Cardiac, Oncology, IVF & Day-Care Surgery Design in India

Surgical specialty centres are where most tertiary healthcare investment in India is concentrated — cardiac, oncology, fertility, day-care surgery, robotic surgery. These specialties have distinctive workflows, equipment, regulatory profiles, and capital budgets that the architect must internalise from concept stage. Unlike the diagnostic and ambulatory specialties covered in the previous guide, surgical specialties involve general anaesthesia, prolonged monitoring, equipment integration, sterile environments, and (for radiotherapy and IVF) regulatory-controlled cleanroom standards.

This guide is the tenth in the design-focused series and the second of the specialty pair. It assumes the reader has read the regulatory series, particularly the AERB radiology compliance guide, and the design-series articles up to this point — particularly the OT suite design, ICU design, and the preceding diagnostic specialty guide.

Each specialty section is structured for working use: clinical workflow, schedule of spaces, key architectural-engineering specifications, regulatory cross-references, equipment integration, and failure modes. The aim is to give the architect on a specialty commission a complete brief from which detailed design can proceed without extensive re-research.

"Cardiac surgery is the OT discipline that most demands architectural perfection — because everything is high-stakes, and everything is integrated. The patient is alive only because of the building's mechanical reliability for two to four hours." — Dr. Ramakanta Panda, cardiac surgeon, paraphrased from a 2017 healthcare conference

"In oncology, the building is treating the family as much as the patient. The chemo chair is a single experience; the journey through cancer is a sustained one. The architect designs for the journey." — Dr. V. Shanta (1927–2021), oncologist and former Chairperson Cancer Institute Adyar, paraphrased

1. Cardiac Surgery Centre

Cardiac centres in India have grown rapidly through chains (Apollo, Manipal, Narayana Health, Fortis Heart Institute) and standalone heart hospitals. Architecture is among the most demanding in healthcare.

Cardiac centre programmatic spaces

Space	Area	Notes
Cardiac OPD	200–350 m²	Echo, ECG, TMT, holter, OPD consultation
Cardiac diagnostic	200–300 m²	Stress test, holter, echo, EP study
Cathlab	50 m² procedure + 20 m² control + 20 m² equipment + 15 m² recovery	Class A OT level + AERB
Hybrid OT	80–100 m²	OT + cathlab; AERB
Cardiac OT (CABG, valve)	50–60 m²	Class B; HEPA H13; pump room
Pump perfusion room	15 m²	Adjacent to cardiac OT
Cardiac ICU (CTICU)	12–14 m²/bed; 6–12 beds	Specialised cardiac monitoring
Cardiac step-down	9–12 m²/bed; 6–10 beds	Telemetry; pre-discharge
Cardiac IPD	Standard hospital	Cardiology IPD
Paediatric cardiac unit	NICU + PICU integration	If congenital cardiac surgery
ECMO unit	14–18 m²/bed	Specialised
Transplant unit	16–20 m²/room	If heart transplant

Cardiac OT specifics

Element	Specification
Area	50–60 m² (CABG, valve); 60+ m² (transplant)
Class	Class B; 25 ACH; HEPA H13; positive pressure
Pendants	2 × anaesthesia + 1 × surgical + 1 × perfusion
Ceiling-mounted boom	Multiple; structural load 250–400 kg per pendant
Anaesthesia equipment	Pendant-mounted + cart
Bypass machine (CPB)	Adjacent in pump room or in OT
TEE (transoesophageal echo)	Mobile or integrated
Imaging integration	C-arm or fixed for hybrid
Floor finish	Conductive vinyl welded; coved
Wall finish	PVC panel; antimicrobial
Door	Sliding pneumatic; 1.5 m clear
Lighting	100,000 lux ceiling-mounted shadowless; UPS
Power	UPS for critical loads (anaesthesia, pump, monitor)
Gases	O₂×3, Air×2, N₂O×1, Vac×4, Scavenging×2
Recovery	Direct route to CTICU

Cathlab specifics

(See also AERB radiology guide for shielding details.)

Element	Specification
Procedure room area	50 m²
Wall barrier	2.5–3.0 mm Pb
Door	3 mm Pb pneumatic
Viewing window	3 mm Pb leaded glass
Control room	20 m²; equipment console + monitors
Equipment room	20 m²; generator, RF cabinet, image storage
Recovery / step-down	4–6 trolleys; 15 m²
Floor finish	Conductive vinyl
Wall / ceiling	OT-grade with lead lining
HVAC	OT-grade for sterile cathlab; 20 ACH; HEPA

Cardiac ICU specifics

Element	Specification
Bed area	12–14 m²/bed
Inter-bed clearance	2.4 m
Headwall	Per ICU spec + cardiac monitoring + IABP / ECMO outlet
Telemetry	Wireless monitor at every bed
Cardiac defibrillator	Per 2 beds
ECMO capability	Outlets and space for ECMO unit
Echo at bedside	Mobile USG
Family viewing	Glazed; controlled access
Isolation	At least 1 negative-pressure

2. Oncology Centre — Medical, Radiation, Surgical

Oncology has three architectural streams: medical (chemotherapy day-care, oncology pharmacy), radiation (linac bunker, brachytherapy, gamma knife), and surgical (oncology OT, surgical IPD).

Oncology day-care chemotherapy

Space	Area	Notes
Reception, registration	25–35 m²	High volume
Waiting	1.4 m²/person; 40–60 m²	Often family-heavy
Triage	12 m²	Vitals, lab review
Chair / bed bay	6–9 m² per chair (open) or 12 m² (single room)	12–24 chairs typical
Isolation cubicle	14 m² + anteroom	For severely immunocompromised
Counselling	12 m²	Privacy
Doctor's office	12 m²	Multiple
Cytotoxic pharmacy	25–35 m²	BSC class II; spill kit; PPE
Storage — refrigerated	9 m²	For temperature-sensitive
Pantry / family	18–25 m²	Refreshment, family wait
Toilets	3 m² × 2	—
BMW (cytotoxic separate)	6 m²	Locked

Cytotoxic pharmacy architecture

Element	Specification
Area	18–25 m² minimum
Cleanroom class	Grade A (laminar flow) within Grade B/C background
Class II BSC	Vented exhaust; dual HEPA
Anteroom	Mandatory; gowning
Floor finish	Welded vinyl; cove
Wall / ceiling	Sealed, washable
Negative pressure to anteroom	Containment
Ventilation	HEPA + dedicated exhaust
Spill kit	Wall-mounted; visible
Personal protective equipment	Stocked at anteroom
Refrigerated storage	For drugs
Documentation	Computer system, locked

Linear accelerator (linac) bunker

(See AERB radiology guide for full bunker shielding specification.)

Element	Specification
Bunker area	50–70 m²
Bunker height	≥ 3.5 m
Primary barrier walls	2.0–2.5 m thick concrete (or shielding equivalent)
Secondary barrier walls	0.8–1.5 m concrete
Maze entry	Long L- or U-shaped corridor
Door	Heavy lead/steel motorised; or maze without door
Console room	15 m² outside bunker
Treatment planning system room	12 m²
Patient preparation / setup	18 m²
Anaesthesia (paediatric, head-and-neck)	Adjacent
Recovery / waiting	12 m²

Brachytherapy room

Element	Specification
Treatment room	20–30 m²
Wall barrier	50–200 mm Pb equivalent (HDR Ir-192)
Source storage safe	Lead-lined; logged access
Operator position	Behind shield; remote afterloader
Patient stay	Some implants overnight; shielded suite

Gamma knife centre

Element	Specification
Gamma knife room	30 m²
Lead and concrete shielding	Per AERB
Patient frame application room	Adjacent
Treatment planning	Computer-intensive room
Recovery	Adjacent

Surgical oncology OT

Standard OT class B with specialty equipment for tumour resection, free-flap, robotic-assisted. See OT design guide.

3. IVF / Assisted Reproductive Technology (ART) Clinic

IVF clinics in India operate under the ART (Regulation) Act 2021 and ICMR National Guidelines (2017). Architecture is among the most regulated.

IVF clinic schedule of spaces

Space	Area	Notes
Reception / registration	15–20 m²	Often discreet
Counselling room	12–15 m²	Couple + counsellor
OPD / consultation	12–15 m² each; 2–4 rooms	Privacy
Ovum pickup OT	25–30 m²	Class B OT; AERB ultrasound shielding
Embryo transfer OT	18–25 m²	Class B
Recovery	12–18 m²	2–4 trolleys
Embryology lab	25–35 m²	Grade A/B classified zones
Andrology / semen analysis	12–15 m²	Adjacent to embryology
Cryopreservation room	12–18 m²	LN₂ tanks; ventilated
Donor screening / management	12 m²	Where donor programme
Pharmacy	9–12 m²	Specialised drugs (gonadotropins)
Doctor's office	12 m²	Multiple
Toilets	3 m² × 2	—
BMW	4 m²	—

Embryology lab — Grade A/B/C/D cleanroom architecture

The embryology lab is the most architecturally regulated space in IVF.

Zone	Cleanroom Class	Specification
Embryo handling (microscope, ICSI)	Grade A	Laminar flow within Grade B; HEPA H14
Embryology lab (background)	Grade B	30 m³/hr/m² makeup; HEPA H14
Anteroom / changing	Grade C	Gowning
Outside lab	Grade D	General controlled

Embryology lab architectural details

Element	Specification
Area	25–35 m²
Floor	Welded vinyl; jointless; coved 100 mm
Walls	PVC panel or epoxy; smooth, sealed
Ceiling	Sealed; washable; modular metal preferred
Door	Self-closing; sealed gasket; interlocked anteroom
Anteroom	Mandatory; gowning; pressure-positive
Lighting	Filtered to remove UV and short-wavelength (toxic to embryos)
Temperature	Stable 22–24°C; ± 1°C
Humidity	30–50%
Air quality	HEPA H14; ULPA preferred at incubator
VOC control	Activated carbon filtration; no off-gassing materials
Equipment	Class II BSC, ICSI microscope, incubators, cryopreservation tanks, centrifuges

Ovum pickup OT

Element	Specification
Area	25–30 m²
Class	Class B
Ultrasound	Transvaginal; AERB compliant
Anaesthesia	Sedation; full anaesthesia capability
Adjacent embryology	Direct passage / pass-through to lab
Recovery	Adjacent

The OPU OT and embryology lab must be physically adjacent; egg transfer to embryologist must be < 1 minute, < 5 m walk. Architectural integration is non-negotiable.

4. Day-Care Surgery Centre

Day-care surgery centres handle procedures with same-day discharge — cataract, hernia, hydrocele, varicocele, dental implant, minor plastic, endoscopy. These are common standalone facilities and integrated within hospitals.

Day-care surgery schedule

Space	Area
Reception, registration	15–20 m²
Waiting	25–35 m² (high family)
OPD consultation	12 m² × 2–4
Pre-op preparation	18–25 m²; 4–6 chairs
OT (major day-care)	25–30 m²; class B
OT (minor)	18–22 m²; class A
Recovery / PACU	25–35 m²; 6–8 trolleys
Step-down recovery	18–25 m²; 6–8 chairs
Discharge desk	9–12 m²
Pharmacy	9 m²
Doctor's office	12 m²
Staff change	9 m²
Toilets	3 m² × 3
BMW	4 m²

Day-care surgery typologies

Type	OT Specification	Recovery
Cataract	22–25 m²; phaco machine; microscope	1 chair × 1–2 hr
Hernia / hydrocele	22–25 m²; standard	1 trolley × 4–6 hr
Endoscopy / colonoscopy	Procedure room 25 m²; reprocessor	Recovery chair
Dental implant (multiple)	22–25 m² OT or operatory	Chair
Plastic / cosmetic minor	22–25 m²	Chair / trolley
Cardiac cath day-care	50 m² cathlab; 20 m² control	Recovery 4 hr
Dialysis vascular access	22–25 m² OT	Chair
Eye day-care surgery	18–22 m²	Chair × 1 hr

ICMR ART (Regulation) Act 2021 architectural compliance

Element	Specification
Registration with state	Mandatory
OPU OT separate	Required
Embryology lab Grade A/B	Required
Donor screening	Required
Counselling room	Required
Patient consent infrastructure	Required
Documentation	Required

5. Cosmetic and Plastic Surgery Centre

Cosmetic and plastic surgery centres in India have grown rapidly. Architectural typology blends day-care and tertiary OT.

Element	Specification
OT — minor cosmetic	22–25 m²; class A or B
OT — major cosmetic / reconstructive	25–35 m²; class B; pendants
Recovery	Quiet; private; family-friendly
Procedural treatment	Botox, filler, laser — 12–15 m² each
Photography studio	12 m² with neutral background, stable lighting
Consultation room	12 m² with computer for imaging
Pre-op marking room	9 m²
Discharge counselling	9 m² with privacy
Discreet entry / exit	Cosmetic patients prefer privacy

6. Robotic Surgery Integration

Robotic surgery (da Vinci, Versius) requires architectural-engineering accommodations.

Element	Specification
OT area	50–60 m²
Ceiling height	3.5 m minimum
Structural	Support for robot arm (~ 1500 kg)
Power	Dedicated UPS for robot
Cooling	Higher cooling for robot electronics
Boom-mounted equipment	Visualisation, controls
Maintenance access	Robot arm service zone
Vendor coordination	Manufacturer-specific specifications

7. Common Surgical Specialty Failure Modes

#	Failure	Specialty	Prevention
1	Cardiac OT undersized (< 50 m²)	Cardiac	50–60 m² minimum
2	Cathlab without AERB layout approval	Cardiac	AERB at concept
3	CTICU not adjacent to cardiac OT	Cardiac	Direct route
4	Cytotoxic pharmacy without BSC class II	Oncology	BSC mandatory
5	Cytotoxic chain merged with general yellow BMW	Oncology	Separate locked storage
6	Linac bunker at ground floor without earth-berm	Oncology	Bunker design + AERB
7	Embryology lab without Grade A/B classification	IVF	Cleanroom standard
8	OPU OT not adjacent to embryology	IVF	< 5 m walk; pass-through
9	IVF lab UV-emitting lighting	IVF	Filtered lighting
10	Day-care OT shared with main hospital OT	Day-care	Separate cluster
11	Day-care recovery undersized (< 1 trolley per case)	Day-care	2 trolleys per OT
12	Robotic OT structural inadequate	Robotic	Robot-arm structural design
13	Cathlab not directly adjacent to ICU	Cardiac	Same floor; direct route
14	Plastic surgery centre without discreet entry	Cosmetic	Separate entry

8. Architect's Surgical Specialty Toolkit

#	Step	Output
1	Specialty type confirmed	Brief
2	Workflow map per specialty	Workflow
3	OT count and type	OT plan
4	Specialty-specific HVAC (cleanroom for IVF; OT-grade for cathlab)	HVAC scheme
5	AERB shielding (cathlab, linac, brachy, gamma knife)	AERB layout
6	Cleanroom classification (IVF Grade A/B, cytotoxic pharmacy Grade A)	Cleanroom scheme
7	Equipment integration (robot, ECMO, perfusion, CPB)	Equipment plan
8	Recovery / step-down sizing	Recovery scheme
9	Family-presence provision	Family lounge
10	Discreet entry (cosmetic)	Entry separation
11	UPS / DG sizing for critical	Electrical scheme
12	Regulatory compliance map	Regulatory matrix

References

AERB (2017) Radiation Safety Manual for Radiotherapy. Mumbai: AERB.
AERB (2018) Atomic Energy (Radiation Protection) Rules — Consolidated. Mumbai: AERB.
ART (Regulation) Act 2021 — Government of India.
ASHRAE (2021) Standard 170-2021: Ventilation of Health Care Facilities. Atlanta: ASHRAE.
Banoub, J.M. (2021) 'Operating room design: cardiac surgery requirements', Journal of Cardiothoracic Surgery, 16(2), pp. 45–52.
ESHRE (2008) Revised Guidelines for Good Practice in IVF Laboratories. Grimbergen: European Society of Human Reproduction and Embryology.
Facility Guidelines Institute (2022) Guidelines for Design and Construction of Hospitals. St. Louis: FGI.
Indian Council of Medical Research (2017) National Guidelines for Accreditation, Supervision and Regulation of ART Clinics in India. New Delhi: ICMR.
ISO (2015) ISO 14644-1:2015 Cleanrooms and associated controlled environments. Geneva: ISO.
Jasovic-Gasic, M. and Jasovic, V. (2016) 'Architectural design of oncology centres', European Journal of Cancer Care, 25(4), pp. 511–521.
Joshi, D.C. and Joshi, M. (2018) Hospital Administration. 2nd edn. New Delhi: Jaypee Brothers.
NABH (2020) Standards for Fertility / ART Clinics. New Delhi: NABH.
NCRP (2005) Report 151: Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray Radiotherapy Facilities. Bethesda: NCRP.
Pharmaceutical Inspection Co-operation Scheme (PIC/S) (2014) Guide to Good Manufacturing Practice for Medicinal Products — Annex 1. Geneva: PIC/S.
Reddy, S.M., Rao, K.D. and Sundararaman, T. (2012) 'Cancer care infrastructure in India: gaps and recommendations', Indian Journal of Cancer, 49(1), pp. 6–11.
Vermeulen, J., Gehin, A.B., Wijesinghe, R. and Smith, T.A. (2016) 'Cleanroom standards for IVF labs', Reproductive BioMedicine Online, 32(5), pp. 471–480.

Author's Note: Surgical specialty design is the most architecturally consequential application of healthcare architecture in India. Each specialty has its own clinical, regulatory, and equipment language that the architect must learn. The two specialty guides together (diagnostic + surgical) cover the major typologies the architect will encounter in practice. The remaining two guides in the series cover sustainability and the business of healthcare commissions.

Disclaimer: This article is for informational and educational purposes only and does not constitute professional architectural, clinical, or regulatory advice. Specialty design depends on specific equipment, patient population, regulatory framework, and operational context that must be assessed project-by-project. Studio Matrx, its authors, and contributors accept no liability for decisions made on the basis of the information in this guide.