直覺手術 (ISRG) 2012 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by.

女士們，先生們，謝謝你們的支持。

And welcome to the Intuitive Surgical Q2 2012 earnings release call.

歡迎參加 Intuitive Surgical 2012 年第二季度財報電話會議。

At this time, all phone participants are in a listen-only mode.

此時，所有電話參與者都處於只聽模式。

Later, there will be an opportunity for your questions.

稍後，將有機會回答您的問題。

Instructions will be given at that time.

屆時將給出指示。

(Operator Instructions) As a reminder, this call is being recorded.

（操作員說明）作為提醒，此通話正在錄音中。

I would now like to turn the conference over to Calvin Darling, Senior Director Investor Relations for Intuitive Surgical.

我現在想將會議轉交給 Intuitive Surgical 投資者關係高級總監 Calvin Darling。

Please go ahead.

請繼續。

Thank you, and good afternoon.

謝謝，下午好。

Welcome to Intuitive Surgical's second-quarter conference call.

歡迎來到 Intuitive Surgical 的第二季度電話會議。

With me today, we have Gary Guthart, our President and CEO; Marshall Mohr, our Chief Financial Officer; and Aleks Cukic, our Vice President of Strategic Planning.

今天和我在一起的是我們的總裁兼首席執行官 Gary Guthart；我們的首席財務官 Marshall Mohr；和我們的戰略規劃副總裁 Aleks Cukic。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements.

在開始之前，我想通知您，今天電話會議中提到的評論可能被視為包含前瞻性陳述。

Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties.

由於某些風險和不確定性，實際結果可能與明示或暗示的結果大不相同。

These risks and uncertainties are described in detail in the Company's Securities and Exchange Commission filings.

這些風險和不確定性在公司提交給證券交易委員會的文件中有詳細描述。

Prospective investors are cautioned not to place undue reliance on such forward-looking statements.

警告潛在投資者不要過分依賴此類前瞻性陳述。

Please note that this conference call will be available for audio replay on our website at IntuitiveSurgical.com on the audio archive section under our Investor Relations page.

請注意，本次電話會議將在我們的網站 IntuitiveSurgical.com 的投資者關係頁面下的音頻存檔部分提供音頻重播。

In addition, today's press release has been posted to our website.

此外，今天的新聞稿已發佈到我們的網站。

Today's format will consist of providing you with highlights of our second-quarter's results, as described in our press release announced earlier today, followed by a question-and-answer session.

今天的形式將包括為您提供我們第二季度業績的亮點，如我們今天早些時候宣布的新聞稿中所述，然後是問答環節。

Gary will present the quarter's business and operational highlights.

Gary 將介紹本季度的業務和運營亮點。

Marshall will provide a review of our second-quarter financial results.

Marshall 將對我們第二季度的財務業績進行審查。

Aleks will discuss marketing and clinical highlights.

Aleks 將討論營銷和臨床亮點。

And I will provide an update to our financial forecast for 2012.

我將提供我們對 2012 年財務預測的更新。

And finally, we will host a question-and-answer session.

最後，我們將舉辦問答環節。

With that, I will turn it over to Gary.

有了這個，我會把它交給加里。

Thank you for joining us today.

感謝您今天加入我們。

In the second quarter, our team has delivered a solid performance, driven by robust growth in both our US gynecology business and our emerging general surgery business.

在第二季度，我們的團隊在美國婦科業務和新興普外科業務強勁增長的推動下取得了穩健的業績。

As a reminder for 2012, Intuitive is focused on the following -- first, continuing our growth in gynecology and urology worldwide, through outstanding execution in the field; second, disciplined execution of our Single-Site and vessel sealing launches, focused on outstanding early customer experiences; third, building robust clinical programs with leading customers in emerging procedures and general surgery, thoracic surgery, and transoral surgery; and, finally, strengthening our capabilities in international markets, particularly Europe, Japan and Korea.

作為 2012 年的提醒，Intuitive 專注於以下方面——首先，通過在該領域的出色執行，繼續我們在全球婦科和泌尿科領域的發展；第二，嚴格執行我們的單點和船舶密封發射，專注於出色的早期客戶體驗；第三，與新興手術和普通外科、胸外科和經口外科領域的領先客戶建立強大的臨床項目；最後，加強我們在國際市場，特別是歐洲、日本和韓國的能力。

In the second quarter, we continued to experience strong growth in gynecology and general surgery.

第二季度，我們繼續經歷婦科和普外科的強勁增長。

Growth in gynecology came from a broad base of procedures, including benign and cancer hysterectomies, sacrocolpopexy, myomectomy and endometriosis resection.

婦科的增長來自廣泛的手術基礎，包括良性和癌症子宮切除術、骶骨固定術、子宮肌瘤切除術和子宮內膜異位切除術。

Growth in general surgery was also multifaceted, including growth in colon and rectal surgery, as well as cholecystectomy.

普通外科手術的增長也是多方面的，包括結腸和直腸手術以及膽囊切除術的增長。

The latter following the introduction of Single-Site earlier in the year.

後者是在今年早些時候引入 Single-Site 之後。

This strength was tempered somewhat by weakness in Europe and a decline in our US da Vinci prostatectomies.

歐洲的疲軟和我們美國達芬奇前列腺切除術的下降在一定程度上削弱了這種力量。

In total, procedures for the second quarter 2012 grew by approximately 26% over the second quarter of 2011.

總體而言，2012 年第二季度的程序比 2011 年第二季度增長了約 26%。

Aleks will provide additional procedure commentary later in the call.

Aleks 將在稍後的電話會議中提供額外的程序評論。

Globally, our business in Asia has continued to build, as a result of fine execution by our team.

在全球範圍內，由於我們團隊的出色執行，我們在亞洲的業務不斷發展。

Japan system sales and procedure performance have responded well to MHLW's reimbursement of da Vinci prostatectomy at the start of the second quarter.

日本系統銷售和程序表現對厚生勞動省在第二季度初的達芬奇前列腺切除術報銷反應良好。

And we continue to invest in building our capabilities in Japan.

我們將繼續投資建設我們在日本的能力。

Conditions in Europe are challenging, with both broad austerity issues, as well as specific structural issues impacting our business.

歐洲的情況充滿挑戰，既有廣泛的緊縮問題，也有影響我們業務的具體結構性問題。

In response to these conditions, we have brought in an experienced executive from our key accounts group in the United States to lead our European commercial organization.

針對這些情況，我們從我們在美國的大客戶團隊中聘請了一位經驗豐富的高管來領導我們的歐洲商業組織。

We also continue to invest in our international regulatory and reimbursement teams.

我們還繼續投資於我們的國際監管和報銷團隊。

Given the depth of environmental issues in Europe, we expect challenging conditions to persist into the second half of the year.

鑑於歐洲環境問題的嚴重性，我們預計充滿挑戰的情況將持續到今年下半年。

Turning to operating highlights for the second quarter.

轉向第二季度的運營亮點。

Procedures grew approximately 26% over the second quarter of 2011.

與 2011 年第二季度相比，程序增長了約 26%。

We sold 150 da Vinci Surgical Systems, up from 129 during the second quarter of last year.

我們售出了 150 台達芬奇手術系統，高於去年第二季度的 129 台。

Total revenue was $537 million; up 26% over last year.

總收入為 5.37 億美元；比去年增長 26%。

Instrument and accessory revenue increased to $224 million; up 30% over Q2 2011.

儀器和配件收入增至 2.24 億美元；比 2011 年第二季度增長 30%。

Total recurring revenue grew to $307 million, up 28% from prior year, and comprising 57% of total revenue.

經常性總收入增長至 3.07 億美元，比上年增長 28%，佔總收入的 57%。

Net income was $155 million; up 32% over last year.

淨收入為1.55億美元；比去年增長 32%。

We generated an operating profit of $259 million before noncash stock option expense, up 27% from the second quarter of last year.

在扣除非現金股票期權費用之前，我們的營業利潤為 2.59 億美元，比去年第二季度增長了 27%。

We generated $223 million in gross cash flow from operations and ended the quarter with $2.631 billion in cash and investments.

我們從運營中產生了 2.23 億美元的總現金流，並在本季度結束時擁有 26.31 億美元的現金和投資。

Turning to recently-launched products and those in development.

轉向最近推出的產品和正在開發的產品。

In the second quarter, we focused on launches of our Single-Site instruments and Vessel Sealer.

在第二季度，我們專注於推出單點儀器和 Vessel Sealer。

We expanded the use of Single-Site cholecystectomy in the US in response to growing early customer demand.

我們在美國擴大了單部位膽囊切除術的使用，以響應不斷增長的早期客戶需求。

Surgeon and patient response to Single-Site has been positive, with over 200 of our US hospital customers having purchased initial Single-Site kits two quarters after launch.

外科醫生和患者對 Single-Site 的反應是積極的，我們的 200 多名美國醫院客戶在推出後兩個季度購買了最初的 Single-Site 套件。

As mentioned in prior calls, we are working on expanding our instrument offering in Single-Site to enable its use in additional indications.

如之前的電話會議所述，我們正在努力擴展我們在單站點中的儀器產品，以使其能夠用於其他適應症。

In our vessel sealing launch, we are optimizing procedure choreography through collaboration with leading surgeons, while firming up our manufacturing and supply chain.

在我們的血管密封發射中，我們正在通過與領先的外科醫生合作優化程序編排，同時鞏固我們的製造和供應鏈。

Clinical response to the Vessel Sealer has been encouraging, with positive commentary on precision, articulation, vessel sealing quality and thermal spread.

對血管密封劑的臨床反應令人鼓舞，對精度、關節、血管密封質量和熱擴散給予了積極評價。

We expect applications for the da Vinci Vessel Sealer to be centered on general surgery and gynecologic oncology procedures.

我們預計達芬奇血管封閉器的應用將集中在普通外科和婦科腫瘤手術上。

Lastly, with regard to our da Vinci Stapler, we are gathering data to respond to FDA questions, and working on product optimization.

最後，關於我們的達芬奇訂書機，我們正在收集數據以回應 FDA 的問題，並致力於產品優化。

As we enter new surgical markets and drive into new product arenas, we continue to invest in building our team and expanding partnerships and in acquiring those technologies that can make a difference to robotic surgery.

隨著我們進入新的外科市場並進入新的產品領域，我們將繼續投資於建立我們的團隊和擴大合作夥伴關係，並收購那些可以對機器人手術產生影響的技術。

This quarter, we added 82 people to our team, predominantly in sales, manufacturing, and R&D, bringing our total team to 2,100 employees.

本季度，我們的團隊增加了 82 人，主要從事銷售、製造和研發，使我們的團隊總數達到 2,100 人。

I'll now pass the time over to Marshall, our Chief Financial Officer.

我現在將把時間轉給我們的首席財務官 Marshall。

Thank you, Gary.

謝謝你，加里。

Our second-quarter revenue was $537 million, up 26%, compared with $426 million for the second quarter of 2011.

我們第二季度的收入為 5.37 億美元，比 2011 年第二季度的 4.26 億美元增長 26%。

And up 8% compared with $495 million reported for the first quarter of 2012.

與 2012 年第一季度報告的 4.95 億美元相比，增長了 8%。

Second-quarter revenues by product category were as follows.

第二季度按產品類別劃分的收入如下。

Second-quarter instrument and accessory revenue was $224 million, up 30% compared with $172 million for the second quarter of 2011 and up 8% compared with $208 million in the first quarter of 2012.

第二季度儀器和配件收入為 2.24 億美元，與 2011 年第二季度的 1.72 億美元相比增長 30%，與 2012 年第一季度的 2.08 億美元相比增長 8%。

The increases in instruments and accessories were driven by procedure growth of approximately 26%, and sales of our new instrument and accessory products including Single-Site, Vessel Sealer, and Firefly.

儀器和附件的增長是由大約 26% 的程序增長以及我們的新儀器和附件產品（包括 Single-Site、Vessel Sealer 和 Firefly）的銷售推動的。

Instrument and accessory revenue realized per procedure, including initial stocking orders, was approximately $2,015 per procedure, which is higher than the $1,940 realized in the second quarter of 2011, and the $1,985 realized in the first quarter of 2012.

每個程序實現的儀器和配件收入（包括初始庫存訂單）約為 2,015 美元，高於 2011 年第二季度實現的 1,940 美元和 2012 年第一季度實現的 1,985 美元。

The increase in I&A per procedure was driven primarily by new product sales in advance of their use in cases.

每個程序的 I&A 的增加主要是由新產品在其用於病例之前的銷售推動的。

Second-quarter 2012 systems revenue of $229 million increased 23%, compared with $187 million for the second quarter of 2011, and increased 11% compared with $207 million for the first quarter of 2012.

與 2011 年第二季度的 1.87 億美元相比，2012 年第二季度 2.29 億美元的系統收入增長了 23%，與 2012 年第一季度的 2.07 億美元相比增長了 11%。

We sold 150 systems in the second quarter of 2012 compared with 129 systems in the second quarter of 2011, and 140 systems in the first quarter of 2012.

我們在 2012 年第二季度售出了 150 台系統，而 2011 年第二季度和 2012 年第一季度分別售出了 129 台和 140 台。

Our second-quarter average sales price per system was $1.53 million, an increase from the $1.44 million realized in the second quarter of 2011, and $1.47 million realized in the first quarter.

我們第二季度每個系統的平均銷售價格為 153 萬美元，高於 2011 年第二季度實現的 144 萬美元和第一季度實現的 147 萬美元。

ASPs include all da Vinci models, all simulators, and Firefly when configured with the system and exclude upgrades.

ASP 包括所有 da Vinci 模型、所有模擬器和 Firefly（當與系統一起配置時）並且不包括升級。

The increase in ASPs compared with the first quarter of 2012 was driven by favorable channel, product, and trade-in mix.

與 2012 年第一季度相比，平均售價的增長是由有利的渠道、產品和以舊換新組合推動的。

From a channel standpoint, we sold proportionally less systems to distributors, which are sold at lower prices than prices charged to direct customers.

從渠道的角度來看，我們向分銷商銷售的系統按比例減少，這些系統的售價低於向直接客戶收取的價格。

There were 14 systems sold to distributors in the second quarter compared with 26 in the first quarter.

第二季度向分銷商銷售了 14 台系統，而第一季度為 26 台。

On the product side, we sold 121 simulators, mostly in conjunction with new system sales, compared with 102 last quarter.

在產品方面，我們售出了 121 台模擬器，大部分是與新系統銷售一起銷售的，而上一季度為 102 台。

We also sold 28 dual console systems compared to 25 in the first quarter.

我們還售出了 28 個雙控制台系統，而第一季度為 25 個。

35 of our second-quarter 2012 systems involved trade-ins comprised of 23 da Vinci S's and 12 standard models.

我們 2012 年第二季度的 35 個系統涉及以舊換新，包括 23 個 da Vinci S 和 12 個標準模型。

While 46 of our first-quarter 2012 system sales involved trade-ins comprised of 27 da Vinci S's and 19 standard models.

雖然我們 2012 年第一季度的 46 項系統銷售涉及以舊換新，但包括 27 種達芬奇 S 和 19 種標準型號。

ASPs will fluctuate quarter to quarter based on product, customer and trade-in mix, as well as foreign exchange rates on direct sales to foreign customers.

平均售價將根據產品、客戶和以舊換新組合以及對外國客戶的直接銷售的外匯匯率逐季波動。

We would expect system ASPs to decline in future quarters, driven by a return to a more historic mix and lower ASPs earned on direct sales for European customers due to lower Euro exchange rates.

我們預計系統 ASP 將在未來幾個季度下降，原因是回歸到更具歷史意義的組合以及由於歐元匯率較低而從歐洲客戶直接銷售中獲得的 ASP 較低。

Service revenue increased $83 million, up 23% compared with $68 million last year, and up 3% compared with $81 million last quarter.

服務收入增加了 8300 萬美元，與去年的 6800 萬美元相比增長了 23%，與上一季度的 8100 萬美元相比增長了 3%。

The growth in service revenue was primarily driven by a larger system installed base.

服務收入的增長主要是由更大的系統安裝基礎推動的。

Total second-quarter recurring revenue comprised of instrument, accessory, and service revenue increased to $307 million, up 28% compared with the second quarter of 2011, and up 6% compared with first quarter of 2012.

由儀器、配件和服務收入組成的第二季度總經常性收入增加到 3.07 億美元，與 2011 年第二季度相比增長 28%，與 2012 年第一季度相比增長 6%。

Recurring revenue represented 57% of total second-quarter revenue compared with 56% in the second quarter last year, and 58% last quarter.

經常性收入佔第二季度總收入的 57%，而去年第二季度為 56%，上一季度為 58%。

International results were as follows.

國際結果如下。

Second-quarter revenue outside the US was $101 million, up 16% compared with revenue of $87 million in the second quarter of 2011, and down 3% compared with revenue of $105 million in the first quarter of 2012.

美國以外的第二季度收入為 1.01 億美元，與 2011 年第二季度的收入 8700 萬美元相比增長 16%，與 2012 年第一季度的收入 1.05 億美元相比下降 3%。

Instrument and accessory revenue grew approximately 21% year-over-year, and decreased 3% sequentially, reflecting procedure growth rates.

儀器和配件收入同比增長約 21%，環比下降 3%，反映了程序增長率。

Procedures outside of the US grew 21% on a year-to-year basis, and decreased approximately 1% sequentially.

美國以外的程序同比增長 21%，環比下降約 1%。

The growth in procedures compared to the prior year primarily reflect EVP growth in Europe.

與上一年相比，程序的增長主要反映了歐洲 EVP 的增長。

The decline in procedures compared with the first quarter reflects the macroeconomic environment in Europe, coupled with fewer operating days due to holidays.

與第一季度相比，程序的減少反映了歐洲的宏觀經濟環境，加上假期導致的營業天數減少。

EVPs in Japan grew at a high rate, albeit off a small base, as national reimbursement was approved at the beginning of the quarter.

日本的 EVP 增長率很高，儘管基數很小，因為國家報銷在本季度初獲得批准。

We sold 26 systems outside the US compared with 30 in the second quarter of 2011, and 35 last quarter.

我們在美國以外銷售了 26 台系統，而 2011 年第二季度為 30 台，上一季度為 35 台。

We sold 13 systems in Europe this quarter, with 16 in the second quarter of 2011, and 14 last quarter.

本季度我們在歐洲銷售了 13 台系統，2011 年第二季度有 16 台，上季度有 14 台。

And we sold 7 systems in Japan compared with 7 last quarter, and 4 in the second quarter of last year.

我們在日本銷售了 7 台系統，而上一季度為 7 台，去年第二季度為 4 台。

The decline in European system sales reflects the difficult macroeconomic environment.

歐洲系統銷量的下降反映了宏觀經濟環境的艱難。

Aleks will provide additional details of international system sales.

Aleks 將提供國際系統銷售的更多詳細信息。

Moving on to the remainder of the P&L, gross margin in the second quarter was 72%, roughly equal to the second quarter of 2011 and the first quarter of 2012.

繼續看損益表的其餘部分，第二季度的毛利率為 72%，大致等於 2011 年第二季度和 2012 年第一季度。

Our gross margin has remained unchanged, as the positive impacts of our higher second-quarter system ASPs were offset by lower margins earned on new products and higher inventory reserves.

我們的毛利率保持不變，因為我們較高的第二季度系統平均售價的積極影響被新產品的較低利潤率和較高的庫存儲備所抵消。

Margins on newly-launched products will typically be lower than those for our mature products, reflecting vendor pricing on low volumes, temporary tooling costs and other startup costs.

新推出產品的利潤率通常低於我們成熟產品的利潤率，這反映了供應商對小批量、臨時工具成本和其他啟動成本的定價。

Over time, as volumes increase, we refine the manufacturing processes and products, we should see improvement in the margins of these newer products.

隨著時間的推移，隨著產量的增加，我們改進了製造工藝和產品，我們應該會看到這些新產品的利潤率有所提高。

Second-quarter 2012 operating expenses of $161.1 million were up 16% compared with the second quarter of 2011, and down 1% compared with the first quarter of 2012.

2012 年第二季度運營費用為 1.611 億美元，與 2011 年第二季度相比增長 16%，與 2012 年第一季度相比下降 1%。

We changed our stock option granting pattern this year so that employees are granted options at both February 15 and August 15 compared with only at February 15 in prior years.

我們今年改變了股票期權授予模式，使員工在 2 月 15 日和 8 月 15 日都獲得期權，而往年僅在 2 月 15 日授予。

Although approximately the same number of options will be granted annually, the amount of expense taken in the first quarter and second quarter was approximately $3 million and $5 million lower.

儘管每年將授予大約相同數量的期權，但第一季度和第二季度的支出金額約為 300 萬美元，低於 500 萬美元。

And the amount of expense in the third quarter will be approximately $8 million higher than had we not changed our stock granting pattern.

第三季度的費用金額將比我們不改變股票授予模式的情況下高出約 800 萬美元。

We added 82 employees in the quarter, including 38 employees in our commercial operations and 39 employees in product operations.

本季度我們增加了 82 名員工，其中包括 38 名商業運營員工和 39 名產品運營員工。

Second-quarter operating income was $225 million, or 42% of sales, compared with $168 million, or 39% of sales for the second quarter of 2011, and $193 million, or 39% of sales for the first quarter of 2012.

第二季度營業收入為 2.25 億美元，佔銷售額的 42%，而 2011 年第二季度為 1.68 億美元，佔銷售額的 39%，2012 年第一季度為 1.93 億美元，佔銷售額的 39%。

Second-quarter 2012 operating income reflected $33 million of noncash stock compensation expense compared with $35 million for the second quarter of 2011, and $34 million last quarter.

2012 年第二季度的營業收入反映了 3300 萬美元的非現金股票補償費用，而 2011 年第二季度為 3500 萬美元，上一季度為 3400 萬美元。

Our effective tax rate for the second quarter was 32% compared with 32% for the second quarter of 2011, and 27% last quarter.

我們第二季度的有效稅率為 32%，而 2011 年第二季度為 32%，上一季度為 27%。

Our 32% second-quarter rate was higher than our previous guidance of 31%, primarily due to a higher proportion of pretax income coming from our US business.

我們第二季度 32% 的稅率高於我們之前 31% 的指引，這主要是由於我們的美國業務在稅前收入中所佔比例較高。

Our net income was $155 million, or $3.75 per share compared with $117 million, or $2.91 per share for the second quarter of 2011, and $144 million, or $3.50 per share for the first quarter of 2012.

我們的淨收入為 1.55 億美元，即每股 3.75 美元，而 2011 年第二季度為 1.17 億美元，即每股 2.91 美元，2012 年第一季度為 1.44 億美元，即每股 3.50 美元。

Let me quickly summarize our results for the first six months of 2012.

讓我快速總結一下 2012 年前六個月的結果。

Procedures grew by 27%.

程序增長了 27%。

Total revenue for the first six months of 2012 was $1.32 billion, up 27% compared with $814 million last year.

2012 年前六個月的總收入為 13.2 億美元，比去年的 8.14 億美元增長 27%。

The revenue increase included recurring revenue growth of 29% and an increase in systems revenue of 23%.

收入增長包括 29% 的經常性收入增長和 23% 的系統收入增長。

Operating income for the first six months of 2012 was $419 million, up 32% compared with $316 million last year.

2012 年前六個月的營業收入為 4.19 億美元，比去年的 3.16 億美元增長 32%。

Operating income included $68 million of stock-based compensation charges in the first six months of 2012 compared with $67 million in 2011.

營業收入包括 2012 年前六個月的 6800 萬美元股票薪酬費用，而 2011 年為 6700 萬美元。

Net income for the first six months of 2012 was $298 million, or $7.26 per share, compared with $222 million, or $5.51 per share last year.

2012 年前六個月的淨收入為 2.98 億美元，即每股 7.26 美元，而去年為 2.22 億美元，即每股 5.51 美元。

Cash flows from operations for the first six months of 2012 was $383 million, compared with $306 million last year.

2012 年前六個月的運營現金流為 3.83 億美元，而去年為 3.06 億美元。

Now moving to the balance sheet.

現在轉到資產負債表。

We ended the second quarter with cash and investments of $2.6 billion, up $260 million compared with March 31, 2012.

我們在第二季度末的現金和投資為 26 億美元，與 2012 年 3 月 31 日相比增加了 2.6 億美元。

The increase was driven by $217 million of cash flow from operations, plus $56 million from the exercise of stock options, partially offset by $15 million in stock buybacks, and $14 million of capital and IP purchases.

這一增長是由 2.17 億美元的運營現金流推動的，加上 5600 萬美元的股票期權行使，部分被 1500 萬美元的股票回購以及 1400 萬美元的資本和知識產權購買所抵消。

We had $553 million board-authorized buybacks remaining.

我們還有 5.53 億美元的董事會授權回購。

Our accounts receivable balance increased to $323 million at June 30, from $300 million at March 31, primarily reflecting our higher second-quarter revenue.

我們的應收賬款餘額從 3 月 31 日的 3 億美元增加到 6 月 30 日的 3.23 億美元，主要反映了我們第二季度收入的增加。

Our net inventory of $119 million at June 30 is equal to the March 31 balance.

我們在 6 月 30 日的淨庫存為 1.19 億美元，相當於 3 月 31 日的餘額。

And with that, I would like to turn it over to Aleks, to go over our sales, marketing and clinical highlights.

有了這個，我想把它交給 Aleks，看看我們的銷售、營銷和臨床亮點。

Thank you, Marshall.

謝謝你，馬歇爾。

During the second quarter, we sold 150 da Vinci systems; 124 in the United States, 13 into Europe, and 13 into rest of world markets.

第二季度，我們售出了 150 台達芬奇系統；美國有 124 個，歐洲有 13 個，世界其他市場有 13 個。

As part of the 150 system sales, 12 standard da Vinci systems, and 23 da Vinci S systems were traded in for credit against sales for new da Vinci Si systems.

作為 150 個系統銷售的一部分，12 個標準 da Vinci 系統和 23 個 da Vinci S 系統被換成新的 da Vinci Si 系統的銷售信用。

We had a net 115 system additions to the installed base during the quarter, which brings to 2,341 the cumulative number of da Vinci systems worldwide; 1,707 in the US, 389 in Europe, and 245 in rest of world markets.

本季度，我們的安裝基礎淨增加了 115 個系統，使全球達芬奇系統的累計數量達到 2,341 個；美國有 1,707 個，歐洲有 389 個，世界其他市場有 245 個。

79 of the 150 systems installed during the quarter represented repeat system sales to existing customers.

本季度安裝的 150 個系統中有 79 個代表對現有客戶的重複系統銷售。

In total, 142 of the 150 systems sold represented da Vinci Si systems, which included 28 dual console systems.

總共售出的 150 個系統中有 142 個代表達芬奇系統，其中包括 28 個雙控制台系統。

The 26 system sales internationally included 7 into Japan, 4 into France, and 3 into the UK.

全球 26 台系統銷售包括 7 台進入日本、4 台進入法國和 3 台進入英國。

Clinically, we had a solid quarter, achieving year-over-year procedure growth of approximately 26%.

在臨床上，我們有一個穩健的季度，實現了約 26% 的同比增長。

Gynecology, general surgery, along with the emerging categories of thoracic and head/neck surgery accounted for a large part of this growth.

婦科、普通外科以及新興的胸外科和頭頸外科手術佔這一增長的很大一部分。

Da Vinci hysterectomy, cholecystectomy, colon and rectal resections, lobectomy, endometriosis resections, myomectomy and partial nephrectomy exhibited strong quarter-over-quarter growth, which was partially offset by DVP softness in the United States.

達芬奇子宮切除術、膽囊切除術、結腸和直腸切除術、肺葉切除術、子宮內膜異位症切除術、子宮肌瘤切除術和部分腎切除術顯示出強勁的季度環比增長，這部分被美國 DVP 的柔軟度所抵消。

The recent pressure from nonsurgical disease management, namely active surveillance, as well as an apparent decline in PSA screening, has caused some pullback in the US DVP number.

最近來自非手術疾病管理的壓力，即主動監測，以及 PSA 篩查的明顯下降，導緻美國 DVP 數量有所回落。

As the incumbent leader in the surgical treatment of prostate cancer, it's difficult, perhaps impossible, to remain unaffected by this larger trend, at least in the short-term.

作為前列腺癌手術治療的現任領導者，至少在短期內很難，也許不可能不受這一更大趨勢的影響。

Recently released new products continue to do well; most notably, Single-Site.

近期發布的新品繼續表現良好；最值得注意的是，單站點。

Early customer feedback has been positive and our initial sales have been strong.

早期的客戶反饋是積極的，我們的初始銷售也很強勁。

Within the first two quarters, post launch, we sold Single-Site kits to over 200 US customers, while demand for training remains strong.

在發布後的前兩個季度，我們向 200 多名美國客戶銷售了單站點套件，同時對培訓的需求依然強勁。

We initiated our phased rollout of the Vessel Sealer product in February.

我們於 2 月開始分階段推出 Vessel Sealer 產品。

And its use within the segments of general, colorectal and GYN surgery has begun.

並且它在普通、結直腸和婦科手術領域的應用已經開始。

The product is performing well.

該產品表現良好。

And the feature set, specifically the articulated wrist design, appears to be satisfying a strong market need.

而功能集，特別是鉸接式手腕設計，似乎滿足了強烈的市場需求。

Operationally, we continue to make progress toward optimizing the manufacturing process, while reducing product cost.

在運營方面，我們繼續在優化製造過程方面取得進展，同時降低產品成本。

Regarding system attachments, namely da Vinci Simulator and da Vinci Firefly.

關於系統附件，即達芬奇模擬器和達芬奇螢火蟲。

Both attachment rates remained high in the second quarter.

在第二季度，這兩種附著率都保持在高位。

Strong market acceptance for these products has helped buoy our da Vinci system ASP to an all-time high.

這些產品的強大市場認可度幫助將我們的達芬奇系統 ASP 推升至歷史新高。

During the quarter, over 350 robotic abstracts and papers representing a variety of surgical specialties were published within various peer-reviewed journals.

在本季度，代表各種外科專業的 350 多篇機器人摘要和論文在各種同行評審期刊上發表。

And the clinical conferences were abundant with live da Vinci procedure transmissions, postgraduate robotic courses and podium presentations and clinical poster sessions.

臨床會議內容豐富，包括現場達芬奇程序傳輸、研究生機器人課程、講台演示和臨床海報會議。

The adoption of our international DVH business has lagged behind the United States for both malignant and benign conditions.

我們的國際 DVH 業務的採用在惡性和良性疾病方面都落後於美國。

Not surprising.

不奇怪。

We believe that DVH for the treatment of malignant conditions will likely pace the international GYN business.

我們認為，用於治療惡性疾病的 DVH 可能會推動國際 GYN 業務的發展。

In a recent addition of the International Journal of Gynecologic Cancers, Doctors Mock and Yang, from the National University in Singapore, published a study describing the conversion of their open hysterectomy practice to a da Vinci hysterectomy practice in treating endometrial cancer.

在最近的國際婦科癌症雜誌上，新加坡國立大學的 Mock 和 Yang 博士發表了一項研究，描述了他們在治療子宮內膜癌時將開放式子宮切除術轉變為達芬奇子宮切除術的做法。

Open surgery is the standard of care for endometrial cancer staging in Singapore, as it is in many other countries.

與許多其他國家一樣，開放手術是新加坡子宮內膜癌分期的標準護理。

This study compared the results of open hysterectomy to DVH in 124 consecutive endometrial cancer patients.

本研究在 124 名連續子宮內膜癌患者中比較了開放式子宮切除術與 DVH 的結果。

The patients in each cohort were of similar age, BMI, and preexisting health condition.

每個隊列中的患者俱有相似的年齡、BMI 和先前存在的健康狀況。

The authors reported that their operating time was longer during their initial 20 DVH procedures, but had dropped significantly thereafter.

作者報告說，在最初的 20 次 DVH 程序中，他們的手術時間較長，但此後顯著下降。

And were subsequently on par with the comparator.

並隨後與比較器相提並論。

Lymph node harvests were also slightly lower within the initial 20 cases, but were similar thereafter.

在最初的 20 例病例中，淋巴結收穫量也略低，但此後相似。

However, DVH was associated with 56% less blood loss than open surgery.

然而，與開放手術相比，DVH 的失血量減少了 56%。

It had a lower rate of postoperative complication; 8.8% versus 26.8%.

術後並發症發生率較低； 8.8% 對 26.8%。

And a lower wound complication rate; 0 versus 9.9%.

並且傷口並發症發生率更低； 0 對 9.9%。

In addition, the requirement for postoperative parenteral analgesia was only 5.9% for the DVH patients as compared with 51.1% for the open laparotomy patients.

此外，DVH患者術後腸外鎮痛的需求僅為5.9%，而開腹手術患者則為51.1%。

And hospitalization was reduced to two days for the DVH patients as compared to 5.9 days for the open laparotomy group.

與開腹手術組的 5.9 天相比，DVH 患者的住院時間減少到兩天。

They concluded their paper by stating, and I quote, our series shows that outcomes traditionally associated with laparoscopic endometrial cancer staging are achievable by laparoscopically naive gynecologic cancer surgeons moving from laparotomy to robotic-assisted endometrial cancer staging after a relatively small number of cases, close quote.

他們在論文的最後陳述，我引用，我們的系列表明，傳統上與腹腔鏡子宮內膜癌分期相關的結果是可以通過腹腔鏡天真的婦科癌症外科醫生在相對較少的病例後從剖腹手術轉向機器人輔助子宮內膜癌分期來實現的，關閉引用。

Early data for da Vinci Single-Site [co-lease] is being collected at various sites within the US and abroad, while the initial EU publications begin to appear in the literature.

達芬奇單一站點 [co-lease] 的早期數據正在美國和國外的各個站點收集，而最初的歐盟出版物開始出現在文獻中。

In a recent addition of the Archives of Surgery, a consortium made up of five leading Italian robotic centers published initial results of their first 100 Single-Site cholecystectomy procedures.

在最近增加的手術檔案中，由五個領先的意大利機器人中心組成的聯盟公佈了他們首批 100 例單部位膽囊切除術的初步結果。

The paper, entitled Overcoming the Challenges of Single Incision Cholecystectomy with Robotic Single-Site Technology, described the contribution of traditional single incision [laparoscomy] as an important development step in moving from multiple site laparoscopy to single-incision interventions.

這篇題為《用機器人單點技術克服單切口膽囊切除術的挑戰》的論文描述了傳統單切口 [腹腔鏡手術] 作為從多部位腹腔鏡手術轉向單切口乾預的重要發展步驟的貢獻。

However, single-incision laparoscopic cholocystectomies has not gained widespread use, due in large part to the physical limitations of the technology, which compromises optimal triangulation, the overall ergonomics of the procedure, and quality of view.

然而，單切口腹腔鏡膽囊切除術並未得到廣泛應用，這在很大程度上是由於該技術的物理限制，這會影響最佳三角測量、手術的整體人體工程學和視野質量。

This, according to the authors.

據作者說，這是。

They also reported that the combination of these factors provides challenges for optimal tissue exposure, and that traditional instruments and platforms have significant limitation when used for SILS.

他們還報告說，這些因素的結合為最佳組織暴露帶來了挑戰，並且傳統儀器和平台在用於 SILS 時存在很大限制。

They went on to say, and I quote, da Vinci Single-Site cholecystectomy was regarded as a safe procedure by all surgeons involved in the study, and as safe as standard four-port laparoscopic operations, close quote.

他們接著說，我引用了，達芬奇單部位膽囊切除術被參與研究的所有外科醫生認為是一種安全的手術，並且與標準的四孔腹腔鏡手術一樣安全，密切引用。

They also reported that four out of the five surgeons participating in this trial claimed to be considering the extension of da Vinci Single-Site technology toward treating other conditions.

他們還報告說，參與該試驗的五名外科醫生中有四名聲稱正在考慮將達芬奇單點技術擴展到治療其他疾病。

In their conclusion, they wrote, and I quote, the robotic technology is a compensatory technique that can overcome the constraints and the ergonomic limitations of SILS, and is potentially capable of realizing the full potential of single access approach.

在他們的結論中，他們寫道，我引用，機器人技術是一種補償技術，可以克服 SILS 的約束和人體工程學限制，並且有可能實現單一訪問方法的全部潛力。

We show that it allows for the quick overcoming of the learning curve that is typical of most new procedures, particularly of laparoscopic single-incision approach.

我們表明，它可以快速克服大多數新程序典型的學習曲線，特別是腹腔鏡單切口方法。

This is likely to increase the safety of single-incision surgery, and, in turn, expand adoption to a wider number of general surgeons and surgical procedures, close quote.

這可能會提高單切口手術的安全性，進而將採用範圍擴大到更多的普通外科醫生和外科手術。

In a recent addition of the British Journal of Urology, an interesting paper out of Asia, authored by Dr. Shin Dong-Chung and others from National University Hospital in Taiwan, studied the readmission rates for patients who had undergone open prostatectomy, lap prostatectomy and robotic prostatectomy.

在最近添加的英國泌尿外科雜誌中，一篇來自亞洲的有趣論文，由台灣國立大學醫院的申東中博士和其他人撰寫，研究了接受開放式前列腺切除術、膝部前列腺切除術和前列腺切除術的患者的再入院率。機器人前列腺切除術。

The nationwide Taiwanese study included 2,741 patients studied over a five-year period, with the objective of determining the sub 90-day readmission rate associated with each of the three techniques.

這項全國性的台灣研究包括在五年內研究的 2,741 名患者，目的是確定與這三種技術中的每一種相關的低於 90 天的再入院率。

The reduction of readmission rates is a goal shared by all economies, since the associated costs can be quite significant for payers and patients.

降低再入院率是所有經濟體的共同目標，因為相關成本對付款人和患者來說可能相當大。

In total, 257, or 9.4% of the 2,741 patients studied required a readmission to a hospital within 90 days post surgery.

在所研究的 2,741 名患者中，總共有 257 名或 9.4% 需要在手術後 90 天內重新入院。

The diagnosis for readmission included intestinal infections, UTIs, hernias, pneumonia, prosthetic hypertrophy, retention of urine, and postoperative infections.

再入院的診斷包括腸道感染、尿路感染、疝氣、肺炎、假體肥大、尿瀦留和術後感染。

The authors reported that the readmission rate for traditional laparoscopic prostatectomy patients was more than twice as common than for patients undergoing a DVP.

作者報告說，傳統腹腔鏡前列腺切除術患者的再入院率是接受 DVP 患者的兩倍多。

8.2% for lap versus 3.6% for DVP.

單圈為 8.2%，而 DVP 為 3.6%。

When comparing the readmission rate for open prostatectomy to DVP, the frequency of readmission was nearly three times as great; 10.7% versus 3.6%.

將開放式前列腺切除術與 DVP 的再入院率進行比較，再入院率幾乎是 DVP 的三倍； 10.7% 對 3.6%。

In their written discussion, the author stated, and I quote, in the present study, we clearly showed that patients undergoing robotic assisted laparoscopic prostatectomy had a lower risk of 90-day readmission than the patients undergoing open prostatectomy.

在他們的書面討論中，作者指出，我引用了本研究，我們清楚地表明，接受機器人輔助腹腔鏡前列腺切除術的患者比接受開放式前列腺切除術的患者再入院 90 天的風險更低。

We think that the present study is an important step in helping to define the relative efficacy of robotic prostatectomy, laparoscopic prostatectomy and open prostatectomy, as a treatment option for localized prostate cancer.

我們認為本研究是幫助確定機器人前列腺切除術、腹腔鏡前列腺切除術和開放式前列腺切除術作為局部前列腺癌治療選擇的相對療效的重要一步。

Moreover, the present findings may prove valuable to patients trying to make an objective decision about the various treatment options.

此外，目前的研究結果可能對試圖就各種治療方案做出客觀決定的患者證明是有價值的。

Because the present study used nationwide population-based data sets, its robust findings can be generalized to a population as a whole, close quote.

由於本研究使用了全國性的基於人口的數據集，因此其穩健的研究結果可以推廣到整個人口，緊密引用。

This concludes my remarks.

我的發言到此結束。

I'll now turn the time over to Calvin.

我現在把時間交給 Calvin。

Thank you, Aleks.

謝謝你，亞歷克斯。

I will be providing you with an update to our financial forecast for 2012, including procedures, revenues, and other elements of the income statement on a GAAP basis.

我將向您提供我們對 2012 年財務預測的更新，包括程序、收入和基於公認會計原則的損益表的其他要素。

I will also provide estimates of significant noncash expenses to provide you with visibility into our expected future cash flows.

我還將提供對重大非現金支出的估計，以便讓您了解我們預期的未來現金流量。

Starting with procedures, on our last call, we forecast procedures to grow approximately 25% to 27% from the base of approximately 360,000 procedures performed in 2011.

從程序開始，在我們上次的電話會議上，我們預測程序將在 2011 年執行的約 360,000 個程序的基礎上增長約 25% 至 27%。

Halfway through 2012, our procedure growth stands at 27%.

到 2012 年中期，我們的程序增長率為 27%。

During the second quarter, we saw continued strength in US gynecology and general surgery procedures, while we experienced a pullback in US DVP volume and challenges in our European procedure business.

在第二季度，我們看到美國婦科和普通外科手術繼續走強，而我們在美國 DVP 數量和歐洲手術業務中遇到了挑戰。

Based upon the net of these factors, we continue to forecast full-year 2012 da Vinci procedure volume to grow approximately 25% to 27% above our 2011 total.

基於這些因素的淨值，我們繼續預測 2012 年全年達芬奇手術量將比我們 2011 年的總量增長約 25% 至 27%。

Moving on to revenues.

繼續收入。

We are increasing our 2012 revenue guidance.

我們正在提高 2012 年的收入指引。

Based primarily upon capital sales trends and revenue contributions from new products, we now expect 2012 revenue to grow between 20% and 23% above total 2011 revenue of $1.76 billion.

主要基於資本銷售趨勢和新產品的收入貢獻，我們現在預計 2012 年收入將比 2011 年 17.6 億美元的總收入增長 20% 至 23%。

This is up from the 19% to 21% revenue growth forecast on our previous call.

這高於我們之前電話會議的 19% 至 21% 的收入增長預測。

Specifically related to system ASP, as Marshall mentioned, our Q2 ASP came in at $1.53 million.

正如馬歇爾所說，特別與系統 ASP 相關，我們的第二季度 ASP 為 153 萬美元。

This metric largely resulted from favorable channel, trade-in, and product mix.

這一指標很大程度上源於有利的渠道、以舊換新和產品組合。

Going forward, we would expect to see a system sales mix more in line with previous patterns.

展望未來，我們希望看到系統銷售組合更符合以前的模式。

In addition, Euro-based system ASPs will be lower in US dollar terms due to the weaker Euro.

此外，由於歐元疲軟，以美元計算的基於歐元的系統平均售價將較低。

As a result, we would expect system ASPs to return to more historic levels realized in previous quarters.

因此，我們預計系統 ASP 將恢復到前幾個季度實現的更多歷史水平。

Overall, we would expect our total Q3 2012 revenue to be near or possibly below our Q2 level.

總體而言，我們預計 2012 年第三季度的總收入將接近或可能低於第二季度的水平。

Now, turning to expenses.

現在，轉向開支。

Consistent with our last call, we continue to forecast full-year noncash compensation to fall within a range of between $152 million and $156 million for the year.

與我們上次的電話會議一致，我們繼續預測全年非現金薪酬將在 1.52 億美元至 1.56 億美元之間。

The timing of these expenses, however, will be considerably different in 2012 as compared to prior years.

然而，與往年相比，2012 年這些費用的時間安排將有很大不同。

As Marshall mentioned, in 2012, we began issuing employee option grants in two installments, one in February and one in August, rather than a single February grant.

正如馬歇爾所說，2012 年，我們開始分兩期發放員工期權補助金，一次在 2 月，一次在 8 月，而不是在 2 月一次。

As a result, in 2012, Q1 and Q2 received lower proportions of the full-year expense.

因此，2012 年第一季度和第二季度收到的全年費用比例較低。

And Q3 will receive a significantly higher proportion.

第三季度將獲得更高的比例。

Specifically, 2012 actual stock compensation was $34.4 million in Q1, and $33.3 million in Q2.

具體來說，2012 年第一季度的實際股票薪酬為 3440 萬美元，第二季度為 3330 萬美元。

We would expect Q3 stock compensation to be between $13 million and $14 million higher than Q2, and come in around $47 million, then declining to around $40 million in Q4.

我們預計第三季度的股票薪酬將比第二季度高出 1300 萬美元至 1400 萬美元，約為 4700 萬美元，然後在第四季度下降至 4000 萬美元左右。

R&D expenses.

研發費用。

Based upon the timing of various R&D projects, we anticipate a significant uptick in Q3 R&D expense compared to Q2.

根據各種研發項目的時間安排，我們預計第三季度的研發費用與第二季度相比將顯著上升。

Based upon the timing of stock compensation and R&D expenses and continuing business growth, we would expect Q3 operating expenses to come in over $20 million higher than Q2.

根據股票補償和研發費用以及持續業務增長的時間，我們預計第三季度的運營費用將比第二季度高出 2000 萬美元以上。

Now, turning to operating income.

現在，轉向營業收入。

Consistent with our previous forecast, we continued to expect operating income to fall within a range of between 39% and 40% of net revenue.

與我們之前的預測一致，我們繼續預計營業收入將在淨收入的 39% 至 40% 之間。

Again, while second-quarter operating income came at 42% of sales, and we stand at 40.6% on a year-to-date basis, based upon the timing of expenses I just described, we expect full-year operating expense to come in within our 39% to 40% guidance range.

同樣，雖然第二季度營業收入佔銷售額的 42%，而我們今年迄今為 40.6%，但根據我剛剛描述的費用時間，我們預計全年營業費用將出現在我們 39% 到 40% 的指導範圍內。

We expect other income, which is mainly comprised of interest income, to total between $16 million and $17 million for the year.

我們預計今年其他收入（主要包括利息收入）將在 1600 萬美元至 1700 萬美元之間。

With regard to income tax, our Q2 reported tax rate of 32.4% was above the 31% projection on our last call.

關於所得稅，我們第二季度報告的 32.4% 的稅率高於我們上次電話會議的 31% 預測。

While our Q2 tax rate was higher than the forecasted rate, our estimate for Q3 and Q4 remains about the same 31% of pretax income rate.

雖然我們第二季度的稅率高於預測稅率，但我們對第三季度和第四季度的估計仍保持在稅前收入的 31% 左右。

We estimate that our share count for calculating EPS in Q3 2012 will be approximately 41.7 million shares.

我們估計我們用於計算 2012 年第三季度每股收益的股票數量約為 4170 萬股。

That concludes our prepared remarks.

我們準備好的發言到此結束。

We will now open the call for your questions.

我們現在將打開您的問題的電話。

(Operator Instructions) Ben Andrew with William Blair.

（操作員說明）Ben Andrew 和 William Blair。

Gary, maybe give us some insights into DVP trends here and how far you think that may go down.

加里，也許在這裡給我們一些關於 DVP 趨勢的見解，以及你認為這可能會下降多遠。

If you can give us some sense of what happened in the quarter.

如果你能給我們一些關於本季度發生的事情的感覺。

Where does this stabilize, in your view, based on the trends?

在您看來，根據趨勢，這在哪裡穩定？

And it does sound like it's a broader industry shift in the way patients are being managed.

聽起來這確實是對患者管理方式的更廣泛的行業轉變。

Obviously it's becoming less important with the growth of the other pieces, but I just wanted to understand and isolate that bit, if we can.

顯然，隨著其他部分的增長，它變得不那麼重要了，但如果可以的話，我只是想理解和隔離這一點。

Yes.

是的。

The way we look at it, it's really being driven by two different effects.

我們看待它的方式，它實際上是由兩種不同的效果驅動的。

One of them has been the scrutiny and discussion around PSA testing and what that impact is.

其中之一是圍繞 PSA 測試及其影響的審查和討論。

It's hard for us to exactly handicap what the impact on PSA tests and discussion is.

我們很難準確判斷對 PSA 測試和討論的影響。

But clearly, as one of the major treatment modalities for prostate cancer care, if there are changes to PSA testing and the number of people going into the pipeline, that will flow through to us.

但顯然，作為前列腺癌護理的主要治療方式之一，如果 PSA 檢測和進入管道的人數發生變化，那將流向我們。

And then the second part that you have described has been, if there is a look at nonsurgical treatment modalities and other alternatives, like active surveillance, that also will have an impact.

然後你描述的第二部分是，如果看看非手術治療方式和其他替代方法，比如主動監測，那也會產生影響。

Hard for us to predict where that will play out over the long haul.

我們很難預測從長遠來看這將在哪裡發揮作用。

We know, with high confidence, that surgery is the best treatment for men with high-risk prostate cancer.

我們非常自信地知道，對於患有高危前列腺癌的男性來說，手術是最好的治療方法。

There's really no question.

真的沒有問題。

Another question is going to be, as surgical societies and surgeons look at this over the long term, how do they vector patients in through their treatment pathways.

另一個問題是，隨著外科學會和外科醫生從長遠來看，他們如何通過治療途徑引導患者。

What we've seen in the past -- just one more comment -- is that over time, as men are moved into active surveillance, and those come in waves having to do with the amount of publicity it gets, over time, people will start coming back out of active surveillance, either because the cancer is progressing or because over time the active surveillance is in and of itself a burden.

我們過去所看到的——只是再提一條評論——隨著時間的推移，隨著男性被轉移到主動監視中，而這些人一波又一波地出現，這與它獲得的宣傳量有關，隨著時間的推移，人們會開始退出主動監測，要么是因為癌症正在進展，要么是因為隨著時間的推移，主動監測本身就是一種負擔。

So hard to predict with a quantitative sense exactly where that will head.

很難用量化的方式準確預測它會走向何方。

But clearly, those two factors are having an impact on us in the US.

但很明顯，這兩個因素正在對我們在美國產生影響。

Maybe try another way, Gary.

也許嘗試另一種方式，加里。

Was it down single-digit percentage?

它下降了個位數的百分比嗎？

Double digit?

兩位數？

And what's baked into guidance for the balance of the year?

什麼是今年餘額的指導？

On our side, it was a significant push.

在我們這邊，這是一個重大的推動。

We don't usually break out the numbers for you quarterly.

我們通常不會按季度為您提供數據。

And so we have gone through and done our best to project.

因此，我們已經完成並儘了最大努力進行項目。

It's an estimate.

這是一個估計。

If I had a perfect crystal ball, I would share it with you, but we don't.

如果我有一個完美的水晶球，我會和你分享，但我們沒有。

Okay.

好的。

And then you talked about some of the timing of research projects.

然後你談到了一些研究項目的時間安排。

Maybe give us some insights to what those are.

也許讓我們對這些是什麼有所了解。

And are we going to see a structural shift in R&D spending, perhaps higher?

我們是否會看到研發支出的結構性轉變，甚至更高？

And also on the operating expense side, can you talk a little bit about opportunities for investment in the sales force?

在運營費用方面，您能談談投資銷售隊伍的機會嗎？

Are you looking to accelerate that, to move things along quicker, maybe offset some of the prostatectomy weakness in other applications?

您是否希望加快這一進程，以更快地推進事情，也許可以抵消其他應用中的一些前列腺切除術弱點？

Or are you happy with where the trends are set there?

或者你對那裡的趨勢感到滿意嗎？

Fair question.

公平的問題。

And a lot of questions.

還有很多問題。

The first side, on the R&D and project side, as you know, we have a few things that we have been working on pretty hard.

第一方面，在研發和項目方面，如您所知，我們有一些我們一直在努力工作的事情。

Stapler, you should think of Stapler not as a single product.

訂書機，你不應該把訂書機看成一個單一的產品。

Stapler will ultimately be a family of products, a platform.

Stapler 最終將成為一個產品系列，一個平台。

That will come out in sequential releases.

這將在連續版本中出現。

There's a set of releases and products that make sense for colorectal surgery, a different set that makes sense for thoracic surgery, and a different set that might make sense for bariatric surgery in the future.

有一系列對結直腸手術有意義的發布和產品，對胸外科有意義的不同系列，以及未來可能對減肥手術有意義的不同系列。

So those things will move in sequence.

所以這些東西會按順序移動。

Likewise Vessel Sealing.

容器密封也是如此。

Vessel Sealing is a strong instrument for us.

容器密封對我們來說是一種強大的工具。

Right now it's pointed at general surgery applications and complex gynecologic cancers.

現在它針對的是普通外科應用和復雜的婦科癌症。

But we can see that as being a platform technology, as well.

但我們也可以將其視為一種平台技術。

So there are investments here that are sequential.

所以這裡有連續的投資。

As you know, we also work on Single-Site expansion to other sets of instruments and then other things longer term, in terms of platform improvements.

如您所知，在平台改進方面，我們還致力於將單站點擴展到其他儀器集，然後是其他更長期的事情。

What I would say is the signal from Q2 to Q3 has more to do with lumpiness and timing than it does a seismic shift in the kind of work we're doing.

我想說的是，從 Q2 到 Q3 的信號更多地與塊狀和時間有關，而不是在我們正在做的工作中發生了翻天覆地的變化。

There is some gradual sequential growth in R&D spend, but mostly what you're seeing is lumpiness.

研發支出有一些逐漸的連續增長，但你看到的主要是塊狀。

Turning to the question of sales force investments.

轉向銷售人員投資的問題。

We are making investments in the sales force.

我們正在對銷售隊伍進行投資。

The way you might think about that is significant investments in Japan in terms of our capabilities.

就我們的能力而言，您可能會認為這是對日本的重大投資。

We're happy with our team there and they are growing and that will be to allow us to have greater presence over time.

我們對我們在那裡的團隊感到滿意，他們正在成長，這將使我們隨著時間的推移擁有更大的存在。

We're also making investments in Europe.

我們也在歐洲進行投資。

The investments there are around the sales and commercial team, mostly around bringing in experience and selling and support skills.

那裡的投資圍繞銷售和商業團隊，主要是圍繞引入經驗以及銷售和支持技能。

As well as investments in our ability to respond to regulatory needs and reimbursement and economic analysis needs.

以及對我們響應監管需求以及報銷和經濟分析需求的能力的投資。

So we're making those investments there.

所以我們在那裡進行這些投資。

They are the kind of investments that are ahead of what you would think of as the US norms.

它們是超越你所認為的美國規範的投資。

In the US, we continue to invest in the US sales force, although about on pace to what you have seen in past quarters.

在美國，我們繼續投資於美國的銷售隊伍，儘管與您在過去幾個季度看到的情況差不多。

We don't feel like we are ahead or behind there.

我們不覺得我們在那裡領先或落後。

But really moving in sync.

但真正同步移動。

Specifically, we added about 20 people to our clinical team in the quarter, bringing us up to about 600 on the clinical side.

具體來說，我們在本季度為我們的臨床團隊增加了約 20 人，使我們在臨床方面達到約 600 人。

And we stayed roughly flat, about 90, on the capital side.

在首都一側，我們大致持平，大約 90。

If I can sneak in one more quick one.

如果我能再快一點偷偷溜進去。

It looks like you had a strong de novo placement effort in the quarter.

看起來您在本季度進行了強大的從頭安置工作。

Talk a little bit about how SIE affected that.

稍微談談 SIE 是如何影響它的。

I heard the number 200 customers.

我聽說有 200 名客戶。

Are you starting to see a lot of productivity from that in terms of initial cases?

您是否開始從初始案例中看到很多生產力？

And are people actually doing cases beyond [choli] already?

人們真的在做 [choli] 以外的案件嗎？

I'll just start and Aleks can jump in.

我剛開始，Aleks 可以加入。

On the Single-Site versus SIE, something a little bit different.

在 Single-Site 與 SIE 上，有些不同。

But with regard to Single-Site, yes, initial purchases, we did say over 200 hospitals in the US have taken their initial kits.

但是關於 Single-Site，是的，初始購買，我們確實說過美國有 200 多家醫院已經拿到了他們的初始試劑盒。

We're seeing good utilization so far, although it's early.

到目前為止，我們看到了良好的利用率，儘管還為時過早。

The response, the commentary in terms of safety and efficacy and repeatability, the ability to learn the procedure quickly, is strong.

反應、安全性、有效性和可重複性方面的評論，快速學習程序的能力，很強。

So we're feeling good about that.

所以我們對此感覺良好。

But we would caution that we're still in the early quarters there.

但我們會警告說，我們仍處於早期階段。

With regard to people having an interest in doing things beyond cholecystectomy, we're FDA approved in the US for choli.

對於有興趣做膽囊切除術以外的事情的人，我們在美國獲得 FDA 批准用於膽汁。

There is surgeon interest O-US, and discussed interest inside the US to do some other things.

O-US 有外科醫生的興趣，並討論了在美國內部做一些其他事情的興趣。

So we're seeing interest in certain gynecologic procedures, perhaps some upper GI procedures over time.

因此，我們看到了對某些婦科手術的興趣，也許隨著時間的推移會出現一些上消化道手術。

And that's where our R&D teams are spending their time.

這就是我們的研發團隊花費時間的地方。

I'll turn it to Aleks.

我會把它交給Aleks。

Yes, I would just reiterate, under the comments pertaining to the 200 customers that have purchased initial sites, what we can tell thus far, really, from that is that there is a lot of general interest to try the system.

是的，我想重申一下，根據與購買初始站點的 200 位客戶有關的評論，到目前為止，我們可以告訴我們，實際上，有很多普遍的興趣來嘗試該系統。

It's too early to make any large clinical claims other than people are looking at improved cosmetics, and then whether or not there's pain differences between one technique versus the other.

除了人們正在尋找改進的化妝品之外，現在提出任何大型臨床聲明還為時過早，然後是一種技術與另一種技術之間是否存在疼痛差異。

But at this stage it's very difficult to say.

但現階段很難說。

But the interest is high to try it.

但是嘗試它的興趣很高。

The training queue is strong.

訓練隊列很強大。

We'll look at it for a few more quarters, I think, before we can assess much more.

我想，我們會再看幾個季度，然後才能評估更多。

In terms of the SIE impact on the quarter, 6 of the 150 systems sold were SIE systems.

就本季度的 SIE 影響而言，售出的 150 個系統中有 6 個是 SIE 系統。

And to remind you, SIEs, these are three-arm versions of SIs and also have some other feature reductions.

提醒您，SIE，這些是 SI 的三臂版本，並且還有一些其他功能減少。

And they're primarily targeted towards the more price-sensitive customers who are engaged in the Single-Site, or engaged in maybe lesser complex hysterectomy.

他們主要針對從事單一站點或從事可能不太複雜的子宮切除術的對價格更為敏感的客戶。

I think we are seeing more interest in this particular segment of our product offering.

我認為我們對我們產品的這一特定部分越來越感興趣。

Thank you.

謝謝你。

Lennox Ketner with Bank of America.

美國銀行的 Lennox Ketner。

If we could maybe just shift gears and focus on Europe for a minute.

如果我們可以換檔，專注於歐洲一分鐘。

I just want to understand, in your view, what's driving the lower procedure growth.

我只是想了解，在您看來，是什麼推動了較低的程序增長。

I know you talked about it being some structural issues.

我知道你談到它是一些結構性問題。

But in terms of the austerity measures impacting it, what I'm struggling a little bit with, obviously we've seen elective procedures impacted there.

但就影響它的緊縮措施而言，我有點掙扎，顯然我們已經看到選擇性程序在那裡受到影響。

Because it's a cancer surgery, I would have thought we would see less.

因為這是癌症手術，我原以為我們會看到更少。

Are you essentially seeing the government just lower their quotas for these surgeries, even though they are cancer surgeries?

你是否看到政府只是降低了這些手術的配額，即使它們是癌症手術？

We definitely see -- it depends on what country you're in.

我們肯定看到——這取決於你在哪個國家。

I would start by saying different countries are behaving a little bit differently.

我首先要說不同國家的行為略有不同。

So one answer won't cover them all.

因此，一個答案不會涵蓋所有內容。

But taking a couple, as an example.

但以一對夫婦為例。

We have seen pressure on quotas.

我們看到了配額壓力。

For sure you see total budgets getting pressured and people are making decisions about how they want to spend that money.

可以肯定的是，您會看到總預算受到壓力，人們正在決定如何使用這筆錢。

We think some of it has to do a little bit with how we've grown our organization and their training and skill.

我們認為其中一些與我們如何發展我們的組織以及他們的培訓和技能有關。

If I just stand back from the point of view of bringing clinical and economic value to a procedure that would have been open, and taking it to minimally-invasive da Vinci procedure, we think there's value there.

如果我只是從為本來可以開放的程序帶來臨床和經濟價值的角度退後一步，並將其用於微創達芬奇程序，我們認為這是有價值的。

And we think we can do well in the presence of even tight budgets.

我們認為即使預算緊張，我們也可以做得很好。

And that's really the internal part that we're working on.

這確實是我們正在研究的內部部分。

Okay.

好的。

Just as a follow-up, you had mentioned that you're investing in regulatory and reimbursement issues.

作為後續行動，您曾提到您正在投資於監管和報銷問題。

Are you focused on changing reimbursement teams in Europe?

您是否專注於改變歐洲的報銷團隊？

Or was the reimbursement comment more directed towards Japan?

還是報銷評論更針對日本？

The answer is a little bit of both.

答案是兩者都有。

In Japan, it tends to be a more direct conversation with surgical societies and the government.

在日本，這往往是與外科學會和政府進行更直接的對話。

In Europe, it tends to be a little bit more working with surgical societies and health technology assessment groups to really understand the clinical benefits and the long-term, the downstream economic benefits of major surgery.

在歐洲，往往更多地與外科學會和衛生技術評估小組合作，以真正了解大手術的臨床益處和長期、下游的經濟效益。

And it's really as a way for hospitals and customers to understand what the total economics are.

這實際上是醫院和客戶了解總體經濟狀況的一種方式。

Okay.

好的。

And then just last question on the Single-Site.

然後是關於單一站點的最後一個問題。

The attachment for that, is it possible to give us some sense of when a hospital does buy the Single-Site attachment, how much you're charging for that?

附件，是否可以讓我們了解醫院何時購買 Single-Site 附件，您為此收取多少費用？

And is that revenue recorded as part of an upgrade revenue, or is that in instruments and accessories?

該收入是作為升級收入的一部分記錄的，還是在儀器和配件中記錄的？

Just to let everyone know, the Single-Site is a set of instruments that attach to the da Vinci Si system.

只是為了讓大家知道，Single-Site 是一組連接到 da Vinci Si 系統的儀器。

And so there's no system upgrade required to do Single-Site procedures.

因此，執行單站點程序無需進行系統升級。

Usually, initial customers, you need to have the 8.5-millimeter endoscopes, as well as the specific instruments for the case and so on.

通常，初始客戶，您需要有 8.5 毫米的內窺鏡，以及用於案例的特定儀器等。

On average out of the gate, it might be something like a $40,000 investment to get going.

平均而言，起步可能需要 40,000 美元的投資。

It's recorded on the instrument and accessory line.

它記錄在儀器和附件線上。

Okay, got it.

好，知道了。

Thanks so much.

非常感謝。

I'll let someone else jump in.

我會讓別人跳進去。

Tycho Peterson with JPMorgan.

第谷彼得森與摩根大通。

I want to go back to the discussion on DVP from before and understand obviously with the change in screening intervals, that's one aspect.

我想回到之前關於 DVP 的討論，並清楚地理解篩選間隔的變化，這是一方面。

But as we think about watchful waiting, do you have any color on what the conversion factor is in terms of patients going into watchful waiting and then coming back and having surgery?

但是當我們考慮觀察等待時，你對患者進入觀察等待然後回來接受手術的轉換因素有什麼看法嗎？

And obviously with PIVOT back in the news, is there anything you need to do differently in terms of data generation or marketing, given that it's back in the public press, if you will?

很明顯，隨著 PIVOT 重新出現在新聞中，您是否需要在數據生成或營銷方面做一些不同的事情，因為它又回到了公共媒體上，如果您願意的話？

I'll speak to the first one, and let Aleks speak to the second one.

我會和第一個說話，讓 Aleks 和第二個說話。

With regard to what the behavior has been historically with regard to people in active surveillance, in very rough outlines, it's been about one-third starting active surveillance and staying in active surveillance throughout.

關於歷史上對主動監視的人的行為，粗略地說，大約有三分之一的人開始主動監視並始終處於主動監視狀態。

About one-third will convert to aggressive disease and in essence be kicked out by progression.

大約三分之一將轉化為侵襲性疾病，實質上會因進展而被淘汰。

And about one-third will choose to leave because of the repeated going back into being tested.

大約三分之一的人會因為反復回到接受測試而選擇離開。

At some point they decide they would rather have a definitive treatment.

在某些時候，他們決定他們寧願接受明確的治療。

And that's been historical.

這是歷史性的。

It's rough and we'll see if it holds going forward.

這很艱難，我們會看看它是否能繼續前進。

With regard to the second part of your question, the PIVOT trial being back in the news.

關於你問題的第二部分，PIVOT 試驗重新成為新聞。

I don't know that there was anything that was new that was reported today.

我不知道今天有什麼新報導。

I think this is something that we've discussed, I think, over the past year, since it had been presented at the AUA.

我認為這是我們在過去一年中討論過的問題，因為它已在 AUA 上展示。

I think the editorial that accompanied the actual report in the New England Journal of Medicine really says, I think, has a pretty consistent tone to the way we think about it, as well.

我認為，伴隨《新英格蘭醫學雜誌》實際報告的社論確實說，我認為，對我們的思考方式也有相當一致的基調。

And then just to clarify your comments on Europe, I'm not understanding why the volumes are really declining here when you've got nationalized healthcare in a lot of these markets.

然後只是為了澄清你對歐洲的評論，我不明白為什麼當你在這些市場中的許多市場都擁有國有化醫療保健時，這裡的銷量真的在下降。

Is it really that variable in these geographies?

在這些地區真的有這麼多變數嗎？

Short answer is yes, it's variable.

簡短的回答是肯定的，它是可變的。

You have a few different things.

你有一些不同的東西。

And, again, I think you have to think, what's happening in Italy, what's happening in Spain, what's happening in Germany, what's happening in France, what's happening in the UK, what's happening in the Scandinavian countries.

而且，我認為你必須想一想，意大利正在發生什麼，西班牙正在發生什麼，德國正在發生什麼，法國正在發生什麼，英國正在發生什麼，斯堪的納維亞國家正在發生什麼。

And they vary.

而且它們各不相同。

In many of the countries, you have a combination of private health systems and public ones.

在許多國家/地區，您擁有私人衛生系統和公共衛生系統的組合。

Their behaviors vis-a-vis da Vinci are quite different.

他們的行為與達芬奇完全不同。

So depending on what the mix of private and public is, and what the government-run hospitals are wanting to do, we'll see different dynamics and behavior.

因此，取決於私立和公立醫院的混合情況，以及政府經營的醫院想要做什麼，我們會看到不同的動態和行為。

And then last one, as we think about some of the gives and takes around procedures, understand obviously you didn't change guidance on procedures this year.

最後一個，當我們考慮一些關於程序的給予和接受時，很明顯你今年沒有改變程序指導。

But do you see a path north of 30% in the medium to intermediate term the next couple of years, given everything you've got in terms of new procedures?

但是，考慮到您在新程序方面擁有的一切，您是否認為未來幾年的中期到中期會有 30% 以上的路徑？

I don't want to box you into giving longer-term guidance, but how do you think about where procedures could go?

我不想讓您提供長期指導，但是您如何看待程序可以去哪裡？

Our best thoughts are in the guidance we provide you.

我們最好的想法是在我們為您提供的指導中。

I was talking beyond this year, though.

不過，我說的是今年以後。

And we'll talk to you about that in January.

我們將在 1 月份與您討論這個問題。

Okay.

好的。

Thank you.

謝謝你。

David Lewis with Morgan Stanley.

大衛劉易斯與摩根士丹利。

Gary, these comments about the DVP in the US, most of the comments so far have really focused on utilization or patient demand creation.

加里，這些關於美國 DVP 的評論，到目前為止，大多數評論都集中在利用或創造患者需求上。

I wonder, have you seen anything in the US that would suggest that maybe it's push and pull, where it's a hospital-specific issue?

我想知道，你有沒有在美國看到任何暗示可能是推拉式的，這是醫院特有的問題？

I'm really referring to ACOs' demonstration projects, where the hospitals are targeting prostatectomy for its declining profitability or something like that.

我真的指的是 ACO 的示範項目，醫院將前列腺切除術作為其目標，因為它的盈利能力下降或類似的東西。

Or this is very acutely the patients just aren't proceeding to surgery and aren't showing up?

或者這是非常嚴重的患者只是沒有進行手術並且沒有出現？

Without having talked to every hospital in the US, I have not heard the concern that you just voiced, that hospitals is trying to direct patients one way or the other due to their perceived profitability.

在沒有與美國的每家醫院交談過的情況下，我沒有聽到您剛才表達的擔憂，即醫院正試圖以一種或另一種方式引導患者，因為他們認為他們的盈利能力。

Generally speaking, most hospitals will offer both, or all three alternatives.

一般來說，大多數醫院都會提供兩種或三種選擇。

They will counsel all of them.

他們將為所有人提供建議。

And in that setting, where all the alternatives are discussed, and a patient has been diagnosed, da Vinci does well.

在那種情況下，所有的替代方案都被討論過，一個病人已經被診斷出來，達芬奇做得很好。

And we've seen a lot of stability there.

我們在那裡看到了很多穩定性。

So short answer is it tends to be more diagnosis and nonsurgical approaches than it is, I think, directed intervention.

所以簡短的回答是，我認為它往往是更多的診斷和非手術方法，而不是直接干預。

Very helpful.

非常有幫助。

And the clear positive this quarter on the capital side in the US is multiple capital peers have reported softness in the second quarter.

本季度美國資本方面的明顯積極因素是多個資本同行報告第二季度疲軟。

You don't appear to have exhibited any of that softness.

你似乎沒有表現出任何那種柔軟。

Is it safe to assume that you feel, at least as far as the second quarter is concerned, relatively insulated from some of the factors that may have been out there, or some of the pushouts that some of your peers have seen in the second quarter?

是否可以安全地假設，至少就第二季度而言，您覺得與可能已經存在的一些因素或您的一些同行在第二季度看到的一些推出相對隔離?

Again, I think the term insulated has got a few meanings.

同樣，我認為絕緣這個詞有幾個含義。

But I would say that if you look at -- and again, back away from just that number for a second and look at the overall procedure business.

但我想說的是，如果你再看一下 - 再一次，從那個數字退後一秒，看看整個程序業務。

We've reported a 26% gain in procedures year-over-year, and for the first half of the year, it's up 27%.

我們報告的程序同比增長了 26%，今年上半年增長了 27%。

That's still a pretty large number.

這仍然是一個相當大的數字。

And so that does necessitate the demand for systems.

所以這確實需要對系統的需求。

And so we do believe that.

所以我們確實相信這一點。

We do believe that very strongly.

我們確實非常堅信這一點。

I don't think there was a particular event or an episode in Q2 that separated us from our peer group or other capital companies any more than just strong procedure demand.

我認為第二季度沒有任何特定事件或插曲將我們與同行集團或其他資本公司分開，而不僅僅是強大的程序需求。

Now, there are, as you said earlier, puts and takes on the procedures.

現在，正如您之前所說的，有一些程序。

While one has gone down, several have gone up.

一個下降了，幾個上升了。

And some have gone up pretty significantly.

有些已經顯著上升。

And on balance, it's a very strong procedure business.

總的來說，這是一個非常強大的程序業務。

And I think that's really what separates us from some of the other companies that are up there when you look at the actual numbers and the percentage of growth.

當您查看實際數字和增長百分比時，我認為這確實是我們與其他一些公司的區別。

So short of that, I don't think there's anything else we can really point to.

這麼短，我不認為還有什麼我們可以真正指出的。

And just Gary, maybe just one quick one, if I could.

只有加里，如果可以的話，也許只是一個快速的。

In the comments about Europe, I wonder, have you seen anything in Europe over the last couple quarters or several quarters that would suggest that perhaps the market development in Europe is going to be different than the US in one particular way.

在關於歐洲的評論中，我想知道，在過去幾個季度或幾個季度中，您是否在歐洲看到任何表明歐洲的市場發展可能會以某種特定方式與美國不同的情況。

Which would be, in the US, you never engaged in a directed significant study to prove a specific procedure.

也就是說，在美國，您從未參與過有針對性的重要研究來證明特定程序。

But you had a wealth of single-center experience data and multi-center experience data that was generated by users.

但是你有豐富的單中心體驗數據和用戶生成的多中心體驗數據。

Is there a sense, based on what you're seeing in Europe, that a more directed or active approach to clinical data is going to be required in Europe?

根據您在歐洲看到的情況，是否有一種感覺，即歐洲需要對臨床數據採取更直接或更積極的方法？

Or is that not the case?

或者事實並非如此？

I think a more active conversation is required.

我認為需要更積極的對話。

And that's a little bit of what we've been talking about with regard to the health technology assessments and other things.

這就是我們一直在談論的關於衛生技術評估和其他事情的一點點。

Now we've been in the market long enough, in some procedures over a decade, that there's actually large population-based studies that are well done, multi-center, tens of thousands of patients in them, that show clear benefits for da Vinci over other surgical alternatives.

現在我們在市場上已經有足夠長的時間了，在某些程序中已經有十多年了，實際上有大量基於人群的研究做得很好，多中心，數以萬計的患者，這表明達芬奇有明顯的好處優於其他手術替代方案。

There's data being generated around comparisons to other treatment modalities, between da Vinci surgery and nonsurgical outcomes.

圍繞與其他治療方式的比較，在達芬奇手術和非手術結果之間產生了數據。

I think that data is going to be helpful worldwide and in Europe.

我認為這些數據將在全球和歐洲有所幫助。

There may be cases, and certainly we're in conversation and have thoughts and plans around specific trials that may help us in different locales, and Europe is one of them.

可能會有一些案例，當然我們正在對話中，並且圍繞特定試驗有想法和計劃，這可能會在不同地區對我們有所幫助，歐洲就是其中之一。

Great.

偉大的。

Thank you very much.

非常感謝。

Larry Keusch with Raymond James.

拉里·庫施與雷蒙德·詹姆斯。

Just to pick up on Europe, Gary, I think I heard you correctly.

只是為了了解歐洲，加里，我想我沒聽錯。

It sounded like there's a change in the leadership there.

聽起來那裡的領導層發生了變化。

And if I caught that accurately, if you could just walk us through what's changing and what's the strategic direction.

如果我準確地抓住了這一點，如果你能引導我們了解正在發生的變化以及戰略方向是什麼。

Yes.

是的。

So we have changed leadership in terms of the leadership of the commercial organization in the direct side of Europe.

因此，我們在歐洲直接一側的商業組織的領導層方面改變了領導層。

As well as overall leadership over the indirect, as well.

以及對間接的全面領導。

This is somebody who has been with us for many years in the US and that had run the national account side of the business here in the United States.

這是在美國與我們共事多年的人，他曾在美國經營國民賬戶方面的業務。

Knows our business very well, has had prior experiences in Europe.

非常了解我們的業務，之前在歐洲有過經驗。

And so he'll be taking over there.

所以他將接管那裡。

But part of the question is, is that the result of the current environment or needing to change your strategic tactics within Europe, coming back to needing more discussions around the marketing of the device and the procedures?

但部分問題是，這是當前環境的結果還是需要改變您在歐洲的戰略策略，回到需要圍繞設備營銷和程序進行更多討論？

Just trying to understand perhaps what there may be in the change in strategy in the European region.

只是想了解歐洲地區的戰略變化可能會發生什麼。

I think it's probably less a capitalized strategy change and more a focus on execution and organizational growth and capability.

我認為這可能不是資本化的戰略變革，而是更多地關注執行、組織發展和能力。

There are some things that we can do a little bit differently and perhaps a little bit better in terms of some of the conversations on the economic side.

就經濟方面的一些對話而言，我們可以做一些不同的事情，也許會做得更好一些。

Small strategy.

小策略。

I don't think it's earth shatteringly different, but I do think it's an emphasis change.

我不認為這是天翻地覆的不同，但我確實認為這是一個重點的改變。

And we're working on those things.

我們正在做這些事情。

Okay, great.

好，太棒了。

And then, obviously it's terrific to hear that the Single-Site procedures are starting to gain some traction.

然後，顯然很高興聽到單站點程序開始獲得一些牽引力。

And I fully understand it's going to take a couple quarters to fully feel that out.

我完全理解這需要幾個季度才能完全感受到。

The conversations that we've had with folks would suggest that, where there is a da Vinci in place, the general surgeons are eager to jump in and get some time on the system to try out these procedures.

我們與人們進行的對話表明，凡是有達芬奇的地方，普通外科醫生都渴望介入並在系統上抽出一些時間來嘗試這些程序。

And generally we have heard very good things once they get to do it.

通常，一旦他們開始這樣做，我們就會聽到非常好的事情。

But the question that I wrestle with is, there's an awful lot of general surgical procedures, prostatectomies in particular, that are probably done in institutions that to date don't have a da Vinci system.

但我要解決的問題是，有很多普通外科手術，特別是前列腺切除術，可能是在迄今為止沒有達芬奇系統的機構中進行的。

So can you make a convincing ROI argument that this system can be used for general surgery, as a stand-alone device, even with the SIE option?

那麼，您能否提出令人信服的 ROI 論點，即該系統可用於普通外科手術，作為獨立設備，即使帶有 SIE 選項？

Or at some point does it have to be a segmentation strategy?

或者在某些時候它是否必須是一種細分策略？

Larry, if you look at the overall number of da Vinci placements in the United States, we have 1,707 total systems.

拉里，如果你看看美國達芬奇安置的總數，我們總共有 1,707 個系統。

And I believe the number of US customers -- Calvin will give it to us -- I believe it's somewhere 1,200 to 1,300, I believe.

我相信美國客戶的數量——Calvin 會給我們的——我相信它在 1,200 到 1,300 之間。

1,275.

1,275。

1,275.

1,275。

What we have seen in prostatectomy, for example, is that the system has, to this point, become somewhat of a consolidator for the procedure, rather than having to put systems in all 4,800 or 5,000 hospitals that are out there.

例如，我們在前列腺切除術中看到的是，到目前為止，該系統在某種程度上已成為該手術的整合者，而不是必須在所有 4,800 或 5,000 家醫院中安裝系統。

You have seen a strong consolidation of, let's say, the urologic oncology business happen around the same base of systems that prior to minimally-invasive introduction was being done at significantly more hospitals.

您已經看到，泌尿腫瘤業務的強大整合發生在與微創引入之前在更多醫院進行的相同系統基礎上。

Fewer were being done at more hospitals.

更多的醫院做的更少。

So I don't think we look at it and say, can we necessarily build this self-standing platform with general surgery as a paramount question today.

所以我不認為我們看著它會說，我們是否一定要建立這個以普外科為首要問題的獨立平台。

Now, what we do believe is with the increased interest, both from the colorectal surgeon, from other complex general surgery procedures, as well as the individual cholecystectomy procedures, that there is enough capacity out there for people to actually try, use it, and then build into the flow of the robotics coordinators in the hospital to make sure that there's enough access, whether it becomes second systems or third systems, et cetera.

現在，我們相信隨著結直腸外科醫生、其他復雜的普通外科手術以及個別膽囊切除術的興趣的增加，人們有足夠的能力去實際嘗試、使用它，並且然後在醫院的機器人協調員流程中構建，以確保有足夠的訪問權限，無論是成為第二個系統還是第三個系統等等。

But the cholecystectomies by themselves is probably not the way we think about it.

但膽囊切除術本身可能不是我們想的那樣。

I think general surgery as a whole, and then leveraging the installed base that we have.

我認為普外科是一個整體，然後利用我們擁有的安裝基礎。

Okay, understood.

好的，明白了。

And then just last one.

然後只是最後一個。

And not to continue to come back to US prostatectomy, but any flavor for where US prostatectomy procedures -- I assume they were down sequentially.

並且不是繼續回到美國前列腺切除術，而是美國前列腺切除術的任何味道——我認為它們是依次下降的。

Would you characterize it as a sharp falloff relative to where we've been over the last couple quarters?

相對於我們過去幾個季度的情況，您會將其描述為急劇下降嗎？

Or, it's been a gradual decline and now we've hit a point where we're down year over year?

或者，這是一個逐漸下降的趨勢，現在我們已經達到了同比下降的地步？

I think the way we think about it, and really what the numbers will tell us, that it's been a gradual decline over the past few quarters.

我認為我們的思考方式，以及數字將告訴我們的真實情況，在過去幾個季度中逐漸下降。

We've called it out in the past.

過去我們已經把它叫出來了。

And now we're calling it out with a little more emphasis.

現在我們更強調一點。

And there appears to be more evidence in the macro environment for prostate cancer that we can refer to with a little more clarity.

在前列腺癌的宏觀環境中似乎有更多的證據，我們可以更清楚地參考這些證據。

Okay, great.

好，太棒了。

Thanks very much.

非常感謝。

Jose Haresco with JMP Securities.

JMP 證券公司的 Jose Haresco。

Couple questions.

幾個問題。

On Single-Site choli, you guys haven't broken this out in the past.

在 Single-Site choli 上，你們過去沒有打破這一點。

But are you at a point where you can give us a sense of how many procedures you think you've done in Single-Site choli?

但是，您是否可以讓我們了解您認為自己在 Single-Site choli 中完成了多少程序？

Or just in general, how many Single-Site procedures have been done since these 200 devices have been placed out there?

或者只是一般來說，自從這 200 台設備被放置在那里以來，已經完成了多少單站點程序？

We're not ready yet to start breaking that out, just because we're still in the early days of seeing new sites come up and really work through their initial orders.

我們還沒有準備好開始打破這一點，只是因為我們仍處於看到新網站出現並真正完成他們最初訂單的早期階段。

What we would like to see is what happens on a sustained basis, how much of their future business they start to convert to Single-Site and so on.

我們希望看到的是持續發生的情況，他們未來有多少業務開始轉換為單站點等等。

And that's just too early to tell.

這還為時過早。

We're happy to talk a little bit qualitatively about how the initial installs are going, but we'll wait a little bit on sequential use.

我們很高興就初始安裝的進展情況進行一些定性的討論，但我們會稍等一下順序使用。

There's probably time for one more question.

可能還有時間再問一個問題。

Sure.

當然。

Just on Europe, trying to get a little bit more.

就在歐洲，試圖獲得更多。

Can you give us a little bit more granularity between, say, regions of Europe, Southern Europe versus Western Europe as an example, and then procedures versus hardware?

您能否給我們提供一些細節，例如歐洲地區、南歐與西歐，然後是程序與硬件？

You guys raised the system guidance, I read in your guidance for the year.

你們提出了系統指導，我在你的指導中閱讀了這一年。

So I want to get a better sense for where that confidence is coming from, beyond just the slight increase in ASP that we saw in the quarter.

因此，我想更好地了解這種信心的來源，而不僅僅是我們在本季度看到的 ASP 略有增加。

On the breakouts country by country, it's a little bit mix.

在逐個國家的突破中，它有點混合。

Probably not real surprising that some of the countries in the south that are always in the news have been most strained in terms of both system sales and procedures.

一些總是出現在新聞中的南方國家在系統銷售和程序方面最為緊張，這可能並不令人驚訝。

Although I would say that Italy has been a bright spot.

雖然我會說意大利一直是一個亮點。

We have seen some pressure in both capital and procedures in some of the core countries of Europe, as well.

我們在歐洲的一些核心國家也看到了資本和程序方面的一些壓力。

And that's where we are and what we're working through.

這就是我們所處的位置以及我們正在努力解決的問題。

Okay, great.

好，太棒了。

Thank you very much.

非常感謝。

Thank you.

謝謝你。

That was our last question.

那是我們的最後一個問題。

As we have said previously, while we focus on financial metrics, such as revenues, profits and cash flow during these conference calls, our organizational focus remains on increasing patient value by improving surgical outcomes and reducing surgical trauma.

正如我們之前所說，雖然我們在這些電話會議期間關注財務指標，例如收入、利潤和現金流，但我們的組織重點仍然是通過改善手術結果和減少手術創傷來增加患者價值。

I hope the following experience from Rebecca in Maryland gives you some sense of what this means in the lives of our patients.

我希望以下來自馬里蘭州麗貝卡的經歷能讓您了解這對我們患者的生活意味著什麼。

Quote -- I went to Dr. Katherine Kratz upon discovering that I had a uterine fibroid and endometrial cyst which had been causing painful menstrual cramps, as well as severe lower back pain.

引述——當我發現我有子宮肌瘤和子宮內膜囊腫時，我去看了凱瑟琳·克拉茨醫生，這會導致痛經，以及嚴重的腰痛。

Dr. Kratz recommended da Vinci surgery for several reasons.

克拉茨博士推薦達芬奇手術有幾個原因。

The procedure is minimally invasive, so the recovery time would be much quicker.

該程序是微創的，因此恢復時間會快得多。

At the time, I was trying to finish up my dissertation and apply for academic jobs.

當時，我正試圖完成我的論文併申請學術工作。

So it was important to me to have a quick recovery.

因此，快速恢復對我來說很重要。

My surgeon also explained that this procedure allows for greater visualization of the area.

我的外科醫生還解釋說，這個程序可以更好地可視化該區域。

As well as providing her a greater range of motion.

以及為她提供更大的運動範圍。

Allowing her to work with great precision in performing the surgery and in doing the stitches.

讓她能夠非常精確地進行手術和縫合。

Because of this, Dr. Kratz was able to save my left ovary, which would not have been possible otherwise.

正因為如此，克拉茨醫生才能挽救我的左卵巢，否則這是不可能的。

After my surgery, not only was I able to return to working on my dissertation within a few days, but I was also able to attend my annual professional conference a few weeks later.

手術後，我不僅能夠在幾天內重新開始我的論文工作，而且幾週後我也能夠參加我的年度專業會議。

Even with all that I had been told, I was shocked at how quickly I had recovered from surgery.

儘管我被告知了所有這些，但我對我從手術中恢復的速度感到震驚。

Every day I was able to move more easily and with far less pain, allowing me to stop taking pain medication after a day or two.

每天我都能夠更輕鬆地移動並且疼痛更少，讓我在一兩天后停止服用止痛藥。

Now I am free of back pain and have nearly no menstrual cramps.

現在我沒有背痛，幾乎沒有月經來潮。

I'm extremely grateful for the da Vinci surgery and the excellent care I received from Dr. Kratz and her entire surgical team because the surgery has significantly improved my quality of life.

我非常感謝達芬奇手術以及克拉茨醫生和她的整個手術團隊對我的出色照顧，因為手術顯著改善了我的生活質量。

When I look back at that time of my life, I have only positive memories of my surgical experience.

當我回首那段人生時，我對我的手術經歷只有積極的回憶。

My surgeon provided me with comprehensive information about my options and about the surgery.

我的外科醫生向我提供了有關我的選擇和手術的全面信息。

And allowed me to make the decision that was best for my situation.

並允許我做出最適合我情況的決定。

End quote.

結束報價。

Patients like these are the strongest advocates for da Vinci surgery and form the very foundation of our operating performance.

像這樣的患者是達芬奇手術的堅定擁護者，也是我們運營業績的基礎。

We have built our Company to take surgery beyond the limits of the human hand.

我們已經建立了我們的公司，以進行超出人手限制的手術。

And I assure you that we remain committed to driving (inaudible) a few things that truly make a difference.

我向您保證，我們將繼續致力於推動（聽不清）一些真正產生影響的事情。

This concludes today's call.

今天的電話會議到此結束。

We thank you for your participation and support on this extraordinary journey to improve surgery.

我們感謝您在這個改善手術的非凡旅程中的參與和支持。

And we look forward to talking with you again in three months.

我們期待在三個月內再次與您交談。

Ladies and gentlemen, that does conclude your conference for today.

女士們，先生們，今天的會議到此結束。

Thank you for your participation, and for using AT&T executive teleconference service.

感謝您的參與，感謝您使用 AT&T 高管電話會議服務。

You may now disconnect.

您現在可以斷開連接。