Twenty-three years after the transatlantic robot-assisted telesurgery executed by Jacques Marescaux, the Da Vinci Surgical System has spread all over the globe with more than 9000 units installed [13]. Between 2012 and 2018, an increase of 13.3% was documented in the use of robotic surgery [1]. In 2023, the Da Vinci Surgical System was used in more than 2.2 million procedures, making the total count over 14 million [14]. Along with the benefits provided to the surgeon while operating, such as tremor filter, three-dimensional view, and more degrees of freedom, patient advantages have been circumscribed as well. Studies were published from various fields of surgery with the conclusion that compared to laparoscopic surgery, the risk for open conversion is lower besides a shorter length of hospitalization. Additional improvements were noticed in the rate of intraoperative complications and blood loss with the downside of longer operation time and higher costs [15,16,17,18]. These findings propose that robot-assisted surgery has a place among gold standard procedures in the future. Many publications and reviews have concluded that robot-assisted surgery should be regarded as an alternative to laparoscopic surgery [19, 20]. Even when studies did not find significant advantages from the aspect of the patients and stated that the outcome is equivalent, improvements in demands from the surgeon were still present [3, 4]. In spite of the prominent conquest of robotic surgery, many unknowns are still present; a worldwide elaborate evidence-based training protocol is lacking. A previous study found that 60% of general surgery residents participate in their first robotic case without prior education or training; however, programs had been introduced with the hopes of standardization [21, 22]. A review examining 39 robotic surgery curricula revealed severe heterogeneity and deficiencies. It suggested the use of educational frameworks to address these issues [23]. In 2024, a protocol was developed to achieve a pan-European consensus on the essential components of a common training program for GI robotic surgery [24]. One of its pillars is simulation education. The same year’s European Society of Coloproctology guideline on training in robotic colorectal surgery states that simulation should be used as part of training curriculum as strong recommendation [25].

Many publications delve into various factors playing a role in performing with the Da Vinci Skills Simulator, most importantly, devoted to establishing a link with video game experience [26, 27]. While other studies have discovered surprising determinants like playing sports or playing a musical instrument [28]. Our study was designed to explore the topic with a more holistic approach primarily, and looking at exact factors secondly. We investigated how different generations with total lack of experience in robotic systems and laparoscopic practice can adjust to controlling the simulator relying purely on the skillset gathered from other origins. Since the simulator operates with a computer-based virtual-reality interface, and with the assumption that youngsters nowadays grow up in an IT rich environment, we hoped to conclude that their performance will be more successful compared to the older generations. In our study, those among the children were selected, who already presented adequate commitment to the task and were able to control the simulator responsibly. The questionnaire served as a proof, that today’s children, Generation Alpha, get in contact with smartphones, video games at a much younger age along with a greater frequency in usage. Our study included children from the middle class mainly; however, we feel confident that our observations are true for the whole generation, alike habits are maintained by the whole society.

Following two practice rounds on the designated task, the results of the third were the basis of statistical analysis. The difference among the generations did not prove to be statistically significant; however, the means displayed the trend we had hoped for. Generation Alpha had the best result in Overall Score and Total Time. Additionally, we witnessed during the practice rounds that youngsters immediately achieved near excellent scores, and fine corrections were only needed for a perfect result. On the other hand, adults had a much harder time getting comfortable with the controls and performed poorly on the first tries. Thus, investigating learning curves could be a promising extension of the study, seeing that previous studies with limited participants suggested that the learning curve is not affected by the mentioned factors only the starting point varies [12].

The key finding was that young adults, participants from Generation Z, are more careful, precise when performing on the simulator, considering that how few penalty points from Glass Movement metric were gathered by them (Table 3 Fig. 1). The missing haptic feedback from current robotic surgical systems was handled the most successfully by them. People in their 20s present adequate vigilance and commitment to the task, and were born into an environment stacked with technology and electronic devices in contrast to the others, who may lack some of the above stated. The new Da Vinci 5 platform equipped with haptic feedback may level the difference reported between age groups [29].

Furthermore, a surprising finding was that typing on smartphones with two fingers fluently rather than using only one may be a skill that enables a more successful simulator experience (Table 4 Fig. 2).

Limitations of this study have to be noted. Only 30 participants were included with one exclusion, leaving a need for more and making it hard to identify significant differences in the results. Besides quantity, the young adult group mainly consisted of medical students, making the group less diverse. Overall ratio of genders was balanced; however, within the groups, major disproportions were witnessed, only male children were involved, and female dominance was present in the young adult group. In addition, only one task was required and no data were registered during the practice rounds. Perhaps, applying more exercises, even harder ones, would result in more significant differences in the outcome.

This study is unique, as we investigated performance on the Da Vinci Skills Simulator with a novel approach. To our knowledge, this is the first study that was conducted with participants aged between 13 and 15, naïve to robotic surgical systems. We demonstrated how generations differ, especially in the aspect of errors made. The results exhibit a need for a more comprehensive study welcoming a larger number of participants preferably necessitating more than one exercise. It also suggests that a possible extension to the topic may be the investigation of learning curves in a similar setup.