I’ve been struggling to find a proper way to classify LifeSigns: Surgical Unit. Part point-and-click adventure, part soap opera, and part Trauma Center clone, it’s an unabashedly Japanese game that will surely appeal to a niche Western audience. Probably best described as "point-and-click interactive anime", LifeSigns has some charming moments. However, its heavy focus on plot, repetitive gameplay, and long breaks between any real action will likely test the patience of most gamers on this side of the ocean.

LifeSigns chronicles the adventures of Dr. Tendo Dokuta, an intern at busy Seimei Medical University Hospital. Tendo enters the medical profession after enduring the childhood trauma of his mother dying of cancer. Every day, he comes across all sorts of medical emergencies, tackling each challenge with the help of his fellow hospital staff. Among these staff members are Suzu, his attractive, older female supervisor; Aoshima, another overworked intern; Hoshi, a well-meaning nurse; and Professor Sawai, the hospital’s gruff head surgeon and Tendo’s boss. Each of the game’s five main episodes involve these characters in some way, with other "guest" characters popping in and out of the narrative as each story unfolds. It’s no coincidence that many of the main characters are women, since there’s a running subplot that hints at plenty of romantic interest in the young doctor.

The interactive aspect of each tale involves two distinct gameplay phases. The first is an adventure and research phase, told via anime-style cutscenes that have you visiting different locations on the hospital map to question characters about the topic at hand. When you get a useful piece of information, it’s stored in a scrollable inventory at the top of the touch screen as the icon of the person who gave it to you. Multiple pieces of information from the same person are differentiated by slightly different icons (e.g. one icon might have a sad look on the person’s face, and one might be happy). When you want to discuss one of your pieces of "evidence" with someone, you simply use the stylus to drag the icon over them to get a response. Sometimes it will be the right topic and they’ll drive the story forward, while other times you’ll receive a canned dismissal or flippant comment.

This research phase is entertaining but flawed. While the stories told are often humorous and engaging, the act of information-gathering is tedious and repetitive. It’s baffling that, with such a text-heavy game, developer Spike didn’t give players the opportunity to skip entire conversations. If you ask somebody a question, be prepared to have to skip through their entire diatribe every time. This is especially irritating when you’re stuck, because you’ll get caught in long conversations that you quickly realize you’ve heard several times over.

As the game progresses, it also becomes obvious that characters appear at certain locations for the sole purpose of furthering the story. Gameplay becomes a simple matter of chatting up each character until you present them with the right piece of evidence that triggers the next piece of critical dialogue. What should be legitimate puzzle-solving is just as easily accomplished through trial-and-error.

The second phase of gameplay has you carrying out life-saving operations on patients. A precursor to most operations is a physical examination, during which you’ll use the stylus to rub areas of a patient’s body, checking for various internal ailments (and yes, there are consequences for rubbing patients in inappropriate places). You can also use a stethoscope to check for other symptoms, which are handily listed on the top screen as they’re discovered. Unfortunately, you’ll sometimes have no clue as to where to examine, so again there’s some trial-and-error involved.

Later episodes will see you executing multiple operations per episode, the stakes getting higher and higher with each trip to the operating room. You can save your game at any time during an episode so you’ll never lose any progress. Operations typically signal a major turn in the story or the conclusion of a story arc, so there’s plenty of build-up; the game does a good job of drawing the user in, making sure you realize that each operation is a critical and delicate procedure. You also score points that can be used to buy unlockable extras after you beat the game, an extra incentive that adds to the tension and your desire to excel.

Operations present a series of touch screen-based tasks for the player to complete. For example, removing a patient’s gallbladder involves cutting him open, securing the gallbladder in place, snipping it out, cleanly removing it, and sewing him back up. These actions are all done with the stylus and require different techniques based on the tools being used. Suturing a cut requires a zig-zag motion across the opening, while using an electric scalpel requires a soft, steady line of pressure that cuts the patient but doesn’t burn him. Because it’s often necessary to hold your DS steady in order to make long, precise cuts, LifeSigns isn’t the greatest game to play on the go. If you don’t have a tabletop or other flat surface around, you’re going to have a hard time with advanced operations.

Part of this difficulty stems from the hint system that guides your incisions. You can use the L and R shoulder buttons to give you a temporary path for an incision; it quickly fades, but gives you an idea of where to cut. Because you’re often doing long cuts, you need to hit the hint button over and over. Each operation becomes a juggling act, with the player hitting L/R, continuing the cut, hitting L/R again, and so on. It can be a tricky proposition.

Of course, any error on your part has an adverse affect on your patient’s health. Repeated screw-ups will exhaust a health meter at the top of the screen, triggering a resuscitation mini-game that has you timing the application of shock paddles. You can only resuscitate a patient once, however, so doing an operation right the first time is always critical. What makes this task difficult is the fact that you can’t restart an operation that’s in progress; even if you screw up early and know you’re doomed, you’re still forced to complete the entire operation. Since later operations can be very long and complex, this can be very frustrating.

Resuscitating a patient isn’t the only mini-game you’ll come across. Each episode has a strangely random unlockable mini-game thrown into the middle of it, featuring such off-the-wall objectives as catching snakes, cooking dumplings, and playing air hockey. They’re nothing like the rest of the game and seem strangely out of place, almost like an excuse to add some extra gameplay content.

In terms of presentation, LifeSigns is Japanese to the core. The hospital scenes are wonderfully drawn, with backgrounds and characters looking like they've been plucked directly from a Japanese anime series. Characters are presented as static drawings, but they all have plenty of different poses and facial expressions that really imbue them with their own personalities. None of the character names have been Westernized, so they can be hard to keep track of at first, but each character design is so unique that you’ll be able to match faces to names in no time. There’s a nice variety of music, with some bouncy "Just another Fine Day at the Hospital" tunes mixed with some more menacing selections for dramatic effect. The score changes dynamically in true soap opera fashion; if somebody gets bad news, the music gets scary, while a successful operation calls for a more upbeat track.

LifeSigns: Surgical Unit will definitely appeal to fans of text or point-and-click adventures who don’t mind wading through a lot of dialogue to get to the action. While the stories presented in the episodes are actually quite enjoyable, the trial-and-error nature of fact-gathering coupled with the inability to skip conversations makes furthering the narrative a tedious and frustrating process. The operation element of the game suffers the same fate; operations are fun to perform, but they can also be difficult and time-consuming, with the lack of a restart function making early mistakes aggravating and costly. If the concept of interactive Japanese manga intrigues you, LifeSigns will certainly satisfy; but those looking for less plot and more action will want to look elsewhere.