Even after mentioning it in my review of LifeSigns almost a year ago, I'm still surprised that there haven't been more copycat versions of Trauma Center. The game still ranks as one of the more unique uses for the DS's tech, and considering some of the highest rated shows on TV are medical dramas, you figure some publisher would follow the money trail.

At first glance, Trauma Center: Under the Knife 2 doesn't look much different than the first game. The slightly abstracted version of the human anatomy has been cleaned up and features upgrades like a new lighting engine and sharper effects. Surgical tools are still laid out along the left and right sides of the screen; though with a noticeably slicker, "high tech" look that brings the DS game more in line with the Wii version. The top screen features a revolving cast of backseat surgeons who help you out during the operations. All of the returning characters have been updated with more expressions and clearer portraits.

Sound is delightfully low key and fits the "medical" mood. It's never distracting and except for the random shouts of, "Doctor" you're pretty much left to the simple sounds of your surgical tools and the menacing beep of the vital signs monitor.

Trauma Center: Under the Knife 2 takes place three years after the first game. Derek and Angie are now volunteers in a dusty refugee camp in Costigar, a country recently torn apart by civil war. The change of setting offers a great backdrop for the game's initial surgery, which manages to be both enjoyable and incredibly poignant at the same time. There's an obvious anti-war sentiment, but all things considered, it isn't completely unexpected. Unlike other games that have tried to push similar messages, Trauma Center 2 manages to do it without being too preachy or obvious - something more games should try.

The change of climate also allows for the introduction of a new cast member, a young surgeon named Adel. Although you'll play as Derek throughout much of the story, in truth, Adel is the story's real protagonist, placing players in the odd position of both mentor and mentee. After a wild time in Costigar, which comes with everything from a late night guerilla attack and the near death of a main character, the story shifts back to America where Derek, Angie and Adel must face the fallout from the GUILT virus (PGS), the terrorist bred disease from the first game.

The basics of gameplay haven't changed much between the first game and the sequel; you still perform operations. The approach still has an arcade-like quality; procedures are much simpler than in real life and you're placed under a strict time limit. As with previous games, saving lives still isn't enough, so you're also rewarded with points based on your accuracy and speed.

In truth, gameplay is just as much about memorization that anything else, though speed plays just as big a role. Not only are you up against the clock, but you also have to keep your patient's vitals stable, otherwise they'll die on the table. This is one of the areas where the game falters the most; even on the easiest setting, it sometimes feels like you're always going back to the stabilizer medication to prop up patient's constantly dropping vitals. I can understand this happening in some of the more invasive surgeries, but vitals will plummet in some of the simpler ones. Faster reaction times and deft hands can alleviate the problem most of the time, but every now and again even the Flash's reflexes wouldn't be quick enough.

While some players will probably lament the absence of features like multiplayer, the amount of single-player game makes up for its absence.

The pacing of operation types is much tighter than the first game, which had a bad habit of throwing incredibly hard procedures at you early on. Although there are a few bumps in the road (your first encounter with PGS is a killer), Trauma Center: Under the Knife 2 takes its time building up to the really hard stuff. The overall feel is much friendlier to newcomers; Normal mode is still challenging, though it is more in-line with what you'd expect "normal" to feel like. The difficulty for each operation can be set independently, so if the game ever feels too easy or hard, you can always bump it up for the next one rather than having to start over from the beginning, which is a nice touch. The hardest setting is pretty brutal, while Easy is a little too easy... so regardless of which end of the experience spectrum you find yourself on, there should be something that fits.

Action takes place on the touch screen as you quickly move between various tools, patching up all manner of maladies. Most revolve around dealing with the various forms of Post-GUILT disorders, usually in the form of mutated tumors than require special removal methods, though you'll also patch up broken bones, treat massive burns and mend a few gunshot wounds.

All of the tools from the last game are present in the sequel, along with a few new medications, most of which are specific to PGS. The icon-based layout is kept intact, so veteran surgeons shouldn't face many hurdles. The Costigar levels are a great tutorial and slowly introduce tools as they are needed. The revolving cast of helpers will also remind you about which tools come next in the sequence in case you forget.

Each tool uses the stylus in a different way. Using the scalpel lets you cut into patients with a slash, while stitching up wounds requires you to draw the "thread" across the wound. Some tools, like the suction tube or syringes, require you to move fluids through the tube by running the stylus down tube. The defibrillator is the trickiest tool to use; the movements are simple, though the timing always seemed a bit off, so I ended up jolting some patients with enough power to solve the nation's energy crisis... or at least it felt that way.

While publishers haven't been raking in money from House and Grey's Anatomy themed Trauma Center variants, the lack of clones has the happy side-effect of keeping the pool from becoming diluted and makes releases like Trauma Center 2 that much more satisfying. Although it doesn't introduce too many changes, Trauma Center 2 improves the original's shortcomings and helps the series retain its place as one of the more unique experiences on the DS.