直覺手術 (ISRG) 2016 Q1 法說會逐字稿

Ladies and gentlemen, thank you for standing by. Welcome to the Intuitive Surgical Q1 2016 earnings release call. (Operator Instructions) As a reminder, the conference is being recorded. I will now turn the meeting over to our host, Senior Director of Finance, Investor Relations, Calvin Darling. Please go ahead.

女士們、先生們，感謝你們的耐心等待。歡迎參加 Intuitive Surgical 2016 年第一季財報發布電話會議。（操作說明）提醒各位，本次會議正在錄音。現在我將把會議交給我們的主持人，財務高級總監兼投資者關係主管卡爾文·達林。請繼續。

Thank you. Good afternoon, and welcome to Intuitive Surgical's first-quarter earnings conference call. With me today we have Gary Goodhart, our President and CEO; Marshall Mohr, our Chief Financial Officer; and Patrick Clingan, Senior Director of Finance.

謝謝。下午好，歡迎參加直覺外科公司第一季財報電話會議。今天和我在一起的有：我們的總裁兼執行長 Gary Goodhart；我們的財務長 Marshall Mohr；以及財務高級總監 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. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties.

在開始之前，我想告知各位，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於存在某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。

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 2, 2016. These filings can be found through our website or at the SEC's EDGAR database. Prospective investors are cautioned not to place undue reliance on such forward-looking statements.

這些風險和不確定性在公司向美國證券交易委員會提交的文件中均有詳細描述，包括我們最近於 2016 年 2 月 2 日提交的 10-K 表格。這些文件可透過我們的網站或美國證券交易委員會的EDGAR資料庫找到。潛在投資者應注意，不要過度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. In addition, today's press release and supplementary financial data tables have been posted to our website.

請注意，本次電話會議的音訊回放可在我們的網站 Intuitivesurgical.com 的投資者關係頁面下的音訊存檔部分找到。此外，今天的新聞稿和補充財務數據表已發佈在我們的網站上。

Today's format will consist of providing you with highlights of our first-quarter results as described in our press release announced earlier today, followed by a question-and-answer session. Gary will present the quarter's business and operational highlights. Marshall will provide a review of our first-quarter financial results. Patrick will discuss marketing and clinical highlights. I will provide our updated financial outlook for 2016. And, finally, we will host a question-and-answer session.

今天的會議形式將包括：首先向您介紹我們今天早些時候發布的新聞稿中描述的第一季業績亮點，然後進行問答環節。Gary 將介紹本季的業務和營運亮點。馬歇爾將對我們第一季的財務表現進行回顧。Patrick 將討論行銷和臨床的亮點。我將提供我們最新的2016年財務展望。最後，我們將舉行問答環節。

With that, I will turn it over to Gary.

接下來，我將把麥克風交給蓋瑞。

Good afternoon, and thank you for joining us on the call today. Our first-quarter Company performance was strong, with excellent global procedure growth, solid capital placements, improving product margins and important new product launches.

下午好，感謝各位今天參加我們的電話會議。公司第一季業績強勁，全球業務成長出色，資本配置穩健，產品利潤率不斷提高，並推出了重要的新產品。

Turning first to procedures, global procedure growth for the quarter was nearly 17%, led by growth in general surgery, growth in the use of da Vinci Surgical Systems outside the United States, continued growth in US urology and modest growth in US gynecology.

首先來看手術量，本季全球手術量增長近 17%，主要得益於普通外科手術量的增長、美國以外地區達文西手術系統使用量的增長、美國泌尿外科手術量的持續增長以及美國婦科手術量的適度增長。

Trends in US general surgery growth continued, with strong growth in inguinal hernia repair and ventral hernia repair, followed by continued growth in colorectal surgery. Customer feedback and commitment to the use of da Vinci in performing inguinal hernia repair for complex conditions has been encouraging in the quarter, increasing our confidence in its long-term acceptance.

美國一般外科手術的成長趨勢仍在持續，其中腹股溝疝氣修補術和腹壁疝氣修補術成長強勁，結直腸手術也持續成長。本季度，客戶對使用達文西機器人進行複雜腹股溝疝氣修補術的回饋和承諾令人鼓舞，增強了我們對該機器人長期被接受的信心。

Procedure growth was variable by country in Europe, with solid performance in the United Kingdom and Germany offsetting slower growth in the Nordic countries. Performance in the quarter was helped by an extra procedure day in some regions relative to Q1 of 2015. Patrick will review procedure trends in greater detail later in the call.

歐洲各國手術量成長情況不一，英國和德國的穩健表現抵消了北歐國家成長放緩的影響。與 2015 年第一季相比，部分地區增加了一天的手術，有助於提升本季的表現。Patrick 將在稍後的通話中更詳細地回顧手術流程的發展趨勢。

We placed 110 da Vinci systems in the quarter, up from 99 in Q1 of 2015. Customers continue to purchase our Xi systems over less expensive and less capable Si models by a factor of approximately 3 to 1. Capital performance was strong in the United States, offsetting capital softness in Europe and the expiration of our quota in China. [Botchley], customer leasing and lease-to-own arrangements are making up a greater percentage of new system placements. Marshall will take you through our finances in more detail later in the call.

本季我們安裝了 110 台達文西手術系統，高於 2015 年第一季的 99 台。客戶購買我們的 Xi 系統的數量仍然比購買價格更低、功能更弱的 Si 型號的數量多出約 3 倍。美國的資本表現強勁，抵銷了歐洲資本疲軟和我們在中國配額到期的影響。[Botchley]表示，客戶租賃和租賃購買安排在新系統部署中所佔比例越來越大。馬歇爾稍後會在通話中更詳細地向您介紹我們的財務狀況。

Our operations teams remain focused on optimizing our manufacturing, design and supply chains for our newer products. Our teams continued to execute against their goals, with steady improvements in reducing product costs for our new systems, advanced instruments, in the quarter. Product cost reductions exceeded our expectations, and we expect them to continue to improve in 2016 and 2017.

我們的營運團隊將繼續專注於優化新產品的製造、設計和供應鏈。本季度，我們的團隊繼續朝著既定目標穩步前進，在降低新系統和先進儀器的產品成本方面取得了穩步進展。產品成本降低幅度超出預期，我們預計在 2016 年和 2017 年將持續改善。

Our offerings make up an ecosystem designed to meet our customer needs in building and running outstanding robotic surgery programs. This ecosystem includes systems and instruments and accessories, training technologies and peer-to-peer coursework, service offerings, and program optimization and analytic support. As a result of the set of products and services that surround our systems, recurring revenue in the quarter comprised 75% of total Company revenue. Highlights of the first-quarter operating results are as follows.

我們的產品和服務構成了一個生態系統，旨在滿足客戶在建造和運行卓越的機器人手術專案方面的需求。該生態系統包括系統、儀器和配件、培訓技術和點對點課程、服務產品以及程序優化和分析支援。由於我們系統相關的產品和服務，本季經常性收入占公司總收入的 75%。第一季經營業績亮點如下。

Procedures grew nearly 17% over the first quarter last year,. We shipped 110 da Vinci Surgical Systems, up from 99 in the first quarter of 2015. Revenue for the quarter was $595 million, up 12% over the prior year. Pro forma gross profit margin was 70%, compared to 65.6% in the first quarter of last year. Instrument and accessory revenue increased to $322 million, up 16%. Total recurring revenue in the quarter was $447 million, representing 75% of total revenue. We generated a pro forma operating profit of $229 million in the quarter, up 24% from the first quarter of last year, and pro forma net income was $170 million, up 27% from Q1 of 2015.

手術量比去年第一季增加了近17%。我們交付了 110 套達文西手術系統，高於 2015 年第一季的 99 套。本季營收為 5.95 億美元，比上年同期成長 12%。經調整後的毛利率為 70%，去年第一季為 65.6%。儀器及配件收入增至 3.22 億美元，成長 16%。本季經常性收入總額為 4.47 億美元，佔總營收的 75%。本季度，我們實現了 2.29 億美元的備考營業利潤，比去年第一季度增長了 24%；備考淨利潤為 1.7 億美元，比 2015 年第一季度增長了 27%。

We continue to enable our Xi platform with new product launches. Our launch of intraoperative table motion is proceeding well, with order flow that has met our expectations and with strong customer feedback on its utility, particularly in general surgery. In the quarter, we also launched our 30-millimeter Xi stapler designed to facilitate stapling in thoracic procedures and our Xi single-site instrument and accessory kit. Both our 30-millimeter stapler and our Xi single-site instruments have started clinical use, with positive feedback on their utility. Our SP program remains on track.

我們不斷推出新產品，為 Xi 平台賦能。我們推出的術中手術台移動系統進展順利，訂單流程符合預期，客戶對其實用性也給予了高度評價，尤其是在普通外科手術中。本季度，我們還推出了 30 毫米 Xi 縫合器，旨在方便胸腔外科手術中的縫合，以及 Xi 單孔器械和配件套件。我們的 30 毫米縫合器和 Xi 單孔器材均已開始臨床使用，並獲得了對其實用性的正面回饋。我們的SP專案進展順利。

As our business has strengthened, we have increased our mid- and long-term investments in research and development. We have been increasing our investments in imaging, analytics and new product architectures based on our belief that substantial opportunity exists to enable better outcomes and to expand access to our technologies globally. Calvin will take you through our projected spending later in the call.

隨著業務的增強，我們增加了對研發的中長期投資。我們一直在增加對成像、分析和新產品架構的投資，因為我們相信，這為實現更好的結果和在全球範圍內擴大我們技術的普及提供了巨大的機會。稍後，Calvin 將在電話會議中向大家詳細介紹我們的預計支出。

As we move forward in 2016, we are focused on the following. First, expanding the use of da Vinci in general and thoracic surgery, particularly colorectal surgery and hernia repair. Second, advancing our ecosystem, including expanding our Xi line and taking our SP product into initial clinical use. Third, driving our organizational capabilites in markets in Europe and Asia. And, finally, assisting our customers in their efforts to maximize the comprehensive value of their programs.

展望2016年，我們將重點放在以下方面。首先，擴大達文西手術系統在一般外科和胸腔外科手術的應用，特別是結直腸手術和疝氣修補術。其次，推動我們的生態系統，包括擴大我們的 Xi 產品線，並將我們的 SP 產品投入初步臨床應用。第三，提升我們在歐洲和亞洲市場的組織能力。最後，協助我們的客戶最大限度地發揮其項目的綜合價值。

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

現在我將把電話交給馬歇爾，他將回顧財務要點。

Thank you, Gary. I will be describing our results on a non-GAAP or pro forma basis, which excludes legal settlements and claim accruals, stock-based compensation and amortization of purchased IP. We provide pro forma information because we believe the business trends and operating results are easier to understand on a pro forma basis.

謝謝你，加里。我將以非公認會計準則或準備為基礎描述我們的業績，其中不包括法律和解和索賠提列、股票選擇權補償和購買智慧財產權的攤銷。我們提供模擬財務訊息，因為我們認為，以模擬財務數據為基礎，更容易理解業務趨勢和經營績效。

I will also summarize our GAAP results later in my script. We have posted reconciliations of our pro forma results to our GAAP results on our website so that there is no confusion.

我稍後會在腳本中總結我們的 GAAP 結果。為了避免混淆，我們已在網站上公佈了備考業績與 GAAP 業績的調整表。

First-quarter revenue was $595 million, an increase of 12%, compared with $532 million for the first quarter of 2015, and a decrease of 12% compared with the seasonally stronger fourth quarter of $677 million.

第一季營收為 5.95 億美元，比 2015 年第一季的 5.32 億美元成長了 12%，但比季節性成長較為強勁的第四季的 6.77 億美元下降了 12%。

First-quarter 2016 procedures of approximately 176,000 increased nearly 17% compared with the first quarter of 2015 and decreased slightly compared with the fourth-quarter procedures of approximately 177,000.

2016 年第一季手術量約為 176,000 例，比 2015 年第一季增長近 17%，但比第四季的手術量（約 177,000 例）略有下降。

Year-over-year procedure growth was driven by general surgery procedures in the US and urology worldwide, and otherwise likely benefited from an additional calendar day associated with leap year.

美國的普通外科手術和全球的泌尿外科手術推動了手術量的逐年增長，此外，閏年多出的一天也可能促進了手術量的增長。

Revenue highlights are as follows. Instrument and accessory revenue of $322 million increased 16% compared with last year and decreased 1% compared with the fourth quarter of 2015. These changes generally reflect changes in procedures. Instrument and accessory revenue realized per procedure, including initial stocking orders, was approximately $1,830 per procedure. This metric continues to fluctuate in a tight range of approximately $1,830 and $1,840 per procedure. Relative to the first quarter of 2015, the current quarter reflects higher sales of advanced instruments offset by the impact of customer buying patterns and foreign exchange.

以下是營收亮點。儀器及配件營收為 3.22 億美元，較去年同期成長 16%，較 2015 年第四季下降 1%。這些變化通常反映了程序上的變化。每台手術的器械和配件收入（包括初始庫存訂單）約為每台手術 1,830 美元。該指標持續在每次手術約 1,830 美元至 1,840 美元的狹窄範圍內波動。與 2015 年第一季相比，本季先進儀器的銷售額有所增長，但被客戶購買模式和外匯匯率的影響所抵消。

System revenue of $148 million increased 5% compared with last year and decreased 36% compared with last quarter. The increase relative to the prior year primarily reflects increased revenue associated with operating lease activities and slightly higher average system selling prices. The decrease relative to the fourth quarter primarily reflects seasonally lower unit sales and slightly lower ASPs, partially offset by increased revenue associated with operating lease activities.

系統營收為 1.48 億美元，比去年同期成長 5%，比上一季下降 36%。與前一年相比，成長主要反映了經營租賃活動收入的增加和平均係統售價的略微上漲。與第四季度相比，下降主要反映了季節性銷售下降和平均售價略有下降，但部分被經營租賃活動帶來的收入增加所抵消。

110 systems were placed in the first quarter, compared with 99 systems in the first quarter of 2015 and 158 systems last quarter. Approximately 77% of the systems shipped in the quarter were Xi's, which is comparable to prior quarters.

第一季安裝了 110 套系統，而 2015 年第一季安裝了 99 套系統，上一季安裝了 158 套系統。本季出貨的系統中約有 77% 是 Xi 的產品，與前幾季的情況類似。

Hospitals financed approximately 37% of the systems placed in the first quarter, up from 17% last quarter. We directly financed 31 systems, including 19 operating leases. As of the end of the first quarter, there were 62 systems out in the field under operating leases. We generated approximately $4 million of revenue associated with operating leases in the quarter, compared with $1 million in the first quarter of 2015 and $3 million in the fourth quarter. We also generated approximately $6 million of revenue during the quarter from lease buyouts, compared with $2 million of revenue in the fourth quarter and no lease buyout revenue in the first quarter of last year. We exclude the impact of operating leases from our system ASP calculations.

第一季度，醫院為所安裝的系統提供了約 37% 的資金，高於上一季的 17%。我們直接為 31 個系統提供融資，其中包括 19 個營業租賃項目。截至第一季末，共有 62 套系統以經營租賃的方式投入使用。本季我們透過經營租賃獲得了約 400 萬美元的收入，而 2015 年第一季為 100 萬美元，第四季為 300 萬美元。本季我們也透過租賃買斷獲得了約 600 萬美元的收入，而第四季為 200 萬美元，去年第一季則沒有租賃買斷收入。我們在系統平均售價計算中排除了經營租賃的影響。

Globally, our average system price of $1.500 million was approximately $30,000 higher than the first quarter of 2015's ASP and approximately $50,000 lower than the ASP last quarter.

在全球範圍內，我們的平均係統價格為 150 萬美元，比 2015 年第一季的平均售價高出約 3 萬美元，比上一季的平均售價低約 5 萬美元。

Relative to the prior year, the increase reflects a proportionally lower trade-in volume in favorable geographic mix partially offset by an unfavorable product mix. The decrease relative to the fourth quarter reflects proportionally higher trade-in volume and lower mix of Xi dual consoles, partially offset by a favorable geographic mix.

與前一年相比，成長反映出有利的地域組合中以舊換新數量的比例下降，但不利的產品組合部分抵消了這一增長。與第四季度相比，下降幅度反映了以舊換新數量比例較高和 Xi 雙主機佔比較低，但部分被有利的地域組合所抵消。

Service revenue of $125 million increased 9% year over year and increased approximately 4% compared with the fourth quarter of 2015. The year-over-year and quarter-over-quarter increases reflect growth in our installed base of da Vinci systems.

服務收入達 1.25 億美元，年增 9%，與 2015 年第四季相比成長約 4%。年比和環比增長反映了我們達文西手術系統安裝量的增長。

Outside of the US, results were as follows. First-quarter revenue outside of the US of $164 million increased 9%, compared with $150 million for the first quarter of 2015, and decreased 25%, compared with seasonally stronger fourth quarter of $219 million. The increase compared with the previous year is comprised of a 14% growth in recurring revenue, which is driven by procedure growth of 22%, and increased systems revenue of 2%. The decrease compared to the fourth quarter reflects seasonally strong fourth-quarter systems placements, partially offset by a 5% growth in recurring revenue.

美國以外地區的結果如下。第一季美國以外的營收為 1.64 億美元，比 2015 年第一季的 1.5 億美元成長了 9%，但比季節性成長較為強勁的第四季的 2.19 億美元下降了 25%。與前一年相比，成長主要體現在經常性收入成長 14%（這主要得益於手術量成長 22%）和系統收入成長 2%。與第四季度相比的下降反映了第四季度系統安裝量的季節性強勁增長，但經常性收入增長 5% 部分抵消了這一影響。

Outside the US, we placed 36 systems in the first quarter, compared with 36 in the first quarter of 2015 and 75 last quarter. Current-quarter system sales included 5 into China and 8 into Japan. System placements outside of the US will continue to be lumpy, as some of these markets are in their early stages of adoption. Some markets are highly seasonal, reflecting budget cycles or vacation patterns. And sales into some markets are constrained by government regulations.

在美國以外，我們第一季安裝了 36 套系統，而 2015 年第一季為 36 套，上一季為 75 套。本季系統銷售額包括在中國銷售 5 套，在日本銷售 8 套。美國以外地區的系統部署仍將不均衡，因為其中一些市場仍處於早期採用階段。有些市場具有很強的季節性，反映了預算週期或度假模式。而對某些市場的銷售則受到政府法規的限制。

Moving on to the remainder of the P&L. The pro forma gross margin for the first quarter was 70%, compared with 65.6% for the first quarter of 2015 and 69.6% for the fourth quarter of 2015. Compared with the first quarter of 2015, the higher gross margin reflects reduction of product and product repair costs, improved manufacturing operations efficiencies, the elimination of the medical device tax, lower costs associated with product field actions and related inventory charges, and a higher mix of instrument and accessory revenue.

接下來來看損益表的其餘部分。第一季的備考毛利率為 70%，而 2015 年第一季為 65.6%，2015 年第四季為 69.6%。與 2015 年第一季相比，更高的毛利率反映了產品和產品維修成本的降低、製造營運效率的提高、醫療器材稅的取消、與產品現場行動和相關庫存費用相關的成本降低，以及儀器和配件收入佔比的提高。

The medical device tax has been suspended for the next two years and reduced our 2015 gross margin by approximately 70 basis points. Future margins will fluctuate based on the mix of our newer products, our ability to further reduce product cost, manufacturing efficiency, costs associated with product field actions and, in the long term, the potential reinstatement of the medical device tax.

醫療器材稅已暫停徵收兩年，導致我們 2015 年的毛利率下降了約 70 個基點。未來的利潤率將根據我們新產品的組合、我們進一步降低產品成本的能力、生產效率、與產品現場行動相關的成本以及從長遠來看，醫療器材稅的潛在恢復情況而波動。

Pro forma operating expenses -- which exclude legal settlements and accruals for legal claims, stock compensation expense, and amortization of purchased IP -- increased 14%, compared with the first quarter of 2015, and increased 5% compared with last quarter. The increases over prior periods reflect increased investments in advanced imaging, advanced instrumentation and next-generation robotics, increased headcount, and higher payroll taxes associated with stock option exercises. Our pro forma effective tax rate for the first quarter was 27.4%, compared with an effective tax rate of 28.9% for the first quarter of 2015 and 24.9% last quarter.

不包括法律和解及法律索賠的提列、股票補償費用和購買智慧財產權的攤銷的備考營運費用，與 2015 年第一季度相比增長了 14%，與上一季相比增長了 5%。與前期相比，成長反映了對先進成像、先進儀器和下一代機器人技術的投資增加、員工人數增加以及與股票選擇權行使相關的工資稅增加。我們第一季的預期實際稅率為 27.4%，而 2015 年第一季的實際稅率為 28.9%，上一季的實際稅率為 24.9%。

In late December 2015, Congress retroactively approved the 2015 Federal Research and Development Credit and made the R&D tax credit permanent going forward. The entire 2015 R&D tax credit was included in the fourth quarter, while no benefit was reflected in the first quarter of 2015. And a proportional benefit is reflected in the first quarter of 2016.

2015 年 12 月下旬，國會追溯批准了 2015 年聯邦研發稅收抵免，並使研發稅收抵免永久化。2015 年的整個研發稅收抵免都計入了第四季度，而 2015 年第一季沒有反映出任何收益。2016 年第一季也體現出了相應的效益。

Other than the impact of R&D credit, fluctuations in our tax rate between this quarter and the first and fourth quarters of 2015 primarily reflect changes in the mix of US and O-US income.

除了研發稅收抵免的影響外，本季與 2015 年第一季和第四季之間稅率的波動主要反映了美國收入和美國境外收入組合的變化。

Our first-quarter 2016 pro forma net income was $170 million, or $4.42 per share, compared with $135 million, or $3.57 per share, for the first quarter of 2015 and $224 million, or $5.89 per share, for the fourth quarter of 2015. Note that fully diluted shares outstanding increased by approximately 400,000 shares relative to the fourth quarter, resulting primarily from the increase in our share price.

2016 年第一季度，我們的備考淨收入為 1.7 億美元，即每股 4.42 美元；而 2015 年第一季為 1.35 億美元，即每股 3.57 美元；2015 年第四季為 2.24 億美元，即每股 5.89 美元。請注意，與第四季度相比，完全稀釋後的流通股數量增加了約 40 萬股，這主要是由於我們的股價上漲所致。

As I indicated earlier, pro forma income provides an easier comparison of our financial results and business trends. I will now summarize our GAAP results.

正如我之前提到的，預測收入可以更方便地比較我們的財務表現和業務趨勢。現在我將總結一下我們的GAAP業績。

GAAP revenue was $595 million for the first quarter of 2016, compared with $532 million for the first quarter of 2015 and $677 million for the fourth quarter of 2015. GAAP net income was $136 million, or $3.54 per share, for the first quarter of 2016, compared with $97 million, or $2.57 per share, for the first quarter of 2015. And $190 million, or $4.99 per share, for the fourth quarter of 2015.

2016 年第一季 GAAP 營收為 5.95 億美元，而 2015 年第一季為 5.32 億美元，2015 年第四季為 6.77 億美元。2016 年第一季度，GAAP 淨收入為 1.36 億美元，即每股 3.54 美元，而 2015 年第一季為 9,700 萬美元，即每股 2.57 美元。2015 年第四季營收為 1.9 億美元，即每股 4.99 美元。

We ended the year with cash and investments of $3.8 billion, up from $3.3 billion as of December 31, 2015. The increase primarily -- was primarily driven by proceeds from stock option exercises and cash generated from operations. As our cash builds, we will continue to evaluate our approach to capital allocation.

截至2015年12月31日，我們的現金和投資總額為38億美元，高於當年的33億美元。成長主要由股票選擇權行使所得和經營活動產生的現金所推動。隨著現金流的增加，我們將繼續評估我們的資本配置方法。

And with that, I would like to turn it over to Patrick, who will go over our procedure and clinical highlights.

接下來，我將把發言權交給派崔克，他將介紹我們的流程和臨床要點。

Thanks, Marshall. Of our first-quarter procedure growth of nearly 17%, US procedures grew approximately 50% and O-US procedures grew approximately 22%. In the US, even though growth benefited from favorable operating days in the quarter, procedure growth outpaced our expectations. First-quarter growth in our mature procedures continued at levels similar to the second half of 2015, generating the majority of the procedure outperformance relative to our expectation. General surgery procedure growth also exceeded our expectation.

謝謝你，馬歇爾。第一季手術量成長近 17%，其中美國手術量成長約 50%，美國境外手術量成長約 22%。在美國，儘管本季受益於有利的營業日，但手術量的成長速度超過了我們的預期。第一季度，我們成熟手術計畫的成長持續保持在與 2015 年下半年類似的水平，這為我們超出預期的手術計畫表現帶來了大部分收益。普通外科手術量的成長也超出了我們的預期。

In US urology, first-quarter growth in da Vinci prostatectomy and kidney procedures continued at similar rates through the second half of 2015. We continue to believe that our US prostatectomy volumes have been tracking to the broader prostate surgery market, and we expect prostatectomy growth to return to levels similar to prostate cancer incidence rates over time.

在美國泌尿外科領域，達文西前列腺切除術和腎臟手術在第一季的成長速度在 2015 年下半年持續維持相似水準。我們仍然相信，我們的美國前列腺切除手術量與更廣泛的前列腺手術市場保持一致，我們預計隨著時間的推移，前列腺切除手術的增長將恢復到與前列腺癌發病率相似的水平。

In US gynecology, first-quarter procedures grew modestly year over ,year with growth led by malignant and complex hysterectomy.

在美國婦科領域，第一季手術量年增率不大，其中惡性子宮切除術和複雜性子宮切除術的成長最為顯著。

Continuing the trend from 2015, we estimate a larger proportion of da Vinci hysterectomy procedures were performed by gynecologic oncologists during the first quarter. Similar to the fourth quarter, US single-site gynecology procedure growth declined compared to the first quarter of 2015.

延續 2015 年的趨勢，我們估計在第一季度，由婦科腫瘤醫師實施的達文西子宮切除手術比例較大。與第四季類似，美國單中心婦科手術量的成長較 2015 年第一季下降。

First-quarter growth in US general surgery procedure adoption remains strong, led by a robust growth in hernia repair and continued adoption of colorectal procedures. Cholecystectomy procedures were roughly flat in the quarter, with growth in multi-floor procedures offsetting declines in single-site procedures.

美國一般外科手術第一季的成長動能依然強勁，這主要得益於疝氣修補手術的強勁成長以及大腸直腸手術的持續普及。本季膽囊切除手術量基本上持平，多層手術量的成長抵消了單中心手術量的下降。

Q1 was another quarter with a large number of clinical publications evaluating da Vinci surgery. Of these, I have selected a couple studies that you may find interesting.

第一季又有大量臨床出版品對達文西手術進行了評估。其中，我挑選了幾項你可能會感興趣的研究。

With the launch about 30-millimeter stapler, surgeon interest in the use of da Vinci for thoracic surgery is growing. A new study comparing open video-assisted thoracic surgery, or VATS, and da Vinci surgery for pulmonary lobectomy was published by Dr. Yang and colleagues from Memorial Sloan Kettering Cancer Center in the Annals of Surgery. Using a prospective database including 2,400 surgeries to treat stage-one non-small-cell lung cancer patients, the officers' propensity matched 470 patients across da Vinci, VATS and open surgery.

隨著 30 毫米縫合器的推出，外科醫生對使用達文西進行胸腔外科手術的興趣日益濃厚。楊醫師及其同事在紀念斯隆-凱特琳癌症中心的同事在《外科年鑑》上發表了一項新研究，比較了開放式胸腔鏡輔助手術（VATS）和達文西手術在肺葉切除術中的應用。利用包含 2400 例手術治療一期非小細胞肺癌患者的前瞻性資料庫，研究人員根據傾向性將 470 名患者與達文西手術、胸腔鏡輔助手術和開放性手術進行了配對。

The study found that da Vinci in minimally invasive VATS approaches enabled a shorter chest tube duration and length of hospital stay compared to open surgery. Da Vinci surgery was also credited with improved lymph node yields as compared to both open surgery and VATS, an important clinical outcome for determining next steps in the patient treatment pathway.

研究發現，與開胸手術相比，達文西機器人輔助微創胸腔鏡手術可以縮短胸管留置時間和住院時間。與開放式手術和胸腔鏡手術相比，達文西手術也被認為提高了淋巴結的檢出率，這是確定患者治療路徑下一步的重要臨床結果。

As it related to the expansion of da Vinci lung resections, the authors highlighted that nearly 57% of pulmonary lobectomies in the US were treated with open surgery. And they see promise in expanding patient access to minimally invasive surgery through da Vinci technology.

關於達文西肺切除術的推廣，作者強調，美國近 57% 的肺葉切除術都是透過開放性手術進行的。他們認為，透過達文西技術擴大患者接受微創手術的機會具有廣闊前景。

Turning abroad, procedure growth outside of the United States was approximately 22% in the first quarter, led by the global adoption of da Vinci prostatectomy and solid contributions from kidney procedures and colorectal resections. Compared to the second half of 2015, procedure growth slowed in both Europe and Asia during the quarter, in part due to the timing of the Easter holiday. Historically, our O-US procedure growth rates have been lumpy and less predictable in the short term. We are focused on improving our O-US procedure performance.

從海外來看，第一季美國以外的手術量增加了約 22%，這主要得益於達文西前列腺切除術在全球範圍內的普及，以及腎臟手術和結直腸切除術的穩健貢獻。與 2015 年下半年相比，本季度歐洲和亞洲的手術量成長均有所放緩，部分原因是復活節假期的時間安排。從歷史數據來看，我們的 O-US 手術成長率在短期內波動較大，難以預測。我們致力於提高O-US手術流程的執行情況。

In Japan, there were positive developments relating to reimbursement in the quarter: the MHLW approved for reimbursement of partial nephrectomy at a premium rate relative to open surgery; and also approved clinical trial enrollment to begin supporting a [section area B] submission for da Vinci malignant hysterectomy.

在日本，本季在報銷方面取得了積極進展：厚生勞動省批准了部分腎切除術的報銷，報銷費率高於開放手術；並且還批准了臨床試驗招募，以開始支持達文西惡性子宮切除術的[B部分]申請。

The recent study funded by Intuitive and published in BJU International by Professor Hughes and colleagues from the University of Chester collected data from the United Kingdom Health Episodes Statistics Database, including more than 20,000 prostatectomy patients and 2,000 partial nephrectomy patients to assess health resource utilization and cost following da Vinci, open and laparoscopic procedures. The database showed that from 2008 to 2013, the use of da Vinci surgery increased from 15% to 50% of prostatectomies and 1% to 22% of partial nephrectomies by displacing open surgery.

由 Intuitive 資助、切斯特大學 Hughes 教授及其同事在 BJU International 上發表的最新研究，收集了英國健康事件統計資料庫的數據，其中包括 20,000 多名前列腺切除術患者和 2,000 名部分腎切除術患者，以評估達文西手術、開放式手術和腹腔鏡手術後的醫療資源利用情況和成本。資料庫顯示，從 2008 年到 2013 年，達文西手術的使用率從前列腺切除術的 15% 增加到 50%，從部分腎切除術的 1% 增加到 22%，取代了開放式手術。

During the first year after the operation, da Vinci surgery was shown to reduce inpatient admissions, hospital bed days, and total costs for both prostatectomy and partial nephrectomy compared to open surgery. At three years post operation, the study showed similar outcomes for prostatectomy and was insufficient to draw conclusions for partial nephrectomy.

手術後第一年，與開放性手術相比，達文西手術可減少攝護腺切除術和部分腎切除術的住院次數、住院天數和總費用。術後三年，研究顯示攝護腺切除術的結果與腎部分切除術的結果相似，但不足以得出腎部分切除術的結論。

Laparoscopic surgery outcomes were at the approximate midpoint between da Vinci and open surgery on resource utilization and costs for both procedures. The authors concluded, quote, our analysis suggests that there are substantial savings associated with robotic-assisted surgery when compared with open and laparoscopic interventions, close quote.

腹腔鏡手術在資源利用和成本方面，其結果大致介於達文西手術和開放手術之間。作者總結道：“我們的分析表明，與開放式手術和腹腔鏡手術相比，機器人輔助手術可以節省大量費用。”

This concludes my remarks. I will now turn the call over to Calvin.

我的發言到此結束。現在我將把電話交給卡爾文。

Thank you, Patrick. I will be providing you with our updated financial outlook for 2016.

謝謝你，派崔克。我將向您提供我們最新的2016年財務展望。

Starting with procedures, on our last call we estimated full-year 2016 procedure growth of 9% to 12%, above the approximately 652,000 procedures performed in 2015. Now, based upon favorable US DBP and gynecology macro trends and US general surgery growth, we are increasing our estimate for 2016. We now anticipate full-year 2016 procedure growth within a range of 12% to 14%.

先從手術量說起，在我們上次的電話會議上，我們估計 2016 年全年手術量增加 9% 至 12%，高於 2015 年進行的約 652,000 例手術。現在，基於美國 DBP 和婦科的良好宏觀趨勢以及美國普通外科的成長，我們提高了 2016 年的預測。我們現在預計 2016 年全年手術量成長將在 12% 至 14% 之間。

Turning to gross profit, on our last call we forecast 2016 pro forma gross profit margin to be within a range of between 68% and 69.5% of net revenue. We are now increasing our estimate. We now expect full-year 2016 pro forma gross profit to be within a range of between 69% and 70% of net revenue.

再來看毛利潤，我們在上次電話會議上預測，2016 年的備考毛利率將佔淨收入的 68% 至 69.5%。我們現在提高了預估金額。我們現在預計 2016 年全年備考毛利潤將佔淨收入的 69% 至 70%。

Turning to operating expenses. As we have described, we will be increasing our investment in key areas that will enable and drive the future of robotic-assisted surgery. On our last call, we forecast to grow pro forma 2016 operating expenses between 9% and 13% above 2015 levels. We are now increasing our estimate for operating expenses to a range of between 12% and 15% above 2015.

接下來談談營運費用。正如我們之前所述，我們將增加對關鍵領域的投資，以推動機器人輔助手術的未來發展。在上次電話會議上，我們預測 2016 年的備考營運費用將比 2015 年的水準成長 9% 至 13%。我們現在將營運費用的預估提高到比 2015 年高出 12% 至 15%。

Consistent with our last call, we expect our non-cash stock compensation expense to range between $170 million and $180 million in 2016, compared to $168 million in 2015. We expect our 2016 other income, which is comprised mostly of interest income, to be in the upper end of the $20 million to $25 million range forecast on our last call.

與上次電話會議一致，我們預計 2016 年的非現金股票補償支出將在 1.7 億美元至 1.8 億美元之間，而 2015 年為 1.68 億美元。我們預計 2016 年的其他收入（主要由利息收入構成）將達到上次電話會議預測的 2,000 萬美元至 2,500 萬美元區間的上限。

With regard to income tax, we continue to expect our 2016 pro forma income tax rate to be between 26.5% and 28.5% of pretax income, depending primarily on the mix of US and O-US profits.

關於所得稅，我們仍然預計 2016 年的預計所得稅稅率將在稅前收入的 26.5% 至 28.5% 之間，主要取決於美國利潤和美國境外利潤的組成。

That concludes our prepared comments. We were now open the call to your questions.

我們的發言到此結束。現在開始回答大家的問題。

(Operator Instructions) Bob Hopkins, Bank of America.

（操作說明）鮑伯霍普金斯，美國銀行。

Two questions, but, first of all, congrats on the great momentum in the business. I have a question on US procedure volume growth, and then on your comments on OpEx spend.

我有兩個問題，但首先，祝賀貴公司業務發展勢頭強勁。我有一個關於美國手術量成長的問題，還有一個關於您營運支出的評論。

First on procedure volume growth, one, can you give us a sense of what you think you grew on the quarter on a same-day selling basis? But then, much more importantly, just give us a sense as to specifically which surgery types accelerated in the US. And what drove the growth? What caused the acceleration? Why did things get better?

首先，關於手術量成長，您能否大致介紹一下您認為本季當日銷售額的成長情況？但更重要的是，請具體說明哪些類型的手術在美國加速發展。是什麼推動了成長？是什麼導致了加速？為什麼情況好轉了？

Bob, thanks for the question. From a same-day selling perspective, estimating the impact of operating days is anything but an exact science. From a tailwinds -- you had leap year that benefited the quarter and some modest benefit from the timing of years being on a Friday rather than a Thursday. And from a headwind perspective, you had the timing of Easter, which moved from the second quarter into the first quarter, but that had more of an impact on the O-US geographies.

鮑勃，謝謝你的提問。從當日銷售的角度來看，估算營業天數的影響絕非一門精確的科學。有利因素包括：閏年有利於季度增長，以及年份是星期五而不是星期四也帶來了一些小幅增長。從不利因素來看，復活節的時間從第二季度移到了第一季度，但這對美國海外地區的影響更大。

From what accelerated -- the mature procedures sustained pretty strong growth in the quarter as they softened up 2015, which was a little bit of a surprise to us relative to our initial expectations. And general surgery continues to be strong and growing off of a larger base, which has more impact on the US procedure growth number.

從加速成長的情況來看——成熟的手術流程在本季度保持了相當強勁的成長，而 2015 年的手術流程則有所放緩，這與我們最初的預期相比有點出乎我們的意料。普通外科手術持續保持強勁勢頭，並在更大的基數上不斷增長，這對美國手術量的增長產生了更大的影響。

Okay. And then -- well, for the follow-up, I wanted to ask Gary a question on the OpEx spend because I think it's an important comment from you guys. Your spending in the quarter was high, exactly as you said it would be, and now you are raising that spend level even further. So can you just talk about where the incremental spend is going? What kind of new incremental technology announcements could that lead to? You mentioned a couple on the call. But I'm just really curious as to where this spending is going and when we could expect to get more visibility on the output from that spending.

好的。然後——嗯，作為後續，我想問 Gary 關於營運支出方面的問題，因為我認為這是你們提出的一個重要意見。正如你所預料的那樣，你本季的支出很高，而現在你還要進一步提高支出水準。那麼，您能談談新增支出都花在了哪些方面嗎？這可能會帶來哪些新的漸進式技術發布？你在電話裡提到了一對夫婦。但我真的很好奇這些支出都花在了哪裡，以及我們什麼時候才能更清楚地了解這些支出的產出。

Sure. On the spend, I think the acceleration is really borne of confidence in the long-term viability of some of the markets and some of the things we are pursuing. You will see it really cut into a couple of buckets. Some of it is investments in O-US markets where we think that we can do more by investing more. And we've been talking you about that.

當然。關於支出，我認為加速成長的真正原因是我們對某些市場和我們正在追求的一些事物的長期可行性充滿信心。你會看到它真的切掉了好幾桶水。其中一些投資是在美國以外的市場，我們認為加大投資可以取得更大的成就。我們一直在跟你談論這件事。

The other side is on R&D.

另一方則專注於研發。

And in terms of categories, we've talked about it before, but we believe in them deeply. Advanced imaging, the ability to see beyond what you can just see with your naked eye. New robotic architectures that allow surgeons to get into and out of the body in different ways, and to different places that make it reach prior. As well as analytics and over-the-shoulder guidance. All things that we have been investing in; some things that we are accelerating.

至於分類方面，我們以前也討論過，但我們對分類深信不疑。先進成像技術，能夠看到肉眼無法看到的東西。新型機器人架構使外科醫生能夠以不同的方式進入和離開人體，並到達不同的部位，從而實現更遠距離的手術。以及分析和手把手指導。我們一直在投資的所有項目；我們正在加速推進的一些項目。

So we won't do product announcements on this call. As we get deeper into those things and are ready to share them more broadly with you, of course, we will.

所以這次電話會議上我們不會發布產品資訊。當然，當我們對這些事情有更深入的了解，並準備好與大家更廣泛地分享時，我們會這樣做。

And then lastly, just to get a sense -- I finally heard something about positive hysterectomy in Japan. It went by pretty quickly. Is there some positive momentum on hysterectomy in Japan from a reimbursement perspective?

最後，只是想了解一下情況——我終於聽說了日本的子宮切除術。時間過得很快。從報銷角度來看，日本的子宮切除術是否有一些正面的發展動能？

Yes, Bob, the NHLW approved clinical trial to begin enrollment supporting malignant hysterectomy under the [section area B] process.

是的，鮑勃，NHLW 已批准臨床試驗開始招募患者，以支持在 [B 部分] 流程下進行惡性子宮切除術。

Perfect. Thank you.

完美的。謝謝。

(Operator Instructions) Tycho Peterson. JPMorgan.

（操作說明）泰科·彼得森。摩根大通。

I just wondered if you could talk a little bit of about Table Motion. How many systems are installed that are capable? What percentage of systems, I guess, have the option included? And if you could just talk a little bit about how it flows through to gross margins as well. It's mainly a software upgrade from your perspective, right?

我想請您簡單談談桌子運動方面的問題。目前已安裝多少組具備相應功能的系統？我猜想，有多少比例的系統包含這個選項？如果您還能稍微談談這是如何影響毛利率的就更好了。從你的角度來看，這主要是一次軟體升級，對嗎？

Yes, we are pretty pleased with the level of adoption for Table Motion. The information we're getting back from surgeons is they are pleased with its usage and its performance. We are not going to be disclosing every quarter just how many tables we have delivered, so I won't go there. I'll just tell you that, again, we're pretty pleased with the level of adoption. These would be the revenue on the margin side.

是的，我們對 Table Motion 的普及程度非常滿意。我們從外科醫生那裡得到的回饋是，他們對該產品的使用和性能感到滿意。我們不會每季都公佈我們交付了多少張桌子，所以我就不多說了。我再說一遍，我們對目前的普及程度非常滿意。這些都是利潤方面的收入。

Yes, the margins -- so, what we are providing is a software update to the Xi that enables the Table Motion. The table itself is being purchased from Trumpf. And the -- and so our billing is 100% margin.

是的，邊距——所以，我們提供的是 Xi 的軟體更新，以啟用桌面運動功能。桌子本身是從 Trumpf 公司購買的。因此，我們的收費是 100% 利潤。

And I guess maybe what I was getting at is the degree to which this is going to drive a bolus of demand for Xi now that you have that plus the full instrument set. Can you maybe just talk a little bit about how you see that flowing through to Xi demand?

我想表達的是，既然有了它以及全套儀器，這將會在多大程度上推動對 Xi 的需求激增。您能否簡單談談您認為這會如何影響習近平的要求？

Yes, I think that it -- each one of these steps, the 30-millimeter Xi stapler, the Integrated Table Motion, now the Xi instrument kit is rounding out that Xi platform. And we have some more to do. It's not all complete, but it's definitely becoming a much fuller and richer ecosystem.

是的，我認為——這些步驟中的每一個，30 毫米 Xi 訂書機，整合式工作台運動系統，現在還有 Xi 器械套件，都完善了 Xi 平台。我們還有些事情要做。雖然還沒有完全建成，但它無疑正在成為一個更完善和豐富的生態系統。

We think that helps. It's very hard to forecast how much it is, how many people sit and wait until the next step. But we think those things add clinical value for sure. 30-millimeter stapler in thoracic procedures is a big win. Likewise, Table Motions for a lot of the more complex procedures.

我們認為這很有幫助。很難預測具體數字，也很難預測有多少人會坐等下一步。但我們認為這些肯定具有臨床價值。30毫米吻合器在胸腔外科手術的應用是一項重大勝利。同樣，對於許多更複雜的手術，也需要進行手術台移動。

So we think that's strong, and there are a group of hospitals that use Si with single-site; that if they are a single-system hospital, they will only own just one, and they have a robust single-site program. This allows them to consider Xi as an upgrade.

所以我們認為這很強大，而且有一批醫院使用 Si 進行單點治療；如果他們是單一系統的醫院，他們只會擁有一台，並且他們有一個強大的單點治療方案。這使得他們可以將習近平視為一種升級選擇。

So it's hard to quantify, but we think directionally it's really strong.

所以很難量化，但我們認為從方向上看，它非常強勁。

Okay. And then, follow up, can you just comment on Europe? It looked like that was a little soft. Maybe just talk about the outlook there for the year.

好的。那麼，能否請您談談歐洲？看起來有點軟。或許可以談談今年的前景。

Yes, Europe was definitely a variable, both in procedures and in systems. On the procedure side, we had some strength in some countries where they are moving along, and we think there's opportunity to do that and better. There are some other countries where it's going a little slower. Sometimes it's a local economy issue; sometimes it's more where we are in maturity. Some of these countries were pretty well-adopted in the mature procedures, and they are really at the beginnings of the emerging procedures. So it depends country by country.

是的，歐洲絕對是一個影響因素，無論是在程序方面還是在製度方面。在程序方面，我們在一些正在推進的國家擁有一定的優勢，我們認為有機會做得更好。還有一些國家進展得稍微慢一點。有時是地方經濟問題；有時更多的是我們發展到什麼程度的問題。有些國家已經相當成熟地採用了相關程序，而對於新興程序，它們則還處於起步階段。所以具體情況因國家而異。

On the capital side, I think there's two things going on. A little bit of environment is one, and a little bit of wait-and-see on competitive offerings as they come out. And we are navigating that pretty well. In terms of head-to-head comparisons with our technology, our systems are coming out great. But it can put a delay in the pipeline, and we are seeing a little bit of that in Europe.

就資金方面而言，我認為有兩個方面正在改變。環境因素是重要因素，同時，也要對競爭對手推出的產品保持觀望態度。我們應付得相當不錯。就與我們的技術進行直接比較而言，我們的系統表現非常出色。但這可能會延遲生產流程，我們在歐洲已經看到了一些這種情況。

The only other thing I would add is that there is -- Europe has become very seasonal. And so if you look at Q4, it was extremely strong relative to the previous couple of quarters. And Q1 is more comparable to the previous year's Q1.

我唯一要補充的是，歐洲的季節性已經非常明顯了。因此，如果你看一下第四季度，你會發現它相對於前幾季來說表現非常強勁。而且，第一季與去年第一季更具可比性。

Okay. Thank you.

好的。謝謝。

David Lewis, Morgan Stanley.

大衛路易斯，摩根士丹利。

Just two quick ones here. Marshall, just coming back to gross margin guidance, GM's have been stronger for five consecutive quarters. And the guidance certainly implies no improvement throughout the year, which seems, I guess, less likely to us just given the cost improvements you've already discussed. So can we just talk to gross margin progressions out the balance of the year and why you think 70% here in the first quarter is the high watermark?

這裡就簡單問兩個問題。馬歇爾，再說回毛利率預期，通用汽車的毛利率已經連續五個季度走強。而且，該指引顯然意味著全年不會有任何改善，考慮到您已經討論過的成本改善，我們認為這種情況不太可能發生。那麼我們能否討論一下今年剩餘時間的毛利率成長情況，以及您為什麼認為第一季的 70% 是最高點？

Sure. One of the biggest factors we see going forward is the product mix. Know that we have higher margins on instruments and accessories than we do on systems, and this Q1 tends to be seasonally a lower quarter for capital. And also, we see growth in the new product, particularly in energy products, stapling and vaso-sealing going forward, and those also have lower margins than the base. So I think, just based on product mix alone, we don't expect to sustain 70%.

當然。我們認為未來最重要的因素之一是產品組合。要知道，儀器和配件的利潤率比系統高，而且第一季通常是資金投入較低的季度。此外，我們看到新產品，特別是能量產品、縫合器和血管封閉器，未來將會成長，但這些產品的利潤率也低於基礎產品。所以我覺得，僅從產品組合來看，我們預計無法維持 70% 的佔比。

Okay. And then Gary, I -- obviously people have asked about spending already. And I note that the R&D spend is the highest we've seen in four years. So you are obviously clearly going to continue to invest. I have no expectations you're going to talk to us about future instrumentation and system announcements. But I think the enigma for most shareholders actually is advanced imaging because that's sort of more future-looking. Is there any chance we get incremental updates or at least even any update on the strategy for advanced imaging this year? Thank you.

好的。然後，Gary，我──顯然已經有人問過關於支出的問題了。我注意到，研發支出是四年來最高的。所以很明顯，你打算繼續投資。我不指望你們會和我們討論未來的儀器和系統公告。但我認為，對大多數股東來說，真正的謎團其實是先進成像技術，因為它更具前瞻性。今年我們有沒有可能獲得一些關於先進成像策略的進展更新，或至少獲得一些更新資訊？謝謝。

Yes, that's a fair question. In general, we have been making early investments in advanced imaging. And what I would tell you there is that it is not one thing. As you know, we have Firefly, which is a molecular imaging base product. We also have invested in raw imaging hardware capabilities, which we'll continue to do.

是的，這確實是個好問題。總的來說，我們一直在對先進成像技術進行早期投資。我想告訴你們的是，這不是一件事。如您所知，我們有 Firefly，它是一款分子成像基礎產品。我們也投資了原始影像處理硬體能力，並將繼續進行這方面的投資。

What we like to do is -- as we have milestones that makes sense, whether it's talking to regulatory bodies or engaging in clinical work, those tend to be good anchors to discuss with you. And as those arrive, then we will share with you what we are thinking.

我們喜歡這樣做——當我們有了有意義的里程碑時，無論是與監管機構交談還是參與臨床工作，這些往往都是與您討論的良好切入點。當這些想法出現時，我們會與你們分享。

And could those arrive potentially in 2016 for advanced imaging, or unlikely?

這些先進影像技術有可能在 2016 年問世嗎？還是不太可能？

You know, I think when we get there, we will let you know.

你知道，我想等我們到了那裡，我們會通知你的。

Okay, sir. Thank you.

好的，先生。謝謝。

David Roman, Goldman Sachs.

大衛羅曼，高盛集團。

I wanted Gary just to come back to some of the early part of your prepared remarks where you discussed the continued momentum that you are seeing in hernia. And it seemed like it's at stages this year, there was sort of a positive tipping point, but just incremental enthusiasm from the physician community around this procedure. Can we just sort of talk about what you think specifically is stimulating that demand and why you are confident in that continuing on a go-forward basis?

我希望 Gary 能回到你準備好的演講稿的開頭部分，你在那裡談到了疝氣領域持續增長的勢頭。而今年似乎正處於一個階段性的發展階段，出現了一個積極的轉折點，但醫生群體對這項手術的熱情只是逐步增強的。我們能否具體談談您認為是什麼刺激了這種需求，以及您為什麼有信心這種需求會持續下去？

There's two ways that our confidence has been building. One of them is around the clinical outcomes and anecdotes that we hear. And that comes to -- as we talked about before, inguinal hernia particularly is a segmented market. Not all patients are suffering the same level of disease. And in the more complex cases, if it's bilateral or prior abdominal surgery of these patients, a large herniated sac, the raw clinical capability of our products is being touted as -- and supported by surgeons as being important to them. A better quality of intervention, consumable costs in line with what their expectations are. So there, I think that we are feeling pretty good.

我們的信心是透過兩種方式建立起來的。其中之一是關於我們聽到的臨床結果和軼事。這就引出了我們之前討論過的一點——腹股溝疝氣尤其是一個細分市場。並非所有患者的病情都相同。而在更複雜的病例中，如果這些患者接受過雙側或先前的腹部手術，或者出現較大的疝囊，我們產品的原始臨床能力被吹捧為——並且得到了外科醫生的支持，認為這對他們來說很重要。更高品質的介入措施，耗材成本符合他們的預期。所以，我覺得我們感覺還不錯。

The second thing we can do is analyze reorder rates from surgeons as they go forward. So as you get through the trial periods, you are seeing where -- as they learn it and get deeper and deeper into it, where do they apply it and how often do they keep buying our products. And that has been supported as well.

我們可以做的第二件事是分析外科醫生未來的複購率。因此，在試用期結束後，你會看到，隨著他們學習並越來越深入地了解產品，他們會在哪些方面應用產品，以及他們多久會繼續購買我們的產品。這一點也得到了支持。

So as those two things come together, we start feeling better about it. That is what is behind that comment.

當這兩件事結合起來時，我們就會感覺好多了。這就是那句話背後的意義。

All right. That's helpful. Thank you. And then just for my follow-up on the operating lease side, it looks like this is a higher quarter for a percentage of total coming from operating leases. So I guess maybe, A, could you just talk sort of the -- through some of the dynamics underpinning that? And then, B, based on your disclosures, it looks like people are buying out these operating leases relatively quickly, so maybe help us understand is that true and why that's the case.

好的。那很有幫助。謝謝。然後，關於經營租賃方面，我的後續情況是，本季經營租賃佔總數的比例似乎更高。所以我想，A，您能否談談——分析一下支撐這背後的一些動態因素？然後，B，根據你披露的信息，看起來人們正在相對快速地買斷這些經營租賃，所以也許可以幫我們了解一下這是不是真的，以及為什麼會這樣。

Sure. The operating leases is our way of being able to be flexible with the customer and meet the customer's needs in terms of financing. Some of the leases are shorter-term and basically bridge their ability to get to a capital approval process. And those are a couple of the ones you have seen bought out in this quarter.

當然。經營租賃是我們能夠靈活滿足客戶需求，並在融資方面滿足客戶需求的一種方式。有些租賃期限較短，主要作用是幫助他們獲得資金批准。以上列舉的就是本季被收購的幾家公司。

Most of the leases -- of the operating leases are longer-term, being four- and five-year terms, and will drive a recurring revenue going forward. Like we said, this quarter was around $4 million.

大多數租賃——尤其是經營租賃——期限較長，為四到五年，並將持續帶來收入。正如我們所說，本季營收約為 400 萬美元。

Okay, got it. Thank you.

好的，明白了。謝謝。

Ben Andrew, William Blair.

本安德魯，威廉布萊爾。

Gary, a question on the ecosystem. One of the most material competitive advantages you guys have is the embedding of the technology and your training and all the other things throughout the health care system. What investments can you guys make and are you planning to make that are different than what you've done before to try to lever that, as you did specifically call that out?

加里，關於生態系統有個問題。你們最實質的競爭優勢之一，就是將科技、訓練以及其他所有因素融入整個醫療保健系統中。你們可以進行哪些投資？你們計劃進行哪些與以往不同的投資來利用槓桿效應？正如你們特別提到的。

Yes, I think the -- making a great robotic surgery program is really the integration of all of those things. And their multi-year efforts to build that set of programs from peer-to-peer networks that do advanced coursework and teaching to validated learning pathways in simulation. Those validations are multi-year efforts to get right to the full instrument kit from vessel sealing to stapling and so on.

是的，我認為——打造一個優秀的機器人手術項目，實際上是將所有這些因素整合起來。他們多年來致力於建立這套項目，從開展高級課程和教學的同儕網絡，到經過驗證的模擬學習路徑。這些驗證工作需要多年時間，才能完成從容器密封到釘合等所有儀器套件的全面驗證。

And so we are pretty thoughtful about balancing that set of investments. The things that have gotten really stronger and interesting in the last couple of years have been our ability to analyze data, look at national benchmarking, look at regional base benchmarking and share that information with our customers so they can make good decisions.

因此，我們在平衡這一系列投資方面考慮得非常周全。近幾年來，我們真正強大且有趣的地方在於，我們能夠分析數據，查看全國基準數據，查看區域基準數據，並將這些資訊分享給我們的客戶，以便他們能夠做出正確的決策。

Sometimes those decisions are good for them and not great for Intuitive in the near term. If they optimize their program, we may get more revenue per procedure in the near term. But we think long-term it's better for everybody. And so we have been making those analytics and those investments and then communicating with hospitals.

有時候，這些決定對他們來說是好事，但對 Intuitive 來說短期內卻不是好事。如果他們優化程序，我們短期內可能會獲得更高的單次手術收入。但我們認為從長遠來看，這對每個人都有好處。因此，我們一直在進行這些分析和投資，然後與醫院溝通。

So we really have been plugging in in each of those settings. And I do think it makes for an ecosystem -- creates a lot of value for the customer and builds our relationship with them.

所以我們確實已經嘗試了所有這些設定。而且我認為這能形成一個生態系統——為客戶創造很多價值，並建立我們與客戶之間的關係。

Thank you. And Patrick, a quick one for you. Can we think about the extra selling day as maybe 1.5 percentage points of procedure growth? I know there's some offsets with Easter, et cetera. But is it in that range of what the bump was, net?

謝謝。派崔克，給你一個簡短的問題。我們能否將額外的銷售日視為手術量增加1.5個百分點？我知道復活節等節日會有一些時間上的偏差。但總體而言，它是否在波動幅度的範圍內？

Yes, Ben. I will let you do your math on this specific percentage. But as it relates to the benefit, it really just -- think of it more as in the US because the favorability of leap year New Year's gets mostly washed out by Easter, particularly in Europe.

是的，本。這個具體的百分比就交給你們自己計算吧。但就其好處而言，這實際上只是——更多地想想美國的情況，因為閏年新年帶來的好運大多會被復活節抵消，尤其是在歐洲。

Got it. Thank you.

知道了。謝謝。

Rick Wise, Stifel.

Rick Wise，Stifel。

I wanted to talk a little bit more about US urology and US gynecology. I was really intrigued with the modest growth on the gynecology side. That's a significant turnaround from the headwind you faced over the last couple of years. Also, urology acting better. Have we worked through some of the challenges in each? And are we actually going to return to more sustainable growth in US gynecology after a year or more or two of training and education, et cetera?

我想再多談談美國泌尿科和美國婦科的情況。婦科領域的穩定成長讓我非常感興趣。這與你過去幾年所面臨的逆境相比，是一個顯著的轉變。此外，泌尿科方面也有所改善。我們是否已經克服了每個挑戰中的一些難題？經過一兩年的訓練和教育等等，我們真的能夠恢復美國婦科的可持續成長嗎？

Let me speak to a couple of the factors, and then I will let Patrick take it from there.

我先談談其中幾個因素，然後就讓派崔克繼續講下去。

As we look at urology, you've got three main procedures in urology; prostatectomy, partial nephrectomy and cystectomy, the biggest one being prostatectomy. We know that there was a bolus of patients that went into watchful waiting, some of whom will have disease progression and come back to definitive treatment.

當我們檢視泌尿外科時，會發現泌尿外科主要有三種手術：前列腺切除術、部分腎切除術和膀胱切除術，其中以前列腺切除術最為重要。我們知道，有一大批患者採取了觀察等待的策略，其中一些患者的病情會惡化，最終需要接受根治性治療。

How long that bolus lasts is a little bit hard for us to predict.

我們很難預測這種大劑量注射的效果能持續多久。

The second thing are the possibility of share changes between some of the treatment modalities: surgery versus radiation versus watchful waiting. That data tends to lag; hard to get it in real time.

第二點是某些治療方式之間的份額可能會改變：手術、放射治療和觀察等待。這些數據往往有滯後性，很難即時取得。

There may be some share change, although if there is it's probably modest. And then there's just demographics. As demographics changes, you have more folks getting diagnosed with prostate cancer over time.

可能會有一些股份變動，但即使有，變動幅度可能也不大。此外，還有人口統計數據這一因素。隨著人口結構的變化，隨著時間的推移，被診斷出患有前列腺癌的人數也會增加。

So those are the three things that are rolling through, and sort of projecting how they balance out is what the challenge is.

所以，這三件事正在發生，而如何預測它們之間的平衡就是挑戰所在。

On the gynecology side, the thing that we are seeing in our experience is that you are seeing more surgery being done by high-volume gynecologists in general. Not just robotic surgery, but laparoscopy and others. We are seeing a consolidation in the marketplace.

在婦科方面，根據我們的經驗，我們發現，一般來說，手術量大的婦科醫師會進行更多的手術。不僅是機器人手術，還有腹腔鏡手術和其他手術。我們看到市場正在整合。

And so folks who are either due oncologists or more routine surgeons, we think that's good for the world and we think that's good for Intuitive. Those more dedicated surgeons tend to be our customers. We see them tackling more procedures in concentrated fashions. And so that's kind of what is happened in gynecology. Likewise, I think there is a demographic element here that is likely to find a bottom and then start to drift up. The unknown is nonsurgical approaches and in-office approaches. And those are the factors at play.

因此，對於即將成為腫瘤科醫生或更常規的外科醫生的人來說，我們認為這對世界有好處，對 Intuitive 也有好處。那些較敬業的外科醫生往往是我們的客戶。我們看到他們正以更集中的方式處理更多程序。所以，婦科領域的情況大致是如此。同樣，我認為這裡存在著一個人口因素，這個因素可能會觸底反彈，然後開始回升。未知的是非手術治療方法和門診治療方法。這就是起作用的因素。

Patrick, I will let you go from there.

派崔克，剩下的就交給你了。

Yes, no, I think you described the urology situation well. The other thing to bear in mind is in the GYN market is while single-site procedures have been declining, some of the other benign procedures have been stabilizing and are creating less of a headwind to us on a year-over-year comparison basis; things like myomectomy.

是的，不，我認為你對泌尿科的情況描述得很準確。另一點要注意的是，在婦科市場，雖然單部位手術一直在減少，但其他一些良性手術已經趨於穩定，從同比來看，對我們造成的阻力較小；例如子宮肌瘤切除術。

And I guess my follow-up question -- and it might've been you, Patrick, who mentioned it. I think somebody described O-US procedure growth as it can be lumpy. And, quote, we are working to improve the performance there. Can you talk a little bit about how you are going about that, what kind of initiatives are underway and what you would hope or we should expect might come from those initiatives? Thank you.

我想問的後續問題是──也可能是你，派崔克，提到過這個問題。我認為有人把 O-US 手術後生長描述為可能呈現塊狀。引用原文：“我們正在努力提高那裡的表現。”您能否談談您是如何進行這項工作的，目前正在進行哪些舉措，以及您希望或我們應該期待這些舉措能帶來什麼成果？謝謝。

Yes, I will take that one, Rick. The opportunity in Europe tends to be country by country. So, where we are looking to do something different or better, it tends to be making sure that we have staff that is supporting local efforts and local needs, that they are working in local language, that they understand the health care systems in intimate ways that are specific to that country.

好的，里克，我接受那個。歐洲的機會往往因國家而異。因此，當我們想要做出一些不同或更好的事情時，往往會確保我們的員工能夠支持當地的努力和需求，能夠用當地語言工作，並能夠深入了解該國的醫療保健系統。

And so, where we see opportunities, we will invest there and build that out. We have been. Where we have made investments, we've seen growth. And so where we see some areas of opportunity, we think we have a playbook, now we have to go execute against that playbook. That's been our perspective there.

因此，凡是我們看到機會的地方，我們都會投資並加以發展。我們一直都是。我們在投資的地方都看到了成長。因此，當我們看到一些機會領域時，我們認為我們已經有了行動方案，現在我們必須按照這個方案去執行。我們一直都是這樣看待這個問題的。

Thank you.

謝謝。

Matt O'Brien, Piper Jaffray.

馬特·奧布萊恩，派珀·賈弗雷。

I was hoping to start on the general surgery side. And it sounds like, again, very good quarter. But I'm just curious if either of the various ventral -- or, I'm sorry, the various hernia cases are really leading the charge in some of that growth. Are you seeing any kind of divergence or inflection in either ventral or inguinal? And are those procedures at this point getting sizable enough to start to sway hospital decision-making as to adding additional systems in order to meet that demand?

我原本希望從普通外科開始。聽起來，這又是一個非常好的季度。但我只是好奇，各種腹股溝疝氣病例是否真的在某些增長中起到了主導作用。您是否觀察到腹側或腹股溝處有任何發散或彎曲？目前這些手術的規模是否已經夠大，以至於開始影響醫院的決策，促使其增加額外的系統來滿足這項需求？

Yes, Matt, thanks for the question. Certainly both ventral and inguinal hernia procedures continue to exhibit robust growth. Inguinal hernias is just a bigger overall procedure category. It's just more commonly performed. But the rates of adoption that we are seeing in both procedures is encouraging. And the surgeon populations that are performing them and are continuing to increase the volumes and procedures that they are doing.

是的，馬特，謝謝你的提問。腹股溝疝氣修補術和腹股溝疝氣修補術無疑都持續呈現強勁成長動能。腹股溝疝氣只是一個更大的手術類別。這種做法比較常見。但我們看到這兩種手術的採用率都令人鼓舞。而進行這些手術的外科醫師群體，其手術量和手術次數也不斷增加。

So it looks promising. And certainly from an overall volume perspective, had some influence because just the numbers are getting to the point where it matters to create access for these surgeons to be able to continue to perform procedures, that they are absorbing systems worth of activity at some of their institutions.

看起來很有希望。從整體數量的角度來看，這肯定產生了一定的影響，因為數量已經達到了一個臨界點，必須為這些外科醫生創造機會，讓他們能夠繼續進行手術，因為他們在某些機構中承擔了相當於整個系統的手術量。

Okay, that's very helpful. And then Gary, your commentary about the delays that we saw in Europe as hospitals are evaluating some competitive systems that are hitting those markets -- just curious to me. Do you think that is something that will linger here throughout 2016 as those systems are fully rolled out? Or do you think it will be a fairly quick process of kind of taking a peek, and maybe they are doing that now, and you could see a snapback in terms of the number of systems placed?

好的，這很有幫助。還有，Gary，你對我們在歐洲看到的醫院在評估一些進入市場的競爭系統時出現的延誤的評論——我只是對此感到好奇。你認為隨著這些系統在2016年全面推廣，這種情況會持續下去嗎？或者你認為這會是一個相當迅速的過程，就像是先試探一下，也許他們現在正在這樣做，那麼你可能會看到部署的系統數量迅速回升？

Specifically, did you see 10, 15 hospitals delay as they were evaluating both systems? And then out of those 10 hospitals, nine of them ended up buying da Vinci late last quarter or even early this quarter?

具體來說，您是否看到有 10 家、15 家醫院在評估這兩個系統時出現延誤？然後，在這 10 家醫院中，有 9 家在上個季度末甚至本季初購買了達文西手術系統？

Yes, the -- I think that it's a little bit harder to predict how fast it will go through. I guess our anecdotal experience has been some have been quick looks and make an evaluation and come sign up with us. And others are going through a little bit longer process. So with regard to a, quote, snapback, I wouldn't bake that in. I think it will play out a little longer than that.

是的，我覺得很難預測它通過的速度。根據我們的經驗來看，有些人只是快速瀏覽一下，做個評估，然後就來和我們簽約了。還有一些人則需要經歷更長的過程。所以，關於所謂的“棒球帽”，我不會把它固定住。我認為事情還會持續更長時間。

Having said that, our -- the response of our customers after they have evaluated the other offerings and come back talk to us has been fantastic. So our confidence that we have good offerings and we can meet these customers' needs is very high. They will go through that process. And I think as new and different technologies come to market, not just the ones that are there today, I think this will be part of the new normal a little bit for Europe as people cross shopping and making decisions. Our goal is to make sure that they find our products to be of very high value. So far, so good.

話雖如此，我們的客戶在評估了其他產品後又回來與我們洽談，他們的回饋非常棒。因此，我們非常有信心我們能夠提供優質的產品和服務，並滿足這些客戶的需求。他們會經歷那個過程。我認為，隨著新技術和不同技術的湧現，不僅僅是目前現有的技術，隨著人們進行跨產業購物和決策，這將成為歐洲新常態的一部分。我們的目標是確保他們認為我們的產品具有很高的價值。到目前為止，一切都很好。

Got it. Very helpful. Thank you.

知道了。很有幫助。謝謝。

Larry Keusch, Raymond James.

Larry Keusch，Raymond James。

Wondered if we could just, first question, start with the trade-ins. I think there were 42, as you mentioned, this quarter. And I think the five quarters, it's been averaging closer to 30. So I'm just trying to understand perhaps what is driving the higher trade-in. And then what's the ultimate opportunity to drive trade-ins in your older system base?

我想知道我們能不能先問第一個問題，從以舊換新開始。正如你所說，我認為本季有 42 例。我認為過去五個季度，平均下來接近 30。所以我想了解一下，是什麼因素導致了更高的舊車置換率。那麼，如何才能最大程度地抓住機遇，推動舊系統以舊換新呢？

There's nothing specific about this quarter that I would call out as it relates to trade-in. I think you have the numbers right. It came off of our -- the detail we provided with the press release. I wouldn't call anything out specifically. I think it -- last quarter, it was around in the high 30s, and it's been there for a little while. I don't know that it will probably fluctuate in that range, so I don't have any specific comments on it.

就本季而言，與以舊換新相關的沒有什麼特別之處需要特別指出。我認為你的數字是正確的。這是根據我們在新聞稿中提供的詳細資訊得出的結論。我不會具體指出什麼。我認為——上個季度，這個數字在 30 多度，而且已經維持了一段時間了。我不知道它是否會在這個範圍內波動，所以我對此沒有任何具體評論。

And then for Gary, maybe just an update on SP. You mentioned some in your prepared comments, but where are we in getting those evaluations going? Is it conceivable that we could see commercial units perhaps by the end of the year?

然後，對於 Gary 來說，或許可以更新 SP 的狀況。您在準備好的評論中提到了一些，但是我們在進行這些評估方面進展如何呢？我們是否有可能在年底前看到商業單位？

We are in discussions with FDA on trial type and endpoints. And we have clinical sites that are getting prepped. Product from the engineering and design and validation point of view is right on track, looks really good. We are not expecting anything of substance in terms of revenue this year. We do -- we expect them in clinical use in the second half, and that's what we are working towards.

我們正在與FDA討論試驗類型和終點指標。我們還有一些臨床試驗點正在準備中。從工程、設計和驗證的角度來看，產品進展順利，看起來非常棒。我們預計今年的收入不會有任何實質成長。的確如此——我們預計它們將在下半年投入臨床使用，這也是我們努力的方向。

Perfect. Thank you.

完美的。謝謝。

Jason Mills, Canaccord Genuity.

Jason Mills，Canaccord Genuity。

Congrats on a great quarter. My first question has to do with just trying to understand better your dogma as it relates to managing the P&L.

恭喜你本季表現出色。我的第一個問題只是想更好地理解您在損益管理方面的理念。

It was -- obviously we're getting here is higher procedural volume guidance and higher operating expense guidance. And what we are seeing -- what we seem to be seeing is some leverage to the operating line. But I'm just curious, Gary, if you could talk about -- Marshall, talk about the -- your dogmas over the next couple of years. And so are you looking for operating margin expansion? Is that what your objective is? Are you managing the business of top-line growth and trying to manage expenses best you can to get there? Could you just talk about your dogma as it relates to managing the P&L?

顯然，我們得到的是更高的手術量預期和更高的營運費用預期。我們看到的——我們似乎看到的是營運線上的一些槓桿作用。但我很好奇，加里，你能不能談談——馬歇爾，談談——你未來幾年的教條？所以，你們是否在尋求提高營業利益率？這就是你的目標嗎？您是否正在努力實現營收成長，並儘可能控製成本以實現這一目標？能否談談您在損益管理上的理念？

Yes, my first statement is kind of a caution of beware of averages. There are places in the business where we are seeking high operational efficiency and leverage. You see that in product cost reductions and some of the things that we're doing in manufacturing. There are other places in the operation where we think we can find leverage. At the same time, we want to turn around and reinvest those savings in opportunity. And we see a lot of opportunity, and I think that's -- that opportunity should be pursued.

是的，我的第一句話其實是在提醒大家要謹慎看待平均值。在業務的某些方面，我們正在尋求較高的營運效率和槓桿作用。這一點體現在產品成本降低以及我們在生產製造方面所做的一些事情。我們認為在營運中還有其他可以發揮作用的地方。同時，我們希望將這些節省下來的資金重新投資於各種機會。我們看到了很多機會，我認為──這些機會應該被抓住。

So, it will be a little bit lumpy. We are trying to be balanced. I wouldn't say that our approach is hard over one or hard over the other. It's not revenue above all else, and it's not profit above all else. We are trying to be balanced in that approach.

所以，表面會有點凹凸不平。我們力求保持平衡。我不會說我們的方法對其中一方或另一方是強硬的。最重要的不是收入，也不是利潤。我們力求在採取這種平衡的方法時做到最好。

And it may be a little bit lumpy. I think opportunities happen when they happen. You can be overly cautious and miss them. And so we -- we will maintain a fiscal discipline. That's been part of our history, and we will keep it. Having said that, we want to make sure that we reinvest some of the benefits that the Company has gained into expanding the opportunity we see in front of us.

它可能有點凹凸不平。我認為機會總會在時機到來時出現。過於謹慎反而會錯過它們。因此，我們將保持財務紀律。那是我們歷史的一部分，我們會保留它。話雖如此，我們希望確保將公司獲得的部分收益再投資於擴大我們眼前的機會。

That's helpful. My second and final question having to do with your cash balance and use of cash, you've been very proficient at buying back stock in the past. Given where the share price is juxtaposed to significantly expanding cash balance, would it be fair to assume that you will do modest -- maybe modest to moderate share repurchases going forward? Or will we see maybe less over the next two years than we saw in the last two years? Thanks.

那很有幫助。我的第二個也是最後一個問題與你的現金餘額和現金使用有關，你過去一直非常擅長回購股票。鑑於股價與大幅成長的現金餘額形成鮮明對比，是否可以合理地假設您未來將進行適度的股票回購——或許是適度到中等的回購？或者，未來兩年我們看到的可能會比過去兩年更少？謝謝。

In terms of just how we think about capital allocation, we are thoughtful and serious about it, as you would expect. We think buybacks are one leg or one tool in capital allocation. We really start with can we reinvest in the business and drive long-term growth and opportunity.

至於我們如何考慮資本配置，我們對此是深思熟慮且認真對待的，正如你所預料的那樣。我們認為股票回購是資本配置中的一個環節或工具。我們首先要考慮的是，我們能否對業務進行再投資，從而推動長期成長和發展機會。

Buybacks, if there are times -- we've been typically patient and opportunistic. And we think because of the volatility of our stock, there are times that makes a lot of sense for us. And in conversations with shareholders and where we are thoughtful and listened, and we have considered dividends, and we will consider them in the future. So we look at those three things and try to trade them off.

如果需要回購股票，我們通常會保持耐心並伺機而動。我們認為，由於我們股票的波動性，有時這樣做對我們來說很有意義。在與股東的對話中，我們認真傾聽並考慮了股利問題，未來我們也會繼續考慮分紅問題。所以我們考慮這三件事，並試著權衡取捨。

And we think for the long term. When we are thinking about capital allocation, we are not trying to do signaling or messaging. We are trying to build value for the business and for the shareholders in the long term.

我們著眼於長遠發展。我們在考慮資本配置時，並不是想進行訊號傳遞或訊息傳遞。我們致力於為公司和股東創造長期價值。

Thank you, guys.

謝謝大家。

Vijay Kumar, Evercore.

Vijay Kumar，Evercore。

Maybe one on the O-US placements. I know China -- I think on the last quarter you said they had about eight systems. Can we expect in a renewed, I guess, a contract from the [gowman freight]? How should we think about O-US from a systems perspective given that China, they are probably at the end of the amount of systems that they can import?

或許可以考慮一下美國海外領地的情況。我知道中國——我想你在上個季度說過他們大約有八個系統。我想，我們能否期待與[高曼貨運公司]續約？鑑於中國可能已經達到了其能夠進口的系統數量的極限，我們應該如何從系統角度看待 O-US？

Yes, I'll speak to China first and then to other locations next.

是的，我會先和中國聯繫，然後再和其他地方聯繫。

As far as China goes, when we left last quarter, there were about six systems left on the quota. With sold five this quarter. There's still one out there; I don't know if it will happen. And they have to go through a tender process, and that tender process had to have already begun.

就中國而言，我們在上個季度離開時，配額上還剩下大約六個系統。本季已售出5件。還有一個機會，我不知道它是否會實現。他們必須經過招標程序，而招標程序必須已經開始。

As far as additional quotas, it is a part of the overall budget -- government budget process in China. And so when that gets completed -- and I don't have a magic ball that tells me when it will be completed -- then we will know whether we are still under the quota system. And we will know whether -- if we are under the quota system, how many will be awarded. And there's no way to predict that in advance.

至於額外配額，它是整體預算的一部分——這是中國政府預算流程的一部分。所以，當這項工作完成時——我沒有魔法球可以告訴我它何時完成——我們就會知道我們是否仍然處於配額制度之下。我們將知道－如果實行配額制，會有多少人獲得獎勵。而且事先也無法預測這種情況。

As far as the rest of the world goes, in my remarks, I mentioned that it's -- fourth quarter is a seasonally strong quarter. If you look at where we came out for this quarter, it was pretty comparable to last year for the first quarter. But it's going to be lumpy market by market depending on circumstances.

至於世界其他地區，我在演講中提到過，第四季通常是季節性強季。如果看看我們本季的業績，會發現它與去年第一季的業績相當。但具體情況因市場而異，市場波動會比較大。

Great. And then maybe one follow-up for Gary. I know the clinical trial -- R&D expense were up 25% in the Q. Does that number include any clinical trial expenses? Because I'm just trying to get a sense for now as you talk with Japan in the starting clinical trial, sort of any potential impact on that number.

偉大的。然後或許可以給加里一個後續問題。我知道本季臨床試驗研發費用增加了25%。這個數字是否包含臨床試驗費用？因為我現在只是想了解一下，在你與日本方面進行臨床試驗啟動談判之際，這對該數字可能產生的任何潛在影響。

Yes, there's some -- we are -- we have said before we are in the middle of gathering data or evidence for gastrectomy in Japan. That doesn't go into R&D. That's actually in our SG&A numbers. And if we were doing -- as far as other clinical trials, we will tell you about them when we think it's appropriate.

是的，有一些——我們——我們之前說過，我們正在收集日本胃切除術的數據或證據。這不屬於研發範疇。實際上，這部分費用已經計入我們的銷售、管理及行政費用了。至於其他臨床試驗，我們會在認為合適的時候告訴大家。

Thanks, guys. Congrats on a strong quarter.

謝謝各位。恭喜你們本季業績出色。

Tao Levy, Wedbush.

陶·利維，韋德布希。

I had a -- we talked a lot about the hernia colorectal surgery. But you mentioned a couple times thoracic surgery and the benefit that particularly the Xi might bring to that procedure. Can you sort of maybe summarize some of the key opportunities within thoracic? Should we think of it as a colorectal-type opportunity, where it's moving in the right direction, but it's a little bit slower? Or could it potentially be more like a hernia or a hysterectomy opportunity?

我——我們談了很多關於疝氣結直腸手術的事情。但您曾多次提到胸腔外科手術，以及 Xi 可能為該手術帶來的好處。您能否概括一下胸腔外科領域的一些主要機會？我們是否應該把它看作是類似大腸癌的機遇，它正朝著正確的方向發展，但速度稍慢一些？或者，這會不會更像是疝氣或子宮切除手術的機會呢？

Just -- I will start, and I will ask Patrick to join in. Just -- from the starting place, these are typically cancer procedures and typically complex. Metastatic cancers, lung cancers.

我先開始，然後我會邀請派崔克一起參與。從一開始，這些通常都是癌症手術，而且通常都很複雜。轉移性癌症，肺癌。

The product set that we have, Xi moves us in the right direction. Some of the instrumentation we are bringing along moves us in the right direction in terms of providing surgeons with the tools they are looking for for efficient procedures. And I think we are at the beginnings of that.

Xi 認為，我們現有的產品組合將帶領我們走向正確的方向。我們帶來的一些儀器設備，在為外科醫生提供他們所需的高效手術工具方面，使我們朝著正確的方向邁進。我認為我們正處於這個階段的開端。

The way to think about the market is there are some minimally invasive surgeries done manually, video-assisted thoracic surgeries. Some institutions do a lot of it with good results. Others do very little of it. If you look at national averages rather than institutional numbers, you see a lot of open surgery done. And we think that that is the opportunity. I will let Patrick characterize it sort of --

看待這個市場的方式是，有一些微創手術是手工完成的，還有一些是視訊輔助胸腔手術。有些機構在這方面投入了許多精力，並且取得了良好的效果。其他人則很少這樣做。如果你看全國平均而不是機構數據，你會發現做了很多開放式手術。我們認為這就是機會。我將讓派崔克來描述一下——

Yes, Tao, we are still pretty early days. We are in the foundation. We have got a small team in the US focused on it. But our focus continues to be on driving general surgery growth in hernia and colorectal resections.

是的，陶，我們現在還處於起步階段。我們正在基金會工作。我們在美國有一個專門負責這項工作的小團隊。但我們的重點仍然是推動疝氣和結直腸切除術等普通外科手術的成長。

And internationally, we are still highly focused on drug and DVP adoption and some emerging procedures in countries where urology is deeply penetrated.

在國際上，我們仍然高度關注藥物和 DVP 的應用，以及泌尿外科滲透率較高的國家的一些新興手術。

And when you look around internationally, it is a cancer that is very common in Asia and other parts. So it's a very big opportunity for us, though perhaps a little bit around the corner from what we are currently focused on.

放眼國際，這種癌症在亞洲和其他地區非常常見。所以這對我們來說是一個非常大的機會，儘管它可能與我們目前關注的重點有點偏離。

Okay. Great. And as my follow-up, you mentioned focusing on urology internationally. I understand that it's still relatively underpenetrated, but it is just the same procedure that you keep on going after internationally. Should we be worried that some of the other procedures that are catching on here in the US over the last few years aren't moving the needle yet internationally? Thanks.

好的。偉大的。作為我的後續問題，您提到要專注於國際泌尿科領域。我知道這項技術目前普及率還比較低，但這正是你們在國際上一直在推行的相同流程。我們是否應該擔心，過去幾年在美國興起的一些其他醫療程序在國際上尚未有顯著成效？謝謝。

Thanks. Tao, that will be our last question. I will answer that, and then we will move on. I think it depends by country. So we see, for example, nice adoption of thoracic surgery in China. We see a pretty different mix of procedures in Korea than we see in the United States.

謝謝。陶，這將是我們的最後一個問題。我會回答這個問題，然後我們繼續討論下一個主題。我認為這取決於國家。例如，我們看到中國對胸腔外科手術的接受度很高。韓國的醫療程序組合與美國截然不同。

So you have to answer it country by country. I don't think there's a systemic worry here that somehow we are stuck at prostatectomy and won't be able to move any further. I do think that it's important for folks on the phone to realize that the profile of procedures in each country is going to differ based on disease state, based on how the reimbursement system works and the relative priorities of their health care system. So we see that reflected. We do see multiple procedure adoptions in different countries; just differs on what they are after.

所以你必須逐國回答這個問題。我不認為這裡存在著一種系統性的擔憂，即我們不知何故被困在前列腺切除術上，而無法取得進一步的進展。我認為，電話諮詢者應該意識到，每個國家的治療程序都會因疾病狀況、報銷制度的運作方式以及醫療保健系統的相對優先事項而有所不同。所以我們看到了這一點。我們看到不同國家採用了多種不同的手術流程；只是他們追求的目標有所不同。

Thank you.

謝謝。

That was our last question. As we have said previously, while we focus on financial metrics such as revenues, profits and cash flows during these conference calls, our organizational focus remains on increasing value by enabling surgeons to improve surgical outcomes and reduce surgical trauma.

這是我們最後一個問題。正如我們之前所說，雖然我們在這些電話會議中關注的是收入、利潤和現金流等財務指標，但我們組織的重點仍然是透過幫助外科醫生改善手術結果和減少手術創傷來增加價值。

We 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.

我們創立這家公司的目的是為了突破人手的限制，讓外科手術更加先進。我向你們保證，我們將持續致力於推動那些真正能帶來改變的關鍵因素。

This concludes today's call. Thank you for your participation and support on this extraordinary journey to improve surgery. I look forward to speaking with you again in three months.

今天的電話會議到此結束。感謝您參與並支持這段非凡的外科手術改進之旅。我期待三個月後再次與您交談。

Thank you. Ladies and gentlemen, we thank you for using AT&T executive teleconference service, and you may now disconnect.

謝謝。女士們、先生們，感謝您使用 AT&T 高階主管電話會議服務，您現在可以斷開連線了。