直覺手術 (ISRG) 2013 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by and welcome to the Intuitive Surgical Q3 2013 earnings release conference call.

女士們先生們，感謝您的支持並歡迎參加 Intuitive Surgical 2013 年第三季度財報電話會議。

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

此時，所有參與者都處於只聽模式。

Later, we will conduct a question-and-answer session and instructions will be given at that time.

稍後，我們將進行問答環節，屆時將給出說明。

(Operator Instructions).

（操作員說明）。

Also as a reminder, today's teleconference is being recorded.

另外提醒一下，今天的電話會議正在錄製中。

At this time, I will turn the conference call over to your host, Senior Director of Finance for Intuitive Surgical, Mr. Calvin Darling.

此時，我會將電話會議轉交給您的主持人，Intuitive Surgical 財務高級總監 Calvin Darling 先生。

Please go ahead sir.

請先生繼續。

Thank you.

謝謝你。

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

下午好，歡迎參加 Intuitive Surgical 第三季度財報電話會議。

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.

今天和我在一起的有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 included in our most recent Form 10-K filed on February 4, 2013, and our Form 10-Q filed on July 22, 2013.

這些風險和不確定性在公司於 2013 年 2 月 4 日提交的最新 10-K 表格和 2013 年 7 月 22 日提交的 10-Q 表格中詳細描述了公司的證券交易委員會文件。

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在 SEC 的 EDGAR 數據庫中找到。

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 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 highlights of our third-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三季度業績的亮點，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 third-quarter financial results.

Marshall 將對我們的第三季度財務業績進行審查。

Aleks will discuss marketing and clinical highlights.

Aleks 將討論營銷和臨床亮點。

Then I will provide an update to our financial forecast for 2013.

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。

This quarter, we continued to see significant pressure on our US business.

本季度，我們的美國業務繼續面臨巨大壓力。

Trends that started in the first half of the year in gynecology have continued.

今年上半年開始的婦科趨勢仍在繼續。

On the procedure side, underlying causes for slowing growth include weaker overall gynecologic admissions which is pressuring surgical volume.

在手術方面，增長放緩的根本原因包括整體婦科入院人數減少，這給手術量帶來了壓力。

There are also lingering ill-founded concerns regarding the benefits of da Vinci surgery compared to the available surgical alternatives.

與現有的手術替代方案相比，達芬奇手術的益處也存在著揮之不去的毫無根據的擔憂。

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

由於我們是子宮切除術的重要組成部分，我們的增長率對這些問題很敏感。

This slowed growth has resulted in capacity in our US installed base, combined with changes in hospital capital spending associated with the implementation of the Affordable Care Act, US capital sales fell substantially compared to prior year.

這種增長放緩導致我們在美國安裝基礎的容量增加，加上與實施“平價醫療法案”相關的醫院資本支出變化，美國資本銷售與去年相比大幅下降。

Overall procedure trends in the quarter were stable, rising 16% over prior year.

本季度的整體程序趨勢穩定，比去年同期增長 16%。

In the United States, general surgery was our fastest-growing segment led by Single-Site cholecystectomy and followed by growth in colon and rectal resections.

在美國，普通外科手術是我們增長最快的部分，以單部位膽囊切除術為主導，其次是結腸和直腸切除術。

Our gynecology business still grew year-over-year, but at a slower pace than prior quarters, and urologic procedures in the US were stable compared to prior year.

我們的婦科業務仍同比增長，但增速低於前幾個季度，美國的泌尿外科手術與去年相比保持穩定。

In Europe, we are continuing our investments in market access and clinical research.

在歐洲，我們將繼續投資於市場准入和臨床研究。

We are seeing early positive results in HTA and reimbursement analyses as a consequence of these efforts.

由於這些努力，我們在 HTA 和報銷分析中看到了早期的積極成果。

Year-over-year procedure growth accelerated, led by urology and other growth in malignant gynecology.

在泌尿科和惡性婦科的其他增長的帶動下，手術同比增長加速。

Growth was strongest in the UK, France, Italy, and the Nordic countries.

英國、法國、意大利和北歐國家的增長最為強勁。

Procedure growth in Asia with solid off a small base led by growth in urology and general surgery.

在泌尿外科和普通外科的增長帶動下，亞洲的手術增長以小基數為基礎。

With regard to resolution of our FDA warning letter, we are making good progress in addressing the elements of the letter and the Form 483 that preceded it.

關於解決我們的 FDA 警告信，我們在處理這封信的內容和之前的 483 表格方面取得了良好進展。

As part of our work in responding to the letter, we expect to file corrections and updates to our labeling and to file documentation for some past field actions.

作為我們對這封信的回復工作的一部分，我們希望對我們的標籤進行更正和更新，並為過去的一些現場行動提交文件。

These activities will be documented on the FDA's website over the next several weeks.

這些活動將在接下來的幾週內記錄在 FDA 的網站上。

Turning to our operating performance for the third quarter, procedures grew approximately 16% over the third quarter of 2012.

談到我們第三季度的經營業績，程序比 2012 年第三季度增長了約 16%。

We sold 101 da Vinci surgical systems, down from 155 during the third quarter of last year.

我們售出了 101 台達芬奇手術系統，低於去年第三季度的 155 台。

Total revenue was $499 million, down 7% from last year.

總收入為 4.99 億美元，比去年下降 7%。

Instrument and accessory revenue was $239 million, up 10% over Q3 2012.

儀器和配件收入為 2.39 億美元，比 2012 年第三季度增長 10%。

Total recurring revenue grew to $341 million, up 11% from prior year and comprising 68% of total revenue.

經常性總收入增長至 3.41 億美元，比上年增長 11%，佔總收入的 68%。

Net income was $157 million, down 14% over last year.

淨收入為 1.57 億美元，比去年下降 14%。

And we generated an operating profit of $225 million before non-cash stock option expense, down 13% from the third quarter of last year and representing 45% of Q3 revenue.

在扣除非現金股票期權費用之前，我們的營業利潤為 2.25 億美元，比去年第三季度下降 13%，佔第三季度收入的 45%。

We ended the quarter with $2.532 billion in cash and investments, down $495 million from last quarter.

我們在本季度末的現金和投資為 25.32 億美元，比上一季度減少了 4.95 億美元。

In the quarter, we generated $204 million in gross cash flow from operations and we repurchased $694 million of our stock.

本季度，我們從運營中產生了 2.04 億美元的總現金流，我們回購了 6.94 億美元的股票。

Our new products continue to gain acceptance with customers.

我們的新產品不斷獲得客戶的認可。

We expanded our stapling rollout at a measured pace through the first three quarters of this year.

在今年的前三個季度，我們以有節制的速度擴大了訂書釘的推廣。

Surgeons' clinical feedback on the stapler has been strong and our stapling operations depth has increased substantially.

外科醫生對吻合器的臨床反饋非常強烈，我們的吻合器操作深度大幅增加。

We will accelerate the stapling launch in Q4 and beyond.

我們將在第 4 季度及以後加速推出主要業務。

This quarter, we received FDA clearance for an expanded indication of our Firefly system to include biliary imaging in combination with normal white light imaging during cholecystectomy.

本季度，我們獲得了 FDA 的批准，以擴大我們的 Firefly 系統的適應症，包括膽囊切除術期間膽道成像與正常白光成像相結合。

This is another step in providing surgeons with imaging capability that enables them to see anatomical structure beyond what can be seen with the naked eye.

這是為外科醫生提供成像能力的又一步，使他們能夠看到肉眼無法看到的解剖結構。

Our Single-Site product line continues to perform well.

我們的單站點產品線繼續表現良好。

Single-Site cholecystectomy is moving out of early adopting centers into the broader clinical practice.

單點膽囊切除術正在從早期採用中心轉移到更廣泛的臨床實踐中。

Single-Site for hysterectomy progressed during the quarter while on limited release.

單點子宮切除術在本季度取得了進展，但發行量有限。

As part of this limited release, customers have requested an additional instrument, a wrist needle driver to complement the product line.

作為此次限量發行的一部分，客戶要求提供額外的儀器，即腕式針頭驅動器，以補充產品線。

We have designed it, are testing it and plan to submit an application in early Q1 to the US FDA for 510(k) clearance.

我們已經設計了它，正在對其進行測試，併計劃在第一季度初向美國 FDA 提交申請以獲得 510(k) 許可。

We believe the addition of a wrist to Single-Site instruments will optimize the procedure for surgeons who expect EndoWrist functionality.

我們相信，在 Single-Site 器械上增加手腕將優化希望使用 EndoWrist 功能的外科醫生的手術過程。

Our Single-Site products are well positioned to deliver increased patient satisfaction with reasonable economics for single incision surgery.

我們的 Single-Site 產品能夠以合理的經濟性為單切口手術提供更高的患者滿意度。

We have great confidence in the safety, efficacy and cost effectiveness of our products and we remain deeply positive on the value da Vinci brings to surgery now and in the future.

我們對我們產品的安全性、有效性和成本效益充滿信心，我們對達芬奇現在和未來為外科手術帶來的價值深表樂觀。

The benefit da Vinci brings as an alternative to open surgery has been demonstrated in hundreds of independent peer reviewed clinical papers.

數百篇獨立的同行評審臨床論文證明了達芬奇作為開放手術的替代方案所帶來的好處。

Increasingly, well-designed cost studies demonstrate that upfront and operating investments in da Vinci surgery are offset by downstream savings resulted from fewer complications, readmissions and length of stay.

越來越多的精心設計的成本研究表明，達芬奇手術的前期和運營投資被並發症、再入院和住院時間減少所帶來的下游節省所抵消。

We have recently updated IntuitiveSurgical.com with links to high level of evidence clinical data and adverse event data, and in the next few days we'll add abstracts of well-designed peer-reviewed cost studies comparing da Vinci surgery to open surgery alternatives.

我們最近更新了 IntuitiveSurgical.com，其中包含高水平證據臨床數據和不良事件數據的鏈接，在接下來的幾天裡，我們將添加精心設計的同行評審成本研究的摘要，將達芬奇手術與開放手術替代方案進行比較。

We encourage a full and careful examination of the literature by anyone interested in the facts about da Vinci use.

我們鼓勵任何對達芬奇使用事實感興趣的人對文獻進行全面而仔細的檢查。

In summary, we continue to see substantial long-term opportunity to fundamentally improve surgery using our technologies.

總之，我們繼續看到使用我們的技術從根本上改善手術的大量長期機會。

and we are focused on the following -- first, educating the surgical community on the facts about da Vinci surgery, including its safety, efficacy and cost effectiveness; next, building da Vinci capability and supporting its use in general surgery; extending the benefits of minimally invasive surgery using da Vinci in gynecology and urology worldwide; and disciplined execution in expanding our stapling and Single-Site adoption.

我們專注於以下方面——首先，向外科界宣傳有關達芬奇手術的事實，包括其安全性、有效性和成本效益；其次，建設達芬奇能力並支持其在普外科中的應用；擴大使用達芬奇在全球婦科和泌尿科進行微創手術的益處；在擴大我們的裝訂和單站點採用方面有紀律地執行。

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.

謝謝加里。

Our third-quarter 2013 revenue was $499 million, down 7% compared with $538 million for the third quarter of 2012, and down 14% from last quarter.

我們 2013 年第三季度的收入為 4.99 億美元，比 2012 年第三季度的 5.38 億美元下降 7%，比上一季度下降 14%。

Third-quarter revenues per product category were as follows.

第三季度每個產品類別的收入如下。

Third-quarter Instrument and Accessory revenue was $239 million, up 10% compared with $218 million for the third quarter of 2012 and down 10% compared with the second quarter of 2013.

第三季度儀器和配件收入為 2.39 億美元，與 2012 年第三季度的 2.18 億美元相比增長 10%，與 2013 年第二季度相比下降 10%。

The year-over-year increase in Instrument and Accessory revenue was driven by procedure growth of approximately 16%.

儀器和附件收入的同比增長是由大約 16% 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 fewer system sales, and the timing of customer orders.

新產品的銷售，包括 Single-Site、Vessel Sealer 和 Firefly，部分被與系統銷售減少相關的儀器和配件庫存訂單減少以及客戶訂單的時間安排所抵消。

The sequential decrease in Instrument and Accessory revenue was driven by lower Instrument and Accessory stocking orders and the timing of customer orders.

儀器和附件收入的連續下降是由於儀器和附件庫存訂單減少以及客戶訂單的時間安排。

The 16% increase in da Vinci procedures for the quarter reflected growth in general surgery and gynecology procedures in the US, and urology procedures outside of the US.

本季度達芬奇手術增加了 16%，這反映了美國普通外科和婦科手術以及美國以外泌尿科手術的增長。

The lower third-quarter growth rate reflects slower growth in US benign gynecologic procedures and flat US DVP volumes.

第三季度較低的增長率反映了美國良性婦科手術增長放緩和美國 DVP 數量持平。

Factors affecting US benign gynecologic procedures include reduced hospital admissions, a trend by payors toward encouraging conservative disease management and treatment in outpatient settings, and negative media reports.

影響美國良性婦科手術的因素包括住院人數減少、支付者傾向於在門診環境中鼓勵保守的疾病管理和治療，以及媒體的負面報導。

Instrument and Accessory revenue realized per procedure, including initial stocking orders, was approximately $1860 per procedure compared to $1980 per procedure in the third quarter of 2012, and $2020 last quarter.

每次手術實現的儀器和附件收入（包括初始庫存訂單）約為 1860 美元，而 2012 年第三季度和 2020 年第三季度的每次手術收入分別為 1980 美元和 2020 美元。

Our third-quarter 2013 revenue per procedure reflected fewer stocking orders associated with fewer system sales and the timing of customer orders.

我們 2013 年第三季度每個程序的收入反映了與更少的系統銷售和客戶訂單時間相關的庫存訂單減少。

Third-quarter 2013 systems revenue of $159 million decreased 32% compared with $232 million for the third quarter of 2012 and decreased 27% compared with $216 million last quarter.

2013 年第三季度系統收入為 1.59 億美元，與 2012 年第三季度的 2.32 億美元相比下降了 32%，與上一季度的 2.16 億美元相比下降了 27%。

Overall, we sold 101 systems in the third quarter of 2013 compared with 155 systems last year and 143 systems last quarter.

總體而言，我們在 2013 年第三季度售出了 101 台系統，而去年為 155 台，上季度為 143 台。

We sold 65 systems into the US market in the third quarter of 2013 compared with 114 systems last year and 90 systems last quarter.

我們在 2013 年第三季度向美國市場銷售了 65 台系統，而去年為 114 台，上季度為 90 台。

The lower third-quarter 2013 US system sales reflected, among other things, the impacts of moderating growth in US benign gynecologic procedures, increased economic pressure on hospitals, uncertainty related to and spending associated with the Affordable Care Act, and negative media reports.

2013 年第三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、醫院經濟壓力增加、與平價醫療法案相關的不確定性和相關支出以及負面媒體報導的影響。

During the third quarter of 2013, we sold 36 systems in the international market, including 17 into Europe and 13 into Japan, compared with 41 into international markets in the third quarter of 2012, which included 13 into Europe and 16 into Japan, and 53 systems in international markets in the second quarter of 2013, which included 21 into Europe and 20 into Japan.

2013年第三季度，我們在國際市場銷售了36台系統，其中歐洲17台，日本13台，而2012年第三季度國際市場41台，其中歐洲13台，日本16台，日本53台。 2013 年第二季度國際市場的系統，其中包括 21 個進入歐洲和 20 個進入日本。

Our third-quarter average sales price per system was $1.56 million compared with $1.48 million realized in the third quarter of 2012, and $1.5 million realized last quarter.

我們第三季度每個系統的平均銷售價格為 156 萬美元，而 2012 年第三季度實現了 148 萬美元，上一季度實現了 150 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），不包括升級。

Our higher third-quarter 2013 ASPs were driven by a higher proportion of dual console configurations and geographic sales mix.

我們較高的 2013 年第三季度 ASP 是由較高比例的雙控制台配置和地理銷售組合推動的。

29 of our third-quarter 2013 systems involve trade-ins compared with 34 trade-ins last year and 43 trade-ins last quarter.

我們 2013 年第三季度的系統中有 29 個涉及以舊換新，而去年有 34 個以舊換新，上季度有 43 個以舊換新。

Service revenue increased to $101 million, up 16% compared with $88 million last year and up 3% compared with $98 million last quarter.

服務收入增至 1.01 億美元，比去年的 8800 萬美元增長 16%，比上一季度的 9800 萬美元增長 3%。

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

服務收入的增長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。

Third-quarter revenue outside the US was $133 million, up 15% compared with revenue of $115 million in the third quarter of last year, and down 16% compared with revenue of $158 million last quarter.

第三季度美國以外的收入為 1.33 億美元，與去年第三季度的 1.15 億美元相比增長 15%，與上季度的 1.58 億美元相比下降 16%。

Our higher year-over-year international revenue was driven by higher recurring instrument, accessory, and service revenue, partially offset by lower systems sales.

我們較高的國際收入同比增長是由較高的經常性儀器、配件和服務收入推動的，但部分被較低的系統銷售額所抵消。

Our lower sequential international revenue primarily reflects summer seasonality.

我們較低的連續國際收入主要反映了夏季的季節性。

Third-quarter 2013 international procedure volume was approximately 25% higher than the third quarter of 2012 and 6% lower than the second quarter of this year.

2013 年第三季度的國際程序量比 2012 年第三季度高出約 25%，比今年第二季度低 6%。

The growth over the prior year reflects DVP growth in Europe and Japan.

與上一年相比的增長反映了歐洲和日本的 DVP 增長。

The decrease compared to last quarter reflects summer seasonality patterns in Europe.

與上一季度相比的下降反映了歐洲夏季的季節性模式。

Moving onto the remainder of the P&L, gross margin in the third quarter of 2013 was 71.5% compared with 72.5% for the third quarter of 2012 and 70% for the second quarter of 2013.

考慮到損益表的其餘部分，2013 年第三季度的毛利率為 71.5%，而 2012 年第三季度為 72.5%，2013 年第二季度為 70%。

Our lower margin percentage compared to the third quarter of last year resulted primarily from the impact of the medical device excise tax.

與去年第三季度相比，我們較低的利潤率百分比主要是由於醫療器械消費稅的影響。

Our higher gross margin percentage compared to last quarter was driven primarily by higher system ASPs.

與上一季度相比，我們較高的毛利率百分比主要是由較高的系統 ASP 推動的。

Third-quarter 2013 operating expenses of $183 million were up 2% compared with last year, and down 2% compared with last quarter.

2013 年第三季度的運營費用為 1.83 億美元，比去年同期增長 2%，比上一季度下降 2%。

Our higher year-over-year operating expense was driven by headcount additions, partially offset by lower incentive compensation and lower R&D prototype expenses.

我們較高的同比運營費用是由員工人數增加推動的，部分被較低的激勵薪酬和較低的研發原型費用所抵消。

Our decrease compared to last quarter was driven by lower incentive compensation, partially offset by stock compensation expenses.

與上一季度相比，我們的減少是由較低的激勵薪酬推動的，部分被股票薪酬費用所抵消。

Third-quarter 2013 operating income was $174 million, or 35% of sales, compared with $211 million, or 39% of sales, last year and $219 million, or 38% of sales, last quarter.

2013 年第三季度營業收入為 1.74 億美元，佔銷售額的 35%，而去年同期為 2.11 億美元，佔銷售額的 39%，上一季度為 2.19 億美元，佔銷售額的 38%。

Third-quarter 2013 operating income included $50 million of non-cash stock compensation expense compared with $47 million last year and $39 million last quarter.

2013 年第三季度的營業收入包括 5000 萬美元的非現金股票補償費用，而去年同期為 4700 萬美元，上一季度為 3900 萬美元。

The increase in stock compensation expense relative to the prior quarter has to do with the timing of stock option grants and a related vesting period.

與上一季度相比，股票補償費用的增加與授予股票期權的時間和相關的歸屬期有關。

Our effective tax rate for the third quarter was 12% compared with 15% for the third quarter of 2012 and 28.6% last quarter.

我們第三季度的有效稅率為 12%，而 2012 年第三季度為 15%，上一季度為 28.6%。

Both the third quarter of 2013 and the third quarter of 2012 tax rates benefited from the release of reserves specific to tax years where the statute of limitations have now expired.

2013 年第三季度和 2012 年第三季度的稅率均受益於針對時效已到期的納稅年度的特定準備金的釋放。

Excluding one-time benefits, our third-quarter 2013 tax provision would have been approximately $26 million higher and our third-quarter 2012 tax provision would have been approximately $35 million higher.

不計一次性福利，我們 2013 年第三季度的稅收準備金將增加約 2600 萬美元，而我們 2012 年第三季度的稅收準備金將增加約 3500 萬美元。

Our net income was $157 million, or $3.99 per share, compared with $183 million, or $4.46 per share, for the third quarter of 2012, and $159 million, or $3.90 per share, for the second quarter of 2013.

我們的淨收入為 1.57 億美元，即每股 3.99 美元，而 2012 年第三季度為 1.83 億美元，即每股 4.46 美元，2013 年第二季度為 1.59 億美元，即每股 3.90 美元。

Excluding the one-time tax benefits, our third-quarter 2013 net income would've been $131 million, or $3.32 per share, and our third-quarter 2012 net income would've been $148 million, or $3.61 per share.

排除一次性稅收優惠，我們 2013 年第三季度的淨收入為 1.31 億美元，即每股 3.32 美元，我們 2012 年第三季度的淨收入為 1.48 億美元，即每股 3.61 美元。

Now, moving to cash flows, we ended the third quarter with cash and investments of $2.5 billion, down $495 million compared with June 30, 2013.

現在，轉向現金流，我們在第三季度末的現金和投資為 25 億美元，與 2013 年 6 月 30 日相比減少了 4.95 億美元。

The decrease was driven by $694 million used to repurchase our common stock and $34 million of capital and IP acquisitions, partially offset by $204 million in cash flow generated from operations.

減少的原因是用於回購我們的普通股的 6.94 億美元以及 3400 萬美元的資本和知識產權收購，部分被運營產生的 2.04 億美元現金流所抵消。

During the third quarter, we bought back approximately 1.74 million shares at an average price of $399 per share.

第三季度，我們以每股 399 美元的平均價格回購了大約 174 萬股股票。

We ended the quarter with approximately $1 billion authorized by the Board for future share buybacks.

我們在本季度末獲得了董事會授權用於未來股票回購的約 10 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.

謝謝馬歇爾。

During the third quarter, we sold 101 da Vinci systems, 65 in the United States, 17 into Europe and 19 in rest-of-world markets.

在第三季度，我們售出了 101 台達芬奇系統，其中 65 台在美國，17 台銷往歐洲，19 台銷往世界其他市場。

As part of the 101 system sales, five standard da Vinci systems and 24 da Vinci S systems were traded in for credit against sales for new da Vinci Si Systems.

作為 101 系統銷售的一部分，5 個標準 da Vinci 系統和 24 個 da Vinci S 系統被換成新 da Vinci Si 系統的銷售信用。

We finished the quarter with a net 72 system additions to the installed base, bringing to 2871 the cumulative number of da Vinci systems worldwide, 2042 in the US, 455 in Europe, and 374 in rest-of-world markets.

本季度末，我們在安裝基礎上新增了 72 個系統，使全球達芬奇系統的累計數量達到 2871 個，美國為 2042 個，歐洲為 455 個，世界其他市場為 374 個。

48 of the 101 systems installed during the quarter represented repeat system sales to existing customers.

本季度安裝的 101 個系統中有 48 個代表對現有客戶的重複系統銷售。

In total, 100 of the 101 systems sold represented da Vinci Si or Si-e systems, which included 32 dual consoles.

總共售出的 101 個系統中有 100 個代表 da Vinci Si 或 Si-e 系統，其中包括 32 個雙控制台。

The 36 system sales internationally included 13 into Japan and six into France.

36 個系統在國際上銷售，其中 13 個銷往日本，6 個銷往法國。

Clinically, Q3 year-over-year procedure growth was approximately 16%, which was led by the category of general surgery and paved by cholecystectomy, followed by colon-rectal resections and bariatric procedures.

臨床上，第三季度手術同比增長約 16%，其中以普通外科手術為主，膽囊切除術鋪平了道路，其次是結腸直腸切除術和減肥手術。

Our US urology business was stable, while growth in the international urology business was solid.

我們的美國泌尿外科業務穩定，而國際泌尿外科業務增長穩健。

As expected, the growth rate in the US for the nine dVH was slightly down from Q2, which continued to place pressure on US system sales.

正如預期的那樣，9 dVH 在美國的增長率比第二季度略有下降，這繼續對美國系統銷售構成壓力。

Demand for recently released new products continues to be strong.

對最近發布的新產品的需求繼續強勁。

Through Q3 2013, we sold Single-Site instrument accessory kits to approximately 825 US customers.

截至 2013 年第三季度，我們向大約 825 名美國客戶銷售了單點儀器附件套件。

Our vessels dealer product utilization trend continues to strengthen, with most of interest coming from the specialties of colorectal, advanced general and GYN surgery.

我們的船舶經銷商產品使用趨勢繼續加強，其中大部分興趣來自結直腸、高級普通和婦科手術。

The customer adoption for both da Vinci simulator and Firefly continues to expand with 63 customers purchasing a da Vinci simulator and 48 customers purchasing Firefly systems as part of their initial system purchases this quarter.

達芬奇模擬器和 Firefly 的客戶採用率繼續擴大，本季度有 63 位客戶購買了達芬奇模擬器，48 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 extended in a measured fashion, so we do not expect them to contribute materially in the near term.

這些部署將以有節制的方式進行擴展，因此我們預計它們不會在短期內做出實質性貢獻。

During the quarter, several hundred robotic abstracts and papers representing a variety of surgical specialties were published within peer reviewed journals, many focused specifically on safety and/or efficacy.

在本季度，數百篇代表各種外科專業的機器人摘要和論文發表在同行評審期刊上，其中許多專門關注安全性和/或有效性。

Clinical conferences also produced several wide da Vinci procedure transmissions, postgraduate robotic courses, podium presentations, and clinical poster sessions, several with emphasis on safety and/or efficacy.

臨床會議還產生了幾個廣泛的達芬奇程序傳輸、研究生機器人課程、講台演示和臨床海報會議，其中一些會議強調安全性和/或有效性。

I'll take a moment to summarize with you.

我會花一點時間和你總結一下。

Da Vinci hysterectomy is the single largest procedure that our customers perform.

達芬奇子宮切除術是我們的客戶執行的最大的單一手術。

It is widely accepted that, when compared to open hysterectomy, the benefits provided to a patient through an MIS approach are significant.

人們普遍認為，與開放式子宮切除術相比，通過 MIS 方法為患者提供的益處是顯著的。

As the data supports, the rapid conversion to open hysterectomy to a minimally invasive approach continues to be led by da Vinci's incorporation into GYN practices.

正如數據所支持的那樣，從開放式子宮切除術到微創方法的快速轉換繼續由達芬奇納入 GYN 實踐引領。

In a recent edition of the Journal of the Society of Laparoscopic Surgery, a group out of the Department of Obstetrics and Gynecology at Yale University published a study entitled "Robotic Versus Abdominal Hysterectomy in Women With Very Large Uteri".

在最近一期的《腹腔鏡外科學會雜誌》上，耶魯大學婦產科的一個小組發表了一項題為“機器人與腹腔子宮切除術在子宮非常大的女性中”的研究。

The study compared the results of 60 hysterectomies, 30 abdominal and 30 DVHs in patients with uteri greater than 1000 grams in weight.

該研究比較了子宮重量大於 1000 克的患者的 60 次子宮切除術、30 次腹部切除術和 30 次 DVH 的結果。

It is generally understood that the larger the uterus, the more complex the surgery, often necessitating an abdominal hysterectomy.

一般認為，子宮越大，手術越複雜，通常需要進行腹部子宮切除術。

On a statistical scale, uteri in excess of 1000 grams are considered very large.

在統計尺度上，超過 1000 克的子宮被認為是非常大的。

The uteri in both cohorts studied ranged in size from between 1000 to just over 3500 grams.

研究的兩個隊列中的子宮大小從 1000 克到剛剛超過 3500 克不等。

The published results were as follows.

公佈的結果如下。

Median length of hospitalization for patients in the da Vinci cohort was one day, with a range from one to two days, as compared to 2.5 days with a range from two to nine days for patients in the abdominal cohort.

達芬奇隊列患者的住院時間中位數為 1 天，範圍為 1 至 2 天，而腹部隊列患者的住院時間為 2.5 天，範圍為 2 至 9 天。

Estimated blood loss was 150 milliliters for the da Vinci patient versus 425 milliliters through the abdominal approach.

達芬奇患者的估計失血量為 150 毫升，而通過腹部方法的失血量為 425 毫升。

Transfusion rates for the da Vinci cohort was 3.3% versus 13.3% with the abdominal approach.

達芬奇隊列的輸血率為 3.3%，而腹部輸血率為 13.3%。

Conversion rates from da Vinci hysterectomy to an abdominal surgery was zero, as was the hernia rate.

從達芬奇子宮切除術到腹部手術的轉化率為零，疝氣發生率也是如此。

In their commentary, the authors pointed out the following findings.

在他們的評論中，作者指出了以下發現。

First, hysterectomies for very large uteri are challenging procedures.

首先，非常大的子宮的子宮切除術是具有挑戰性的手術。

Second, obesity and morbid obesity and/or previous surgeries compound the difficulty.

其次，肥胖和病態肥胖和/或以前的手術使困難更加複雜。

Despite these challenges, patients who are obese experience some of the greatest differential benefits for minimally invasive surgery.

儘管存在這些挑戰，肥胖患者仍能體驗到微創手術帶來的最大差異化益處。

Finally, morbid obesity and/or previous procedures appear to not be an impediment for completing these procedures robotically.

最後，病態肥胖和/或以前的程序似乎不是機器人完成這些程序的障礙。

Within general surgery, procedures related to the colon and rectal disease management have been among our most promising.

在普通外科手術中，與結腸和直腸疾病管理相關的手術一直是我們最有前途的手術之一。

Right and left colon resections, sigmoid resections, low anterior resections and rectopexy continue to exhibit solid growth.

左右結腸切除術、乙狀結腸切除術、低位前切除術和直腸固定術繼續表現出堅實的增長。

With the exception of right-handed colectomy and rectopexy, laparoscopic penetration has been modest within colorectal surgery.

除了右手結腸切除術和直腸固定術外，腹腔鏡在結直腸手術中的滲透率一直很低。

Rectopexy is a procedure designed to address pelvic floor disorders, or PFDs.

直腸固定術是一種旨在解決盆底疾病或 PFD 的手術。

Among other things, PFDs obstruct a patient's ability to defecate.

除其他外，PFD 會阻礙患者排便的能力。

A recent French study compared the results of patients undergoing a laparoscopic rectopexy versus a da Vinci rectopexy.

法國最近的一項研究比較了接受腹腔鏡直腸固定術和達芬奇直腸固定術的患者的結果。

118 patients were evaluated in the study, 44 da Vinci as compared to 74 lap.

研究中評估了 118 名患者，達芬奇 44 圈與 74 圈相比。

The study evaluated OR time, blood loss, complications, length of hospitalization, and postoperative ODS scores for obstructive defecation syndrome.

該研究評估了阻塞性排便綜合徵的手術時間、失血量、並發症、住院時間和術後 ODS 評分。

Regarding total OR time, which included system time, the da Vinci rectopexy took approximately 15% longer than the laparoscopic approach, but the authors noted that their times came down over their last 20 patients and were expected to continue to trend up.

關於總手術時間（包括系統時間），達芬奇直腸固定術比腹腔鏡手術花費了大約 15% 的時間，但作者指出，他們的手術時間在過去 20 名患者中有所下降，並且預計將繼續呈上升趨勢。

Blood loss was difficult to even detect during the da Vinci rectopexy and measured only 8 milliliters as compared to 42 milliliters in the lap cohort.

在達芬奇直腸固定術期間甚至很難檢測到失血量，與膝關節組中的 42 毫升相比，失血量僅為 8 毫升。

Complications with the da Vinci approach were 2% as compared to 11% in the lap patients.

達芬奇方法的並發症為 2%，而膝關節患者為 11%。

Hospitalization was reduced by a full day when using da Vinci, which the authors attributed to a less strenuous tissue manipulation due to improved vision and dexterity.

使用達芬奇時住院時間減少了一整天，作者將其歸因於視力和靈巧度的提高，減少了組織操作的強度。

Post-op ODS scores improved for patients in both groups.

兩組患者的術後 ODS 評分均有所改善。

However, the difference in improvement for patients in the da Vinci cohort was substantial and deemed statistically significant.

然而，達芬奇隊列中患者的改善差異是巨大的，並且被認為具有統計學意義。

In their conclusions, the authors stated, and I quote, "Although not a randomized comparison, this study shows that ventral mesh rectopexy performed by a robot was followed by better function than lap rectopexy."

在他們的結論中，作者說，我引用，“雖然不是隨機比較，但這項研究表明，由機器人進行的腹側網狀直腸固定術比膝部直腸固定術具有更好的功能。”

Da Vinci thoracic procedures, specifically lobectomy and segmental resections had been steadily expanding over the past few years.

達芬奇胸外科手術，特別是肺葉切除術和節段切除術在過去幾年中一直在穩步擴大。

Similar to colon and rectal surgery, the presence of minimally invasive resection has been minor as compared to open surgery.

與結腸和直腸手術類似，與開放手術相比，微創切除術的存在較小。

In the recent edition of analysts of the Annals of Thoracic Surgery, physician and healthcare economists from both Harvard Medical School and Cornell Medical Center collaborated on the study which compared open surgery, video assisted thoracoscopy, or VATs, and da Vinci resections.

在最近一期的《胸外科年鑑》分析師中，哈佛醫學院和康奈爾醫學中心的醫生和醫療保健經濟學家合作開展了一項比較開放手術、視頻輔助胸腔鏡或 VATs 和達芬奇切除術的研究。

The study evaluated the results of over 33,000 patients who had received pulmonary resection within the eight-state study cohort.

該研究評估了八州研究隊列中超過 33,000 名接受肺切除術的患者的結果。

While the mix of patients was dominated by patients undergoing an open resection, the rate of growth for da Vinci surgery was significant over the three-year study period.

雖然患者的組合主要是接受開放性切除術的患者，但在三年的研究期間，達芬奇手術的增長率是顯著的。

Da Vinci expanded from 0.2 of the pulmonary resection studied in the first year to 3.4 by the third year, numbering 430 in total.

達芬奇從第一年研究的肺切除術的 0.2 增加到第三年的 3.4，總共 430 例。

Da Vinci procedures were performed in all states studied with 38 being performed in community hospitals.

達芬奇手術在所有研究的州進行，其中 38 例在社區醫院進行。

The results.

結果。

In a propensity matched analysis, da Vinci resections were associated with significant reductions in mortality, 0.2% versus 2.0% for open surgery.

在傾向匹配分析中，達芬奇切除與死亡率顯著降低相關，分別為 0.2% 和 2.0% 的開放手術。

Length of stay was 5.9 days for the da Vinci patients versus 8.2 days for the open surgery.

達芬奇患者的住院時間為 5.9 天，而開放手術為 8.2 天。

Overall complication rate was 43.8% for da Vinci versus 54.1% for open surgery.

達芬奇手術的總體並發症發生率為 43.8%，而開放手術為 54.1%。

These improvements were all considered statistically significant.

這些改進都被認為具有統計學意義。

In a propensity matched analysis versus VATs, da Vinci lobectomy demonstrated directional improvements in mortality and length of stay.

在與 VATs 的傾向匹配分析中，達芬奇肺葉切除術證明了死亡率和住院時間的定向改善。

In their summary, the authors wrote, and I quote, "Case volume for pulmonary resections have increased significantly during the study period of thoracic surgeons, and thoracic surgeons have been able to adopt the robotic approach safely.

在他們的總結中，作者寫道，我引用，“在胸外科醫生的研究期間，肺切除術的病例數量顯著增加，胸外科醫生已經能夠安全地採用機器人方法。

Robotic resection appears to be an appropriate alternative to VATs and is associated with improved outcomes compared with open thoracotomy."

機器人切除似乎是 VATs 的合適替代方案，與開胸手術相比，結果更好。”

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

我的發言到此結束，現在我將把時間交給 Calvin。

Thank you Aleks.

謝謝亞歷克斯。

I will be providing you with an update 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 non-cash 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 our full-year 2013 procedures to grow between 15% and 18% above 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 年全年的程序將比 2012 年執行的約 450,000 個程序的基數高出 15% 至 18%。

Now, with one quarter remaining in 2013, we are refining our estimate for full-year 2013 procedure growth to a range of between 16% and 17%.

現在，在 2013 年還剩四分之一的情況下，我們正在將 2013 年全年程序增長的估計調整為 16% 到 17% 之間的範圍。

Moving to revenues.

轉向收入。

As has been discussed earlier, several factors are pressuring our business, making it difficult to predict system sales volumes.

正如前面所討論的，有幾個因素正在給我們的業務帶來壓力，因此很難預測系統銷量。

On our last call, we projected full-year 2013 revenue to range from approximately flat to 7% growth.

在我們上次的電話會議上，我們預計 2013 年全年收入將增長約持平至 7%。

We now expect full-year revenue growth in the lower half of that range.

我們現在預計全年收入增長在該範圍的下半部分。

Turning to operating income, on our last call, we forecast operating income to fall within a range of between 37% and 38% of net revenue.

談到營業收入，在我們上次的電話會議上，我們預測營業收入將在淨收入的 37% 至 38% 之間。

We are taking steps to scale back our expenses while not compromising our longer-term expansion strategies.

我們正在採取措施縮減開支，同時不影響我們的長期擴張戰略。

We continue to anticipate full-year 2013 operating income to fall within a range of between 37% and 38% of revenue.

我們繼續預計 2013 年全年營業收入將在收入的 37% 至 38% 之間。

Now, with regard to non-cash stock compensation expenses, we're refining our forecast to between $169 million and $172 million for the year.

現在，關於非現金股票補償費用，我們將全年預測調整至 1.69 億美元至 1.72 億美元之間。

We expect Other Income, which is comprised mostly of interest income, to total between $16 million and $17 million in 2013.

我們預計 2013 年主要由利息收入組成的其他收入總額將在 1600 萬美元至 1700 萬美元之間。

With regard to income tax, as Marshall described, our Q3 tax rate benefited from nonrecurring discrete events.

關於所得稅，正如馬歇爾所描述的，我們第三季度的稅率受益於非經常性離散事件。

For Q4 2013, we'd expect our tax rate to be approximately 28% of pretax income, slightly lower than previously forecast primarily due to the geographic mix of our pretax income.

對於 2013 年第四季度，我們預計我們的稅率約為稅前收入的 28%，略低於先前的預測，主要是由於我們的稅前收入的地域組合。

Our share count for calculating EPS in Q3 2013 was approximately 39.3 million shares, declining 1.5 million shares in the quarter primarily due to buyback activities.

我們計算 2013 年第三季度每股收益的股票數量約為 3,930 萬股，該季度減少了 150 萬股，主要是由於回購活動。

In Q4, we expect our share count to decline approximately 600,000 shares further based upon the full-quarter impact of our Q3 buybacks.

根據我們第三季度回購對整個季度的影響，我們預計第四季度的股票數量將進一步減少約 600,000 股。

The actual Q4 share count will depend on several factors, including the magnitude and timing of additional share buybacks, if any.

第四季度的實際股票數量將取決於幾個因素，包括額外股票回購的規模和時間（如果有的話）。

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）。

Tycho Peterson, JPMorgan.

第谷彼得森，摩根大通。

Hi, thanks for taking my question.

您好，感謝您提出我的問題。

I guess, first of all, just given the change in procedures in [NAC] SRT, could you talk about whether we should be assuming that there will be US placements only if system utilization continues to increase sequentially?

我想，首先，考慮到 [NAC] SRT 程序的變化，您能否談談我們是否應該假設只有當系統利用率繼續按順序增加時才會有美國安置？

And how are you thinking about where system utilization could ultimately go in the next couple of years?

您如何看待未來幾年系統利用率最終會走向何方？

I think, in the near term the factors that place new systems will be a few, as you know.

我認為，如您所知，在短期內放置新系統的因素將很少。

So one of them is procedure growth.

所以其中之一是程序增長。

One of them is access to new technologies for folks who have older technology.

其中之一是為擁有舊技術的人提供新技術。

And then the last one is point of care where, in the hospital, they want to use the devices.

最後一個是護理點，在醫院裡，他們想使用這些設備。

And by far the biggest driver of those three is the procedure side.

到目前為止，這三者中最大的驅動力是程序方面。

So I think utilization, over time, I think people are going to look at it and look as capital owners to drive it up.

所以我認為利用率，隨著時間的推移，我認為人們會關注它並作為資本所有者來推動它。

It can be lumpy though.

雖然它可能是塊狀的。

I don't know that it has to progress linearly in terms of increases.

我不知道它必須在增加方麵線性發展。

As I said before, if you have an S platform and you want to have access to stapling, that requires and Si that can make changes as we go through.

正如我之前所說，如果你有一個 S 平台並且你想要訪問裝訂，這需要 Si 可以在我們經歷的過程中做出改變。

And then on Japan, given that you're not likely to have reimbursement for additional procedures until 2016, could you maybe talk about how you think about the trends there?

然後在日本，鑑於您在 2016 年之前不太可能獲得額外程序的報銷，您能否談談您如何看待那裡的趨勢？

Is there going to kind of a pause in investments beyond this initial round of placements (technical difficulty) procedures?

除了第一輪安置（技術難度）程序之外，投資是否會暫停？

I think, in terms of the process for reimbursement, just so everybody knows, that will be a set of clinical data collection that is going on out there.

我認為，就報銷流程而言，眾所周知，這將是一組正在進行的臨床數據收集。

And that will involve some hospitals getting limited approval from the government to collect that data.

這將涉及一些醫院獲得政府的有限批准來收集這些數據。

So we'll see that.

所以我們會看到的。

I think that capital sales by the broad market will be really lumpy in this period.

我認為這個時期大盤的資金拋售真的會很顛簸。

I think it will be very hard to predict accurately what the sales profile will look like as people go through that set of clinical data and trial data.

我認為當人們瀏覽那組臨床數據和試驗數據時，很難準確預測銷售概況會是什麼樣子。

I think the commentary from the Japanese market as to their interest is strong.

我認為日本市場對他們的興趣的評論很強烈。

Okay.

好的。

And one last one for Marshall, quickly on inventories.

最後一個給馬歇爾，很快就存貨了。

$200 million.

2億美元。

Can you comment on why they were that high?

你能評論他們為什麼這麼高嗎？

We run leadtimes that we provide to our suppliers, and for particularly the system itself.

我們運行我們提供給供應商的交貨時間，尤其是系統本身。

And we obviously didn't sell the number of systems we had anticipated until (technical difficulty) we are still taking that inventory in.

而且我們顯然沒有出售我們預期的系統數量，直到（技術難度）我們仍在盤點該庫存。

We don't think there's any exposure there.

我們認為那裡沒有任何曝光。

We're talking about Si, and Si is a very capable unit and capable of doing all of the surgeries we see in our near-term future.

我們談論的是 Si，Si 是一個非常有能力的單位，能夠完成我們在近期看到的所有手術。

Okay, thank you.

好的謝謝你。

Ben Andrew, William Blair.

本安德魯，威廉布萊爾。

Good afternoon.

下午好。

Maybe, Gary, talk a little bit about any shift in the spending plans that Calvin referred to, and if you can give us a little of the detail on that and over what time frame we might see that pull back.

也許，加里，談談卡爾文提到的支出計劃的任何轉變，如果你能給我們一些細節，以及在什麼時間範圍內我們可能會看到這種回調。

I think there are some things that make sense in the next quarter or two in terms of spending, some things that just scale with production volume and things like that that make a lot of sense.

我認為在下一兩個季度的支出方面有些事情是有意義的，有些事情會隨著產量的增加而增加，諸如此類的事情很有意義。

The other side is being careful in prioritizing the investments that we make, both in terms of prototype spending and in terms of expansion plans.

另一方面，在原型支出和擴張計劃方面，我們在優先考慮我們所做的投資時都很謹慎。

We have a pretty clear set of priorities in terms of the kinds of products and the markets we want to invest in.

在我們想要投資的產品種類和市場方面，我們有一套非常明確的優先事項。

We will not short those.

我們不會做空那些。

But for things that are perhaps a little further out or a little bit more on the edges, then we will be careful about where we put our investment.

但是對於可能更遠或更邊緣的事情，那麼我們將謹慎對待我們的投資。

Okay.

好的。

And then on the clinical side, what sort of role do you have in data collection for things like complications and other clinical data sets relative to procedures like COLI where there's an opportunity to maybe transform a space further with a strong registry set, or clinical study?

然後在臨床方面，對於並發症和其他臨床數據集，您在數據收集中扮演什麼樣的角色，這些數據集與 COLI 等程序相關，有機會通過強大的註冊集或臨床研究進一步改變空間?

And is that a material kind of investment for you all at this point?

在這一點上，這對你們所有人來說是一種物質投資嗎？

We do have programs where we invest in clinical research.

我們確實有投資臨床研究的項目。

We also invest in things like supporting registries.

我們還投資於支持註冊管理機構之類的事情。

Also, we will go out and provide materials and access to training and other types of resources to allow people to design trials.

此外，我們將走出去提供材料、培訓和其他類型的資源，以允許人們設計試驗。

So, we perform that way.

所以，我們這樣做。

We also fund fellowship training.

我們還資助獎學金培訓。

We also fund residency training in different places.

我們還資助不同地方的住院醫師培訓。

So we have a set of things that we do.

所以我們有一系列的事情要做。

There are institutions that will look for our help, and there are institutions who want to do things at arm's length and that makes sense too.

有些機構會尋求我們的幫助，有些機構想在一定程度上做事，這也是有道理的。

So there's a combination of all of those things.

所以有所有這些東西的組合。

I think the areas of study are diverse from very large population studies that occur in more mature procedures to smaller cohorts that are direct comparisons across one or two centers for things that are emerging.

我認為研究領域是多種多樣的，從在更成熟的程序中進行的非常大的人口研究到較小的隊列，這些隊列是在一個或兩個中心對新興事物的直接比較。

So, as you think about cholecystectomy and use of Single-Site and things like Firefly imaging, you'll see the smaller cohort studies start and those will get bigger as time goes on.

因此，當您考慮膽囊切除術和使用單點以及螢火蟲成像之類的東西時，您會看到較小的隊列研究開始，隨著時間的推移這些研究會變得更大。

Okay.

好的。

And then finally for me, in terms of the pipeline for system sales in the quarter, did you see a shift in terms of how people characterize them as a delay or cancellation or any other trends there?

最後對我來說，就本季度的系統銷售渠道而言，您是否看到人們將其描述為延遲或取消或任何其他趨勢的轉變？

Thank you.

謝謝你。

It's pretty similar to last quarter.

這與上一季度非常相似。

We had a number of systems where we got the approvals that we were accustomed to, but then, at the end, we couldn't get the CEO or the CFO and there was a hesitation there on the basis of their own concerns or uncertainties, I should say, their own uncertainties around spending capital.

我們有許多系統，我們獲得了我們習慣的批准，但最後，我們無法獲得首席執行官或首席財務官，並且基於他們自己的擔憂或不確定性而猶豫不決，我應該說，他們自己在支出資本方面的不確定性。

And then of course there's some capital spending that's required under the ACA for IT and so forth, and so I think those are also capturing a greater part of the pie than we're used to.

當然，在 ACA 下，IT 等方面還需要一些資本支出，所以我認為這些支出也比我們以往佔據了更大的份額。

But I don't know that there was anything in particular I would point out.

但我不知道有什麼特別要指出的。

Tao Levy, Wedbush.

陶徵，韋德布什。

Good afternoon.

下午好。

So one of the questions I had was just jumping on what Ben had just asked.

所以我的問題之一就是直接回答 Ben 剛剛問的問題。

Is there anything that you are doing differently now on the activities or investments that you weren't doing previously, just to address some of the challenges that have cropped up over the last few quarters?

您現在在活動或投資方面有什麼不同之處，而您以前沒有這樣做，只是為了應對過去幾個季度出現的一些挑戰？

No, I think the things that are perhaps front and center is making sure that people have access to all the data that's out there.

不，我認為可能最重要的事情是確保人們可以訪問那裡的所有數據。

There's an enormous amount of published literature on da Vinci.

有大量關於達芬奇的已發表文獻。

People looking for proof points can absolutely find them.

找證據點的人絕對能找到。

I think the total publication database now is greater than 5000 peer-reviewed journal articles on da Vinci.

我認為現在的總出版數據庫超過 5000 篇關於達芬奇的同行評審期刊文章。

The number of level II evidence and above, high-level evidence, is greater than 200.

II級及以上，高級別證據的數量大於200。

The issue is not a dearth of clinical data.

問題不在於缺乏臨床數據。

There were cost studies.

有成本研究。

We'll be posting them on -- links to them on the Web.

我們將把它們張貼在網絡上——它們的鏈接。

There's a fair amount out there.

那裡有相當數量。

What we can do better is make sure people know it and see it and are able to digest it.

我們可以做得更好的是確保人們知道它、看到它並且能夠消化它。

So we've been doing that kind of activity.

所以我們一直在做這樣的活動。

We've talked about, both in Japan and in Europe, the economic analysis that needs to be done with regard to reimbursement from government payors is work that we can do, and we are having success in that work.

我們已經談到，在日本和歐洲，需要對政府支付者的報銷進行經濟分析，這是我們可以做的工作，我們在這項工作中取得了成功。

The data is out there.

數據就在那裡。

The analysis can be done.

分析是可以的。

And so we are making those kinds of investments.

所以我們正在進行這些投資。

And so we've been scaling.

所以我們一直在擴展。

Okay.

好的。

And if you can maybe comment on sort of how we should think about prices on per procedure over the near term until I guess systems start to recover.

如果你能評論一下我們應該如何考慮短期內每個程序的價格，直到我猜系統開始恢復。

Is it here sort of in the $1850, $1860 range?

它在 1850 美元、1860 美元的範圍內嗎？

I let Calvin go into the modeling and the mix, but before he does, just a high-level comment.

我讓 Calvin 進入建模和混音，但在他這樣做之前，只是一個高級別的評論。

I think there are a couple things going on.

我認為有幾件事正在發生。

On things like Single-Site and some of the benign procedures that are more cost sensitive, we have offerings that reflect that greater cost sensitivity.

在單站點和一些對成本更敏感的良性程序等方面，我們提供的產品反映了更高的成本敏感性。

And we are happy to provide them.

我們很樂意提供它們。

I think, it makes sense and they fit the procedure profile.

我認為，這是有道理的，它們符合程序配置文件。

And at the other end, on the more complex procedures, the cancers, some of more reconstructive procedures, we have a set of products that have -- carry higher ASPs, the stapler and vessel sealer and the like.

另一方面，在更複雜的程序、癌症、一些更重建的程序上，我們有一套產品——攜帶更高的 ASP、縫合器和血管密封劑等。

And so I'll let Calvin go through the modeling dynamics for you, but those are the push and pull of this kind of conversation.

因此，我將讓 Calvin 為您介紹建模動態，但這些都是這種對話的推動力和拉力。

And as Marshall described on the call, the Q3, the lower revenue per procedure in Q3 specifically was driven by lower stocking orders associated with the lower system sales in Q3.

正如馬歇爾在第三季度電話會議上所描述的那樣，第三季度每個程序的收入下降具體是由於與第三季度系統銷售下降相關的庫存訂單減少所致。

As well as timing of orders, we saw hospitals reducing inventory levels in the quarter as well.

除了訂單的時間安排外，我們還看到醫院在本季度也降低了庫存水平。

Longer-term, as Gary was mentioning, the initial sales of and increased utilization of vessel sealer product, Firefly and stapler, will help us garner a larger portion of the overall procedure revenue and serve to bolster our revenue per procedure.

從長遠來看，正如 Gary 所提到的，血管密封劑產品 Firefly 和訂書機的初始銷售和增加的利用率將幫助我們獲得整個手術收入的大部分，並有助於增加我們每個手術的收入。

But then offsetting that will be diminishing impact of stocking orders as well as procedure mix as we move deeper into benign procedures and they become a larger portion of our overall business.

但是，隨著我們更深入地進入良性程序並且它們成為我們整體業務的更大部分，這將抵消庫存訂單和程序組合的影響。

It's likely, in the much longer term, that this procedure mix could serve to trend the overall revenue per procedure down.

從長遠來看，這種程序組合可能會導致每個程序的總體收入下降。

So should we keep it in sort of this $1860 level or higher?

那麼我們是否應該將其保持在 1860 美元或更高的水平？

I wasn't sure which --

我不確定哪個——

Yes, there are a lot of factors.

是的，有很多因素。

I think there were some specific factors that impacted Q3 that will be pretty relevant --

我認為影響第三季度的一些具體因素非常相關——

Higher than that.

高於那個。

-- as you look at Q4 and next year and some of these other things are longer-term.

- 當您查看第四季度和明年時，其中一些其他事情是長期的。

If I could ask the last question.

如果我能問最後一個問題。

Procedure trends in the quarter, it seems like September might have been particularly strong for you guys on a worldwide basis.

本季度的程序趨勢，似乎 9 月對你們來說在全球範圍內可能特別強勁。

Is that the case?

是這樣嗎？

Or September year-over-year was pretty much the same?

還是 9 月的同比增長幾乎相同？

Generally speaking, you see people coming back from vacations globally in September, and so the seasonality there is such that September is usually stronger than the prior months.

一般來說，您會在 9 月看到全球各地的人們從假期回來，因此那裡的季節性使得 9 月通常比前幾個月更強。

And we would expect that.

我們會期待這一點。

And then the other piece is that as our business has a greater share of benign surgeries in it over time, those tend to be more subject to seasonality.

然後另一部分是，隨著時間的推移，隨著我們的業務在良性手術中所佔的份額越來越大，這些往往更受季節性影響。

So the mix is becoming a more seasonal mix relative to prior years.

因此，與往年相比，這種組合正變得更具季節性。

And so you see both of those effects kind of compound.

所以你會看到這兩種效果都是複合的。

Thanks.

謝謝。

David Roman, Goldman Sachs.

大衛羅曼，高盛。

Hi guys.

嗨，大家好。

This is Chris in for David.

這是大衛的克里斯。

Can you hear me okay?

你能聽到我的聲音嗎？

Wonderful.

精彩的。

Thank you for taking the questions.

感謝您提出問題。

First question, I feel like, historically, the mantra has always been that procedure growth drives system utilization.

第一個問題，我覺得從歷史上看，一直以來的口頭禪是程序增長推動系統利用率。

But at this point, it feels like the rate of change in the delta for a procedure is a lot slower than what's happening at the system level, and that's kind of given rise to this overcapacity debate a little bit.

但在這一點上，感覺程序增量的變化速度比系統級別發生的變化慢得多，這有點引發了這種產能過剩的爭論。

And I'm a little bit curious about how your visibility, and given the revised guidance, where the confidence is coming from in the revised outlook on systems growth.

我有點好奇你的知名度如何，鑑於修訂後的指導，對修訂後的系統增長前景的信心來自哪裡。

What has changed in the conversations with administrators for some of the pipeline accounts that makes you feel that these guys are still in the pipeline, that they won't push out their decision-making another six months, nine months or 12 months?

與某些管道帳戶的管理員對話發生了什麼變化，讓您覺得這些人仍在管道中，他們不會再推遲六個月、九個月或 12 個月的決策？

And maybe you can share a couple of anecdotes of specific conversations that are happening to let us have a better feel for it.

也許您可以分享一些正在發生的特定對話的軼事，讓我們對此有更好的感受。

I'll answer the last part first.

我先回答最後一部分。

On the systems side, I think we've given you a pretty broad range for the results for Q4.

在系統方面，我認為我們為第四季度的結果提供了相當廣泛的範圍。

And that reflects -- Calvin even said this in his script -- that reflects uncertainty as to how capital will close.

這反映了——卡爾文甚至在他的劇本中這麼說——反映了資本將如何關閉的不確定性。

I don't think we exuded any particular confidence on what will happen in Q4 relative to Q3 on --

我不認為我們對第四季度相對於第三季度會發生什麼表現出任何特別的信心——

Our visibility to procedures is better.

我們對程序的可見性更好。

It is imperfect but it is better than into capital purchasing decisions, particularly in the US where you are seeing some market dynamic changes.

它是不完美的，但它比資本購買決策要好，特別是在你看到一些市場動態變化的美國。

And so we've given you a broad range, and the reason for that broad range is it's hard to predict how a hospital administration will be some of their decisions.

因此，我們為您提供了廣泛的範圍，而范圍廣泛的原因是很難預測醫院管理部門將如何做出他們的一些決定。

Right now, some of the anecdotes are that hospital administrators are trying to project what their revenues will look like as the elements of the ACA get implemented.

現在，一些軼事是，醫院管理人員正試圖預測他們的收入將在 ACA 的要素得到實施後的樣子。

And that revenue uncertainty on their side just flows through into capital decision-making uncertainty down the line.

而他們方面的收入不確定性只會流入資本決策的不確定性。

Great, that's very helpful.

太好了，這很有幫助。

Thank you.

謝謝你。

And if I can have a follow-up here, I'm curious and I know that there's a lot of work being done on the share repurchase side, but given the significant amount of cash that you guys have and the financial flexibility, is there any reason that you wouldn't be able to up the R&D spending and really focus on addressing some of the concerns that have been out in the media and some of the major bodies of recent to help address some of the perception issues that seem to kind of keep coming up and potentially could be impacting some of the near-term system placement sales?

如果我可以在這裡跟進，我很好奇，我知道在股票回購方面有很多工作要做，但鑑於你們擁有大量現金和財務靈活性，是否存在任何你無法增加研發支出並真正專注於解決媒體和最近一些主要機構中出現的一些問題的任何理由，以幫助解決一些似乎不錯的認知問題不斷出現並可能會影響一些近期的系統配置銷售？

And you could -- I feel like, with the financial flexibility, that more repurchases could offset that level of spending.

你可以 - 我覺得，憑藉財務靈活性，更多的回購可以抵消這種支出水平。

Is that something that is on the table or has been considered or not?

那是擺在桌面上還是已經考慮過的事情？

With regard to -- there's a couple of things wrapped together there, just teasing them apart.

關於--那裡有幾件事被包裹在一起，只是將它們分開。

With regard to the R&D spend side, we are thoughtful and serious about our R&D priorities and the spending the goes with it.

在研發支出方面，我們對我們的研發重點和相應的支出進行了深思熟慮和認真對待。

We listen really carefully to surgeons and hospital customers about what we think they need and what they think they need to make for both great surgery and surgery whose economics makes sense for all of the players.

我們非常仔細地傾聽外科醫生和醫院客戶的意見，了解我們認為他們需要什麼，以及他們認為他們需要為偉大的手術和經濟對所有參與者都有意義的手術做些什麼。

And so that's baked into our product development pipeline and something we do continuously.

因此，這已融入我們的產品開發流程以及我們不斷做的事情。

With regard to R&D being the solution to some of the concerns in the press, I would encourage you to go look at our website, look at the data.

關於研發是解決媒體一些問題的方法，我鼓勵你去看看我們的網站，看看數據。

The safety profile of da Vinci is outstanding when it is compared with the surgical alternatives that people have.

與人們擁有的手術替代品相比，達芬奇的安全性非常出色。

So, I think, on that side, that's not really an R&D investment sort of issue.

所以，我認為，在這方面，這並不是一個真正的研發投資問題。

With regard to the use of cash and buybacks and how we think about that, I'll turn that to Marshall.

關於現金和回購的使用以及我們對此的看法，我將把它交給馬歇爾。

We look for opportunities or discontinuities in the share price relative to the market, and we did some buybacks this last quarter.

我們尋找股價相對於市場的機會或不連續性，並在上個季度進行了一些回購。

It's really a board decision.

這真的是董事會的決定。

We'll be having those discussions on an ongoing basis with the board and you will see what comes out of it.

我們將與董事會持續進行這些討論，你會看到結果如何。

All right, great.

好的，太好了。

Very helpful.

非常有幫助。

Thank you guys.

感謝你們。

Amit Hazan, SunTrust.

阿米特哈贊，SunTrust。

Good afternoon guys.

各位下午好。

I thought maybe I'd ask the first question about existing versus new customers.

我想也許我會問關於現有客戶和新客戶的第一個問題。

Just regarding the US system side, if you can distinguish between existing customers adding capacity and then new customers?

就美國系統而言，你能區分現有客戶增加產能和新客戶嗎？

I think, if we think about last quarter, you seem to be saying that most of the weakness came from existing customers who chose to defer.

我認為，如果我們考慮上個季度，您似乎是在說大部分弱點來自選擇推遲的現有客戶。

It seems like that's the case again here.

好像這裡又是這樣。

What has been happening more on the new customer side, new customer additions, and the trend line there?

新客戶方面、新客戶增加以及那裡的趨勢線發生了什麼更多的事情？

Just to kind of review the numbers, as was mentioned, there were 65 total system sales in the third quarter.

只是為了回顧一下這些數字，如前所述，第三季度共有 65 台系統銷售。

22 of them went to brand-new customers, greenfields as we call them, and 43 were to existing customers.

其中 22 家面向全新客戶，即我們所說的新客戶，43 家面向現有客戶。

So, then let's see.

那麼，讓我們看看。

It was 19 of them -- 24 involved trade-ins, so that means 19 added systems for capacity reasons in the quarter.

其中有 19 個——24 個涉及以舊換新，這意味著本季度由於容量原因增加了 19 個系統。

So I think when you look at the capital environment, we talked about the issues impacting it.

因此，我認為當您查看資本環境時，我們談到了影響它的問題。

I believe the issues described, whether it be capacity from the decreasing growth in benign hysterectomy or the various macro issues, including the ACA, I think they really impacted all of these categories.

我相信所描述的問題，無論是良性子宮切除術增長下降的能力，還是包括 ACA 在內的各種宏觀問題，我認為它們確實影響了所有這些類別。

Okay.

好的。

Then moving onto the procedure side, I want to just make sure I ask the question so it's very clear.

然後轉到程序方面，我想確保我提出的問題非常清楚。

I think you might have touched on it.

我想你可能已經觸及了它。

But if we go through the US benign hysterectomy side and think about how to model it for the next several quarters and how you saw this quarter versus last quarter, is the impact that you are seeing there -- and obviously I'm referring to the concerns, the developments earlier in the year more than anything -- has it gotten -- did it get worse this quarter or was it something that you saw as stable versus last quarter?

但是，如果我們仔細研究美國良性子宮切除術方面，並考慮如何在接下來的幾個季度中對其進行建模，以及您如何看待本季度與上一季度的對比，您會看到那裡的影響——顯然我指的是擔憂，今年早些時候的事態發展比什麼都重要 - 它已經得到 - 本季度是否變得更糟，還是您認為與上一季度相比穩定？

As we mentioned in the script, I think it's following a pretty normal trajectory or trend from what we introduced in Q2 and in Q3, the Q1, Q2, Q3.

正如我們在腳本中提到的，我認為它遵循我們在 Q2 和 Q3、Q1、Q2、Q3 引入的非常正常的軌跡或趨勢。

So it was pretty stable, and I would say seasonally stable going into a Q3, so not much of a change between the two quarters.

所以它非常穩定，我會說進入第三季度的季節性穩定，所以兩個季度之間變化不大。

Great.

偉大的。

Just the last one for me.

對我來說只是最後一個。

In terms of the impact from that same noise on other procedure categories, urology or general surgery in the US, do you feel at all that hospitals have applied more scrutiny to those as well because of the noise factor coming out of the first half of this year?

關於同樣的噪音對美國其他程序類別、泌尿科或普通外科手術的影響，您是否覺得醫院也對這些程序進行了更嚴格的審查，因為前半部分出現了噪音因素年？

It's an interesting question.

這是一個有趣的問題。

You really have to tease it apart and you have to take a look at the underlying condition, the surgical specialty itself, the alternative opportunity, the alternative treatment.

你真的必須把它分開，你必須看看潛在的狀況、外科專業本身、替代機會、替代治療。

In other words, when you're looking at urology, and you're talking about kidney cancer, bladder cancer, prostate cancer, I think it's safe to say that you are more immune to some of these sort of allegations that people are throwing out in the media than you are versus, let's say, a benign procedure that has some benign therapies and they'll pile on costs and some incorrect comparators.

換句話說，當你在看泌尿科時，你在談論腎癌、膀胱癌、前列腺癌時，我認為可以肯定地說，你對人們拋出的一些此類指控更有免疫力在媒體上，比你在與，比方說，一個良性程序，有一些良性療法，他們會堆積成本和一些不正確的比較。

And so I would say the majority of that noise that we have heard and have felt is probably been on the benign GYN side more than anything else we've seen thus far.

所以我想說，我們聽到和感受到的大部分噪音可能都來自良性的 GYN 方面，而不是我們迄今為止看到的任何其他噪音。

And I think that continues.

我認為這種情況還在繼續。

Okay, thanks guys.

好的，謝謝各位。

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 questions.

感謝您提出問題。

I just had a quick question on I guess a few pipeline products.

我只是有一個關於我猜一些管道產品的快速問題。

of you guys.

你們。

Starting with Single-Site, I had a question about adding wristed capabilities.

從單站點開始，我有一個關於添加手腕功能的問題。

You mentioned I guess the needle driver that should be submitted for 510(k) approval next year.

你提到我猜想明年應該提交510（k）批准的針頭驅動器。

Are there plans to expand the wristed capabilities across other aspects of the Single-Site platform?

是否有計劃將手腕功能擴展到單站點平台的其他方面？

Like what are the main obstacles in doing this?

這樣做的主要障礙是什麼？

And what impact do you believe this could have on broader adoption?

您認為這會對更廣泛的採用產生什麼影響？

I think -- so the first question is it limited to needle driver or can it be taken more broadly?

我認為 - 所以第一個問題是僅限於針驅動器還是可以更廣泛地採用？

I think that a needle driver is clearly the first one to go with with regard to Single-Site as applied to hysterectomy.

我認為針頭驅動器顯然是第一個用於子宮切除術的單點驅動器。

I think that once you have that architecture, you can start to broaden it in terms of what's possible.

我認為一旦你有了那個架構，你就可以開始擴展它的可能性。

And the decisions that would be made as to which ones come next and why will have a lot to do with which indications are the next most interesting indications for Single-Site.

以及接下來將做出哪些決定以及為什麼將與哪些跡像是單站點的下一個最有趣的跡像有很大關係。

So that will be a process.

所以這將是一個過程。

If you've followed us for a while, you'll see that same kind of behavior that, as indications change, then you bring instruments in to help you optimize that set of indications.

如果您已經關注我們一段時間，您會看到同樣的行為，隨著適應症的變化，您會引入工具來幫助您優化這組適應症。

And then second also I guess, moving onto the stapler rollout, as you continue with the rollout, I was just wondering if there was a potential timeline in expanding the stapler offering, the different sizes, so maybe it could be a little more effective for bariatric surgery or other surgeries.

然後我猜第二個是訂書機的推出，當你繼續推出時，我只是想知道是否有可能擴展訂書機產品的時間表，不同的尺寸，所以也許它可能更有效一點減肥手術或其他手術。

So our first expansion will really be in terms of number of sites supported with the existing stapler.

因此，我們的第一個擴展實際上將是現有訂書機支持的站點數量。

So the stapler we have today is really targeted and optimized for colorectal procedures in terms of how big it is and what the staple reloads look like, and so we're going to do that.

因此，我們今天擁有的訂書機確實針對結直腸手術進行了優化，包括它的大小和裝訂器的外觀，因此我們將這樣做。

And that's what we're focused on in the near term.

這就是我們近期關注的重點。

Longer term, we are working on prototypes and developing the capability for other types of reloads focused on other types of procedures.

從長遠來看，我們正在研究原型並開發其他類型的重裝能力，重點是其他類型的程序。

And we'll do that.

我們會這樣做的。

That will be further out.

那會更遠。

That's not a near-term.

這不是近期的。

Okay, very helpful.

好的，很有幫助。

I just had a quick follow-up on the procedure guidance.

我剛剛對程序指南進行了快速跟進。

I know you guys have given a little bit of detail here, but I just wanted to push a little further.

我知道你們已經在這裡提供了一些細節，但我只是想更進一步。

I think it implies roughly 13% to 17% procedure growth in the fourth quarter.

我認為這意味著第四季度大約有 13% 到 17% 的程序增長。

And I was wondering if maybe you could discuss some of the assumptions across the product categories that drove you to that guidance, and if you see any significant acceleration or deceleration across any of the large groups.

而且我想知道您是否可以討論驅動您獲得該指導的產品類別中的一些假設，以及您是否看到任何大型組的任何顯著加速或減速。

Yes, I think it's probably similar to the commentary we had last quarter in that, at the higher end of the range, you're talking about a continuation of the trends that we are on from benign gynecology, general surgery, and prostatectomy in the US as well as international growth rates.

是的，我認為這可能與我們上個季度的評論相似，在該範圍的較高端，您所說的是我們在良性婦科、普通外科和前列腺切除術中的趨勢的延續。美國和國際增長率。

At the lower end of the guidance would just be contemplation of if other factors come into play in terms of a further decline in benign demand for benign procedures.

在指南的低端，只是考慮是否有其他因素在對良性程序的良性需求進一步下降方面發揮作用。

You're entering a quarter that's typically very strong seasonally, and if it comes out less strong for some reason, that would be considered as well as if you see any changing trends in cholecystectomy or prostatectomy, that would be reflective of the lower end.

您正在進入一個季節性通常非常強勁的季度，如果由於某種原因表現不那麼強勁，那麼如果您看到膽囊切除術或前列腺切除術的任何變化趨勢，這將反映低端。

Thank you, very helpful.

謝謝，很有幫助。

Bob Hopkins, Bank of America.

鮑勃霍普金斯，美國銀行。

Good afternoon.

下午好。

So I just wanted to ask a big picture question on procedure volume growth.

所以我只想問一個關於手術量增長的大問題。

As I look at the model going back to the first quarter of 2012, your procedure volume growth was close to 30%, and it's kind of gone down a little bit each quarter.

當我查看可追溯到 2012 年第一季度的模型時，您的手術量增長接近 30%，而且每個季度都有點下降。

And now we are at 16% this quarter, and you're looking at fourth quarter maybe being at the same level or a little bit lower.

現在我們本季度的增長率為 16%，而您看到的第四季度可能處於同一水平或略低一些。

And so I guess, just from a big picture perspective, I wanted to get a sense of your confidence that the sort of midteens procedure volume growth rate is close to a bottom, or is the bottom.

所以我想，從大局的角度來看，我想了解你的信心，即青少年手術量增長率接近底部，或者是底部。

Any thoughts there would be helpful.

那裡的任何想法都會有所幫助。

I don't think we are ready to give really 2014 guidance.

我認為我們還沒有準備好提供真正的 2014 年指導。

What I would say here in terms of what are the dynamics, what's going on underneath these things, I think we have a large category that, in the US, grew quickly, and is now growing more slowly, and that was gynecology.

我在這裡要說的是什麼是動態，這些事情背後發生了什麼，我認為我們有一個很大的類別，在美國，增長很快，現在增長更慢，那就是婦科。

And we have a large category in the US in general surgery that's on the early part of this adoption.

我們在美國有一個大類別的普通外科手術，處於這種採用的早期階段。

And I think the answer to your question is going to come down to the rates of growth on both of those sides.

我認為你的問題的答案將歸結為這兩個方面的增長率。

And I think what you would expect of the Company is to manage the activities that would support growth.

我認為您對公司的期望是管理支持增長的活動。

And so in the US, our activities are focused on supporting general surgery growth.

因此，在美國，我們的活動重點是支持普外科的發展。

And that comes down to making sure the product set makes sense for that customer, making sure that our training capability is aligned and ready to go, our sales force is capable of doing what they need to do.

這歸結為確保產品集對該客戶有意義，確保我們的培訓能力保持一致並準備就緒，我們的銷售人員能夠做他們需要做的事情。

And we have opportunity for growth or accelerated growth in OUS markets, in Japan, where we are making investments in Europe.

我們有機會在 OUS 市場，在日本進行增長或加速增長，我們正在歐洲進行投資。

So those are the underlying drivers.

所以這些是潛在的驅動因素。

And how it shakes out in future quarters we will report to you as we have greater visibility.

以及它在未來幾個季度的變化情況，我們將向您報告，因為我們有更大的知名度。

You know, I appreciate that.

你知道，我很感激。

I really wasn't asking about any particular quarter, just asking about all the different trends that are impacting growth and where we stand now and just trying to gauge your confidence on, at this point, are there more positives than negatives.

我真的沒有問任何特定的季度，只是詢問影響增長的所有不同趨勢以及我們現在的立場，只是試圖衡量你的信心，在這一點上，積極因素多於消極因素。

And again, just trying to gauge confident as to sort of where we are in the cycle right now and your confidence that this obviously critically important metric to your Company, that we have your best sense as to where that is going to fall out.

再一次，只是試圖衡量我們現在在周期中所處的位置的信心，以及您對這對貴公司顯然至關重要的指標的信心，我們對您將在哪裡出現問題有最好的了解。

One of the challenges has always been trying to breeze the assumptions that we've given you and hold them for long periods of time.

挑戰之一一直是試圖輕而易舉地接受我們給你的假設並長期持有它們。

In other words, we are -- we're almost -- the way the question is framed, it's almost asking us to sort of freeze the assumption as the final assumptions and not take into consideration things like potential expansion of let's say Single-Site hysterectomy and/or international market growth where we are putting in a lot of resources and training centers and so on and so forth.

換句話說，我們是 - 我們幾乎是 - 問題的框架方式，它幾乎要求我們將假設凍結為最終假設，而不考慮諸如單站點的潛在擴展之類的事情子宮切除術和/或國際市場增長，我們正在投入大量資源和培訓中心等等。

So, I would say, from a confidence standpoint, we believe there are a lot of future drivers and present drivers in the business.

所以，我想說，從信心的角度來看，我們相信這個行業有很多未來的驅動力和現在的驅動力。

And it becomes, as it always does, and execution story, both downstream and upstream execution of what we think are great opportunities.

就像往常一樣，它變成了執行故事，下游和上游執行我們認為是很好的機會。

And that's what you should judge us on, and that's where our focus is.

這就是你應該判斷我們的地方，這就是我們的重點所在。

Time for one more follow-up question.

是時候再提出一個後續問題了。

Thanks.

謝謝。

Just one real quick one on utilization, that's also a challenging part of the model going forward.

只是一個真正快速的利用率，這也是該模型前進的一個具有挑戰性的部分。

How do you think that we should be thinking about utilization sort of per system going forward?

您認為我們應該如何考慮未來每個系統的利用率？

I assume that needs to continue to climb up, but just any general thoughts on kind of utilization per installed base as we look forward?

我認為這需要繼續攀升，但是對於我們期待的每個安裝基數的利用率有什麼一般的想法嗎？

If you look at the trends coming up prior to 2013, we've seen gradual increases in utilization per system as measured by procedures done in a quarter as a numerator and denominator of the systems installed at the beginning of the quarter.

如果您查看 2013 年之前出現的趨勢，我們已經看到每個系統的利用率逐漸增加，這是根據一個季度完成的程序作為季度初安裝的系統的分子和分母來衡量的。

We've seen that gradually increasing.

我們已經看到這種情況逐漸增加。

Now you get to 2013 with the moderating growth in benign gynecology, now you're seeing moderate decreases in each of the first three quarters of this year.

現在到了 2013 年，良性婦科的增長放緩，現在你看到今年前三個季度的每個季度都有適度的下降。

Ultimately, I think we still say procedures are really what drives this business here.

歸根結底，我認為我們仍然會說程序是推動這項業務的真正動力。

There are other factors that impact the timing of system sales, which we have been through.

還有其他影響系統銷售時間的因素，我們已經經歷過。

But, again, procedures and the greater growth there is going to be the key.

但是，再一次，程序和更大的增長將是關鍵。

And I think the ultimate utilization is going to depend on a lot of factors, hospitals gaining efficiency, Affordable Care Act, procedure mix, so the ultimate direction, it's hard to really say.

而且我認為最終的利用率將取決於很多因素，醫院提高效率，平價醫療法案，程序組合，所以最終的方向，很難說。

Thanks very much.

非常感謝。

That was our last question.

那是我們的最後一個問題。

As we've 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，雖然我們關注收入、利潤和現金流等財務指標，但在這些電話會議期間，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。

The following is a part of an interview published by Medscape with Dr. Joseph Colella, Director of Robotic surgery at Magee Women's Hospital, part of UPMC.

以下是 Medscape 對 UPMC 旗下 Magee 婦女醫院機器人外科主任 Joseph Colella 博士發表的採訪的一部分。

When he was asked about the future of robotic assisted surgery, he answered as follows.

當被問及機器人輔助手術的未來時，他的回答如下。

"As a potential patient, stop for a moment and put on the common sense hat.

“作為一個潛在的病人，停下來，戴上常識的帽子。

The surgeon tells you that he can see 100% better in three dimensions, that he can sew better, and in the future he'll be able to do every procedure through one incision.

外科醫生告訴你，他可以在三個維度上看清 100%，他可以更好地縫製，將來他將能夠通過一個切口完成所有手術。

You can imagine that the sky is the limit in employing robotic surgery.

你可以想像，天空是使用機器人手術的極限。

It is an enabling technology.

這是一項使能技術。

I firmly believe that we are finding new and beneficial applications almost on a monthly basis.

我堅信我們幾乎每個月都會發現新的有益的應用程序。

For instance, nobody ever thought you would be able to resect tumors of the larynx without taking half the face of part to get to them.

例如，沒有人曾想過你可以切除喉部的腫瘤，而不需要切除一半的面部。

With a robot in the right hands, you can do those operations in an hour and the patient goes home the next day."

有了機器人，你可以在一個小時內完成這些手術，病人第二天就可以回家了。”

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 three months.

我們感謝您參與和支持這次改善手術的非凡旅程，我們期待在三個月後再次與您交談。

Thank you.

謝謝你。

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

女士們，先生們，今天的電話會議結束了。

We do thank you for your participation and for using AT&T Executive Teleconference.

我們非常感謝您的參與和使用 AT&T 行政電話會議。

You may now disconnect.

您現在可以斷開連接。