Review: Trauma Center: Under the Knife (DS)

Genre: Medical Simulation
Platform: DS
Rating: T (Teen)
Publisher: Atlus
Developer: Atlus
Release Date: 10/04/2005

Atlus’ latest offering, Trauma Center: Under the Knife, may be one of the oddest yet coolest games to date for the Nintendo DS. Whoever thought performing surgery could be so much fun? This ain’t high school biology class, so if you’re ready to save some lives, read on!


It’s the year 2018. Maladies such as cancer, TFTA, and AIDS are nearly gone now, due to recent medical advances. But, as is the nature of things, something else has taken their place: a disease known as GUILT (gangliated utrophin immuno-latency toxin). It’s possible that this is a bioweapon, but either way, it must be stopped. Enter the secret organization known as Caduceus International. (Think Area 51 mixed with the CDC.) The group is doing its best to find a treatment as well as keep GUILT out of the public eye, but time is running out.

How does all of this affect you? Well, you take on the role of young Dr. Derek Stiles, a doctor who recently completed his residency at Hope Hospital. While Dr. Stiles starts out handling routine surgeries and work his way up the medical latter, fate has some interesting plans in store for him…

Take the drama of ER, add a dash of conspiracy theory, and mix it together with the suspense of a Robert Ludlum novel, and you’ve got Trauma Center. It’s not just the tale of a virulent plague out to destroy mankind; it’s also the story of a young doctor coming to terms with himself, and realizing just how good of a surgeon he can be. The story grips you from the get-go, and keeps up the pace as Dr. Stiles gains confidence in himself.

(Rating: 8/10)


The top screen is used for dialogue, character portraits, and so on, and usually stays strictly 2D. The graphics up there are razor-sharp, though, and the backgrounds are often incredibly photorealistic. You won’t see a lot of animation up top, but that’s done on purpose; you don’t want to be distracted from the real action on the lower screen.

The lower screen is where the game is really played; you’ll be using the stylus for everything. Here, the various surgical tools are represented by crisp 2D icons, with the actual patient’s body parts in smoothly animated 3D. There’s usually not a ton of texture detail, but it isn’t necessary. In fact, too much detail could serve to confuse you.

(Rating: 8/10)


The music during briefings, story sequences, and introductions to surgeries is upbeat and makes use of plenty of synths. During operations, though, you’ll hear dramatic piano dirges that really ratchet up the tension. As if saving someone’s life wasn’t stressful enough! Still, use of the music in this way really adds to the game. None of the music tracks in the game seem like they were just thrown together; every single one complements the mood in each scene perfectly. Sound effects are relatively minimal, with the most common ones being the very blips and beeps of EKG monitors, and “success” noises when you pull of a procedure properly. There’s a little bit of a digital speech, too, but most of it’s fairly routine stuff during surgery. The story is advanced through textboxes, not full voice acting.

(Rating: 8/10)


While there’s plenty of story sequences and cutscenes to keep the plot moving, the main focus of Trauma Center is naturally the surgeries you’ll perform. Before each operation, you’ll be briefed on the patient’s problems, what needs to be operated on, and any other factors you need to take into account. Once the surgery begins, you’ve got three important things that can make or break the operation: vitals, time, and misses.

Vitals are how stable the patient is while you operate upon them. (Think of them as HP, if you wish.) If the vitals get low, you can inject the patient with a booster to temporarily raise them. If they drop to zero, you lose. Keeping your patient stable is key.

Each operation also has a time limit. Often, your patient’s health is dependent on a speedy procedure; work quickly, but don’t make mistakes. Running out of time will also result in failure, and your game ends.

Last but not least, you get a certain amount of misses per operation. Obviously, performing a procedure wrong will earn you a miss, such as improperly suturing a wound, or failing to disinfect. As with the above examples, if you miss too many times, your game is over.

Aside from the specter of failure hanging over your head, the vitals/time/misses trio also affects your rank as a doctor. If you can complete an operation quickly, safely, and with minimal misses, your rank will be quite high. You’ll need to balance this with the need to work carefully and take your time if necessary.

Now to examine the surgery gameplay itself. If you’ve got shaky hands, then Trauma Center may not be the game for you. Precision is required for surgery, as you should be well aware. Each of your different tools is used in a different manner; for example, you draw a line to make incisions with the scalpel, drag the stylus to spread antibiotic gel, tap the screen to use a laser, and zigzag to suture wounds. As the game progresses, your assistant will always explain what each tool does the first time you use it, but make sure you remember it well; you won’t get step-by-step instructions for long. Furthermore, later surgeries will involve multiple procedures, where time is critical. You’ll concentrate and sweat, but the payoff is worth it.

The sensitivity of the touch screen is used to its highest degree here. In fact, Trauma Center is best played with the DS sitting on a desk or table, so you can really focus expertly controlling the stylus. The game’s not so anal that a micron’s error will completely screw you up, though. At any rate, the control is absolutely flawless in Trauma Center. The DS keeps getting titles that make better and better use of that touch screen, and Trauma Center likely tops them all.

(Rating: 10/10)


While Trauma Center is not a game designed to be played over and over again in the main story mode, every single surgery in the game can be replayed in Challenge mode, so that you can try to improve your rank and score. It’s such a satisfying playthrough, that you’ll likely keep challenging yourself out of principle.

(Rating: 6/10)


The first few operations in Trauma Center are your “training missions,” for lack of a better term. Nurse Mary (and later, Nurse Angie) will assist you, while simultaneously teaching you how to use each surgical tool at your disposal. The challenge factor increases accordingly as time goes on, plus, you often won’t have anyone giving you step-by-step instructions. You’ll need to work on the fly, and make lifesaving decisions quickly. This is all part of the fun, and as you practice, your surgical skills will improve.

(Rating: 7/10)


Sure, there’s been surgery software in the past, but none like this. Most of those past software titles were educational in nature, anyhow. Trauma Center is more like the classic board game Operation, amplified by a factor of 1000. The use of the DS’ two screens is perfect, and the touch scsreen almost seems to have been made specifically for this game. Tied in with the whole race-to-find-a-cure angle, you’ve got a recipe for success.

(Rating: 10/10)


For someone who’s never been to medical school, nor had in any interest in doing so, I had a very hard time putting Trauma Center down. When you’re really into a complex surgery, time nearly stands still…except for the in-game clock, of course. It’s astonishing that something as niche as a “medical simulation” could draw a gamer in so much, but Trauma Center delivers in spades.

(Rating: 8/10)


How do you quantify this? What kind of gamer does a medical simulation appeal to? Therein lies both a great mystery and a simple answer. Trauma Center could very well appeal to anyone. Why? Because 99.9% of the time, someone playing it has never played a medical simulation before. If nothing else, the appeal of Trauma Center is in the curiosity factor. Good thing it’s backed up with a solid game! Still, some folks may be put off by the fact that it may look “too weird.” This is the biggest strike against Trauma Center, but hopefully it won’t hurt sales too much.

(Rating: 7/10)


There’s plenty of blood and guts in this game, but GTA it is not. In fact, the blood in Trauma Center is the exact opposite of what you’d want in an action game; if you see blood here, that’s bad news, and you’ll want to fix it as soon as possible. How often do you see that in games? Everything comes together so beautifully in Trauma Center; every gamer needs to at least give it a try. You’re missing out otherwise.

(Rating: 7/10)

Final Scores:

Story: 8/10
Graphics: 8/10
Sound: 8/10
Control & Gameplay: 10/10
Replayability: 6/10
Balance: 7/10
Originality: 10/10
Addictiveness: 8/10
Appeal: 7/10
Miscellaneous: 7/10

Overall Score: 79/100