This game improves upon its predecessor in many ways
You once again play as a surgeon known as Derek Stiles who must perform a number of operations together with his lovely assistant Angie Thompson. Fans of the first game will remember that Dr. Stiles had seemingly gotten rid of the deadly disease known as GUILT. He is now famous and is receiving lots of attention from the media. While the first game's story dealt with Derek's rise to fame, this one focuses on what happens after he (together with the team at the health organization known as Caduceus) eradicates GUILT. In other words, the story focuses more on the different problems that Derek has to go through because of his new popularity and the different situations Caduceus must go through as different medical companies try to get affiliated with them. While the plot itself isn't too amazing (yet still has large amount of text which can be annoying) and flows really unnaturally at times (at one moment you're doing normal operations and next you're kidnapped by terrorists), it's still interesting enough to hold this game together.
This game may not be well known for its plot but where it really shines is its gameplay. Trauma Center: Under the Knife 2 strikes a good balance between keeping the same feel of its predecessor yet it still adds a few new touches to improve upon the first game's gameplay mechanics. Those who mastered the first game will be able to adjust very easily to this one as you'll be seeing all the tools that you used in the first game. There are also a few new tools added like the defibrillator and a penlight which is used in dark areas and while these tools were present in the Wii versions, it's nice to know that they can just as easily be used on the DS.
The main attraction of the game's mechanics this time around is the variety in the operations. The first game got a bit repetitive towards the end because all that you ever seemed to be operating on was GUILT and the next operations always consisted of just harder forms of GUILT. It seemed as if Derek and Angie were now a specialized medical team who only treated the GUILT disease. It's much more realistic this time though as you will now occasionally be treating bullet wounds, hemorrhaging, and applying skin grafts onto inflamed pieces of skin and each patient has a different problem. This is a refreshing change of pace and makes this game much better than the first in terms of gameplay.
Atlus has also listened to many people's complaints and have fixed some of the other problems of the gameplay by making the tool icons bigger and the health bar a bit more visible. One of the bigger minor problems which many people complained about in the first game was the difficulty level which Atlus also fixed. Instead of one predetermined difficulty level that's really hard, Atlus now gives us three difficulty modes to choose from which are Easy, Normal, and Hard. Those who enjoyed the challenge of the first game should look towards Normal and Hard while those who liked the first game but could never finish it because they lacked the coordination and reflexes can still enjoy the game on Easy. Its nice touches like these which show that Atlus does listen to its fans and all these factors ultimately make Trauma Center: Under the Knife 2 a much better experience than the first game in terms of gameplay.
Even though Atlus could've made a great sequel solely by its gameplay improvements, they also decided to upgrade the game's graphics. The slightly pixelated backgrounds of the first Trauma Center are gone and replaced with much cleaner looking visuals. The characters also thankfully lost their simple anime character design and have been replaced with the more detailed and likable character designs from Trauma Center: Second Opinion. The operation interface itself looks much cleaner with bigger tool selection buttons and a much more stylish look. The organs also look a bit more realistic together with the blood. Overall, this game looks beautiful for a DS game and is a definite improvement over its somewhat cheap-looking predecessor.
The new music is a love it or hate it affair. While the Trauma Center: Under the Knife had a more dramatic feel and was composed by Shoji Meguro (musical composer of some of the Shin Megami Tensei games), this Trauma Center has a more upbeat and techno style composed by Manabu Namiki. Some fans like the new music, others don't like it, it's simple as that. If you're more into upbeat catchy techno music that makes operating o n someone's body actually feel fun then you'll love the music of this game, but if you don't then prepare to be disappointed. I personally liked both though and I though that this game's music pretty good. Aside from the music which you will like depending on your opinion, the audio is great. The characters have more voice acting this time around, and many of the sound effects sound appropriate with a few being over exaggerated (cuts that are made during the operation still sound like sword slashes)
In terms of length and content, this game doesn't offer much. There are only 38 operations in the main storyline and your first playthrough can easily last only around 10 hours. What this game is rich in however is replayability. Right after you complete an operation, you are given a rating of either C, B, A, S, or XS. Perfectionists will keep on playing an operation several times until they get at least an A or an S which can greatly extend the playtime for this game. Not to mention that there are a few incredibly hard bonus missions added once you finish the game once which you are bound to keep retrying before you even succeed at them. This can easily make the game's length rise to above 20 hours meaning that as long as you aren't content with just finishing the main story on Easy, this game will definitely keep you occupied.
In the end, the one thing that Trauma Center: Under the Knife 2 can be described as is an improvement. It manages to keep the same feel of the first Under the Knife game yet it improves on so many aspects. The gameplay has improved greatly with multiple difficulty choices and a cleaner interface, the graphics are more detailed, there's more voice acting, and the game is still as addictive as the first one. I would recommend this to all the people who loved the first game and anyone who just wants to have a nice and fun DS game to play as this is much more accessible (yet it can still be challenging for hardcore fans) than the first game and is an improvement in almost every way.