What to expect on the day of your operation.
Before your operation
Do ask as many questions as you need to. It may help to make a list before you go into hospital. If you have more questions when you’re there, the nurses can answer them or get the doctor to talk to you again.
Eating and drinking
If you find eating and drinking difficult, you may have a drip (intravenous infusion) put into your arm before your surgery. This gives you fluids so you don’t get dehydrated before your operation.
Shaving the surgical area
The nurse may shave the area where your wound will be. This is usually the side or back, but sometimes across the chest and tummy. Shaving can reduce the risk of an infection in your wound.
They may shave you in the ward, or in the operating theatre after you've had your anaesthetic.
When you wake up
You may wake up in intensive care or a high dependency recovery unit. You can have one to one nursing care there, and your surgeon and anaesthetist can keep a close eye on your progress.
When you wake up, you have several tubes in place. These include:
- drips (intravenous infusions) to give you blood transfusions and fluids
- one or more drains coming out of your back or side, near your wound – these stop blood and tissue fluid collecting around the operation site
- a tube down your nose into your stomach (nasogastric tube) to drain fluid and stop you feeling sick
- a tube into your bladder (catheter) so your urine output can be measured
If you had part of a kidney removed, you also have another drainage tube from the wound site. This collects urine and stops it leaking into the wound.
You will also have:
- a blood pressure cuff on your arm
- a little clip on your finger (called a pulse oximeter) to measure your pulse and the oxygen levels in your blood
You may also have an oxygen mask on for a while.
Your nurse checks your blood pressure often in the first few hours. Your urine output is checked very closely, at least once an hour at first.
As soon as your doctors are sure you’re recovering well, you are moved back to the ward.
If you have open surgery, you will almost certainly have pain for the first week or so. If you have keyhole surgery, you may not have pain for as long as that.
You may have painkillers given into the fluid around the spinal cord for the first day or so. This works very well. You have a very fine tube taped to your back. It’s connected to a pump that gives a continuous dose.
Tell your doctor or nurse as soon as you feel any pain. There are many different painkilling drugs you can have. They need your help to find the right type and dose.
Giving yourself painkillers
You may have a hand control with a button to press, to give yourself extra painkillers through a drip. This is called patient controlled analgesia (PCA).
Painkillers work best when you take them regularly, so do use it whenever you need to. You can’t overdose because the machine is set to prevent that. Tell your nurse if you need to press it very often. You may need a higher dose in the pump.
Eating and drinking
After surgery to the abdomen, the bowel often stops working for a while. Until it starts up again, you will not be able to eat or drink.
At first you can have clear fluids. Once you’re able to drink without being or feeling sick, your nurse takes out your drip and the tube down your nose into your stomach (nasogastric tube). You can then try something like tea or soup.
When your doctor can hear the normal gurgling sounds that your bowel makes when it’s working normally, you can start eating solid food. Usually people can eat normally 2 or 3 days after surgery.
When you’re producing enough urine, a nurse will take your catheter out.
You still need to collect all the urine you produce while you’re in hospital. This is noted down and compared to the amount you’re drinking, so the treatment team can make sure your kidney is working well.
With open surgery, your wound is usually on your side or back, but sometimes across the chest and tummy. With keyhole surgery, you have two or more small wounds.
Wounds are covered up when you come round. After a couple of days, the nurse changes the dressings and cleans the wounds.
The wound drain tubes stay in until they stop draining fluid. The nurse usually takes them out 3 to 7 days after your operation. Your stitches or clips are left in for at least 10 days.
Problems after surgery
Infections and blood clots are the most common problems after surgery for kidney cancer.
Infections can develop in your lungs or in your wound.
Your breathing exercises will help to stop you from developing a chest infection.
Your nurse will change the dressings to help keep it clean. You will have antibiotics straight away if any signs of infection appear.
If you think you might have an infection tell your doctor or nurse. The signs are:
- oozing from the wound
Because you’re not moving around as much as usual, blood clots can develop.
You may have compression stockings to wear. These, along with your leg exercises, help to keep your blood moving. The nurses will encourage you to get up and move around as soon as you can. This helps to stop clots from forming.
If you think you might have a blood clot tell your doctor or nurse. The signs are:
- pain in the leg, usually the calf
- swelling in an arm or leg
- sudden chest pain and breathlessness
Your doctor may give you anti clotting medicines such as heparin, tinzaparin, or dalteparin to prevent them. You have these as daily injections just under the skin.
Getting up may seem impossible at first. Moving about helps you get better but you need to start very gradually.
Your physiotherapist visits every day to help you with your breathing and leg exercises. After one or two days your nurses encourage you to get out of bed and sit in a chair. They help you with the drips and drains.
Once your tubes, bottles and are taken out it’s much easier to get around. That’s when you feel you’re beginning to make progress.
You may be ready to go home about a week after open surgery or a few days after keyhole surgery.
Before leaving hospital, you usually book an outpatient appointment for 6 weeks after your operation.