A character can perform surgical operations to remove life-threatening conditions. For example, if a person has a badly infected (e.g. gangrenous) leg, the leg could be amputated. If a person suffers a bursting appendix, an operation could remove the appendix. If a baby is being born in the breach position, a caesarian section might save the baby's and/or mother's life.
In what is essentially a mediaeval world, surgery is a last resort and can often end up killing the recipient. It should be reserved for situations where the person on which the surgery is being performed will probably die without the operation.
An operation will remove a source of wounds from the person on which the operation is being performed. For example, when a leg is amputated, all wounds on the leg are removed with it. However, the operation itself causes a new wound (which may in some cases be worse than the wound the surgery was meant to cure).
The level of the new wound caused by the operation depends on the result of a dice roll made by the character performing the operation. The character should use his/her Medicine (including surgery specialism) + ST (if the operation is an amputation requiring brute force and speed) or CO (if the operation is an internal operation requiring fine control). The dice roll result determines the wound level as follows:
| Wound level caused by surgery | Low risk (e.g. cutting out a lump, trachiotomy, etc.) | Medium risk (e.g. amputating a limb, etc.) | High risk (e.g. removing an appendix, caesarian section) | Very high risk (e.g. open heart surgery) |
| Scratch | 10 1/2 or more | N/A | N/A | N/A |
| Light | 5 1/2 - 10 | 14 1/2 or more | N/A | N/A |
| Medium | 1/2 - 5 | 10 1/2 - 14 | 15 1/2 or more | N/A |
| Serious | 0 or lower | 6 1/2 - 10 | 10 1/2 - 15 | 14 1/2 or more |
| Critical | N/A | 2 1/2 - 6 | 5 1/2 - 10 | 8 1/2 - 14 |
| Fatal (i.e. patient dies during operation) | N/A | 2 or lower | 5 or lower | 8 or lower |
There is a +4 modifier on the dice roll if the person on whom the operation is being performed is anaesthetised through drugs or acupuncture.
If the patient survives the operation, the new wound created in the operation can cause shock or become infected in the normal way for a wound. Hence, the patient may survive the operation but die from the consequences later.