Background: Video games have become extensively integrated into popular culture. Anecdotal observations of young surgeons suggest that video game play contributes to performance excellence in laparoscopic surgery. Training benefits for surgeons who play video games should be quantifiable. Hypothesis: There is a potential link between video game play and laparoscopic surgical skill and suturing. Design: Cross-sectional analysis of the performance of surgical residents and attending physicians participating in the Rosser Top Gun Laparoscopic Skills and Suturing Program (Top Gun). Three different video game exercises were performed, and surveys were completed to assess past experience with video games and current level of play, and each subject's level of surgical training, number of laparoscopic cases performed, and number of years in medical practice. Setting: Academic medical center and surgical training program. Participants: Thirty-three residents and attending physicians participating in Top Gun from May 10 to August 24, 2002. Main Outcome Measures: The primary outcome measures were compared between participants' laparoscopic skills and suturing capability, video game scores, and video game experience. Results: Past video game play in excess of 3 h/wk correlated with 37% fewer errors (P < .02) and 27% faster completion (P < .03). Overall Top Gun score (time and errors) was 33% better (P < .005) for video game players and 42% better (P <. 0 1) if they played more than 3 h/wk. Current video game players made 32% fewer errors (P = .04), performed 24% faster (P < .04), and scored 26% better overall (time and errors) (P < .005) than their non-playing colleagues. When comparing demonstrated video gaming skills, those in the top tertile made 47% fewer errors, performed 39% faster, and scored 41% better (P < .001 for all) on the overall Top Gun score. Regression analysis also indicated that video game skill and past video game experience are significant predictors of demonstrated laparoscopic skills. Conclusions: Video game skill correlates with laparoscopic surgical skills. Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery. Video games may be a practical teaching tool to help train surgeons.