直覺手術 (ISRG) 2013 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by.

女士們，先生們，謝謝你們的支持。

Welcome to the Intuitive Surgical fourth-quarter earnings release.

歡迎來到 Intuitive Surgical 第四季度財報發布。

(Operator Instructions).

（操作員說明）。

As a reminder, this conference is being recorded.

提醒一下，本次會議正在錄製中。

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

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

Please go ahead.

請繼續。

Thank you.

謝謝你。

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

下午好，歡迎參加 Intuitive Surgical 第四季度財報電話會議。

With me today we have Gary Guthart, our President and CEO; Marshall Mohr, our Chief Financial Officer, and Patrick Clingan, Director of Finance.

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 和財務總監 Patrick Clingan。

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, including our most recent Form 10-K filed on February 4, 2013 and our Form 10-Q filed October 18, 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，包括我們最近於 2013 年 2 月 4 日提交的 10-K 表格和 2013 年 10 月 18 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上進行音頻重播，網址為：intuitivesurgical.com，位於我們投資者關係頁面下的音頻檔案部分。

In addition, today's press release and supplementary financial data tables have been posted to our website.

此外，今天的新聞稿和補充財務數據表已發佈到我們的網站。

Today's format will consist of providing you with highlights of our fourth-quarter results as described in our press release announced early 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描述的第四季度業績的亮點，然後是問答環節。

Gary will present the quarter's business and operational highlights, Marshall will provide a review of our fourth-quarter financial results, Patrick will discuss marketing and clinical highlights, and I will provide our financial outlook for 2014.

Gary 將介紹本季度的業務和運營亮點，Marshall 將回顧我們第四季度的財務業績，Patrick 將討論營銷和臨床亮點，我將提供我們 2014 年的財務展望。

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 on the call today.

感謝您今天加入我們的電話會議。

2013 was a challenging year for Intuitive.

2013 年對 Intuitive 來說是充滿挑戰的一年。

Trends that emerged in the second quarter of 2013 continued through the balance of the year, including revenue uncertainties for United States customers due to pressure on gynecologic surgery broadly, the implementation of the Affordable Care Act, and confusion surrounding the public debate regarding some da Vinci procedures.

2013 年第二季度出現的趨勢在今年餘下時間繼續存在，包括由於廣泛的婦科手術壓力導緻美國客戶的收入不確定性、平價醫療法案的實施以及圍繞某些達芬奇的公開辯論的混亂程序。

These factors resulted in the slowing of our growth in gynecology and a subsequent decline in the sale of systems in the United States.

這些因素導致我們在婦科領域的增長放緩，隨後在美國的系統銷售下降。

The year also featured several strengths in our business.

這一年還體現了我們業務的多項優勢。

Among them, the publication of several large studies supporting the clinical and economic value of da Vinci use.

其中，發表了幾項支持達芬奇使用的臨床和經濟價值的大型研究。

We also experienced the acceleration of procedure growth in Europe and Japan, broad-based growth in general surgery procedures in the United States, and continued adoption of our new products worldwide.

我們還經歷了歐洲和日本手術增長的加速、美國普通外科手術的廣泛增長以及我們新產品在全球範圍內的持續採用。

I'll start with a review of procedures.

我將從審查程序開始。

Year-over-year growth in procedures closed at 16%, led by growing use of da Vinci in general surgery in the United States, accelerating growth in the use of da Vinci outside the United States, and continued uptake in US gynecology.

手術的同比增長達到 16%，這主要是由於美國普外科使用達芬奇的增加、美國以外的達芬奇使用加速增長以及美國婦科的持續採用。

General surgery growth in the United States was 93% in the year, including increased use of da Vinci in colorectal surgery and cholecystectomy using da Vinci Single-Site and Firefly, as well as growth in other general surgery procedures.

美國的普通外科手術在這一年增長了 93%，包括在結直腸手術和膽囊切除術中使用 da Vinci Single-Site 和 Firefly 的使用增加，以及在其他普通外科手術中的增長。

In the fourth quarter, general surgery overtook urology as the second largest category of da Vinci use in the United States.

第四季度，普外科超過泌尿外科，成為美國第二大達芬奇使用類別。

Outside of the United States, procedure growth accelerated, rising 21% over procedures in 2012, based on strength in Europe and Japan.

在美國以外，基於歐洲和日本的實力，程序增長加速，比 2012 年的程序增長 21%。

We will review procedure trends in greater detail later in the call.

我們將在稍後的電話會議中更詳細地審查程序趨勢。

Looking at trends in capital sales for the year, procedure deceleration in the United States freed capacity on already installed systems.

從今年資本銷售的趨勢來看，美國的程序減速釋放了已安裝系統的容量。

Combined with a lack of visibility of revenue for our customers due to pressure on gynecologic surgery and the Affordable Care Act, US capital sales fell for the year.

由於婦科手術和平價醫療法案的壓力，加上我們客戶的收入缺乏可見性，美國資本銷售今年下降。

Outside of the United States, our capital business in Europe and Asia performed very well with international systems revenue growing 59% over 2012.

在美國以外，我們在歐洲和亞洲的資本業務表現非常出色，國際系統收入比 2012 年增長了 59%。

Investments in Europe have yielded solid results, and we expect to continue to grow our European team given the large opportunity we see for da Vinci use in several procedures and countries.

在歐洲的投資取得了可觀的成果，鑑於我們看到達芬奇在多個程序和國家使用的巨大機會，我們預計將繼續壯大我們的歐洲團隊。

As we have mentioned on prior calls, sustained growth in our business in Japan depends upon approval for reimbursement for additional procedures, which is targeted for the 2016 revision to national insurance coverage.

正如我們在之前的電話會議中提到的，我們在日本的業務的持續增長取決於是否批准額外程序的報銷，這是 2016 年修訂國民保險的目標。

Until additional procedure reimbursement is received in Japan, capital sales are likely to be constrained and to varying timing.

在日本收到額外的程序報銷之前，資本銷售可能會受到限制並且時間會有所不同。

The combination of gynecology trends and the ACA implementation in the United States and uncertainty of future capital purchases in Japan creates difficulty in revenue forecasting for at least the first half of 2014.

婦科趨勢和美國 ACA 實施的結合以及日本未來資本購買的不確定性給至少 2014 年上半年的收入預測帶來了困難。

Calvin will take you through our view of 2014 later in the call.

Calvin 將在稍後的電話會議中帶您了解我們對 2014 年的看法。

Our product launches proceeded well in 2013 and reflect the growing segmentation of our business.

我們的產品發佈在 2013 年進展順利，反映了我們業務的日益細分。

The combination of enabling technology, procedure opportunity, and aligned economics is important.

使能技術、程序機會和一致的經濟學相結合很重要。

In the higher volume benign segment we serve, our Single-Site kit of instruments and accessories are being used increasingly for hysterectomy, as well as cholecystectomy.

在我們服務的高容量良性細分市場中，我們的單點器械和附件套件越來越多地用於子宮切除術和膽囊切除術。

We plan on rolling out our Single-Site kit for hysterectomy more broadly in 2014 and are working on a wristed Single-Site needle driver to augment our existing offering.

我們計劃在 2014 年更廣泛地推出用於子宮切除術的 Single-Site 套件，並正在開發一種腕式 Single-Site 針頭驅動器，以增強我們現有的產品。

We anticipate submitting the wristed Single-Site needle driver 510K in the first half of 2014.

我們預計在 2014 年上半年提交腕式單點針頭驅動器 510K。

In 2013, we received a biliary visualization indication for our Firefly Fluorescence Imaging System in the third quarter, enabling enhanced visualization of anatomy during cholecystectomy.

2013 年，我們在第三季度收到了螢火蟲熒光成像系統的膽道可視化指示，從而在膽囊切除術期間增強了解剖結構的可視化。

Firefly use in biliary imaging grew nicely in the fourth quarter.

螢火蟲在膽道成像中的使用在第四季度增長良好。

Turning to products used for procedures typically performed for an open incision, our focus has been on creating products that improve visualization, precision and control for surgeons performing these procedures.

談到用於通常用於開放切口的程序的產品，我們的重點一直是創造產品，以提高執行這些程序的外科醫生的可視化、精確度和控制。

Taking colorectal surgery as an example, open colorectal surgery is hard on patients with high complication, morbidity, and readmission rates compared with minimally invasive surgery.

以結直腸手術為例，與微創手術相比，開腹結直腸手術對於並發症、發病率和再入院率高的患者來說難度較大。

We now offer colorectal surgeons the combination of wristed vessel sealing, wristed stapling, and Firefly perfusion imaging.

我們現在為結直腸外科醫生提供手腕血管密封、手腕縫合和螢火蟲灌注成像的組合。

The combination of these technologies with the base capability of da Vinci is powerful and enabling minimally invasive colorectal surgery for a larger patient population.

這些技術與達芬奇的基礎能力相結合是強大的，可以為更大的患者群體進行微創結直腸手術。

Looking at each product individually, our Vessel Sealer was cleared for use in Korea in Q3 and Japan in Q4 of 2013, and feedback from general surgeons and gynecologists has been positive.

單獨來看每個產品，我們的血管密封劑在 2013 年第三季度和第四季度獲准在韓國和日本使用，並且來自普通外科醫生和婦科醫生的反饋是積極的。

We are also pleased with the performance of our da Vinci Stapler in 2013 with outstanding feedback from customers on its clinical performance, easy-of-use, and smart plant feature.

我們也對 2013 年達芬奇訂書機的表現感到滿意，客戶對其臨床性能、易用性和智能工廠功能的出色反饋。

We expect most use of our current stapler to be in colorectal procedures.

我們預計我們目前的訂書機大部分用於結直腸手術。

We are currently expanding our rollout of the stapler to general surgery customers in the United States.

我們目前正在將訂書機的推廣範圍擴大到美國的普通外科客戶。

A brief aside, you may have seen a press release yesterday by Luna Innovations announcing our acquisition of their shape-sensing business for medical use.

簡而言之，您可能已經看到 Luna Innovations 昨天發布的新聞稿，宣布我們收購了他們用於醫療用途的形狀傳感業務。

We have worked with Luna for several years and believe this sensing technology and the team that invented it represent a foundation for new types of flexible mechanisms that can augment or extend our products.

我們與 Luna 合作了幾年，相信這種傳感技術和發明它的團隊代表了新型靈活機制的基礎，可以增強或擴展我們的產品。

This is part of a long-term effort by Intuitive to innovate in reducing invasiveness in the access to the body, and we do not expect it to materially impact our business in 2014.

這是 Intuitive 在減少進入身體的侵入性方面進行創新的長期努力的一部分，我們預計它不會對 2014 年的業務產生重大影響。

Looking back at the full-year 2013, our operating performance was as follows.

回顧2013年全年，我們的經營業績如下。

Worldwide procedures grew by approximately 16%.

全球程序增長了約 16%。

We sold 546 da Vinci Surgical Systems in the year, down from 620.

我們在這一年售出了 546 台達芬奇手術系統，低於 620 台。

Total revenue grew to $2.265 billion, up 4% over 2012.

總收入增長至 22.65 億美元，比 2012 年增長 4%。

Recurring revenue grew to $1.430 billion, up 15% and comprising 63% of total revenue.

經常性收入增長至 14.30 億美元，增長 15%，佔總收入的 63%。

We generated $1.021 billion in operating profit before non-cash stock compensation expense, down 1% from last year.

在扣除非現金股票補償費用之前，我們的營業利潤為 10.21 億美元，比去年下降 1%。

GAAP net income grew to $671 million, up 2% year over year, and we reduced our shares outstanding by repurchasing 2.6 million shares during 2013.

GAAP 淨收入增長至 6.71 億美元，同比增長 2%，我們在 2013 年通過回購 260 萬股減少了流通股。

Finally, we generated $880 million in cash flows from operations, ending the year with $2.8 billion in cash and investments.

最後，我們從運營中產生了 8.8 億美元的現金流，到年底有 28 億美元的現金和投資。

Turning to our operating performance for the fourth quarter.

談到我們第四季度的經營業績。

Procedures grew approximately 12% over the fourth quarter of last year.

程序比去年第四季度增長了約 12%。

We sold 138 da Vinci Surgical Systems, down from 175 in the fourth quarter of 2012.

我們售出了 138 台達芬奇手術系統，低於 2012 年第四季度的 175 台。

Total revenue for the quarter was $576 million, down 5% from the prior year.

本季度總收入為 5.76 億美元，比上年下降 5%。

Instrument and accessory revenue increased to $268 million, up 6%.

儀器和配件收入增至 2.68 億美元，增長 6%。

We generated an operating profit of $250 million in the quarter before non-cash stock option expense, down 13% from the fourth quarter of last year, and GAAP net income decreased to $166 million, down 5%.

我們在扣除非現金股票期權費用之前的季度實現了 2.5 億美元的營業利潤，比去年第四季度下降了 13%，GAAP 淨收入下降到 1.66 億美元，下降了 5%。

In 2013, we opened two new technology training centers in the United States, one at our headquarters in Sunnyvale and the other in Atlanta.

2013 年，我們在美國開設了兩個新技術培訓中心，一個在桑尼維爾總部，另一個在亞特蘭大。

We ended the year with 2792 members on our team and anticipate growing our organization in specific areas through 2014, with a particular emphasis on Asia and Europe.

到 2014 年底，我們的團隊共有 2792 名成員，預計到 2014 年，我們的組織將在特定領域發展壯大，尤其是亞洲和歐洲。

Before reviewing our priorities for 2014, I'll take a moment to touch on our mission.

在回顧我們 2014 年的優先事項之前，我將花點時間談談我們的使命。

In the face of near-term pressure and scrutiny, our commitment to our mission to fundamentally improve surgery remains unshaken.

面對近期的壓力和審查，我們對從根本上改善手術的使命的承諾仍然堅定不移。

Around the globe, surgery for many complex conditions is still conducted through an open incision, with serious risks of complications, morbidity, mortality, readmission, and prolonged recovery.

在全球範圍內，許多複雜情況的手術仍然通過開放切口進行，存在並發症、發病率、死亡率、再入院和恢復時間延長的嚴重風險。

Despite their long availability, conventional MIS technologies are difficult to apply to some patient populations, and the advanced skills required to use them for complex procedures are hard to master.

儘管它們的可用性很長，但傳統的 MIS 技術難以應用於某些患者群體，並且難以掌握將它們用於復雜程序所需的高級技能。

da Vinci has overcome these limitations for our targeted procedures with proven results.

達芬奇已經克服了我們的目標程序的這些限制，並取得了可靠的結果。

Furthermore, today's minimally invasive surgery still leaves room for improvement in outcomes, predictability, recovery, and economics.

此外，今天的微創手術在結果、可預測性、恢復和經濟性方面仍有改進的空間。

Taken together, these opportunities are the focus of our current and future product development efforts.

總之，這些機會是我們當前和未來產品開發工作的重點。

Our team has weathered 2013 well and is fully engaged in the challenge of providing tools that improve the experience of surgery for those who need it.

我們的團隊很好地度過了 2013 年，並充分參與了為需要它的人提供改善手術體驗的工具的挑戰。

Looking to 2014, our priorities are as follows.

展望 2014 年，我們的工作重點如下。

First, we will focus on the expanded use of da Vinci in general surgery, particularly colorectal surgery and single incision surgery.

首先，我們將重點關注達芬奇在普外科，特別是結直腸手術和單切口手術中的廣泛應用。

Second, we will support growth of da Vinci use in gynecology and neurology worldwide.

其次，我們將支持達芬奇在全球婦科和神經科中的應用增長。

Third, we will broaden our stapling and Single-Site lodges, including the planned introduction of the wristed Single-Site instrument, and finally, we will continue to strengthen our capabilities in international markets, particularly Europe and Japan.

第三，我們將擴大我們的訂書機和 Single-Site Lodge，包括計劃推出腕式 Single-Site 儀器，最後，我們將繼續加強我們在國際市場，特別是歐洲和日本的能力。

Before passing the time over to Marshall, I would like to take a moment to thank Aleks Cukic for his outstanding service to this group.

在將時間轉給 Marshall 之前，我想花一點時間感謝 Aleks Cukic 對這個團隊的出色服務。

Aleks will continue to work with the Company in an advisory capacity, but will no longer join us on these calls.

Aleks 將繼續以顧問身份與公司合作，但將不再加入我們的電話會議。

We welcome Patrick Clingan to this role.

我們歡迎 Patrick Clingan 擔任這一職務。

Many of you know Patrick already, and he has ably represented us.

你們中的許多人已經認識帕特里克，他幹練地代表了我們。

With that, I turn the call over to Marshall who will review financial highlights.

有了這個，我把電話轉給馬歇爾，他將審查財務亮點。

Thank you, Gary.

謝謝你，加里。

Our fourth-quarter 2013 revenue and procedures were consistent with the press release issued on January 14.

我們 2013 年第四季度的收入和程序與 1 月 14 日發布的新聞稿一致。

Fourth-quarter revenues were $576 million, down 5% compared with $609 million for the fourth quarter of 2012 and up 15% from last quarter.

第四季度收入為 5.76 億美元，比 2012 年第四季度的 6.09 億美元下降 5%，比上一季度增長 15%。

Procedures for the fourth quarter grew approximately 12% compared with the fourth quarter of 2012 and approximately 8% compared with last quarter.

與 2012 年第四季度相比，第四季度的程序增長了約 12%，與上一季度相比增長了約 8%。

Procedure highlights will be covered by Patrick.

帕特里克將介紹程序亮點。

Revenue highlights are as follows.

收入亮點如下。

Instrument and accessory revenue grew 6% compared to the fourth quarter of 2012 and 12% compared to the third quarter of 2013.

與 2012 年第四季度相比，儀器和配件收入增長了 6%，與 2013 年第三季度相比增長了 12%。

The increase relative to the prior year reflects procedure growth in 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.

與上一年相比的增長反映了新產品（包括 Single-Site、Vessel Sealer 和 Firefly）銷售額的增長，部分被與系統銷售減少相關的儀器和配件庫存訂單減少所抵消。

The change from the prior quarter reflects procedure growth in the sales of new products.

與上一季度相比的變化反映了新產品銷售的程序增長。

Instrument and accessory revenue realized for procedure, including initial stocking orders, was approximately $1930 per procedure compared with $2050 in the fourth quarter of 2012 and [$1060 -- $860] last quarter.

手術實現的儀器和配件收入（包括初始庫存訂單）約為每次手術 1930 美元，而 2012 年第四季度為 2050 美元，上一季度為 [1060 美元 - 860 美元]。

The decrease from the prior year reflects fewer stocking orders associated with fewer system sales, partially offset by new product sales.

與上年相比的減少反映了與系統銷售減少相關的庫存訂單減少，部分被新產品銷售所抵消。

The increase from the prior quarter primarily reflects new product sales and the timing of customer orders.

較上一季度的增長主要反映了新產品銷售和客戶訂單的時間安排。

Systems revenue of $205 million decreased 23% compared with the fourth quarter of 2012 and increased 29% compared with the third quarter of 2013.

系統收入為 2.05 億美元，與 2012 年第四季度相比下降了 23%，與 2013 年第三季度相比增長了 29%。

The decline in systems revenue primarily reflects fewer system sales in the US, partially offset by higher system sales outside of the US.

系統收入的下降主要反映了美國系統銷售的減少，部分被美國以外的系統銷售增加所抵消。

In the US, we sold 72 systems in the fourth quarter compared with 133 systems in the fourth quarter of 2012 and 66 systems in the third quarter of 2013.

在美國，我們在第四季度售出了 72 個系統，而 2012 年第四季度和 2013 年第三季度分別售出 133 個和 66 個。

The decline in US system sales relative to the fourth quarter of 2012 reflects the impact of lower procedure growth, spending uncertainties associated with the Affordable Care Act, and confusion surrounding the public debate regarding some da Vinci procedures.

相對於 2012 年第四季度，美國系統銷售額的下降反映了較低的程序增長、與平價醫療法案相關的支出不確定性以及圍繞某些達芬奇程序的公眾辯論的混亂的影響。

The increase relative to the third quarter of 2013 reflects seasonality and increased sales of our SIE product.

相對於 2013 年第三季度的增長反映了我們 SIE 產品的季節性和銷售增長。

As benign procedures are becoming a larger portion of our procedure mix in the US, we are experiencing demand for lower-cost systems for use in reimbursement-sensitive benign conditions in patient settings.

隨著良性程序在美國的程序組合中所佔的比例越來越大，我們正在經歷對低成本系統的需求，以用於患者環境中對報銷敏感的良性條件。

As a result, we sold 20 SIEs with prices between $1 million to $1.2 million, depending on their configuration.

結果，我們售出了 20 個 SIE，價格在 100 萬美元到 120 萬美元之間，具體取決於它們的配置。

Globally, our system ASP of $1.455 million declined relative to the third quarter system ASP of $1.556 million.

在全球範圍內，我們的系統 ASP 為 145.5 萬美元，相對於第三季度 155.6 萬美元的系統 ASP 有所下降。

The decline reflects a higher proportion of SIE systems in the US, partially offset by geographic mix and a higher mix of dual console systems.

這一下降反映了美國 SIE 系統比例較高，但部分被地理組合和雙控制台系統的較高組合所抵消。

In the fourth quarter, we sold 38 dual console systems compared with 32 systems in the third quarter.

第四季度，我們售出了 38 台雙控制台系統，而第三季度為 32 台。

Outside the US, we sold 66 systems in the fourth quarter, including 28 into Europe and 21 into Japan, compared with 42 into international markets in the fourth quarter of 2012, which included 24 into Europe and 10 in Japan and 36 systems in the international markets in the third quarter of 2013, which includes 17 into Europe and 13 into Japan.

在美國以外，我們在第四季度售出了 66 台系統，其中 28 台銷往歐洲，21 台銷往日本，而 2012 年第四季度為 42 台銷往國際市場，其中歐洲 24 台，日本 10 台，國際市場 36 台2013 年第三季度的市場，其中包括 17 個進入歐洲和 13 個進入日本。

Fourth-quarter system sales also included eight into Korea, seven into Italy, five into France, and seven into the Nordic countries.

第四季度的系統銷售還包括韓國的 8 個、意大利的 7 個、法國的 5 個和北歐國家的 7 個。

Moving on to the remainder of the P&L, gross margin in the fourth quarter of 2013 was 69.1% compared with 71.9% for the fourth quarter of 2012 and 71.5% for the third quarter of 2013.

繼續看損益表的其餘部分，2013 年第四季度的毛利率為 69.1%，而 2012 年第四季度為 71.9%，2013 年第三季度為 71.5%。

Our lower margin percentage reflects expensing certain system production costs in light of lower system unit production.

我們較低的利潤率百分比反映了由於較低的系統單位產量而支出了某些系統生產成本。

Fourth-quarter 2013 operating expenses of $189 million were approximately the same as the fourth quarter of 2012 and were up 4% compared with last quarter.

2013 年第四季度運營費用為 1.89 億美元，與 2012 年第四季度大致相同，與上一季度相比增長 4%。

Our fourth-quarter 2013 operating expense compared to 2012 operating expense reflects headcount additions offset by lower incentive compensation and lower R&D prototype expenses.

我們 2013 年第四季度的運營費用與 2012 年的運營費用相比反映了員工人數的增加被較低的激勵薪酬和較低的研發原型費用所抵消。

Our increase compared the last quarter was driven by higher R&D prototype costs, severance costs, and increased headcount, partially offset by lower stock compensations cost.

與上一季度相比，我們的增長是由較高的研發原型成本、遣散費和增加的員工人數推動的，部分被較低的股票補償成本所抵消。

Our effective tax rate for the fourth quarter was 22.5% compared with 30.5% for the fourth quarter of 2012 and 12% last quarter.

我們第四季度的有效稅率為 22.5%，而 2012 年第四季度為 30.5%，上一季度為 12%。

The third quarter of 2012 tax rate benefited from the release of reserves specific to tax years where the statute of limitations have now expired.

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

The fourth quarter of 2013 rate benefited from a greater proportion of our pretax income coming from outside the US where our tax rates are lower.

2013 年第四季度的稅率得益於我們更大比例的稅前收入來自我們的稅率較低的美國以外地區。

Our net income was $166 million or $4.28 per share compared with $175 million or $4.25 per share for the fourth quarter of 2012 and $157 million or $3.99 per share for the third quarter of 2013.

我們的淨收入為 1.66 億美元或每股 4.28 美元，而 2012 年第四季度為 1.75 億美元或每股 4.25 美元，2013 年第三季度為 1.57 億美元或每股 3.99 美元。

Excluding one-time tax benefits, our third-quarter 2013 net income would have been $131 million or $3.32 per share.

不計一次性稅收優惠，我們 2013 年第三季度的淨收入為 1.31 億美元或每股 3.32 美元。

An important measure of our performance is cash flow from operations.

衡量我們業績的一個重要指標是運營現金流。

We define cash flow from operations as net income excluding after-tax non-cash compensation and amortization of intangible assets.

我們將運營現金流定義為不包括稅後非現金補償和無形資產攤銷的淨收入。

We will refer to this as non-GAAP net income.

我們將其稱為非公認會計原則淨收入。

For the fourth quarter of 2013, we generated $193 million in non-GAAP net income or $4.98 per share compared with $205 million or $4.99 per share for the fourth quarter of 2012.

2013 年第四季度，我們創造了 1.93 億美元的非公認會計原則淨收入或每股 4.98 美元，而 2012 年第四季度為 2.05 億美元或每股 4.99 美元。

For the year ended December 31, 2013, we generated $795 million in non-GAAP net income or $19.83 per share compared with $777 million or $18.91 per share last year.

截至 2013 年 12 月 31 日的年度，我們產生了 7.95 億美元的非公認會計原則淨收入或每股 19.83 美元，而去年為 7.77 億美元或每股 18.91 美元。

We will be providing the statistic to you going forward.

我們將在未來向您提供統計數據。

We ended the year with cash and investments of $2.8 billion, up $222 million compared with September 30, 2013.

年末我們的現金和投資為 28 億美元，與 2013 年 9 月 30 日相比增加了 2.22 億美元。

This increase was primarily driven by net cash provided by operating activities.

這一增長主要是由經營活動提供的淨現金推動的。

During the year, we repurchased 2.6 million shares for $1.1 billion at an average stock price of $429 per share.

年內，我們以每股 429 美元的平均股價以 11 億美元的價格回購了 260 萬股股票。

As of December 31, we still have $1 billion of share buybacks authorized.

截至 12 月 31 日，我們仍有 10 億美元的股票回購授權。

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

有了這個，我想把它交給帕特里克，他將介紹我們的營銷和臨床亮點。

Thanks, Marshall.

謝謝，馬歇爾。

Q4 year-over-year procedure growth was approximately 12%, which was led by US general surgery and international procedures.

第四季度手術同比增長約 12%，主要由美國普通外科和國際手術主導。

In the US, general surgery was paced by cholecystectomy, colorectal resections, and a wide variety of emerging procedures, reflecting the broad-based interest in da Vinci surgery among different subspecialties within general surgery.

在美國，普通外科以膽囊切除術、結直腸切除術和各種新興手術為主，反映了普通外科不同亞專科對達芬奇手術的廣泛興趣。

US urology continues to show signs of stabilization as modest declines in DBP were nearly offset by growth in treatments for kidney cancer.

美國泌尿外科繼續顯示出穩定的跡象，因為 DBP 的適度下降幾乎被腎癌治療的增長所抵消。

As expected, the growth rate for US benign GYN procedures was down from Q3, which continued to place pressure on US system sales.

正如預期的那樣，美國良性婦科手術的增長率較第三季度有所下降，這繼續對美國系統銷售構成壓力。

Q4 international procedure growth of 23% was led by urology with contributions from GYN and general surgery.

第四季度國際手術增長 23% 由泌尿科引領，婦科和普通外科貢獻。

DBP uptake in Europe and Japan was robust, accelerating in the back half of 2013.

歐洲和日本的 DBP 吸收強勁，在 2013 年下半年加速。

During the fourth quarter, international DBP volumes surpassed US DBP volumes, despite representing approximately 30% penetration in key developed markets.

儘管在主要發達市場的滲透率約為 30%，但國際 DBP 銷量在第四季度超過了美國。

Earlier this month, the UK National Institute for Health and Care Excellence published an update to its 2008 clinical guidelines on prostate cancer, which recommends consideration of robotic surgery in the treatment of prostate cancer.

本月早些時候，英國國家健康與護理卓越研究所發布了其 2008 年前列腺癌臨床指南的更新，建議在前列腺癌治療中考慮機器人手術。

The recommendation also states that surgical treatments of localized prostate cancer are cost effective by basing them in centers that are expected to perform at least 150 procedures per year.

該建議還指出，局部前列腺癌的手術治療具有成本效益，因為它們位於預計每年至少進行 150 次手術的中心。

As Gary mentioned, our US customers are increasingly segmenting our business between less complex benign and complex for cancer procedures, and we are pursuing strategies to realize the opportunities for the new segments.

正如 Gary 所提到的，我們的美國客戶越來越多地將我們的業務劃分為不太複雜的良性和復雜的癌症手術，我們正在尋求實現新細分市場機會的戰略。

The adoption of da Vinci surgery in less complex benign procedures has changed our procedure mix, growing from approximately 40% to approximately 60% of our US procedures over the past three years.

在不太複雜的良性手術中採用達芬奇手術改變了我們的手術組合，在過去三年中，我們在美國手術中的比例從大約 40% 增長到大約 60%。

In order to provide solutions for customers to address lower reimbursements and alternate sites of care, we have launched products such as Single-Site and SAE.

為了為客戶提供解決方案以解決較低的報銷和替代護理站點，我們推出了 Single-Site 和 SAE 等產品。

Single-Site instruments are lower cost, enabling us to offer the advantages of robotic surgery at a lower instrument price.

單點器械成本較低，使我們能夠以較低的器械價格提供機器人手術的優勢。

The addition of a wristed needle driver to the Single-Site product family will optimize this technology for additional procedures, beginning with benign hysterectomy.

在 Single-Site 產品系列中添加腕式針頭驅動器將優化該技術以用於其他程序，從良性子宮切除術開始。

Single-Site surgery provides an alternative to traditional approaches for procedures that are largely being performed in a minimally invasive manner.

單點手術為主要以微創方式進行的手術提供了傳統方法的替代方法。

However, the push by robotic surgeons into less complex benign procedures is not simply about patient choice, but the potential for safer outcomes.

然而，機器人外科醫生推動不太複雜的良性手術不僅僅是關於患者的選擇，而是更安全結果的潛力。

Following our September 510-K approval of Firefly for biliary imaging, we have witnessed acceleration in the adoption of fluorescence imaging during da Vinci cholecystectomies as Firefly enables visualization of the biliary anatomy that cannot be seen under white light.

在我們 9 月 510-K 批准 Firefly 用於膽道成像之後，我們見證了在達芬奇膽囊切除術中採用熒光成像的速度加快，因為 Firefly 能夠可視化在白光下無法看到的膽道解剖結構。

During the fourth quarter, Firefly was included on 80% of the US SIE systems licenses.

在第四季度，Firefly 被納入了 80% 的美國 SIE 系統許可證。

While the available capacity on our existing installed base has served as a headwind to 2013 system sales, not all capacity is in the right location.

雖然我們現有安裝基地的可用容量對 2013 年的系統銷售造成了不利影響，但並非所有容量都位於正確的位置。

This industry-wide shift in surgery from inpatient to outpatient settings has led some hospitals to pursue robotic surgery in an outpatient setting.

這種從住院到門診的全行業手術轉變導致一些醫院在門診進行機器人手術。

We believe our SIE platform is suited to meet the needs of these hospitals.

我們相信我們的 SIE 平台適合滿足這些醫院的需求。

At the other end of the spectrum, we believe the value proposition and evidence-based supporting conversion of complex and cancer surgeries from open to MIS is growing increasingly clear.

另一方面，我們認為價值主張和循證支持將復雜和癌症手術從開放式轉換為 MIS 正變得越來越清晰。

Traditional minimally invasive tools have attempted to make inroads into these procedures for decades, but the technical complexity and challenging patient anatomies has limited adoption.

幾十年來，傳統的微創工具一直試圖進入這些程序，但技術複雜性和具有挑戰性的患者解剖結構限制了採用。

We believe da Vinci surgery represents an evolution in minimally invasive technology that can expand MIS more deeply into a number of traditionally open procedures.

我們相信達芬奇手術代表了微創技術的發展，可以將 MIS 更深入地擴展到許多傳統的開放手術中。

Given the high value we bring to converting complex open surgery to MIS, we are seeing increased global interest in our fully featured systems and advanced instrumentation.

鑑於我們將復雜的開放式手術轉換為 MIS 帶來的高價值，我們看到全球對我們功能齊全的系統和先進儀器的興趣日益增加。

Vessel sealing and stapling technologies are important tools for colorectal surgeons, and with our stapler entering full launch mode in the US, we believe we are well suited to drive adoption in colorectal resections.

血管密封和縫合技術是結直腸外科醫生的重要工具，隨著我們的縫合器在美國進入全面啟動模式，我們相信我們非常適合推動結直腸切除術的採用。

Globally, there are more open colorectal resections than prostatectomies and malignant hysterectomies combined, and we believe our vessel sealing, stapling, and Firefly technologies bring a powerful tools to enable deeper penetration of MIS into colorectal surgery.

在全球範圍內，開放式結直腸切除術比前列腺切除術和惡性子宮切除術加起來還要多，我們相信我們的血管密封、縫合和螢火蟲技術帶來了強大的工具，可以使 MIS 更深入地滲透到結直腸手術中。

During the quarter, we continue to see growth in peer-reviewed publications, highlighting robotic surgery in a number of journals.

在本季度，我們繼續看到同行評審出版物的增長，在許多期刊中突出了機器人手術。

I'll take a moment to highlight just a few.

我會花一點時間來強調一些。

Dr. Davids from M.D. Anderson offered a multi-institution database study in the December issue of Journal of Endourology that evaluated over 71,000 prostatectomy patients from 2004 to 2010.

來自 M.D. Anderson 的 Davids 博士在 2004 年至 2010 年的 12 月刊的 Endourology 雜誌上提供了一項多機構數據庫研究，評估了 71,000 多名前列腺切除術患者。

This paper shows da Vinci surgery has a shorter hospital stay and lower rate of complications compared to open surgery, even for surgeons in their initial 25 procedures.

這篇論文表明，與開放式手術相比，達芬奇手術的住院時間更短，並發症發生率更低，即使對於最初進行 25 次手術的外科醫生來說也是如此。

We believe these outcomes reflect the value created by the totality of resources available for safely training sessions on da Vinci.

我們相信這些成果反映了可用於達芬奇安全培訓課程的全部資源所創造的價值。

Turning to GYN and specifically benign hysterectomy, while near-term ACA implementation creates some uncertainty among our customers, this study supports how da Vinci surgery aligns with the underlying principles of healthcare reform published in the October version of the Journal of Minimally Invasive Gynecology.

談到婦科，特別是良性子宮切除術，雖然近期 ACA 的實施給我們的客戶帶來了一些不確定性，但這項研究支持達芬奇手術如何與發表在 10 月版《微創婦科雜誌》上的醫療改革的基本原則保持一致。

Dr. Martino and colleagues from the Lehigh Valley Health Network presented results covering more than 2500 benign hysterectomies because all four surgical modalities -- robotic, laparoscopic, vaginal, and abdominal.

來自 Lehigh Valley 健康網絡的 Martino 博士及其同事展示了涵蓋超過 2500 例良性子宮切除術的結果，因為所有四種手術方式——機器人、腹腔鏡、陰道和腹部。

The authors concluded that da Vinci benign hysterectomy had a statistically significantly lower rate of 30-day readmissions, as well as reduced blood loss and length of stay compared to the other three modalities of care.

作者得出結論，與其他三種護理方式相比，達芬奇良性子宮切除術的 30 天再入院率在統計學上顯著降低，失血量和住院時間也減少了。

Moving back to urology, a national database study of approximately 5500 prostatectomy patients was published by [Dr.

回到泌尿科，一項對大約 5500 名前列腺切除術患者的國家數據庫研究由 [Dr.

Pileggi] from Northwestern in the November Journal of Endourology.

Pileggi] 來自西北大學，發表在 11 月的泌尿外科雜誌上。

This study reported statistically significant results that favored robotic surgery, including a total complication rate of 6% for da Vinci versus 23% for open surgery, a surgical complication rate of 1% for da Vinci versus 3% for open surgery, and a readmission rate of 3.5% for da Vinci versus 5.5% for open surgery.

該研究報告了有利於機器人手術的統計學顯著結果，包括達芬奇的總並發症發生率為 6%，開放手術為 23%，達芬奇手術並發症發生率為 1%，開放手術為 3%，以及再入院率達芬奇為 3.5%，而開放手術為 5.5%。

These results came at the cost of an additional 38 minutes of operative time for da Vinci.

這些結果是以達芬奇額外 38 分鐘的手術時間為代價的。

Finally, we will conclude with a large national database study on colon resection.

最後，我們將以一項關於結腸切除術的大型國家數據庫研究結束。

Originating from [Dr.

源自 [Dr.

Juo] and colleagues at Johns Hopkins who studied 244,000 US surgeries from 2008 to 2010, this paper published in the December edition of JAMA showed that minimally invasive colon resections offered lower mortality rates, lower complication rates, shorter length of stay, and reduced costs compared to open surgery.

Juo] 和約翰霍普金斯大學的同事從 2008 年到 2010 年研究了 244,000 例美國手術，這篇發表在 12 月版 JAMA 上的論文表明，微創結腸切除術提供了更低的死亡率、更低的並發症發生率、更短的住院時間和更低的成本。開手術。

Robotic surgery represents less than 1% of the colectomies performed in this data set.

機器人手術僅佔該數據集中進行的結腸切除術的不到 1%。

When comparing this small cohort to laparoscopy, there were two statistically significant outcomes in favor of robotics -- reduced hospital stay and lower conversion rate -- while costs statistically significantly favored laparoscopy.

當將這個小隊列與腹腔鏡進行比較時，有兩個統計學上顯著的結果有利於機器人技術——減少住院時間和降低轉化率——而成本在統計學上顯著有利於腹腔鏡。

The authors concluded that robotic surgery was similar to laparoscopy with a higher cost, but noted that less than 50% of colon resections within this study were performed laparoscopically in 2010.

作者得出結論，機器人手術與腹腔鏡手術相似，但成本較高，但指出本研究中不到 50% 的結腸切除術是在 2010 年通過腹腔鏡進行的。

The authors could not include rectal resections in the study, which are notably absent given a higher proportion of open surgery.

作者無法在研究中包括直腸切除術，鑑於開放手術的比例較高，直腸切除術明顯不存在。

We encourage you to look closely at the underlying data and consider the opportunity for da Vinci surgery to expand MIS for colon resections as adoption grows among colorectal surgeons.

我們鼓勵您仔細查看基礎數據，並考慮隨著結直腸外科醫生採用率的增長，達芬奇手術擴大結腸切除術 MIS 的機會。

Please visit the Clinical Evidence section of our website to learn more about these and other publications regarding da Vinci surgery.

請訪問我們網站的臨床證據部分，以了解有關這些和其他有關達芬奇手術的出版物的更多信息。

Thank you for your time, and I will now turn the call over to Calvin.

感謝您抽出寶貴時間，我現在將把電話轉給 Calvin。

Thank you, Patrick.

謝謝你，帕特里克。

I will be providing you with our financial outlook for 2014.

我將為您提供我們 2014 年的財務展望。

Starting with procedures.

從程序開始。

In 2013, total da Vinci procedures grew approximately 16% to roughly 523,000 procedures performed worldwide.

2013 年，達芬奇手術總數增長了約 16%，達到全球約 523,000 例。

We exited 2013 with fourth-quarter procedures up approximately 12% versus the prior year.

我們在 2013 年結束時，第四季度的程序比上一年增長了約 12%。

During 2014, we anticipate a stabilization of the procedure growth rate with the full-year procedures growing within a range of approximately 9% to 12%.

2014 年，我們預計手術增長率將趨於穩定，全年手術增長率將在約 9% 至 12% 之間。

Based on an increasing proportion of benign procedures in our procedure mix, we anticipate a more pronounced quarterly seasonality impact in the upcoming first quarter of 2014.

基於我們的程序組合中良性程序的比例越來越高，我們預計在即將到來的 2014 年第一季度會有更明顯的季度季節性影響。

Moving to revenues, as has been discussed earlier, several factors are pressuring our business, making it difficult in the near-term for us to predict system sales volumes and, as a consequence, total revenue.

如前所述，轉向收入，有幾個因素正在給我們的業務帶來壓力，使我們在短期內難以預測系統銷量，從而預測總收入。

As we enter 2014, our visibility into system sales is challenged by the breath of the range of our procedure growth forecast.

隨著我們進入 2014 年，我們對系統銷售的可見性受到我們程序增長預測範圍的挑戰。

As a reminder, procedures drive capital sales and the relationship between procedure growth rates and capital sales is highly sensitive.

提醒一下，程序驅動資本銷售，程序增長率和資本銷售之間的關係是高度敏感的。

Economic pressure and uncertainty at hospitals associated with the implementation of the Affordable Care Act, evolving utilization patterns, and point of care dynamics as described by Patrick early in the call, and likely variability in the timing of Japan's system sales given the time until additional procedure reimbursement anticipated in 2016.

與實施平價醫療法案相關的醫院的經濟壓力和不確定性、不斷變化的使用模式和帕特里克在電話會議早期所描述的護理點動態，以及考慮到額外程序之前的時間，日本系統銷售時間的可能變化預計在 2016 年償還。

Given our capital sales performance in the back half of 2013 and the persistence of some of the issues described above, it is likely that we will sell fewer systems in 2014 than the 546 systems sold in 2013.

鑑於我們在 2013 年下半年的資本銷售業績以及上述一些問題的持續存在，我們在 2014 年銷售的系統可能會少於 2013 年銷售的 546 台系統。

Due to limited visibility regarding the capital side of our business, we will not be providing revenue forecasts at this time.

由於我們業務資本方面的可見性有限，我們目前不會提供收入預測。

As we gain greater visibility, it is our intention to reinstate revenue guidance.

隨著我們獲得更大的知名度，我們打算恢復收入指導。

We believe deeply in our ability to fundamentally improve surgery and are pursuing plans to increase the use of da Vinci enabled MIS around the globe.

我們深信我們有能力從根本上改善手術，並正在製定計劃，在全球範圍內增加使用達芬奇的 MIS。

As a result, 2014 will be a year of increased investment for Intuitive Surgical, even during this upcoming period of capital sales uncertainty.

因此，2014 年將是 Intuitive Surgical 投資增加的一年，即使在即將到來的資本銷售不確定時期也是如此。

We will be building our international capabilities, investing in new product development, and pursuing growth in both of our procedures businesses segments.

我們將建立我們的國際能力，投資於新產品開發，並在我們的兩個程序業務領域尋求增長。

In 2014, we plan to grow our operating expenses roughly 12% to 15% above 2013 levels.

2014 年，我們計劃將我們的運營費用比 2013 年的水平增加約 12% 至 15%。

We expect our non-cash stock compensation to range between $180 million and $190 million in 2014 compared to $169 million in 2013.

我們預計 2014 年我們的非現金股票薪酬將介於 1.8 億美元至 1.9 億美元之間，而 2013 年為 1.69 億美元。

We expect other income, which is comprised mostly of interest income, to total between $15 million and $20 million in 2014.

我們預計 2014 年其他收入（主要由利息收入組成）總計在 1500 萬美元至 2000 萬美元之間。

With regard to income tax, we expect our 2014 income tax rate to be between 25% and 28% of pretax income, depending primarily on the mix of US and international profits.

關於所得稅，我們預計 2014 年的所得稅稅率將在稅前收入的 25% 至 28% 之間，主要取決於美國和國際利潤的組合。

This forecast does not assume the reinstatement of the R&D tax credit in 2014.

該預測不假設在 2014 年恢復研發稅收抵免。

Our share count for calculating diluted EPS in Q4 2013 was approximately 38.8 million shares, declining 500,000 shares in the quarter, primarily due to the full quarter impact of Q3 buybacks.

我們計算 2013 年第四季度攤薄後每股收益的股票數量約為 3880 萬股，本季度減少了 50 萬股，主要是由於第三季度回購對整個季度的影響。

Our actual Q1 and fiscal year 2014 share count will depend on several factors, including the magnitude and timing of any additional share buybacks.

我們實際的第一季度和 2014 財年的股票數量將取決於幾個因素，包括任何額外股票回購的規模和時間。

That concludes our prepared comments.

我們準備好的評論到此結束。

We will now open the call to your questions.

我們現在將打開您的問題的電話。

Thank you.

謝謝你。

(Operator Instructions).

（操作員說明）。

Tao Levy, Wedbush.

陶徵，韋德布什。

Yes, hello.

是的你好。

Good afternoon.

下午好。

So a couple questions on my end.

所以我有幾個問題。

Obviously, the decision not to provide full-year guidance leaves us a little bit, not necessarily confused, but struggling to figure out where our numbers should end up this year, especially given all the volatility.

顯然，不提供全年指導的決定讓我們有點困惑，不一定是困惑，但很難弄清楚我們今年的數字應該在哪裡結束，尤其是考慮到所有的波動性。

Would you maybe comment on the comfort that you feel around where consensus is at this moment in terms of your topline, or do you want to stay away from that type of guidance?

您是否會評論一下您對此時就您的頂線達成共識的感覺感到舒適，或者您是否想遠離這種類型的指導？

It is not clear where consensus will wind up, so I think trying to project where that will go I think is probably not worth speculating on the call.

目前尚不清楚共識將在哪裡結束，所以我認為試圖預測會走向何方可能不值得在電話會議上推測。

I think we laid out the underlying dynamics that had reduced near-term visibility through the script pretty well, and if we had greater visibility on that, we would share it with you.

我認為我們通過腳本很好地展示了降低近期知名度的潛在動態，如果我們對此有更大的知名度，我們會與您分享。

I think that looking out at what the inpatient admissions will be for the benign procedures we serve and what those dynamics will be has been moving around, looking at how hospitals model their revenues in the face of ACA and that benign segment that we operate in and then trying to predict what Japan will do.

我認為，看看我們所服務的良性程序的住院病人將是多少，以及這些動態將如何變化，看看醫院如何在 ACA 和我們經營的良性細分市場中建立收入模型，然後試圖預測日本會做什麼。

We have an operating plan.

我們有一個運營計劃。

We understand what we are going.

我們明白我們要做什麼。

We are disciplined about what we expect to do in terms of activity, but there's a wide range.

我們對我們期望在活動方面做的事情有紀律，但范圍很廣。

And so rather than speculate, I think this is where we are.

因此，與其推測，我認為這就是我們所處的位置。

Okay.

好的。

And I think at the beginning of the script, you'd mentioned that there was more concern around the first half of the year, specifically on capital system placements.

而且我認為在劇本的開頭，您提到今年上半年有更多的擔憂，特別是在資本系統配置方面。

Is there something that happens in the middle of the year, back half of the year, that, you know, again, would get you more comfortable?

年中、後半年有沒有什麼事情發生，你知道，再一次，會讓你更舒服嗎？

I don't think it's an event.

我不認為這是一個事件。

I think more around, as we see how patient flows are going to our customers, they'll have a better view, and as their view improves, our view improves.

我想得更多，當我們看到患者流如何流向我們的客戶時，他們會有更好的視野，隨著他們的視野改善，我們的視野也會改善。

I think it's really as simple as that.

我覺得真的就這麼簡單。

Okay.

好的。

And just lastly, maybe you can talk a little bit about the profitability of the SIE system versus the SIE, just given that that's becoming a bigger part of your mix?

最後，也許您可以談談 SIE 系統相對於 SIE 的盈利能力，只是考慮到這正在成為您組合中更大的一部分？

Thanks.

謝謝。

Here, I'll ask Marshall to take you through a little bit of what that framing looks like, and my only comment before he jumps in is beware of averaging.

在這裡，我會請馬歇爾帶你了解一下這個框架是什麼樣的，在他介入之前我唯一的評論是提防平均化。

There's now multiple products in the line, and the average is not necessarily predictive of what's going on underneath.

現在有多種產品在生產線上，平均值不一定能預測下面發生的事情。

So, as I said in the call, the average pricing that we received for SIEs was between about $1 million and $1.2 million depending on the configuration.

因此，正如我在電話會議中所說，我們收到的 SIE 平均定價在 100 萬美元到 120 萬美元之間，具體取決於配置。

That's obviously lower than a SI with four arms.

這顯然低於具有四臂的 SI。

The SIE, though, is -- does only have three arms, and so it does not cost the same amount of money to produce.

不過，SIE 只有三個臂，因此生產成本並不相同。

The gross margins are several points below -- 6 to 7 points below what they are for SIE systems.

毛利率比 SIE 系統低 6 到 7 個百分點。

But if it's able to open up benign procedures for us, particularly in outpatient settings, we are all for it.

但如果它能夠為我們開闢良性程序，特別是在門診環境中，我們都支持它。

Thank you.

謝謝你。

Tycho Peterson, JPMorgan.

第谷彼得森，摩根大通。

Hey.

嘿。

Thanks for taking my question.

感謝您提出我的問題。

Maybe just following up on the last one, what should we thinking about in terms of our run rate for SIE placements, and maybe could you also just touch on your pricing assumptions that you're thinking about for 2014 overall?

也許只是跟進最後一個，就 SIE 展示位置的運行率而言，我們應該考慮什麼，也許你也可以談談你對 2014 年整體考慮的定價假設？

So we really have -- if you go back, we sold three in the first quarter, two in the second quarter, two in the third quarter, and then we sold 21 total.

所以我們真的有——如果你回去，我們在第一季度賣了三個，第二季度賣了兩個，第三季度賣了兩個，然後我們總共賣了 21 個。

There were 20 in the US.

美國有20個。

21 total.

共 21 個。

That's an -- to me, that's one quarter of success in selling it at a -- to customers that are looking for a lower cost system for benign conditions.

這是一個 - 對我來說，這是成功向正在尋找低成本系統以適應良性條件的客戶銷售它的四分之一。

I think -- I don't have enough data to really predict exactly how many I'm going to be selling every quarter, so I'm not going to go there.

我認為 - 我沒有足夠的數據來準確預測我每個季度要銷售多少，所以我不會去那裡。

And then can you comment on your pricing assumptions for 2014?

然後你能評論一下你對 2014 年的定價假設嗎？

Yes, I assume you mean the system pricing assumptions, and like Gary said, here it's really important to be aware of the averages.

是的，我假設您的意思是系統定價假設，就像加里所說，在這裡了解平均值非常重要。

If you look at it overall, our ASP was about $1.5 million in both the full year of 2012 and 2013, and in Q4, our ASP declined to $1.455 million as we saw this significant increase in the lower-priced three-arm SIEs.

整體來看，我們的 2012 年和 2013 年全年的 ASP 約為 150 萬美元，而在第四季度，我們的 ASP 下降至 145.5 萬美元，因為我們看到低價三臂 SIE 的顯著增長。

As you know, these SIEs are targeted towards a growing procedure segment of Single-Site and less complex procedures, and in 2014, we will remain focused on growing this procedure category with more SIE system sales.

如您所知，這些 SIE 的目標是不斷增長的單站點程序部分和不太複雜的程序，並且在 2014 年，我們將繼續專注於通過更多的 SIE 系統銷售來發展這一程序類別。

But also as was mentioned, at the same time, the proportion of the higher featured dual console and Firefly systems also increased in 2013, and furthermore, the systems that went in Japan in strong numbers were higher.

但也如前所述，與此同時，2013年更高功能的雙控制台和螢火蟲系統的比例也有所增加，而且大量進入日本的系統也更高。

So I guess the point of it is, going forward, the ASPs will potentially vary more significantly quarter to quarter based upon this broader pricing mix.

因此，我想重點是，展望未來，基於這種更廣泛的定價組合，ASP 可能會隨著季度的變化而更加顯著。

And I'll just pull short of trying to guess which way it's going to go.

而且我不會試圖猜測它會朝哪個方向發展。

One comment I guess I'd add and a little clarity there is I don't think within each subsegment, the ASPs are going to fluctuate that much.

我想我會添加一條評論，並且有點清楚，我不認為在每個子部分中，ASP 會波動那麼大。

It's the mix of those subsegments that makes the prediction hard.

正是這些子段的混合使預測變得困難。

Okay.

好的。

That's helpful.

這很有幫助。

And then on Japan, it sounds like we should assume that you had a bullish placement here, and then that's going to slow a little bit.

然後在日本，聽起來我們應該假設你在這裡看漲，然後會放緩一點。

Is that the right way to be thinking about it for 2014?

這是考慮 2014 年的正確方式嗎？

The timing of it is very hard to predict, but we have 2014 and 2015 before the next round of broad national reimbursements.

它的時間很難預測，但在下一輪廣泛的國家報銷之前，我們有 2014 年和 2015 年。

There may be hospitals that get individual exemptions to collect data, but broadly, there will be some time.

可能會有醫院獲得個人豁免來收集數據，但總的來說，會有一段時間。

And so figuring out how much absorption there will be in Japan over that two-year period is just very hard to model.

因此，要弄清楚日本在這兩年期間的吸收量是非常難以建模的。

And so what the timing looks like is hard to predict.

因此，時間的樣子很難預測。

But over time, I think it's going to be constrained until -- directionally, I don't think you'll keep selling systems at a very high rate until that constraint is broken with reimbursement.

但隨著時間的推移，我認為它會受到限制，直到——在方向上，我認為你不會繼續以非常高的速度銷售系統，直到這種限制被報銷打破。

And then last one, you talked about we're having to reinvest a bit this year.

然後最後一個，你談到我們今年必須進行一些再投資。

You had a small headcount reduction at the end of last year.

去年底，您的員工人數略有減少。

Maybe just should we be thinking about headcount being up and talk maybe a little bit more specifically if you can on where those investments are being made?

也許我們應該考慮增加員工人數，如果可以的話，可以更具體地談談這些投資是在哪裡進行的？

Do you need to build the channel to the ambulatory market, for example?

例如，您是否需要建立通往門診市場的渠道？

Yes, good question.

是的，好問題。

So we had a small reduction in our US sales force at the end of the year.

因此，我們在年底時對美國銷售人員進行了小幅裁減。

It was about 50 people.

大約有50人。

Just for those who may be listening that haven't heard this conversation, we had a team that had grown that was layered on top of our main force that was designed to pursue gynecology.

只是對於那些可能在聽但沒有聽過這段對話的人來說，我們有一個已經成長的團隊，它位於我們的主要力量之上，旨在追求婦科。

As gynecology has matured in US, they were, in a sense, double serving those accounts, and so we folded them back into the main force.

隨著婦科在美國的成熟，從某種意義上說，他們為這些賬戶提供了雙重服務，因此我們將它們重新折疊成主力軍。

So that was 50 out of a commercial force of about 800.

所以這是大約 800 名商業力量中的 50 名。

We anticipate growing forward in the year in a few places.

我們預計今年在一些地方會向前發展。

Europe, we continue to see investment in our organizations there.

歐洲，我們繼續看到對我們組織的投資。

In Asia, more broadly, we will invest in that opportunity in our channel there.

在亞洲，更廣泛地說，我們將在我們的渠道中投資這個機會。

In the US, in product development, we will continue investments and in -- other parts of our operations.

在美國，在產品開發方面，我們將繼續投資以及我們業務的其他部分。

So I think headcount growth will continue through the year.

所以我認為員工人數的增長將持續到今年。

It won't be a sharp increase, but I think it will be targeted where we need it.

它不會急劇增加，但我認為它將針對我們需要的地方。

With regard to how we discuss opportunities with hospital customers in terms of site of care, we think our capital sales team is well-positioned to start the year here to have those conversations.

關於我們如何與醫院客戶討論護理地點方面的機會，我們認為我們的資本銷售團隊已經準備好在今年開始在這裡進行這些對話。

Thank you.

謝謝你。

David Roman, Goldman Sachs.

大衛羅曼，高盛。

Thank you and good afternoon.

謝謝你，下午好。

I also wanted to point out that it's very helpful -- all the additional disclosure you're giving on the website.

我還想指出它非常有幫助——您在網站上提供的所有額外披露。

I know it takes time to add that altogether, so thank you for that.

我知道完全添加它需要時間，所以謝謝你。

So I guess on my question -- I wanted just to take a step back for a second.

所以我想我的問題——我只想退後一步。

As you look at the overall US market and what's transpired this year, I guess in some ways when I look at the trends in capital, that this could have happened at any point in time as procedure volumes slowed because what I'm trying to reconcile is that you had a modest slowing in procedure volumes but a very significant drop-off in capital.

當您查看整個美國市場以及今年發生的情況時，我想在某些方面，當我查看資本趨勢時，隨著程序量的放緩，這可能隨時發生，因為我試圖調和是您的手術量略有放緩，但資本大幅下降。

So I am just wondering if you can talk about why we shouldn't think that there's overcapacity in this system and that you penetrated just a large segment of the addressable market here and that there's going to be sort of a normalization period until procedure volume picks back up?

所以我只是想知道你是否可以談談為什麼我們不應該認為這個系統存在產能過剩並且你在這裡只滲透了可尋址市場的很大一部分並且在程序量挑選之前會有一個正常化期備份？

Let me start, and Calvin, you can jump in.

讓我開始吧，卡爾文，你可以加入。

I think a couple of things.

我認為有幾件事。

Underlying capital sales are really three factors, and you've hit on a couple.

潛在的資本銷售實際上是三個因素，你已經找到了幾個。

Well, one of them is procedure capacity, and that's a highly sensitive element.

嗯，其中之一就是程序能力，這是一個高度敏感的因素。

So that just a percent change in procedure growth rate can free about 20 systems worth of capacity give or take, not an exact number.

因此，程序增長率的百分之一變化可以釋放大約 20 個系統的容量，而不是一個確切的數字。

So there is a high sensitivity there since capacity is highly sensitive to pursuit of growth rate.

所以那裡的敏感性很高，因為產能對追求增長率非常敏感。

That's one element.

這是一個要素。

The second element is, do hospital customers feel they have the right technologies to pursue the opportunity that's in front of them?

第二個要素是，醫院客戶是否認為他們擁有正確的技術來追求擺在他們面前的機會？

So if they have an S system and they want to pursue colorectal or Single-Site, then there is an upgrade opportunity for them to move up into SI.

因此，如果他們有一個 S 系統並且他們想要追求結腸直腸或單站點，那麼他們就有升級到 SI 的機會。

And then Patrick pointed out in his section that not always -- the systems are not always in the same operating rooms.

然後帕特里克在他的部分指出，並不總是——這些系統並不總是在同一個手術室裡。

So that if hospitals are doing benign procedures in a different point and ambulatory surgery environment costs alone, it's not the same set of oars.

因此，如果醫院在不同的地點進行良性程序並且僅門診手術環境成本，那麼這不是同一組槳。

So while they have capacity in one place, it's not necessarily in the right place.

因此，雖然他們在一個地方有能力，但不一定在正確的地方。

And so those three things are underlying what happens, and one of them, highly sensitive procedure volume, the other two, one is sensitive to technology, one is point of care.

所以這三件事是發生的事情的基礎，其中之一是高度敏感的手術量，另外兩個是對技術敏感，一個是護理點。

Calvin?

卡爾文？

Yes, I mean I don't have much to add to that other than just to acknowledge that prior to 2013, we had really a long standing history of gradually increasing utilization per system.

是的，我的意思是我沒有什麼要補充的，只是承認在 2013 年之前，我們確實有著逐步提高每個系統的利用率的悠久歷史。

And it is true that, based upon the issues that we described, we had a modest decrease in utilization -- average utilization and again, beware of averages, in 2013.

確實，根據我們所描述的問題，我們在 2013 年的利用率略有下降——平均利用率，再次提防平均值。

But, again, capacity is really just one of the factors involved in system acquisitions by hospitals.

但是，容量實際上只是醫院採購系統的因素之一。

But then, and to finish the thought, to acknowledge your question, I think our procedures are the number one.

但是，為了完成這個想法，承認你的問題，我認為我們的程序是第一位的。

Of the three things, procedures are very important, and procedure growth rate is important, and it's something we're focused on.

這三件事中，程序很重要，程序增長率很重要，也是我們關注的重點。

Okay.

好的。

That's helpful.

這很有幫助。

Then maybe just a follow-up, as you sort of think about the operating profile of the business from a profitability standpoint, I know you've talked a lot about being focused on topline growth, and while your margins have come down, they are still very high, particularly on a cash basis.

然後也許只是一個後續行動，當您從盈利能力的角度考慮業務的運營狀況時，我知道您已經談論了很多關於專注於收入增長的話題，雖然您的利潤率已經下降，但它們是仍然很高，特別是在現金基礎上。

Can you maybe just talk about how you're thinking about P&L leverage versus efforts you are undertaking to restimulate topline growth?

您能否談談您如何看待損益槓桿與您為重新刺激收入增長所做的努力？

And I would assume that at this point resumption of topline growth is a priority and that you have financial levers to help protect earnings, or am I not thinking about that the right way?

我會假設此時恢復收入增長是當務之急，並且您有財務槓桿來幫助保護收益，還是我沒有正確考慮這一點？

I'll start and Marshall can chime in.

我會開始，馬歇爾可以插話。

I think the first thing is we will manage the business for the long-term.

我認為第一件事是我們將長期管理業務。

And we will look around and say, our mission, our mission of the Company, and the way we ought to be evaluated is are we satisfying the mission of improving surgery in the areas and markets that we can do that, and I think there's a lot of opportunity for us, and we will pursue that.

我們會環顧四周，說，我們的使命，我們公司的使命，以及我們應該被評估的方式是我們是否滿足了在我們可以做到的領域和市場中改善手術的使命，我認為有一個我們有很多機會，我們將繼續努力。

Fiscal discipline is important, and I think it's important in two ways.

財政紀律很重要，我認為這在兩個方面很重要。

One is spending discipline is important, so make sure that we're careful about where we spend.

一是支出紀律很重要，因此請確保我們對支出的地方保持謹慎。

And investment discipline is important.

投資紀律很重要。

In this period of time, we will invest.

在這段時間裡，我們會投資。

We'll invest in a disciplined way, but we think that the opportunity ahead of the Company to make surgery better is substantial, and we are in a great position to do it.

我們將以有紀律的方式進行投資，但我們認為公司在改善手術方面的機會是巨大的，我們處於有利地位。

And I think pulling back that set of investments in the face of some near-term uncertainty would not be in the long-term interests of the Company.

而且我認為，面對一些近期的不確定性，撤回那套投資不符合公司的長期利益。

So that's how we look at it.

所以我們就是這麼看的。

In terms of operating levers, there is sort of near-term and long-term, and I'll let Marshall talk to that.

就操作槓桿而言，有短期和長期之分，我會讓馬歇爾談談。

Some operating levers are already certain.

一些操作槓桿已經確定。

They operate on their own.

他們自己運作。

What I mean by that is a large portion of our cost base is variable.

我的意思是我們的成本基礎的很大一部分是可變的。

It varies with revenue.

它隨收入而變化。

So even in the SG&A category, a large portion is commission based.

因此，即使在 SG&A 類別中，很大一部分也是基於佣金的。

And so as revenue fluctuates, so does the amount of costs that we have and -- but otherwise, I think Gary sort of outlined some of the other things.

因此，隨著收入的波動，我們擁有的成本數量也會波動——但除此之外，我認為加里在某種程度上概述了其他一些事情。

I think that we have some levers, but we're going to continue to invest in our future.

我認為我們有一些槓桿，但我們將繼續投資於我們的未來。

I got it.

我知道了。

Thank you.

謝謝你。

Ben Andrew, William Blair.

本安德魯，威廉布萊爾。

Good afternoon guys.

各位下午好。

It's actually Margaret this time.

這次真的是瑪格麗特。

Thanks for taking the questions.

感謝您提出問題。

Gary, if we look at the opportunity in colorectal in 2014 and as you kind of look at the current system and the current toolset, do you think that can get you to the procedure growth so at least you are modeling internally.

加里，如果我們看看 2014 年結直腸的機會，當你看看當前的系統和當前的工具集時，你認為這可以讓你實現程序增長，所以至少你在內部建模。

It's not getting to us.

它沒有到達我們。

And then how do you view the rate of penetration in general surgery over the next several years and 2014?

那麼您如何看待未來幾年和 2014 年普外科的滲透率？

Is it going to be similar to DVP, DVH, or slower?

它會類似於 DVP、DVH 還是更慢？

Any clarity would be helpful.

任何清晰都會有所幫助。

Well, I'll speak to the first one.

好吧，我會和第一個說話。

The second question has several moving parts.

第二個問題有幾個活動部分。

On the first one, we think that the set of Vessel Sealer, stapler -- as you know, stapler as a whole marketplace is quite broad in terms of the number of sub products you need in a stapling family.

在第一個方面，我們認為 Vessel Sealer，訂書機 - 如您所知，訂書機作為一個整個市場，就您在訂書機系列中所需的子產品數量而言相當廣泛。

Our first offering is targeted at colorectal, and feedback on that has been great, and then perfusion imaging with Firefly, those three things together combined with da Vinci is really powerful and a great starting point.

我們的第一個產品是針對結直腸的，對此的反饋非常好，然後使用 Firefly 進行灌注成像，這三樣東西與達芬奇相結合真的很強大，也是一個很好的起點。

It will not be the last set of things we do in general surgery, but we think it's powerful, and I think that it is in a good position to power the early growth that we are seeing in colorectal surgery here and later in markets outside the United States.

這不會是我們在普外科做的最後一組事情，但我們認為它很強大，而且我認為它處於有利位置，可以推動我們在結直腸手術中看到的早期增長，以及後來在美國以外的市場美國。

In terms of what that looks like for total colorectal as a whole, I think we're early in the adoption, but I think we'll have a real opportunity for growth there.

就整個結腸直腸癌的整體情況而言，我認為我們處於採用的早期階段，但我認為我們將有一個真正的增長機會。

You had said how do we think about general surgery growth rates as a whole, and I'll give you one framework that I think is important is we have gynecology and urology as precedents.

你說過我們如何看待整個普通外科手術的增長率，我會給你一個我認為重要的框架，即我們有婦科和泌尿科作為先例。

In urology, prostatectomy was really the lead procedure, and there are just a few procedures that followed it, like kidney cancer treatment and partial nephrectomy bladder cancer treatment and cystectomy.

在泌尿外科，前列腺切除術確實是主要的手術，之後只有少數手術，如腎癌治療和部分腎切除術膀胱癌治療和膀胱切除術。

So it was not a huge broad set.

所以這不是一個龐大的廣泛集合。

Gynecology is little bit broader, but hysterectomy was really the leading growth engine and then some other procedures behind it, myomectomy and sacrocolpopexy, pelvic floor reconstruction.

婦科範圍更廣一些，但子宮切除術確實是主要的增長引擎，然後是其他一些手術，子宮肌瘤切除術和骶骨固定術，盆底重建術。

General surgery does not quite have that same structure.

普通外科並不完全具有相同的結構。

There are some specialties that are quite broad.

有一些專業是相當廣泛的。

So you have colorectal subspecialty.

所以你有結直腸專科。

You have [forga] procedures.

你有 [forga] 程序。

You have bariatric surgery.

你做了減肥手術。

What the folks do in academic centers is quite different than what they do in community centers.

人們在學術中心所做的與他們在社區中心所做的完全不同。

So the category as a whole is going to be the sum of adoptions in different places.

因此，整個類別將是不同地方收養的總和。

The sum of adoption in Single-Site, the sum of adoption in colorectal, and those are really different.

Single-Site 的採用總和，結腸直腸的採用總和，這些確實是不同的。

Single-Site is largely done in community settings.

單站點主要在社區環境中完成。

Cholecystectomies are.

膽囊切除術是。

Colorectal procedures are largely concentrated in cancer hospitals.

結直腸手術主要集中在癌症醫院。

And so those different growth rates, they differ.

所以那些不同的增長率，它們是不同的。

How they add up I think is a little bit harder to predict.

我認為它們如何加起來有點難以預測。

Patrick or Calvin, anything you'd like to add?

Patrick 或 Calvin，你有什麼要補充的嗎？

Is there something on the learning curves that can maybe speed that up as you come out with kind of new add-ons, toolsets, and so on to help drive general surgery?

當您推出新的附加組件、工具集等來幫助推動普通外科手術時，學習曲線上是否有一些東西可以加快速度？

I think that the new instruments that we are bringing in, I think the broadening of the launch of stapling and use of Firefly, those are enabling technologies.

我認為我們引入的新工具，我認為擴大裝訂和使用 Firefly 的範圍，這些都是使能技術。

They speed the efficiency of the procedure, and they allow a better workflow, and so I think that's helpful.

它們加快了程序的效率，並允許更好的工作流程，所以我認為這很有幫助。

The investments we have made in our training centers are really to make for easy access for learning surgeons that have access to resources.

我們在培訓中心進行的投資實際上是為了讓能夠獲得資源的學習外科醫生更容易獲得。

And I think that's been a good investment for us, and that can help the investments we've made in simulation and access to simulation are other things that I think help.

我認為這對我們來說是一項很好的投資，這可以幫助我們在模擬和獲得模擬方面的投資是我認為有幫助的其他事情。

And, you know, we're really happy and feel that the Davis study is important in showing that the totality of learning resources for surgeons, not just what Intuitive does, what proctors do, what advanced coursework does, has resulted in great and safe adoption of new technology, and I think that's a powerful message and likely to be repeated in other disciplines beyond just prostatectomy.

而且，你知道，我們真的很高興，並認為戴維斯的研究很重要，它表明外科醫生的全部學習資源，而不僅僅是 Intuitive 所做的、監考人員所做的、高級課程所做的，已經產生了巨大而安全的結果採用新技術，我認為這是一個強有力的信息，並且可能會在除前列腺切除術之外的其他學科中重複出現。

Okay.

好的。

And then on the gynecology side, you guys are clearly fairly well penetrated in hysterectomy and kind of some of the other ancillary procedures, [miles] and the sacros.

然後在婦科方面，你們顯然在子宮切除術和其他一些輔助手術中滲透得相當好，[英里]和骶骨。

But how should we think about that as a category now that it's over 50% penetrated?

但是，既然它已經超過 50% 的滲透率，我們應該如何將其視為一個類別呢？

Should it materially slow in 2014, gradual changes?

2014年是否應該大幅放緩，逐漸變化？

And then could Single-Site actually become quickly material?

那麼Single-Site 真的會很快成為材料嗎？

Thanks.

謝謝。

A fair question.

一個公平的問題。

I think -- and you know this well, I know your team knows this well, but once you are on these adoption curves, the year-over-year growth rate falls.

我認為 - 你很清楚這一點，我知道你的團隊很清楚這一點，但是一旦你處於這些採用曲線上，同比增長率就會下降。

That's just the nature of those adoption curves.

這就是那些採用曲線的本質。

So on the multi-forward side, I would expect that it continues in the US, that there is a continued deceleration, the pace of which will be hard to predict and we'll see.

因此，在多前鋒方面，我預計美國會繼續減速，減速的速度將難以預測，我們拭目以待。

Hysterectomy -- Single-Site hysterectomy is an opportunity.

子宮切除術——單點子宮切除術是一個機會。

We're early in that opportunity.

我們處於這個機會的早期。

We've been in limited launch.

我們一直在有限的發布。

The limited launch has gone very well clinically, and it's gone really well from uptake in the way surgeons who are being trained have adopted it.

有限的發佈在臨床上非常順利，並且在接受培訓的外科醫生採用它的方式上也非常順利。

We are adding some instruments into that kit, bringing back some wristed instruments that will, we think, optimize the procedure and give surgeons a little more flexibility in approaching tissue, and we are working through those things.

我們正在向該套件中添加一些儀器，帶回一些腕式儀器，我們認為，這些儀器將優化手術並讓外科醫生在接近組織時更加靈活，我們正在努力解決這些問題。

I think that's a well-known pathway for us, and we think that will help.

我認為這對我們來說是一條眾所周知的途徑，我們認為這會有所幫助。

That's still early.

那還早。

We're not into a full very broad launch there, although we have broadened the launch from its earlier days really starting in the fourth quarter and continuing through here.

儘管我們已經從早期的第四季度開始並一直持續到這裡，但我們並沒有在那裡進行全面的非常廣泛的發布。

So I think that launch will open up through to Single-Site hysterectomy, and we'll continue to report on it to you as to how we progress.

因此，我認為此次發布將開放至單點子宮切除術，我們將繼續向您報告我們的進展情況。

And I would just add, we still feel we have a significant opportunity here in women's health, specifically hysterectomy on the more complex multi-forward side.

我只想補充一點，我們仍然覺得我們在女性健康方面有很大的機會，特別是在更複雜的多前鋒方面的子宮切除術。

There are over 100,000 women now who are still having open hysterectomies in the United States where we think our technology can improve their outcomes.

在美國，現在仍有超過 100,000 名女性在進行開放式子宮切除術，我們認為我們的技術可以改善她們的結果。

And then we're very early on the less complex side on our Single-Site offering where there's something like 200,000 laparoscopic and vaginal procedures that perhaps we would have a place there.

然後我們很早就在我們的單一站點產品中不太複雜的一面，那裡有大約 200,000 個腹腔鏡和陰道手術，也許我們會在那裡佔有一席之地。

Great.

偉大的。

Thank you.

謝謝你。

Bob Hopkins, Bank of America.

鮑勃霍普金斯，美國銀行。

Hello, thanks.

你好謝謝。

Good afternoon.

下午好。

Can you hear me okay?

你能聽到我的聲音嗎？

Great.

偉大的。

So just a couple on the guidance.

所以只是一對夫婦的指導。

I heard your comments about operating expenses for the year, but I was wondering if you had any comments on gross margins, both as it relates to 2014, and then given some of the changes in the customer mix longer-term, just any longer-term thoughts on gross margin as well?

我聽到了您對本年度運營費用的評論，但我想知道您是否對毛利率有任何評論，因為它與 2014 年有關，然後考慮到長期客戶組合的一些變化，只是更長-對毛利率的長期想法？

So, again, for 2014, and then longer-term, any thoughts on gross margin?

那麼，對於 2014 年以及長期而言，對毛利率有什麼想法嗎？

Yes, I think you saw in the fourth quarter, there were some points that were mentioned.

是的，我想你在第四節看到了一些要點。

First off, the margin -- the gross margin was impacted by lower production volumes, which when you divide some of the manufacturing costs by fewer units of production, that has a negative impact on margin, and so you saw that.

首先，利潤率——毛利率受到產量下降的影響，當你將一些製造成本除以更少的產量時，這會對利潤率產生負面影響，所以你看到了這一點。

Could that be a continuing headwind to some extent?

在某種程度上，這可能是一個持續的逆風嗎？

I would say yes.

我會說是的。

Then, beyond that, you come down to some of the product mix discussions on gross margin that I think we're not predicting how much it's going to be, SIE versus a forearm SI, geographic.

然後，除此之外，您可以歸結為毛利率的一些產品組合討論，我認為我們無法預測它將是多少，SIE 與前臂 SI，地理。

I think it's too many moving parts to make a prediction there on that.

我認為有太多的活動部分無法對此做出預測。

You know, I think you had asked kind of a longer-term question -- directionally how do we think about it?

你知道，我認為你問了一個長期的問題——我們如何看待它？

And I think as we look at the opportunities and we talk about segmentation of the business, we want to match the clinical and technical capability of the products we bring.

我認為，當我們看到機會並談論業務細分時，我們希望與我們帶來的產品的臨床和技術能力相匹配。

The procedure opportunity and underlying economics of those procedures together.

這些程序的程序機會和潛在的經濟性結合在一起。

And we think we have opportunities to do that, and we think it's really in the best interest of the Company to do it.

我們認為我們有機會這樣做，而且我們認為這樣做確實符合公司的最佳利益。

I think we can get to an attractive margin profile in both segments.

我認為我們可以在這兩個領域獲得有吸引力的利潤率。

Some of that is near term, and some of that is long term in terms of investments and product, and so we will do that.

其中有些是短期的，有些是長期的投資和產品，所以我們會這樣做。

And then on the decision on the revenue guidance or lack thereof for 2014, I just want to ask a little bit about that.

然後關於 2014 年收入指導或缺乏指導的決定，我只想問一點。

Because you guys have always been so adamant about saying that system sales are driven by procedure volume, and you're willing to give procedure volume numbers, but not some thoughts on system sales.

因為你們一直很固執的說系統銷量是由手術量驅動的，你願意給出手術量的數字，而不是對系統銷量的一些想法。

And so I was wondering if there's anything sort of different in that relationship going forward?

所以我想知道這種關係在未來是否有什麼不同？

In other words, we have historically assumed that utilization just has to go up, and that's the way we've tried to predict your system sales.

換句話說，我們歷來假設利用率只會上升，這就是我們試圖預測您的系統銷售的方式。

Is there something unique about 2014 that would cause that relationship to bifurcate further?

2014 年是否有什麼獨特之處會導致這種關係進一步分化？

Do we need to assume much greater utilization than we've been seeing in the past in terms of increases, and again, just want to ask about that because you guys have been so adamant about the correlation.

在增加方面，我們是否需要假設比我們過去看到的更多的利用率，再次，只是想問一下這個問題，因為你們一直對相關性如此堅定。

I just -- maybe start -- two ways to think about it.

我只是 - 也許開始 - 兩種方式來思考它。

I think the first one is the range and procedure guidance is pretty broad relative to the base, and because system placements are sensitive to that range, that's a multiplier on the uncertainty.

我認為第一個是范圍和程序指導相對於基礎相當廣泛，並且由於系統放置對該範圍很敏感，這是不確定性的乘數。

That's one.

那是一個。

The second one is that it may be that utilization trends differ over time just because of point of care, as Patrick had mentioned pretty clearly, and because hospitals may look out and say I want clear capital utilization of what I've got.

第二個原因是，使用趨勢可能會隨著時間的推移而不同，這僅僅是因為帕特里克已經非常清楚地提到的護理點，並且因為醫院可能會留意並說我想要清楚地利用我所擁有的資金。

And I'm willing to make some compromises in convenience to get that.

我願意為了方便而做出一些妥協。

We may see those two different things that work against each other and so how that plays out.

我們可能會看到這兩種不同的東西相互對抗，以及它是如何發揮作用的。

What I'd say on that second half is that those changes are unlikely to switch on a dime because they're operational in nature.

我在下半場要說的是，這些變化不太可能一毛錢，因為它們本質上是可操作的。

You have to move.

你必須搬家。

You have to adjust hospital operations to make it happen.

您必須調整醫院的運營以實現這一目標。

So that may happen, but I don't think that happens the day after tomorrow.

所以這可能會發生，但我認為這不會在後天發生。

I think that's something that would play out in time.

我認為這會及時發揮作用。

(multiple speakers) To add to what Gary said, you're right.

（多位發言者）補充加里所說的，你是對的。

We do believe that procedures will drive systems in the long-term, so there's going to be short-term fluctuations in capital sales.

我們確實相信程序將長期推動系統，因此資本銷售將出現短期波動。

But overall, long-term, particularly in mature markets, you're going to see capital sales catch up or fall behind -- will catch up over time.

但總體而言，從長期來看，尤其是在成熟市場，您會看到資本銷售會趕上或落後——隨著時間的推移會趕上來。

Having said that, in nascent markets like Japan, which also causes our overall utilization statistic to fluctuate, we're selling systems ahead of procedures, and so that one is more difficult to predict.

話雖如此，在像日本這樣的新興市場，這也導致我們的整體利用率統計數據波動，我們在程序之前銷售系統，因此更難以預測。

And then lastly, you guys have again talked about the opportunity for outpatient and more benign type procedures.

最後，你們再次談到了門診和更良性程序的機會。

Can you help us think about how big of an opportunity that might be for the Company?

您能幫我們想想這對公司來說有多大的機會嗎？

I assume today sales into outpatient surgery centers and centers like that are pretty minimal.

我認為今天門診手術中心和類似中心的銷售額非常少。

So have you guys given much thought to how big an opportunity that might be?

那麼你們有沒有想過這可能有多大的機會？

You know, as always, we start with procedures and work our way back rather than thinking about outpatient operating rooms and working our way forward.

您知道，與往常一樣，我們從程序開始，然後往回走，而不是考慮門診手術室和往前走。

And so Calvin or Patrick can speak to it.

所以 Calvin 或 Patrick 可以與之對話。

Yes, so if you look at where most of the outpatient surgeries are performed, it's in a hospital outpatient setting.

是的，因此，如果您查看大多數門診手術的執行地點，那就是在醫院門診環境中。

So either within the four walls of the hospital or in an adjacent ambulatory care facility, but the predominance of them are, in, fact channels as opposed to the physician-owned freestanding facilities.

因此，無論是在醫院的四堵牆內，還是在相鄰的門診護理設施中，但實際上，它們的優勢在於渠道，而不是醫生擁有的獨立設施。

Thank you.

謝謝你。

We have time for one more question.

我們有時間再問一個問題。

David Lewis, Morgan Stanley.

大衛劉易斯，摩根士丹利。

Good afternoon.

下午好。

Thanks for fitting me in.

謝謝你讓我適應。

Gary, I wonder if you could just talk qualitatively about procedures in 2014.

加里，我想知道你是否可以定性地談論 2014 年的程序。

I'm assuming the two biggest dynamics driving procedure deceleration is one, obviously still very rapid growth in general surgery, but maybe slowing up a larger base, and then hysterectomy, either that's deceleration or stabilization.

我假設兩個最大的動力驅動程序減速是一個，顯然在普通外科手術中仍然非常快速增長，但可能會放慢更大的基礎，然後是子宮切除術，要么是減速要么是穩定。

I wonder if just very broadly, you could help us understand those two buckets?

我想知道您是否可以廣泛地幫助我們理解這兩個桶？

Can general surgery hold its growth rate trend line based on a further or broader launch in the minimally invasive in colorectal, and do you expect DVH to hold its trendline, slightly decelerate, or potentially even improve in 2014?

普通外科能否在結直腸微創領域進一步或更廣泛推出的基礎上保持其增長率趨勢線，您預計 DVH 是否會在 2014 年保持其趨勢線、略微減速甚至可能改善？

Yes, I'll start with hysterectomy.

是的，我將從子宮切除術開始。

I think that the underlying disease state is not changing in the US.

我認為美國的潛在疾病狀態沒有改變。

I don't see any rapid change there.

我看不到那裡有任何快速變化。

I think the set of treatments that are being offered are also not changing very much.

我認為所提供的治療方案也沒有太大變化。

What we seem to be seeing change is payer behavior and kind of patient decision-making with that payer behavior.

我們似乎看到的變化是付款人的行為以及這種付款人行為的耐心決策。

And so it's a little bit harder to predict what that would look like over time, and I think any of the three possibilities you outlined is possible, I think.

所以很難預測隨著時間的推移會是什麼樣子，我認為你概述的三種可能性中的任何一種都是可能的，我認為。

I look out and -- Calvin mentioned it really well, there are 100,000 or so open procedures being done for women in the United States for hysterectomy, many of whom are great candidates for a proven, safer minimally invasive procedure, and yet they're getting open procedures, and that's an opportunity.

我看出來了——Calvin 說得非常好，美國有 100,000 例左右的開放手術正在為女性進行子宮切除術，其中許多人是經過驗證的、更安全的微創手術的理想人選，但她們是獲得開放的程序，這是一個機會。

And so if that patient population comes in and has an opportunity, then that would be a positive and an upside.

因此，如果患者群體進來並有機會，那將是積極的和有利的。

The other possible upside is, of course, single incision, Single-Site hysterectomy if that kit pulls out further and we augment it.

當然，另一個可能的好處是單切口、單部位子宮切除術，如果該套件進一步拉出並且我們對其進行擴充。

So those are possible upsides.

所以這些都是可能的好處。

How payer behavior changes through the year, what some of the patient decision-making looks like, that's a little bit harder to predict.

付款人的行為如何在一年中發生變化，一些患者的決策是什麼樣的，這有點難以預測。

On the general surgery side, as you know, adoption rates are always -- year-over-year growth rates and adoption curve are always highest at the beginning, and then they decline over time as the base grows.

如您所知，在普外科方面，採用率始終是 - 年增長率和採用曲線在開始時始終最高，然後隨著基數的增長而隨著時間的推移而下降。

It's absolutely a natural progression.

這絕對是一個自然的進步。

The speed of that, I think, is going to depend on procedure by procedure.

我認為，其速度將取決於逐個程序。

What is the total available market for single incision cholecystectomy?

單切口膽囊切除術的總可用市場是多少？

That's an estimate.

這是一個估計。

Everybody would look at that and try to figure it out.

每個人都會看著它並試圖弄清楚。

It's not a clear substitution against another one that's just sitting there, and so we'll see what that looks like.

這不是對另一個只是坐在那裡的明確替代，所以我們會看看它是什麼樣子。

Colorectal, I think, we feel really good about.

結直腸，我想，我們感覺很好。

You look out at colorectal, and we bring a huge amount of value there.

你看看結腸直腸，我們在那裡帶來了巨大的價值。

Cholecystectomy, patient enthusiasm, surgeon commitment, training, and growth in those procedures has been really encouraging.

膽囊切除術、患者的熱情、外科醫生的承諾、培訓和這些程序的成長確實令人鼓舞。

And the last thing is that general surgery has been growing beyond those two into some other things, and we will let them evolve for a couple of quarters.

最後一件事是普通外科已經超越了這兩個領域，進入了其他領域，我們將讓它們發展幾個季度。

But I think that will be interesting to see where else general surgeons take the opportunity and the technology, and it looks to be broader than just those two.

但我認為看看普通外科醫生在哪裡利用機會和技術會很有趣，而且它看起來比這兩個更廣泛。

And so overall, I think our feeling we can bring a lot of value to general surgery is high.

所以總的來說，我認為我們可以為普外科帶來很多價值的感覺很高。

Okay, Gary.

好的，加里。

Just one quick one on -- just so I understand SIE, I think that's --

只需快速打開 - 只是為了讓我了解 SIE，我認為是 -

The quick one.

快的那個。

This is going to be very quick and I promise, even for me.

這將非常快，我保證，即使對我來說也是如此。

On the SIE, it's been available for a while, but it sounds like there is sort of growing enthusiasm.

在 SIE 上，它已經有一段時間了，但聽起來似乎有越來越多的熱情。

So I'm trying to understand that trendlines are relatively stable, which is hard to understand just obviously because this year the larger capital is under pressure.

所以我試圖理解趨勢線是相對穩定的，這很難理解，因為今年較大的資本面臨壓力。

So is the situation with SIE, you now see better positioning in the ambulatory care market, and have there been upgrades to that system, or is this simply going to be a corporate focus on the SA heading into 2014?

SIE 的情況也是如此，您現在看到了在門診醫療市場的更好定位，並且該系統是否已經升級，或者這僅僅是進入 2014 年的 SA 公司的重點？

I'm just trying to figure out what is changing relatively given the systems that are available.

鑑於可用的系統，我只是想弄清楚相對而言發生了什麼變化。

Thank you.

謝謝你。

Yes, the question.

是的，問題。

So short answer, a combination of a couple things.

如此簡短的回答，結合了幾件事。

The Single-Site instrument kit is both procedurally adopted to a three-arm system.

Single-Site 儀器套件在程序上均適用於三臂系統。

It's also priced right for that set of procedures, and then Firefly adding into that is a nice mix together that gives kind of a fully capable system to do those things in an adulatory setting.

它的價格也適合那套程序，然後 Firefly 加入其中是一個很好的組合，它提供了一種功能齊全的系統，可以在奉承的環境中做這些事情。

So I think those combinations brought together help and I think with an organizational alignment around describing the value of that also helps, and so that's how we've gotten where we are.

所以我認為這些組合帶來了幫助，並且我認為圍繞描述其價值的組織一致也有幫助，這就是我們如何到達現在的位置。

Thank you for the question.

感謝你的提問。

That was our last question.

那是我們的最後一個問題。

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

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

I hope the following segment of an editorial by Dr. Tim Wilson, Chief of the Division of Urology and Neurologic Oncology at the City of Hope Cancer Center, gives you some sense of what this means to da Vinci surgeons and their patients.

我希望希望之城癌症中心泌尿外科和神經腫瘤科主任 Tim Wilson 博士的社論的以下部分能讓您了解這對達芬奇外科醫生及其患者意味著什麼。

Quote-unquote, in this era of healthcare reform, policymakers, hospitals, and providers are all evaluating ways to reduce the overall cost burden to society while improving the quality of outcomes for patients.

引用-不引用，在這個醫療改革的時代，政策制定者、醫院和提供者都在評估如何減少社會的總體成本負擔，同時提高患者的治療質量。

Often lost in the debate is the need for investment in technology that can help mitigate the significant cost drivers of healthcare.

在辯論中經常忽略的是對有助於減輕醫療保健成本驅動因素的技術投資的必要性。

Robotic-assisted surgery is a gamechanging technology in medicine, yet it is deeply misunderstood and often dismissed as just another expensive tool for driving costs up.

機器人輔助手術在醫學領域是一項改變遊戲規則的技術，但它卻被深深地誤解，並經常被視為另一種抬高成本的昂貴工具。

This cannot be further from the truth.

這與事實相去甚遠。

The cost of our technology has to be compared with the alternative cost of treatment.

我們的技術成本必須與替代治療成本進行比較。

Displacing large abdominal decisions that have complications, high rates of death, blood loss, and high risk of infection, and higher length of hospital stay is a good investment, and aligns with the goals of healthcare reform.

取代具有並發症、死亡率高、失血率高、感染風險高以及住院時間長的大型腹部決定是一項很好的投資，並且符合醫療改革的目標。

Medicine needs innovation, but is usually slow to change.

醫學需要創新，但通常變化緩慢。

Decades ago, the same criticisms of robotic surgery plague laparoscopy.

幾十年前，對機器人手術的同樣批評困擾著腹腔鏡檢查。

It was expensive, unproven, and unsafe.

它昂貴、未經證實且不安全。

To date, more than 2.1 million da Vinci surgeries have been performed worldwide with an extremely low death rate, a declining rate of adverse events, and a growing body of clinical evidence that demonstrates safety, effectiveness, and an ability to reduce both costs and complications about surgery.

迄今為止，全球已進行了超過 210 萬例達芬奇手術，死亡率極低，不良事件發生率下降，並且越來越多的臨床證據證明了安全性、有效性以及降低成本和並發症的能力關於手術。

As a surgeon who has performed thousands of procedures, including open, manual laparoscopic, and robotic-assisted urologic cancer surgeries, I believe robotic assisted surgery is the kind of technological disruption they truly will reform healthcare.

作為一名進行了數千次手術的外科醫生，包括開放式、手動腹腔鏡手術和機器人輔助泌尿系統癌症手術，我相信機器人輔助手術是他們真正將改革醫療保健的技術顛覆。

The improvements in surgery described by Dr. Wilson drive our team to form the foundation of our operating performance.

威爾遜博士描述的手術改進促使我們的團隊成為我們運營績效的基礎。

We have built our Company to take surgery beyond the limits of the human hand, and I assure you that we remain committed to driving the vital few things that truly make a difference.

我們已經建立了我們的公司，以超越人手的限制進行手術，我向您保證，我們將繼續致力於推動真正產生影響的少數重要事情。

This concludes today's call.

今天的電話會議到此結束。

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