Review by Kevin Cox

"Doctor! One major boost of adrenaline, STAT! And pass the stylus!"

Trauma Center: Under the Knife is easily one of the most addictive and challenging games of today. You're still fighting your battles and aiming to kill everything that moves on the screen, but with a twist: you're killing tumors, polyps, and horrible twisted viruses... saving peoples' lives. Saving lives is not a new concept, as most RPG games require you to Save The World From Apocalyptic Doom Of Some Sort, but presenting it as "You're the doctor - no, the surgeon!" in a non-edutainment game is new, refreshing, and amazingly cool. Cutscenes before, after, and between surgeries document how the characters in the game grow and change as a result of their actions, and sometimes the reactions are as blunt as possible: "You're not worthy of being called a doctor!" is one early-game shot aimed at your character. The patients' lives are truly in your hands, Dr. Derek Stiles.

The graphics are a pretty good anime-inspired indicator of what the DS is capable of. Character portraits on the top screen, shown while they're speaking, are large and detailed without being too distracting. And though they're static portraits, some of them are done exquisitely well, making you really empathize with the pain the character's in... right before you operate on them. Wanting to see the person smile just one more time... that's a great incentive to figure our the surgery.

While the top screen is taken up by character portraits on beautifully detailed backgrounds, the bottom screen shows one of several things. It is usually a nicely-made 3D overview of the region you're currently working in, and there are at least two of those overviews. Immediately before a surgery, it shows the patient's name, height, and weight with notes on their condition and a wireframe model showing where the problems are with red dots. It also tells you your time limit... while that sounds like it's a major obstacle, the time limit is one of the least of your concerns for most of the game. Then when surgery begins is when the touch screen starts to shine. You're treated to a 3D model of your patient lying down (no, even though you operate on women, they are as anatomically detailed as Barbie.), and when you make your incision into the patient's organ, said organ is 3D and pulsing with life as well, and you can see other organs and major veins and arteries in the background. Fluids bubble, gas floats, tumors pulse, and more shocking things than those happen in a majority of the missions, some of which are amazingly unique even for this game! But don't ever spend too long admiring the graphics, or your patient will die and you'll have to restart the level.

Yes, the game is that tough. You've got three meters to worry about, one of which is crucial in every operation, no matter what. Your time limit is on the top screen, but it's -usually- not that big a factor... just keep it in mind, OK. You've also got a "Miss Limit", showing how many times you can do something wrong and still keep going with the surgery. Again, only a few missions are really ones you can "Miss" frequently on once you're comfortable with the controls. Then there's the kicker: the patient's vitals, shown on the touch screen. If those hit a point where they would drop -below- 00, you lose. I always have to devote at least half an eye to that number in the corner, as several missions are constructed to allow that number to drop faster than you can raise it if you're not careful. It's those missions that give you a sense of accomplishment and triumph when you have finished them... believe me, it's a wonderful feeling knowing that your skill has overcome precise and complex patterns and a good dose of difficulty.

Of course, no self-respecting surgeon ever goes into the OR alone... you've got an assistant in every level. Some levels are tough enough that a second assistant shows up to give you another tool or a third point of view... and they've all got their own sound clips that play when you begin, end, do something well, mess up, mess up quite often, or when something completely unexpected shows up mid-operation! They're usually nice encouraging clips such as "Doctor.", "Derek.", "Nice work, Dr. Stiles", or "Okay, let's begin", but one particularly surly and blunt assistant can say "What the heck are you DOING?". They're repetitive, but not overly so. And their text on the top screen changes to give you hints if you're doing badly (or in the earliest missions, the timer pauses and you get specific detailed instructions on what to do) or their reactions to a sudden change in the situation. Sometimes this will pause the timer, so I keep about a quarter-eye on the timer. Add in that I have to keep two eyes on the surgery and half an eye on what my stylus is doing, and you almost need three or four eyes to keep track of everything!

The background music is well-composed as well, never being too overbearing that you lose track of the surgery, but with enough tension that you know you're under pressure... and there are three tunes that can play depending on what your operation is. Several other upbeat and downbeat pieces are reserved for events in and around the hospitals, as well as a tense pre-surgery piece to get your adrenaline flowing in advance... especially because the pre-surgery briefings can reveal some startling stuff later on in the game, or say "We have no idea what is going on here"... that second one is bad, as it means you'll have to use your brain on overdrive coupled with occasional insights from your assistant. And one mid-game stage even puts your character's life in peril... I have to say that's one of the most innovative stages in the whole game, as you're using your tools in unexpected and sometimes unorthodox ways.

Ah, yes. The tools. The core of the game's interface. Five on each side of the touch screen... thankfully, no mission requires use of all of them. But some missions do require use of six or seven or even eight of them... your antibiotic gel, scalpel, sutures, and bandage are used in more or less every mission. Most missions are tough enough that you will have to use the syringe to inject a stabilizer into the patient several times, or maybe use it to inject another medicine as needed. So many things require removal from the body that you'll get used to the drain, forceps, and laser as well quite fast... and sometimes you need to use your hand to smooth something out or use the ultrasound/magnifier to see more clearly. I've nearly torn hair out on some levels that had so much going on, I needed to use three tools at once (an impossibility, as you can only have one "equipped" at a time). Of course, the hand, ultrasound/magnifier, and bandages are the least-required tools, as they are only used in the most specialized situations... but after about the first six surgeries, I found that I had to instinctively know where each one was located on the screen.

I haven't really mentioned the plot, as it takes a backseat to the gameplay. Basically, you're Derek Stiles (ouch, two puns in one. Dr. DS, and "Stiles" sounds similar to "stylus"), a beginning surgeon at a hospital in LA, and you save peoples' lives. At least, that's how it begins... you'll learn some unexpected sci-fi things about Derek early in the game, and that knowledge will help with the later part of the game, where you're dealing with complicated things that make the first few surgeries -really- look easy by comparison. Not all the way to the RPG extreme of one-hit killing the earliest enemies when you're about to face the game's final boss, but surgeries that took you maybe two minutes or more the first time through because you were just learning the ropes now take you under a minute because you know what to do and you know how to do it fast. That ties in nicely with a great feature the game has: Challenge Mode. How it works is that once you have finished a surgery successfully, you can replay it as often as you like, whether it's to practice against a nasty combination of things, to go back and work on skills you might not have needed for a few levels, or just to try to get a better score/rank. Believe me, most of my ranks were C's at first (and many still are... that's the lowest rankings can go), but a couple levels have yielded to superior speed and technique and given me B's, A's, and even the elusive S-rank. If you can get an S-rank on every single mission as well as the bonus missions that beating the game opens... you have my eternal respect. Those last fourteen missions, especially (also known as Chapter 6 and the bonus ones)... the difficulty has been tweaked to the extreme. I still haven't finished Chapter 6 yet... each mission there is one you've seen before, but things are made very hard.

This game has been re-released twice due to its immense popularity, and the first US release wasn't even a year ago! If puzzle games aren't really your thing, this game might just change that... and the friend who recommended this game to me was at first thinking the game was mediocre. Then she hit a point in the game somewhere that completely reversed her opinion of the game, to the point where she's fangirling over one or two of the characters. The risk of addiction is extremely high with this game, but hey, it's all about curing people. If you see this game in the store or online, I'd buy it. Atlus created one of the best DS games with Trauma Center, a Wii-make is in the works for use with the Wiimote (adding new tools, new characters, a new chapter, new surgeries, and new artwork... but still the same game at heart)... but don't play it so much that you forget to eat and have to be taken to the hospital yourself. Real-life surgery is painful, Trauma Center only makes it -look- easy. And as the instruction booklet says, the game itself is NO substitute for medical school... there's no "Try Again?" option in real life.

Reviewer's Rating:   5.0 - Flawless

Originally Posted: 09/20/06

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