Surgeon Simulator 2013 started out as a simple Game Jam game. Built in roughly 48 hours, it was a mess with tons of bugs and a very bad control scheme. Despite this, it was fun, and developer Bossa Studios continued working on it for another 48 hours. It was released to the public on Steam and to much acclaim. After a trip to the iOS, the game comes to the PS4 in the form of Surgeon Simulator 2014: Anniversary Edition.

You play the role of Nigel Burke, a surgeon who's able to get the job done despite some unusual circumstances. Working at a hospital in the UK, your job is to perform surgery on a patient only known as Bob, who has one malady after another. Using the tools at hand, you have to successfully perform all of these surgeries in any way you can. Truth be told, the story is only here as window dressing. Despite some things that try to flesh out the tale, such as random phone calls to your office, there's nothing to drive the story to any real conclusion. It's a throwaway aspect to the game, but that doesn't hurt it.

Surgeon Simulator only features one mode where you progress through the surgeries one at a time. You start off with a heart transplant before moving on to a double kidney transplant and then a brain transplant. You also get the eye transplant and tooth transplant scenarios that were exclusive to the iOS version. In all of those surgeries, you're free to plan out what to do until you make the first incision. Once that occurs, the game becomes timed since blood loss occurs, forcing you to get each procedure done before the patient dies of blood loss.

After conquering all of those scenarios in the operating room, you'll go through them again — in the back of a moving ambulance. Survive that, and you'll get to perform the same surgeries on a gurney that's moving through hospital hallways. The difference is that you'll sometimes lose access to tools that aren't in your hand, since trays disappear for a while. To compensate for this, you'll get access to a defibrillator that gives you a chance to revive your patient if the blood count drops to zero. Pass this, and you'll get to perform the surgeries in outer space before taking on one last surgery that's different from the rest. The only thing missing is the Team Fortress 2-related mission with the Heavy, but otherwise, this is a pretty complete version of the game.

When you start out, you're presented with an office full of items, and this is where you realize what you're up against. First, your surgeon only has one functional arm. Everything that needs to be done, from picking up objects to manipulating any tool, must be done with only one hand. Second, the control of the arm is pretty precise. Not only can you control the height of the arm, but you can also control the actions of the wrist and fingers. Third, the collision for the game is pretty bad. Trying to pick up something as delicate as a scalpel is a challenge, and there will be times where you'll poke at something like the intestines and wondering if the stabbing will eventually lead to an actual cut. Finally, the physics are out of control, since anything can be tossed around without a sense of weight, and objects can easily get knocked over.

Getting to the operating table, you can see how the game mechanics have made difficult acts even harder. Trying to break open a ribcage, for example, can be done by rotating your wrist to make the tool hit the bones or repeatedly raising and lowering your arm so the tool and bones can make contact. Picking up a scalpel will most likely see you knocking over an empty soda bottle, a plastic fork, and a rotary hand saw before you grab it with the blade that's barely sticking out of your fingers. You might even poke your arm on the blood thickener and see the world in psychedelic colors. Try exposing the brain stem, and you might see the whole thing go through the side of the head and jiggle uncontrollably. If you ever wanted to imagine what a game would look like without anyone in the QA department checking it, this would be it.

Looking at it as a serious game, Surgeon Simulator fails on all levels. The difficulty of the controls and host of bugs render the game almost unplayable unless your goal is to fail each and every time. However, the game is presented as more of a comedy, something of a spoof on simulator titles, and hints of that intent are seen in other elements of the game. You have the freedom to use any tool you want for surgery, and while some work better than others, no tool is wrong for the job. You can use a bone saw to break open a skull, but you can also use the scalpel or a hammer if you want. If you want to use a pair of tweezers to cut out the stomach, it may take a very long time to accomplish, but it will work eventually. There's no reason to obey standard medical procedure, so you can simply rip out a liver with your bare hands and set it next to your empty soda bottle, or you can drape the intestines over Bob's neck like a scarf. You can even use the body as a tray for your tools, since there's no penalty for placing a jar of cotton swabs in the lung cavity. If you happen to get to the organ in question, simply tossing it in there counts as a successful surgery, so even though the kidneys may be out of place, it'll count as a victory if they're in the right area.

With all of these elements mixed together, you have a title that is fine with your victories but is more interested in seeing how badly you can botch things up or how you barely made the surgery work. It relishes you making a mess of things, and that makes for some interesting streaming material when you share your mishaps with others. Though the local multiplayer co-op mode is coming, the game in its current state is the perfect title to play with friends as long as you're in the mood to see something gruesomely funny. The right mood is the key to enjoying the title, since the joke of playing a very inept surgeon can wear thin if you're trying to pull off a successful surgery with the highest rating possible and minimal blood loss. Unless you're into the absurd and are fine with an intentionally rough gameplay experience, this might not be the title for you.

For PC players, the question is how well the developers translated that for the PS4 control pad. The PC version let you control all five fingers individually, and you can be more accurate with your hand movements if you're using a mouse. The verdict is that using the controller is not bad. Your left analog stick controls arm movement while L2 controls the height of the arm. It lacks the precision of the mouse, especially with no way to adjust sensitivity, but it works well enough, considering how the game wants you to mess up all the time. Instead of controlling each finger individually, you control them in groups. R1 handles the thumb and forefinger while R2 handles the other three digits. Again, you lose accuracy and the ability to do things like pull off the devil horns for the hell of it, but it still works fine. Wrist rotation can be handled by the right analog stick or by using the accelerometer on the controller. The former is fine if you want to get a little serious about the operations while the latter works surprisingly well without making the controls too difficult to handle. All in all, the controller works fine for this game without making a difficult situation even worse. The game is also one of the few PS4 titles to use the PlayStation Camera as an alternate means of control, but we weren't able to test that out with the game at this time.

The graphics are in no way pushing the early potential of the PS4, but they're functional. The environments are sterile as far as graphical flourishes are concerned, and there's nothing too impressive to see. Both Bob and your arm look like they jumped out of a PS2 game, and that would be a condemnation if it didn't actually lend to the humor of the game. Anything more realistic-looking and the game could seem rather morbid to some players. The same goes for the organs, which possess a plastic sheen. As mentioned earlier, the out-of-control physics system leads to plenty of instances of clipping, and some of the instruments never look like they're being held correctly in Nigel's hands, but that isn't much of a complaint when you consider how intentional the effect is.

The sound matches the vibe of the game rather well. The few voices that are present are decent enough to give off the vibe of a bad medical drama. That theme is emphasized further by the music, which goes for a 1980s synth and guitar score that sounds authentic enough, even if it is presented in mono instead of stereo. It sounds very cheesy during surgery, even if it is supposed to present the idea that these are life-and-death situations, and the failure music is hilarious since it goes over the top to try to elicit tragedy. Oddly, no pieces are played for a successful surgery. As for the effects, they're appropriately gross but good. The sounds of metal banging on bone can be a tad unnerving, as are the squishy sounds of you cutting and pulling organs away from the body.

You have to be of a certain mindset to enjoy Surgeon Simulator 2014: Anniversary Edition. You have to be willing to accept the game as a big joke and each failure as the punch line. You have to be open to the fact that the clumsy controls, questionable physics, and bad collision detection are all tools to help you get to that bad conclusion. You have to realize that overcoming the odds in light of all of the near-impossible circumstances is the big reward to the overwhelming challenge. It isn't a game for everyone, especially those who demand tight controls and realistic simulation titles or Trauma Center, but if you can deal with the silliness of it all, you'll find Surgeon Simulator to be enjoyable enough.

Score: 7.0/10