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Guide:Surgery

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This is a page featuring information and guides about surgery.

Update History

Surgery is a feature in Growtopia that allows players to perform various types of surgeries on other players using various tools. It was first introduced in the Growtopia General Hospital update on November 21, 2013. It introduced a surgical pack costing 7,000 gems consisting of seven tools, namely, Surgical Sponge, Surgical Scalpel, Surgical Antibiotics, Surgical Stitches, Surgical Splint, Surgical Antiseptic and Surgical Anesthetic each with its unique ability when performing a surgery.

The pack was updated during Anniversary Week 2017 on January 6, 2017, adding six new tools: Surgical Lab Kit, Surgical Defibrillator, Surgical Pins, Surgical Clamp, Surgical Transfusion and Surgical Ultrasound.

On June 13, 2019, during the Blocktor's Orders! update, x10 Med-A-Check and a Train-E was added to the pack. In addition, it introduced 'maladies' and the Dr. title, rewarded for successfully performing surgery 5,000 times (excluding on Train-Es).

As of Player Appreciation Week 2022 Day 5 on February 13, 2020. Heart Monitor, Hospital Bed, and Med-A-Check are no longer available in this pack. Two additional Surgery-related packs were added in the Growtopia Store: Surgery Starter Pack and Master Surgeon's Tool Bag.

On August 26, 2024, during Player Appreciation Week 2024 Day 1, a hospital update was introduced. With a Reception Desk, players can turn a world into a hospital and level it up to receive rewards such as an Auto Surgeon Station that allows players with a malady to cure themselves for a price and an Operating Table that summons a Surg-E daily. Additionally, it revamped maladies and made them give players a debuff depending on the malady received, so players are encouraged to get them cured by other players.

Performing Surgery

A player can perform surgery on another player if the latter is standing on a Hospital Bed or Starship Sickbay Bed, and is not affected by the recovering mod. By using the Wrench and clicking the "Perform Surgery" button, the player can perform surgery on the other player. A Surg-E or Train-E is also available for players to be able to perform surgery without having other players as their patients.

Item Packs

There are three different packs, each pack containing different items/amounts:

Tools

The following tools are needed in performing surgeries. Not every single tool is required to complete a surgery; however, players are strongly recommended to carry at least 10 of each tool in case they are needed for different diagnoses and conditions. These are arranged in the order they show up in the surgery interface.

Tool Usage and effect
Surgical Defibrillator Used to shock a patient back to life. If the patient's heart has stopped, this must be given to the patient within 2 moves or the patient will die and the surgery will fail. This tool is only available when the patient's heart has stopped.
Surgical Sponge Used to clean up the operation site and make it easier to see. It is the only usable tool when the message "You can't see what you are doing!" is shown.
Surgical Anesthetic Used to put a patient to sleep for 9 more turns. Surgical Scalpel can only be used safely when the patient is not Awake.
Surgical Stitches Used to decrease bleeding and close up incisions. This tool is usually used when the patient is "losing blood" or "losing blood quickly", or after the "Fix it" button when the player's incisions need to be closed.
Surgical Scalpel Used to cut open the patient. The "Fix it" button will appear once the patient is diagnosed and enough incisions are made. It is also used to access shattered bones so that Surgical Pins can be used. Every use causes a small amount of bleeding.
Surgical Ultrasound Used only once to diagnose a patient as well as detect broken and shattered bones. If the root cause is not a fever, the player must use this to discover the patient's condition.
Surgical Antiseptic Used to disinfect the operation site. If the operation site is unsanitary, this can be used to clean it. This prevents infections that raise the patient's temperature. If the operation site is unsanitary when either the patient is bleeding or there is one or more incisions, a fever will start.
Surgical Gloves Unobtainable by players; used as an icon for the "Fix it!" button to resolve the diagnosis.
Surgical Lab Kit Used only once to diagnose flu, and unlock Surgical Antibiotics. Surgical Antibiotics cannot be used before using this tool.
Surgical Antibiotics Used to stop fever from climbing and increase the rate of lowering the patient's temperature, to a minimum of 98.6°F. Surgical Lab Kit must be used before this can be used.
Surgical Transfusion Used to transfuse several pints of blood into a patient. Increases the strength of the patient's pulse, which is an indication of how much blood the patient has.
Surgical Splint Used to fix broken bones. This tool can only be used after Surgical Ultrasound.
Surgical Pins Used to fix shattered bones. When used, a shattered bone turns into a broken bone. This item can only be used when the patient has at least one incision and Surgical Ultrasound is already used.
Surgical Clamp Used to clamp up blood vessels and reduce blood loss. This tool can only be used when the patient has at least one incision. This tool is less effective than Surgical Stitches.
Surgical Love Mallet Used to remove the 'Love Struck' status that only appears during Valentine's Week. "Love Struck" causes the patient to become more and more unconscious until they become trapped in a permanent coma.
Empty Surgery Tray Unobtainable by players; used as an icon for when a tool is unavailable for use, whether because it is locked, not needed at all, or the player does not have one in their inventory.

Skill Fails

Skill Fail is a mechanic that complicates surgeries and makes them more realistic. During surgery, the surgeon may randomly fail to use a tool properly. This event is called a skill fail, and the tool could do nothing, do the opposite, or cause other negative effects. When this happens, a message announces the skill fail along with the probability of it occuring. The tool is still consumed in the process.

The operation site becomes less and less visible when there are more incisions and when the patient is losing blood. This increases the chances of skill fails by up to 5 times as likely, and the message "It is becoming harder to see your work" shows up to prompt the user to resolve this by using Surgical Sponge.

Players have a "Surgeon Skill" level that simulates the learning process of becoming better at surgery. Players new to surgery start off with 0 Surgeon Skill and a very high base rate of skill fails at around 20%. Every successful surgery on a Surg-E or another player, or each of the first 20 successful surgeries on a Train-E, will increase the player's Surgeon Skill by 1 each, up to a maximum of 100. This number can be seen by wrenching themselves, or a Train-E or Surg-E. At Surgeon Skill of 100, the base rate of skill fails is greatly reduced to 5%.

The "Steady Hands" bonus from the Surgery Role Quests reduce the chance of skill fails by up to a further 3%.

Items like Skill Spice, Tea and Exquisite Bone Saw give the player mods that further halve the chance of skill fails.

Players do not encounter skill fails when performing surgery on a Train-E.

The following messages will appear if the player suffers a skill fail for a particular tool used. Skill fails for some tools cause the conditions to worsen.

Tool Message Effect
Surgical Defibrillator "You electrocuted yourself!" No effect, but the move is wasted.
Surgical Sponge "You somehow managed to eat the sponge." No effect, but the move is wasted.
Surgical Anesthetic "You end up inhaling all the anesthetic yourself. You feel woozy." Makes it harder to see.
Surgical Stitches "You somehow tied yourself up in stitches." No effect, but the move is wasted.
Surgical Scalpel "This will leave a nasty scar, but you managed to cut the right place." While this still adds an incision, it causes more bleeding than usual.
Surgical Ultrasound "You scanned the nurse with your ultrasound!" No effect, but the move is wasted.
Surgical Antiseptic "You spilled antiseptic on your shoes. They are very clean now." No effect, but the move is wasted.
Fix it! "You screwed it up! Try again." No effect, but the move is wasted.
Surgical Lab Kit "You contaminated the sample." No effect, but the move is wasted.
Surgical Antibiotics "This is the wrong medication! The bacteria like it." Patient's temperature increases faster.
Surgical Transfusion "You spilled blood everywhere!" Operation site becomes less sanitary and less visible.
Surgical Splint "You somehow cut the patient." Causes slight bleeding.
Surgical Pins "You jabbed the pin through the artery!" Causes bleeding, makes it harder to see.
Surgical Clamp "The clamp fell out of your hand, oh well."

"You clamped your nose shut."

No effect, but the move is wasted.
Surgical Love Mallet "You hit yourself on the knee." Presumably no effect, but the move is wasted.

Tool usage limits

Just beacuse a tool is available for usage does not mean it is needed. Messages will show up when the player uses a certain tool to try to achieve an effect that is at its limit and cannot be improved further.

Tool Message Effect
Surgical Sponge "Everything is already clean, you wasted a sponge!." Visibility is already at its maximum. The Surgical Sponge is consumed without doing anything.
Surgical Stitches "You can't stitch the patient's mouth shut." The patient has 0 incisions and is not bleeding, so stitches are unnecessary. The Surgical Stitches are consumed without doing anything.
Surgical Scalpel "You stabbed the patient in a vital organ!" This does not add an incision, but instead increases bleeding greatly while consuming the Surgical Scalpel. This happens when enough incisions have already been made to unlock 'Fix it!', or 'Fix it!' does not have to be found for the diagnosis.
Surgical Ultrasound You scanned the patient, but didn't find any abnormal masses. (flu)

"You scanned the patient, but only found self-esteem issues!" (nose job)

The patient has a condition that does not require the use of ultrasound to diagnose. The Surgical Ultrasound is consumed without doing anything.
Surgical Antiseptic "You disinfected the operating site." (implicit limit) When the operation site is already clean, the Surgical Antiseptic is consumed without doing anything.
Surgical Lab Kit "You performed lab work on the patient, and have antibiotics at the ready." (not always needed) Some conditions can be cured without the use of Surgical Antibiotics at all, so the player would not need to unlock them by using Surgical Lab Kit.
Surgical Antibiotics "You used antibiotics to reduce the patient's infection." (implicit limit) Patient's temperature cannot be reduced lower than 98.6. At that point, the Surgical Antibiotics would be consumed without doing anything.
Surgical Transfusion "You transfused several pints of blood into your patient." (implicit limit) When the patient's pulse is already strong, the Surgical Transfusion is consumed without doing anything.
Surgical Splint "Please don't slap patients with splints." The patient has 0 broken bones, so splints are unnecessary. The Surgical Splint is consumed without doing anything. Surgical Pins are needed to fix shattered bones instead of Surgical Splint.
Surgical Pins "We're not impressed with your pin-juggling." The patient has 0 shattered bones, so pins are unnecessary. The Surgical Pins are consumed without doing anything.
Surgical Clamp "You clamped some blood vessels." (implicit limit) When the patient is not bleeding, the Surgical Clamp is consumed without doing anything.

Patient status and alerts

The patient's information shows how healthy they are, and each may have a condition which must be addressed using the relevant tool. Some red conditions must be addressed immediately as the patient may die if these are left unattended.

Pulse: Strong (green) / Steady (blue) / Weak (amber) / Extremely weak (red)

  • A weaker pulse indicates lower blood supply. Surgical Transfusion can be given to the patient to prevent them from bleeding out and dying.

Status: Awake (red/blue) / Coming to (amber) / Unconscious (green) / Near coma (red) / Heart stopped! (red)

  • The player immediately fails the surgery if they use Surgical Scalpel when the patient is Awake.
  • If the patient wakes up while not all incisions are patched, they will "scream and flail", causing intense blood loss and poor visibility. This can easily lead to a chain of skill fails, resulting in death by blood loss.
    • The patient's status changes from "Unconsious" to "Coming to" when they will wake up after 2 moves if Surgical Anesthetic is not used again. Players must use Surgical Anesthetic early if they need more moves to finish work and close all incisions.
  • The patient's status changes to "Near coma" when a Surgical Anesthetic is given to the patient, giving them 14-15 moves before they wake up (7 if hyperactive). The patient cannot have more than 15 moves left (8 if hyperactive) or they will fall into a permanent coma.
  • If the patient's heart has stopped, Surgical Defibrillator must be given to the patient within 2 moves.

Temperature (Temp): 98.6-100 (green), 100-102 (blue), 102-107 (amber), 107-110 (red)

Operation site: Clean (green) / Not sanitized (blue) / Unclean (amber) / Unsanitary (red)

  • If the operation site is unsanitary when there is 1 or more incision or when the patient is bleeding, a fever will develop due to infection and Surgical Antibiotics should be used instead.

Visiblity: "It is becoming hard to see your work." (amber) / "You can't see what you are doing!" (red)

  • The operation site becomes less and less visible when there are more incisions and when the patient is losing blood. This increases the chances of skill fails by up to 5 times as likely. With "You can't see what you are doing!", the player cannot proceed with the surgery at all. Address this by using Surgical Sponge.

Incisions: (number of incisions)

Bones: (number) broken, (number) shattered

  • Surgical Pins can only be used to fix shattered bones when there is at least 1 incision. This will turn the bone from shattered to broken.
  • Surgical Splint can be used to fix broken bones anytime.

Bleeding: "Patient is losing blood slowly." (blue) / "Patient is losing blood." (amber) / "Patient is losing blood quickly!" (red)

  • Bleeding causes the operation site to become dirtier and less visible, the pulse to become weaker, and the visibility to become poorer.
    • If the patient is losing blood while incisions exist, either Surgical Stitches (reduces 1 incision and blood loss) or Surgical Clamp (reduces blood loss, but less effective than stitches) can be given to the patient. If the patient is losing blood when there are no incisions, only Surgical Stitches can be used.
    • Using Surgical Stitches when there is only 1 incision removes that incision and all blood loss at once.

Fever: "Patient's fever is slowly rising." (blue) "Patient's fever is climbing." (amber) / "Patient's fever is climbing rapidly!" (red)

Surgery Success and Failure

To finish a surgery, the patient must have the diagnosis fixed, no broken or shattered bones, no incisions, no visible bleeding, a body temperature of 100.4 or less, and the heart is not stopped. Pulse strength, visibility and whether temperature is rising are not considered when evaluating success.

Failure of surgery can be caused by these issues below. The player will receive one of these messages below and get the Malpractice mod, which disallows the player from performing surgery for a period of time.

  • "The patient was not resuscitated in time. YOUR MEDICAL LICENSE IS REVOKED!" Surgical Defibrillator was not used within 2 moves after the heart stopped.
  • "You just stabbed someone who was fully awake! YOUR MEDICAL LICENSE IS REVOKED!" Surgical Scalpel was used while the patient was awake.
  • "The patient has bled out! YOUR MEDICAL LICENSE IS REVOKED!" Blood loss has caused the pulse to fall below "Extremely weak".
  • "The patient has succumbed to infection. YOUR MEDICAL LICENSE IS REVOKED!" The patient's temperature has risen above 110 degrees.
  • "You put the patient to sleep. Permanently." Using Surgical Anesthetic makes the patient unconscious for 9 more moves (4 with hyperactive). If the patient is put unconscious for more than 15 moves (7? with hyperactive), the patient is considered to be in a permanent coma and the surgery is failed.
  • "You couldn't save them!" The player deliberately gave up the surgery.
  • "You abandoned your patient!" The player quit the surgery due to some other action like leaving the world.
  • "Someone seems to have smashed your surgical robot." The Surg-E or Train-E was broken by punching before the player could finish the surgery.

Diagnoses and cures

For most diagnoses, the player must use Surgical Ultrasound to reveal the diagnoses, any broken or shattered bones, and extra conditions. Then, enough incisions need to be made using Surgical Scalpel to reveal the underlying cause and the Fix it button. For flu, using Surgical Lab Kit is enough.

A 'clean' state refers to the patient having no bleeding, no fever, no heart stop, full visibility, and ideally a strong pulse and clean operation site. For serious diagnoses, it is recommended to reach this clean state before starting to make incisions and fix issues.

Surgery is, by nature, highly situational, and there is the possibility of extra conditions, random heart stops and skill fails requiring adaptability. This table serves only as a guide and not step-by-step instructions. Players should react to and resolve all conditions at hand appropriately.

Problem Steps to fix
Broken Arm Patient is bleeding slightly and has 1 broken bone.


Use Surgical Splint to repair the broken bone. Use Surgical Stitches to stop the bleeding. The Fix it button does not show up for this diagnosis.

Broken Leg Patient is bleeding slightly and has 1 broken bone and 1 shattered bone.


Put the patient to sleep using Surgical Anesthetic and cut the patient open using 1 Surgical Scalpel. Use Surgical Pins to fix the shattered bone. Close the incision using Surgical Stitches, then use Surgical Splints to repair the broken bones. The Fix it button does not show up for this diagnosis.

Bird Flu
Turtle Flu
Monkey Flu

Bird flu: Patient has a medium fever climbing, with low visibility.
Turtle flu: Patient has a slight fever climbing rapidly, with low visibility.
Monkey flu: Patient has a high fever climbing rapidly.

Use Surgical Lab Kit to unlock Surgical Antibiotics and keep using Surgical Antibiotics.

Nose Job Patient is in a clean state and wants a nose job. Surgical Ultrasound is not needed.


Put the patient to sleep using Surgical Anesthetic and cut the patient open using 1 Surgical Scalpel. Use Surgical Stitches to close up the incision.

Lung Tumor Patient is in a clean state.


Put the patient to sleep using Surgical Anesthetic and cut 1 incision using Surgical Scalpel. Select the Fix it button and use Surgical Stitches to close up the incision.

Heart Attack Patient is in a clean state.

Use Surgical Antibiotics (optional) until the temperature is at 98.6. Put the patient to sleep using Surgical Anesthetic and cut 2 incisions using Surgical Scalpel. Use Surgical Stitches to close up the incisions.

Brain Tumor Patient is in a clean state.


Put the patient to sleep using Surgical Anesthetic and cut 5 incisions using Surgical Scalpel. Use Surgical Stitches to close up the incisions.

Liver Infection Patient has a medium fever climbing, and is unclean.


Use Surgical Antibiotics (usually 2). Put the patient to sleep using Surgical Anesthetic and cut 2 incisions using Surgical Scalpel. Use Surgical Stitches to close up the incisions.

Kidney Failure Patient has a slight fever climbing, and is unclean.


Use Surgical Antibiotics (usually 2). Put the patient to sleep using Surgical Anesthetic and cut the patient open using a Surgical Scalpel. Use Surgical Stitches to close up the incisions.

Appendicitis Patient has a slight fever climbing rapidly, and is unsanitary.


Use Surgical Antibiotics (usually 2). Use Surgical Antiseptic until site is clean. Put the patient to sleep using Surgical Anesthetic and cut 3 incisions using Surgical Scalpel. Use Surgical Stitches to close up the incisions.

Swallowed a World Lock Patient has a slight fever climbing rapidly, and is unclean, with low visibility.


Use Surgical Antibiotics (usually 2). Put the patient to sleep using Surgical Anesthetic and cut 2 incisions using Surgical Scalpel. Use Surgical Stitches to close up the incisions.
When incisions are made, the operation site becomes unsanitary and visibility reduces very fast (since you are cutting into the stomach).

Herniated Disc/Damaged spine Patient has an almost feverish but stable temperature.


Use Surgical Antiseptic until site is clean. Put the patient to sleep using Surgical Anesthetic and cut 3 incisions using Surgical Scalpel. Use Surgical Stitches to close up the incisions.

Broken Everything/Run over by a truck Patient is bleeding slowly, has 4 shattered bones, and is unsanitary, with low visibility.


Use Surgical Antibiotics until the temperature is at 98.6. Put the patient to sleep using Surgical Anesthetic and cut 2 incisions using Surgical Scalpel. Use Surgical Stitches to close up the incisions until one remains. Use Surgical Pins to fix the shattered bones. Close up the last incision using Surgical Stitches and use Surgical Splints to repair the broken bones.

Serious Head Injury Patient has a weak pulse and is losing blood quickly, and is unsanitary, with low visibility.


Use Surgical Stitches until the patient is no longer bleeding. Put the patient to sleep using Surgical Anesthetic and cut 1 incision using Surgical Scalpel. Use Surgical Stitches to close up the incisions.

Serious Trauma with a punctured lung Patient is losing blood and has 2 broken and 1 shattered bones, and is unsanitary, with low visibility.


Use Surgical Stitches until the patient is no longer bleeding. Use Surgical Antiseptic once. Put the patient to sleep using Surgical Anesthetic and cut 2 incisions using Surgical Scalpel. Use Surgical Stitches to close up the incisions until one remains. Use Surgical Pins to fix the shattered bones. Close up the last incision using Surgical Stitches and use Surgical Splints to repair the broken bones.

Massive Trauma Patient has a steady pulse and is losing blood quickly, and has 3 broken and 2 shattered bones, and is unsanitary, with low visibility.


Use Surgical Stitches to stop blood loss. Use Surgical Ultrasound to diagnose the patient. Put the patient to sleep using Surgical Anesthetic and cut 3 incisions using Surgical Scalpel. Use Surgical Stitches to close up the incisions until one remains. Use Surgical Pins to fix the shattered bones. Close up the last incision using Surgical Stitches and use Surgical Splints to repair the broken bones.

Torn Punching Muscle (malady) Patient is in a clean state.


Put the patient to sleep using Surgical Anesthetic and cut 1 incision using Surgical Scalpel. Use Surgical Stitches to close up the incision.

Gem Cuts (malady) Patient is bleeding slightly.


Put the patient to sleep using Surgical Anesthetic and cut 2 incision using Surgical Scalpel. Use Surgical Stitches to close up the incisions.

Broken Heart (malady) Patient has a high fever climbing rapidly, and has 2 shattered bones.


This malady has very frequent heart stops, hence the name "Broken Heart."

Use Surgical Antibiotics (usually 4). Use Surgical Antiseptic until site is clean. Put the patient to sleep using Surgical Anesthetic and cut 2 incisions using Surgical Scalpel. Use Surgical Stitches to close up the incisions until one remains. Use Surgical Pins to fix the shattered bones. Close up the last incision using Surgical Stitches and use the Surgical Splints to repair the broken bones.

Grumbleteeth (malady) Patient has a medium fever climbing slowly, and has 1 shattered bone, with low visibility.


Use Surgical Antibiotics (usually 2). Put the patient to sleep using Surgical Anesthetic and cut 1 incision using Surgical Scalpel. Use Surgical Pins to fix the shattered bone. Close up the last incision using Surgical Stitches and use Surgical Splint to repair the broken bone.

Chicken Feet (malady) Patient has a slight fever climbing rapidly, has 2 shattered bones, and is unsanitary.


Use Surgical Antibiotics (usually 2). Put the patient to sleep using Surgical Anesthetic and cut 2 incisions using Surgical Scalpel. Use Surgical Stitches to close up the incisions until one remains. Use Surgical Pins to fix the shattered bones. Close up the last incision using Surgical Stitches and use Surgical Splints to repair the broken bones.

Chaos Infection (malady) Patient is losing blood, has high fever climbing rapidly, and has broken bones, with low visibility.


This malady can cause random patient status changes like temperature rising or dropping by itself, heart stops, patient falling asleep without an anesthetic and patient instantly waking up. It is advised to observe every move carefully whilst performing this malady.

Use Surgical Antibiotics (usually 4). Use Surgical Stitches to stop the bleeding. Put the patient to sleep using Surgical Anesthetic and cut 3 incisions using Surgical Scalpel. Use Surgical Stitches to close up the incisions.

Vicious: Patient's chaotic energy becomes virulent, causing random problems to occur more frequently.

Lupus (malady) Patient has a weak pulse, an almost feverish temperature that is climbing rapidly, and is bleeding slightly.


This malady has a random chance of causing this event: "The patient howls in their sleep, tearing at their own skin!" This adds an incision and causes bleeding. The bleeding is exacerbated if the an incision is torn open when the patient is awake, leading to "screams and flails". The opening is highly reliant on luck; if the patient howls on the first and second moves, it instantly becomes impossible due to the two incisions while the patient is awake causing rapid bleeding.

The moment you know the diagnosis, use Surgical Anesthetic as soon as possible. Even if the patient with the malady has not already told you they have Lupus, you may use the unique starting conditions to infer this even before using Surgical Ultrasound.

After that, continue using Surgical Antibiotics, Surgical Sponge and Surgical Antiseptic to reach a clean state. Use Surgical Transfusion until the pulse is strong. If the patient howls before reaching 3 incisions, spam Surgical Clamps. Otherwise, use Surgical Scalpel to reach 3 incisions. Use Surgical Stitches to close up the incisions, then select Fix it. Make sure the patient is unconsious by using Surgical Anesthetic as needed throughout the entire operation.

Vicious: Increases the chances of the patient howling. Additionally, vicious have 1 broken bones instead of 2 shattered bones.

Brainworms (malady) Patient is losing blood, has medium fever climbing, and has 1 shattered bone, with low visibility.


This malady has a random chance for the brainworms to escape back into the brain after the Fix it button has been used, requiring Fix it again. This can happen multiple times.

Use Surgical Antibiotics. Then, use Surgical Stitches to stop the patient from bleeding. Use Surgical Sponge, Surgical Transfusion and Surgical Antiseptic to reach a clean state. Put the patient to sleep using Surgical Anesthetic and cut 1 incision using Surgical Scalpel. Use Surgical Pins to fix the shattered bone and Surgical Splint to repair the broken bone. Then, cut 1 more incision using Surgical Scalpel. Use Surgical Antibiotics, Surgical Sponge, and Surgical Anesthetic early to avoid having to use them while removing the worms using Fix it. If brains escape to the back of the brain, repeat. Use Surgical Stitches to close incisions after observing that the worms have not escaped back after numerous moves.

Vicious: Increases the worms' odds to escape.

Moldy Guts (malady) Patient has a medium fever climbing, has 1 shattered bone, and is unsanitary, with low visibility.


This malady has a random chance of causing this event, reducing visibility: The patient's guts burst making it impossible to see anything! Surgical Sponge must be used to address this.

Use Surgical Lab Kit to unlock Surgical Antibiotics and then reduce the patient's temperature back to 98.6. Put the patient to sleep using Surgical Anesthetic and cut 2 incisions using Surgical Scalpel. Use Surgical Stitches to close one incision, then use Surgical Pins once on the shattered bone. Use Surgical Stitches to close the incisions and select the Fix It button. Use Surgical Splint until the patient no longer has broken bones.

Vicious: The patient's temperature will always rise and become more severe.

Ecto-Bones (malady) Patient has 6 broken and 2 shattered bones, with low visibility. The Fix it button should become available the moment Surgical Ultrasound is used.


This malady may have an increased skill fail chance for Surgical Pins, and such skill fails may create extra shattered bones, with the message shown: "The pin phased through the bone and jabbed an artery, shattering another bone in the process!".

Put the patient to sleep using Surgical Anesthetic and cut 1 incision using Surgical Scalpel. Use Surgical Pins to repair the shattered bones. Use Surgical Stitches to close up the incision. Use Surgical Splint to repair the broken bones.

Vicious: Guarantees the extra shattered bones, and increases skill fail when using Surgical Pins.

Fatty-Liver (malady) Patient has medium fever climbing rapidly.


This malady has a random high chance of causing this event when the patient is not awake, leading to the heart stopping: "The fat build up has caused the patient's heart to stop!"

Use Surgical Antibiotics. Use Surgical Sponge and Surgical Antiseptic to reach a clean state. Put the patient to sleep using Surgical Anesthetic and cut 3 incisions using Surgical Scalpel. Use Surgical Stitches to close the incisions. Use Surgical Sponge every time the visibility drops to prepare for the frequent heart stops.

Vicious: Further increases the chance of heart stop and gains slight resistance to Surgical Antibiotics

Extra conditions

During surgery, some patients may have one special condition on top of their main diagnosis. These can be revealed by Surgical Lab Kit or Surgical Ultrasound, and they may make the operation more difficult.

  • "The patient exhibits very tough skin. Possibly a superhero." - requires 2 incisions using Surgical Scalpel to unlock Fix It, Surgical Clamp and Surgical Splint. These tools become locked again when the 2nd incision is stitched up.
  • "The patient has an antibiotic-resistant infection." - Surgical Antibiotics causes a smaller rate of decrease in temperature.
  • "The patient is absolutely filthy." - the operation site will become unsanitary faster than normal. Surgical Antiseptic is less viable, and more Surgical Antiseptic or Surgical Antibiotics may be needed during surgery.
  • "The patient is hyperactive." - Each Surgical Anesthetic used puts the patient to sleep for 4 turns instead of 9. The "Coming to" status also only lasts 1 turn.
  • "The patient is a hemophiliac." - the patient bleeds faster than normal.

Additional Tips

  • Before surgery, it is heavily advised that players have enough backpack space to collect their prize. Otherwise, they will drop on the ground, allowing other players to pick them up.
  • It is advised for players with a lower Surgeon Skill to perform easier surgeries. When the player has reached Surgeon Skill 100, they can attempt harder surgeries such as Massive Trauma.
  • Using the Fix It button immediately when it appears is not required; players can close up incisions before using the button, reducing the chances of skill fail. However, if the patience has tough skin, the button will disappear after the 2nd incision is closed.
  • Closing the first incision stops all bleeding at once. When the patient is losing blood or losing blood quickly as the starting condition, instead of using three Surgical Stitches, it is advised to use Surgical Transfusion immediately to strengthen the pulse, then use Surgical Anesthetic, one Surgical Scalpel, and one Surgical Stitches to stop all bleeding.
  • When the heart stops and "It's becoming hard to see..." occur at the same time, it is advised to first use Surgical Sponge first to reduce the skill fail chance, and then use Surgical Defibrillator. This is most useful for Broken Heart and Fatty Liver maladies where heart stops are frequent.

Bonus items

There are several items players can use to assist them with surgeries:

Items Item Types Benefits
Healing Tome Clothing (chest) Reduces the cooldown of Malpractice and Recovery mods by 25%, but doesn't stack with other items with similar effects
Pet Chorizo Clothing (hand) Reduces the cooldown of Malpractice and Recovery mods by 25%, but doesn't stack with other items with similar effects.
Stethoscope Clothing (chest) Reduces the chance of skill fails by 50%
Exquisite Bone Saw Clothing (hand) Reduces the chance of skill fails by presumably 50%
Nano Nurse Bot Clothing (hand) Reduces the chance of skill fails by presumably 50% and grants the chance of not using up a surgical tool
Skill Spice Consumable Reduces the chance of skill fails by 50%
Tea Consumable Reduces the chance of skill fails by 50%, but doesn't stack with other items that reduce skill fails.
Med-A-Check Consumable Used to check if a player patient has a malady before performing surgery. Will not be consumed if the player does not have a malady. This is not a replacement for Surgical Ultrasound, which still must be used during operations with maladies.

Maladies

Maladies are a type of disease that was introduced as part of the Blocktor's Orders! update on 13 June 2019.

Activity Maladies

Activity maladies can be randomly caught by players that are performing certain related actions. These actions include:

Maladies Action
Torn Punching Muscle Punching
Gem Cuts Picking up Gems
Broken Heart Performing Surgeries
Grumbleteeth Chatting
Chicken Feet Walking

A player that successfully performs surgery on a player or Surg-E has a small chance to get any of these maladies themselves.

Any player logging on for the first time during Surgery Day will also get any of the five maladies above.

These maladies may give a special prize when successfully cured:

Maladies Reward
Torn Punching Muscle Punchy Fist
Gem Cuts Gem Hair
Ice Shard Hair (whilst Growch's heart size is at least 9)
Broken Heart Loving Halo
Widow's Hat
Widow's Makeup
Widow's Corset
Widow's Skirt
Grumbleteeth Terrifying Toothface
Chicken Feet Chicken Feet

Vial Maladies (Vile Vials)

On top of being randomly caught by players when doing certain actions, these maladies can be inflicted directly by using Vile Vials, which are consumables. Vile Vials also have a small chance of inflicting a Vicious Malady. If a player has vicious malady, this will be harder to perform surgery but can give special rewards such as Doctor's Blingin' Set. Vicious maladies can be made easier if the player has a UV Vaccine equipped.

The vile vials of each malady are:

Vile Vial Recipe Reward Possible reward from curing a vicious malady
Vile Vial - Lupus Possible bonus reward from completing a WOLFWORLD.

Malady can be caught upon completing a WOLFWORLD.

Snakewolf (very rare)

Howly Hat (rare)

Doctor's Lab Coat (rare)

Mean Wolf Block (common)

Doctor's Blingin' Mask
Vile Vial - Moldy Guts Possible bonus reward from infecting another player with the G-Virus or by infecting people while being a zombie.

Malady can be caught by infecting people while being a zombie, or killing zombies.

Block o' Barf (rare)

Gut Buster (rare)

Stitchlips (common)

Doctor's Blingin' Booties
Vile Vial - Ecto-Bones Possible bonus reward from exploding a Spirit Storage Unit.

Malady can be caught while catching ghosts.

Ghostking's Glory (very rare)

Ecto-Lock (rare)

Steppin' Ghost (common)

Doctor's Blingin' Pants
Vile Vial - Chaos Infection Possible bonus reward from defeating Growlactus.

Malady can be caught when completing a Startopia voyage.

Hands of the Void (rare)

Feet of the Void (rare)

Chaos Corruption (very rare)

Scarf of Prometheus (very rare)

Doctor's Blingin' Cross
Vile Vial - Fatty Liver Possible bonus reward from cooking any meal with at least 95% quality.

Malady can be caught by cooking any meal.

The Fattenator (very rare)

Cupcake Hat (rare)

Big Belly (rare)

Doctor's Blingin' Top
Vile Vial - Brainworms Possible bonus reward from catching a perfect fish.

Malady can be caught by catching fish.

Clockwork Fish (random chance to get 1lb-200lb) (rare)

Wormtouch (very rare)

Doctor's Blingin' Cap

Malady De-Buffs

As of Player Appreciation Week 2024 - Day 1, being infected with a malady will grant you a de-buff that corresponds to the type of malady you have. These de-buffs include:

Malady Obtainment Debuff
Torn Punching Muscle · Punching · Reduced Punch Damage
Ecto-Bones · Ghost catching · Reduced Ghost Catching (by chance of a miss in catching a ghost)
Lupus · Completing WOLFWORLDs · Reduced WOLFWORLD time to complete to 8 minutes
Fatty Liver · Cooking · Reduced Cooking Quality
Chaos Infection · Completing Startopia voyages · Reduced Startopia Success (by higher chances of skill fails)
Moldy Guts · Killing zombies or infecting people · Reduced Zombie Hunting & Infection (by chance of a miss in killing a zombie or infecting people)
Chicken Feet · Walking and jumping · Reduced Jump Height
Brainworms · Fishing · Reduced Fishing Skill (by chance of a miss in catching a fish)
Grumbleteeth · Talking · Reduced Talking (all characters entered by the player into chat get replaced with "m" and "f")
Broken Heart · Completing a Surgery · Reduced Surgery Skills (by higher chances of skill fails)
Gem Cuts · Collecting Gems · Reduced Gems (by cutting gems picked up by half)

Surgery Rewards

Upon completing the surgery successfully, the player will directly receive a prize. Some of the rewards are rarer than others. If a player receives a common prize, the player will also be rewarded with a Caduceus, which can later be traded in for items when calling the Sales-Man using a Telephone.

Among the possible prizes are:

There are also exclusive rewards obtainable from doing a surgery on a player standing on a Starship Sickbay Bed. The possible prizes are:

If the player has successfully performed surgery on the patient, the patient will receive 100 gems, and a random surgery tool or 1-7 Vaccine Drops.

There are also exclusive rewards obtainable from doing a surgery on a Surg-Bot on an Operating Table. The possible prizes are:

Event-related Rewards

These rewards are only given by the player if they complete a surgery successfully during a particular time or event. These prizes are not guaranteed, as the player can also receive normal prizes.

Anniversary Week
UbiWeek
Valentine's Week
St. Patrick's Week
Easter Week
Grow4Good Week
Cinco De Mayo Week
Super Pineapple Party
Pegasus Pursuit
SummerFest
Garuda's Glory
Wonder Week
Halloween Week
WinterFest

Mods

  • Malpractice - If the player fails or gives up any surgery, the player is unable to perform surgery for the next hour. This mod can be removed instantly using Legal Briefs. It is reduced from 1 hour to 15 minutes during Surgery Day. Equipping a Healing Tome while the Malpractice mod is active will accelerate the countdown, reducing it to 45 minutes from 1 hour. Additionally, on Surgery Day, the duration is further reduced to 11 minutes and 15 seconds.
  • Recovering - If the player has had surgery performed on them (regardless of failure or success), the player cannot have surgery performed on them for the next four hours (one hour if cured of a malady). Reduced from 2 hours to 1 hour during Surgery Day.

Events

Daily Challenge

In the Doctors' Duel Daily Challenge (and its respective Guild Challenge), players compete to complete the most successful surgeries in two hours (50 points per surgery and -1 point per tool used).

Surgery Day

Surgery Day is a monthly event where both the Malpractice (15 minutes instead of 1 hour) and Recovering (1 hour instead of 4 hours) mods are shorter than usual. The prizes that can exclusively be obtained during Surgery Day are as follows:

Surgeon Role

The Role Up! update was released on September 17th 2018 as Part 2 of the September Update. The update included roles that can be accessed through the /roles command. Leveling up specific roles will grant the player items. Each day, there will be a specific role that will give extra points and a Growtoken upon completing the first quest.

The following are the quests that can be encountered:

  • Complete 2-5 Surgeries
  • Submit 2 Caduceus
  • Submit 20 Hospital Door
  • Submit 20 Hospital Window
  • Submit 20 Hospital Curtain
  • Submit 20 of a Surgical Tool.

Steady Hands is the Surgeon Role bonus that can level up as the player progresses their roles.

  • Level 2: 0.5% increase to success chance when using Surgery Tools.
  • Level 4: 1% increase to success chance when using Surgery Tools.
  • Level 6: 1.5% increase to success chance when using Surgery Tools.
  • Level 8: 2% increase to success chance when using Surgery Tools.
  • Level 10: 3% increase to success chance when using Surgery Tools.
  • Level 10: Unique Surgeon's Flag and skin.

The following items are earned as the player levels up their Surgeon Role:

Items Recipe
EMT Jumpsuit Reach Surgeon Level 1.
Bio-Waste Has a chance of being awarded to the player for completing a Surgery after reaching Surgeon Level 3.
Tiled Hospital Wall Has a chance of being awarded to the player for completing a Surgery after reaching Surgeon Level 4.
Toffee Block Has a chance of being awarded to the player for completing a Surgery after reaching Surgeon Level 5.
Electrical Power Cube Has a chance of being awarded to the player for completing a Surgery after reaching Surgeon Level 6.
Operating Theater Lamp Has a chance of being awarded to the player for completing a Surgery after reaching Surgeon Level 7.
Tiled Staircase Has a chance of being awarded to the player for completing a Surgery after reaching Surgeon Level 9.
Slip 'n' Slide Slime Floor Has a chance of being awarded to the player for completing a Surgery after reaching Surgeon Level 10.
Wheelchair Speedster Reach Surgeon Level 10.

During a Surgeon Day, the points from completing a Surgeon role quest is increased by 25%. Completing a quest for the first time on that day will reward a Growtoken.

Angel of Mercy's Wings and Dr. Title

During the Blocktor's Orders! update on 13 June 2019, the Angel of Mercy's Wings was added as a prize for successfully completing a vicious malady while equipping a Doctor's Blingin' Booties, Doctor's Blingin' Cap, Doctor's Blingin' Cross, Doctor's Blingin' Mask, Doctor's Blingin' Pants and Doctor's Blingin' Top, provided that they have completed 2,000 surgeries after the update was released (Train-E's do not count). If the player tries to do this before having done 2,000 surgeries, a system message will appear on the amount of surgeries remaining, and the set is not consumed.

To obtain the Dr. Title, the player needs to complete 3,000 surgeries while wearing the Angel of Mercy's Wings (progress is displayed in the description of the wings, for every surgery done, it counts as an Angelic Healing). This will add "Dr." before the player's name and change the color to red.

Achievements

Below are the list of Achievements that are related to Surgery.

Achievements Description
Surgeon (Classic) Earned for successfully performing surgery.
Chief Of Surgery (Classic) Earned for performing 20 successful surgeries.
Surgeon General (Classic) Earned for performing 100 successful surgeries.
The Doctor Earned for performing 1,000 successful surgeries.
Master Surgeon Earned for reaching level 10 on Surgeon Speciality.
Bones! Earned for successfully performing 10 surgeries on a Starship Sickbay Bed.
Vicious Victory Earned for successfully curing 50 patients of any Vicious malady.
Angel of Mercy Earned for joining the Angels of Mercy.

To earn this achievement, players must equip the Doctor's Blingin' Top, Doctor's Blingin' Pants, Doctor's Blingin' Mask, Doctor's Blingin' Cross, Doctor's Blingin' Cap and Doctor's Blingin' Booties and successfully perform 2000 surgeries.

Medical Marvel Earned for performing 3000 surgeries as the Angel of Mercy.

To earn this achievement, players must equip the Angel of Mercy's Wings and successfully perform 3000 surgeries.

Hospitals

Hospitals were introduced to the game as a part of Player Appreciation Week 2024 Day 1 on August 26, 2024. Upon placing a Reception Desk in any world, the world can function as a hospital.

General Information

Anyone can view information about a hospital by wrenching the Reception Desk, whether they have access to the block or not. The desk displays the level and ratings of the hospital while allowing the owner to:

  • View their Hospital Stats.
  • Level up their hospital.
  • Add other players as registered doctors in their hospital.

The table below shows hospital upgrading requirements and rewards:

Levels
Requirements
Perks
Rewards
Level 1 to 2
  • Cure 20 Patients
  • Add 1 Doctor
  • Reach 1 Rating
  • Cure 5 Torn Punching Muscle Malady
  • Cure 5 Gem Cuts Malady

Cost: World Lock ×10

  • Operating Table capacity +1
  • Surg-E Patient Duration: Between 4 hours, 5 minutes and 6 hours
Level 2 to 3

Cost: World Lock ×20

  • None
Level 3 to 4

Cost: World Lock ×20

  • Operating Table capacity +1
  • Surg-E Patient Spawn Delay: Between 22 hours, 55 minutes and 1 day, 1 hour
  • Surg-E Patient Duration: Between 4 hours, 10 minutes and 6 hours, 10 minutes

All types of maladies that Auto Surgeon Station can cure now require 1 less Surgical Scalpel

Level 4 to 5

Cost: World Lock ×30

Level 5 to 6

Cost: World Lock ×30

  • Surg-E Patient Duration: Between 4 hours, 15 minutes and 6 hours, 10 minutes
Level 6 to 7

Cost: World Lock ×40

Level 7 to 8

Cost: World Lock ×40

  • Auto Surgeon Station capacity +1
  • Operating Table capacity +1
  • Doctor Capacity +1
  • Surg-E Patient Spawn Delay: Between 22 hours, 50 minutes and 1 day, 50 minutes
  • Surg-E Patient Duration: Between 4 hours, 20 minutes and 6 hours, 20 minutes

All types of maladies that Auto Surgeon Station can cure now require 1 less Surgical Stitches

  • None
Level 8 to 9

Cost: World Lock ×50

Level 9 to 10

Cost: World Lock ×50

  • Operating Table capacity +1
  • Surg-E Patient Duration: Between 4 hours, 25 minutes and 6 hours, 20 minutes
Level 10 to 11

Cost: World Lock ×50

  • None
Level 11 to 12

Cost: World Lock ×60

  • Surg-E Patient Spawn Delay: Between 22 hours, 45 minutes and 1 day, 50 minutes
  • Surg-E Patient Duration: Between 4 hours, 30 minutes and 6 hours, 30 minutes

Ecto-Bones Malady that Auto Surgeon Station can cure now require 1 less Surgical Splint

Level 12 to 13

Cost: World Lock ×60

Level 13 to 14

Cost: World Lock ×70

  • Auto Surgeon Station capacity +1
  • Doctor capacity +1
  • Surg-E Patient Duration: between 4 hours, 35 minutes and 6 hours, 30 minutes
  • None
Level 14 to 15

Cost: World Lock ×70

  • None
Level 15 to 16

Cost: World Lock ×70

  • Operating Table capacity +1
  • Surg-E Patient Spawn Delay: Between 22 hours, 40 minutes and 1 day, 40 minutes
  • Surg-E Patient Duration: Between 4 hours, 40 minutes and 6 hours, 40 minutes
Level 16 to 17

Cost: World Lock ×70

  • None
  • None
Level 17 to 18

Cost: World Lock ×80

  • Operating Table capacity +1
  • Doctor capacity +1
  • Surg-E Patient Duration: Between 4 hours, 45 minutes and 6 hours, 40 minutes
Level 18 to 19

Cost: World Lock ×80

  • None
Level 19 to 20

Cost: World Lock ×80

  • Surg-E Patient Spawn Delay: Between 22 hours, 35 minutes and 1 day, 40 minutes
  • Surg-E Patient Duration: Between 4 hours, 50 minutes and 6 hours, 50 minutes
Level 20 to 21

Cost: World Lock ×80

Level 21 to 22

Cost: World Lock ×90

  • Doctor capacity +1
  • Surg-E Patient Duration: Between 4 hours, 55 minutes and 6 hours, 50 minutes
  • None
Level 22 to 23

Cost: World Lock ×90

Level 23 to 24

Cost: World Lock ×90

  • Surg-E Patient Spawn Delay: Between 22 hours, 30 minutes and 1 day, 30 minutes
  • Surg-E Patient Duration: Between 5 hours and 7 hours
  • None
Level 24 to 25

Cost: World Lock ×90

  • None
Level 25 to 26

Cost: World Lock ×100

  • Surg-E Patient Duration: Between 5 hours, 5 minutes and 7 hours
  • None
Level 26 to 27

Cost: World Lock ×100

  • None
Level 27 to 28

Cost: World Lock ×100

  • Surg-E Patient Spawn Delay: Between 22 hours, 25 minutes and 1 day, 30 minutes
  • Surg-E Patient Duration: Between 5 hours, 10 minutes and 7 hours, 10 minutes

None

Level 28 to 29

Cost: World Lock ×100

Level 29 to 30

Cost: World Lock ×100

  • Surg-E Patient Duration: Between 5 hours, 15 minutes and 7 hours, 10 minutes
  • None
Level 30 to 31

Cost: World Lock ×110

Level 31 to 32

Cost: World Lock ×110

  • Surg-E Patient Spawn Delay: Between 22 hours, 20 minutes and 1 day, 20 minutes
  • Surg-E Patient Duration: Between 5 hours, 20 minutes and 7 hours, 20 minutes
  • None
Level 32 to 33

Cost: World Lock ×110

  • Doctor capacity +1
Level 33 to 34

Cost: World Lock ×110

  • Surg-E Patient Duration: Between 5 hours, 25 minutes and 7 hours, 20 minutes
  • None
Level 34 to 35

Cost: World Lock ×110

  • None
Level 35 to 36

Cost: World Lock ×110

  • Surg-E Patient Spawn Delay: Between 22 hours, 15 minutes and 1 day, 20 minutes
  • Surg-E Patient Duration: Between 5 hours, 30 minutes and 7 hours, 30 minutes
  • None
Level 36 to 37

Cost: World Lock ×110

Level 37 to 38

Cost: World Lock ×120

  • Surg-E Patient Duration: Between 5 hours, 35 minutes and 7 hours, 30 minutes
  • None
Level 38 to 39

Cost: World Lock ×120

  • None
Level 39 to 40

Cost: World Lock ×120

  • Operating Table capacity +1
  • Surg-E Patient Spawn Delay: Between 22 hours, 10 minutes and 1 day, 10 minutes
  • Surg-E Patient Duration: Between 5 hours, 40 minutes and 7 hours, 40 minutes
  • None
Level 40 to 41

Cost: World Lock ×120

  • Doctor capacity +1
  • None
Level 41 to 42

Cost: World Lock ×120

  • Doctor capacity +1
  • Surg-E Patient Duration: Between 5 hours, 45 minutes and 7 hours, 40 minutes
Level 42 to 43

Cost: World Lock ×120

  • None
  • None
Level 43 to 44

Cost: World Lock ×120

  • Surg-E Patient Spawn Delay: Between 22 hours, 5 minutes and 1 day, 10 minutes
  • Surg-E Patient Duration: Between 5 hours, 50 minutes and 7 hours, 50 minutes
  • None
Level 44 to 45

Cost: World Lock ×120

  • None
  • None
Level 45 to 46

Cost: World Lock ×120

  • None
Level 46 to 47

Cost: World Lock ×130

  • None
  • None
Level 47 to 48

Cost: World Lock ×130

  • Surg-E Patient Spawn Delay: Between 22 hours, and 1 day
  • Surg-E Patient Duration: Between 6 hours, and 8 hours
Level 48 to 49

Cost: World Lock ×130

  • Doctor capacity +1
  • None
Level 49 to 50

Cost: World Lock ×130

  • Surg-E Patient Duration: Between 6 hours, 5 minutes and 8 hours
  • None

Extra Info About Upgrading Process

The following formula is used to calculate the cured patients requirement for the hospital leveling system:

P = 30*L^2 - 30*L - 40

where L is the level of the Hospital and P is the amount of cured patients required to reach level L.

Hospital Exclusive Items

The following items are only obtainable through performing specific actions in a Hospital World:

Item Recipe
Operating Table 1 can be obtained from leveling up the hospital.
Auto Surgeon Station
Aura of Zen 1 has a chance to be obtained from performing a surgery on a:
•    Surg-Bot on an Operating Table.
OmriTheBest's Brain

Trivia

  • Players can talk during surgery by clicking any of the blank tools and quickly pressing the chat button (or the Enter button).
  • Players can trade the Caduceus they earn from receiving common prizes from surgery to the Sales-Man for rarer items, such as the Thingamabob and Medical Scarf.
  • Successfully performing a Massive Trauma surgery for the first time completes an Epic Quest.
  • Players who get cured of any malady have a small chance to get a rare prize from the respective malady.

Gallery

  • Player with Doctor's Title and Angel of Mercy equipped
    Player with Doctor's Title and Angel of Mercy equipped
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