There's one thing you need to know right up front: Trauma Center: Under the Knife 2 is one of the best DS games to date, even without the benefit of some of the things that were added to the Wii entries in the medical franchise. The gameplay is much improved over the already-excellent first title, and the biggest complaint made by the original's detractors -- the difficulty -- is mitigated here by the inclusion of a range of difficulty settings. The result is pretty close to spectacular.

But when the gameplay is so good that there are few complaints, it's a lot easier to nitpick other aspects of the title, and we've got nitpicks in spades. That's all they are, though: tiny complaints that hardly matter. Under the Knife 2 should be remembered as one of the most satisfying experiences on the DS. Unfortunately, that's not likely to happen.


The fourth game in the franchise sees Dr. Stiles and company return to the DS, where, frankly, we think they should have been all the time. The Wii games added a lot to the series, but there's just something more innately satisfying and immersive, at least to me, about playing the games with the stylus and touchscreen that the Wiimote hasn't captured. But in heading back to its original stomping grounds, Trauma Center sacrifices features like multiplayer and full voice acting, and the game's reception will suffer because of it. What Under the Knife 2 gains, however, is the surety of great controls that are even better this time around, as well as a single player mode that's so strong that the lack of multiplayer is barely noticeable.

Under the Knife 2 kicks off in an all-new environment: a refugee camp in a war-torn African nation. This new position for Dr. Derek Stiles and his nurse Angie provides a lot of opportunity for drama, and in these early operations, you encounter a number of new characters -- including Dr. Adel Tulba, whom you'll see a lot of throughout the game, even after your eventual departure from the camp. Here, the game brings in a lot of devastating stories "ripped from the headlines," as it were, but that presents a problem as well. Under the Knife 2 works with a limited number of character portraits, which is fine ... but it's a little hard to get really into the storyline of a landmine victim when said victim looks no different than they did when last you saw them.

It's a nitpick, though, a minor irritation, and while these early missions -- and some of the later stories, too -- really make the lack of variety in character portraits obvious, it doesn't really matter. The story itself is good, almost great, but at times, there's just a little too much of it. I'm thrilled to be more interested in the goings-on this time around, but Trauma Center still exists for one reason only: to slice open livers with the stylus.

And in that aspect, Trauma Center: Under the Knife 2 is glorious. A lot of the operations revisit familiar territory -- the same tumors, vessel attachment, and shard-extraction we've done before -- but every single aspect is vastly improved over the original DS game. Not only do you have the choice of three difficulty modes, but the stylus is more precise, and the directions are, as well. Rare were the moments in Under the Knife 2 when I found myself uncertain of how to proceed -- a much more common problem in the first game -- and the instructions were so much more precise that every aspect of the surgery was more satisfying. There are still a few moments of frustration here or there, however, when you find yourself scanning frantically for that last thing you have to finish, or picking up the wrong tool. For the most part, though, the gameplay flows beautifully, and it's a lot easier to feel like a brilliant young surgeon.

The graphics are improved as well. Though some fans of the first aren't big on the newer art style, the game itself is much more bright and crisp, and is overall more pleasing to the eye -- and that makes surgeries easier, too.

Under the Knife 2 is short on flash and extras, but incredibly long on gameplay. Trying to get the best ranks on your chosen mode should be enough to keep anyone busy, but expect the inevitable complaints about the lack of modes and the character portraits. If you can get past all of that, there's a game here that makes brilliant use of the unique qualities of the DS, and if every game played as well as this one, the handheld really would take over the world.

Controls: In a word, incredible. Few DS titles control so well -- would that they all did! The stylus and touchscreen are in their elements here.

Visuals: A little more variety in the character portraits would have been nice, but everything is still improved over the first title, including where it counts: on the operating table.

Sound: Gone is the shrill, lower-quality sound from the first DS game. Like the graphics, Under the Knife 2 is a step up in the sound department, with better music. The random dollops of voice acting could be improved, however. Get used to hearing Angie direct you to "use the forceps." It's her favorite phrase, apparently.

Story: Still twisted, because it's Trauma Center, melodramatic in places, and rather too lengthy in parts ... and yet it manages to be engrossing. There's a lot of intrigue and politicking cluttering up the works, and you're charged with performing through it all.

Difficulty: Magically, refreshingly adjustable for each challenge. Choose from Easy, Normal, and Hard, and tailor the Trauma Center experience to your preferences. That should gain the series some new fans!

Final verdict: 9.0/10 - despite the lack of flashy, decorative extras and multiplayer, Atlus delivered the game that we didn't even know we were missing out on the first time around.