bɪɡˈɪnɪŋ pɹədˈʌkʃən ɪn tˈuː θˈaʊzənd fˈoːɹ, ðə tˈiːm wˈɔntᵻd tə ɹˌiːkɹiːˈeɪt ðə sˈɜːdʒɪkəl sˌɪmjʊlˈeɪʃən ɡˈeɪmpleɪ ʌv pˌiːsˈiː tˈaɪɾəlz fɚðə dˌiːˈɛs, sˈɪns ɪts kəntɹˈoʊlz ænd hˈɑːɹdwɛɹ wɜː mˈoːɹ kˈeɪpəbəl kəmpˈɛɹd tʊ ˈʌðɚz ʌvðə tˈaɪm.
Beginning production in 2004, the team wanted to recreate the surgical simulation gameplay of PC titles for the DS, since its controls and hardware were more capable compared to others of the time.