Well, I calculated that in the end, the fastest time 'sadistic surgeon' will be roughly 1 minute faster. Because, geling before the last bandage takes about an extra second (and there's lots of missions!), and there's other little ways that getting all 'cool!'s wastes some time here and there (like having to gel some extra before rubbing a bandage). Finally, at the final Savato mission, to get S rank you need to heal all the slice wounds before delivering the black syringe, which is like 50 or so wounds; rather than deliver the syringe at the first opportunity.
This is what I'm talking about. (Off topic, I wish Savato had final boss music as good as
the sequel.)
I kinda liked the sadistic goal (you can tell from my avatar), what with extreme surgery with the patient's vitals not being a concern at all, then patching up and saying "done!" while the patient is still bleeding. However, the perfect surgeon is good because now I can do two things a human player can never do; get insanely fast times and get all cools.
Also, open question, does anyone know how the X missions are accessed? Is it after the credits? I want to do those missions as well, but I don't know if I have to beat the final boss, sit through all of the credits, then do the x missions, and end the movie file at the last X mission without any more credits to show.