Trauma Center: Under the Knife

"You're the doctor, it's so much fun to play" was the catchy jingle used on adverts for MB's "Operation" during the 90s, and it could easily apply to Atlus' Trauma Center: Under The Knife for the Nintendo DS. When looking into buying this, at the back of my mind was how much I loved Operation as a child and I figured that gameplay might pan out similarly: a steady hand and concentration being the keys to success. How wrong I was..

Upon starting my career in surgery, I soon discovered that gameplay was much faster paced and relied more on your ability to multitask and quickly recall skills previously learnt than having pin-sharp hand-eye co-ordination.

After a quick briefing by your superior or assistant nurse, you're presented with a selection of icons representing surgical implements down either side of the touch screen, with the area in the middle being your "working area": a view of the torso or whatever area you're operation on. The top screen displays time remaining and other information, as well as on-screen advice from the nurse assisting you during this operation.

You select implements with a touch of their icon, then perform an action on the right area of the touch screen to use them to, hopefully, cure the patient before the time runs out, you make too many mistakes or their health drops below a certain amount. Their health can be increased a slight by filling up a syringe and injecting your patient to ease their suffering, giving you a better chance of getting to the root of the underlying problem.

Your assistant usually gives you plenty of advice and hints on what to do in the earlier levels, and there's usually a dotted line to show you where to slice the patient open. Succeed and "Good" pops up to confirm you've done the current action correctly and you can move on to the next. If you've been a little haphazard, "Bad" pops up and you can still move on to the next action. Do particularly well and you'll be treated to "Cool". I laugh big at the inappropriateness of slicing someone open to be rewarded with a "Cool".

Even without any assistance, the actions are fairly intuitive: drawing liquid out with a syringe or the draining utensil requires you to press on the touch screen and move the stylus upwards, while slicing the patient open requires a straight line to be swiftly drawn in the right area. More complex procedures require similarly simple actions that just feel right, for example stitching up a wound requires a zig zag to be drawn quickly without lifting the stylus and heart massage requires touching and keeping pace with a steadily moving pendulum (bringing back the pulse of a virtual life is a surprisingly moving experience).

So then, with such simplicity where lies the challenge? Well, although the actions alone are very simple, combine memorising what to do and the specific order in which to do it with the need to do it at great speed and you're soon applying antiseptic cream when you don't have to and forgetting to drain off poison before making incisions, all the while feeling confused and annoyed at your "unresponsive" hands.

In that respect it is sort of like playing Bop It!, but the selection of the right tool for the job and the juggling of these tools reminds me a lot of Pssst! on the ZX Spectrum, while the priority-managing aspects reminds me of Worse Things Happen At Sea also on the ZX Spectrum. There was also a surgery sim on the Amiga called Life & Death (or Life Or Death) and if I'd played that, I'd probably find similarities with this too. The gameplay owes a lot to the titles I've mentioned, but it's the combination of these elements and the use of the touch screen that make this a truly unique experience.

As do the overwhelming feelings of guilt when you let the patients down. Thankfully, even when you do make more mistakes than allowed, run out of time or forget to keep an eye on your patient's health, they don't die. The head surgeon always comes back from a conference or meeting just in the nick of time to save the day! You are then presented with the Game Over screen, an image of your character (the just out of med school Derek Stiles) walking down a street in his long jacket and plain clothes looking guilt-ridden which reminds me of numerous ER episodes.

The plot, following Derek on his medical career from its bumbling beginnings to eventually having to deal with the discovery of a sinister supervirus, is moved on with reasonably well-drawn Manga style comic-book interludes between levels. The dialogue isn't great and it's initially quite uninvolving, but it picks up and the comedy interchanges you have with some of the patients you meet and Derek's over-reactions and pre-op powering up are pretty comical.

The during op graphics are more realistic than comic booky and are kind of drab and functional. Although it's not photo-real or anything, it's still quite unnerving to see your patient bleed all over the place as you remove a splinter of glass from their heart. I would perhaps not recommend it to sensitive young children, but to be honest with you I'm probably as squeamish as a 6 year old and the in game graphics don't bother me too much. The audio is ok, the music being suitably medical and urgent while the sound effects sound like exaggerated versions of what they're meant to be.

The learning curve is good, teaching you only a few actions per level until you're up to speed with them all, or at least most of them. Lifespan is fairly good, I don't feel I'm near the end yet and I've failed and had to replay many of the operations a few times before progressing to the next. The coroner? I'm sick of that guy.

In all, this is incredible fun, looks good and during gameplay uses the touch screen exclusively and does so in a novel way. Solving the puzzle of each operation, working out what order to do things in and maintaining the balance is a difficult job and success really is a satisfying experience. And it's not even smug satisfaction, it's genuinely rewarding.

I give this 8 videogame hearts out of 10 for giving me a sense of worth. And at under £25 to buy from Play-Asia it's real value for money. Or just fill your cart up with capsule toys and J-crap to make it up to the price you'd pay for a UK release. It's worth it.

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