The day of the surgery
This section provides a general overview of what may happen on the day of the surgery. Procedures vary between hospitals and according to whether you have surgery as an inpatient or outpatient.
The hospital will give you a time to arrive, called the admission time. Arriving earlier doesn’t mean you’ll be admitted or have surgery sooner. When you’re admitted, you might not know the exact time of the surgery, but you’ll probably know if it will be in the morning or afternoon. Sometimes there are unexpected delays due to emergencies – the receptionists and nurses will keep you informed.
Before you go to the operating theatre, a nurse will:
- review your medical history and whether you have any allergies
- place an identification band around your wrist or ankle
- check your blood pressure, pulse and weight
- ask when and what you last ate and drank.
You will change into a surgical gown and put your personal possessions in a bag for storage or to give to your support person. If the surgery is to a part of your body with hair, it will be shaved unless you have already done it yourself. Some people are given a sedative (premedicine or premed) as an injection or tablet to relax them.
Let the nurse know if you think you have a cold or the flu, so they can assess your fitness for surgery.
You will be given drugs (anaesthetic or anaesthesia) to temporarily block any pain or discomfort during the surgery. An anaesthetist will give you these drugs and check you throughout the operation.
Before you receive anaesthetic, the anaesthetist will talk to you about your medical history. They will also check the last time you ate or drank, and whether you have any allergies. It’s important to tell the anaesthetist if you have had a previous reaction to an anaesthetic.
There are different types of anaesthetic:
Light or conscious sedation – You will be given drugs to relax you and make you sleepy. You will still be able to respond to directions from your surgeon but may not remember what happened during the procedure.
Local anaesthetic – This involves numbing the skin or surface of the part of the body being operated on. It is usually done via an injection, but drops, sprays or ointments may be used instead. You may also be given a sedative to help you relax. You are still awake during surgery, but you won’t feel any pain or discomfort. The numbness typically lasts for several hours to a day.
Regional anaesthetic (nerve block) – A local anaesthetic is injected through a needle placed close to a nerve or nerves near the surgical site. This numbs the part of the body being operated on. A local anaesthetic cream is usually applied to the skin first to minimise the pain from the needle. You may be given a light sedative to help you relax, or stronger medicine to put you to sleep.
General anaesthetic – This is usually an injection of drugs into a vein that puts you into an unconscious state. A general anaesthetic can also be given as gas through a mask that the anaesthetist places over your face. You may experience some side effects, such as nausea, when you wake up from general anaesthetic. Most of these effects are temporary and are easily managed by your medical team.
Risks of anaesthetic
It’s uncommon to have an allergic reaction to anaesthetic. Your medical team will review your medical records and general health to work out your risk of having a reaction. Anaesthetists are trained to recognise the harmful effects of anaesthetic. Your anaesthetist will monitor you throughout the surgery and give you medicine to manage any complications.
You will lie on a bed that is wheeled into the operating theatre, which is a purpose-designed, very clean room where the surgery occurs. The surgical team will wear caps, masks and gowns to help prevent infection.
If you are having a general anaesthetic, the anaesthetist will put a small tube (cannula) into a vein in the back of your hand or arm. The anaesthetic will be injected into the cannula. You might feel a slight stinging sensation, but once the drugs start to work you won’t be aware of what’s happening. Some people say that having a general anaesthetic feels like a deep, dreamless sleep.
During surgery under general anaesthetic, a machine called a ventilator helps you breathe or may breathe for you. The anaesthetist constantly checks your vital signs (heart rate, temperature, blood pressure and blood oxygen levels) to ensure they remain at normal levels. They also give you pain medicine so you are comfortable when you wake up.
When the surgery is finished, the anaesthetic will begin to wear off slowly, or you will be given more medicine to reverse the effects. You’ll be taken to the recovery room, and your vital signs will be checked until you are fully awake.
There are some things the medical team may not know until the surgery is in progress. The surgeon will discuss these with you during your preoperative assessment appointment.
Taking a different approach – The surgeon may start the operation as keyhole surgery but have to change to open surgery. This is usually so they can more easily reach the tumour or safely deal with any complications that arise.
Adding another surgeon – Another surgeon may be called into the theatre to assist your surgeon. This is standard practice, as the extra support can help achieve the best outcome for you. For example, a gynaecological surgeon may ask a colorectal surgeon to assist if they discover gynaecological cancer extending into the bowel.
Removing extra tissue – It may be difficult for your doctor to tell you exactly what will be removed during the surgery, as scans don’t always detect all of the cancer. If the cancer is found in places not shown on scans, your surgeon may remove extra tissue to cut out as much cancer as possible.
Creating a stoma – The medical team will talk to you before surgery if there is a possibility of creating an artificial opening in the body (stoma). An example of a stoma is a colostomy, when part of the large bowel is brought out through a surgically created opening in the abdomen, and a disposable bag is attached to collect waste matter from the body. A stoma may be temporary or permanent.
Needing a blood transfusion – If you lose a lot of blood during surgery, some blood or blood products can be transferred into your body through a vein (transfusion).
Blood from a donor is usually used. There are strict screening and safety measures in place, so transfusion is generally very safe. If you’re concerned about receiving someone else’s blood products, you might be able to bank some of your own blood before the surgery so it can be transfused back to you. However, this procedure is rarely used. Talk to your doctor if you are worried about needing a blood transfusion.
Your surgeon will close up the wound (incision) created during the surgery. Their approach will depend on the part of your body affected and the kind of surgery you had (e.g. open or keyhole surgery). Common ways to close a surgical wound include:
- sutures or stitches – sewing the wound closed using a strong, threadlike material that can dissolve or will be removed at a later date
- staples – small metal clips that will be removed by your doctor once the wound has healed
- glue – clear liquid or paste used to seal minor wounds (up to 5 cm) or applied on top of sutures
- adhesive strips – pieces of tape placed across the wound to hold the edges together; may be used with sutures.
The wound will usually be covered with a surgical dressing to keep it dry and clean. The dressing will be changed as needed. If you have surgery as an inpatient, the nurses will look at the wound to see if it’s healing and to check for bleeding or signs of infection. When you have a shower, if the dressing is not waterproof it may need to be covered or taken off and reapplied afterwards.
The wound may feel itchy or irritated after surgery. Tell the nurses if this happens – it could be a sign it’s healing, but it may also be a problem, such as an allergic reaction to adhesive tape.
If you have day surgery, you may need to visit your GP to have the wound checked before seeing your surgeon a few weeks later. You may be given instructions on how to care for the wound at home.
Sometimes problems or complications occur during surgery. It’s very unlikely that all of the complications described here would apply to you. Your surgeon can give you a better idea of your actual risks.
Generally, the more complex the surgery is, the higher the chance of problems.
Bleeding – You may lose blood during surgery. Your surgeon will usually manage and control bleeding. Rarely, you may receive a blood transfusion during surgery to replace lost blood.
Damage to nearby tissue and organs – Most internal organs are packed tightly together, so operating on one part of the body can affect nearby tissue and organs. This may alter how other organs work after surgery – for example, the surgeon’s handling of the bowel during pelvic surgery may cause temporary constipation (difficulty passing a bowel motion) or a build-up of gas in the abdomen.
Drug reactions – In rare cases, some people have a bad reaction to anaesthetic or other drugs used during surgery. This can cause a drop in blood pressure, heart rate and breathing, which is why an anaesthetist observes you during surgery.
Tell your doctor if you’ve had any previous reactions to over-the-counter, prescribed or herbal medicine, even if the reaction was small.
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This information is reviewed by
This information was last reviewed April 2019 by the following expert content reviewers: Prof Andrew Spillane, Surgical Oncologist, Melanoma Institute of Australia, and Professor of Surgical Oncology, The University of Sydney Northern Clinical School, NSW; Lynne Hendrick, Consumer; Judy Holland, Physiotherapist, Calvary Mater Newcastle, NSW; Kara Hutchinson, Cancer Nurse Coordinator, St Vincent’s Hospital Melbourne, VIC; A/Prof Declan Murphy, Urologist and Director of Genitourinary Oncology, Peter MacCallum Cancer Centre, VIC; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Prof Stephan Schug, Director of Pain Medicine, Royal Perth Hospital, and Chair of Anaesthesiology and Pain Medicine, The University of Western Australia Medical School, WA; Dr Emma Secomb, Specialist Surgeon, Hinterland Surgical Centre, QLD.