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In its second DS outing (and fourth overall), Trauma Center hasn't changed in any fundamental way. It remains an unusually flashy digital take on Operation, that famous kids' board game with the electrified tweezers whose obnoxious buzzing alarm has tormented generations of parents.

There's not a thing wrong with that, though. In Trauma Center: Under the Knife 2 for the DS, we get to encounter a new setting, new operations, some new touch-screen maneuvers, and many more momentous ego-stroking declarations about what a magnificent surgeon you are. If the basic concept isn't completely new, it's certainly been dressed up in a snappy new outfit.

This sequel also throws in some seemingly minor changes that make a big difference in the playability of the game. The variable difficulty levels will be a godsend to players who hit the wall in the original Trauma Center (and many players definitely did). Just that one change makes this a major improvement on the previous game.

The Pros from Dover

Unlike the two Trauma Center titles for the Wii, Under the Knife 2 is a proper sequel to the previous DS games, taking place a short while after super-surgeon Derek Stiles eradicated the terrorist-engineered GUILT parasite. The story begins in a fictitious African nation, where Derek and his faithful assistant Angie are working with a sort of Doctors-Without-Borders-style relief organization to patch up the refugees of a nearby guerrilla war.

It's too bad the game doesn't stay in Africa for very long, because the setting allows for some interesting operation concepts – patching up bullet wounds from guerrilla raids, putting crocodile-mangled broken legs back together. Eventually, though, you'll be paying less attention to those sorts of background details and more attention to the nuts-and-bolts gameplay challenges in front of you.

In case you're new to the Trauma Center series, this is a deceptively simple surgical simulation driven entirely by the DS touch screen. Each patient represents a different collection of ailments that have to be fixed with a dozen or so different surgical tools, which you control with motions of the stylus. To repair a long gash, for instance, you might slide the stylus upward repeatedly to drain away blood and discharge, quickly streak along the length of the cut to disinfect it, and then draw a little zigzag across it to suture it closed.

Some experienced players may complain that the sequel uses more or less the same collection of surgical instruments as the first game. It's true that most of what you'll be doing is familiar – disinfecting, slicing, suturing, grabbing bits and pieces with the forceps, picking out trouble spots with the ultrasound, and so forth. Trauma Center 2 does a good job of mixing up all the different moves, though, in ways that seem fresh each time. It never feels like you’re doing the same thing over and over.

Hard As You Want It

It also rarely feels like you're going to break your DS clean in half out of maddened frustration. As mentioned above, the big addition in the sequel is a variable difficulty level. You can pick between easy, normal, and hard levels at the beginning of the game, and if the level you started with proves a little too easy or a little too tough, you can adjust the difficulty up or down at any point in the campaign.

The game keeps records of your score for each operation on each difficulty level. In other words, if you clear one surgery on easy or normal and feel like revisiting it at a harder level, you can go back to play through it again at any time and see how the results compare to an earlier effort.

The normal difficulty level should be about right for folks who've played a few DS games and know their way around the touch-screen. If you've put in a lot of time on, say, Elite Beat Agents (or the original Trauma Center, for that matter), you might want to ratchet up to the hard level. The easy mode is pretty darned easy, but that's fine – it makes the game accessible to just about any player, and novices who grow out of it can switch up to the normal mode as soon as they decide they're ready.

Some Real Sharp Surgeons

The bits of the game that take place in between the surgeries, it has to be said, are less than compelling. The background graphics and character artwork are pretty sharp, and Atlus USA did its best to edit the dialogue into something readable, but this is not a game you're going to play to get wound up in a compelling plot and deep, well-developed characters. As a rule, the cutscenes are several times too dramatic for their own good.

That's not such a big problem, though – this is still a game worth playing simply to play it. The controls are intuitive, the operations are well-organized, and now that you can tweak the difficulty to your liking, you can challenge yourself as much as you'd like to. It may still bring back memories of playing Operation when you were a kid, but it's the best game of Operation anyone's ever made.

Review by: D.F. Smith