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1[[quoteright:350:https://static.tvtropes.org/pmwiki/pub/images/surgeon-simulator-2013_8086.jpg]]
2[[caption-width-right:350:Don't worry, [[BlatantLies I'm a trained professional.]]]]
3
4->''"It's somewhere between TabletopGame/{{Operation}} and VideoGame/{{QWOP}}."''
5-->-- '''LetsPlay/NerdCubed'''
6
7''Surgeon Simulator'', formerly named ''Surgeon Simulator 2013'', is an inspiring video game in which you take on the role of a skilled surgeon, deftly saving precious lives on the operating table.
8
9[[BlatantLies Yeah, right.]]
10
11''Surgeon Simulator'' is, if anything, a [[NeverTrustATitle very inaccurate simulator]] wherein you control the hand of [[BackAlleyDoctor "surgeon"]] Nigel Burke, allowing you to attempt all kinds of bizarre operations. Since Nigel is apparently either suffering from a neurological disorder, coming down from the effects of anesthesia, or grossly incompetent, this mostly involves failing in [[BlackComedy hideous yet hilarious ways]]; as the first hurdles involve [[FakeDifficulty learning to grasp objects]], it isn't hard to imagine the results you'll be seeing.
12
13The original version, created in just 48 hours, gained popularity very quickly due to its infamously horrible (albeit humorous) control scheme and difficulty. A full version was [[http://store.steampowered.com/app/233720/ released on Steam]] in April 2013 to critical acclaim.
14
15During the 2019 Game Awards, Bossa Studios [[https://www.youtube.com/watch?v=NzEqC1cxfc0 announced a sequel]], ''VideoGame/SurgeonSimulator2'' that entered into open beta in August 2020.
16
17See also ''VideoGame/IAmBread'', another Bossa Studios game with similarly wacky controls. Nigel later made an appearance in the SpiritualSequel, ''VideoGame/IAmFish''.
18
19----
20!!Perform a Tropes Transplant...
21
22* AcceptableBreaksFromReality: It doesn't take a medical degree to realize that there's more to heart replacement surgery than just plopping a new heart where the old one used to be. Then again, adding realism would make things extremely complicated for minimal gain in fun.
23* AchievementMockery:
24** "What Have I Done??" requires you to lose your patient within 15 seconds.
25** "Hammer Time" requires you to lose a total of 50,000ml of blood using the hammer.
26** "It's In! It's In I Tell You!" requires you to lose the patient even though the replacement organ lands safely in its intended spot.
27** "Enter The Code" is awarded for successfully typing in a code during the space surgery [[ThrownOutTheAirlock that opens up the door to outside]], leading to NonStandardGameOver.
28** "I Have No Idea What I'm Doing" requires you to quickly smash up all the canisters containing the replacement organs during the [[spoiler:alien]] surgery.
29* AffectionateParody: Of the genuine surgery game ''Surgery Simulator 2011''.
30* AlienBlood: The alien in the alien surgery level has blue blood.
31* AllThereInTheManual:
32** The Steam page and the diploma names the surgeon Nigel Burke.
33** The Britannia 88 discs to the side of the computer offer diagrams of how to properly sever various organs and bones, as well as suggesting which tools to use. It isn't always good about suggesting the best ones, though. The Know Your Syringes disc teaches you what the two colored syringes do, including the very important knowledge that the green one stops bleeding. You have to beat the appropriate surgery once to actually unlock the requisite disc, though, and the syringe disc is last.
34** The phone calls seem to say that Nigel is probably drugged, and might not even be a real doctor.
35** [[http://mrnigelburke.tumblr.com/ Nigel has a tumblr.]]
36* AlreadyDoneForYou: You gotta wonder who exactly cuts out the skin of the patients and then hands these patients over to Nigel...
37* ArtisticLicenseMedicine: Some minor liberties have been taken regarding human physiology, such as being able to survive without otherwise vital organs. [[WhoEvenNeedsABrain Like a brain.]]
38** Also [[LampshadeHanging alluded to]] with some achievements: for example, "I'm sure he'll live" requires finishing surgery when the patient has a very small amount of blood left.
39** An average human male can lose up to 40% of his blood before his body can no longer keep up with the loss and he's on his way to a better world (unless some immediate medical help is applied), and even at this point his body becomes rather pale (which isn't shown in the actual game). This means that once your patient's blood level goes below 3360ml, "I'm sure he'll live" becomes a rather [[BlatantLies blatant lie]]. Not that it's saying much, considering Nigel's methods of performing the surgeries...
40** This also applies to you, the player character. Rather than wear gloves or any other form of protection, you're jabbing needles and knives into exposed body parts and tissue with absolutely nothing to stop the blood and other fluids getting on your hands. Hell, it's doubtful you're even wearing anything like scrubs, a face mask, or a hair net. It's a good thing the patients don't have any diseases that transfer via contact with skin or other liquids, otherwise you'd probably have gotten very ill or otherwise dead soon after the first operation.
41** The A&E DLC adds a phone call from Bob, who says he feels much better, but isn't sure he should be able to see into his own ribcage. Guess nobody bothered to close him back up after Nigel was finished.
42* AscendedMeme:
43** "Like an Animal" and "Like a Wet Paper Towel" are taken from the famous Creator/AchievementHunter [[https://www.youtube.com/watch?v=Y2F3ZWEEbF4 video of it]].
44** The "Shh I Doctor Now" achievement was taken from a image macro.
45** Likewise, the achievement "I Should Never Have Doubted Myself", and the patient's official name being Bob, are taken from the Let's Play done by LetsPlay/{{Robbaz}}.
46** Achievements have been added in the most recent update referring to the [[https://www.youtube.com/watch?v=AYjCXjIeNJk gameplay video by Birgirpall]], including one that requires you to do a 180 Spoon Flip.
47** The "It's In! It's In I Tell You" achievement was inspired by a LetsPlay/PewDiePie accident: He placed the heart upside-down and couldn't fix that before the patient died.
48* AwesomeButImpractical: There are a great many tools, most of which are fun to play with. All of them are fairly useless compared to the humble hammer, bone saw, and scalpel.
49* BatterUp: The hammer replacement in the ''Meet the Medic'' level, courtesy of the Scout.
50* BizarreAlienBiology: [[spoiler:The alien surgery has a bunch of organs with nonsensical names, and each time only one out of six is the right one. Among them is a stomach ball, a glowing intestine, some kind of living creature which makes noise when you detach it, a purple lung, an orange heart-like thing that causes hallucination if you touch the spikes, and a cybernetic implant. The organ names are Easter eggs, each one based on popular [=YouTubers=] who have played the game, including LetsPlay/{{Robbaz}}, LetsPlay/PewDiePie and [[Creator/AchievementHunter Gavin Free and Michael Jones]].]]
51* BlackComedy: It starts with being able to smash the ribs of the patient you're doing a heart transplant on and goes further from there.
52* BlatantLies:
53** When you fail: "And it was going so well."
54** When you succeed: "Looks fine to me, I'm sure he'll live."
55* BloodyHilarious: The whole point.
56* BonusLevel: The space heart surgery was initially this, unlocked once you beat the rest of the game. The game was then updated, adding two more levels based on the other two surgeries and making the bonus level part of the regular rotation. The new bonus level requires figuring out the code to the keypad in the final level, unlocking the [[spoiler:alien surgery]].
57* BoringButPractical: With the exception of the eye and teeth surgeries, every operation is best attempted using a combination of the bone saw (or hammer) and a scalpel, which will reliably net an A++ rating. The eye surgery adds a pencil to the mix and cutting is best accomplished with scissors, while the teeth surgery needs a small hammer and tweezers to put the new teeth in.
58* BrainInAJar: Where you get the replacement brain.
59* BraggingRightsReward: An A++ rating on all surgeries gets you a fancy certificate. The certificate actually serves a purpose following the update which added more space levels, containing one third of a code that unlocks the bonus level. Beating the ''Meet the Medic'' bonus level gets you a little Medic figurine. Beating the [[spoiler:alien surgeries]] nets you an [[spoiler:alien head bust]].
60* BunnyEarsLawyer: Granted, Nigel can transplant a heart in a matter of minutes, but it doesn't change the fact he simply removes and discards other bones and organs to get there quicker. Exaggerated when you realize he performs kidney operations by going through the abdomen ''instead of more directly through the back.''
61* CentipedesDilemma: Go ahead and pick up the closest object to you right now. Effortless, right? Now try to do it by consciously thinking which muscle you're going move next then doing it all one at a time. Then imagine what it'd be even worse to do it without being able to feel the object you're picking up (i.e. what's touching it and what isn't) and you get why the control scheme for a hand is so difficult.
62* ComicallyIneptHealing: Every single other trope on this page should elaborate on how.
63* TheComputerIsALyingBastard: The Britannia 88 discs recommend various tools to do the operations. Half the time, it's full of crap.
64** The brain surgery recommends slicing the brain stem with the hatchet. Doable? Absolutely. Needlessly dangerous? Of course. A scalpel will do the same job and causes less damage if you miss.
65** For the eye surgery, you have to stab the eyes and yank them out. The game recommends a scalpel, which causes bleeding. Pencils do the job without losing a drop. Then you have to shake the eyes out of the sockets once you've loosened them, which the game tells you do by taking a hammer to his temples. Bitch-slapping the patient (no, seriously) does the same job without blood loss.
66** The game says you should use the drill to get the teeth out. Not only are you liable to accidentally hit the patient trying to aim that unwieldy thing, it causes far more blood loss than a small hammer will, the latter also being more accurate.
67* CriticalExistenceFailure: The patient will do just fine no matter what you do to him, even if he has just 1 milliliter of blood left. If that last milliliter drops to zero, the patient dies.
68* {{Crossover}}: The first DLC, released as a free update on June 21st, 2013, adds a new level accessed via a research tape Nigel has on his desk. It's essentially the operation from ''Meet the Medic'', where you're [[VideoGame/TeamFortress2 the Medic]], tasked with installing the Uber Heart into [[VideoGame/TeamFortress2 the Heavy]].
69* DrivesLikeCrazy: Whoever's driving the ambulance during the Ambulance Operations either has a serious case of reckless road rage or has to put up with horrible traffic conditions...or all of the above. It doesn't change the fact that their constant swerving and braking is going to make it that much harder to operate without killing the patient.
70* EarlyInstallmentWeirdness: The infamous prototype version of the game that was made in 48 hours feels very strange compared to the more fleshed out version on Steam; there's no persistent blood loss, there's less tools to use, the syringes aren't included, it only has heart surgery, and said surgery is easier because the patient has no stomach or liver to dig out. Nigel is also voiced here and reacts to various actions with a mixture of distress and disgust.
71* EnergyWeapon: The surgical laser. It can cut through anything, but it causes ''massive'' blood loss if you use it on soft tissue. Prior to the A&E DLC, it also caused no blood loss when cutting bone, which has since been adjusted to cut bone quickly at a loss similar to the hammer (if you're careful). There's an achievement for beating a level with only the laser, best attempted on the brain surgery.
72* ExplosiveOverclocking: As in the ''Meet the Medic'' video, attempting to ubercharge a normal heart makes it explode.
73* EyeScream: The eye transplants from the A&E DLC. As if the fact that you have to rip out your patient's eyes wasn't enough, the recommended way to make them come out of their sockets is to ''jam a pencil into each one with full force and then yank it out.'' Then, just for fun, you can stuff fake eyes back in the hole, ''and it still counts''.
74* FaceDoodling: The ''Inside UsefulNotes/DonaldTrump'' DLC lets you doodle and apply makeup to Donald Trump's face.
75* FantasticallyChallengingPatient: In one operation, you open a metal capsule with a hiss of steam, revealing an opened alien lying in front of you with an array of bizarre internals of all shapes and sizes. As you're taking the role of a surgeon, your goal is to perform a transplant of one of several bizarre organs.
76* FlippingTheBird: You can do this with the right keys held down. There's even an achievement for it.
77* GameBreakingBug:
78** Replacement organ or important tool clipping into the patient/table? ''[[UnintentionallyUnwinnable Hopefully you don't mind starting over.]]''
79** Especially guilty in the ''VideoGame/TeamFortress2'' level. Not only does opening the fridge for the second heart require twisting your arm backwards to hook the awkward handle, but the Medigun required to finish the operation can be infuriating; ignoring that it can get stuck pointed at the ceiling, rendering the level unwinnable and forcing you to reset, trying to aim it is difficult simply because you move it in directional nudges and it has a habit of [[FakeDifficulty not staying still when you let go of the controls.]]
80** The A&E DLC for the PC version causes unexpected problems for players who have already beaten the rest of the game. Surgeries previously beaten are locked until the proper triggering events are activated again. For the normal surgeries, you have to go through the eye and teeth surgeries in each section to reach the next set. For the space surgeries, you have to use the special disk generated by beating the normal ones. The alien and ''[=TF2=]'' surgeries likewise need their tapes to be used once to unlock them on the menu.
81* GrievousBottleyHarm: The Demoman's liquor bottle (several of them, in fact) is available in the ''Meet the Medic'' level. It'll break if you swing it hard enough.
82* GuideDangIt: This is very much a trial-and-error game, especially if you're going for A++. The first few times you play the game, it'll be an achievement just getting through the bones, let alone taking out an organ. It certainly doesn't help that the Britannia 88 discs, which are supposed to teach you how to properly perform tasks, aren't unlocked until you've beaten the requisite surgery once and even then don't always recommend the best tools. There are, however, several specific examples that go above and beyond that.
83** The kidney surgery requires no less than five precision cuts just to get the first set of organs out, one of which is buried beneath the top set of intestines, forcing you to stab your way through. Then you have to get the kidneys out, which requires a spoon or some other soft object because they're positioned in such a way that you can't just grab them easily. ''Then'' you have to put the new kidneys back in at the right angle.
84** The eye surgery is relatively straightforward, except for the part where you have to yank the eyes out. Even in [[BloodyHilarious this game]], stabbing pencils in the eyes is on the low priority end of potential test attempts. Furthermore, it might not be immediately apparent that the same method can be used to put the new eyes back in.
85** The teeth surgery requires knowing (or at least making the uncharacteristically logical guess) that the tweezers will actually pick up teeth.
86** Deliberately invoked with the [[spoiler:alien]] surgery, which changes the objective on each playthrough and doesn't tell you what's what.
87** The ''[=TF2=]'' surgery has several points which are somewhat confusing, even if you've seen the associated short film it's based on. The fridge door has an obvious opening mechanism but it is extremely difficult to actually use it (use your hand as a sideways hook on the end). The tools also cause varying amounts of blood loss, so getting an A++ requires finding the tool which will get through the ribs with a minimum of blood loss.
88* HubLevel: Nigel's desk, which contains floppy disks (tutorials and other stuff), a clipboard with notes (access to the surgery levels, change the game's options, and view achievements), and a VCR with cassette tapes (used to play the ''VideoGame/TeamFortress2'' crossover surgery and [[spoiler: the alien surgery]]). Because you control Nigel's hand the same way as you do in a surgery, you're bound to send the objects on the desk flying and crashing to the floor. Luckily, you can reset the desk to restore everything to their original positions.
89* ImprovisedWeapon:
90** Accidentally dropped the drill? Maybe you can open his ribcage with a hammer! Lost the hammer out of the back of the ambulance? This LASER will do!
91** At least in the original version, every object given to you is capable (with some effort) of breaking the ribs, and only a few are ''not'' capable of cutting out the heart. So you can complete the ''entire'' surgery with nothing but a scalpel, or a pen, or a shard of broken glass. You could even tear out ribs ''with your bare hands.''
92** The ''Meet the Medic'' level is an even bigger offender, having replaced all of the surgical tools with the melee weapons of the different classes (where appropriate).
93* InfiniteSupplies: In all of the Corridor surgeries, your supplies and replacement organs are randomly carted to you and then roll away after a few seconds. Even if you knock all of the organs or supplies off the cart, there will always be another cart with replacements coming up. Actually getting the supplies you need on the next cart, however, [[RandomNumberGod is hit or miss]].
94* InstantWinCondition: It doesn't matter if the patient is at double-digit milliliters of blood, their ribs are completely smashed, and they're missing a lung; as long as you do the specific thing you were asked to, the game counts the surgery as completed. The game does give you a better rank for less time and low blood loss, though.
95-->"[[BlatantLies Looks fine to me, I'm sure he'll live]]."
96** One achievement requires getting the patient down to 10 or less milliliters before saving them.
97* InterfaceScrew:
98** Grabbing the green syringe by the needle end will cause you to hallucinate, giving you purple and green double vision and distorting the music. Doing the same to the purple one cancels it out. Jamming a scalpel in the electrical socket will cause your mouse movements to reverse.
99** Ambulance mode randomly tosses objects in the air and throws your hand side to side as a consequence of the vehicle swerving. Space mode removes gravity, which makes it even harder to grab objects and keep them in place.
100** Corridor mode in the [=iPad=] version and the A&E Steam DLC has your patient rushing down a corridor. Aside from putting almost all of your instruments in random carts you pass by, at random intervals you'll smash open a door, which will probably send everywhere whatever is on the operating table.
101* IntoxicationEnsues: Stabbing yourself with the green syringe will cause an InterfaceScrew to simulate being drugged up. Thought performing surgery was hard ''before''?
102* IntoxicationMechanic: Among the tools that can be used in each stage are a pair of syringes that can either speed up a patient's bleeding or stop it. Pricking yourself on the stop-bleeding needle, even accidentally, will result in your vision and hearing being distorted, but this can be reversed by pricking yourself on the other needle.
103* LuckBasedMission: Everything after the first missions, which take place outside of an operating theatre.
104** The eye transplant is complicated by the fact that the patient's head isn't secured and they tend to flail around as you're cutting their eyes out. Not to mention the fact that the eyes have four different cut points and bleed profusely as you're doing it.
105** The teeth transplant, if you're going for time, can be a breeze or a nightmare. The three requisite teeth are randomized, so you can get two at opposite corners or the mouth or all three dead-center.
106** If you're going for the time achievements, Corridor mode leaves you at the mercy of the RandomNumberGod, who may or may not give you the tools/organs you need to do the job in a timely manner.
107** Ambulance mode's constant jostling can cause you to fail through no fault of your own. This makes any of the related achievements that much harder to earn.
108** Space missions are even worse, since there's no gravity and you don't have limitless reach. You have to make sure your tools don't go floating away. Heart surgery ''requires'' trapping the heart in its case, because it ''will'' float away.
109* MadDoctor: According to the various phone calls that you can listen to, Nigel Burke is a... troubled individual, apparently being on quite a lot of drugs as well as donating MysteryMeat to a friend's kebab shop. His landlord also chews him out for leaving red footprints all over his apartment building and his father chastises him for getting 'ketchup' stains all over his new trousers.
110* MagicalDefibrillator: In the [=iPad=] version. Once charged, all you have to do is put the paddles on a {{flatlin|e}}ing patient to revive them.
111* MeatgrinderSurgery: Literally the only way to accomplish anything is to rip out everything between you and the organ you intend to fix. It gets even worse if you're going for time achievements. Most of those involve throwing caution to the wind and butchering the patient as fast as possible, hoping you fix him before he bleeds out.
112* MedicalGame: This is basically a game where you play as a surgeon but the physics of the game screw you over.
113* MortonsFork: In the [=iPad=] version, repeated injuries make the patient's heart rate rise until he goes into cardiac arrest, at which point the player has to use the defibrillator to save the patient. Alternatively, the player can use anesthetics to lower the patient's heart rate... until he completely stops it. Whip out the defibrillator again...
114* NoOSHACompliance:
115** Ambulance mode, to the point where even the doors aren't shut properly.
116** Who needs gloves? You don't! Who needs a hatchet? You do!
117** Due to the awkward positioning of the kidneys, one of the more efficient means of getting them out once you've severed them is to knock them loose with a pencil or spoon.
118** Oops, my watch fell in again.
119*** Not just watches: If you accidentally drop a tool into the patient, it may be prudent to just ''leave'' it there, especially during Corridor Mode where you can just get a replacement anyway.
120** Corridor Mode in the [=iPad=] version and the A&E DLC on Steam. Rushing down a corridor to quickly take the patient to their operation is a staple in medical dramas. ''Operating'' while ''you are rushing down said corridor'', taking your instruments from random carts you pass by, is definitely '''not'''.
121* OutsideTheBoxTactic: While the game does give you instructions on how to do certain surgeries properly, sometimes it can be easier or safer to use a completely different method to perform an operation by experimenting with other tools.
122* PhonyDegree: After completing the surgeries with an A++ rating, a diploma appears on your desk that says that you're a qualified surgeon. It seems legit at first, until you notice that the name seems to be written on what appears to be correction fluid... implying that the main character actually ''stole someone's diploma and forged it to make it seem like it's his own.''
123* PlotHole: If Nigel isn't even a proper doctor, doing butcher-like surgery, why the hell did [=NASA=] send him to space to do surgery? This might be explainable by RuleOfFun, or [[ReassignedToAntarctica a way to get him as far away from Earth as possible]].
124* OpenHeartDentistry: In the anniversary edition, Nigel has expanded his expertise to dentistry.
125* RecycledInSpace: The Space levels, and the hidden [[spoiler:alien level]].
126* RefugeInAudacity: Cutting out peoples' vital organs in order to perform surgery on other vital organs? [[BloodyHilarious Perfectly acceptable]].
127* RoadsideSurgery: Plays it for laughs, by having Nigel - the highly inept surgeon you're playing as - performing surgery in various, less-than-ideal situations. This includes an ambulance with a crazy driver, him running down a corridor, or operating while in space with zero gravity.
128* SarcasmMode: ''The title''.
129* SaveScumming: In Corridor mode, getting a high rank/time achievement basically requires restarting constantly until the carts produce the necessary tools/organs in a timely manner.
130* TheSecretOfLongPorkPies: It's implied that Nigel's been donating spare organs from surgery as tripe for his dad's butcher shop.
131* SequenceBreaking: In a meta example, the code for the [[spoiler:alien surgery]] requires deciphering three clues, each containing one, two-digit section of the number. As soon as people got the second clue, which was the most straightforward of the bunch, they brute-forced the remaining four digits (on a keypad with no zero, this is 6561 combinations to try). The answer to the first clue became obvious after that, and the third code proved to be the most obscure of the bunch.
132* ShoutOut: Quite a few of the Steam Achievements are references to things.
133** In a non-achievement related note, doesn't the laser look like a [[Series/DoctorWho certain screwdriver?]]
134*** Additionally, the achievement "Vworrrp Vworrrp" requires you to "create a Time Lord".[[labelnote:explanation]]The achievement itself refers to Time Lords having two hearts, and requires inserting the transplant before removing the old organ (plus your watch for the "time" part).[[/labelnote]]
135** The kidney transplant is the first level in which you can use the laser. The patient has a ventilator that sounds just like [[Franchise/StarWars Darth Vader's]] signature wheeze.
136** In the original version, using the hammer to break the ribcage would result not only in major blood loss, but said blood loss being labelled as "[[Music/MCHammer HAMMER TIME]]!"
137** The Surgeon's last name, Burke, is likely a reference to the famous bodysnatcher.
138** All but one of the [[spoiler:alien organs]] are shout outs to notable players and other recognizable names. These are:
139*** [[spoiler: [[LetsPlay/PewDiePie The Pewdsball]]]]
140*** [[spoiler: [[LetsPlay/{{Robbaz}} The Robbaloraz]]]]
141*** [[spoiler: [[Creator/AchievementHunter The]] [[Creator/GavinFree Gavi]][[Creator/MichaelJones chal]]]]
142*** [[spoiler: [[LetsPlay/NerdCubed The Cubed Trangrifier]]]]
143*** [[spoiler: [[LetsPlay/{{Birgirpall}} The Birgirspallex]]]]
144** The theme tune from the BBC medical drama ''Series/{{Casualty}}'' can be heard in-game.
145** The achievement for using the laser during the eye surgery is [[Franchise/MassEffect "Go For The Optics!"]]
146** The VR version features Webcomic/{{Polandball}}, as shown in [[https://youtu.be/Sb0aoJhe9mY?t=788 this video]]. Even though they mistake it for a [[Franchise/{{Pokemon}} Voltorb.]]
147* SistineSteal: Used in a promo image for the "Meet The Medic" DLC. Medic plays the role of Adam, while Nigel plays God.
148* SomeDexterityRequired: This is the point of the game. How well can you control your hand if you have to consciously manipulate all your fingers and your wrist at the same time, not to mention a total lack of sensation?
149** ASinisterClue: Given he's a VillainProtagonist, Nigel fits this instead.
150** The [=PS4=] version of A&E offers co-op multiplayer, one player operating each hand. Which is no doubt as chaotic as you'd expect.
151* StealthParody: Stealthy like the Hulk, but still some people on the internet managed to miss the joke.
152* StupidityIsTheOnlyOption: Need to get to a certain internal organ? Just break and toss everything else in your way. [[BlatantLies The patient is not going to need them]].
153* SuddenlyVoiced:
154** [[InvertedTrope Inverted]]; Nigel does speak in the demo, but he's completely silent in the full game.
155** Played straight with Bob, who is voiced in a new phone call added in the A&E DLC.
156* TheToothHurts: The [=iPad=] version and the A&E DLC on Steam have teeth transplants. There's an achievement for knocking them all out, and another for only getting the bad ones.
157* ThisIsADrill: A cordless drill is one of your tools, pretty much just for laughs. In the [=iPad=] version and the A&E DLC, it is recommended as the way to get the bad teeth out, but a small hammer is a lot safer.
158* ThroughTheEyesOfMadness: Nigel is presented this way in [[https://www.youtube.com/watch?v=LrBFUP7JLJ0 a promotional animation.]]
159* ThrownOutTheAirlock: By entering 296145 on the keypad in space brain surgery, you can do this to ''yourself''. It unlocks the [[spoiler:alien surgery]].
160* TrustMeImAnX: The achievement "Trust Me, I'm Not A Dentist."
161* UnintentionallyUnwinnable:
162** The ambulance and space levels, with their constant motion, can potentially toss your replacement organs or vital tools somewhere you cannot reach them. It doesn't happen that often, but it can.
163** Even the core missions apply, as dropping the transplant or a vital tool on the floor means ''you can't recover it.''
164** In the [[VideoGame/TeamFortress2 TF2]] [[DownloadableContent DLC]], the medigun can get stuck pointed upwards, with no way of bringing it back down.
165* VideoGameCrueltyPotential:
166** So much. The game even refers to a game over as [[LampshadeHanging "Brutal]] [[YouBastard Murder"]]. There's even an achievement for losing your patient in 15 seconds or less. Good way to do this? Take a bone saw to the guy you're doing a ''brain transplant on''.
167** Lampshaded in the "Meet the Medic" operation, where one of the Medic's "operation failed" lines has him calling it "doctor-assisted ''homicide''".
168* VillainProtagonist: It's strongly implied that Nigel is on drugs, sending MysteryMeat to his [[TheSecretOfLongPorkPies friend's diner]], is an organ thief, and is actually just someone posing as a doctor.
169* WhoEvenNeedsABrain: You can brutally remove the brain of your patient by cutting it off with a ''hatchet'' and then carelessly dunk a new one inside his skull, and he is still going to live afterwards. [[UnreliableNarrator Or so the game says...]]
170* WorstAid: This game can be considered a checklist of sorts of what NOT to do in an actual surgery.
171----
172->[[InstantWinCondition Looks fine to me]], I'm [[BlatantLies sure he'll live]]...

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