Surgical Strike

Surgical Strike is a Special Attack that can be used in either V.A.T.S. or in real time combat that each have unique characteristics. These attacks, which come with special animations, may allow for faster attacks, greater damage, special effects or some combination of these advantages.

Gameplay
A special attack only used by the Cosmic knife clean, Surgical Strike combines damage one and a half times normal with a greater cost in action points. Similar to Back Slash, this attack is a wide side swing with the weapon held in a reverse grip.

V.A.T.S.
When the player has 50 Melee Weapons skill points, they have access to special melee attacks which consume a certain amount of action points for a variety of effects in V.A.T.S. Attacks most often couple a lower action point cost with lower damage, allowing for more attacks per V.A.T.S. round, but with a lower damage inflicted by each individual attack; a higher action point cost with greater damage, allowing for fewer, more damaging attacks; or a higher action point cost and a lower damage, but the addition of a special effect like the chance to knock down enemies.

Note that, in general, the reduction of action points expended for some special attacks does not make up for the corresponding decrease in damage, compared to usage exclusively in V.A.T.S. The only exceptions are when this reduction allows for a player to make 3 or 2 attacks in one V.A.T.S. round instead of 2 or 1. All Unarmed/Melee attacks in V.A.T.S. double weapon's base damage.

Outside of V.A.T.S.
It is possible to execute special attacks outside of V.A.T.S., without the required Melee skill of 50 to perform the moves, by initiating a power attack (hold attack button) while moving forward. Special melee attacks outside of V.A.T.S., however, don't have any special properties to them, but are considered as a standard power attack. All Unarmed/Melee power attacks double weapon's base damage.