Despite being the focus of a Wham Episode in Under the Knife 2, Nous is pathetic, even for a first boss. It only has one attack and gives the player ample time to raise the vitals whenever it's damaged. The only way to fail this operation is if you don't realize that the tumors Nous creates must be treated in the order they appear before the core can be excised.
The battle against Twisted Rosalia in Trauma Team is ridiculously simple and repetitive compared to pretty much every other boss in the series. Somewhat justified in that it's the only pathogen that was not artificially designed to be used as a bioweapon.
The final operation in Second Opinion is intentionally this. You operate on Savato, like on Blackwell in the main story, but this time you work alongside Naomi, who doesn't have the restriction on her Healing Touch like Derek does. While using Derek's HT before you're supposed to is still out of the question, you're still operating on a strain you've already beaten before with a much larger advantage this time.
Dying is bad, and wanting to die or other people to die is even worse. Also, modern medicine is awesome and anything that interferes with it is bad for society at large.
The latter gets deconstructed in Under The Knife 2 and Trauma Team, as some of the villains of those two games are well intentioned extremists whose attempts to improve modern medicine ultimately cause countless deaths.
Base-Breaking Character: In Trauma Team, Tomoe is criticized for her perceived flat personality, dull voice acting and annoying catchphrase. Others were a bit warmer to her character, as the story portrays her as a dedicated and kind doctor, and find her backstory as a ninja to be very interesting.
Best Known for the Fanservice: "Moving Heart" is one of Trauma Team's most infamous levels. How so? It's a Diagnostics level, and you sometimes need to get your patients to lift up their shirts in order to listen with your stethoscope. In that particular level, your patient is an attractive woman with, um, great cleavage that's even acknowledged in-universe. Do the math.
For players with higher skill levels, chapter 5-2, Under the Knife, is this for the game Under the Knife and its remake, Second Opinion, for making you operate on three to five kyriaki patients in quick succession. The large amount of Kyriaki make for a fast-paced and difficult, yet fair operation that tests your skills, all without being a puzzle boss.
Challenge Operation A-4 in New Blood. You perform a simulated operation proctored by Derek and Angie, who introduce some interesting tricks like adding GUILT. And having you treat GUILT and Stigma at the same time. And unlike the other characters who watch over you in Brutal Bonus Levels, Derek and Angie are very friendly and encourage you to succeed, rather than taunting you about how there is no hope for you. It is also the only Challenge Operation with a proper narrative.
First Response in general in Trauma Team. It's fast-paced, fair, and has you deal with up to six patients at once instead of just one.
Of all the original GUILT strains, Tetarti is often seen as the easiest to treat, due to it not being able to do a lot of damage unless the player screws up the injection. The variation introduced in Second Opinion also lacks the No Miss special bonus to give the player more leeway with it. When it gets re-hashed in Under the Knife 2, its method of being more difficult is... 2 more colours to spot and memorize, which is far easier than the increased tedium and aggression of Kyriaki and Pempti respectively.
Soma in New Blood. Just keep the drain active on it and occasionally laser its weak "attacks" and drained core. Even when in operations that have it alongside something else, it's pretty harmless.
Broken Base: Trauma Team's noticeably lower difficulty. Trauma Center, like many Atlus games/series, is renown for being Nintendo Hard, so it falls into It's Easy, So It Sucks! for many players. Others, however, hated getting stonewalled by sudden difficulty spikes in the other games (most especially in New Blood) when they just want to see the rest of the games' content, and appreciated that Team allowed players to move through it at a steady pace.
Under the Knife: Erich von Raitenau, aka Adam, is the hypocriticalStraw Nihilist leader of a terrorist organization who believes medicine is a product of the devil and mankind deserves to be destroyed for rejecting the "gift" of death. In order to do so, he has created artificial parasites called GUILT, all of which are highly contagious and capable of killing their victims in horrible ways all while claiming biblical justification by equating GUILT with the Seven Plagues of Revelation and himself with the "devouring angel" Abbadon (yup, the one with the locusts) while boasting to Derek that he alone will watch as Derek and friends burn in Hell. When Derek and Angie join the raid on Delphi's floating headquarters, they discover Adam has kept seven children (dubbed "Sinners" to go with his deranged ideology) in a nightmarish near-death state as culture grounds for the GUILT.
Under the Knife 2: Heinrich von Raitenau is the grandson of Adam, and is just as bad as his grandfather. He shares all the atrocities of the game with fellow Big Bad Patrick Mercer. Having inherited his grandfather's legacy, at an old age himself, Heinrich experiments on and uses children as GUILT hosts, including his own (whom he doesnt care if they die). Some die and the lucky ones that don't barely survive. He also manages to give GUILT to another villain, and while Heinrich is ultimately arrested for terrorism due to creating the virus he so precariously used, he attempts to give Derek Stiles's nurse Angie Thompson GUILT, which would give Derek a Sadistic Choice between her life or Heinrich's children. In the end he was a petty, self-centered scientist who only cared about advancing his own research even at the cost of others.
Victor Niguel and "Little Guy". The latter becomes surprisingly popular within the fandom, despite his very minor role.
Linda Reid (a patient) in Under the Knife. The major reasons are that she's at the center of Derek's character development and she's the first GUILT patient. Linda's huge popularity is probably one of the bigger reasons Angie developed a hatedom, thanks to losing her temper with Linda's suicidal tendencies and telling her to just die.
Fan Nickname: Pempti and Soma are referred to as autoscrollers by the speedrunning community due to being the series' versions of just that.
Genius Bonus: The series is filled with references to Greek mythology, right down to the protagonists' workplace being named after Caduceus, a staff carried by the god Hermes. The GUILT's names are also taken from the Greek words for the days of the week.
Germans Love David Hasselhoff: This game series is far more popular in America than Japan, to the degree that from Second Opinion onwards, the games are released in North America before Japan. New Blood and Trauma Team even take place in the United States.
You can skip a Savato phase by lasering it at nearly the same time you cut it, which allows you to cut it again. Sadly, you aren't able to do it twice in a row, but it reduces the post-web phases from 3 to 2. This only works in Under the Knife.
In Second Opinion, while waiting for your scalpel to be replaced after cutting a Savato web, you can repeatedly tap to Z button while keeping A held down to "use" the scalpel in short bursts. This can save you some time for this phase of the fight.
You can prevent the Kyriaki queen from laying eggs in Under the Knife 2 by having eight lacerations on screen at once, due to a memory limit preventing more from appearing. Doesn't stop her from cutting the patient for vital loss, however.
While dealing with Bythos, place your stylus on the GUILT's core, then touch the tray you are supposed to transfer it to. Lift the stylus and watch as the core is magically transported to the tray, thus bypassing the entire Bullet Hell segment of the level.
Cheir can be stunlocked by repeatedly pressing A on it with the laser instead of holding it, which dramatically cuts its difficulty down. This amusingly also makes it become less threatening when two of them fuse together instead of the opposite.
Ho Yay: Adel and Derek in Under the Knife 2. In one scene about halfway through, Adel's reaction when he discovers that Derek wasn't the doctor who operated on him is suspiciously similar to how a person would react to their partner's infidelity.
It's Easy, So It Sucks!: Trauma Team to many longtime fans, with the lack of bosses other than the pitifully simple Twisted Rosalia being a particularly sore point. The leniency when it comes to losing patients in First Response and making mistakes in Orthopedics, as well as the ability to abuse saving in Forensics and Diagnosis also drain whatever difficulty those modes could present.
Adam is a deranged lunatic who wishes for humanity to be wiped out via horrible parasites, and he crossed it by taking seven innocent children and using them as incubators for GUILT.
Much like his predecessor Adam, Heinrich von Raitenau harvests the GUILT parasites from the bodies of innocent children, but he crosses the line even further by using his own son and daughter as living incubators for the diseases.
Narm: In Under the Knife 2, the "operation" where Derek tries to practice his Healing Touch and is unable to pull it off would be pretty heartbreaking, except that the "Operation Failed" overlay still says "The medical board will be notified." Notified for what, failing a personal practice session that doesn't hurt anyone?
Older Than They Think: This wasn't the first major surgery-based game (that would be Life and Death for MS-DOS, Amiga, and other operating systems of the time) but since it's been fifteen years since that game was made, it is often credited as the first surgical game. It might as well be, considering the rarity of Life and Death these days. In fact, it isn't even the first DS surgery game! That belongs to the first Kenshūi Tendō Dokuta game, which was only released in Japan, although the second game in the series was localized in US and EU as Lifesigns. It notably focuses on realism, however, and places much more emphasis on the characters than the surgery.
Under the Knife 2 punches you with Emilio's death. He was a sinner, he survived a new form of GUILT that was dormant in a transplanted liver for him, and then he gets infected with GUILT again. Derek plans to operate on him after taking care of several other patients, but when he's ready to operate on Emilio, he dies.
In Trauma Team, the final phase of "Proud One". The patient, agonizing due to the effects of the Rosalia Virus, knows he is going to die and begs dr. Cunningham to tell his Last Words to his family. The gameplay changes in that you are no longer looking for symptoms, but for reasons to encourage the poor guy to keep fighting for his life. Then the chapter ends, and it's heavily implied that the patient did not make it...
Scrappy Mechanic: The fact that the X operations in Second Opinion have two versions where the only key difference is which doctor, and thus which Healing Touch, is used and that using a Healing Touch disqualifies you from an XS rank. If you're trying to nail 100% Completion, that means that you have to get XS twice on each operation, one for each of the two barely-different versions (since you can't use either doctor's Healing Touch) of the operation.
Signature Scene: The mission where you defuse a bomb with surgery tools in the original game. It's not widely remembered because it's fun or challenging or anything, but because it was a ridiculously big Unexpected Gameplay Change.
Stoic Woobie: CR-S01/Erhardt Muller in Trauma Team. He was hated by his parents, his adoptive father went insane and killed his sister and thousands of other people. He was then convicted of killing those people and sentenced to 250 years in jail. Even when he can reduce his sentence by performing surgeries, he has to go back to his cell shortly after the operations and thus can't hang out with the rest of the cast. Despite all of this, he doesn't seem that affected on the outside.
Strawman Has a Point: Tyler Chase, as the titular Death Doctor. Despite the first game's anti-euthanasia bent, he makes a lot of convincing arguments in favor of it before you cure Amy.
That One Achievement: One of the achievements in Trauma Team require you to get a Cool rating while shaving a bone in less than one second. That's incredibly fast, and you need to be accurate in a step where you can easily over or undershoot, and runs contrary to the more relaxed atmosphere of Orthopedics. You only need to do this once but it will take plenty of practice to get the timing right.
Aletheia in Under the Knife 2, despite being a Final Boss. It's a Final-Exam Boss due to how it summons waves of previous GUILT strains, but due to restrictions of the surgery environment the GUILT summoned by it can behave much differently from when they were encountered in the main story. It becomes temporarily vulnerable when defeating individual GUILT bodies during a wave, but good luck getting to inject the main body while managing what's going on around it.
Kyriaki will likely be the first wall you hit, even in Second Opinion where it's at its easiest. Unlike the other GUILT, it doesn't have a gimmick and just hits hard and often, forcing you to keep up with it. It's made worse in Under the Knife 2 where it has a queen that lays eggs, forcing you to hunt for those to avoid additional Kyriaki spawn while it cuts up the patient. Its successor in New Blood, Cheir, isn't much better due to creating tumors and gaping wounds in addition to cutting. It's also a lot harder to deal with, since it takes a lot more hits and can't be locked down like Kyriaki can. The only thing that makes it easier is that you don't need to search for it and cut it out.
Triti is infamous due to being a rather mean type of Puzzle Boss. The game gives you hints on how to do it, but they are incredibly vague. While it can be trivialized with the Healing Touch, this is guaranteed to destroy your rank, so those seeking to get a good rank will be forced to look up a guide to extract it efficiently. It's so bad that there's a tutorial video on it on YouTube.
Pempti is less well-known than Triti, but arguably worse. You start by injecting nanomachines into its core, which causes it to withdraw its tissue and then expose itself in self-defense. Now you just blast it with the laser. Simple, right? Of course not, this is an Atlus game. While you're attacking it, Pempti generates mini-cores that can cause lacerations, send up a wave of fluid that creates small tumors, or just drain the vitals directly. It's relatively simple to fight them off, but once you start taking hits, it's easy to get caught in a downward spiral, especially since taking any time to restore vitals means taking the laser off of Pempti and its mini-cores, which causes you to lose more ground. Is it any surprise an entire chapter was devoted to finding a way to kill this thing? The Pempti mutation in Under the Knife 2 makes this much harder as you have to juggle your focus between 2 slightly weaker cores. But when one core goes down, the other literally Turns Red as it attacks much more aggressively until it is destroyed. Hope you weren't just focusing all your firepower into a singe core... The X mission then complicates this slightly by making one core take a little more punishment than the other before it goes down, just to trip up the players who figured out to spread the damage evenly.
That One Level: Various levels can classify as this for two different reasons. One reason is that the difficulty of the level itself is rather high and can prove a source of frustration to those merely trying to clear the main plot. The other reason is that the level is straightforward when playing through the plot, but has incredibly tight conditions for an XS rank, turning into a major hurdle for those trying to XS every level. The former type of That One Level tends to be observed more often in New Blood as several operations, especially on Hard, are balanced towards two players simultaneously operating on the patient.
The ninth operation of the original, "Awakening", should be mentioned, especially since it's non-GUILT related. The patient's large intestine is suffering from aneurysms. To complete one, first, you have to magnify it. Then, shrink it with a needle until you can scalpel it. Then, forceps it to a tray. Drain the excess blood. Forceps the vessels together. Stitch. It's not the hard the first time, but once multiple ones start appearing, even the Healing Touch won't help. This extends to any aneurysm mission. The danger from them bursting is so great that after the first game this operation almost always takes place within the brain just so you can start and stop immediately, and so the impact of multiple aneurysms bursting at once is more realistic. Hell, this mission was made easier for Second Opinion - one fewer aneurysm develops during the last push.
"Under the Knife" is a rather climactic episode, and the level content is fitting - five Kyriaki operations in 10 minutes. A daunting task, but not entirely impossible for the skilled. Midway through the level, though, the player does receive a lifeline in that once they reach the 3rd patient, backup arrives and can take over the remaining patients, so past that point the player does not receive the game over for running the timer and can still proceed if they're falling behind and/or not aiming to S-rank everything. However, a player is more likely to reflexively restart the mission once they see the timer begin to run out, and they end up getting stuck on this mission.
Paraskevi is a straightforward, if potentially tedious, Asteroids Monster of a GUILT. But the pain comes when trying to S-rank its first mission in Under the Knife. The conditions include not letting any Paraskevi fragments escape to other organs, along with a completion time of under 3 minutes and 30 seconds. As you cut the Paraskevi down, the smaller fragments move and escape faster — sometimes within seconds after their Mercy Invincibility wears off. You also have to take the time to fix up the lacerations that Paraskevi makes each time you cut it. All in all you will either lose the time bonus or the no-escape bonus, and the S rank goes with it. The other Paraskevi missions at least are more lenient on your time, and the Second Opinion version is less brutal.
"Fallen Heroes", the penultimate story operation of Second Opinion, can be surprisingly brutal. It's a multi-stage GUILT operation, and because you alternate between two doctors, you have two Healing Touches at your disposal for different parts of the level. You'll probably need both of them. Here's why:
The first part of the mission is Triti (reasons regarding its difficulty are listed above). If you didn't already know how to efficiently treat it, you might end up wasting Derek's Healing Touch to entirely trivialize this part, giving up an asset that could help for the next portion of the level.
The second part is Kyriaki, which is trivial by this point in the game, but third patient has Deftera. What makes this GUILT more annoying is that blood regularly pools over the field, forcing you to drain it otherwise you can't treat what's underneath. If Deftera is going berserk and blood pools over it, you'll waste a bit of time getting it out of the way - enough time for more tumors to appear and for vitals to plummet.
The final part is Paraskevi on the heart. Unlike 6-4 where they're miniscule and can be removed quickly, here you have to deal with one entire Paraskevi. You cannot afford to let a single one escape, or it's an immediate Game Over.
There are four challenge missions in New Blood that involve treating a series of patients in a simulation. The final one involves one patient with that is infected with Kyriaki, Cheir, and infant Savato, and the one before that involves a simultaneous Deftera and Soma infection.
In the main storyline of New Blood, there is an arguably even harder mission, "Strike Force", that involves three patients. The first one is a Brachion infection, which is the Puzzle Boss of New Blood. It's not particularly hard, but it eats up a large amount of time and can get nasty if the heads regenerate. The second operation is a simultaneous Cheir and Soma infection, which is nasty combination, but can be overcome with the right strategy and a little luck. The final operation is the worst thing ever. This patient is infected with both Soma and Onyx. Onyx is not mentioned until you either ready the magnifier and spot its shadow, or it first attacks while you're treating Soma. Treating Onyx invariably means taking your eye off Soma to find the hidden Onyx and you are almost guaranteed that a red tumor will harden while doing so. The kicker for these multiple patient operations is that when you lose, you have to start from the beginning, making it all the more annoying considering the Onyx/Soma combination is intricate enough to be its own mission.
"Lost in Flames", where you're treating a burns victim. The process to treat a burn is simple on paper: inject clear skin with culture fluid, scalpel the skin loose, forceps three pieces of skin onto a burn, secure with antibiotic gel. This is complicated by a couple of things: firstly, some of the wounds are blackened and cauterized, requiring them to be injected with coolant, cut free, and moved away with forceps before donor skin can be placed. Simple enough. The real killer, however, are blood pools. Blood appears frequently and at random spots over the wounds, and will dislodge any unsecured donor skin over the burn. Worse, the burns overlap, making it far too easy to put a piece of skin over the wrong one, and a blood pool will almost certainly form by the time more is ready. The standard 5-minute timer might be very generous for most ops at this end of the game, but it's hell even on easy here. If you somehow manage to intuit draining all the blood before doing anything else dramatically slows the rate of new pools forming it gets easier, but it's still hell to get a decent rank on.
Under the Knife 2 takes the premise of this and ups the ante with "Hall of Shadows", giving you three burn victims to treat but only 5 minutes to do so. Each burn victim also presents with increasingly severe burns and less area for skin culture. You're prone to expending the Healing Touch just to make it in time.
While Trauma Team is notably easier than the past games, getting an XS rank is now much more difficult. Nowhere does this become more apparent than "Blade of Resolve" and "Love in the Ground", which require the player to get all COOL miniranks and to finish absurdly fast.
If you're handling Tomoe's missions and the level involves multiple branching paths, on the first go you're nearly guaranteed to get lost and waste precious time. The one where you have to search for Dr. Cunningham in a huge pile of rubble is the prime example.
They Changed It, Now It Sucks!: Trauma Team has caused a Broken Base in this respect. General consensus is that while Surgery is as fun as ever (if a bit too easy) and First Response is incredible, Orthopedics is too repetitive for its own good, and Forensics and Diagnosis are so much of a genre shift that they would have worked better as a separate game entirely. Also, almost everyone agrees that Endoscopy is the worst gameplay of the bunch.
They Wasted a Perfectly Good Character: Adel starts out a largely sympathetic character that is apparently bound to be Derek's apprentice, but quickly becomes Out of Focus past the first chapter of the sequel. He barely has any impact in the story, joining HOA halfway through the game and requiring to be saved from a Neo-GUILT in the final chapter.
They Wasted a Perfectly Good Plot: In Under the Knife 2, the premise of an African country being devastated both by a civil war and a mysterious pandemic is interesting in its own right, but it's only the focus of the prologue. The rest of the game has the main characters dealing with the remnants of Delphi and a corrupt corporation back in Japan/America (depending on if you play the Japanese or English verison), while the aforementioned plot points are largely forgotten and still unresolved by the epilogue.
Viewer Gender Confusion: Adel Tulba in Under the Knife 2. He's a black guy who can perfectly pass as a woman to new players.
Waggle: Ultimately, this is what makes the endoscope operations in Trauma Team so hated. It forces you to move the Wiimote forward like when using a defib, but you need to constantly pull it back and forth rather than it being uncommon and rarely appearing more than two times every ten operations, or fifteen patients in First Response. You also need to look around to do things, which is far slower than moving with the ultrasound while undergoing surgery. These factors together mean that it's painfully slow compared to the much-loved Surgery and First Response, but doesn't have the laid-back atmosphere of Orthopedics that makes it work. Rather than implementing motion controls in a way that feels natural and fluid like the others, Endoscopy feels forced and unnatural.
All of the Sinners, by virtue of being young children orphaned and subjected to horrific experiments, but Emilio takes the cake. His suffering is prolonged by his PGS, which destroys his liver. Then during the transplant, he ends up contracting a second GUILT. When that's taken care of and it seems his life will finally take a turn for the better, Emilio is at the epicenter of a terrorist attack that infects him with Kyriaki, which ultimately takes his life.
In Trauma Team, Rosalia Rosselini. An innocent girl that only wants to help people ended up killed by her own stepfather because she is the carrier of a doomsday virus.