About Your Surgery
This guide will help you prepare for your kidney surgery at Memorial Sloan Kettering (MSK), and help you understand what to expect during your recovery. Read through this guide at least once before your surgery and then use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery, so that you and your healthcare team can refer to it throughout your care.
The type of surgery you’ll have depends on the size and location of the cancer. Your surgeon will talk with you about the option that is right for you.
- A partial nephrectomy is the removal of the part of the kidney that has the cancer and the tissue surrounding it. If necessary, the lymph nodes will also be removed. Some of your kidney will remain in your body.
- A radical nephrectomy is the removal of the entire kidney and the tissue that surrounds it. If necessary, the lymph nodes and the adrenal gland will also be removed.
- A nephroureterectomy is the removal of the entire kidney, surrounding tissue, lymph nodes, the adrenal gland if necessary, all or part of the ureter, and part of the bladder. If the cancer spreads, one of the first places it spreads to is usually the lymph nodes. Your doctor may decide to remove some of your lymph nodes and check them for cancer cells. You have many lymph nodes, so your body will not miss these few.
Kidneys are bean-shaped organs about the size of your fist, located near the middle of your back. You have 2, one on each side. They filter blood, regulate hormone levels, and regulate your blood pressure.
Lymph nodes are small oval or round structures found throughout your body. Lymph nodes make and store cells that fight infection.
Adrenal glands produce hormones that help you cope with stress.
Your ureter is the tube that connects your kidney to your bladder.
Your bladder stores your urine.
Kidney surgery can be done using different techniques. Your surgeon will talk with you about which options are right for you.
Your surgeon will make 3 to 5 small incisions (surgical cuts). Using small tools and a camera, he or she will remove all or part of your kidney, depending on the cancer.
Your surgeon will make 1 incision (surgical cut), usually about 5 inches long. He or she will remove all or part of your kidney, depending on the cancer.
Figure 1.Your urinary system
Figure 2. Your kidney
Before Your Surgery
The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
You and your healthcare team will work together to prepare for your surgery.
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.
- Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medications to help prevent them.
- If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.
Here are things you can do to prevent problems before your surgery:
- Be honest with your healthcare provider about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you cannot stop drinking.
- Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.
- I take a blood thinner. Some examples are heparin, warfarin (Coumadin®), clopidogrel (Plavix®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.
- I take prescription medications.
- I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia in the past.
- I have allergies, including to latex.
- I am not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke.
- I use recreational drugs.
People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program at 212-610-0507.
About Sleep Apnea
Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems when you have surgery. Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (CPAP) for sleep apnea, bring it with you the day of your surgery.
Before your surgery, you will have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.
You can eat and take your usual medications the day of your PST appointment. During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who will be giving you medication to put you to sleep during your surgery). He or she will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers.
Your nurse practitioner will talk with you about which medications you should take the morning of your surgery.
It is very helpful if you bring the following with you to your PST appointment:
- A list of all the medications you are taking, including patches and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
- The name(s) and telephone number(s) of your doctor(s).
Complete a Health Care Proxy Form
If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. The person you identify is called your health care agent. If you are interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advanced directive, bring it with you to your next appointment.
Identify Your Caregiver
Your caregiver plays an important role in your care. He or she will learn about your surgery with you from your healthcare provider. Your caregiver will need to be present after your surgery for the discharge instructions so that he or she is able to help you care for yourself at home. Your caregiver will also need to take you home after your surgery.
Do Breathing and Coughing Exercises
Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, please read How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.
Try to do aerobic exercise every day, such as walking at least 1 mile, swimming, or biking. If it is cold outside, use stairs in your home or go to a mall or shopping market. Walking will help your body get into its best condition for your surgery and make your recovery faster and easier.
Eat a Healthy Diet
You should eat a well-balanced, healthy diet before your surgery. If you need help with your diet talk to your doctor or nurse about meeting with a dietitian.
Stop Taking Certain Medications
If you take vitamin E, stop taking it 10 days before your surgery. If you take aspirin, ask your surgeon whether you should continue. Medications such as aspirin, medications that contain aspirin, and vitamin E can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Purchase Hibiclens® Skin Cleanser
Hibiclens is a skin cleanser that kills germs for 6 hours after using it. Showering with Hibiclens before surgery will help reduce your risk of infection after surgery. Hibiclens is available at your local pharmacy without a prescription.
Stop Taking Herbal Remedies
Stop taking herbal remedies or supplements 7 days before your surgery. If you take a multivitamin, talk with your doctor or nurse about whether you should continue. For more information, please read Herbal Remedies and Cancer Treatment.
Stop Taking Certain Medications
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil®, Motrin®) and naproxen (e.g., Aleve®). These medications can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Note the Time of Your Surgery
A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive for your surgery. If you are scheduled for surgery on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call 212-639-5014.
Eat a Light Diet
Eat a light diet, such as small sandwiches, eggs, toast, crackers, soup, or cereal. Limit the amount of dairy products, and avoid fried foods and foods with a lot of seasoning.
Shower With Hibiclens
The night before your surgery, shower using the Hibiclens solution. To use Hibiclens, open the bottle and pour some solution into your hand or a washcloth. Rub it gently over your body from your neck to your waist and rinse. Do not let the solution get into your eyes, ears, mouth, or genital area, or on wounds. Do not use any other soap. Dry yourself off with a clean towel after your shower.
Go to bed early and get a full night’s sleep.
Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of clear liquids (see Figure 3).
Examples of clear liquids include:
- Clear broth, bouillon, or consommé (no particles of dried food or seasonings)
- Gelatin, such as Jell-O®
- Clear fruit juices (no pulp), such as white cranberry, white grape, or apple
- Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, or Gatorade®
- Coffee or tea, without milk or cream
Shower With Hibiclens
Shower using Hibiclens just before you leave. Use the Hibiclens the same way you did the night before. Do not use any other soap. Do not put on any lotion, cream, powder, deodorant, makeup, or perfume after your shower.
Take Your Medications as Instructed
If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a small sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.
Things to Remember
- Do not put on any lotions, creams, deodorants, make-up, powders, or perfumes.
- Do not wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Leave valuables, such as credit cards, jewelry, or your checkbook at home.
- Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles, such as a rosary.
- If you wear contact lenses, wear your glasses instead.
- A pair of loose-fitting pants (sweat pants are a good choice).
- Sneakers that lace up. You may have some swelling in your feet, lace up sneakers can accommodate this swelling.
- Only the money you may need for a newspaper, bus, taxi, or parking.
- A CD player and CDs or an iPod, if you choose. However, someone will need to hold these items for you when you go into surgery.
- Your incentive spirometer, if you have one.
- Your breathing machine for sleep apnea (such as your CPAP), if you have one.
- If you have a case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary, bring it with you.
- Your Health Care Proxy form, if you have completed one.
- This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
Once You’ve Arrived for Your Surgery
You will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having surgery on the same day.
Get Dressed for Surgery
You will be given a hospital gown, robe, and nonskid socks.
Meet With Your Nurse
A nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them. Your nurse will insert an intravenous (IV) line into a vein in your arm.
Marking Your Surgical Site
In addition to being asked your name and birth date, you may also be asked the name of your surgeon, what operation you are having, and which side is being operated on. Your surgeon or another member of the surgical team will use a marker to initial the site on your body that will be operated on. This is for your safety; it ensures that all members of the surgical staff are clear about the plan for your surgery.Back to top
After Your Surgery
The information in this section will tell you what to expect after your surgery, both during your stay and after you leave. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
When you wake up after your surgery, you will be in the Post-Anesthesia Care Unit (PACU) or your recovery room. You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
Your nurse will tell you how to recover from your surgery. Below are examples of ways you can help yourself recover safely.
- It is important to walk around after surgery. Walking every 2 hours is a good goal. This will help prevent blood clots in your legs.
- Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. When using your incentive spirometer or other breathing exercises, it may help to splint your incision. To do this, hold a pillow or blanket against the incision sites. This will reduce movement in your muscles. For more information, please read How to Use Your Incentive Spirometer.
Will I have pain?
You will have pain on the side where you had your surgery and in area of your incisions. Your doctor and nurse will ask you about your pain often, and give you medication to manage your pain. Your goal is to feel comfortable enough to increase your activity every day. The pain will slowly get better as your body heals.
If you had an open nephrectomy, you will have patient-controlled analgesia (PCA). See the insert titled Patient-Controlled Analgesia (PCA).
Will I be able to eat?
You will have a full liquid diet the day of your surgery. The first day after surgery, you can have a light breakfast and light foods during the day (sandwich, yogurt, soup, and liquids). Drinking plenty of liquids is important during the first few days after your surgery. Soups and broth are good choices until you regain your appetite.
When you go home, you can eat your normal diet again. We recommend eating 3 to 6 meals a day, depending what feels the most comfortable for you. Because you might have fewer red blood cells for the first couple months after your surgery, you should eat foods high in iron, such as:
- Red meat
- Cooked clams, oysters, beef, and all types of liver
- Iron enriched baked goods and cereals
- Legumes and spinach
You should also eat foods high in protein, such as chicken, fish, and eggs. Protein will help you heal after your surgery.
How can I prevent constipation?
It is common to have constipation after surgery, especially while you’re taking pain medication. Take a stool softener such as docusate sodium (Colace®), 3 times a day to prevent constipation. Continue taking the stool softener until you are no longer taking pain medications. Drinking plenty of liquids and walking also help prevent constipation. If you are constipated, talk with your nurse. He or she can give you suggestions, as well as written information about what you can do.
How do I care for my incisions?
You will have an incision along your side. Sutures (stitches) and Steri-Strips™ (small strips of tape) will hold your incision closed. If you had laparoscopic kidney surgery, you will have 4 or 5 small incisions, which may also have Steri-Strips. Before you leave, your nurse will show you how to clean your incision(s).
You can shower anytime after your surgery. When you shower, remove the bandage and let the water run over the incision, but don’t scrub the area. After showering pat your incision dry. You don’t need to put a bandage on your incision if it’s not leaking any fluid. You must wait until your incision is completely healed before taking a bath. It usually takes 3 to 4 weeks for the incision to heal.
Will I have any drains when I go home?
You may have a urinary catheter (thin, flexible tube) after surgery. The urinary catheter, also called a Foley catheter, drains the urine from your bladder into a bag. It’s usually removed the day after surgery, but in some situations the catheter is left in longer. If you go home with the catheter still in, your nurse will teach you how to take care of it, and will insert information into this guide called Caring for Your Urinary (Foley) Catheter.
You might have a Jackson Pratt® drain after your surgery. The drain is used to collect extra fluid to decrease your risk for infection and help your body heal. Your doctor will decide when to remove the drain, depending on how much fluid is coming out. If you will need to go home with the drain still in, your nurse will teach you how to care for it and insert information into this guide called Caring for Your Jackson-Pratt Drainage System.
When can I go back to work?
Most patients return to work 3 to 4 weeks after the surgery. In some cases it’s OK to return to work earlier, with light activity only. If your work requires heavy physical activity, you may need more time. You may be comfortable with desk or office work. Talk to your doctor about when it would be safe to return to work.
- Have swelling or tenderness in your calves or thighs
- Have one leg that is more swollen than the other
- Become short of breath
- Cough up blood
- Have a temperature of 101° F (38.3° C) or higher
- Have blood in your urine
You will see your doctor 4 weeks after your surgery to talk about:
- Your final pathology results.
- Any problems with your recovery.
- Any further treatment that may be needed.
The next visit with your doctor will be in 6 months. You might have more blood tests at that time. After your second visit with your doctor, your surveillance protocol begins. This might include tests such as x-rays, CT scans, ultrasounds, or magnetic resonance imaging (MRI) to watch for signs that the cancer is coming back.Back to top
- Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- Herbal Remedies and Cancer Treatment
- How to Use Your Incentive Spirometer
- Patient-Controlled Analgesia (PCA)