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JadeDragon's game reviews and playing tips: Nintendo DS games
Read our review of the Nintendo DS!

Trauma Center: Under the Knife

Reviewed March 2006 by Alex Lifschitz

Publisher: Atlus
Developer: Atlus
Release Date: October, 2005
ESRB Rating: T for Teen
Genre: Simulation
Price: $29.99

Next to firemen, astronauts, and superheroes, most children aspire to be a doctor someday (Superhero is more of a fallback profession, no?). Who could refuse the opportunity to help countless sick and dying as a profession? Sounds like fun. Well, it isn’t all that it’s cracked up to be. Why, in Trauma Center: Under the Knife by Atlus, it can be the most harrowing job on earth. Sure, you might expect to deal with a bad case of the mumps here or there. But bioterrorism? Crackpot philosophy? Defusing bombs? Even James Bond doesn’t get this much action. But is the scalpel any replacement for the PP7? Indeed, the life of a doctor has never been more challenging – or entertaining – than this.


It would be hard to call this kind of game familiar. Arguably the most inventive use of the DS touch screen to date, Trauma Center is a delightful blend of strategy, puzzles, and pure reflex. You play as the young, newbie surgeon Derek Stiles at Hope Hospital. You go through a number of routine operations, and then you almost lose a patient. Cue the angst, introspection, and brooding cutscenes, and suddenly, a patient arrives that only Derek can heal. It turns out that Derek has the Healing Touch – think a Matrix-esque ability to slow down time and operate at superhuman speeds. After perfecting this, a new and deadly strain of virus called GUILT is released by terrorists, and lo and behold, the world needs a doctor of your caliber to figure the whole mess out. After this point, the plot takes a couple of hairpin turns too complicated to explain. Needless to say, it’s one of the best plots this side of Final Fantasy, and it has the gameplay to back it up.

The actual bulk of the game – the operations – takes place between the cutscenes, with little to no free roaming. The top screen contains your patient’s vital signs, your miss counters (how many times you can slip up before the patient kicks it), as well as your time limit and your assistant, who tells you about your operation and gives you tips and explanations of the current situation. The bottom screen contains what begins as a featureless body, which you then cut open and begin operating on. This leads to a cornucopia of colorful, pulsating organs, ready for a severe thrashing by way of your large collection of tools. Most tools in the medical profession are here. There is, of course, the scalpel, used to get into the body and extract unwanted foreign bodies. You also have the needle and thread, used for suturing small wounds and incisions. You have bandages for finishing up the surgery, and antibiotic gel to stop infections and kill certain parasites. You have a tube for siphoning unwanted fluids from the body, a syringe for extracting and injecting fluids, and even a laser for zapping the little’uns that you can’t quite get with the conventional tools or methods. The sheer amount of tools is mind boggling, and you will use every one of them on a fairly frequent basis. This introduces the cerebral aspect of this game. Your assistant is fairly competent, but for the most part, it is you who will end up assessing the situation. You need to figure out what to do, what to do it with, when to do it, and how frequently you will have to do it in order to pull it off. It sounds like tedium, but it is actually a delightful and challenging puzzle aspect, adding extra layers of challenge to the game.

The operations are also extremely inventive. Early on, as a regular doctor, you will be operating on crash victims, cancer patients, and other such subjects. But the creativity of the operations themselves takes center stage. You will be doing everything from removing polyps to killing insectoid infections, all with strategy and skill. There is even one memorable segment where you must use your tools to defuse a bomb. Each of these operations offers a unique twist on the standard medical procedures. At its heart, the game is a puzzler, offering many different operation types (extraction, removals, etc.), and making you take on operations with both mind and reflex. Think of it like playing chess while skydiving… Winner gets the parachute.

Don’t think that this game is a walk in the park, though. Many of the operations are notoriously difficult. Some of them will make you want to rip your hair out. However, they are strangely alluring. The mental portions, as well as the myriad of tools and strategies used to tackle the operations, make the frustration melt away when you attempt it over and over again, and there is no better feeling than completing a difficult operation. The operations each have their own processes and stages that must be followed to a T, but the timing therein is what must be subject to strategy. Time management is essential when your patient’s vitals are dropping by the second, and having to micromanage these functions while tackling the problem means that you will be engaged for the whole operation. As an avid gamer, I can say that this is the first time my hand has ever cramped up so badly that I had to stop playing, but never once did that deter me from playing the operation again a few minutes layer. It is supremely addictive.

Aside from the operations, the bottom screen will contain your location in the story, while the top screen displays the well-written dialogue that propels the stellar plot along. The characters that you meet along the way are well-developed, and are integral throughout the course of the game. Half the fun is watching the story unfold and getting to know the cast better, from deep-seated anxieties to secret double lives. The sheer number of places you go to for operations, from a city street to a village in another country, helps add a continuity to the game that is rare in most current games, especially when you consider the proximity of each location based on the lower screen map. You also save your game at regular intervals. Scarceness of checkpoints is no obstacle, thankfully.



Screen shots:

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One of the better parts of the game is how fast the state of an operation can turn around. You must be constantly vigilant about your patient during the operation. Ignoring drops in vital signs for too long will kill them, and tending to their vitals while ignoring the problem will only end in failure, due to a time limit placed on the operations (though said time limit is usually somewhat generous). You must strike a perfect balance between keeping your patient alive and solving the problem. You could have a patient with a 99 vital rating, and then suddenly have a large parasite burst through an organ and have their vitals plummeting at ridiculous rates. You can usually remedy this through original use of the touch screen, such as massaging their heart during cardiac arrest or injecting vital-boosting serums, but this kind of situation will often call for use of the Healing Touch, which requires you to draw a pentagram on the screen which will initiate a slow-motion sequence that will allow you to operate with superhuman reflexes (in some operations, this option MUST be used for particular segments, though you can only use it once per operation). After playing for a while, though, the Healing Touch may seem frivolous. Getting used to the pace of these operations will practically imbue you with the same kind of superhuman speed, and you will need lots of practice to finish some of the later operations.

Multiplayer is, sadly, nonexistent. It would have been great to have some sort of game where two doctors operate on two different patients for time, or perhaps where two players must operate on two different parts of the same patient, each affecting the other, but there is nothing of the sort. Rather, for replayability, you can access any operation that you have completed and retake it in hopes of a higher letter grade for efficiency upon completion. Some levels may repel you do to sheer difficulty, but some are genuinely fun enough to try again. Still, multiplayer is missed, and would have been a great addition to the single player game.


The controls are rather intuitive for a game that involves so much switching. The tool bars are located on the left and right sides of the screen, and you must tap the appropriate tool to use it. The tools themselves make you feel as if you are actually performing the tasks – cutting, suturing, disinfecting, etc. If there was any game more suited for a touch screen, I couldn’t think of it. Atlus did a remarkable job in replicating the feel of an actual operation. However, the operations are just so damn fast-paced that even taking a half-second to switch to another tool could mean failure. Some have even suggested laying the DS flat down and using two styli to perform the operations. The ambidextrous have an advantage here. Still, the game is clearly doable with one stylus and some skill, but what really counts in a game like this – the feel of it – is accomplished extremely well. Just rest your hand before major operations. Cramping is common.


The DS has never sported the best graphics around, so some games have created an art style all their own to compensate. This game combines both unique style and 3D graphical effects. The organs that you operate on are in rendered in pulsating 3D glory, while some elements therein, such as parasites, are 2D GBA-esque sprites. The presentation is remarkably good, but the real attraction is the character cells during the story. It clearly draws on anime styles to present the characters, though there is no character animation – simply cells that represent the atmosphere. Each of the character models is vivid and drawn accurately, and anybody who appreciates Anime or similar art forms will enjoy it. It is perfect for the text-heavy storytelling, and varied enough for such a wonderful story. There is nothing jaw-dropping gorgeous, but the presentation is high quality, as are the character cells and 3D animations. The 2D sprites are a bit pixilated, though, but this does not affect the feel or gameplay in the least.


Like most DS games, Trauma Center features nothing very grand due to the arguably poor quality of the DS speakers. The sound, though, is still quite good in execution. The sound effects are decent, though somewhat overused. The quality itself is arguable. The soundtrack delivers, though. The map and cutscene theme is a light piano tune with modern elements, and compliments the usual gravity of the situations Derek encounters. The operation theme is rather serious and foreboding, which is reflective of the nature of the operations themselves. There is a boss theme that is meant to imply some kind of grand operatic element, which it does, but again, the quality is arguable. Despite this, the sound is atmospheric enough to sufficiently draw the player into the game.


If you’ve abandoned that childhood dream to be a doctor, skip the years of medical school and tuition fees and pick Trauma Center up. It is highly engaging, and is one of the best puzzlers available on this or any platform. The atmosphere and presentation is first-class, and the gameplay itself is inventive. The lack of multiplayer is disappointing, and the high difficulty is evident, but any DS owner deserves to have this game safely tucked away with his or her DS. Besides, who knows the next time you’ll have to do an emergency appendectomy? Might as well get the practice in.

Playing Hints and Tips

  • Always heal open wounds and anything bleeding before continuing an operation. These will drop your patient’s vitals faster than you can say “DoA”.
  • Save the Healing Touch for later in the operations. They tend to get progressively harder, and you will want it for quick healing and extraction.
  • After beating the game, go to your completed operations. There will be 6 extra “classified” files in which you operate on a certain character and take on the hardest forms of GUILT.


Ratings (scale of 1 to 5):


While not gorgeous, the 3D rendering is accurate and engaging, and the anime-inspired character designs are wonderfully suited for the game.


The sound is engaging, which is clearly what it sets out to be, but the quality is a bit tinny.

Fun Meter

This game truly one of the greatest puzzlers currently available (barring classics like Tetris), providing a sleek combination of both mental and physical tests to keep you playing and enjoying every second of it. The difficulty is noticeable, but is actually a bonus, and quite entertaining.


No matter how many operations you bungle, cuts you forget to suture, parasites that ravage the patient, or any other particular ailment, the game is disgustingly addictive, and I mean that in the best possible way. It really is that hard to put down.

Total Score= 4.375 Dragons, 87.5%

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