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First NOTES appendectomy made in 1908

D.O. Ott – Pioneer of Endoscopic Appendectomy

A.V. Fedorov,V. E. Olovyanny, S. P. Glyantsev
Institute of Surgery A.V. Veshnevskogo, Moscow, Russia; Northern Medical Centre, Arkhangelsk, Russia; Scientific Centre of Cardiovascular Surgery A.N. Bakuleva, Moscow, Russia

The article provides unknown to most surgeons facts concerning the first appendectomy through colpotomy performed by Russian gynecologist Dmitry Ott one hundred years ago. An endoscopic method - ventroscopy - was used in order to perform this operation. The data discovered support with new evidence the authors´ statement about Dmitry Ott as the founder of endoscopic surgery.

The first endoscopic appendectomy is believed to have been performed by German gynecologist K. Semm in 1982 [1]. This is a well-known and widely described in literature fact. Yet the results of our medicohistorical study raise doubts about its truthfulness.

We have already written about Russian gynecologist Dmitry O. Ott from St.-Petersburg - the founder of ventroscopy, an endoscopic method of abdominal cavity examination that preceded G. Kelling's laparoscopic technique. We were the first to discover that Dr. Ott's ventroscopy had been the minimally invasive surgical method in abdominal surgery of the time [2, 6]. To prove this statement we gave examples of gynecological operations through colpotomy performed by Dr. Ott at the beginning of the XX century during which he simultaneously made an endoscopic diagnosis of concomitant abdominal pathology (gallbladder stones, omental tumors, nephroptosis etc.).

Furthermore, Dr. Ott's publication of 1908 mentions two appendectomies performed on patients with empyema appendicularis, with the author pointing out that “both these cases of operating through vaginal access are, by the way, first ever described in literature, which can be easily explained by the very fact that due to the lack of illumination such operations are hardly feasible”.
In respect to the history of endoscopic surgery, this fact, so far unknown to most surgeons, seemed interesting to us and stimulated our further search for historical data on these operations. The present article came as a result of our work.

We ascertained that the first mention of the operations on appendix through colpotomy performed by Dr. Ott belongs not to the surgeon himself but to G. P. Serezhnikov, the senior doctor of the Obstetric Institute headed by Dr. Ott in 1893-1917. In his speech at the session of The Sientific Society of Obstetricians and Gynecologists held November 30, 1906 in St.-Petersburg Serezhnikov told about the appendectomy after hysterovariectomy by means of posterior colpotomy performed by Dr. Ott on April 26, 1906. “In professor Ott’s clinic, while making the final examination by means of long illuminated specula, we always pay attention to the appendix of the caecum”, reported the speaker. This woman’s “appendix appeared to be strongly thickened and deformed… Due to that it was ablated through vagina according to general rules” [4].



The description of the operative technique, provided by the reporter, is of certain interest. “First of all a retention ligature was applied on the appendix close to the caecum, then mesoappendix was tied up in two bunches, with the appendix separated from it and brought down to the small pelvis. A circumferential incision was made on the appendiceal serosa and a cuff was formed. The appendix was tied en masse and excised. Appendiceal lumen was cauterized by thermocauter and closed by the cuff sutured up above the appendiceal stump. The retention ligature was cut off. Postoperative course proceeded without any complications” [4].

In debate after the report D.O. Ott noted that he would not have chosen a vaginal approach specially for the operation described, but he just wanted to demonstrate the possibility of such an appendectomy provided there were indications for appendix ablation and abdominal cavity was already open via vagina for other purposes [4]. We would like to emphasize that for these operations the author of ventroscopy used special surgical instruments 35 – 60 cm (14 – 24 in) long.

The search for earlier records of operations performed on abdominal cavity with the use of endoscopic instruments conducted by us in medical archives of Russian scientific institutions and online data bases gave no results.

Therefore, in accordance with the newly discovered data, we can assert that D.O. Ott was the first surgeon to operate on abdominal cavity using endoscopic technique (to perform endoscopic appendectomy in this case).

If we consider Dr. Ott’s ventroscopy (invented in 1899) to be the precursor of the present-day laparoscopic method, then we should recognize D.O. Ott as the father of endoscopic surgery in the world in general.

Besides, these cases (apparently the first in the world) of simultaneous hysterectomy, ovariectomy and appendectomy through colpotomy highlight D.O. Ott’s exceptional surgical skills.

No wonder that later his disciples would wrote “Dr. Otts’ unsurpassed results of operations via vaginal approach placed him in the front line, made him a head of a new trend in gynecology not only in Russia but also in Europe, as by his achievements he left behind him all the leading specialists of the time” [6].

In addition, we would like to say that D.O. Ott should be considered the founder of a new trend not only in gynecology but in surgery as well. The name of this trend is endoscopic surgery.



  1. Semm K. (1982). Advances in pelvioscopic surgery (appendectomy). Curr Prob Obstet Gynecol 5(10): entire issue.
  2. Glyantsev S.P., Fedorov A.V., Olovyanny V.E. (2005). D.O. Ott (1855 – 1929) – the founder of endoscopic surgery (on the occasion of 150th anniversary of birth of D.O. Ott). Endoskopicheskaya Hirurgia 2: 3-8.
  3. Ott D.O. (1908). Results achieved by the use of direct illumination of the abdominal cavity, colon and urinary bladder during operations and for examination. Russky Vrach 43: 3-11.
  4. Seriojnikov G.P. (1907). Vaginal approach in bowel surgery. Zhurnal Akusherstva i Zhenskih Bolezney 3: 524-529.
  5. Bublichenko L.I., Mandelshtam A.E. (1960). D.O. Ott: Ocherk Zhizni i Deyatelnosti (1855 - 1929). Medgiz: 145
  6. Olovyanny V., Glyantsev S. (2006). D.O. Ott (1855 - 1929) – the founder of endoscopic surgery. Abstract book of the 10th World Congress of Endoscopic Surgery, Berlin, 2006, 13 – 16 September. P 29.




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