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"Your medicine has given birth to lives which never should have been. They are your guilt."

"No matter how hard you try, you cannot overcome the power of death!"

X1: Kyriaki[edit]

Difficulty Rating 6

"This...is mankind's first sin. Man created swords to kill, and was in turn killed by swords. Don't you see? Man has always sought ways to achieve death."

No, you didn't misread. The difficulty rating is "6". This operation is borderline-unreasonable. Gel and incise.

Begin by suturing the medium-sized lacerations. Suture all but one large laceration. Gel and stabilize vitals. Perhaps you've noticed how far they've dropped? It gets worse. Suture up the last large laceration to draw Kyriaki out of hiding.

Immediately, 3 immature Kyriaki will appear and start lacerating the daylights out of the patient's lung. The patient's vitals are going to start plummeting at an alarming rate. You're going to have to exercise every ounce of reflex you have just to keep the patient alive long enough to excise the Kyriaki. Don't bother suturing lacerations yet; Kyriaki will simply make more, dropping vitals each time and wasting precious seconds on the clock. Instead, you're going to adjust your pattern:

Search: Gel, stabilize, gel, ultrasound twice, gel, excise (scalpel), gel, stabilize. Repeat this until you've excised all 3 immature Kyriaki. Then the pattern shifts to:

Destroy: Gel, stabilize, gel, laser all Kyriaki once. Repeat until all Kyriaki are dead.

Three more immature Kyriaki will appear, even before you've killed off the last Kyriaki of the first wave, forcing you to deal with four immature Kyriaki at once. Laser off the one that's already excised, then repeat the "Search" and "Destroy" procedures for the three new immature Kyriaki until they're defeated. Assuming the patient is still alive at this point, gel, stabilize, and suture lacerations until all but one remain. Gel and stabilize vitals to 99, then suture the laceration. The mature Kyriaki will appear, with an immature accomplice. Once again, ignore any lacerations the Kyriaki make. Begin the "Search" procedure until you've excised the immature Kyriaki and killed it off with the "Destroy" procedure. Then, execute the "Search" and "Destroy" procedures on the adult until it too is defeated. Continue gelling, stabilizing, and suturing until all wounds are healed.

Take care not to take too long stabilizing the patient. Try to gauge it so that the patient will survive, and nothing more. You only have five minutes to complete the operation. Also, there is no real recommendation for when to invoke the Healing Touch. Some prefer to invoke it when the immature Kyriaki first appear, and then deal with the adult head-on. Some prefer to save the Touch for the second wave of immature Kyriaki, or even for the adult. No matter when you use it, this operation is going to be absurdly difficult.

When all Kyriaki are defeated and all wounds are treated, suture, gel (and stabilize if you have time), and bandage the patient. Operation complete.

X2: Deftera[edit]

Difficulty Rating 5

"Man crawls the earth like vermin, breeding and fighting for eternity. Yet you dare judge them. ...You who lost the will to die properly."

Gel and incise.

This operation is going to be exactly like the "Second Sin" operation, except the patient's vitals will drop faster. Remember to moderate your use of gel when steering opposite-type Deftera into each other. Conserve your laser as much as possible, and stabilize as often as possible. As long as you're only fighting one pair of Deftera, the operation should be fairly straightforward.

Suture, gel, and bandage once all Deftera have been excised. Operation complete.

X3: Triti[edit]

Difficulty Rating 5

"Modern man is the very model of hypocrisy. You glorify the discovery of medicine, but hide the fact that your own kind is creating disease!"

Gel and incise.

The operation is basically "Third Sin" all over again, except the patient's vitals will drop faster. Just be sure to stay on top of the patient's vitals, and immediately drain thorns should they vaporize.

When Triti is extracted, suture, gel, and bandage. Operation complete.

X4: Tetarti[edit]

Difficulty Rating 4

"Nature mandates that mankind will eventually succumb to its poison. However, humans created their own poison, called medicine. It's delusional to believe you can poison Nature to avoid your fate."

Tetarti is arguably the easiest of the X missions. Gel and incise.

Neutralize the diverticula. You may or may not be forced to let one of the diverticulum grow to critical size and expel gas, considering how rapidly they grow. If this happens, bite the bullet and neutralize the diverticulum afterward, then stabilize the patient's vitals to 99. When all diverticula are treated, Tetarti will appear, mobile and agile. The patient's vitals will drop at a quicker rate than in "Fourth Sin," but you should only have to stabilize vitals every so often unless new diverticula form due to an erroneous injection, or if you miss and inject the patient by accident. Save the Healing Touch, if you must use it, for after you've injected Tetarti at least four times.

When Tetarti is neutralized, suture, gel, and bandage. Operation complete.

X5: Pempti[edit]

Difficulty Rating 5

"Mankind's greed has no ending... You continue to consume everything, until even your host is laid to waste. Is your survival that important? ...So important that you would trade it for the earth's destruction?"

Gel and incise. Richard Anderson must be rolling in his grave right now.

As with all the other X missions, the patient's vitals are going to drop uncharacteristically quick. The mini-cores attack at an even faster rate, if that's possible. Gel, stabilize, and suture any lacerations immediately after the mini-cores subside. Laser any tumors and gel them as quickly as you can. If the patient's vitals will allow, forego an injection of stabilizer in favor of attacking the main core, lest the clock become your enemy. It will take about 8 long bouts of laser fire to eradicate Pempti for good.

Suture, gel, and bandage. Operation complete.

X6: Paraskevi[edit]

Difficulty Rating 5

"In young forests at the dawn of time, plants were born with the ability to kill humans. ...Such simple, perfect beings. Do you understand the meaning of such toxic organisms? They demonstrate that all creation seeks an end to mankind."

Gel and incise, so you can be rid of this fibrous pain-in-the-ass once and for all.

There will be more lacerations initially than in "Infection." Vitals are also going to drop quickly here, more so than other X missions but less still than "X1: Kyriaki." You have the option of suturing lacerations as soon as they're made, or using the "gel, stabilize, gel, attack" pattern and suturing later. Whenever Paraskevi escapes into a new organ, save one wound and stabilize vitals to 99 before treating and continuing. Try to whittle down Paraskevi into segments in the intestine and stomach, then invoke the Healing Touch and remove them all at the liver.

When Paraskevi is extracted, suture, gel, and bandage. Operation Complete. Just one more to go...

X7: Savato[edit]

Difficulty Rating 5

"My beautiful, perfect image of Death itself...Savato. But... What if I told you this Death existed in all human DNA? ...I merely gave it the chance to take form. This is the Death you have denied. ...Our guide to the truth."

Gel and incise for the final operation in Trauma Center: Under The Knife.

Remember not to use the Healing Touch until after the Touch invokes itself automatically.

Your primary focus immediately after incising is attacking the web. As more and more strands are cut, the web will start preparing to sap vitals at an even quicker rate. When two or less threads in a web remain, the web will remain inactive for up to 10 seconds, then fade completely to red in about 2 seconds. The web will sap 50 points from the patient's vitals, almost guaranteed to kill the patient instantly, especially so if any blue Savato have formed. After you cut a strand, inject one syringe-full of stabilizer, then pick up your scalpel the second it becomes available and cut another strand. Keep cutting at the web until all 4 webs are destroyed, then begin attacking Savato.

Immediately suture any lacerations Savato makes and inject one syringe-full of stabilizer when you're finished. Keep the laser on Savato as much as possible; disregard the immature/blue Savato completely, unless they drop vitals by creating new blue Savato, at which time you simply inject a syringe-full of stabilizer and resume attacking the mature pathogen. Attempt to chain the laser/scalpel attacks once the armor is burned off once, otherwise, resume attacking. When Savato is rendered vulnerable and absorbs the immature/blue Savato, stabilize vitals to 99, and then inject it with the black serum. After the Touch invokes, invoke it a second time to freeze time, then finish off Savato.

"As written in Revelations 9:6, 'During those days, men will seek death, but will not find it. They will long to die, but death will elude them.' Just as the prophecy states, I have set a plague upon mankind to torment those who have betrayed natural law. ...At the end of all life, I alone will stand as an angel before the gaping abyss.... I, who have become the great destroyer Apollyon! ...Your medicine is nothing but deceit, and you are nothing but a false prophet..."

Suture, gel, and bandage for the final time. Operation complete. Trauma Center: Under The Knife is complete.