For a review of the mechanics and overall design of Under the Knife 2, I refer you to our reviews of the previous games in the series. Unfortunately, this sequel is so formulaic and rehashed that it feels like a remake of the original game, which has already been remade once for the Wii. It also rolls back many of the advancements in the first sequel (also on Wii), and it blatantly copies the new surgeries introduced in that game while introducing very few new operations of its own.

The story takes place three years after the first Under the Knife game. Dr. Derek Stiles and his nurse, Angie Thompson, return essentially unchanged. The game starts in the fictional African nation of Costigar, where we meet a young doctor named Adel Tulba. He plays an important role in the overall plot of the game, but is never a playable character. Make no mistake, Dr. Stiles is very much the star of this game.

The plot concerns the aftermath of the GUILT infestation attempted by "medical terrorists" in the first game. You'll start by treating "Post-GUILT Syndrome", but eventually face a resurgence of GUILT itself. There are a couple of interesting new characters, but most of the cast, locations, and indeed the plot itself are all too familiar. The returning characters exhibit very little character development, although there are (finally) the faintest hints of romance between Derek and Angie. The writing is solid, but overly heavy foreshadowing and a reliance on old narrative tricks make the whole story arc predictable for anyone who has played another Trauma Center game. Also annoying is the notable increase in story-only missions, which are each five to ten minutes of literally paging through dialogue with no gameplay at all.

I've focused on the story so far because it is the newest thing about Under the Knife 2. While a bit formulaic and redundant, the story is relatively fresh compared to the rest of the game. The gameplay, controls, graphics, strategies, and types of operations are all carbon-copied from the original Under the Knife, with a few elements carried over from New Blood. Sadly, large portions of the story seem contrived to allow the game to simply reuse assets and surgeries from the other games. I praised New Blood for introducing new kinds of surgery and new strategies to the series, but Under the Knife 2 is undeserving of any such praise. All it offers are a couple of new types of GUILT which you might see once or twice each, but this paltry sample of new content doesn't even show up until the last two chapters of the game. That means you could be playing for seven or eight hours (roughly 80% of my completion time) before seeing anything that you haven't seen before.

To be fair, Under the Knife 2 is still a Trauma Center game, and that means challenging, skill-based gameplay. However, the game feels entirely unnecessary and frankly boring when compared with New Blood, which was released less than a year earlier. This newest game also feels like a step backward after the last one offered cooperative multiplayer and full voice acting, neither of which can realistically be implemented in a DS game of this type.

Although I've been a fan of Trauma Center from the start and am glad to see Atlus supporting it with sequels, Under the Knife 2 is such a complete rehash that it makes me question the reason for its existence. It's nice to see the series return to its original home on the DS, but nothing has been added to take advantage of the system's unique capabilities except an obnoxious microphone-blowing incident in one mission. Even a modest step forward, such as adding more frames of animation to the character portraits, would have made the game feel fresher and more vibrant. As it is, Under the Knife 2 comes across as a cynical cash-in, a mission pack so lazy that it doesn't even have new missions. Avoid this game and instead check out the far more innovative and satisfying Trauma Center: New Blood on Wii.