Trauma Center: Under the Knife 2 (DS) review "There's still a learning curve for those new to the franchise, but returning veterans should be able to jump right into the action. Working too quickly is likely to lead to errors just as it should, but missed slices and injections feel like true blunders instead of something that can be blamed on faulty hit detection. As a result, tense operations feel challenging for all of the right reasons."

Trauma Center: Under the Knife introduced players to a dazzling new franchise that has quickly gone on to become one of the most successful that Atlus has ever produced. Released for the DS, the title utilized touch controls in a compelling fashion that allowed players to picture themselves as surgeons working on the cutting edge of medicine and battling terrorists willing to use human bodies as weapons. Despite some weighty flaws—chief among them a relentless and occasionally unfair difficulty level that prevented many players from completing the adventure—that game inspired two Wii follow-ups that met with similar acclaim. Now Derek Stiles, the promising young doctor whose triumphs and failures have kept players challenged and intrigued, has returned to the DS.

Three years have passed and for Derek, little has changed. He's still performing incredible operations with assistance from the Healing Touch (a mythical ability to focus so intently that time seems almost to stand still) and nurse Angie Thompson remains at his side, tongue as sharp as ever.

As the game begins, Derek and Angie are working in a small African country. They remain in the employ of Caduceus, the independent medical group that helped them battle GUILT in the past. In fact, their journey to this continent is related to those operations. There's a new disorder that they're investigating, called PGS (Post-GUILT Syndrome). Patients cured of the initial symptoms are suddenly falling gravely ill and it's clear that something must be done.

Africa isn't an entirely new setting for the series and here it's again a temporary one. Before long, the two stars of Caduceus are called back to the states with a new acquaintance—a young native named Dr. Tulba—in tow. From there, the plot ventures in the direction you might expect if you've been following events in the past games. Elements from the previous titles are cribbed shamelessly, such as an operation on television and a few instances where skin must be grafted from one location to another (which, as in Trauma Center: New Blood, easily provide some of the most challenging and irritating moments in the whole game). Some might view the familiar narrative tone in a negative light and that's understandable, yet the brief retreads don't feel tiresome. Meeting familiar physicians and patients three years later in their lives is interesting and even some of the challenges Derek faces with his own psyche ring true despite their unexpected nature.

Of course, many players might have skipped the plot in the first game, or they might be new to the franchise and less interested in the tribulations of Derek Stiles and company. That's fine, too. Trauma Center has always relied on its unique gameplay to build its fan base and things are no different with Trauma Center: Under the Knife 2.

First, know that the selectable difficulty levels from the Wii releases are back. You can choose from three settings and change them whenever you like, including mid-campaign. As always, even the 'Easy' setting is a rigorous test of your dexterity. For beginning players, it'll probably still be too much to handle, but for fans of the previous games it should feel almost perfect. Some operations still require repeated attempts to clear even with a 'C' ranking (much less and 'A' or 'S' one, though you can always go back for those later) and some are a walk in a park. Progression isn't always even, either, with the final plot-based procedure feeling simpler than a skin grafting assignment that comes just before it, but for the most part there's little reason to complain about balance.

Thankfully, there also aren't too many moments were in-operation chatter demolishes a player's concentration. Your assistant for each surgery—typically the delightful Ms. Thompson—is genuinely helpful in the advice she gives and the transition from one maneuver to the next feels smooth. Sometimes it can be easy to forget the exact process to excise a tumor or something similar, but the game provides useful tips along the way so that you're not left grinding your teeth as seconds tick down and you can't remember what you were supposed to be doing. If you really start to screw up, you'll sometimes notice little hints in the top screen to remind you what you're doing wrong. None of this means that you can coast through the game, but it does contribute to a general sense of fairness.

Controls have seen similar refinement in the years since the original Trauma Center. There's still a learning curve for those new to the franchise, but returning veterans should be able to jump right into the action. Working too quickly is likely to lead to errors just as it should, but missed slices and injections feel like true blunders instead of something that can be blamed on faulty hit detection. As a result, tense operations feel challenging for all of the right reasons.

A good example of that comes well into the game when you must dismantle an electronic device (echoes of the bomb sequence in Trauma Center: Under the Knife, except less confusing). You'll be asked first to tap an array of colored dots along the screen to remove a lid, then to carefully pull lengthy pins out of holes without brushing against the sides. The first few times as your hands are shaky and you're unsure, you'll possibly mess up too many times and fail the operation. Then as you make more confident swipes with the stylus, everything can go off without a hitch and you might even earn an 'S' ranking. The genuine sense of accomplishment in such moments lends this installment a welcome quality that it didn't quite have the first time around.

Don't worry if the reference to an electrical operation has warning bells sounding in your head, either. The procedures here feel appropriate to the plot and a greater number of them seem to place focus on standard medical scenarios. You'll be piecing bones together, removing glass shards and bullets, installing pacemakers... all of the things you might hope for. While there certainly are plenty of moments that venture into science fiction territory, here they are spaced out more evenly and don't halt the game with outright cheapness. For the most part, they serve as the equivalent of boss battles and in that role, they're perfectly fine.

The more you play, the more it becomes clear that this most recent installment in the unique franchise was anything but a quick cash-in. Atlus has responded admirably to fan criticisms without weakening the core gameplay that made the franchise so attractive in the first place. Now that everything is more cohesive and the design warts and wrinkles have been so proficiently excised, there's never been a better time to see what all of the buzz has been about. Trauma Center: Under the Knife 2 is as good as it gets.

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Staff review by Jason Venter (July 07, 2008) Jason Venter has been playing games for 30 years, since discovering the Apple IIe version of Mario Bros. in his elementary school days. Now he writes about them, here at HonestGamers and also at other sites that agree to pay him for his words.