The X or Extreme missions are a special set of operations that are unlocked in Trauma Center games after completing all of the standard missions on any difficulty. These missions always are focused around a single GUILT or Stigma strain that is exceptionally more powerful than when encountered on any regular mission. These missions are listed under the "Extreme" difficulty.

Major Differences - GUILTEdit


  • Kyriaki attack with much higher frequency
  • Lacerations caused will deal much more damage
  • More Kyriaki bodies will be present
  • If on Under the Knife 2: the number of Kyriaki pupas will increase each time the Queen Kyriaki hides into the organ after it is lasered. (2,2,3,3,4,5)
  • Vitals will drop much faster
  • Increased HP


  • Tumors will drop vitals much faster
  • Tumors will spawn polyps faster
  • Deftera will cause more vital damage when two of the same color Deftera combine
  • Deftera will cause hemorrhaging (Second Opinion only)


  • Triti layout will be much less conducive to removal
  • Purple sections will deal dramatically more damage
  • Thorns will vaporize more often
  • Vapor will move faster


  • Diverticula will grow faster
  • Tetarti will move faster
  • Less time to inject all three with antigen
  • Poison mist will do more damage


  • There will be less time between each attack
  • Attacking bodies will be more resilient to damage
  • Polyps and lacerations will deal more damage
  • Pempti sometimes sends out two waves of attacking bodies in succession
  • In Under the Knife 2, Pempti core resilience will be slightly unevenly distributed


  • Vitals will be maxed at 50 (Second Opinion only)
  • Dissecting a Paraskevi body will deal 30 damage (Second Opinion only)
  • Paraskevi will attempt to move to next organ earlier


  • Nest will turn red significantly faster
  • Savato will spawn more mini-Savato bodies with its attacks
  • Attacks will occur with higher frequency
  • Laser will need to be applied much longer than normal during the second phase
  • Mutated Savato

Major Differences - StigmaEdit


  • More Cheir bodies will attack at once
  • Cheir will attempt to create large lacerations and tumors, as well as the normal lacerations


  • Small tissues will harden faster
  • Soma will spawn more red and blue polyps
  • All polyps and hardened tissue will deal significantly more damage


  • Smaller bodies will fire nutrients more frequently
  • Tumors will deal massive damage if detonated
  • Ops will take more laser hits to defeat
  • Tumors spawn much more often
  • Ops cores splitting after to 2 laser incinerations


  • Onyx will not wait as long to attack (You've got approximately 7 seconds to find Onyx)
  • Letting Onyx attack will deal 70 vital damage
  • Venom in third phase will drain vitals much faster


  • Venom will move through the feelers much more quickly
  • If the venom is allowed to reach the feelers, it will deal much more damage
  • Feelers need to be removed an additional time
  • There are 21 graplers to be extracted instead of 14 (3,3,3,4,4,4)


  • Red tiles will reduce max vitals by much more
  • Cardia will attempt to detonate tumors in the second phase more quickly
  • More laser hits will be required to finish it off

Major Differences - Neo-GUILTEdit


  • Amount of tumors will increase (Last stand is 6 spore tumors, instead of 5)
  • Smaller window of time to treat and remove tumors before Nous dives
  • Instead of 30 vital loss per tumor when a wrong tumor is touched, the vitals drop by 65 per tumor


  • More lacerations at the pre-GUILT stage (8 instead of 4)
  • Core has to be removed 6 times
  • Core spores move faster
  • Greater vital damage if a spore or shard is touched (50 vital damage)


  • Hematocelae are created more frequently
  • Sige will move faster
  • More clones created by Sige
  • Pus is formed very fast and will cause severe damage


  • Vitals will drop much faster
  • Smaller window of time to inject antibiotic into Aletheia
  • Blood veins will alternate faster