直覺手術 (ISRG) 2013 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Surgical Q2 2013 earnings release conference call.

女士們先生們，感謝您的支持，歡迎參加 Intuitive Surgical 2013 年第二季度財報電話會議。

(Operator Instructions).

（操作員說明）。

And as a reminder, this conference is being recorded.

作為提醒，本次會議正在錄製中。

I would now like to turn the conference over to our host, Calvin Darling, Senior Director of Finance for Intuitive Surgical.

我現在想將會議轉交給我們的主持人，Intuitive Surgical 財務高級總監 Calvin Darling。

Please go ahead, sir.

請繼續，先生。

Thank you.

謝謝你。

Good afternoon and welcome to Intuitive Surgical's second-quarter earnings conference call.

下午好，歡迎參加 Intuitive Surgical 第二季度財報電話會議。

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's filings, including our most recent Form 10-K filed on February 4, 2013; and our Form 10-Q filed on April 19, 2013.

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，包括我們在 2013 年 2 月 4 日提交的最新表格 10-K；以及我們於 2013 年 4 月 19 日提交的 10-Q 表格。

These filings can be found through our website or at the SEC's Edgar database.

這些文件可以通過我們的網站或 SEC 的 Edgar 數據庫找到。

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 Archives 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檔案部分提供音頻重播。

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 the highlights of our second-quarter 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今天早些時候宣布的新聞稿中所述的第二季度業績的亮點，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; then I will provide an update to our financial forecast for 2013.

Aleks 將討論營銷和臨床亮點；然後我將更新我們對 2013 年的財務預測。

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

最後，我們將舉辦問答環節。

With that, I'll 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。

As we previously announced, our second quarter has been a challenging one.

正如我們之前宣布的那樣，我們的第二季度一直充滿挑戰。

Capital sales fell 5% from the prior year, with the shortfall concentrated in United States.

資本銷售比上年下降 5%，缺口集中在美國。

We attribute the miss primarily to slower-than-expected da Vinci benign gynecology procedure growth in the United States.

我們將失敗主要歸因於美國達芬奇良性婦科手術增長慢於預期。

Taken globally, overall procedure performance in the quarter was solid, rising 18% over prior year in the face of several headwinds.

在全球範圍內，本季度的整體程序表現穩健，面對一些不利因素，比去年同期增長 18%。

Summarizing procedures in the United States, strong general surgery growth continued, centered within Single-Site cholecystectomy and colorectal resections.

總結美國的手術程序，普通外科手術繼續強勁增長，主要集中在單部位膽囊切除術和結直腸切除術。

In gynecology, dVH for malignant conditions was solid, while dVH growth for benign indications grew more slowly than expected.

在婦科，惡性疾病的 dVH 穩定，而良性適應症的 dVH 增長比預期的要慢。

Urologic procedures continued to be stable.

泌尿外科手術繼續穩定。

In Europe, procedures grew sequentially over Q1, led by urology and early growth in malignant dVH.

在歐洲，在泌尿外科和惡性 dVH 早期增長的帶動下，手術在第一季度連續增長。

Growth was strongest in the UK and Nordic countries, moderate in the core countries, and weakest in the South.

英國和北歐國家的增長最為強勁，核心國家的增長溫和，而南方國家的增長最弱。

Procedure growth in Asia was strong off of a small base, led by growth in urology in general surgery, with particular strength in Japan, Taiwan, and China.

亞洲的手術增長在一個小基數的基礎上強勁增長，其中泌尿外科在普外科的增長帶動下，尤其是在日本、台灣和中國大陸。

Turning to systems, we sold 143 systems -- 7 fewer than Q2 of 2012 -- with sales of new systems in the United States totaling 90, down from 124 a year ago.

談到系統，我們售出了 143 台系統——比 2012 年第二季度減少了 7 台——在美國銷售的新系統總計 90 台，低於一年前的 124 台。

We believe the slowing of our growth in benign gynecologic procedures in the United States to be a significant contributor to weaker-than-expected system sales.

我們認為，我們在美國良性婦科手術增長放緩是系統銷售弱於預期的重要原因。

There appear to be a couple of underlying causes for slower-than-expected US benign dVH growth.

美國良性 dVH 增長慢於預期似乎有幾個根本原因。

Overall admissions for benign gynecology appear to be under pressure in the first half of 2013.

2013 年上半年，良性婦科的整體入院似乎面臨壓力。

Since we are a significant share of hysterectomy, our growth rate in dVH is sensitive to these admissions.

由於我們是子宮切除術的重要部分，我們的 dVH 增長率對這些入院很敏感。

Second, our MCS notification and negative press occurred in the quarter and may have pressured growth in utilization, although estimating their impact on procedure volume is difficult.

其次，我們的 MCS 通知和負面新聞發生在本季度，可能對利用率的增長造成壓力，儘管很難估計它們對手術量的影響。

Given that the average da Vinci system is used for hundreds of procedures per year, a change in da Vinci patient admissions can free capacity on existing systems and pressure new system sales.

鑑於達芬奇系統平均每年用於數百個程序，達芬奇患者入院的變化可以釋放現有系統的容量並給新系統的銷售帶來壓力。

This appears to be the case this quarter.

本季度似乎就是這種情況。

Looking toward the second half of the year, we see increasing pressure on US system sales.

展望下半年，我們看到美國系統銷售的壓力越來越大。

Globally, our business in Asia has continued to build.

在全球範圍內，我們在亞洲的業務不斷發展。

In Japan system sales were strong in the quarter, showing continued interest in da Vinci surgery.

本季度日本系統銷售強勁，顯示出對達芬奇手術的持續興趣。

Our work with surgical societies is ongoing in their efforts to obtain national reimbursement for procedures beyond prostatectomy.

我們正在與外科學會合作，努力為前列腺切除術以外的手術獲得國家報銷。

Currently it appears unlikely that additional procedures will receive national reimbursement in the April 2014 insurance revision, given recent guidance from MHLW.

鑑於厚生勞動省最近的指導，目前看來，在 2014 年 4 月的保險修訂版中，額外的程序不太可能獲得國家報銷。

As we have said in the past, we continue to expect Japan system sales to be highly variable from quarter to quarter.

正如我們過去所說，我們繼續預計日本系統的銷售在每個季度都會有很大的變化。

We are investing in building our team in Japan with a view towards long-term performance.

我們正在投資建設我們在日本的團隊，著眼於長期業績。

Capital sales in Europe have grown over the past few quarters in a difficult environment.

在艱難的環境中，歐洲的資本銷售在過去幾個季度中有所增長。

As we've said on prior calls, sales force changes in Europe have made a positive difference.

正如我們在之前的電話會議中所說，歐洲銷售隊伍的變化產生了積極的影響。

We're gathering European clinical and reimbursement data and expect these investments to increase in the future.

我們正在收集歐洲臨床和報銷數據，並預計這些投資在未來會增加。

Given macroeconomic stresses in Europe and government processes, we expect reimbursement efforts to be a long-term endeavor.

鑑於歐洲的宏觀經濟壓力和政府流程，我們預計償付工作將是一項長期努力。

During the quarter FDA conducted an on-site audit of ISI and issued a set of 4 observations in a Form 483, previously reported in June.

在本季度，FDA 對 ISI 進行了現場審核，並在 483 表中發布了一組 4 項觀察結果，此前曾在 6 月報告過。

Yesterday we received a warning letter from the FDA as a follow-on to these audit inspection findings, asking for additional steps to resolve 2 of the observations.

昨天，我們收到了 FDA 的警告信，作為對這些審計檢查結果的跟進，要求採取額外措施來解決其中 2 個觀察結果。

These concerns are addressable, and we are in the process of doing so.

這些擔憂是可以解決的，我們正在這樣做。

Turning to operating performance for the second quarter, procedures grew approximately 18% over the second quarter of 2012.

談到第二季度的運營業績，程序比 2012 年第二季度增長了約 18%。

We sold 143 da Vinci Surgical Systems, down from 150 during the second quarter of last year.

我們售出了 143 台達芬奇手術系統，低於去年第二季度的 150 台。

Total revenue was $579 million, up 8% over last year.

總收入為 5.79 億美元，比去年增長 8%。

Instrument and accessory revenue increased to $265 million, up 18% over Q2 2012.

儀器和配件收入增至 2.65 億美元，比 2012 年第二季度增長 18%。

Total recurring revenue grew to $363 million, up 18% from prior year and comprising 63% of total revenue.

經常性總收入增長至 3.63 億美元，比上年增長 18%，佔總收入的 63%。

Net income was $159 million, up 3% over last year.

淨收入為 1.59 億美元，比去年增長 3%。

And we generated an operating profit of $257 million before noncash stock option expense, down 1% from the second quarter of last year and representing 45% of Q2 revenue.

在扣除非現金股票期權費用之前，我們的營業利潤為 2.57 億美元，比去年第二季度下降 1%，佔第二季度收入的 45%。

We ended the quarter with $3.270 billion in cash and investments, down $89 million from last quarter.

我們在本季度末的現金和投資為 32.7 億美元，比上一季度減少了 8900 萬美元。

In the quarter we generated $189 million in gross cash flow from operations, which is 119% of our reported GAAP net income.

在本季度，我們從運營中產生了 1.89 億美元的總現金流，占我們報告的 GAAP 淨收入的 119%。

And finally, we repurchased $270 million of our stock.

最後，我們回購了 2.7 億美元的股票。

Before turning the time over to Marshall, it's worth taking a step back and looking at a longer-term view of da Vinci technology in surgery.

在把時間交給馬歇爾之前，有必要退後一步，從長遠的角度看待達芬奇技術在手術中的應用。

We remain deeply positive on the value da Vinci can bring to surgery now and in the future.

我們對達芬奇現在和未來可以為外科手術帶來的價值保持非常積極的態度。

The benefit da Vinci brings as an alternative to open surgery has been demonstrated in hundreds of the peer-reviewed clinical papers and is widely accepted by our customers.

達芬奇作為開放手術的替代方案所帶來的好處已在數百篇經過同行評審的臨床論文中得到證明，並被我們的客戶廣泛接受。

As some da Vinci procedures mature in the United States, we are increasingly exposed to volatility in patient admissions for our core procedures and the consequent lumpiness in capital sales.

隨著一些達芬奇程序在美國的成熟，我們越來越多地面臨核心程序患者入院的波動以及隨之而來的資本銷售波動。

Viewed over the long term, da Vinci surgery contributes to a trend in surgery toward consolidation of procedures and to fewer surgeons with higher volume.

從長遠來看，達芬奇手術有助於手術趨向於鞏固手術並減少外科醫生數量增加。

We believe this consolidation is good for patients, surgeons, hospitals, and Intuitive.

我們相信這種整合對患者、外科醫生、醫院和 Intuitive 都有好處。

We are still early in the global adoption of da Vinci-enabled minimally invasive surgery as applied to complex conditions.

我們仍處於全球採用達芬奇技術應用於復雜條件的微創手術的早期階段。

In recent quarters we have seen building interest in the use of da Vinci in general surgery, spanning procedures from the pelvis to the upper gastrointestinal tract.

最近幾個季度，我們看到人們對達芬奇在普通外科手術中的應用產生了濃厚的興趣，涵蓋從骨盆到上消化道的手術。

As we expand our offerings in technologies like vessel sealing, stapling, and Firefly, we are seeing increased utilization and efficiency in general surgery procedures that are otherwise very difficult to perform.

隨著我們在血管密封、縫合和螢火蟲等技術方面的產品擴展，我們看到普通外科手術的利用率和效率都有所提高，否則這些手術將很難執行。

Taking a recent example, EndoWrist Vessel Sealers are now installed in roughly half of our US customers.

舉一個最近的例子，我們大約一半的美國客戶現在安裝了 EndoWrist 血管密封器。

These technologies also open the door to additional clinical applications such as thoracic surgery, where long-term additions to stapling can bring benefit to procedures that are often difficult to perform through small incisions.

這些技術還為其他臨床應用打開了大門，例如胸外科手術，長期增加縫合可以為通常難以通過小切口執行的手術帶來好處。

Looking at single-incision surgery, Single-Site cholecystectomy kits have been purchased by approximately half of our US customers 18 months after launch.

在單切口手術方面，我們大約一半的美國客戶在推出後 18 個月購買了單部位膽囊切除術套件。

This procedure is currently growing faster than any prior da Vinci procedure.

該程序目前的增長速度比任何先前的達芬奇程序都快。

Early-adopting clinical sites have been progressing in refining procedure choreography with Single-Site hysterectomy, as well.

早期採用的臨床站點也在改進單站點子宮切除術的程序編排方面取得了進展。

Furthermore, we are investing in expanding Single-Site technology and expect to bring to market additional Single-Site instruments as well as integration with other da Vinci technologies, including Firefly and simulation.

此外，我們正在投資擴展 Single-Site 技術，並希望將更多的 Single-Site 儀器推向市場，並與包括 Firefly 和模擬在內的其他達芬奇技術集成。

As our product suite develops further, we anticipate pursuing additional clinical indications for Single-Site.

隨著我們產品套件的進一步發展，我們預計會為 Single-Site 尋求更多的臨床適應症。

Considering trends in healthcare policy around the globe, a long-term intention to move away from fee-for-service and towards single payment per treatment event can advantage those approaches with fewer complications and fewer readmissions.

考慮到全球醫療保健政策的趨勢，從按服務收費轉向每次治療事件單次付款的長期意圖可以使那些並發症更少和再入院更少的方法受益。

Also, the trend toward public transparency of individual surgeon and hospital outcomes has potential to shift patient dynamics toward those programs showing the best outcomes.

此外，個體外科醫生和醫院結果公開透明的趨勢有可能將患者動態轉向那些顯示最佳結果的項目。

Again, while we cannot predict future implementations of policy, we believe their direction may set up well for da Vinci surgeons, their patients, and hospital programs.

同樣，雖然我們無法預測政策的未來實施，但我們相信他們的方向可能會為達芬奇的外科醫生、他們的患者和醫院項目設置良好的方向。

In summary, we continue to see a long-term opportunity to fundamentally improve surgery and are focused on the following -- extending the benefits of minimally invasive surgery using da Vinci in gynecology and urology worldwide; building da Vinci capability and supporting its use in general surgery; disciplined execution in our stapling and Single-Site product launches; and finally, continuing to invest in our capabilities in international markets, particularly Europe and Japan.

總之，我們繼續看到從根本上改善手術的長期機會，並專注於以下方面 - 擴大使用達芬奇在全球婦科和泌尿科的微創手術的好處；建立達芬奇能力並支持其在普通外科手術中的應用；在我們的裝訂和單站點產品發布中嚴格執行；最後，繼續投資於我們在國際市場的能力，尤其是歐洲和日本。

I will 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 $579 million, up 8% compared with $537 million for the second quarter of 2012, and down 5% from last quarter.

我們第二季度的收入為 5.79 億美元，比 2012 年第二季度的 5.37 億美元增長 8%，比上一季度下降 5%。

Second-quarter revenues by product category were as follows -- second-quarter instrument and accessory revenue was $265 million, up 18% compared with $224 million for the second quarter of 2012 and up 1% compared with the first quarter of 2013.

第二季度按產品分類的收入如下——第二季度儀器和配件收入為 2.65 億美元，比 2012 年第二季度的 2.24 億美元增長 18%，比 2013 年第一季度增長 1%。

The year-over-year increase in instrument and accessory revenue was driven by procedure growth of 18%.

儀器和配件收入的同比增長是由 18% 的程序增長推動的。

Sales of new products, including Single-Site, Vessel Sealer, and Firefly, partially offset by lower instrument and accessory stocking orders associated with lower second quarter systems sales.

新產品的銷售，包括 Single-Site、Vessel Sealer 和 Firefly，部分被與第二季度系統銷售下降相關的儀器和配件庫存訂單減少所抵消。

The 18% increase in da Vinci procedures for the quarter reflected strength in general surgery procedures and slower growth in benign gynecologic procedures.

本季度達芬奇手術增加了 18%，這反映了普通外科手術的實力和良性婦科手術的增長放緩。

As Gary indicated, the slowdown in benign gynecologic growth reflects a number of factors including but not limited to weaker hospital admissions for benign da Vinci procedures.

正如 Gary 所指出的，良性婦科增長放緩反映了許多因素，包括但不限於良性達芬奇手術入院人數減少。

Our second-quarter 2013 US dVP procedures were approximately 5% lower than the second quarter of 2012 and 2% lower than the first quarter of 2013.

我們 2013 年第二季度的美國 dVP 程序比 2012 年第二季度低約 5%，比 2013 年第一季度低 2%。

The sequential increase in instrument and accessory revenue compared with last quarter was driven by higher procedure volume, partially offset by lower instrument and accessory stocking orders.

與上一季度相比，儀器和附件收入的環比增長是由手術量增加推動的，但部分被儀器和附件庫存訂單減少所抵消。

Instrument and accessory revenue realized per procedure, including initial stocking orders, was approximately $2,020 per procedure, which was roughly equal to the second quarter 2012 and lower than the approximately $2,110 last quarter.

每個程序實現的儀器和附件收入（包括初始庫存訂單）約為 2,020 美元，大致等於 2012 年第二季度，低於上一季度的約 2,110 美元。

The decrease compared to the first quarter reflected lower stocking orders and the timing of orders.

與第一季度相比的下降反映了較低的庫存訂單和訂單時間。

Second-quarter 2013 systems revenue of $216 million decreased 6% compared with $229 million for the second quarter of 2012, and decreased 16% compared with $256 million last quarter.

2013 年第二季度的系統收入為 2.16 億美元，與 2012 年第二季度的 2.29 億美元相比下降了 6%，與上一季度的 2.56 億美元相比下降了 16%。

Overall, we sold 143 systems in the second quarter of 2013 compared with 150 systems in the second quarter of last year and 164 systems last quarter.

總體而言，我們在 2013 年第二季度售出了 143 台系統，而去年第二季度為 150 台，上季度為 164 台。

We sold 90 systems into the US market in the second quarter of 2013 compared with 124 systems last year and 115 systems last quarter.

我們在 2013 年第二季度向美國市場銷售了 90 台系統，而去年為 124 台，上季度為 115 台。

The lower second quarter 2013 US systems sales reflected, among other things, the impacts of moderating growth in US benign gynecologic procedures and increased economic pressure on hospitals.

2013 年第二季度美國系統銷售額下降反映了美國良性婦科手術增長放緩和醫院經濟壓力增加的影響。

During the second quarter of 2013 we sold 53 systems into international markets, including 21 into Europe and 20 into Japan.

2013 年第二季度，我們向國際市場銷售了 53 台系統，其中 21 台銷往歐洲，20 台銷往日本。

Compared with 26 in international markets in the second quarter of 2012, which included 13 into Europe and 7 into Japan; and 49 systems in international markets in the first quarter of 2013, which included 16 into Europe and 25 into Japan.

2012年第二季度國際市場為26家，其中歐洲13家，日本7家； 2013年第一季度國際市場49個系統，其中歐洲16個，日本25個。

Our second-quarter average sales price per system was $1.5 million compared with $1.53 million realized in the second quarter of 2012 and the $1.55 million realized last quarter.

我們第二季度每個系統的平均銷售價格為 150 萬美元，而 2012 年第二季度實現了 153 萬美元，上一季度實現了 155 萬美元。

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

ASP 包括所有 da Vinci 模型、所有模擬器和配置系統時的 Firefly，不包括升級。

Our second-quarter 2013 ASPs were lower than the first quarter due to a lower proportion of dual-console configurations and slightly higher proportion of sales involving trade-ins.

我們 2013 年第二季度的 ASP 低於第一季度，原因是雙控制台配置的比例較低且涉及以舊換新的銷售比例略高。

43 of our second-quarter 2013 systems sales involved trade-ins, comprised of 39 da Vinci Ss and 4 standard models.

我們 2013 年第二季度的系統銷售中有 43 個涉及以舊換新，包括 39 個達芬奇 Ss 和 4 個標準型號。

35 of our second quarter 2012 sales involved trade-ins, and 39 of our first-quarter 2013 sales involved trade-ins.

我們 2012 年第二季度的銷售額中有 35 項涉及以舊換新，我們 2013 年第一季度的銷售額中有 39 項涉及以舊換新。

Service revenue increased to $98 million, up 18% compared with $83 million last year and up 4% compared with $94 million last quarter.

服務收入增至 9800 萬美元，比去年的 8300 萬美元增長 18%，比上一季度的 9400 萬美元增長 4%。

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。

International revenue results were as follows.

國際收入結果如下。

Second-quarter revenue outside the US was $158 million, up 56% compared with revenue of $101 million in the second quarter of last year, and up 3% compared with $153 million last quarter.

美國以外的第二季度收入為 1.58 億美元，與去年第二季度的收入 1.01 億美元相比增長 56%，與上一季度的 1.53 億美元相比增長 3%。

Our higher year-over-year international revenue growth was driven primarily by higher da Vinci systems sales into the Japanese and European markets.

我們較高的國際收入同比增長主要是由於達芬奇系統在日本和歐洲市場的銷售增加。

Our higher sequential international revenue was driven by higher European systems sales, partially offset by lower systems sales into Japan.

我們較高的連續國際收入是由較高的歐洲系統銷售額推動的，部分被日本系統銷售額的下降所抵消。

The second-quarter 2013 international procedure volume was approximately 23% higher than the second quarter of 2012 and 6% higher than the first quarter of this year.

2013 年第二季度的國際手術量比 2012 年第二季度高出約 23%，比今年第一季度高出 6%。

Moving on to the remainder of the P&L, gross margin in the second quarter of 2013 was 70% compared with 72% for the second quarter of 2012 and 71% for the first quarter of 2013.

繼續看損益表的其餘部分，2013 年第二季度的毛利率為 70%，而 2012 年第二季度為 72%，2013 年第一季度為 71%。

Our lower margin percentage compared to the second quarter of last year resulted primarily from the impact of the Medical Device Excise Tax enacted beginning in 2013 and product mix.

與去年第二季度相比，我們較低的利潤率百分比主要是由於 2013 年開始實施的醫療器械消費稅和產品組合的影響。

Our lower gross margin percentage compared to last quarter was driven primarily by costs associated with the MCS recall, lower system ASPs, and product mix.

與上一季度相比，我們較低的毛利率百分比主要是由於與 MCS 召回、較低的系統 ASP 和產品組合相關的成本。

Second-quarter 2013 operating expenses of $187 million were up 16% compared with the second quarter of 2012 and up 2% compared with the first quarter of this year.

2013 年第二季度的運營費用為 1.87 億美元，比 2012 年第二季度增長 16%，比今年第一季度增長 2%。

Our higher year-over-year operating expense increase was driven by headcount additions.

員工人數增加推動了我們較高的同比運營費用增長。

Our increase compared to last quarter was driven by headcount additions and higher legal costs, offset by lower incentive compensation.

與上一季度相比，我們的增長是由員工人數增加和更高的法律成本推動的，但被較低的激勵薪酬所抵消。

Second-quarter 2013 operating income was $219 million or 38% of sales, compared with $225 million or 42% of sales last year, and $251 million or 41% of sales last quarter.

2013 年第二季度的營業收入為 2.19 億美元，佔銷售額的 38%，而去年同期為 2.25 億美元，佔銷售額的 42%，上一季度為 2.51 億美元，佔銷售額的 41%。

Second-quarter 2013 operating income included $39 million of noncash stock compensation expense, compared with $33 million last year and $38 million last quarter.

2013 年第二季度的營業收入包括 3900 萬美元的非現金股票補償費用，而去年同期為 3300 萬美元，上一季度為 3800 萬美元。

Our effective tax rate for the second quarter was 28.6% compared with 32.4% for the second quarter of 2012 and 26.1% last quarter.

我們第二季度的有效稅率為 28.6%，而 2012 年第二季度為 32.4%，上一季度為 26.1%。

Our second-quarter rate was a bit lower than the midpoint of our 28% to 30% guidance range, primarily reflecting a higher proportion of international pretax income.

我們第二季度的稅率略低於我們 28% 至 30% 指導範圍的中點，主要反映了較高的國際稅前收入比例。

Our net income was $159 million or $3.90 per share, compared with $155 million or $3.75 per share last year, and $189 million or $4.56 last quarter.

我們的淨收入為 1.59 億美元或每股 3.90 美元，而去年為 1.55 億美元或每股 3.75 美元，上一季度為 1.89 億美元或每股 4.56 美元。

Now moving to cash flows.

現在轉向現金流。

We ended the second quarter with cash and investments of $3 billion, down $89 million compared with March 31, 2013.

我們在第二季度末的現金和投資為 30 億美元，與 2013 年 3 月 31 日相比減少了 8900 萬美元。

The decrease was driven by $270 million used to repurchase our common stock and $25 million of capital and IP acquisition, partially offset by $189 million in cash flow generated from operations.

減少的原因是用於回購我們的普通股的 2.7 億美元以及 2500 萬美元的資本和知識產權收購，部分被運營產生的 1.89 億美元現金流所抵消。

During the second quarter we bought back approximately 546,000 shares at an average price of $493 per share.

在第二季度，我們以每股 493 美元的平均價格回購了大約 546,000 股。

We ended the quarter with approximately $900 million authorized by the Board for share buybacks.

我們在本季度末獲得了董事會授權用於股票回購的約 9 億美元。

And with that, I'd like to turn it over to Aleks, who will go over our sales, marketing, and clinical highlights.

有了這個，我想把它交給 Aleks，他將審查我們的銷售、營銷和臨床亮點。

Thank you, Marshall.

謝謝你，馬歇爾。

During the second quarter we sold 143 da Vinci systems -- 90 in the United States, 21 into Europe, and 32 into rest of world markets.

在第二季度，我們售出了 143 台達芬奇系統——其中 90 台在美國，21 台銷往歐洲，32 台銷往世界其他市場。

As part of the 143 systems sales, 4 standard da Vinci systems and 39 da Vinci S systems were traded in for credit against sales for new da Vinci Si systems.

作為 143 套系統銷售的一部分，4 套標準達芬奇系統和 39 套達芬奇 S 系統用於抵扣新達芬奇 Si 系統的銷售額。

We finished the quarter with a net 89 system additions to the installed base, bringing to 2,799 the cumulative number of da Vinci systems worldwide -- 2,001 in the United States, 443 in Europe, and 355 in rest of world markets.

本季度末，我們在已安裝基礎上新增了 89 個系統，使全球達芬奇系統的累計數量達到 2,799 個——美國為 2,001 個，歐洲為 443 個，世界其他市場為 355 個。

61 of the 143 systems installed during the quarter represented repeat systems sales to existing customers.

在本季度安裝的 143 個系統中，有 61 個代表對現有客戶的重複系統銷售。

In total, 140 of the 143 systems sold represented da Vinci Si or Si-e systems, which included 27 dual-console systems.

總共售出的 143 個系統中有 140 個代表達芬奇 Si 或 Si-e 系統，其中包括 27 個雙控制台系統。

The 53 systems sales internationally included 20 into Japan, 4 into Russia, and 3 into the countries of France, Germany, the UK, Australia, and Taiwan.

53個系統的國際銷售包括20個銷往日本，4個銷往俄羅斯，3個銷往法國、德國、英國、澳大利亞和台灣。

Clinically, Q2 year-over-your procedure growth was approximately 18%, led by the category of general surgery, paced by cholecystectomy, followed by colorectal resections.

在臨床上，第二季度的手術增長率約為 18%，主要是普通外科手術，其次是膽囊切除術，其次是結直腸切除術。

Other general surgery procedures showing strong growth included gastric, pancreatic, and esophageal procedures.

其他表現出強勁增長的普通外科手術包括胃、胰腺和食道手術。

Overall, urology growth was solid and included strong OUS dVP growth, with continued stability in US dVP.

總體而言，泌尿科增長穩健，包括強勁的 OUS dVP 增長，美國 dVP 持續穩定。

As Gary stated, our benign GYN procedure growth moderated for the second quarter in a row, which had an adverse effect on our US systems sales.

正如 Gary 所說，我們良性的 GYN 手術增長連續第二個季度放緩，這對我們在美國的系統銷售產生了不利影響。

We believe that our US procedure opportunity within benign GYN remains solid, though we do recognize that the procedures remaining on the back half of the adoption curve will be more difficult to consolidate.

我們相信我們在良性 GYN 中的美國程序機會仍然穩固，儘管我們確實認識到留在採用曲線後半部分的程序將更難以鞏固。

The slower adoption within the benign GYN segment will most likely lead to continued lumpiness in US system placements.

良性 GYN 領域的較慢採用很可能導緻美國系統放置的持續混亂。

Recently-released new products continue to perform well.

近期發布的新產品繼續表現良好。

Through Q2 we've sold Single-Site instrument and accessory kits to approximately 740 US customers.

在第二季度，我們向大約 740 名美國客戶銷售了單點儀器和附件套件。

Our Vessel Sealer product sales were strong, with most of the interest coming from the specialties of colorectal, advanced general, and GYN surgery.

我們的 Vessel Sealer 產品銷售強勁，大部分興趣來自結直腸、高級普通和婦科手術等專業。

The customer adoption for both da Vinci Simulator and Firefly continues to expand, with 96 customers purchasing a da Vinci Simulator and 76 customers purchasing Firefly systems as part of their initial system purchase this quarter.

達芬奇模擬器和 Firefly 的客戶採用率繼續擴大，本季度有 96 位客戶購買了達芬奇模擬器，76 位客戶購買了 Firefly 系統作為其初始系統購買的一部分。

In addition, we've expanded our phased rollout of both the da Vinci surgical stapling system and Single-Site hysterectomy products to several new sites.

此外，我們已將達芬奇手術吻合系統和單點子宮切除術產品的分階段推出擴展到幾個新的站點。

These rollouts will be expanded in a measured fashion, so we do not expect them to contribute materially to 2013 revenue.

這些部署將以有節制的方式擴大，因此我們預計它們不會對 2013 年的收入做出重大貢獻。

During the quarter several hundred robotic abstracts and papers representing a variety of surgical specialties were published within various peer-reviewed journals, while quarterly clinical conferences produced several live da Vinci procedure transmissions, postgraduate robotic courses, podium presentations, and clinical poster sessions.

在本季度，數百個代表各種外科專業的機器人摘要和論文發表在各種同行評審期刊上，而季度臨床會議產生了幾個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。

So I'll take a few moments to summarize a couple that provide interesting perspectives within the area of general surgery.

因此，我將花一些時間來總結一些在普外科領域提供有趣觀點的夫婦。

The rate of surgical conversions from the laparoscopic procedure to an open surgery is most often related to the complexity of the procedure.

從腹腔鏡手術到開放手術的手術轉換率通常與手術的複雜性有關。

We've described this relationship within our urologic and gynecologic procedure businesses and believe it applies to all surgical specialties in which we participate.

我們已經在我們的泌尿外科和婦科手術業務中描述了這種關係，並相信它適用於我們參與的所有外科專業。

This past quarter several peer-reviewed general surgery studies described da Vinci surgery within this very context.

上個季度，幾項經過同行評審的普通外科研究在這種背景下描述了達芬奇手術。

A colorectal study published in the journal Surgical Endoscopy compared 84 consecutive minimally-invasive, low-anterior resections, 47 incorporating da Vinci and 37 employing traditional laparoscopic technique.

發表在《外科內窺鏡》雜誌上的一項結直腸研究比較了 84 例連續的微創、低位前切除術，其中 47 例採用達芬奇技術，37 例採用傳統腹腔鏡技術。

The study, emanating out of a division of colorectal surgery at Yonsei University Hospital, completed in 2010, had a median follow-up period of 31.5 months.

該研究源自延世大學醫院結直腸外科，於 2010 年完成，中位隨訪期為 31.5 個月。

Within their review the authors described overall safety and efficacy as similar within the 2 cohorts.

在他們的審查中，作者描述了 2 個隊列中的總體安全性和有效性相似。

However, the differences in the conversion rate from MIS to open and overall hospital stay were considered significant.

然而，從 MIS 到開放和總體住院時間的轉換率差異被認為是顯著的。

Within the laparoscopic cohort, 16.2% of the patients had required conversions to open surgical technique as compared to 2.1% within the da Vinci cohort.

在腹腔鏡隊列中，16.2% 的患者需要轉為開放手術技術，而在達芬奇隊列中這一比例為 2.1%。

Though both techniques are minimally invasive, the requisite hospitalization for patients undergoing a da Vinci colorectal resection was reduced by 2 days.

儘管這兩種技術都是微創技術，但接受達芬奇結直腸切除術的患者所需的住院時間減少了 2 天。

The authors stated, and I quote, we compared the long- and short-term results for patients who underwent robotic and laparoscopic low-anterior resection and colo-anal anastomosis.

作者說，我引用，我們比較了接受機器人和腹腔鏡下前路切除和結腸肛門吻合術的患者的長期和短期結果。

Robotic colo-anal anastomosis had short- and long-term outcomes comparable with those of the laparoscopy.

機器人結腸肛門吻合術的短期和長期結果可與腹腔鏡檢查相媲美。

In particular, we found that patients in the robotic group demonstrated significantly lower rates of conversion to open surgery and had shorter hospital stay than the patients in the laparoscopic group.

特別是，我們發現與腹腔鏡組患者相比，機器人組的患者中轉開放手術的比例顯著降低，住院時間也更短。

A low rate of conversion to open surgery has a very important impact clinically, because the conversions often are associated with high complication rate and a poor prognosis.

中轉率低在臨床上具有非常重要的影響，因為中轉率通常與高並發症率和不良預後有關。

End quote.

結束報價。

In the Annals of Surgery, a study conducted at the University of Pittsburgh, entitled Robotic-assisted Minimally Invasive Distal Pancreatectomy Is Superior to Laparoscopic Technique, compared the results of the department's first 30 da Vinci distal pancreatectomies to a historical cohort comprised of their last 94 laparoscopic distal pancreatectomies.

在《外科年鑑》中，匹茲堡大學進行的一項題為“機器人輔助微創胰腺遠端切除術優於腹腔鏡技術”的研究將該部門的前 30 例達芬奇遠端胰腺切除術的結果與他們過去 94 例的歷史隊列進行了比較。腹腔鏡遠端胰腺切除術。

The patients in the study demonstrated equivalent age, sex, race, ASA scores, and tumor size.

研究中的患者表現出相同的年齡、性別、種族、ASA 評分和腫瘤大小。

Within their comments, the authors noted to their surprise that the operating time between the 2 cohorts showed a substantial reduction of over 75 minutes in favor of the da Vinci technique.

在他們的評論中，作者驚訝地註意到 2 個隊列之間的操作時間顯著減少了超過 75 分鐘，有利於達芬奇技術。

In addition, they reported that the rate of conversion to open surgery was 16% for the laparoscopic patients versus 0% among the da Vinci patients.

此外，他們報告說，腹腔鏡患者中轉開放手術的率為 16%，而達芬奇患者中為 0%。

This despite a greater probability for malignancy within the da Vinci group.

儘管達芬奇組內惡性腫瘤的可能性更大。

Also noteworthy was more pancreatic ductal adenocarcinomas were approached robotically -- 43% -- then laparoscopically, at 15%.

同樣值得注意的是，更多的胰腺導管腺癌是通過機器人進行治療的——43%——然後是腹腔鏡檢查，佔 15%。

Oncologic outcomes in these cases were superior for the robotic-assisted group, with higher rates of margin-negative resection and improved lymph node yield for both benign and malignant lesions.

這些病例的腫瘤學結果優於機器人輔助組，邊緣陰性切除率更高，良性和惡性病變的淋巴結產量均有所提高。

In their summaries, the authors wrote, and I quote, robotic distal pancreatectomies were equivalent to lab distal pancreatectomies in nearly all measures of outcomes and safety, but significantly reduced the risk of conversion to open resection despite a statistically greater probability of malignancy in the robotic cohort.

在他們的總結中，作者寫道，我引用了，機器人遠端胰腺切除術在幾乎所有結果和安全性指標上都等同於實驗室遠端胰腺切除術，但儘管在統計學上機器人中惡性腫瘤的可能性更大，但仍顯著降低了轉換為開放切除術的風險隊列。

We concluded that robotic assistance may broaden indications for minimally invasive pancreatectomy.

我們得出結論，機器人輔助可能會擴大微創胰腺切除術的適應症。

End quote.

結束報價。

This concludes my remarks, and I will now pass the time over to Calvin.

我的發言到此結束，現在我將把時間轉給 Calvin。

Thank you, Aleks.

謝謝你，亞歷克斯。

I will be providing you with an update to our financial forecast for 2013 on a GAAP basis.

我將根據公認會計原則向您提供我們對 2013 年財務預測的更新。

I will also provide estimates of significant noncash expenses.

我還將提供對重大非現金費用的估計。

Starting with procedures, on our last call we projected full-year 2013 procedures to grow towards the lower end of a range of between 20% and 23% from the base of approximately 450,000 procedures performed in 2012.

從程序開始，在我們上次的電話會議上，我們預計 2013 年全年的程序將在 2012 年執行的約 450,000 例程序的基礎上增長到 20% 至 23% 範圍的下限。

Now, based upon moderating growth rates for US benign gynecologic procedures, we are adjusting our projection for full-year 2013 procedure growth to a range of between 15% and 18%.

現在，基於美國良性婦科手術的溫和增長率，我們正在調整我們對 2013 年全年手術增長率的預測，範圍在 15% 和 18% 之間。

Moving to revenues, as has been discussed earlier on this call, capital sales of da Vinci systems are highly sensitive to changes in procedure growth patterns.

轉向收入，正如本次電話會議之前討論的那樣，達芬奇系統的資本銷售對程序增長模式的變化高度敏感。

Moderating procedure growth has led to increased capacity in our installed base.

適度的程序增長導致我們安裝基礎的容量增加。

Given this sensitivity, it is challenging for us to forecast the number of systems we expect to sell in the second half of this year, so we have widened our guidance range.

鑑於這種敏感性，我們很難預測今年下半年預計銷售的系統數量，因此我們擴大了指導範圍。

Given the significant portion of our revenue that is derived from system sales, we now expect total 2013 revenue to range from approximately flat to 7% growth compared to full-year 2012.

鑑於我們收入的很大一部分來自系統銷售，我們現在預計 2013 年的總收入與 2012 年全年相比將在大約持平至 7% 的範圍內增長。

Turning to operating income, on our last call we forecast operating income to fall within a range of between 38% and 39% of net revenue.

談到營業收入，在上次電話會議上，我們預測營業收入將在淨收入的 38% 至 39% 之間。

At this point, given our reduced revenue expectations, we are taking steps to scale back expenses.

在這一點上，鑑於我們降低的收入預期，我們正在採取措施縮減開支。

We do not intend to make short-term spending cuts in areas that would compromise our longer-term expansion strategies.

我們不打算在會損害我們長期擴張戰略的領域進行短期支出削減。

As a result, we now anticipate full-year 2013 operating income to fall within a range of between 37% and 38% of revenue.

因此，我們現在預計 2013 年全年營業收入將在收入的 37% 至 38% 之間。

Now with regard to noncash stock compensation expenses -- on our last call we forecast 2013 total stock compensation to total between $184 million and $192 million for the year.

現在關於非現金股票補償費用——在上次電話會議上，我們預測 2013 年的總股票補償總額將在 1.84 億美元至 1.92 億美元之間。

Based upon our current stock price, we are reducing our forecast to a range of between $164 million and $172 million for the year.

根據我們目前的股價，我們將今年的預測下調至 1.64 億美元至 1.72 億美元之間。

Timing of recognition should follow a quarterly pattern similar to 2012.

識別時間應遵循類似於 2012 年的季度模式。

We expect other income, which is comprised mostly of interest income, to total between $17 million and $19 million in 2013.

我們預計 2013 年其他收入（主要包括利息收入）總額將在 1700 萬美元至 1900 萬美元之間。

With regard to income tax, our Q2 tax rate was 28.6% of pretax income.

關於所得稅，我們第二季度的稅率為稅前收入的 28.6%。

Our rate for the remainder of the year will likely be close to that level.

我們今年剩餘時間的利率可能會接近這個水平。

Our share count for calculating EPS in Q2 2013 was approximately 40.8 million shares.

我們計算 2013 年第二季度每股收益的股票數量約為 4080 萬股。

Directionally in Q3, our share count will likely modestly decline from the Q2 level.

從第三季度的方向來看，我們的股票數量可能會從第二季度的水平溫和下降。

The actual share count will depend on several factors, including the magnitude and timing of share buybacks.

實際的股票數量將取決於幾個因素，包括股票回購的規模和時間。

That concludes our prepared remarks.

我們準備好的發言到此結束。

We will now open the call to your questions.

我們現在將打開您的問題的電話。

(Operator Instructions).

（操作員說明）。

Ben Andrew, William Blair.

本安德魯，威廉布萊爾。

Wanted to follow up on a couple of points to start.

想跟進幾點開始。

And Gary, you had talked about the fact that system growth would likely be lumpy over the course of the coming quarters.

加里，你談到了這樣一個事實，即係統增長在接下來的幾個季度中可能會出現波動。

Can you give us some sense of what your inputs have been lately from the field and from customers, relative to how lumpy?

您能否讓我們了解一下您最近從該領域和客戶那裡獲得的投入，相對於波濤洶湧的程度？

And what the mix between new customers and existing customers is likely to look like going forward?

新客戶和現有客戶之間的組合未來可能會是什麼樣子？

I think the commentary is pretty much as we've outlined it for you.

我認為評論與我們為您概述的差不多。

We see really an issue in the US of existing customers looking at capacity.

在美國，我們確實看到了現有客戶關注產能的問題。

We don't see existing customers walking away from the technology or the opportunity, but more a question of timing for them.

我們沒有看到現有客戶離開技術或機會，但更多的是他們的時間問題。

So it feels more like a delay than otherwise.

所以感覺更像是延遲。

As we have said in the past, I think that capital sales are really driven by 3 underlying drivers.

正如我們過去所說，我認為資本出售實際上是由 3 個潛在驅動因素驅動的。

One of them is additional capacity in existing customers.

其中之一是現有客戶的額外容量。

One of them is technologies or new features that they would like to get.

其中之一是他們想要獲得的技術或新功能。

And the third are customers that are not yet da Vinci owners who are interested in engaging.

第三類是有興趣參與的尚未成為達芬奇所有者的客戶。

We've had good success with the new technologies that we have been bringing out, and so we see that as proceeding.

我們在推出的新技術方面取得了巨大成功，因此我們認為這是在進行中。

I think the growth rate on benign gynecologic procedures has come in in the second quarter.

我認為良性婦科手術的增長率在第二季度已經出現。

It grew, but grew at a slower rate than we were expecting.

它增長了，但增長速度比我們預期的要慢。

And there's just a multiplier effect there on capacity.

這對容量有乘數效應。

And so the capacity constraints in existing accounts will take some quarters to work out.

因此，現有賬戶的容量限制需要幾個季度才能解決。

And Gary, can you maybe give us some comments, or maybe perhaps Aleks on this, about any correlation between the volume of benign GYN cases and physician visits?

加里，你能不能給我們一些評論，或者也許是 Aleks，關於良性 GYN 病例的數量與就診之間的任何相關性？

Because we've heard some noise back and forth about flattish or even sometimes declining patient volumes overall.

因為我們反复聽到一些關於患者數量持平甚至有時下降的噪音。

Does that appear to be part of it?

這似乎是其中的一部分嗎？

Is maybe hysterectomy being utilized less frequently?

也許子宮切除術的使用頻率較低？

Any other things like that around the procedure growth?

圍繞程序增長還有其他類似的事情嗎？

Because obviously a big change in hysterectomy growth has kind of happened here in the last couple of quarters.

因為很明顯，在過去的幾個季度中，子宮切除術的增長發生了很大的變化。

I think in terms of total in-patient admissions as a whole and then people coming in seeking -- women coming in seeking hysterectomy, as you know, the inpatient admission data broadly lags for a while.

我認為就整個住院患者的總入院人數以及前來尋求子宮切除術的女性而言，如您所知，住院患者入院數據普遍滯後一段時間。

So we get at that by more or less the same way you do, by talking to our customers, by looking at survey data, and trying and look at other analysis.

因此，我們通過與我們的客戶交談、查看調查數據並嘗試查看其他分析的方式或多或少與您相同的方式來解決這個問題。

It's clear that in the first quarter, total inpatient admissions were lower than people had expected them, and in some cases, in some institutions, negative.

很明顯，在第一季度，住院總人數低於人們的預期，在某些情況下，在某些機構中，是負數。

As the total in Q2, we are hearing mixed feedback on total.

作為第二季度的總數，我們聽到了關於總數的混合反饋。

For hysterectomy as a whole, our customers are seeing a pressure both in Q1 and in Q2.

對於整個子宮切除術，我們的客戶在第一季度和第二季度都面臨壓力。

Quantifying that in Q2 is tough, just because the data lags.

在第二季度量化這一點很困難，只是因為數據滯後。

And so qualitatively we've seen some pressure there.

因此，從質量上講，我們在那裡看到了一些壓力。

And then there were some things that are just hard for us to handicap in terms of Intuitive-specific events and their impact on benign hyst.

然後有一些事情我們很難在直覺特定事件及其對良性歇斯底里的影響方面造成障礙。

Things like the MCS notification are just harder for us to quantify what that impact was.

像 MCS 通知這樣的事情對我們來說更難量化這種影響是什麼。

Sure.

當然。

And then Calvin, very briefly on the procedure guidance, the 15% to 18%, does that assume that benign hysterectomy grows sequentially in the back half versus the first half?

然後 Calvin，非常簡要地介紹了 15% 到 18% 的程序指導，這是否假設良性子宮切除術在後半部分與前半部分依次增長？

I know you have got some big year-over-year comparisons there as well, so maybe a different answer versus year on year.

我知道你在那裡也有一些大的同比比較，所以可能與同比不同的答案。

Yes, I think when you look at the overall guidance and the revised range, we are talking about your general surgery performing well and in line with our earlier guidance.

是的，我認為當您查看總體指導和修訂後的範圍時，我們談論的是您的普外科表現良好並符合我們之前的指導。

And similarly on the urology side and international.

同樣在泌尿科方面和國際上。

So I think the change overall really is very much attributable to the benign gynecologic procedures in the US.

所以我認為總體上的變化確實很大程度上歸功於美國的良性婦科手術。

And so I think we're still talking about growth.

所以我認為我們仍在談論增長。

It's a moderating growth pattern, and the trajectory through the quarters ought to follow a similar pattern to what we have seen historically.

這是一種緩和的增長模式，每個季度的軌跡應該遵循與我們歷史上看到的相似的模式。

Thank you.

謝謝你。

Tao Levy, Wedbush Securities.

韋德布什證券公司的陶徵。

On the warning letter that you received, it seems rather fast for the FDA to come in in June and then a few weeks later give you guys a warning letter.

根據你們收到的警告信，FDA 似乎很快就會在 6 月份進來，然後幾週後給你們一封警告信。

Can you maybe go into a little more details as to what they are looking for on that?

您能否詳細介紹一下他們正在尋找什麼？

The content of the letter is really a reflection of the content that was in the 43 Form that was issued in June.

這封信的內容實際上反映了 6 月份發布的 43 表格中的內容。

There were 4 observations.

有 4 個觀察結果。

There are 2 mentions in the warning letter, which will become public.

警告信中有 2 處提及，將公開。

2 mentions of things they'd like additional insight into.

2 次提及他們希望進一步了解的事情。

One of them had to do with procedure by which recalls are classified and their participation in that classification.

其中之一與召回分類的程序及其參與分類有關。

That was the first bullet.

那是第一顆子彈。

And the other bullet they want additional information on has to do with user input and design elements, having to do with a particular product.

他們想要更多信息的另一個項目與用戶輸入和設計元素有關，與特定產品有關。

I think those are addressable.

我認為這些是可以解決的。

We are working on addressing them.

我們正在努力解決這些問題。

I think we can address them quickly, and we will move on.

我認為我們可以迅速解決這些問題，我們將繼續前進。

Did the letter mention anything about having to come back and revisit the facility, or it's --?

這封信有沒有提到必須回來重新訪問該設施，或者它是——？

There is a mention that they will come back and audit specifically around recall classifications.

有人提到他們會回來並專門圍繞召回分類進行審計。

And you also mentioned about Japan now not expecting any additional reimbursed procedures in the next cycle.

您還提到日本現在不希望在下一個週期有任何額外的報銷程序。

What did the MHLW mention to you guys about that?

厚生勞動省對你們提到了什麼？

MHLW is working on guidance documentation for reimbursement -- more broadly than us -- for new technologies.

MHLW 正在為新技術制定報銷指南文件——比我們更廣泛。

That is outlining data requirements for what they'd like to see in Japan.

這概述了他們希望在日本看到的數據要求。

Japan-specific data.

日本特有的數據。

For prostatectomy we were able to use global data and had a good interaction with MHLW.

對於前列腺切除術，我們能夠使用全球數據並與 MHLW 進行了良好的互動。

Given current guidance, again, I think it's a class of products more broad than us.

鑑於目前的指導，我認為這是一類比我們更廣泛的產品。

They're looking for additional data collection in Japan, specifically.

他們正在日本尋找額外的數據收集，特別是。

That's going to vary by procedure; their data requirements appear to vary by procedure having to do with the maturity of clinical data.

這將因程序而異；他們的數據要求似乎因與臨床數據成熟度有關的程序而異。

And so it's not all locked down yet.

所以它還沒有全部鎖定。

We're continuing to work with the surgical societies, who in turn work with MHLW.

我們將繼續與外科學會合作，後者又與 MHLW 合作。

But given the visibility we have on it now, it looks like there will be partial reimbursement followed by national reimbursement on a timeline that has to be decided based on their data requirements.

但鑑於我們現在對其的可見性，看起來將在必鬚根據其數據要求決定的時間表上進行部分報銷，然後是國家報銷。

As we get additional insight and understand it deeper, we will share that with you.

隨著我們獲得更多見解並更深入地了解它，我們將與您分享。

Lastly, the cadence on systems sales throughout the rest of the year -- is the pressure that we should model that's primarily just US-based?

最後，今年餘下時間系統銷售的節奏——我們應該模擬的壓力主要來自美國嗎？

Is that the right way to think about it?

這是正確的思考方式嗎？

Or do you see anything else in Europe, rest of the world, Japan, as well?

或者你在歐洲、世界其他地方、日本也看到了什麼？

I will start with a broad answer and let Marshall color it as well.

我將從一個廣泛的答案開始，並讓 Marshall 為它著色。

In the US I think the dynamics that we saw in the second quarter may persist for the back half of the year.

在美國，我認為我們在第二季度看到的動態可能會持續到今年下半年。

In terms of OUS, we are pleased with the progress we're making in Europe, but as you know, Europe can be really lumpy.

就 OUS 而言，我們對我們在歐洲取得的進展感到滿意，但如您所知，歐洲可能真的很崎嶇不平。

And likewise in Japan.

在日本也是如此。

I think that Japan has had some boluses of pent-up demand, and what that looks like in future quarters is likely to not be stable.

我認為日本有一些被壓抑的需求，未來幾個季度的情況可能不穩定。

I don't think I would use the last couple of quarters to predict the future -- next quarters.

我不認為我會用最後幾個季度來預測未來——下幾個季度。

Marshall, if you would --.

馬歇爾，如果你願意——。

Yes.

是的。

Specifically in Japan, we introduced Si at the beginning of the year, and I think that helped drive increased systems sales.

特別是在日本，我們在年初推出了 Si，我認為這有助於推動系統銷售的增長。

And we don't see that level continuing.

而且我們認為這一水平不會持續下去。

As Gary said, Europe will be lumpy.

正如加里所說，歐洲將是崎嶇不平的。

Particularly Q3 is the vacation period for them, and so historically we've seen lower sales in Europe in Q3.

特別是第三季度是他們的假期，因此從歷史上看，我們看到第三季度歐洲的銷售額較低。

Thanks.

謝謝。

David Roman, Goldman Sachs.

大衛羅曼，高盛。

I wanted to -- Gary, I think in both your and Aleks's prepared remarks, you referenced the volume of data that continue to come out regarding the da Vinci system.

我想 -- Gary，我認為在你和 Aleks 準備好的評論中，你提到了關於達芬奇系統的大量數據。

But as you think about some of the headlines out there that have materialized in the past 6.5 months and the rising concerns, potentially around from payers as it relates to hysterectomies, to what extent have you started to rethink the need or potential need for a large-scale, randomized clinical trial to really definitively put a line in the sand on the value proposition of da Vinci that is a multi-center, multi-hundred patient clinical trial?

但是，當您考慮過去 6.5 個月內出現的一些頭條新聞以及日益增加的擔憂（可能來自與子宮切除術相關的付款人）時，您在多大程度上開始重新考慮是否需要或潛在需要大規模化、隨機化的臨床試驗能否真正明確地確定達芬奇的價值主張，即多中心、數百名患者的臨床試驗？

Even if it is sponsored by the Company?

即使它是由公司贊助的？

That's a good question.

這是個好問題。

Going forward, I think clearly large-scale studies are -- multi-institutional, multi-surgeons, are powerful and are important.

展望未來，我認為大型研究顯然是——多機構、多外科醫生、強大且重要。

Speaking to the headlines a little bit, I think the headlines often confound the differences between complex procedures and simple ones, and the use of da Vinci as an alternative to open versus the use of da Vinci as an alternative to laparoscopy.

稍微談到頭條新聞，我認為頭條新聞經常混淆複雜程序和簡單程序之間的差異，以及使用達芬奇作為開放手術的替代方法與使用達芬奇作為腹腔鏡檢查的替代方法。

I think there's a lot of very strong data for the use of da Vinci as an alternative to open surgery.

我認為有很多非常有力的數據表明使用達芬奇作為開放手術的替代方案。

That said, going back to your comment, we are investing in large-scale studies.

也就是說，回到您的評論，我們正在投資於大規模研究。

They're not always prospective randomized trials.

它們並不總是前瞻性隨機試驗。

Sometimes they are registries; sometimes they are occupational trials; sometimes they are prospective randomized.

有時它們是註冊表；有時它們是職業試驗；有時它們是前瞻性隨機的。

That depends a lot on the institutions that are doing them, and the nature of the data they already have, and the data they are collecting.

這在很大程度上取決於從事這些工作的機構、他們已經擁有的數據的性質以及他們正在收集的數據。

But we are believers in big datasets.

但我們相信大數據集。

We think that matters.

我們認為這很重要。

And over time you'll see more of that come out, both in hysterectomy and in other procedures.

隨著時間的推移，您會在子宮切除術和其他手術中看到更多這樣的結果。

And maybe just on the system side, I certainly can appreciate that the slowing utilization or the slowing procedure volumes will impact the rate at which you sell systems, but it seems like a pretty fast drop-off in system placements relative to what is -- at least looks to be in the quarter -- a pretty modest slowing in procedure volumes.

也許只是在系統方面，我當然可以理解，放緩的利用率或放緩的程序量會影響您銷售系統的速度，但與現在相比，系統放置似乎是一個相當快的下降——至少看起來是在本季度——程序量的放緩相當溫和。

So is that -- am I reading that wrong if I say that there was already a lot of capacity out there of systems, and that a small tweak on the volume side is going to make a big impact on procedures?

那麼——如果我說系統已經有很多容量，並且在容量方面的小調整將對程序產生重大影響，我是不是讀錯了？

Or is that something that procedures worsened throughout the quarter, so the forward view is a little bit more cautious?

或者這是整個季度程序惡化的事情，所以前瞻觀點更加謹慎？

Am I looking at that wrong?

我看錯了嗎？

I will separate it into two things.

我會把它分成兩件事。

I'm going to take the second part first.

我要先講第二部分。

The idea of did we see a softening in the back end of the quarter in terms of procedures and that, driving additional conservatism for the back half of the year, we did not see a strong falloff in procedures through the quarter.

我們是否看到本季度末程序方面的軟化以及在今年下半年推動額外的保守主義的想法，我們沒有看到整個季度程序的大幅下降。

It wasn't that we got to the end, and procedures were really ramping down or anything like that in terms of rates.

並不是說我們走到了盡頭，而且就費率而言，程序確實在減少或類似的事情。

In terms of sensitivity, we came out of a strong fourth quarter of 2012, both in procedures and in systems.

就敏感性而言，我們在 2012 年第四季度表現強勁，無論是在程序方面還是在系統方面。

We saw some mixed dynamics in Q1 across the industry, us included, in terms of procedure volumes and in-patient admissions.

在手術量和住院人數方面，我們在第一季度看到了整個行業的一些混合動態，包括我們在內。

And that benign hysterectomy for da Vinci growth rate really struggled to gain traction again in Q2.

而達芬奇增長率的良性子宮切除術在第二季度確實難以再次獲得牽引力。

And I think that has added up to the sensitivity you're seeing and systems.

我認為這增加了你所看到的敏感性和系統。

I do think because systems are used for hundreds of procedures a year, and we're doing a fair number of procedures in the US that are benign -- but on hysterectomy procedures, there is the sensitivity that gets you to the capital number.

我確實認為，因為系統每年用於數百次手術，而且我們在美國進行了相當數量的良性手術——但在子宮切除手術中，您對資本數字的敏感性。

Okay, that's helpful.

好的，這很有幫助。

And maybe lastly, on the guide, the flat to up 7% total revenue guidance for the year, just roughly looking at it, it seems as though you've taken a pretty conservative approach with respect to systems.

也許最後，在指南上，今年的總收入指導持平至 7%，只是粗略地看一下，似乎你在系統方面採取了相當保守的方法。

It almost looks like you're extrapolating second-quarter trends and close to flatlining them through the balance of the year.

看起來您幾乎是在推斷第二季度的趨勢，並且在今年餘下的時間裡接近趨於平緩。

So is that guidance meant to reflect the degree of uncertainty that might exist in both the capital markets as well as the timing of any correlation to slowing procedure volumes and slowing systems?

那麼，該指導是否旨在反映資本市場中可能存在的不確定性程度以及與減緩程序量和減緩系統的任何相關性的時間？

That this is a view based on what you know today, and taking that forward, and that gives you some room on the overall performance of the business?

這是基於你今天所知道的觀點，並向前推進，這給你一些關於業務整體表現的空間？

David, our wider range in the revenue guidance does reflect the slower growth in da Vinci procedures.

大衛，我們更廣泛的收入指導確實反映了達芬奇程序的增長放緩。

And really the uncertainty in the trend in dVH.

確實是 dVH 趨勢的不確定性。

Our underlying assumptions -- we assume roughly flat system utilization for the back half of the year, with the reduced growth assumptions on procedures, and the rest basically falls through.

我們的基本假設——我們假設下半年的系統利用率大致持平，對程序的增長假設減少，其餘的基本上都失敗了。

Again, as we discussed, the capital sales are highly sensitive to changes of procedure growth trends.

同樣，正如我們所討論的，資本銷售對程序增長趨勢的變化高度敏感。

And our guidance does assume materially fewer system sales in the second half of 2013 than the first.

我們的指導確實假設 2013 年下半年的系統銷售額比上半年要少得多。

And a couple of other points on guidance while we're on the topic.

在我們討論這個主題時，還有一些關於指導的其他要點。

We talk a lot about system ASPs.

我們經常談論系統 ASP。

It's probably likely the second half system ASPs may be modestly lower than the first half, based on a higher proportion of sales that may involve trade-ins with the lower volumes.

基於較高比例的銷售可能涉及較低銷量的以舊換新，下半年系統 ASP 可能會略低於上半年。

And then secondly, the second-half instrument and accessory revenue per procedure will probably also directionally be a bit lower than we saw in the first half, just based upon fewer stocking orders associated with the lower system sales.

其次，由於與較低的系統銷售相關的庫存訂單減少，下半年每個手術的儀器和配件收入也可能會定向地低於我們在上半年看到的水平。

Okay.

好的。

That is extremely helpful.

這非常有幫助。

Thank you.

謝謝你。

Amit Hazan, SunTrust.

阿米特哈贊，SunTrust。

Just one question on the dVH side.

只有一個關於 dVH 方面的問題。

One of the reasons you noted for weakness was the move of hysterectomy from the inpatient to the outpatient setting.

您指出虛弱的原因之一是子宮切除術從住院部轉移到門診部。

But the data shows pretty clearly that this has been an ongoing things for years now, maybe about 5% or so a year consistently for a long time.

但數據非常清楚地表明，這已經持續了多年，可能在很長一段時間內每年持續大約 5% 左右。

So I'm wondering, what has really changed now, particularly this quarter, for you to have noted that beyond that already existing long-term trend?

所以我想知道，現在真正發生了什麼變化，尤其是本季度，您是否注意到除了已經存在的長期趨勢之外？

I think there are a couple of underlying dynamics in the dVH space, and actually pulling them apart and putting numbers on them is very, very tough.

我認為 dVH 領域存在一些潛在的動態，實際上將它們分開並在它們上面加上數字是非常非常困難的。

One of them has been we've seen over recent quarters a pressure by payers on the use of hysterectomy as a whole.

其中之一是我們在最近幾個季度看到付款人對整個子宮切除術的使用施加壓力。

And we're hearing that back through our surgeon channels -- what it takes to authorize a hysterectomy and conservative medical management before that.

我們通過我們的外科醫生渠道聽到了這一點——在此之前授權進行子宮切除術和保守的醫療管理需要什麼。

We're also seeing payer policies towards driving them into the ambulatory settings versus inpatient settings.

我們還看到付款人政策將他們推向門診環境而不是住院環境。

After that, the deductible dynamics and other macroeconomic trends, and then some Intuitive-specific dynamics around negative press and/or MCS notification, and you have got a set of things that can be contributors.

在那之後，免賠額動態和其他宏觀經濟趨勢，然後是圍繞負面新聞和/或 MCS 通知的一些直觀的動態，你有一系列可以成為貢獻者的東西。

Sorting exactly which is which in real time is very tough for us to do.

對我們來說，實時準確地排序是非常困難的。

It really is going to be survey data and retrospective analysis to figure out which of those is dominant.

這確實將是調查數據和回顧性分析，以確定其中哪些占主導地位。

Some of them are increasing trends; some of them seem to be episodic trends.

其中一些是增加趨勢；其中一些似乎是偶發趨勢。

Okay.

好的。

And then back to the systems side, I want to maybe touch on the deferral versus cancellation.

然後回到系統方面，我想談談延期與取消。

Again, I think you guys were using the word deferral in your preannouncement press release.

同樣，我認為你們在發布前的新聞稿中使用了延期一詞。

Can you talk a little bit about the systems that maybe you were close to closing and didn't that were deferred because of the lower trajectory of expected growth for procedures, and whether you were hearing in large part that that was a deferral, and not necessarily cancellation and a move away from the technology?

您能否談談可能您即將關閉但由於程序預期增長軌跡較低而沒有推遲的系統，以及您是否在很大程度上聽說這是推遲，而不是一定要取消並遠離技術？

And are we talking virtually pretty much all of the units that fell into that bucket, or were there some that you feel were cancellation, and they were really moving away from your technology?

我們是在談論幾乎所有落入那個桶的單元，還是有一些你覺得被取消了，他們真的遠離了你的技術？

The pipeline entering the quarter, as we commented 3 months ago, was strong.

正如我們 3 個月前評論的那樣，進入本季度的管道很強勁。

But as you know, capital sales tend to be back-ended.

但如您所知，資本銷售往往是後端。

So it wasn't until the end of the quarter that things started to drop off.

因此，直到本季度末，情況才開始下降。

The reasons that we were given for systems falling off included things like inability to get financing, just additional levels of approval required within hospital systems.

系統崩潰的原因包括無法獲得融資，只是醫院系統內需要額外的批准級別。

So it just felt like a harder environment from an economic perspective.

因此，從經濟角度來看，這只是一個更艱難的環境。

It did feel like a number of them were pushed off.

確實感覺他們中的一些人被推開了。

Now, we see them being pushed off.

現在，我們看到他們被推開。

Do they ultimately get done is really hard to predict.

他們最終能否完成真的很難預測。

And we don't know if someone was hesitant to buy because of hospital dynamics, or concerns about the economy; whether they will still have those concerns for a quarter or two out; or whether those will go away, and capacities will catch up such that they buy.

而且我們不知道是否有人因為醫院動態或對經濟的擔憂而猶豫購買；他們是否還會有這些擔憂一兩個季度；或者這些是否會消失，並且容量會趕上他們購買。

So it's really hard for us to predict which ones will come back and which ones will not.

所以我們真的很難預測哪些會回來，哪些不會。

But the initial commentary that we're getting from hospitals was they were pushing them off.

但我們從醫院得到的最初評論是他們正在推遲。

Okay.

好的。

And just one final one for me on utilization.

最後一個對我來說是關於利用率的。

I think you mentioned you are assuming flat utilization in the back half.

我想你提到你假設後半部分的利用率持平。

I'm just wondering, as we kind of start to think about general surgery, and especially cholecystectomy in there being a shorter procedure, whether we should be considering utilization for systems starting to go up a little bit more than it has been in historical trend?

我只是想知道，當我們開始考慮普通外科手術，尤其是膽囊切除術，因為手術時間更短，我們是否應該考慮系統的利用率開始比歷史趨勢高一點?

It's a great point.

這是一個很好的觀點。

As choles and other simpler procedures get done, they are faster.

隨著 choles 和其他更簡單的程序完成，它們會更快。

They are also -- tend to be more schedule-able.

他們也 - 往往更能安排時間。

A benign disease patient can schedule into a slot, often, better or easier than in the case of a malignant disease.

良性疾病患者通常可以比惡性疾病更好或更容易地安排時間。

So if that becomes material and bigger, I think that utilization may well go up.

因此，如果這變得更重要並且更大，我認為利用率可能會上升。

And I think ultimately that is a good thing for hospitals and a good thing for us.

我認為最終這對醫院來說是一件好事，對我們來說也是一件好事。

But it can create some uncertainty in terms of predicting where utilization ought to settle.

但它可能會在預測利用率應該在哪裡解決方面產生一些不確定性。

Now things like, just to add a point, colorectal procedures that are also growing are complex, longer general surgery procedures and cancer procedures.

現在的事情就像，只是補充一點，也在增長的結直腸手術是複雜的、更長的普通外科手術和癌症手術。

So you have both of those dynamics going on at once.

因此，您同時擁有這兩種動態。

And so the mix change is the thing you have to predict to get to utilization, and that is how Calvin arrived at his guidance on it.

所以混合變化是你必須預測到的事情，這就是卡爾文如何得出他的指導的。

Yes.

是的。

The trends have been, over the last few years, gradual growth.

在過去的幾年裡，趨勢是逐漸增長的。

Low/mid single-digit percentage growth in utilization per system.

每個系統利用率的低/中個位數百分比增長。

There are almost 2,800 systems out there now, and they are all at the various stages of adoption.

現在有近 2,800 個系統，它們都處於採用的不同階段。

So my point is it's a large sample size, and that metric historically has moved very gradually in direction.

所以我的觀點是，它的樣本量很大，而且從歷史上看，該指標已經朝著非常緩慢的方向發展。

And just speaking for the long term, looking out all of the quarters, higher utilization is ultimately great for the hospitals.

就長期而言，放眼所有方面，更高的利用率最終對醫院來說是件好事。

They get a good return on their investment, and it is great for the Company.

他們的投資獲得了不錯的回報，這對公司來說非常好。

So over time if it heads that way, then you will adjust.

所以隨著時間的推移，如果它朝那個方向發展，那麼你就會調整。

Thanks, guys.

多謝你們。

David Lewis, Morgan Stanley.

大衛劉易斯，摩根士丹利。

This is actually Jon Demchick in for David.

這實際上是大衛的喬恩德姆奇克。

Thanks for taking the question.

感謝您提出問題。

So you gave some numbers on the magnitude of growth for your dVP in the quarter, but I didn't really hear, I guess, anything that specific towards dVH.

所以你給出了一些關於你的 dVP 在本季度的增長幅度的數字，但我猜我並沒有真正聽到任何關於 dVH 的具體信息。

So I was wondering if you could give, maybe, additional color on the magnitude for malignant or benign.

所以我想知道你是否可以給惡性或良性的幅度提供額外的顏色。

And if not, if you could also maybe discuss how you're thinking about some of those pressures, if they are maybe more temporary?

如果沒有，您是否也可以討論您如何看待其中一些壓力，如果它們可能更暫時？

Or if you think that they are more permanent or structural, and maybe the total addressable market that you've previously discussed maybe needs to come down a bit?

或者，如果您認為它們更具永久性或結構性，那麼您之前討論的整個潛在市場可能需要下降一點？

I don't think we are going to give specific percentage growth rates in the hysterectomy here, but I think we were on a certain trajectory, I think, through 2012, and then it was a noticeable change in the growth rate in Q1 that was continued out into Q2.

我不認為我們會在這裡給出子宮切除術的具體百分比增長率，但我認為我們在一定的軌跡上，我認為，到 2012 年，然後第一季度的增長率發生了顯著變化，那就是持續到第二季度。

And when we look at our guidance, I think we are projecting out our growth rates at that lower trend.

當我們查看我們的指導時，我認為我們正在以較低的趨勢預測我們的增長率。

Yes, and as far as the addressable market, our -- again, what we have created is really a construct for the way we think about the procedures that we can access.

是的，就目標市場而言，我們 - 再次，我們創造的實際上是我們思考我們可以訪問的程序的方式的構造。

We talk about -- in the case of dVH, it started with the complex, beginning with malignant endometrial cervical cancers, et cetera.

我們談論 - 在 dVH 的情況下，它始於復合體，始於惡性子宮內膜宮頸癌等。

And then into the complex benign.

然後進入複雜良性。

And we ultimately are going after what is open surgery.

我們最終會追求什麼是開放式手術。

There may be some intersection between laparoscopic and so on, but really the primary target -- we still stand by that.

腹腔鏡等可能有一些交叉點，但實際上是主要目標——我們仍然堅持這一點。

We believe that is our target market.

我們相信這是我們的目標市場。

But what we have really realized is that as you get to the back half of these adoption curves, accessing those procedures with the same approach as you did on the front half of it is difficult.

但我們真正意識到的是，當您到達這些採用曲線的後半部分時，使用與前半部分相同的方法訪問這些程序是很困難的。

In other words, they don't consolidate the same way at the same pace.

換句話說，它們不會以相同的速度以相同的方式整合。

So we feel strongly about the opportunity still being there and fruitful, but the timing of it on the back end is going to be difficult to predict.

因此，我們對機會仍然存在並且富有成效感到強烈，但它在後端的時機將很難預測。

And therein lies the challenge that you saw in the first couple of quarters, and the effect that it had on systems.

這就是你在前幾個季度看到的挑戰，以及它對系統的影響。

Thank you.

謝謝你。

Very helpful.

非常有幫助。

And thinking more on the dVH side, also, will the dVH outlook maybe impact any hiring that is going on on the procedure side for general surgery?

並且更多地考慮 dVH 方面，dVH 前景是否會影響普通外科手術方面正在進行的任何招聘？

Or maybe affect the balance of just reps you have in access in both areas?

或者可能會影響您在這兩個領域中訪問的代表的平衡？

As we think about opportunity, we look at it in terms of procedure growth regionally.

當我們考慮機會時，我們會從區域程序增長的角度來看待它。

So we look out at the US and the various regions and see what opportunity and penetration levels look like.

因此，我們著眼於美國和各個地區，看看機會和滲透水平是什麼樣的。

And they are non-uniform.

而且它們是不均勻的。

It's not that the whole country is all at the same level of adoption.

並不是整個國家都處於相同的採用水平。

As adoption is deep in some areas for gynecology, that frees resources to pursue general surgery and other things.

由於婦科在某些領域的採用率很高，因此可以騰出資源進行普通外科手術和其他事情。

And so that's really how we are directing our sales force.

這就是我們指導銷售人員的方式。

And just one quick follow-up on the buyback authorization from March.

並且只是對 3 月份回購授權的快速跟進。

I was just wondering if you could give any additional color on your thoughts toward the capital deployment and maybe timing.

我只是想知道您是否可以就您對資本部署和時機的想法提供任何額外的顏色。

It will be consistent with what we've said in the past.

這將與我們過去所說的一致。

We'll look for the right opportunity to buy back shares.

我們將尋找合適的機會回購股票。

So looking for discontinuities in the stock price from the market.

因此，從市場中尋找股票價格的不連續性。

We have it authorized, and we intend to use it appropriately.

我們已獲得授權，我們打算適當地使用它。

Thank you very much.

非常感謝。

Tycho Peterson, JPMorgan.

第谷彼得森，摩根大通。

First one, just on the general road map here for general surgery, can you talk a little bit about how sustainable you think the demand you are seeing in chole is right now?

第一個，只是在普通外科的一般路線圖上，你能談談你認為你現在在膽汁中看到的需求有多可持續嗎？

Are you seeing centers trial and then either ramp up, or -- what is the dynamic like there?

您是否看到中心試驗，然後加速，或者 - 那裡的動態是什麼樣的？

And then can you also talk on bariatric and maybe some of these other opportunities in general surgery beyond chole and LAR, APR?

然後你能不能談談減肥和普通外科手術中除膽汁和 LAR、APR 之外的其他一些機會嗎？

On Single-Site cholecystectomy we've seen a good stick rate.

在單部位膽囊切除術中，我們看到了良好的堅持率。

In some ways a better stick rate than past procedures in terms of early experiences.

就早期經驗而言，在某些方面比過去的程序更好的堅持率。

And we've seen great growth out of some centers.

我們已經看到一些中心的巨大增長。

One of the exciting things about Single-Site cholecystectomy is that, number one, it is a procedure where surgeons can see high volume.

單部位膽囊切除術令人興奮的事情之一是，第一，它是一種外科醫生可以看到大量手術的手術。

So when they move, they get a lot of experience quickly.

因此，當他們移動時，他們會很快獲得大量經驗。

So the early part of that experience has been good.

因此，這種體驗的早期部分一直很好。

Having said that, there are absolutely some surgeons and there are absolutely some institutions who will not participate.

話雖如此，絕對有一些外科醫生，絕對有一些機構不會參加。

There are some folks who believe in the value proposition and see the benefits it's bringing, and bringing to them its patients.

有些人相信價值主張，看到了它帶來的好處，並為他們帶來了患者。

We've had some centers have great growth in their admissions.

我們有一些中心的招生人數有很大的增長。

But there are some who are on the sidelines and may stay on the sidelines.

但也有一些人在場邊，可能會留在場邊。

So I think it's going to split the field for some time.

所以我認為它會在一段時間內分裂這個領域。

How far it penetrates and how long -- I think that remains to be seen.

它滲透多遠和多長時間——我認為這還有待觀察。

I think there's a segment of patients that value it.

我認為有一部分患者重視它。

I think there's a segment of surgeons who value it and who are gaining experience rapidly.

我認為有一部分外科醫生重視它並且正在迅速獲得經驗。

But trying to call where the end is is not something we can do.

但試圖找出終點在哪裡不是我們能做的。

And with respect to the broader category that you outlined, and I think there's really two things to think about, or two ways to think about it.

關於您概述的更廣泛的類別，我認為確實有兩件事要考慮，或者有兩種考慮方式。

One is the absolute contribution of the individual procedure.

一是個體程序的絕對貢獻。

So, for example, on a distal pancreatectomy or on a liver procedure, a spleen procedure, esophageal, they are going to contribute in the form of INE.

因此，例如，在遠端胰腺切除術或肝臟手術、脾臟手術、食道手術中，它們將以 INE 的形式發揮作用。

But really, the hidden power there is the combination of strength from the surgeons that are performing a lot of the benign operations coupled with the strength of the surgeons who are seeing demand in things like colorectal, distal pancreatectomy, collectively getting together into the system purchasing suite or decision is also pretty powerful.

但實際上，隱藏的力量是執行大量良性手術的外科醫生的力量與看到結直腸、遠端胰腺切除術等需求的外科醫生的力量相結合，共同參與系統採購套件或決策也很強大。

So we don't really per se value them as one for one.

因此，我們本身並不真正將它們視為一對一。

I think the broader you go between malignant and cancer -- I should say malignant and benign -- the more strength you see in terms of placing systems out of that particular vertical, which we saw in gynecology and we saw in neurology, as well.

我認為你在惡性和癌症之間的範圍越廣——我應該說惡性和良性——在將系統置於特定垂直之外的方面，你看到的力量就越大，我們在婦科和神經病學中也看到了這一點。

Tycho, we will give you one last follow-up here.

第谷，我們將在這裡給你最後一次跟進。

Just on Japan, can you talk about how the growth trajectory is going to change in the absence of the new procedures?

就日本而言，您能談談在沒有新程序的情況下增長軌跡將如何變化嗎？

And you alluded to the fact that they are looking for Japan-specific data, so you probably won't get the reimbursement code, but is that a definitive decision at this point that you won't get it?

你提到他們正在尋找日本特定的數據，所以你可能不會得到報銷代碼，但在這一點上你不會得到它是一個明確的決定嗎？

It is not definitive, but the conversation is ongoing.

這不是確定的，但對話仍在進行中。

And per our statements, we think that broad approvals across multiple procedures are unlikely.

根據我們的聲明，我們認為跨多個程序的廣泛批准不太可能。

I can describe the process.

我可以描述這個過程。

What the growth rate looks like, I think, is hard to predict.

我認為，增長率看起來很難預測。

Process-wise, we will submit data for the surgical societies.

在流程方面，我們將為外科協會提交數據。

They will in turn work with MHLW.

他們將依次與 MHLW 合作。

MHLW may require them to solicit and collect data in Japan.

MHLW 可能會要求他們在日本徵集和收集數據。

That may involve a partial reimbursement for certain number of centers.

這可能涉及對某些中心的部分報銷。

And if so, then that will start the process of data collection for a group of hospitals in Japan.

如果是這樣，那麼這將開始為日本的一組醫院收集數據。

How many and how many procedures concurrently, we don't have resolution on yet.

有多少程序同時進行，我們還沒有解決辦法。

But as I said before, as we get closer to it, we will share it with you.

但正如我之前所說，隨著我們越來越接近它，我們將與您分享。

Okay, thank you.

好的謝謝你。

Okay.

好的。

That was our last question.

那是我們的最後一個問題。

I'd like to close with a letter we received this week from a surgeon and a medical director at one of the US academic centers.

我想以我們本週收到的一封來自美國一個學術中心的外科醫生和醫療主任的信作為結尾。

We talk about our finances and cash flow and so on, but it sort of takes us back to what the value of our products is.

我們談論我們的財務和現金流等等，但這有點讓我們回到我們產品的價值是什麼。

And so this came from a surgeon and medical director.

所以這來自外科醫生和醫療主任。

Quote, the work you are doing is touching patients' lives.

引述，你所做的工作是觸及病人的生命。

It is healing them and getting them better.

它正在治愈他們並使他們變得更好。

You cannot put a price on curing someone of their cancer and doing it with minimal change to their life.

你不能為治愈某人的癌症付出代價，並在對他們的生活改變最小的情況下做到這一點。

It is priceless.

它是無價的。

Let that inspire you to go ahead and continue the innovation to lead surgery into the future.

讓這激勵您繼續前進並繼續創新，引領外科手術走向未來。

Patients are your partners in this endeavor.

在這項工作中，患者是您的合作夥伴。

Sure, everything can be refined and everything can be improved, but you only get one chance sometimes to cure someone of their cancer.

當然，一切都可以改進，一切都可以改進，但有時你只有一次機會治愈某人的癌症。

Your technology has given me a step up in that pursuit.

你的技術讓我在追求上更上一層樓。

Companies that help us change patients' lives will survive and prosper.

幫助我們改變患者生活的公司將會生存和繁榮。

End quote.

結束報價。

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, and we look forward to talking with you again in 3 months.

我們感謝您參與和支持這次改善手術的非凡旅程，我們期待在 3 個月後再次與您交談。

Ladies and gentlemen, that does conclude our 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.

感謝您的參與和使用 AT&T 行政電話會議服務。

You may now disconnect.

您現在可以斷開連接。