INTRODUCTION: Digital 3D exoscopes are novel alternatives for operating microscopes in microneurosurgery. We studied the potential benefits of a background in video gaming on adaptation to exoscopic microsurgery. Such effects have not been reported before. METHODS: Twenty preclinical medical and dental students with no surgical experience participated in our study. Eleven (gamer group) were proficient (> 1000 h) in video gaming, whereas nine (control group) had no to very little gaming experience (< 500 h). We developed a microsurgical training model for evaluating adaptation to exoscope use in a manual task. Each student completed the task thrice in a row. We evaluated handling of the exoscope, fine motor skills, and the duration of each performance. RESULTS: Prior video gaming experience correlated with superior adaptation to the exoscope. Gamers moved and tilted the exoscope camera less often than the control group but nevertheless obtained good visuals. The gamer group also completed all tasks faster (median 10 min 14 s) than the control group (median 13 min 01 s). All students improved in their task completion times over the test period. Similar fine motor skills were observed in both the gamer and the control group. CONCLUSION: Prior experience in video gaming was associated with better adaptability to the exoscope. This may be due to superior 3D perception, acquired playing video games.