During surgery you will notice a few tools. It is important to master these tools to progress forward in your surgery. Some are easy to use, while others are very difficult. COUGH COUGH spinning starFor example, in your first surgery, the heart surgery, there are few useful tools and many useless tools- in my opinion. The "useful tools" will be the ones listed. Items that should not be present during real-life surgery will not be listed (ie. orange soda, q-tips?)

The Hammer is a straightforward tool used to break and smash open the patient's skull the ribcage. However, some people have trouble since they break open the center of the ribcage but not the side bones; breaking these may take a while and deter you from getting an A++ on this surgery. The Hammer is still useful however, in case you throw away the best tool (again, in my opinion) for cutting open ribcages.

Use it for speedruns.

Looks to me like a reskin of the hammer.

This is probably the most useful tool during the heart, maybe brain, and alien surgery. The end of the ribcage, closest to the patient's flesh and farthest from the center, is very vulnerable to this saw's cutting ability. Sawing these ends of the ribcage will save you minutes of time and help you get a good grade on the heart surgery. However, do not let it touch the flesh of the patient, as it will make him lose large quantities of blood (about 150 ml if held right at him for 1 second) and raise bleeding level for about 5 ml/s every second. Do not let this saw touch the patient's flesh!

Use it for quality operations.

These two scalpels are the only two useful scalpels for the Heart Surgery. The Gullet knife is used to cut the esophagus- the knife looks like a pocket knife: long handle with short, sharp, and pointed blade. If you look closely at the esophagus you can see dark lines near the top and bottom. These are the places you will cut with the gullet knife. If you cut directly on these lines, it will come off without any blood loss at all!

The Heart Scalpel looks like a pocket knife with a longer blade; however, it has a small, stretched ovalish hole in the handle, and one of the areas of the blade, to the right of it, is slightly darker. Cutting the tubes of the heart with this scalpel will be a breeze. Again, there are small dark lines where you are supposed to cut. You will know that you have successfully removed the heart if it stops beating.

1. Get the pizza cutter rotary saw and saw the ends of the ribcage.
2. Remove the ribcage.
3. Remove the lungs with your hand.
OPTIONAL: Remove the liver with your hand.
4. Get the Gullet Knife and cut the top and bottom of the esophagus.
5. Remove the stomach and esophagus only if they are blocking the way to the heart.
6. Get the Heart Scalpel and cut the tubes of the Heart.
7. Remove the old heart.
8. Open the box near the top-right and grab the new heart.
9. Place or drop the new heart in the cavity where the old heart was.
OPTIONAL: Before you place the heart in to complete the surgery, you can place it upside down and kill the patient. This will unlock an achievement referencing one of PewDiePie's Surgeon Simulator videos.

--Done! You have completed the Heart surgery! You are now about 11% of the way to getting your certificate for practicing surgery for real!

For some of you who like to be master surgeons such as moi (I have all 72 of the original achievements), you may have trouble trying to speedrun certain operations or do some under a certain amount of time losing a certain amount of blood. Here's how to do these two for the heart transplant:

SPEEDRUN:
As fast as you can, grab the hammer and rub it all over the ribcage. It should break in less than 15 seconds. Rip out the lungs and, if you want, remove the top part of the esophagus to make cutting the heart a bit easier. Then remove the heart. Toss in the heart (not literally) and you're done. Just remember, the ribcage is the hardest part. Good luck!

QUALITY:
My completion time for getting an A++ on this procedure is having 5098 ML of blood remaining and completed in 4:45 minutes. The limits are probably losing only 600 mL of blood under 5 minutes. Since this is the first operation it is the easiest to do for quality.
Follow the procedures you already read at the beginning of this guide. Try to lose a minimal amount of blood by sawing open the ribcage with the circular saw. Be sure to use the right scalpel and don't make Bob bleed. Good luck!

The intestines block the way to old, withered kidneys. Will the patient be able to pee? Maybe, if you put in two fresh, new ones. Here, only two, and up to three tools wills be needed to complete the surgery. I think it is much easier since you are hopefully more experienced with virtual surgery.

The most useful scalpel in this operation. It is very rounded in all locations, even the blade. If you look closely at the intestines there are red spots: these are vulnerable to the gut scalpel's blade. After cutting out the large intestine, you can place it around Bob's neck to get an achievement!! However, it must be not visible, so under the covers.

So the stomach seems to regenerate. Back when you cut it out (if you did) in the heart surgery, it made squishy noises and the like. If you want, you can cut out the stomach to make access to the right kidney a little easier.

The Kidney Knife is easy to remember since it looks like a hollow kidney with a blade at the end. Cut the ends of the yellow tube attached to the kidneys. However if you notice the left kidney, there is a green structure that seemingly can't be removed. It is the gall bladder, and to my knowledge, cannot be removed. It is really annoying for the left kidney.

1. Grab the gut scalpel and cut in the areas shown above (circled in blue).
OPTIONAL: Remove the portion of the ribcage sticking out.
2. Grab the kidney knife and remove the kidneys.*
OPTIONAL: Remove the liver for some stretching, smushing, squashy noises!
3. Find a way to move the kidneys out of the way, whether it's using a spoon or by using a large tool to flick it out.
4. Grab the new kidneys and place them in the holes. NOTE HOWEVER, that, to my knowledge, you can only place them in the way they are supposed to be. If you grabbed the left kidney from the box, put it in the left hole, just in case. I have not tested putting them in the opposite places; notify me in comments if you can.
5. You have completed the kidney transplant~

*Some people have trouble removing the kidneys. They seem to be out of reach, so this is what I do: Get a spoon and spoon it out. Most of the time, with correct grip, it'll work. You'll have to be patient and master it! Good luck!

As mentioned before some people may have trouble speedrunning an operation or getting an A++ on it. Here are some helpful tips for speedrunning and getting an A++ on the kidney transplant.

SPEEDRUN:
QUICK! GET THE GUT SCALPEL AND STAB THE RED AREAS! Then take chuck the intestines out at his face or whatevs, and using the same scalpel (it takes a precious 5 seconds to get another one) stab the stomach out. Then stab the kidneys with the kidney knife in their "cut" locations, and move them out with the spoon or the kidney knife if you can. Chuck the remaining organs out of his body and drop in the new kidneys (carefully). Good luck!

QUALITY:
My record for the kidney transplant is 5273 mL remaining in 3:19 minutes. This operation is a fairly easy one and you should not lose blood. The method you are using is the same you read when you did the kidney transplant for the first time; use the gut scalpel carefully and remove the kidneys. I assume the limit is 5000 mL in under 4 minutes. Good luck!

Probably the funniest transplant in surgeon simulator. The quality runs are difficult and the speedruns are easy. Remember the spoiler text where the hammer broke open the patient's skull? Yep, it's gonna be useful now for speedruns. Anyhoozers, the brain transplant is my favorite of them all (probably because I want to be a neurosurgeon) because it's easy and funny.

Use for speedruns!

The hammer is great for exploding half of the patient's skull off. Using it right can save you half a minute in time of speedrunning. However, the hammer causes tons of blood loss and should be used for speedruns only, unless you just wanna go back to the old times and smash off his skull millions of times.

The most awful, enraging, horrible tool. Not only is the laser extremely difficult to use, it only serves one purpose: quality runs for the brain transplant. I spent days upon days trying to master this, until I finally did it.

The laser is extremely difficult to use because it can cause a LOT of bleeding. However, it does not affect blood loss when used in the right place. The laser is found at the top right of the transplant in a machine. It should be used only for quality transplants by burning the skull off, which takes a long time. Be careful not to scrape the brain, as it does major damage and could jeopardize the current quality run. This tool is extremely difficult to learn and even more difficult to master. Good luck!