Trauma Center: Under the Knife 2

"The New GUILT is Your New Addiction"

When people think of the Nintendo DS, there are quite a few things that come to mind, but one of those things is definitely not surgery. Well, thanks to the success of the first Under the Knife title on the DS, followed by the port, Second Opinion, as well as an original, oft mentioned title, New Blood, the surgery simulator is now a respected and almost entirely exclusive genre to Atlus. Now, several years after the release of the first title on the DS, the first actual sequel to the original, cult classic has been released in Under the Knife 2.

It has been three years since the outbreak of GUILT, a scientifically created virus used by the terrorist organization Delphi in an attempt to rid the modern world of medicine, believing that doctor's quest to heal those in need of assistance harms the evolution of the world by allowing the weak to survive. Derek Stiles began his work as an unsteady intern, but quickly became the pride of the medical community, and, alongside the star nurse, Angie Thomson, broke down Delphi and brought an end to the reign of GUILT across the world.

Now, Derek is assisting in the small, war-torn African country of Cogistar, bringing medical aid to the victims of internal struggle. It is not long, however, before several patients come in bearing very odd and frighteningly familiar conditions that bring Derek, Angie, and upcoming hopeful Adel Tulba, back to the United States – it appears that GUILT ridden patients are now bearing post-operation mutations, and that the shadows of a dead organization are moving in the darkness to bring back the former glory that is medical terrorism.

While the plot is definitely not going to be winning awards, it follows suit in being very well written and holding together an otherwise odd and really quite far-fetched idea while keeping the interest of the player. There's a bit of character evolution, some falling outs, as well as enough changes to familiar faces to keep things moving forward at a constant, steady pace; those who have played the previous installments in the series will be welcomed by familiar faces, though new players won't be completely alienated by anything, either. Overall, it's not particularly amazing, but just interesting enough to hold the game together, as well as flesh out operations.

The bulk of the game is based in the operating rooms, however, and Atlus definitely does not disappoint this go around – in keeping things mostly the same, but by changing just a few keep elements, gameplay feels refreshing and original without feeling like more of the same or constant repetition, much like the first title was.

Each patient comes in with some sort of problem, and it's up to Derek and an assortment of assistance to rid the patient of that problem. The variety seen in this title is a refreshing change of pace from all other showings, in that it mixes in enough normal, general operations, like the removal of aneurisms and fixing up someone after a car accident, while throwing in just enough of the new GUILT showings without going overboard – Under the Knife was a constant GUILT frenzy, while New Blood barely use it's unique and highly entertaining Stigma, so finding a correct balance makes sure that nothing gets too old.

Once you've arrived to the body of the patient, you're welcomed to a somewhat new interface – namely, the icons for each tool are much larger, and the heart rate bar, the sort of health meter that measures the current liveliness of your patient, seems more prominent without being overly obnoxious. The changes might take a little while getting used to, but everything seems to be for the better; selecting tools is a bit easier, and checking the current vitals, as well as the vital maximum, now marked on the bar, doesn't feel too much like looking away from the patient entirely.

From here, it's a matter of what the symptoms are that determine how you go about the operation, but, for each task, the objectives are clear, precise, and, as far as theory goes, easy to perform. The literal difficulty in performing the operation remains one of Trauma Center's defining traits – the game continues to be extremely difficult, oftentimes maddening, but the addition of an easier difficulty, as well as a far more difficult option, as well as the ability to freely change between difficulties during the game, makes sure that you can turn down the insanity if things become too hard, or turn it up if things are becoming too simple. The unlockable missions still remain on “Battletoads” difficulty.

The use of each tool is simple, but their performances have changed just enough to be noticeably different, for the better and the worse. The Antibiotic gel now has a far shorter use period, meaning that you can't hold down the stylus for as long before needing to reapply the miracle medication – a different, but not necessarily a setback. The drain still remains awkward, but now an auto-suction feature seems to have been put in place in that, just by pressing the tube, the material moves upwards, rather than you actually moving it up. However, that feature doesn't work upon placement, meaning that you still need to motion to suck, very much unlike the Wii titles. It's an improvement over the first DS title, but still annoying when in the fray. Thankfully, the syringe now completely plunges upon placement, meaning that you don't have to drag it down – though an IV machine would still be nice…

Operations are now better than ever thanks to a refreshing array of new obstacles, such as the removal of a gull bladder and a few new, interesting showings in the GUILT department. These changes, as well as a few new twists on old operations, will keep the veteran on their toes while keeping new players equally excited to see what trick is going to be taught to the old dog. The changes also ensure that once fairly difficult operations are now even more challenging, but, when playing religiously on the Normal difficulty, the overall challenge doesn't stray too much from an overall difficult average, though a few missions do feature notable difficulty spikes, chiefly the skin graft operation and one horrific example of what happens when you have no stabilizers to boost the patients vitals.

Beyond the operating room, a few new additions to the game have been added, primly a graphical update. The game's visuals in the first were very well done, but a lot of the character portraits were almost comical and didn't really fit the overall tone of the game. Now, the entire theme has been noticeably darkened and has been sprinkled with a bit more reality than the almost anime style of the first Under the Knife. Character portraits are now extremely detailed and very series, reflecting the tone of each passage well and more accurately.

Operating visuals are a bit of a mixed situation however – in a change from the rather unrealistic offerings of the first DS title, organs and bodies are now displayed in a much more realistic fashion, much like the Wii titles, but a few scenes have a few noticeable hiccups in that the organs oftentimes appear overly pixilated, but this is very limited and rare. Overall, the new theme is greatly appreciated, and some of the effects look much better and believable now than beforehand, such as graphical changes in the appearance of different ailments and far more serious GUILT sprites.

Another notable feature is the soundtrack – the first game was surprising for its excellent music offering, as well as the two Wii titles, but this Trauma Center especially features very well done music. There are several tracks that fit the mood down to the last pixel, pushing the realism and theme of the case to the most immersive yet, but the out-of-operation sound list appears to be disappointingly barren, offering up a scant selection of tunes when you're not cutting someone up. Granted, each of these songs is great, but their use for some situations feels a bit canned and unfitting.

On a more hilarious note are the wide amount of voice clips for almost every featured character. These are impressive from a designers point of view, being of a high sound quality and quantity, but all of these bytes become extremely awkward, odd, and even unintentionally funny, as they are very over dramatic and mismatched to both the dialogue, tone and implications, even going so far as to say the exact opposite of what the text of the character is saying, chief among which is when Derek's voice protests Angie's text:

“You're a doctor!” – “I… I…”, as the text states. However… “You're a doctor!” – “I DISAGREE!” sounds the voice clip. Yeah, did anyone actually notice that, while Derek goes on to state that he really is a doctor, the audible factor makes one of the more funny moments in a game? You know, play test the game?

Overall, Trauma Center: Under the Knife 2 is definitely a different game, offering up a gameplay format that most people have not tried, and one that most really don't want to try. But, thanks to a proficient story, addictive and ever challenging gameplay, a constant, great theme, and a surprising soundtrack, the fifth surgery sim (Under the Knife, Second Opinion, New Blood, Under the Knife 2, and a dating sim with a surgery mini game (double parenthesis, yes I'm making fun of the latter game)) is definitely a great, original game that DS owners who can stomach the relatively mild content should try out. Issues are far and between, but unfortunately remain obvious enough to be accounted for.

The Medical Board is harsh, man – they're informed if you even fail to break a lock...

Reviewer's Score: 9/10, Originally Posted: 07/17/08

Game Release: Trauma Center: Under the Knife 2 (US, 07/02/08)