Trauma Center: Under the Knife review
Lifesigns Detected


Just when you thought Natsume were the leaders of the "let's take a strange activity and turn it into a fun game" along comes Atlus and takes the whole thing to a completely new level. Surgery? Yes, they've taken the life saving operations into the virtual world and crafted a gaming experience from it. The DS is clearly the ideal platform for such an endeavour and amazingly it works.

You're put in the role of Doctor Derek Stiles, a rookie doctor who has just started practicing at Hope Hospital. Initially you're put under the guidance of Mary, who works as your assistant shortly before transferring to another hospital. From there you'll be advised by numerous other characters, with new recruit Angie Thompson being the main one. While the pair start off on bad terms as Angie doubts Derek's commitment and skills, a certain incident changes her mind and the two begin to build a strong bond. The chemistry between the two and the way their partnership develops is quite nice.

The overall plot itself works quite well. The text speed is somewhat slow (it can be displayed faster by tapping A but this is a bit annoying) but the general progression of events is good and there are a few key events that will really interest the gamer. The story goes beyond treating regular problems to fighting new strains of viruses created as part of a terrorist plot. The ending is a bit odd but it's interesting to go through and gave more than enough incentive to drive onward to the next operation.

The game presents two distinct visual styles. Story sequences, as well as the look of your assistant during operations, is done through the whole background plus sliding portraits style. If you're familiar with the various strategy titles on the DS (or even the GBA) then you'll know this already. Character half body sprites slide on and off screen to show who is talking, and each character typically has a number of images to represent different expressions. The artwork is impressive and the character designs vivid and interesting. Backgrounds are used fairly effective to show the current location, and it's more than just hospital rooms. I'm not sure why characters need to slide off and on to change emotion though - other games (such as Luminous Arc) manage to simply change the images in use as they sit there.

Try not to get Angie mad. She's scary.

The operations makes effective use of the dual screens. The top screen has your assistant giving out advice, as well as tracking certain stats like remaining misses and the countdown timer. The bottom screen shows your patient, tool icons neatly aligned in two rows on the left and right and your patient's current vitality. Bodies and organs have some kind of 3D effect to them and plenty of detail and vibrancy to make things clear. It also looks a bit like cel shading or something similar, which helps if you're not that keen on seeing too more blood around (although be prepared to see plenty of the red stuff anyway when operating).

Music is pretty pleasant during story cutscenes as it happily hums along in the background. Can't say I noticed more variety in the background music selection, but then it always seemed to play such an understated role, aside from the Savato operation music (you'll know it when you get to it). Might have been nice to have more forceful music in place, but not too bad.

Operations typically tend to avoid distracting music, although be prepared for the various sound effects. Throughout you'll have a pulse monitor beeping away at you tracking the patient's vitals, which lends a sense of authenticity to proceedings. Your assistant will sometimes shout out "doctor", which is sometimes a cue to do something, although some other less important soundbites are included too. More voice work would have been nice though. The sounds of the tools all sound appropriate enough, from the slicing with the scalpel to the burning with the laser.

Everything in the game is handled on the touch screen, and Trauma Center is one of those games that shows just how to use the special features of the DS (mic excluded) without resorting to cheap gimmicks. You have 11 tools at your disposal to treat a variety of wounds and illnesses. You can laser off tumours, disinfect wounds with gel, stitch up those wounds, make incisions with the scalpel, remove objects with the forceps and plenty more.

All these things make use of the touch screen in their own ways and you'll often be required to do combinations of actions for various things. Making an incision involves disinfecting the cut area first with gel and then cutting along the guideline by dragging the stylus from one end to the other. Switching tools is as simple as tapping the relevant icon onscreen. Everything acts so responsively and it all feels very accurate so I could never blame the controls for when things went wrong. When performing actions you'll be given constant signals in the form of small OKs to signify that you've completed the current action and can move onto the next.

This may sound complicated and hard to follow, but the way the game eases you in helps tremendously in that regard. Early operations form the tutorial, where you'll be guided through simple procedures, with lots of advice streaming from your assistant on what to do and how to do it. Actions are fed to you slowly and you'll be picking up new actions throughout the story mode right up to the final section. Be aware that you will be required to remember how to do things for when they crop up later, but the requirements should sink in well and become second nature. As soon as you see the guideline you will instinctively grab the gel and then the scalpel, and it's that kind of tutorial training that works so well. The game also gives you a pre-op rundown of the patient and their condition, giving you some idea of what you're going in for.

Preparations are underway.

However, the game is far from easy, and this is something that may put off some gamers. Trauma Center is hard. Ridiculous hard at times. Once past the early operations the average gamer should not be surprised to see operations fail at least once before they get past it. For the most part this is good, as it provides some much needed challenge and often you'll know where you went wrong and how to fix your mistake later on. Sometimes though it can just lead to utter frustration. For me, the GUILT virus that involves extracting needles can be utter torment and involved lots of failures. It doesn't help when sometimes an operation going well can go horribly wrong in a matter of seconds, leading to a downward spiral that is difficult to recover from.

So then, what can go wrong in an operation? You typically have three factors that can result in failure. FIrst of all is the patient's vitality, and this is probably what's going to affect you the most. This number can go right up to 99, and often starts lower than that. The progression of the current ailment and the actions of the surgeon can cause this number to drop, and when it hits zero it's game over. You can boost the number via injection, so it becomes a battle between fighting the illness and keeping vitals steady.

The other two failures methods are less common. You're up against a time limit (which is usually set at 5 minutes but may be more sometimes), and if this runs out you lose. Misses are when you make mistakes during operations, but you're given a huge amount of allowed misses, and honestly since most misses cause a drop in vitals I never found myself hurt by this. Unlike vitals, you can't boost either of this back up.

One aspect to mention is the Healing Touch. A special command that can be activated by double tapping the hand tool and drawing a star onscreen (don't worry - you get a tutorial for this too). This special power can only be used once per operation but it slows time down for a brief period. If vitals are dropping fast or a viruses is acting too quickly for you then this can be a real life saver. The game is still extremely hard though even with this.

There is a lot of variety contained in here, tackling a wide variety of cases involving many different procedures. The GUILT viruses will provide a wealth of different approaches too that will go out of the expected norm. Some operations are completely oddball and interesting too, like using your tools to defuse a bomb or solving a logic puzzle to help devise a new treatment. There are a lot of operations to work your way through too, and Challenge Mode lets you replay any operation you've reached as often as you like.

Replay is for encouraged by rankings. You are graded on each surgery by your performance. You earn points for every successful action based on how well you did it, and you also gain points for remaining time, vitals and a special bonus boost. Grades range from C to S, with the higher grades being quite difficult to hit.

I went for Trauma Center because it was promising quite a different experience, and for me it was well worth the effort. It certainly is different and, some difficulty issues aside, delivers an excellent gaming experience that also shows us that those DS features really can make a difference. Definitely a game worth considering for any DS owner.

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