The film stars Tobin Bell, Costas Mandylor, Betsy Russell, Mark Rolston, Peter Outerbridge, and Shawnee Smith.

Similar to its predecessor, Saw VI maintains the focus on the posthumous effects of the Jigsaw Killer (Bell) and the progression of his successor, Detective Lieutenant Mark Hoffman (Mandylor).

The plot follows insurance executive William Easton (Outerbridge), who must complete a series of deadly "games" set up by Hoffman in order to rescue his employees and family.

Predatory lenders Eddie and Simone are locked in head harnesses with screws aimed at their temples, and have one minute to each cut flesh from their bodies and weigh the scale in their favor to survive.

Eddie, who is overweight, slices several chunks of fat from his stomach, but is killed after Simone chops off her arm and tips the scale before the timer expires.

Hoffman arrives at Jill Tuck's clinic and demands five envelopes containing photographs of the following game's test subjects from the box left to her in John Kramer's last request.

[a] The game involves health insurance executive William Easton and his associates, whose company's dubious business policy turned down their clients' coverage for medical treatment, one of them being John Kramer.

After Hoffman abducts them to an abandoned zoo, William and his janitor, Hank, are suspended in chains with large metal vises that will crush their bodies each time they breathe in their oxygen masks.

At the boiler room, William releases his lawyer Debbie, who attacks him to retrieve a key inside his body and unlock a speargun attached to her harness.

The game is viewed by mother Tara with her teenage son Brent, and news journalist Pamela Jenkins from two opposite animal enclosures below the observation room.

He is confronted by Tara and Brent, the widow and son of Harold Abbott, a former client who succumbed to his heart disease after William denied his medical request.

John's videotape informs Tara to decide William's fate by using the lever in her cell connecting to tanks of hydrofluoric acid from each cage.

[6] Greutert found the process of transitioning from editor to director easy due to his experiences in developing short films and his knowledge about the discussions between the producers and filmmakers.

[9] During the early planning stage for the script it was suggested that Costas Mandylor's character, Detective Hoffman, should take on the mafia due to his vigilante modus operandi, but the idea was quickly dismissed as not "feeling Saw enough" and more like "The Punisher".

[16] Mandylor commented on his character, "Hoffman is sort of torn of becoming a mad man or becoming a guy that's more composed, coming from a pure place like Jigsaw.

[18] Greutert stated that Saw VI would have the most characters of any Saw film to date but reassured the writers would stay true to previous storylines to prevent any "violations of logic and chronology".

[20] On April 19 it was announced that James Van Patten would return as Dr. Adam Heffner, a character featured in the opening scene of the fourth installment performing the autopsy on John Kramer.

[28] Greutert felt that there was some bold visual design stemming from what have been shown in previous Saw films, choosing to reuse past aspects he liked like some of the characters, leading him to search their salient points in the storyline to include them into the plot.

[7] Armstrong told Bloody Disgusting reviewer Mike Pereira that he thinks "visually" Saw VI might be his favorite, saying "We're kind of pulling back a little bit in the color palette.

[31] The Motion Picture Association of America only took issue with the opening scene, in which two characters have 60 seconds to escape a mechanical device on their heads with screws pointing at their temples by cutting off their flesh and tossing it into a scale.

[35] Saw VI: Original Motion Picture Soundtrack includes music by the bands Every Time I Die, Chimaira, Suicide Silence, Nitzer Ebb, Mushroomhead, and Lacuna Coil, among others.

He said in his review that "It's a fitting marriage, as hard rock and heavy metal are the sonic suitors to horror and torture porn films and video games".

[39] The DVD and Blu-ray releases include an additional scene after the credits roll, featurettes about Jigsaw, the traps, and the first look at Universal's Halloween Horror Nights "Saw: Game Over" maze.

The website's consensus reads: "It won't earn the franchise many new fans, but Saw VI is a surprising step up for what has become an intricately grisly annual tradition.

"[4] Rob Nelson of Variety wrote, "Squeezing another pint of blood from its torture porn corpus, Lionsgate slays again with Saw VI, a film so frighteningly familiar it could well be called 'Saw It Already'.

At least the requisite moralism is more playful than pious in this edition", but added, "Presumably owing to director Kevin Greutert's work as editor of all five previous Saw pics, the film's juggling of chronology is the franchise's best...."[62] IGN's Christopher Monfette rated Saw VI three out of five and wrote, "while Saw VI certainly offers a redemption for the series and the promise of a coming power struggle for Jigsaw's legacy, Saw VII will no doubt mark the time to either shake things up or watch this franchise get the ax".

He closed his review saying, "As usual, what gives the film whatever interest it has -- beyond satisfying the rapacious appetites of gore aficionados -- is the moral element attached to the various Rube Goldberg-style set pieces.

[65] The Los Angeles Times's Robert Abele gave the film a negative review, writing "But, really, do reformers and victims of callous health insurers really want a guy with a penchant for elaborately constructed death panels of his own to be their advocate?

"[68] Wesley Morris of The Boston Globe gave the film a two and half out of four stars saying, "Who knew that the franchise's creators would eventually find a plot twist that made sense?

"[70] Marc Savlov of The Austin Chronicle gave the film one and half out of five stars, saying "Enshrouding the whole gooey mess in the already blood-spattered surgical garb of the ongoing health care debate is a crafty move on the screenwriters' part, but once you get past that pseudo-ironic touch, this Saw is no more or less disturbing than any other in the series".