Although the plot revolves around the aftermath of the events in the previous DS game, newcomers to the franchise should be able to dive in without any problems.

The most obvious change is the game’s aesthetics, which have been upgraded from anime caricatures to the more realistic personas seen on the Wii. Between operations the game focuses heavily on dialogue and the intricate plot, which can be annoying, but at least the cut-scenes can all be fast-forwarded.

The first Trauma Center was infamous for its nightmarish difficulty. However, the sequel offers a choice of three difficulty levels for each chapter. Even on normal the game can be challenging, but much of the title’s replay value comes from revisiting previous chapters to perfect your technique and score. While your female colleague will assist you when you’re not sure what to do next, the game can sometimes rely on trial and error rather than what seems to be the natural solution.

You have a wide array of medical tools and will need to use several simultaneously in the more complicated operations. The gameplay is fun, but the stylus occasionally doesn’t sync up with the on-screen actions as it should. There is some repetition, too, as there are only so many ways a person can be healed.

Under The Knife 2 may be more of the same, yet it still remains one of the more unique, intense experiences available on the DS. The melodramatic story and improved presentation really drive the gameplay, while the multiple difficulties should allow a broader audience to start saving digital lives.