To add challenges within the game, there are seven achievements and one easter egg. Tools indicated with "*" are new to this game. Here is the list of tools used in the game as shown on the procedure's toolbar: When completing one of the surgeries, it can be played again by selecting "Level Select" on main menu screen and choose which surgery to play, since the progress has been saved on the client-side web database. Fortunately, unlike in the previous game, a player can repeat the same surgery over again. Once the procedure ends in a bad way, by running out of health points or by forcing the shrapnel into the second patient's head, the screen fades into negative-white and the flatline is heard before the screen shows the tombstone of a fallen soldier. However, they are no longer highlighted after the first use so the player must learn the ways of treating the patient quickly and carefully. The instructions are carried out and some of the tools are highlighted on the first stage, whenever they first and new to be used during the surgery. There are four stages in total for the whole game. Also, blood and pus are improved realistically. Every image and graphics in the game are now photorealistic, unlike in a previous game when backgrounds and objects are hand-drawn.Also, the tools used on a patient painfully won't lose points faster if the drunkenness meter is filled up. Starting at 100, it serves as a countdown timer depending on the player's speed and performance throughout the procedure. It is helpful to simplify the game's speed handicap and difficulty. Drunkenness meter is added to help the patient sedated and slow down the decrease of health points.They are colored in silhouettes but they are named when a mouse pointer hovers onto it. Tools are manually selected that can be seen on bottom leftmost part of the screen.However, there are few changes and improvements from the previous game: The gameplay itself returns the stars within the area of surgery. The player's leg is revealed to be punctured by large wooden shrapnel and he must be amputated with a little amount of health remaining.
Sudden cannon explosion causes the tent to be destroyed during the third surgery, making it a lose-lose treatment procedure.