Before the Nintendo DS found its way into our hands and hearts, the idea of a videogame in which the player performs surgery on virtual patients would never have even crossed my mind. A company would have had to tap the deepest pit of their creative resources to portray the real world physics of surgical procedures in a fun and intuitive way. With Atlus's 2005 release for the DS, Trauma Center: Under the Knife, players were pleasantly surprised at both the concept and the playability. With a compelling story told through stylish anime-style text and responsive controls via the stylus, it was well received by gaming critics worldwide.

Unfortunately, Under the Knife fell into the dreaded out of print phantasm, only recently returning to store shelves. In an attempt to expand the series' visibility, the game has been 'wiimade' for Nintendo's newest system as Trauma Center: Second Opinion, to yet again take advantage of a unique control scheme. Atlus didn't stop there however, as the entire presentation has been given a facelift, along with exclusive new tools and missions. If you have yet to try your hand at digital medicine then there's no better time than now to join the team at Hope Hospital. Returning doctors fearing too much of a retread to dip in once again, fear not - the new controls alone change the dynamics enough to warrant a second opinion from you.

Told through the eyes of Hope Hospital's newest resident doctor, twenty-six-year-old Derek Stiles, Second Opinion (and Under the Knife before it) sutures together a story of commitment, redemption and personal discovery, not unlike your favorite medical drama. Set in the year 2018 in a bustling metropolis area known as Angeles Bay, the world has seen the eradication of nearly every major disease, including AIDS and cancer. As the game opens, Stiles is about to enter surgery, the first that he is solely responsible for. At this point he is still struggling to refine and discover his healing abilities - both physical and supernatural - as well as make the transition between slacker med student and serious doctor.

Unfolding through high resolution (which can be bumped up to 480p by those HDTV and component cable owning Wii owners, although lacking a 16:9 resolution setting) and completely still anime-style backgrounds and character portraits, with plain, silent text, Second Opinion weaves an intriguing six chapter story (the final chapter of which is brand new) of medicine and personal journey that appears to steal pages from the dramedy Scrubs before absorbing the laughs into a more serious tone. Once each chapter comes to a close, a new Wii-exclusive "Z" episode opens up, each of which stars Japanese surgeon Dr. Nozomi Weaver. As the story and characters are established during the first two chapters, there is a heavy amount of text outside of the context of actual surgery, as a proper introduction should require - but as the second chapter hits full gear, the gameplay takes the surgeon's role while the story is relegated to nurse status. What story is provided takes a noticeable hit as a drier script, cardboard cutout graphics and very, very little voice acting (the previous promised "more voice acting" has changed into a handful), stalling character development a bit more than I would have liked. Another story annoyance is the odd break up of surgical missions and story bits on the level select screen. Even if the story bit is only a few screens of text, and even if it's directly tied to the beginning or end of a surgical mission, you still need to choose the next level. The only thing that hurts the flow of a story more than having it constantly interrupted is to have it constantly interrupted by the table of contents!

The gameplay runs more smoothly, as Atlus's focus was clearly on upgrading the playable part of Under the Knife. As has been mentioned already, Second Opinion is about performing digital surgery - but it's more than that. The best description I have read is 'surgical puzzle game', which sums up the gameplay perfectly; as you go through the surgical motions, each action is given a score based on precision, performance and speed, with a final tally at the end handing out a letter rank. This is straightforward in explanation and exasperatingly joyful in practice.

Building upon the original's simplistic, 3D rendered graphics, Second Opinion turns in a fantastic performance using a stylistic graphical look that perfectly achieves a sense of realism while avoiding nausea. This essentially gore-less system revolves around realistic shapes, such as the bodies of patients and their organs, filled in with unrealistic and almost psychedelic colors. If you grow woozy from surgical shows (real or fake), have a distaste for open wounds or pass out at the sight of blood, you should still find no reason for distress here.

Once you engage these graphics with the new control system, using a stylus just won't be the same. Atlus have taken full advantage of the Wii's controllers, putting nearly every button and feature to use. The Wiimote's job is the most obvious, handling all movement and action that was once controlled by the stylus. On screen, where you're aiming is represented as a small circle, much like a red dot from a laser pointer, giving your actions guidance. The nunchuck's main job is to handle tool selection, accomplished by pointing at the desired point on the tool wheel with the analog stick, as well as helping with the defibrillator tool. After you select your tool and hold down the necessary button(s), your Wiimote movements are executed onscreen. This can take the form of slicing, suturing and object removal, all of which react to even the slightest of twitches.

Expect a significant learning curve in the controls (and medical terms), especially if you are new to the Trauma Center series. The first chapter introduces you by throwing you right into the fire, forcing you to actively learn. This might seem insensitive at first, but the tension of not quite being sure of your skills is intentional, as Stiles is struggling with the same problem. Don't be surprised when the difficulty ramps up after chapter one though, regardless of the selected difficulty, with missions taking an hour or two full of mistakes and dead patient screens to complete. You may want to approach with a wild and free surgical spirit, but Second Opinion will break you into a stern-faced, boulder-stiff surgeon with a steady but swift hand. It may be painfully frustrating at times, but stick with it and feel the wondrous reward of each victory.

The sound department feels a bit understaffed, as the short tracklist's sound quality is far closer to the DS version than you would prefer. What is here is decent, successfully portraying relief, joy, tension and tension overload, but I still kept feeling like I mistakenly hooked my DS to my TV! The sound effects are excellent, especially the shocking loud mistake noises that both alert you of an error while scaring the consciousness out of you, only further stirring up tensions. The sound of failing to remove an object never stopped making me jump either!

With missions taking over an hour just to overcome, story mode should take between twenty and thirty hours to just finish, depending on your skill and chosen difficulty; achieving the elusive XS rank for each mission will take even longer. The game doesn't end once Chapter 6 comes to a close though, as there are still the aforementioned Z chapters, as well as the unlockable X chapter and Extreme mode; there's more than enough staying power for both the casual and the hardcore gamer here.

Trauma Center: Second Opinion may not be the sequel that Under the Knife fans were hoping for, or even the step forward in storytelling that Atlus hinted at, but don't think for a minute that the spot on controls, engaging puzzles that demand more from you in one mission than most games do in ten hours, and the one-of-a-kind gameplay tip the scale back in its favor. This is without doubt a worthy launch title that deserves a truly Wii-specific sequel… stat!

Reviewed by Tony Peters for AceGamez (All Rights Reserved).