll be time to switch to the scalpel and slash him once. He moves around a lot so be careful. When you do that, he’ll escape down to the bottom of the heart, and you’ll have to repeat the procedure again. If you’ve been very aggressive you can get him to move out to the bottom before the clock goes below 8. Of course this also depends a little on how aggressive HE is acting. Sometimes he attacks so much that you can’t help but take longer. Don’t worry about it. Repeat the procedure in the exact same way and make him move to the top again. Now this will be the final round. Here I’d recommend to be as aggressive as you’ve been up till now and get his outer layer off as soon as possible, then cut him up. Now he’ll be vulnerable. In a best case scenario the clock should be over 6:30. But the actual time limit is 1:30, so if you took a couple minutes longer, don’t sweat it. Raise vitals to higher than 30 if necessary, then inject the black serum into him. You may be tired by now. Be careful and make sure you don’t get a miss.

Now Savato will go balls out. This is the phase in which you’re going to stall to rack up points for the XS. Right after you inject the serum, he’ll create 8 lacerations and automatically bring down vitals to 30. Here Naomi will automatically activate her Healing Touch. If you’re fast, though, you can inject almost a full syringe of stabilizer before it gets activated.

Since Naomi’s Healing Touch is so god-mode, all you have to do is keep suturing and that will keep the patient alive while you rack up points. However, it doesn’t slow down time as much as Derek’s, so it’s very difficult, maybe even impossible, to keep up with how fast Savato will create lacerations. This means that there will be a huge number of them everywhere. This, coupled with how tired your wrist is likely to be, makes it very difficult to avoid getting BADs in at least some sutures. But don’t sweat it, because at this point you should already be over the 200 chain that you need for the XS.

Another thing is that you’ll be suturing so fast here that the tool will actually start to wear down. Once you see it become red, it’s best to switch to the syringe for a second and raise vitals that way while the sutures recover. Don’t do it for too long though. Just one or two injections. Because the stabilizer just can’t keep up with how fast extreme Savato drains vitals.

In any case, just keep suturing. How long should you stall in this phase? It’s up to you. The longer you keep doing this, the higher your score will be. The time limit is 1:30, so if you wanted to get the highest score possible you’d stall until around 1:45 or so. Of course, this is far from necessary. If you want to end a little sooner feel free to do so. I had no choice but to end sooner myself, since youtube has a video limit of 10 minutes. In any case, once you’re satisfied, simply activate the ultimate Healing Touch. Now time will stop completely. Suture ALL of the remaining lacerations. When that’s done, inject a FULL syringe of serum into the Savato. Make sure it’s full. Otherwise it won’t work. That’ll be it. Vitals should already be at 99.

All that’ll be left is the final suture and bandage. Chances are your wrist is very tired by now. I know mine was. Just look at that sorry excuse for a final suture in the Derek video. It might be a good idea to pause the game for a second here to get your bearings back, not to mention get the feeling back in your wrist. The final suture here is actually a little weird. Normally you’d make the lines wider than the opening, but that seems to only net you a GOOD here. To get the COOL you actually have to make very narrow lines. Narrower than the opening. Check my Naomi vid to see what I mean. Not the Derek one though because I suck and got a GOOD there. Still, it doesn’t actually matter if you get GOODs or BADs here, as you should have way more points than you need. However, if you get a miss you can forget about getting the XS.

Conclusion

Well now, the game is over and all the operations XS’d. I have to say that I was surprised at how easy it all was in this playthrough. Whereas on my first playthrough operations like Triti or extreme Paraskevi took me like 50 retries and many shot nerves to XS, I consistently managed it on my first or second try this time. Guess that’s a testament to how well designed it is. It certainly seems more lenient than New Blood or Under the Knife 2, but it’s also better. Though who knows. UTK2 was great. I just don’t like the DS controls as much as the Wii.

Either way let me once again praise Second Opinion for being the best game the Wii might ever know. This game is the ONLY thing that keeps the wiimote from being the biggest waste of space ever created. And judging by how much Nintendo is sucking recently, it doesn’t seem like this will change any time soon. But oh well. What can ya do. The console was worth getting for this game. I hope Atlus continues milking this franchise forever. They might not get it right every time, but I still have faith.

It seems there are low chances of Atlus porting UTK2 to the Wii though, which makes me sad. I mean sure, I wouldn’t mind a new game, but a new game PLUS a port of UKT2 would be even better. Come on Atlus, it can’t be that hard. According to an interview on 1up:

“And as far as the future of the series goes, I know there’s an audience both on the Wii side and the DS side, but I also don’t think we can just keep bringing ports back and forth like some companies do.

People were very understanding with Second Opinion because it was such, I think, an amazing proof of concept; it really worked on the Wii and showed the series could be just as fun on the Wii. A lot of people who bought the DS version also bought the Wii version. But as Yu says, going back and forth, I don’t think that’s what the fans want.

I think if we tried to double-dip too many times, fans would turn on the series.”

Come the fuck on. That’s the most ridiculous thing I’ve ever heard. I dare you to find one Trauma Center fan who would be against porting UTK2 to the Wii. I would buy it nine times even if it had absolutely NOTHING new. Stop disappointing me and port that shit already!

Anyway, it was fun replaying Second Opinion. I really needed to. Had to get it out of my system, know what I’m sayin’? What did I learn from this project? I learned that fuck me, writing a guide is so much harder than just playing a game. I’m amazed that I didn’t give up halfway through considering how much of a lazy motherfucker I am. Probably the only reason I didn’t was because I was being encouraged by friends along the way. But it was close man. It was fucking close. I think I started around the 5th, and now it’s the 20th. That’s 15 days of pretty much nonstop work. You know how much that is for someone as lazy as me? And the game isn’t that complex. I gotta say I respect people who have the dedication to write guides for the really long and complicated games. It’s not easy. Overall I think I like how this came out. Sure it’s not perfect but gimme a break, I’m fucking exhausted man. Leave me alone.

Well I’ve rambled on for long enough. I guess I don’t really have anything worthwhile to say other than congratulations if you’ve XS’d this game. You chose a damn fine game to master. I’m outta here.

Stay gold,
~S.A. Renegade