Trauma Center: Under the Knife

Trauma Center: Under the Knife is a video game that combines surgical simulation gameplay with storytelling using non-interactive visual novel segments using static scenes, character portraits, text boxes, and voice clips during gameplay segments. The top screen of the Nintendo DS is dedicated to story sequences and level statistics displayed as 2D artwork, while the bottom touch screen is dedicated to the operations themselves rendered using 3D models. All of these actions are accomplished using the DS stylus. Operations range from treating surface wounds and extraction operations, to special operations where Stiles must confront strains of a man-made parasitic infection dubbed GUILT. These strains can be highly mobile, complicating the operation. Some operations are affected by environmental hazards, such as turbulence on a plane. A key story-based ability is Stiles's Healing Touch, triggered by drawing a five-pointed star on the touch screen. The Healing Touch slows down time for a limited period, allowing the player to perform operation actions without the patient dying. Points are awarded with how fast and efficiently an action is performed, and graded from "Bad" to "Cool". After each operation, the player is graded on their performances, with rankings going from "C" (the lowest) to "S" (the highest). After an operation is completed in the story mode, players can attempt it again in the Challenge mode for a higher score. The player can save their game after each story chapter. If the patient dies or the timer runs out, the game ends and the player must restart from their last save. ==Synopsis==

Trauma Center is set in a near future Earth of 2018, where medical science has advanced to the point that previously major diseases such as AIDS and cancer are easily cured. The world's pioneering medical foundation is Caduceus, a multinational, semi-covert organization dedicated to researching and curing intractable diseases. The story follows Derek Stiles, a young doctor who discovers his mystical Healing Touch during a difficult operation on an emergency patient from a car crash. After treating another patient infected with an unknown parasitic disease, Stiles is offered a position at Caduceus, which he accepts. The parasite is known as the Ganglia Utrophin Immuno Latency Toxin (GUILT for short), a manmade disease being distributed by the medical terrorist cell, Delphi. Along with his companion and assistant, nurse Angela "Angie" Thompson, Stiles begins confronting new strains of GUILT in different patients, along with surviving attempts on his life by Delphi. During their work, several Caduceus staff members are infected, including the director, Richard Anderson. While the strain is eventually removed, Anderson ultimately succumbs to the stress on his body from multiple operations and gives his position to Stiles's former superior, Robert Hoffman. During an attempted raid by Delphi on Caduceus, the intruder is identified as Angie's father Kenneth Blackwell. Trailing him to a Delphi laboratory, Stiles and Angie successfully treat a highly-virulent GUILT strain, first in a nascent form in a test subject, and then in Blackwell himself. Once cured, Blackwell offers his full cooperation and rejects Caduceus's offer of amnesty, wishing to serve out his term in prison to atone for his actions. Blackwell's information leads to the location of Delphi's headquarters, which consisted of an ocean vessel. When Stiles and Angie assist with a raid in cooperation with Caduceus Europe, they find that Delphi has been using children to incubate GUILT, and after curing the patients, they encounter Delphi's leader, Adam, now a vegetable host for all seven strains of GUILT, as well as a unique, eighth strain known as "Bliss." Caduceus Europe impound Adam's remains, and Stiles is hailed for his actions. ==Development==

The original plan for Trauma Center was created by the game's producer Katsura Hashino. During this early stage, many staff compared the game to similar surgery simulations for Windows. The concept behind Trauma Center originated several years before development started. While Atlus had explored the possibilities of a surgical simulation game, gaming hardware at the time was not able to realize their vision. This changed with internal previewing of the DS, which had the controls and functions to make the simulation elements work as intended. Planning for the game began in the summer of 2004. Most of the staff were veterans of Atlus's Megami Tensei role-playing video game (RPG) franchise, making the development a difficult one due to its thematic and gameplay differences. Production proved a challenge due to the new gaming hardware and its deviation from the RPG mechanics Atlus was known for. One of the more difficult elements was getting the gameplay to function, which they finally achieved after settling on a first-person perspective for surgery. The art style was described as "very anime-styled". ==Release==

The game was first announced in July 2004 alongside five other Atlus titles for the DS. The game was released in Japan on June 16, 2005. A commercial demo was released through Nintendo's online store on May 29. While it lacked the high amount of blood and gore that would have earned it a mature rating, its content still merited a CERO rating of "B", indicating an age range of early teens and up. A soundtrack album was released by Sweep Records in October 2011, The game was first revealed under its English name at the 2005 Electronic Entertainment Expo. It released in North America on October 4. The game was localized for the West by Atlus USA. For the game's English version, the game's setting was changed from Japan to North America. Derek Stiles's English name was written as a pun on the word "stylus", referencing the DS stylus. The English dub was handled by PCP Productions, who had previously worked with Atlus on Shin Megami Tensei: Digital Devil Saga. Voice acting was restricted to shoutouts during operations, while Stiles himself did not have a voice actor. Due to their lack of a European branch, Atlus USA did not publish the game in the region. The game was instead published by Nintendo of Europe on April 28, 2006. ==Reception==

In Japan, Trauma Center did not appear in Japanese gaming magazine Famitsus top 500 best-selling titles for 2005, which suggests that the game sold less than 15,000 units. In contrast, the North American release sold significantly better according to Atlus. The game's popularity prompted Atlus to issue further print runs of the game. The game also met with strong sales in Europe. While Atlus had seen financial losses prior to 2006, the international success of Trauma Center contributed to the company making a profit. Review aggregate website Metacritic awarded the game a score of 81 out of 100 based on 45 reviews, indicating "generally favorable" reviews, GamesBeat writer Stephen Kleckner retrospectively considered it among the most memorable games of 2005. Famitsu praised the game's innovative use of the touch screen, Eurogamers Tom Bramwell praised the gameplay, although he found faults in the game's presentation and confusing or arbitrary mechanics. The use of the DS touch screen and stylus were generally lauded by critics; East called it a concept only made possible by the hardware, while Leeper had issues with stylus motions registering. The story was generally praised, with many calling it both silly and engaging, and a few noting its handling of mature themes. Others also negatively noted the large amount of text, which slowed the game's pace. Difficulty spikes in later portions of the game, lack of room for improvisation, and general repetitiveness were noted by reviewers as detrimental factors. ==Legacy==

During their 2005 gaming awards, GameSpot nominated Trauma Center in their "Most Innovative Game" category. In the years following its release, Trauma Center would become a notable success for Atlus, breaking into mainstream gaming when they had previously been restricted to niche success. In a feature by Jess Ragan for 1UP.com, Trauma Center: Under the Knife was described as having "helped pull the Nintendo DS out of a debilitating software drought and demonstrated the system's potential to both hardcore gamers and skeptical outsiders alike". Website VentureBeat listed Under the Knife as one of the most memorable games of 2005 due to breaking away from gaming trends and creating an experience focused on saving lives. Following the release of Under the Knife, most of Hashino's team shifted to work on the Persona series, with a small number of staff being assigned to form a new team for further development of the series. This group would be known internally as "CadukeTeam". The Trauma Center series would be continued with three subsequent games on Nintendo hardware; Trauma Center: New Blood for the Wii in 2007, the direct sequel Trauma Center: Under the Knife 2, released in 2008 for the DS; and Trauma Team for the Wii in 2010. In a series retrospective, Peter Davison of USGamer noted both the series' notable position in Atlus's gaming library, and how the titles made use of the Nintendo console mechanics. == Notes ==