Surgeon Simulator: Inside the world's hardest game

We meet the studio behind Operation in Space to get the prognosis on the toughest indie game ever.

It’s a cold day outside, and we’re sitting inside an ambulance in the parking lot of London’s Earls Court exhibition centre. There’s blood on the walls, men in scrubs and surgical masks, and syringes everywhere. Passersby are begging to clamber in.

Don’t ask. Just go with it: that’s how Bossa Studios’ founder Henrique Olifiers rolls, and it’s got him this far.

Screenshot from console game Surgeon Simulator 2013
Surgeon Simulator 2013

The studio is one of the shining lights of London’s Silicon Roundabout, the cluster of tech start-ups around the Old Street gyratory in the east of the city, and the animated OIifiers is here to talk about the team’s latest and most unexpected success, Surgeon Simulator 2013 - which is anything but a simulator of real life.

“The team did their research” he jokes. “The organs. They're to scale and kind of in the right place...but I don't think they have hammers in the operating theatre.”

A photo of a customized ambulance used to promote Surgeon Simulator 2013
The Surgeon Simulator ambulance

Gran Turismo or Call of Duty this is not. Surgeon Simulator is an outlandish Operation for the digital age. You play average joe Nigel Burke in a series of ridiculous, escalating scenarios that call upon you to perform emergency procedures including heart and brain transplants, without killing the patient - or yourself.

It’s a comedy as dark as the flying viscera - and also fiendishly difficult. Like cult web game QWOP, you control individual limbs and even digits with separate keys, making precise control extraordinarily difficult, even in a game that lets you implant a donor heart by quite literally shoving it into some poor soul’s rib cage.

“Surgeon Simulator makes it incredibly complicated to so much as pick up a scalpel,”said Gamespot at the time of the game’s release on PC in April. “Performing a successful operation, meanwhile, is like juggling and riding a bicycle at the same time.”

Despite this, the game received critical acclaim for its outrageous concept. Players have managed to master its intricacies too. Leaderboard champion Matt Shea needs to be seen to be believed: he can perform surgeries in under five seconds with no blood loss, and even lob a brain into a patient from across the room like a three point swoosh shot - Bossa actually went back and added an in-game achievement to celebrate his exploits.

All this from an idea that started out as little more than a joke at a 48 hour game jam and a Monty Python reference. Not entirely unlike the unfortunate Nigel, Olifiers and his team reacted to circumstance.

“The theme of the game jam was heartbeat, and that was the first step to it. They had this thing where they wanted to make a game where hardcore gamers and first time casuals will be at the same place, they will struggle at the same time,” Olifiers says.

Inspired by Valve’s hilarious Meet The Medic promotional video for Team Fortress 2 (below) and a scene from sketch film The Meaning Of Life. The team whipped a working prototype around within the two day deadline, “and we went from there”

They moved fast. Within a month and a half a commercial version was released to the world. By April, the game was released on Steam, the biggest digital game download store on PC. By June, the team had worked in Oculus Rift support, drumming up a playable version in just 72 hours. Olifiers admits carrying out surgery with a virtual reality headset can get pretty nauseous, and not just because of the arterial jets.

“If you pair it with the Razer Hydra controller, you have two arms, and it's really something. That's really crazy. You can get pretty sick.”

By September, Bossa had released downloadable content for the game, set in space. Because, of course. If there’s anything harder than surgery with a hammer, or surgery in the back of a moving ambulance, it’s surgery in zero gravity.

An in-game screenshot from Surgeon Simulator's zero gravity space level
Zero gravity Space Surgery

Bossa Studios’ chaos is a very controlled type, of course. Take the van we’re in: the surgeons are actors, the blood is painted on and the hypodermic needles are actually branded clicky pens. The spark for Surgeon Simulator was provided by little more than a joke and good fortune, but the best game developers make their own luck, over and over again.

Bossa Studios, for instance, had been around for three years and already scooped a BAFTA for one of their titles, online game Monstermind (think of it as Godzilla meets Civilization), by the time Surgeon Simulator was born.

Olifiers, a former employee at social network game developer Playfish, founded the studio with marketer Roberta Lucca and Jagex games developer Imre Jele, and they’ve focused on relentless brainstorming and iterating, mercilessly canning any ideas that aren’t up to scratch.

“We have this system in the studio that can let anyone who works there come up with a game idea,” he says. “We have a team that works two weeks together to make that game idea into a prototype. We ended up with some 25 or 26 games over the years that we created them, but we've never shown any of them to anyone, as we didn't think they were strong enough.”

Except for one, which Olifiers is betting heavily on as the studio’s next title. “We've got this game called Time to Live. We kept coming back to it over and over.”

“Imagine a MOBA [multiplayer online battle arena game] that's cross-platform, where instead of having to kill each other with weapons and what not, you have these six players who are running around, and things spawn, good or bad, but you don't know what they are until they spawn. So, you have two minutes to survive, and after those two minutes, you die - but the objective of the game is to be the last man standing. So you have to avoid the red ones, and stand on the green ones, but only one of you can, and everyone is going to run over to it, but you don’t know what it's going to be until you stand on it.”

It sounds like League of Legends with a time limit, but from the footage we were shown, it looks even more frantic.

“This game has been live for 60 players in the office and they just don't stop,” Olifiers says. It’s “out first quarter [2014], out on everything. It's already playable on all sorts of platforms.”

Olifiers says concepts like these - turned around so quickly or on so many platforms - would never have been possible a few years ago, before the rise of mobile and social gaming made large indie studios possible.

“I don't think Surgeon would ever make it through the pitching process. It would be killed in the pitching process. ‘I will make a game that has the clunkiest controls ever and is about a guy who smashes ribs to replace body parts.’ They'd just look at me.”

An in-game screenshot from Surgeon Simulator 2013
Fire extinguisher surgery

“But that's the beauty of the indies, they don't have to go through that stuff. The best games we have, it was not us sitting down and deciding 'that's the game we're going to make'. Every time we think that, we fail. These games are almost like accidents. Take DayZ, a game that a guy did in his spare time. All of a sudden, he's big. Those are becoming more and more frequent. If you have an idea, you should be able to go and do it. That's why we two-week prototype.”

Alongside Time To Live, Olifier’s team have been working on an iPad version of Surgeon Simulator, due out towards the end of the month. It promises to open up Surgeon Simulator to a whole new audience, but the touchscreen also means that Bossa has had to rethink the controls - and ensure they’re still dastardly difficult.

“It could be made too easy, or impossible as we have three axises, and how do you do that on a screen? Do you control the arm with your arm? We went up asking all these different questions, and so we ended up removing the arm. We also got rid of the Z axis, so if you slice to this point where your finger stops, so now we have something that works, but the new challenge is to make something that's equally as difficult as the original.”

Screenshot from Surgeon Simulator 2013 game
Laser surgery simulator

“It's just so many new levels we have to make to make it work,” he says as his patient bleeds out on the screen in front of him. “We still have a lot to do, but we have a control mechanism that feels a lot like the PC version, and it's nice and keeps the feel of the original surgery.”

What we’re less likely to see in the near future: any Surgeon Simulator sequels for PC. Olifiers laughs when asked if a 2014 follow up is on the cards - or rather, being prepped for surgery.

“I don't think so. We'll try to get Nigel on new adventures, there are some weird stuff that we want to do with him. We want to explore some new opportunities with him - we want to get him out of the hospital. Maybe back in space, or in a plane.”

Kidney transplants in turbulence on a crowded charter flight to the Canary Islands? Sounds like another winning formula to us.