What is the value of animal models in laparoscopic surgery?—a systematic review

Background: Animal models are essential in both basic and applied medical research and in the development of surgical skills. This presents the classic dilemma whereby the gaining of knowledge for human good is confronted by its critical impact on animals. Against this background, this review assesses animal models in laparoscopic surgery by literature research. Methods: In line with PRISMA guidelines, a systematic literature search was performed in PubMed, Google Scholar, and Web of Science. All studies reporting on animal models for basic research, technological and skills training in laparoscopic surgery, published between 2016 and 2021 were included. The selection was based on a three-step algorithm, considering specific inclusion and exclusion criteria. The retrieved studies were assessed for methodological quality and potential bias by Cochrane Handbook for Systematic Reviews of Interventions. Results: The search criteria were met by 356 publications. Of these, 177 were included by title, abstract and full text availability and 94 studies were excluded from further analyses by exclusion criteria. The remaining 83 studies consisted of 45 studies (54.2%) about skills training or technological testing and 38 studies (45.8%) about basic science research. The 38 studies on basic or applied scientific research included three publications on mouse models (7.9%), 24 on rat models (63.1%), two on rabbit models (5.3%), and nine on porcine models (23.7%). The 45 studies on skills training or technological testing included eight publications on rat models (17.8%), three on rabbit models (6.7%), and 34 on porcine models (75.5%). Discussion: The various animal models are discussed focusing on their value for basic science research or surgical testing and training. Animal models in laparoscopic surgery are of essential value. The rat model in laparoscopy is more suitable for basic and applied research, while porcine models are more suitable for training in surgical skills and testing in technology. Current efforts based on artificial intelligence and virtual reality might reduce or even replace the animal models in the not-too-distant future. 13