Trauma Center: Under the Knife
Trauma Center: Under the Knife
Game Information
Developer Atlus Japan
Publisher Atlus U.S.A.
Year 2005 (US)
System Nintendo DS
Genre Hospital Simulation /
Arcade Action
Multiplayer No
Co-Op No
Series Trauma Center

Trauma Center: Under the Knife, known in Japan as Chōshittō Caduceus (超執刀 カドゥケウス Chōshittō Kadukeusu?, lit. Super Surgical Operation: Caduceus), is a surgical simulation game developed and published by Atlus for the Nintendo DS and is the first entry in the Trauma Center series. The game was released in Japan on June 30, 2005, in North America on October 4, and in PAL regions on April 28, 2006.Like all games in the Trauma Center series, the player is tasked with performing surgery on various injured patients. The player uses the Nintendo DS touch screen to use the available medical instruments and perform the required actions. The player assumes the role of Derek Stiles, a young surgeon who possesses a unique and rare ability called the "Healing Touch," which briefly allows him to operate exceptionally quickly and accurately. His ability leads him to work for Caduceus, an organization dedicated to researching diseases, where he is tasked with treating a series of increasingly dangerous strains of a man-made disease called GUILT.Under the Knife received favorable reviews, gaining aggregate scores of 80.31% and 81 on GameRankings and Metacritic.[1][2] A remake, Trauma Center: Second Opinion, was released in 2006 as a launch title for the Wii console and a direct sequel, Trauma Center: Under the Knife 2, was released in 2008. ==Gameplay==

Trauma Center is divided into several chapters and operations within each chapter. Each operation must be completed in order to access the next one and progress through the game.

The lower screen on the DS is used to display the patient, the patient's vitals, the instruments available, and the operation field. The top screen is used to display instructions, the time remaining, the player's miss limit and score.

A typical mission requires the player to operate on a patient. During each operation, the player must keep the number of errors committed below a set limit, ensure that the patient's vitals remain above zero and keep within the time limit. If the player runs out of time, reaches the miss limit, or the patient's vitals reach zero, another surgeon will take over the operation, which will always seem to fail.

Upon successful completion of an operation, the player is ranked based on the time remaining, the health level of the patient, and a net score based on the accuracy of the operation. The total score is then ranked, with special score rankings for each operation. Rankings for these are graded:

  • Rank S- Master Surgeon
  • Rank A- Senior Surgeon
  • Rank B- Specialist
  • Rank C- Rookie Doctor

The player may repeat any operation in Challenge Mode and attempt to earn a better grade. Three save slots are available, but only the best score is recorded for each operation.

In addition to normal operations, there are operations known as "X-missions". The X-missions are seven operations, each one containing an Extreme version of a strain of GUILT. However, the game does not notify the player about the X-missions, unlike the other games in the series. As with every game in the series, the X-missions are unlocked after beating the game once, and are found in the challenge mode, with fake records used to fill the time/score/rank slots (such as exactly 30 seconds remaining on the clock). As with every game in the series, the player is not required to complete these operations.


There are a number of instruments available for surgery.

  • Surgical laser - Used to cauterize objects that are too small to remove from the body otherwise.
  • Antibiotic gel - Used to disinfect areas and treat small cuts.
  • Drain - Used to remove excess fluids, such as blood.
  • Forceps - Used for removal of foreign objects and tumors.
  • Hands - Used for heart massage if the patient goes into cardiac arrest, and for the Healing Touch. Also used to affix synthetic membranes.
  • Ultrasound - Used for finding objects, such as tumors, that are hidden inside organs.
  • Magnifier - Used for zooming in and out on parts of the body.
  • Scalpel - Used for making incisions.
  • Sutures - Used for closing or tightening incisions.
  • Syringe - Used for administering medications.
  • Bandages - Used to bandage sutured incisions.

The Healing TouchEdit

The Healing Touch is an ability, according to the ancient Greeks, descended from Asclepius, the Greek god of medicine. It allows a surgeon to focus his concentration to superhuman levels in order to move extremely quickly and precisely for a limited amount of time. In the surgeon's mind, this appears to slow time.


Gangliated Utrophin Immuno Latency Toxin is a group of deadly man-made parasites that start to infect patients later in the game, which are supposed to be "boss battles". There are seven strains that the player encounters throughout the course of the game, each one representing a Greek day of the week:

  • Kyriaki (Sunday) - An arrow shaped-parasite which hides inside organs and attempts to kill off organs by creating lacerations on it. (Occurs at Episode 2, Chapter 9)
  • Deftera (Monday) - A 'moving' tumour that attacks in pairs and attempts to kill patients via creation of nutrient-sucking tumours.
  • Triti (Tuesday) - A mass membrane with thorns at each corner, pinning it to the organ. It will slowly calcify the organs. As the pieces of the membrane are removed, it will spread according to the placement of the thorns.
  • Tetarti (Wednesday) - Parasites that come in 3 types. It creates poisonous gases and spreads them in the organ. Also, it creates diverticula on organs.
  • Pempti (Thursday) - A core-like virus that creates a gelatinous membrane on the lungs or intestines. It is immune to physical injury. It will react offensively and spawn smaller cores which will cause lacerations, absorb nutrients or create tumours.
  • Paraskevi (Friday) - A fibrous GUILT which will attempt to burrow through organs to the heart, killing the patient if it reaches the heart. If player attempts to cut it down to smaller size for extraction, it will cause lacerations.
  • Savato (Saturday) - A parasite which spins a web around the heart to steal the heart's energy for itself. Causes lacerations that spawn mini-Savato which will attempt to merge into a bigger mini-Savato that will cause vital damage. It also moves extremely fast, needing the doctor to stop time to deal the final blow.


Under the Knife is set in the year 2018, where medical technology has advanced such that effective treatments for previously incurable diseases, such as AIDS and cancer, are available.[1] The story is told to the player via dialogue between the characters, either presented in cutscenes or during operation.

The player assumes the role of Derek Stiles, a doctor at Hope Hospital. After the near-death of a patient due to his negligence, he encounters the scene of a car crash and ends up working on a patient with incredibly severe injuries to the heart. Just as it seems like the patient is done for, a power within Derek is unlocked, and miraculously saves the patient. The power emerges once more, and Derek saves another patient when a seemingly routine operation gets dangerously out of hand. His superiors recognize the ability. They tell him that his power is said to be that of a descendant of the Greek god of medicine, Asclepius, and his gift is known by the same name, though is more frequently referred to as the Healing Touch. He practices his use of the ability, though is left weakened after forcing the power to activate under his own will. After performing another operation, Derek blacks out for a short period of time. Dr. Kasal advises Derek to avoid using the ability due to the toll it takes on his body, and Director Hoffman tells him to outright turn his back on the ability, saying that the responsibility is too great for him to handle. After saving Linda Reid, a teen with a strange parasite (eventually known as Kyriaki), he learns of a new man made disease known as GUILT, which is distributed by a medical-terrorist organization known as Delphi.

It is at this point that Derek decides to embrace his ability and use it to end the threat of GUILT. He then begins working for Caduceus USA as their main surgeon, where he heals a young girl who has the second known strain of GUILT (Deftera). During a conference, Delphi sets a bomb with the intent of killing the doctors attending. However, with the help of Cybil Myers, he successfully defuses the bomb. After this, he flies to Africa to aid Caduceus Europe, and encounters the third strain of GUILT (Triti) in a young boy.

Back in America, Derek encounters the next strain of GUILT (Tetarti), which is only manageable after finding samples and using them to produce a few serums that are used to counteract the GUILT. Greg Kasal ends up being among those infected with the new strain, and is saved by Derek. Afterwards, Richard Anderson, the Head of Caduceus USA, becomes infected with a strain of GUILT (Pempti) that seems to be resistant to everything that is thrown at it. Eventually, Victor Niguel, Caduceus USA's head researcher, manages to come up with measures to defeat the GUILT and after much resistance, the strain is finally removed from Anderson's body. However, Anderson succumbs to the toll taken on his body and dies soon afterwards, leaving Hoffman as the new director of Caduceus USA.

Not long after this, outbreaks of Kyriaki, Triti, and Tetarti emerge and are thwarted by Derek and the other surgeons. Then, one night, a man breaks into Caduceus USA and ends up infecting Cybil with the sixth strain of GUILT (Paraskevi), though Derek manages to remove the parasite from Cybil's body. The man who broke in turned out to be Kennith Blackwell, the father of Derek's assistant Angie, and they manage to trail him back to a research lab. There, they encounter the final strain of GUILT (Savato), first an immature form within one survivor, and then the main form within Blackwell himself. Practically being death incarnate, Savato proves to be a difficult challenge for Derek, being so swift that not even his normal Healing Touch is able to let Derek deliver the final blow. Using the Healing Touch twice in succession, the Healing Touch intensifies to the point where time seems to stop, and Derek finally manages to destroy Savato.

Blackwell offers his full cooperation for saving his life 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 a great wealth of knowledge about Delphi's operation and eventually the location of Delphi's headquarters. When Derek and Angie assist with a raid in cooperation with Caduceus Europe, they find that Delphi has been using children to incubate the seven strains of GUILT, and after curing the patients, Derek and Angie encounter Delphi's leader, Adam. What they also find is that Adam is practically a corpse, heavily infected with GUILT himself. Derek operates on all 7 strains and rids the world of GUILT. With the threat of GUILT eliminated, Derek becomes well known as the man who saved the world.


See also: List of characters in the Trauma Center series
  • Derek Stiles (age 26, Born 1992) - The main character and a surgeon at Hope Hospital. He is just beginning to realize his potential.
  • Angela "Angie" Thompson (age 21, Born 1997) - A young nurse that works as Derek's assistant. She is part German and was raised by a very well-educated family.

Hope Hospital staffEdit

  • Mary Fulton (age 32, Born 1986) - The senior surgical assistant for Hope Hospital. She is a nurse who helped Derek learn the basics of surgery. She moved away from Hope Hospital, where Angie took her place.
  • Greg Kasal (age 38, Born 1980) - The senior surgeon at Hope Hospital.
  • Robert Hoffman (age 55, Born 1963) - Dr. Hoffman was an exceptional surgeon who stopped practicing in his 40s. He's now the director of Hope Hospital.

Caduceus USA staffEdit

This is known as Caduceus Japan in the Japanese version and in Trauma Center: New Blood.
  • Sidney Kasal (Age 35, Born 1983) - Greg's younger brother and director of Caduceus USA, who dedicated his life to the study of clinical medicine after his wife died of illness.
  • Stephen Clarks (Age 42, Born 1976) - Caduceus' head surgeon.
  • Cybil Myers (Age 34, Born 1984) - The leading anesthesiologist at Caduceus. She was previously a policewoman.
  • Victor Niguel (Age 26, Born 1992) - Head of research and development. He focuses mainly on his work and its uses. He is considered a recluse and can't stand the thought of "idiots" being near him.
  • Tyler Chase (Age 26, Born 1992) - A former schoolmate of Derek's. He tries to keep everyone in a good mood. He is secretly the "death doctor" of Cadaceus as he administers euthanasia to GUILT victims that he deems incurable. Derek talks him out of it.
  • Leslie Sears (Age 26, Born 1992) - One of the many nurses on staff at Caduceus. She looks after many GUILT patients, including Tyler's sister, Amy.
  • Richard Anderson (Age 60, Born 1958-2018) - The head director of Caduceus USA and Secretary of Health. Died after three treatments in a short period of time from Pempti.

Members of DelphiEdit

  • Adam (Age 121) - Born Erich von Raitenau in Austria in 1897, he was the head of the Delphi organization. He has been sustaining his life deep within the Delphi Headquarters situated on a boat in the Pacific Ocean, and has been the main culprit in helping to create the GUILT outbreak. As the leader of Delphi he believes that humans deserve the "blessing" of disease as it is what God's will and it is his quest to rid the world of doctors curing GUILT. He claimed that the GUILT virus originally came from his body before being modified by Delphi's scientists and then released into the world. However, the details of the origin of the GUILT and how he came to be in his current disease-ridden state, and how he can seem to communicate through the voice of others (Suspended Animation) are not described within the game.
  • Professor Kennith Blackwell (Age 46, Born 1972) - The father of Angie who left his family when Angie was only 8 years old. After discovering that Delphi wanted to use his own daughter in their GUILT experiments, he made a deal to join them and in return they let his daughter stay with his family. Blackwell was infected with the mature form of Savato. However, he was saved by Derek.
  • Ludwig Milan (Age 37, Born 1981) - A Delphi agent found at the medical facility where Professor Blackwell was conducting his research. He was the first victim of the immature form of Savato, which was in a developing form at that time. After he was saved by Derek, he helped create the serum that led to Savato's destruction.

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