As Dr. Stiles, it's your responsibility to save your ailing victims in a variety of operations. Using the touch screen, you have access to ten different surgical tools to use at your disposal in saving their lives. Scalpel, drain, antibiotic gel, forceps, and ultra-sound to name a few. When you start off, your nurse walks you through exactly what to do for the first few missions, getting you used to what each tool does and when to use it. Unfortunately, she never really shuts up as the game goes along.

Controlling with the stylus is what makes this game - cutting into their skin with the scalpel is a quite fun. The missions you do are all very different and interesting. You work on different ages and different situations such as removing a tumor or giving your patient stitches.

Every move you make is given a "Miss," "Bad," "Good," or "Cool," ranking which are worth various points towards your total score. So using precision and speed are especially important in this game.

This game is no walk in the park. Under the Knife starts out relatively challenging and then just becomes ridiculously impossible by the end. I'm not kidding either. I still haven't beaten the final mission.

What's even funnier is apparently the amount you worry about keeping your patient alive isn't stressful enough, so they made sure there were three ways you could lose your mission.

1. Their life falls to zero.
2. Time runs out.
3. Receive too many "Miss" ranks.

So not only are you incredibly stressed by how low their heart is beating, but you can't be too slow, and you can't mess up too many times. Great...

When their heart falls to zero, your nurse tells you to go away and have the other doctor take over. Why? They're dead! Just to rub it in, your "Game Over" screen shows you walking the steet without a job and hanging your head in shame.

The debriefing before hand helps get you excited (and worried) for the mission.

Things get really difficult later on. I'm not kidding. It's near impossible.

After the first handful of missions, you realize you have a special skill called the Healing Touch. By drawing a giant star on the screen, you can activate the Healing Touch, allowing you to work on the patient in slow motion. Pretty soon after that, you discover there's a GUILT virus going. The virus is infecting people with strange little manta-ray looking creatures that swim below their skin and cause damage to them while you're operating.

For me, I wasn't too happy with these changes in the story. For one, the Healing Touch and the GUILT virus twists it into a Sci-Fi story. This doesn't necessarily make the game bad, but I enjoyed working on patients as though they were real, with real and common emergencies. Making me treat bizarre alien-looking viruses while using my supernatural power takes me away from the realism of it quite a bit. I wish they wouldn't have gone that direction, but that's just me.

This is all part of the story which is explained by cutscenes inbetween each operation. The story is pretty stupid, if you ask me, and most of the time I just felt like skipping it and going to the mission. The story feels rushed and unnecessary to an otherwise brilliant gameplay.

Aside from the pathetic story line and Sci-Fi elements, this is a great game. The gamplay is really what moves this game forward, and using the stylus to treat wounds feels natural and exciting. The stress level from this game is through the roof - you really have to get good at using your tools effectively. The graphics could have been improved a bit, but the gameplay holds its own, and that's what matters for this title. You've never played a game like this before.

Atlus is in the process of developing a sequel titled, Trauma Center: Second Opinion - and it's being made for the Nintendo Wii. Using the Wii-mote to tackle surgical operations could make for an interesting and unique game. We'll have to see how that one turns out too.

Verdict: Very fun, very difficult.