Trauma Center: Under the Knife 2 is the sequel to 2005's Under the Knife, which introduced the world to the amazing Dr. Derek Stiles and a deadly infection concocted by a crazed terrorist group hell-bent on destroying humanity. Many puzzle fans couldn't put the game down despite its outrageous plot and painful difficulty, and the sequel is just as addictive. Though you'll still spend time fighting fictional diseases spread by bioterrorism, Under the Knife 2 is such an exceptional medical-themed puzzler that you'll forget the game's absurdity as you're sucked in by its consuming gameplay.
The game recasts you as Derek Stiles and opens in Costigar, a fictional African state attempting to recover from decades of brutal civil war. It has been three years since the eradication of GUILT, the man-made infection crafted by terrorists, and though it has been successfully treated worldwide, it seems that those who had previously suffered from the disease have developed new symptoms, prompting Derek to return to the United States to contend with new strains.
Gameplay in Under the Knife 2 proceeds in much the same fashion as in the original, and operations play out in chapter episodes after a cutscene provides the appropriate backdrop. Before each operation, you're given a patient briefing and a surgical objective by your assistant, after which the standard five-minute time limit appears and the patient's life is in your hopefully very steady hands. You work externally to internally, making incisions with the scalpel, removing foreign objects with the forceps, and coating the patient's wounds in the strongest antibacterial gel ever created. You complete an operation by fixing whatever ails the patient and are awarded a rank according to how quickly and effectively you work.
Though it sounds simple enough, operations in Under the Knife 2 quickly intensify because the fast-paced procedures require you to tackle multiple tasks simultaneously; the difficulty comes not in any one procedure's complexity but in the speed with which you need to perform it as you struggle to stabilize a patient's vitals while feverishly sucking out pools of pus and zapping tumors. This hectic push for speed is the game's high point and significantly increases an operation's difficulty--since the slightest slip of the hand damages a patient's vitals. Fortunately Derek has a healing touch ability, which appears to slow time as he moves faster than an infection can progress. You'll also receive clear verbal cues about your next procedure from your assistant, which is a blessing when a patient's condition is spiraling out of control and you're clueless as to what to do next.
If you've spent any time at all with the Trauma Center series, then the game's standard tool offering won't surprise you; in fact, most of the tools are identical to those in the original game and function similarly, with the exception of the defibrillator, which comes in handy when patients go into cardiac arrest. You drain disgusting bodily fluids by drawing the stylus up from the target pool, stitch up gaping wounds by zigzagging the stylus across them, and make clean incisions with the scalpel by following the dotted line. Any sloppy suturing isn't likely to get you chastised, but Under the Knife 2 is more of a fast-paced puzzler than a straight medical simulation, and the mixture of both elements makes the game incredibly fun and addictive. The surprising amount of operation variety is also refreshing considering the plot's heavy focus on the new GUILT; you'll do an organ transplant, extract fragmented bones in the dark, inject color-coded serum into bacteria, and even play laser tag with giant moving tumors.
Atlus took Under the Knife's strongest criticism to heart when designing its sequel, forgoing a single punishing difficulty level for three difficulty modes. You can adjust these for individual chapters, which should make the game accessible to anyone intimidated by the original game's insane difficulty. You'll still end up repeating a fair number of operations, even on normal mode, but the additional settings make it possible for you to do so without pulling your hair out, which is a welcome improvement.
The game's presentation is similar to its predecessor's; the instructions, time limit, and stage score are displayed on the top screen, and the operation field is on the bottom. Patient models are in 3D and feature comparatively more-realistic organs and wounds, while the game's 2D anime style has been toned down a bit so that characters look less comical. With that said, their dialogue is still ridiculously melodramatic at times, complete with "I'm a doctor!" and "Pull yourself together!" lines. The music is very quick and upbeat, with great tunes supplied during key operations that are sure to get your blood pumping. Minimal voice work is also provided to emphasize important plot segments.
Under the Knife 2's only flaw is that it feels a bit light on content, offering only 38 operations that take a few minutes each to play through. You won't necessarily complete them all first time, of course, but even allowing for failed attempts and lengthy cutscenes it shouldn't take you more 15 hours or so to beat the game. Finishing the game does grant you access to "confidential" operations, but these are set on extreme difficulty, leaving those who shied away from the hard setting woefully unprepared for the challenges ahead. Even with these bonus operations the game still feels padded, containing entire episodes without operations that amount to little more than lengthy dialogue filler. There's some replay value at least, since the ranking system encourages you to repeat past surgeries to increase your score. All in all, Trauma Center: Under the Knife 2 successfully blends a creative medical theme with bizarre but fun puzzle gameplay to create an addictive treat.