直覺手術 (ISRG) 2016 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by and welcome to the Intuitive Surgical third-quarter 2016 earnings release call.

女士們、先生們，感謝各位的耐心等待，歡迎參加直覺外科公司2016年第三季財報發布電話會議。

(Operator Instructions)

（操作說明）

As a reminder, this conference is being recorded. I would now like to turn the conference over to Senior Director of Finance, Investor Relations, Calvin Darling. Please go ahead.

再次提醒，本次會議正在錄音。現在我將會議交給財務及投資者關係高級總監卡爾文·達林先生。請開始。

Thank you. Good afternoon, and welcome to Intuitive Surgical's third quarter earnings conference call. With me today we have Gary Guthart, our President and CEO, Marshall Mohr, our Chief Financial Officer, and Patrick Clingan, Vice President of Finance and Sales Operations.

謝謝。下午好，歡迎參加直覺外科公司第三季財報電話會議。今天與我一同出席的有：總裁兼執行長加里·古薩特，財務長馬歇爾·莫爾，以及財務和銷售營運副總裁帕特里克·克林根。

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. 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 and 10-Q, filed on July 20, 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.

在會議開始之前，我想告知各位，今天電話會議中提及的評論可能包含前瞻性陳述。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有重大差異。這些風險和不確定性已在公司提交給美國證券交易委員會（SEC）的文件中詳細描述，包括我們最近於2016年2月2日提交的10-K表格和於2016年7月20日提交的10-Q表格。這些文件可透過公司網站或SEC的EDGAR資料庫查閱。敬請各位潛在投資者註意，切勿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網站intuitivesurgical.com的「投資者關係」頁面下的「音訊存檔」欄位中找到。此外，今天的新聞稿和補充財務資料表也已發佈在我們的網站上。

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

今天的會議形式如下：首先，我們將重點介紹今天早些時候發布的新聞稿中所述的第三季度業績；隨後進行問答環節。 Gary 將介紹本季度的業務和營運亮點；Marshall 將回顧我們第三季度的財務業績；Patrick 將討論手術和臨床方面的亮點；之後，我將提供我們更新後的 2016 年財務展望。最後，我們將進行問答環節。

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 Company performance in the quarter was solid, with increasing customer adoption of procedures and growth in system placements.

下午好，感謝各位參加今天的電話會議。本季公司業績穩健，客戶對各流程的採納率不斷提高，系統安裝量也有所成長。

Global procedure growth was over 14% year over year in the quarter. Drivers of growth centered on US general surgery and growth in the use of da Vinci Surgical Systems outside the United States. In the United States, year-over-year growth in ventral inguinal hernia repair continues to be strong. US colon resection and lung resection also contributed to solid growth. As we have stated in prior calls, we're expecting growth rates in mature procedures in the US to moderate, and US DVP is starting to follow this pattern, driven by the macro economic environment for prostate cancer diagnosis and treatment.

本季全球手術量年增超過14%。成長主要得益於美國一般外科手術的成長以及美國以外地區達文西手術系統使用量的成長。在美國，腹股溝疝氣修補術的年成長依然強勁。美國結腸切除術和肺切除術也為穩健增長做出了貢獻。正如我們在先前的電話會議中所述，我們預計美國成熟手術的成長速度將會放緩，而受前列腺癌診斷和治療宏觀經濟環境的影響，美國達文西手術量也開始呈現這種趨勢。

In Europe, procedure growth tempered in the quarter, with some countries posting solid performance while growth softened in others. We're pleased with growth in procedures in Asia, with Korea and China in particular demonstrating continued strength. Patrick will review procedure trends in greater detail later in the call.

在歐洲，本季手術量成長放緩，部分國家表現穩健，有些國家則成長乏力。我們對亞洲的手術量成長感到滿意，尤其是韓國和中國，它們持續保持強勁勢頭。 Patrick 將在稍後的電話會議中更詳細地分析手術量趨勢。

We placed 134 da Vinci systems in the quarter, up from 117 in Q3 of 2015. While we offer a range of models and price points, our most capable model, da Vinci Xi, again represented roughly three quarters of new capital placements. As we've said on previous calls, capital placements are lumpy, and this quarter was no exception.

本季我們共安裝了134台達文西手術系統，高於2015年第三季的117台。雖然我們提供多種型號和價位的手術系統，但功能最強大的達文西Xi手術系統再次佔據了新增安裝量的約四分之三。正如我們在先前的電話會議中提到的，新安裝量存在波動，本季也不例外。

Healthy placement stood out in the US, while placements in our European region softened relative to a year ago. Capital placements in Asia are particularly unpredictable given environmental constraints like reimbursements in Japan and quotas in China. Placements in Asia were in line with prior quarters.

在美國，健康的投資配置表現突出；而歐洲地區的投資配置較去年同期放緩。鑑於日本的報銷政策和中國的配額限制等環境因素，亞洲地區的資本配置尤其難以預測。亞洲地區的投資配置與前幾季基本持平。

Turning to revenue and gross margin dynamics, we experienced some one-time tailwinds in the quarter that contributed to higher-than-expected net income. Marshall will take you through these events and our general finances in greater detail later in the call.

談到營收和毛利率，本季我們遇到了一些一次性利多因素，促成了高於預期的淨利。馬歇爾將在稍後的電話會議中更詳細地介紹這些因素以及我們的整體財務狀況。

Turning to highlights of our third-quarter operating results. Procedures grew approximately 14% over the third quarter of last year. We shipped 134 da Vinci Surgical Systems, up from 117 in the third quarter of 2015.

接下來是第三季營運業績的亮點。手術量較去年同期增加約14%。我們交付了134套達文西手術系統，高於2015年第三季的117套。

Revenue for the quarter was $683 million, up 16% from the prior year. Pro forma gross profit margin was 73.1%, compared to 69.3% in the third quarter of last year. Instrument and accessory revenue increased to $348 million, up 17%.

本季營收為6.83億美元，較上年同期成長16%。以備考基準計算的毛利率為73.1%，去年同期為69.3%。儀器及配件收入增至3.48億美元，成長17%。

Total recurring revenue in the quarter was $478 million, representing 70% of total revenue. We generated a pro forma operating profit of $308 million in the quarter, up 28% from the third quarter of last year. And pro forma net income was $246 million, up 23% from Q3 of 2015.

本季經常性收入總額為 4.78 億美元，佔總營收的 70%。本季以備考基準計算的營業利潤為 3.08 億美元，較去年同期成長 28%。以備考基準計算的淨利潤為 2.46 億美元，較 2015 年第三季成長 23%。

As we discussed with you on our last call, as our businesses strengthen, we have increased our mid-and long-term investments in creating our next generation of products and services. We have been increasing these investments based on our belief that substantial opportunity exists to enable better outcomes and to expand access to our technologies globally.

正如我們在上次電話會議中與您討論的那樣，隨著業務的不斷增強，我們增加了對下一代產品和服務研發的中長期投資。我們之所以增加這些投資，是因為我們相信，透過這些投資，我們能夠獲得更好的成果，並在全球範圍內擴大我們技術的應用範圍。

We continue to enhance features and expand access to our Xi suite of instruments, accessories and imaging products. In the third quarter, we added the ability to ship Xi single site, Xi 30-millimeter stapler and Firefly to several countries. In addition, inter operative table motion uptake and performance is meeting our expectations. We are continuing to invest in expansion and refinement of our base instrument, stapling and vessel sealing products for our Xi platform.

我們持續改進功能，並擴大Xi系列器材、配件和影像產品的供應範圍。第三季度，我們新增了向多個國家運送Xi單孔手術器械、Xi 30毫米縫合器和Firefly成像系統的功能。此外，手術台間移動裝置的使用率和性能均符合預期。我們將繼續投資，拓展和改進Xi平台的基礎器械、縫合器和血管封閉產品。

New system platforms continue to make good progress. Our da Vinci single port is progressing in its in-house clinical evaluations and preparations for human clinical trials expected later this quarter. As we've discussed on prior calls, we plan first markets to include head and neck surgery, urology and colorectal surgery. SP is a platform technology that allows high-dexterity access with great 3D vision to confined surgical spaces. Commentary by surgeons after in-house evaluations have indicated strong interest in the clinical potential of this platform.

新型系統平台持續取得良好進展。我們的達文西單孔手術系統正在進行內部臨床評估，並已做好準備，預計本季稍後進行人體臨床試驗。正如我們在之前的電話會議中討論過的，我們計劃首批市場包括頭頸外科、泌尿外科和結直腸外科。 SP平台技術能夠實現高度靈巧的操作，並具備出色的3D視覺，從而能夠進入狹小的手術空間。外科醫生在內部評估後的回饋表明，他們對該平台的臨床應用潛力表現出濃厚的興趣。

In the quarter, we also announced the creation of a joint venture with Fosun Pharma, owner of our current da Vinci Partner in China. The JV's first objectives are to work with ISI and Fosun to produce products that address an acute need in the diagnosis and cost-effective treatment of lung cancer. One of the most commonly diagnosed forms of cancer in the world, and for which early detection and treatment are important.

本季度，我們也宣布與復星醫藥成立合資公司，復星醫藥是我們目前在中國的達文西手術系統合作夥伴。合資公司的首要目標是與ISI和復星醫藥合作，開發能夠滿足肺癌診斷和經濟有效治療方面迫切需求的產品。肺癌是世界上最常見的癌症之一，早期發現和治療至關重要。

The technology underpinning the system is based on computer-controlled catheters, advanced image processing and sophisticated sensing. It incorporates a substantial set of proprietary intellectual property developed, owned or licensed by Intuitive over the past several years. The system is in its early stages of our human clinical experience, and final clearance and launch targets are not yet set. That said, the raw capability of the technology is compelling. And it has the potential to perform as a broader diagnostic and treatment platform over time.

該系統的核心技術是基於電腦控制的導管、先進的影像處理和精密的感測技術。它融合了Intuitive公司過去幾年開發、擁有或授權的大量專有智慧財產權。該系統目前仍處於人體臨床試驗的早期階段，最終的審批和上市目標尚未確定。儘管如此，該技術的潛力已十分顯著，並且預計在未來發展成為一個更廣泛的診斷和治療平台。

Bringing new platforms to the market represents a significant investment. We have added approximately 400 employees year to date, and expect increased fixed investments and some lumpiness in spending in future quarters as these platforms move through design, validation, data collection and early launch.

將新平台推向市場是一項重大投資。今年迄今為止，我們已新增約 400 名員工，並且預計隨著這些平台推進設計、驗證、數據收集和早期發布等階段，未來幾季固定投資將會增加，支出也會出現一定程度的波動。

As we close 2016, we have 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 new clearances, additional clinical and economic validation, training centers and the expansion of our product offerings. Third, driving our organizational capabilities in markets in Europe and Asia. And finally, assisting our customers in their efforts to maximize the comprehensive value of their programs.

2016年即將結束，我們將重點放在以下幾個面向。首先，擴大達文西手術系統在一般外科和胸腔外科，特別是大腸直腸手術和疝氣修補術的應用。其次，完善我們的生態系統，包括獲得新的認證、進行更多臨床和經濟驗證、建立培訓中心以及擴展產品線。第三，提升我們在歐洲和亞洲市場的組織能力。最後，協助客戶最大限度地提升其項目的綜合價值。

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

謝謝，Gary。我將以非GAAP或備考財務報表的形式介紹我們的業績，其中不包括索賠提列中的特定法律和解、股權激勵以及已購買知識產權的攤銷。我們提供備考資訊是因為我們認為，以備考財務報表的形式更容易理解業務趨勢和經營績效。稍後，我也會在我的演講稿中總結我們的GAAP業績。為了避免任何混淆，我們已在網站上發布了備考業績與GAAP業績的調節表。

Third-quarter 2016 revenue was $683 million, an increase of 16% compared with $590 million for the third quarter of 2015 and an increase of 2% compared with the second-quarter revenue of $670 million. Third-quarter 2016 procedures increased 14% compared with third quarter of 2015 and decreased 1% compared with last quarter. Procedure growth relative to last year has been driven by general surgery in the US and urology worldwide. The decrease relative to the prior quarter primarily reflects seasonality.

2016年第三季營收為6.83億美元，較2015年第三季的5.9億美元成長16%，較第二季的6.7億美元成長2%。 2016年第三季手術量較2015年第三季成長14%，較上一季下降1%。與去年同期相比，手術量的成長主要得益於美國一般外科手術和全球泌尿科手術的成長。與上一季相比的下降主要反映了季節性因素。

Revenue highlights are as follows. Instrument and accessory revenue of $348 million increased 17% compared with last year, and increased 3% compared with the second quarter of 2016. Growth in instruments and accessory revenue generally reflects procedure growth and increased sales of stapling and vessel sealing products.

營收亮點如下：器械及配件營收達3.48億美元，較上年同期成長17%，較2016年第二季成長3%。器械及配件營收的成長主要反映了手術量的成長以及縫合釘和血管封閉產品銷售的增加。

Instrument and accessory revenue realized per procedure, including initial stocking orders, was approximately $1,870 per procedure compared with $1,840 last year, and $1,810 last quarter. The increases relative to the third quarter of 2015 and last quarter reflect increased sales for staplings and vessel sealing products. The increase compared to the second quarter of 2016 also reflects the impact of customer buying patterns.

每台手術的器械及配件收入（包括初始庫存訂單）約為 1,870 美元，而去年同期為 1,840 美元，上季度為 1,810 美元。與 2015 年第三季和上季相比，成長主要反映了縫合釘和血管封閉產品的銷售增加。與 2016 年第二季相比，成長也反映了顧客購買模式的變化。

System revenue of $205 million increased 18% compared with the third quarter of 2015, and increased 1% compared with last quarter. The year-over-year and quarter-over-quarter increases reflect higher system placements and higher revenue associated with lease buyouts, partially offset by lower average system selling prices.

系統營收達2.05億美元，較2015年第三季成長18%，較上一季成長1%。年成長和環比成長主要得益於系統安裝量增加和租賃買斷收入成長，但部分被系統平均售價下降所抵銷。

We generated approximately $13 million of revenue during the quarter from lease buyouts, compared with $3 million in the third quarter of 2015 and $13 million last quarter. While lease buyouts are difficult to predict, we expect the level of fourth-quarter lease buyouts to be below those of the third quarter.

本季我們透過租賃買斷業務獲得了約1300萬美元的收入，而2015年第三季為300萬美元，上一季為1300萬美元。雖然租賃買斷業務難以預測，但我們預期第四季的租賃買斷業務量將低於第三季。

134 systems were placed in the third quarter of 2016, compared with 117 systems in the third quarter of 2015 and 130 systems last quarter. 15 systems were placed under operating lease transactions in the current quarter, compared with 15 last quarter and 13 systems in the third quarter of 2015. As a reminder, revenue on operating lease transactions is recognized ratably over the life of the lease.

2016年第三季共部署了134套系統，而2015年第三季為117套，上季為130套。本季透過經營租賃方式部署了15套系統，上季為15套，2015年第三季為13套。需要注意的是，經營租賃交易的收入將在租賃期間內按比例確認。

As of the end of the third quarter, there were 74 systems out in the field under operating leases. We generated approximately $4 million of revenue associated with operating leases in the quarter, compared with $2 million in the third quarter of 2015 and approximately $4 million last quarter. We exclude the impact of operating leases and lease buyouts from our system ASP calculations.

截至第三季末，共有74套系統以經營租賃方式投入使用。本季經營租賃相關收入約400萬美元，而2015年第三季為200萬美元，上季約400萬美元。我們在系統平均售價（ASP）的計算中剔除了經營租賃和租賃買斷的影響。

Globally, our average system price was $1.53 million, compared with $1.61 million last year and $1.56 million last quarter. The decreases compared with prior periods primarily reflect a lower mix of dual-console systems, partially offset by a lower mix of trade-in systems in the third quarter of 2016.

全球範圍內，我們的平均係統價格為153萬美元，而去年同期為161萬美元，上季度為156萬美元。與前期相比，價格下降主要反映了雙控台系統佔比降低，但部分被2016年第三季以舊換新系統佔比降低所抵銷。

Service revenue of $130 million increased 10% year over year, and increased approximately 1% compared with the second quarter of 2016. The year-over-year and quarter-over-quarter increases reflect growth in our installed base of da Vinci systems.

服務收入達 1.3 億美元，年增 10%，與 2016 年第二季相比成長約 1%。年比增長和環比增長反映了我們達文西手術系統裝機量的增長。

Outside of the US, results were as follows. Third-quarter revenue outside the US of $189 million increased 25%, compared with $151 million for the third quarter of 2015 and increased 2% compared with $185 million for the second quarter. The increase compared with the previous year is comprised of the 26% growth in recurring revenue, which is driven by procedure growth of 25% and increased systems revenue of 24%.

美國以外地區的表現如下：第三季美國以外地區的營收為1.89億美元，較2015年第三季的1.51億美元成長25%，較第二季的1.85億美元成長2%。與上年同期相比的成長主要得益於經常性收入26%的成長，而經常性收入的成長又主要由手術量成長25%和系統收入成長24%所驅動。

The increase compared to the second quarter reflects systems revenue growth of 2% and recurring revenue growth of 2% in a seasonally slower quarter. Outside the US, we placed 49 systems in the third quarter, compared with 37 in the third quarter of 2015 and 51 systems last quarter.

與第二季相比，第三季營收成長反映了系統營收和經常性收入均成長了2%，而第三季通常是淡季。在美國以外，我們第三季共安裝了49套系統，而2015年第三季為37套，上季為51套。

Current quarter systems sales included 18 into Europe, 2 into China, 11 into Japan in 18 into rest-of-world markets. System placements outside of the US will continue to be lumpy, as some of the OUS markets are in the early stages of adoption. Some markets are highly seasonal, reflecting budget cycles or vacation patterns, and sales into some markets are constrained by government regulation.

本季系統銷售包括歐洲18套、中國2套、日本11套以及世界其他地區18套。美國以外地區的系統部署量仍將呈現波動，因為部分美國以外市場尚處於早期應用階段。部分市場受季節性影響顯著，反映出預算週期或假期模式的變化，此外，部分市場的銷售也受到政府監管的限制。

Moving on to the remainder of the P&L. Pro forma gross margin for the third quarter of 2016 was 73.1%, compared with 69.3% for the third quarter of 2015 and 71.9% for the second quarter of 2016. The pro forma gross margin for the third quarter of 2016 included $7.1 million of medical device tax refunds. Without the medical device tax refunds, our pro forma gross margin would have been the same as the second quarter or 72%.

接下來來看損益表的其餘部分。 2016年第三季的備考毛利率為73.1%，而2015年第三季為69.3%，2016年第二季為71.9%。 2016年第三季的備考毛利率包含了710萬美元的醫療器材退稅。如果不計入這筆醫療器材退稅，我們的備考毛利率將與第二季持平，即72%。

Compared with the third quarter 2015, the higher gross margin reflects reduces product costs, the medical device tax refunds and manufacturing efficiencies. Future margins will fluctuate based on the mix of our newer products, the mix of system and instrument and accessory revenue, costs associated with our scope exchange program, our ability to further reduce product costs and improve manufacturing efficiency, and in the long term, the potential reinstatement of the medical device tax.

與2015年第三季相比，毛利率的提高反映了產品成本的降低、醫療器材稅退稅以及生產效率的提升。未來的毛利率將根據新產品組合、系統和儀器及配件收入組合、內視鏡更換計劃的相關成本、我們進一步降低產品成本和提高生產效率的能力，以及長期來看醫療器械稅可能恢復徵收等因素而波動。

Pro forma operating expenses increased 14% compared with the third quarter 2015, and increased approximately $6 million compared with last quarter. The increases reflect increased headcount, increased product development activities, and investments in our OUS commercial organization. We added over 400 employees, primarily into product operations area over the past year. The increase compared with the prior quarter primarily reflects increased headcount costs.

預計營運費用較2015年第三季成長14%，較上季增加約600萬美元。成長主要反映了員工人數增加、產品研發活動增加以及對海外商業機構的投資。過去一年，我們新增了400多名員工，主要集中在產品營運領域。與上一季相比，成長主要反映了人力成本的增加。

Our pro forma effective tax rate for the third quarter was 22.7%, compared with an effective rate of 18.4% for the third quarter of 2015 and 27.8% last quarter. The pro forma third quarter of 2016 tax rate reflected $16 million of tax benefits or $0.40 per share realized as a result of the statute of limitation expirations in various jurisdictions. The third quarter of 2015 tax rate reflected $29 million or $0.77 per share related to a favorable tax court ruling involving an independent third party. Our tax rate will fluctuate with changes in the mix of OUS and US income, and with the impact of one-time items.

我們第三季的備考實際稅率為22.7%，而2015年第三季的實際稅率為18.4%，上一季為27.8%。 2016年第三季的備考稅率反映了因多個司法管轄區的訴訟時效到期而實現的1,600萬美元稅收優惠，相當於每股0.40美元。 2015年第三季的稅率反映了與涉及獨立第三方的有利稅務法庭裁決相關的2,900萬美元，相當於每股0.77美元。我們的稅率將隨美國境外收入和美國境內收入組成的變化以及一次性項目的影響而波動。

Our third quarter 2016 pro forma net income was $246 million or $6.19 per share, compared with $199 million or $5.24 per share for the third quarter of 2015 and $220 million or $5.62 per share for the second quarter of 2016. Excluding one-time income tax and medical device tax benefits, pro forma net income would have been $225 million or $5.65 per share. As I indicated earlier, pro forma income provides an easier comparison of our financial results and business trends.

我們2016年第三季的備考淨利為2.46億美元，即每股6.19美元，而2015年第三季為1.99億美元，即每股5.24美元，2016年第二季為2.2億美元，即每股5.62美元。若不計入一次性所得稅和醫療器材稅優惠，備考淨利將為2.25億美元，即每股5.65美元。正如我之前提到的，備考利潤能更清楚地展現我們的財務表現和業務趨勢。

I will now summarize our GAAP results. GAAP net income was $211 million or $5.31 per share for the third quarter of 2016, compared with $167 million or $4.40 per share for the third quarter of 2015 and $185 million or $4.71 per share for the second quarter of 2016.

現在我將總結一下我們的GAAP業績。 2016年第三季GAAP淨利為2.11億美元，即每股5.31美元，而2015年第三季為1.67億美元，即每股4.40美元，2016年第二季為1.85億美元，即每股4.71美元。

We ended the quarter with cash and investments of $4.6 billion, up from $4.2 billion as of June 30, 2016. The increase was primarily driven by cash generated from operations, and proceeds from stock option exercises. As our cash builds, we will continue to evaluate our approach to capital allocation.

本季末，我們的現金及投資總額為46億美元，高於2016年6月30日的42億美元。成長主要得益於經營活動產生的現金流量以及股票選擇權行使所得。隨著現金流的增加，我們將繼續評估我們的資本配置策略。

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.

謝謝你，馬歇爾。

Of our third-quarter procedure growth of 14%, US procedures grew approximately 11% and outside of the United States procedures grew approximately 25%. During the first three quarters of 2016, global procedure growth was nearly 16%. In the United States taken together, growth in our mature procedures slowed in the third quarter compared to the first half of the year. General and thoracic procedure growth remained healthy.

第三季度，我們的手術量增加了14%，其中美國手術量增加約11%，美國以外地區的手術量增加約25%。 2016年前三個季度，全球手術量成長接近16%。在美國，成熟手術的整體成長在第三季較上半年放緩。一般外科手術和胸腔外科手術的成長依然保持良好勢頭。

In US urology, third-quarter growth in da Vinci Prostatectomy slowed to low single-digit growth, a level that we believe to be similar to the overall rate of diagnoses of new prostate cancers. We believe that our US prostatectomy volumes have been tracking to the broader prostate surgery market.

在美國泌尿外科領域，達文西前列腺切除術第三季度的增長放緩至個位數低位，我們認為這一增速與前列腺癌新發病例的總體診斷率相近。我們相信，我們在美國的前列腺切除術量與更廣泛的前列腺手術市場趨勢一致。

In US gynecology, third-quarter procedures grew modestly year over year, with growth led by malignant and complex benign hysterectomy. Continuing the recent trend, we estimate a larger proportion of da Vinci Hysterectomy procedures were performed by gynecologic oncologists during the third quarter. Procedures for benign gynecologic conditions grew modestly during the third quarter, continuing a trend from the first half of the year.

在美國婦科領域，第三季度手術量同比增長略有增長，其中惡性子宮切除術和複雜良性子宮切除術的增長最為顯著。延續近期的趨勢，我們估計第三季由婦科腫瘤醫師實施的達文西機器人輔助子宮切除術比例增加。良性婦科疾病的手術量在第三季也略有成長，延續了上半年的成長趨勢。

Third-quarter US general and thoracic surgery procedure adoption remains strong, led by solid growth in hernia repair and continued adoption of colorectal procedures. Hernia repair continues to contribute the largest volume of new procedures in general surgery, and existing surgeon retention and utilization remains encouraging.

第三季美國一般外科和胸腔外科手術量依然強勁，主要得益於疝氣修補術的穩健成長和大腸直腸手術的持續普及。疝氣修補術仍然是一般外科新增手術量最大的手術，現有外科醫師的留任率和使用率也保持良好動能。

Cholecystectomy procedures declined in the quarter, with growth in multi-port procedures being offset by declines in single-site procedures. Early-stage adoption of lobectomies and other thoracic procedures is encouraging.

本季膽囊切除術數量有所下降，多孔手術的成長被單孔手術的減少所抵消。肺葉切除術和其他胸腔外科手術的早期發展令人鼓舞。

Last month at the global symposium on robotic assisted and minimally invasive hernia repair, several new data sets comparing da Vinci to open and laparoscopic hernia repair were presented. Among the most notable presentations, Doctor Rosen from the Cleveland Clinic presented new data on retro muscular ventral hernia repair from the American Hernia Society's quality collaborative, or the AHSQC.

上個月舉行的全球機器人輔助和微創疝氣修補術研討會上，公佈了多項比較達文西機器人手術與開放式和腹腔鏡疝氣修補術的新數據。其中最引人注目的是，克利夫蘭診所的羅森醫生公佈了美國疝氣學會品質協作計畫（AHSQC）提供的關於腹壁後肌疝氣修補術的新數據。

In a prospective cohort of more than 400 patients case matched between da Vinci and open surgery, da Vinci surgery was shown to reduce the length of hospitalization by two and a half days compared to open surgery. With similar levels of wound outcomes, readmissions and re-operations. Intuitive is a founding partner of AHSQC, and we are supporting its expansion to include data for inguinal hernia repair.

在一項前瞻性隊列研究中，研究人員對400多例接受達文西機器人手術和開放手術的患者進行了病例匹配，結果顯示，與開放手術相比，達文西機器人手術可縮短住院時間兩天半，且傷口癒合情況、再入院率和再次手術率均相似。 Intuitive是AHSQC的創始合作夥伴，我們正在支持其擴展，將腹股溝疝氣修補術的數據納入其中。

Turning abroad, procedure growth outside of the United States was approximately 25% in the third quarter, led by the global adoption of da Vinci Prostatectomy with solid contributions from kidney procedures. Total procedure growth in Europe and Asia was similar to the first half of the year, though procedure performance varied by country. Strong growth continued in China, South Korea, Japan and Germany.

從海外市場來看，第三季美國以外地區的手術量成長約25%，主要得益於達文西前列腺切除術在全球的普及，腎臟手術也貢獻顯著。歐洲和亞洲的手術量總成長與上半年基本持平，但各國的手術量表現有所不同。中國、韓國、日本和德國的手術量持續保持強勁成長。

While adoption of da Vinci in urology is the primary driver of procedure growth outside of the United States, we are seeing multi-specialty adoption in certain countries. In China, roughly half of the year-to-date procedure growth has come from categories outside of urology. In South Korea, approximately 60% of the year-to-date procedures have come from categories outside of urology.

雖然在美國以外地區，泌尿外科領域對達文西手術系統的應用是推動手術量成長的主要動力，但我們也看到一些國家出現了多學科聯合應用的情況。在中國，今年迄今的手術量成長中，約有一半來自泌尿外科以外的領域。在韓國，今年迄今的手術量成長中，約有60%來自泌尿外科以外的領域。

We are investing in the development of clinical evidence to support the adoption of da Vinci surgery in markets around the world. Globally, we support several evidence initiatives and registries, including AHSQC, gynecologic oncology societal registries in the US and Europe and the colorectal registry in Europe.

我們正投資於臨床證據的開發，以支持達文西手術在全球市場的推廣應用。在全球範圍內，我們支持多項循證研究計劃和註冊項目，包括AHSQC、美國和歐洲的婦科腫瘤學會註冊項目以及歐洲的結直腸癌註冊項目。

In the US, we are also supporting several comparative perspective and retrospective multi-center studies on hernia repair, colorectal surgery and thoracic surgery. Outside of the United States, we are sponsoring clinical studies in Japan to support reimbursement submissions for malignant hysterectomy and gastrectomy.

在美國，我們也支持多項關於疝氣修補術、大腸直腸手術和胸腔外科手術的比較性研究和回顧性多中心研究。在美國以外，我們正在日本贊助臨床研究，以支持惡性子宮切除術和胃切除術的醫療保險報銷申請。

In Europe, we provide support for studies in colorectal, thoracic and gynecologic oncology. We are committed to developing local evidence in key markets to support the adoption of da Vinci Surgery where our technology can bring value to hospitals, surgeons and patients.

在歐洲，我們為大腸直腸腫瘤、胸腔外科腫瘤和婦科腫瘤領域的研究提供支持。我們致力於在關鍵市場開發本地證據，以支持達文西手術系統的應用，因為我們的技術能夠在這些市場為醫院、外科醫生和患者帶來價值。

The third quarter was another quarter with a large number of clinical publications evaluating da Vinci Surgery. Of these, I have selected a few studies that you may find interesting.

第三季又發表了大量評估達文西手術系統的臨床論文。我從中挑選了一些您可能感興趣的研究。

Dr. [Delush] and colleagues from Indiana University published a study in Surgical Endoscopy comparing da Vinci to laparoscopic colorectal procedures captured in the American College of Surgeons National Surgical Quality Improvement Project, or NSQIP, database from 2011 through 2014. Including over 27,000 procedures across a range of colon and rectal resections, in exchange for an approximate 45-minute longer operative time, da Vinci low anterior resections and right colectomies showed a reduction in conversion rates.

德魯甚博士及其印第安納大學的同事在《外科內視鏡》雜誌上發表了一項研究，比較了達文西機器人手術與腹腔鏡結直腸手術，數據來自美國外科醫師學會國家外科品質改進計畫（NSQIP）資料庫，時間跨度為 2011 年至 2014 年。該研究涵蓋了超過 27,000 例結腸和直腸切除術，結果顯示，達文西機器人手術雖然手術時間延長了約 45 分鐘，但其低位前切除術和右半結腸切除術的轉換率有所降低。

Left colectomies trended towards a reduction in conversion rates without statistical significance. Low anterior resections also showed a lower rate of sepsis, with a higher rate of diverting ostomy. Across all cohorts, da Vinci surgery generated a reduction in length of hospital stay.

左半結腸切除術的轉換率呈下降趨勢，但未達統計意義。低位前切除術的膿毒症發生率也較低，但造口發生率較高。在所有隊列中，達文西手術均縮短了住院時間。

The next study was published by Dr. Ozben and colleagues from the Acibadem University in Istanbul, Turkey in the Journal of Surgical Laparoscopy, Endoscopy and Percutaneous Technology. In a small case series, the authors compared their experience in performing rectal resections on da Vinci Xi to da Vinci Si.

下一項研究由土耳其伊斯坦堡阿奇巴德姆大學的奧茲本博士及其同事發表在《外科腹腔鏡、內視鏡和經皮技術雜誌》。在一項小型病例係列研究中，作者比較了他們在達文西Xi和達文西Si手術系統中進行直腸切除術的經驗。

They found that da Vinci Xi was associated with an approximate 40 minutes of reduced operative time. The reduction in operative time was attributable to an elimination of double docking in hybrid surgeries in the da Vinci Xi cohort. The surgeons also found the da Vinci Xi patient population experienced an increase in lymph nodes harvested and quicker return of bowel function with a one-day longer length of hospital stay.

研究發現，使用達文西Xi手術系統可使手術時間縮短約40分鐘。手術時間的縮短歸因於達文西Xi手術組在混合手術中無需進行雙重對接。外科醫生還發現，使用達文西Xi手術的患者淋巴結清除數量增加，腸道功能恢復更快，但住院時間延長了一天。

The authors concluded quote, the Xi generation appeared to allow shorter [console] times, and its broader capabilities promised to make it a lot easier for surgeons to perform this complex robotic procedure, close quote. While the study highlights the enhanced workflow capabilities of da Vinci Xi for multi-quadrant surgery such as rectal resection, our da Vinci Si installed base has remained stable in 2016 as customers continue to find value in its utilization. Taken together, procedures performed on da Vinci Si and Xi platforms represented over 95% of our third-quarter procedures.

作者總結：「Xi 代系統似乎能夠縮短操作時間，其更廣泛的功能有望使外科醫生更容易地完成這種複雜的機器人手術。」雖然該研究強調了達文西 Xi 系統在直腸切除等多像限手術中增強的工作流程能力，但由於客戶持續認可其價值，我們 2016 年達文西 Si 系統的裝機量保持穩定。總體而言，在達文西 Si 和 Xi 平台上進行的手術占我們第三季手術總量的 95% 以上。

This concludes my remarks, I'll 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。我將為你提供我們更新後的2016年財務展望。

Starting with procedures. On our last call, we estimated full-year 2016 procedure growth of 14% to 15% above the approximately 652,000 procedures performed in 2015. Now, as we enter the fourth quarter, we continue to forecast full-year procedure growth of 14% to 15%, likely towards the higher end of the range.

首先來看手術量。在上一次電話會議上，我們預計2016年全年手術量將比2015年約65.2萬例增加14%至15%。現在，隨著第四季的到來，我們仍然預測全年手術量將增加14%至15%，很可能接近預測範圍的上限。

With regard to Q4 2016 system placements, we directionally expect system placements for the quarter to follow recent seasonal trends. However, we anticipate system placements outside of the US will continue to be lumpy as some of our US OUS markets are in early stages of adoption and sales into sub markets are constrained by government regulations.

關於2016年第四季的系統部署情況，我們預期該季度的系統部署量將大致遵循近期的季節性趨勢。然而，我們預期美國以外地區的系統部署量仍將呈現波動，因為我們在美國以外的部分市場仍處於早期應用階段，且向細分市場的銷售受到政府法規的限制。

Recall, we placed 13 systems into China and 7 systems into Brazil in the fourth quarter of 2015. As the quota in China expired in 2015 and a new quota has not yet been issued and as we are in the very early stages of adoption in Brazil, we do not expect comparables and placements into these markets in the fourth quarter of 2016.

回顧一下，我們在 2015 年第四季在中國部署了 13 套系統，在巴西部署了 7 套系統。由於中國的配額已於 2015 年到期，新的配額尚未發放，而且我們在巴西的採用還處於非常早期的階段，因此我們預計 2016 年第四季不會在這些市場進行類似的部署。

Also, we believe that the flexibility we have offered customers in the form of operating leases has been well received. As a result, as compared to prior periods, we expect a higher proportion of Q4 2016 placements to be under operating leases with revenue recognized in future periods. Finally, we expect to see a lower number of lease buyouts in the fourth quarter compared to the previous two quarters, given the lower number of short-term leases that are outstanding at this time.

此外，我們相信，我們以經營租賃形式為客戶提供的靈活性受到了客戶的歡迎。因此，與前期相比，我們預計2016年第四季將有更多租賃項目採用經營租賃方式，並將在未來期間確認收入。最後，鑑於目前未結清的短期租賃數量較少，我們預計第四季度租賃買斷數量將低於前兩季。

Turning to gross profit, on our last call, we forecast 2016 pro forma gross profit margin to be within a range of between 70% and 71% of net revenue. We now expect our full-year 2016 pro forma gross profit margin to be approximately 71.5% of net revenue.

關於毛利潤，我們在上次電話會議上預測，2016年備考毛利率將佔淨收入的70%至71%。我們現在預計，2016年全年備考毛利率約為淨收入的71.5%。

As Marshall indicated, the third quarter benefited from a $7.1 million medical device tax refund. Excluding that benefit, our gross profit margin would have been 72%. We expect our fourth-quarter margin to be directionally lower than the third quarter, primarily due to product mix.

正如馬歇爾所指出的，第三季受益於710萬美元的醫療器材退稅。若不計入這筆退稅，我們的毛利率將達到72%。我們預計第四季度的毛利率將略低於第三季度，主要原因是產品組合的變化。

Turning to operating expenses, based upon investments we are making in key areas of the business, we expect expense growth will continue to accelerate. On our last call, we forecast pro forma 2016 operating expenses to grow between 12% and 15% above 2015 levels. We are now refining this range to 13% to 14%.

就營運費用而言，基於我們在關鍵業務領域的投資，我們預計費用成長將繼續加速。在上一次電話會議上，我們預測2016年備考營運費用將比2015年水準成長12%至15%。現在，我們將此範圍調整為13%至14%。

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 other income to total approximately $33 million in 2016, higher than the $30 million forecast on our last call, due primarily to higher interest income. With regard to income tax, consistent with previous guidance, we expect our Q4 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 international profits.

與上次電話會議一致，我們預計2016年非現金股權激勵支出將在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年其他收入總額約3,300萬美元，高於上次電話會議預測的3,000萬美元，主要原因是利息收入增加。關於所得稅，與先前的指引一致，我們預計2016年第四季備考所得稅率將在稅前利潤的26.5%至28.5%之間，主要取決於美國和國際利潤的組成。

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

我們的發言到此結束。現在開始接受各位提問。

(Operator Instructions)

（操作說明）

Bob Hopkins, Bank of America.

鮑伯霍普金斯，美國銀行。

Thanks, good afternoon. Can you hear me okay?

謝謝，下午好。你聽得清楚我說話嗎？

We can.

我們可以。

Great. So I had two questions. First for Marshall, just to clarify a couple of things that were mentioned relating to the fourth quarter and then a question for Gary on the Fosun agreement.

好的。我有兩個問題。第一個問題想問馬歇爾，澄清一下之前提到的一些關於第四季的事情；第二個問題想問加里，關於復星協議。

But, Marshall, I will start with you. Just two quick clarifications. One, on the medical device tax and the $7 million, could you explain why that is one time? And then on the system sales guidance that you're providing, is that essentially suggesting that systems will be globally roughly flat in Q4? Thank you.

不過，馬歇爾，我先問你兩個問題。第一，關於醫療器材稅和那700萬美元，你能解釋為什麼是一次性的嗎？第二，你提供的系統銷售預期，是否代表第四季全球系統銷售量將大致持平？謝謝。

Yes, sure. So the medical device tax is the results -- refund is the result of a -- when you originally compute the tax, there is some subjective areas and we modified what we had previously filed. So we get a one-time refund, and it is over. And they have -- we've received the money and there has been an audit, so we are all done with that.

是的，當然。醫療器材稅的退稅結果——也就是退款——是在最初計算稅款時，考慮到一些主觀因素，我們修改了先前提交的申報表。所以我們獲得了一次性退款，事情就此結束。我們已經收到退款，也經過了審計，所以這件事就徹底解決了。

The second question had to do with the level of systems. I think that what Calvin said was that the systems are seasonally stronger in Q4. What he was trying to set up, however, was that relative to the prior year, there are some hard comparables given that we had some markets that are rather lumpy like China and Brazil.

第二個問題與系統層級有關。我認為卡爾文的意思是，系統在第四季通常表現更強。但他想表達的是，考慮到中國和巴西等市場波動較大，與去年同期相比，存在一些難以比較的因素。

You had a second question on Fosun? I think Bob had a question on Fosun before he got to it. If you still have them, if not, we'll come back around in queue.

你還有關於復星的問題嗎？我記得鮑伯在回答之前也問過關於復星的問題。如果你還有問題，如果沒有，我們會按順序再問。

I'm here. Can you hear me?

我在這裡。你聽得到我說話嗎？

I can. Go.

我可以。走吧。

Okay, great. Thank you very much for that it. So I just -- yes, I was wondering if you could give us some perspective on the biopsy platform and the joint venture? Because it seems to me like this is an entirely new platform that you are announcing here.

好的，太好了。非常感謝。那麼，我只是想問一下——是的，我想請您介紹一下活檢平台和合資企業的情況？因為在我看來，您在這裡宣布的似乎是一個全新的平台。

So I was wondering if you could just give us a little more color on what this is? Is this a new totally new system or just an add on to Xi?

所以我想請您再詳細介紹一下這是什麼？這是一個全新的系統，還是只是Xi系統的附加元件？

Should we think about it as being a couple years away from commercialization, or is it really a longer-term project? I was just wondering if you could provide some perspective.

我們應該認為它距離商業化還有幾年時間，還是說它實際上是一個長期專案？我只是想聽聽您的看法。

I'll give you little bit of an overview. We'll of course give you additional detail in coming quarters. It is not currently designed as an add-on. The technology is based, as I said, in the prepared remarks on computer-controlled catheters along with some special sensing technologies and some image analysis.

我先簡單介紹一下。當然，我們會在接下來的幾季提供更多細節。目前它並非設計成附加元件。正如我剛才所說，這項技術是基於電腦控制導管，並結合了一些特殊的感測技術和影像分析。

Currently, the current configuration it is in, it is a standalone. Those types of technologies in the future could be integrated into other things, and we won't preclude ourselves from doing that.

目前，它採用的是獨立配置。未來這類技術可能會整合到其他系統中，我們不會排除這種可能性。

We do conceive of it as a way to access the body through natural orifices and other means, where you want to follow a prescribed pathway to get to some deep place in the body and do something. Our first clinical interest is in biopsying lung cancers or biopsying suspicious lesions in the lung.

我們將其視為一種透過自然腔道和其他途徑進入人體的方法，即遵循既定路徑到達身體深處並進行操作。我們最初的臨床研究方向是肺癌切片或肺部可疑病灶切片。

We think that that is important globally, and particularly important in China. And as a result, the Partnership with Fosun, who we have known through their Chindex Company for many years made a lot of sense to us, and we're excited about it.

我們認為這在全球範圍內都非常重要，在中國尤其重要。因此，與我們多年來透過其旗下Chindex公司認識的複星集團建立合作關係對我們來說意義重大，我們對此感到非常興奮。

We are not ready to give you commercial timelines yet. The technology is mature enough that we are in our initial human clinical experience. That's really the very beginnings for us, and as we get greater clarity on our launch timelines and thoughts we will share them with you.

我們目前還無法提供商業化時程。這項技術已經足夠成熟，我們正處於初步的人體臨床試驗階段。這對我們來說只是起步階段，一旦我們對產品上市時間表和相關想法有了更清晰的認識，我們會及時與您分享。

Thank you.

謝謝。

David Lewis, Morgan Stanley.

大衛路易斯，摩根士丹利。

Good afternoon. Gary, I wanted to start with a strategic question, then maybe have two follow-up boring questions. It occurred to me on this call that actually the Intuitive story is poised for a pretty significant change.

午安. Gary，我想先問一個策略性問題，然後再問兩個可能比較枯燥的後續問題。在這通電話中，我突然意識到，Intuitive的發展前景或許即將迎來一個相當重大的轉變。

I really think Intuitive has always really been about one system. I know you have multiple configurations. But in this quarter alone, Xi was still 75% of new placements. But if I think about the next two years, you're still going to have Xi and all those multitude of prior systems, have XSP and you're also now going to have this catheter-based sensing system.

我真的覺得Intuitive一直都專注在單一系統上。我知道你們有多種配置。但光是本季，Xi系統就佔了新植入量的75%。但如果展望未來兩年，你們仍然會有Xi系統以及之前眾多的系統，還有XSP系統，現在還會推出這種基於導管的感測系統。

So I wonder if you could help us understand, are we right to think about this Company as morphing these next two years? And how does supporting multiple platforms now impact the addressable markets you can serve, your ability to accelerate growth and obviously just flat out R&D spending across these platforms? I know it's a big question, but I think it's an important one.

所以我想請您幫我們理解一下，我們是否可以這樣認為，這家公司在未來兩年內會轉型？支援多個平台會如何影響您可服務的目標市場、加速成長的能力，以及顯然會如何影響您在這些平台上的研發投入？我知道這是一個很大的問題，但我認為它非常重要。

Yes, fair enough. I think as you think about SP, SP shares a lot in architecture and in underlying technology with the Xi platform. We do think it branches us in two places that are hard to reach otherwise, literally hard to reach, with conventional technologies, open surgery, conventional laparoscopy or with Xi.

是的，說得有道理。我認為，正如您所想，SP 在架構和底層技術方面與 Xi 平台有許多共同點。我們確實認為，它讓我們能夠觸及兩個傳統技術（例如開放式手術、傳統腹腔鏡手術或 Xi 平台）難以企及的領域。

So we think SP can broaden clinically what surgeons can do. I think that will start in niches, and then we'll move out into broader applications as we gain clinical experience.

所以我們認為SP可以拓展外科醫師的臨床操作範圍。我認為這會先從一些特定領域開始，然後隨著臨床經驗的積累，我們會逐步擴展到更廣泛的應用領域。

It does increase our support load a little bit in terms of complexity with regard to the SP, just because it's a new set of instruments and add-on accessories. But it's not an entirely new set of computational platform and things like that.

這確實會稍微增加我們對SP的支援工作量，因為它包含了一套新的儀器和附加配件。但它並不是一套全新的計算平台之類的東西。

As you start thinking about the catheter-based technologies, again, that's a new set of technologies. So you had framed in a two-year horizon; I would stretch that horizon out a little bit. I wouldn't anchor us there.

當你開始考慮基於導管的技術時，你會發現這是一套全新的技術。你之前設定了兩年的展望期；我會把這個展望期稍微延長一些，不要局限於此。

I do think that takes us to different places. I think it allows access to parts of the body that you may not think of surgically. It may be more around diagnostics, and I think it will open up to practitioner's ways of approaching tissue that they just haven't thought about before.

我認為這會將我們引向不同的方向。它使我們能夠接觸到一些你可能想不到的手術部位。它可能更多地與診斷相關，而且我認為它會為醫生開闢新的組織處理方式，讓他們能夠以以前從未想過的方式進行手術。

And that's why we're doing it. You have seen us increase our R&D spend, and we have been both talking about it and doing it, and part of it has been investing in these technologies. I think it matters.

這就是我們這樣做的原因。你們已經看到我們增加了研發投入，我們一直在談論這件事，也一直在付諸行動，其中一部分就是對這些技術的投資。我認為這很重要。

I think as people look -- as we look out from the bottom of your feet to the top of your head and look for opportunities to get better outcomes, we think there are a variety of technologies. From access technologies, to imaging technologies, to computational technologies that can really make a difference, and we're putting our money where our mouth is.

我認為，當我們從腳底到頭頂審視自身，尋找提升生活品質的機會時，我們會發現有很多科技可以真正帶來改變。從無障礙技術到成像技術，再到計算技術，我們都在用實際行動實踐這項承諾。

Okay, thanks, Gary. And, Marshall, the Company has always been hesitant to talk about margins on a go-forward basis. Obviously margins this year is a huge part of the story, and they've been, frankly, kind of extraordinary.

好的，謝謝，加里。還有，馬歇爾，公司一直不願就未來的利潤率發表意見。當然，今年的利潤率是其中非常重要的一部分，坦白說，今年的利潤率相當出色。

So as you head into 2017 just on a lot of the spending comments you've made, I don't think it's realistic for investors to expect 200 basis points of margin expansion in 2017. Based on your comments on spending and what you're going to have to do to support these platforms, how should we calibrate our thinking next year between an extraordinary 2016 expansion and a more moderate 2015 margin expansion? Should we be thinking about something between those two poles as more appropriate than what we're seeing this year which seems very outsized?

鑑於您先前對支出的諸多表態，我認為投資人期望2017年利潤率成長200個基點並不現實。基於您對支出的論述以及為支持這些平台所需採取的措施，我們明年應該如何權衡2016年驚人的利潤率增長和2015年較為溫和的利潤率增長？我們是否應該考慮介於兩者之間的某種情況，而不是像今年這樣看似過於強勁的成長？

Clearly, we'll give you guidance in January on what 2017 is going to look like. But some of the variables that can occur obviously have to do with product mix. And as you introduce new products, new products have, by their nature, lower margins than existing products.

顯然，我們會在1月向您提供2017年的發展展望。但一些可能出現的變數顯然與產品組合有關。而新產品的推出，其利潤率自然會低於現有產品。

And so if there were, as we introduced stapling for example, we saw a decline in margin initially. As we improve the manufacturability and efficiency of the manufacturing processes, we see improvements in margins.

例如，當我們引入裝訂流程時，最初利潤率確實有所下降。但隨著我們提高製造流程的可製造性和效率，利潤率也隨之提高。

So I'm not going to predict what we are going to do next year. I would just say that there are a lot of moving parts. Mix geographically also has an impact. Mix between systems and instruments and accessories has an impact.

所以我不會預測我們明年會做什麼。我只能說，有很多變數。地域分佈會產生影響。系統、儀器和配件的組合也會產生影響。

There's just a lot of variables that go into it. I think what you've seen this last year is though is outstanding performance by our manufacturing group to reduce the cost of newer products that were lower margin year ago.

這其中涉及很多變數。但我認為，在過去一年裡，我們製造團隊表現出色，成功降低了以往利潤率較低的新產品的成本。

Okay. And then just, Gary, just really quickly lastly. On the ex-US business on systems, I think the commentary on Brazil and China, those seem very short term in nature.

好的。最後，加里，就簡單說一句。關於美國以外的系統性業務，我認為對巴西和中國的評論，似乎都帶有非常短期的色彩。

Eventually those tenders will get raised. But in terms of the European business, did you see any impact from Brexit, or do you just think this is lumpiness that always occurs generally in your business? Thank you.

最終這些招標都會進行。但就歐洲業務而言，您是否看到英國脫歐對其產生任何影響？或者您認為這只是貴公司業務中一直存在的波動？謝謝。

I think the dynamics in the UK in particular, it's hard for us to segregate what is Brexit and what isn't. The capital acquisition pipelines are pretty long relative to these things, and it's been clear that in the UK that they're, NHS anyway, that NHS England has been looking at how to spend their money and trying to cover budget shortfalls. So there's been pressure there for some time, Brexit likely doesn't help.

我認為英國的情況尤其複雜，我們很難區分哪些是脫歐的影響，哪些不是。相對於這些因素而言，資本收購計畫的周期相當長，而且很明顯，在英國，至少英格蘭國民醫療服務體系（NHS England）一直在考慮如何使用資金，並試圖彌補預算缺口。因此，一段時間以來，NHS一直面臨壓力，而脫歐可能加劇了這種壓力。

With regard to Europe more broadly, it really is varying country by country. Some places we see reasonable growth and supports, other countries have been a little bit more of a struggle. The response to that really has been to increase local presence, increase local data generation and be in close contact with government payers and private payers.

就整個歐洲而言，情況確實因國家而異。有些地方發展勢頭良好，獲得了良好的支持，而有些國家則面臨更多挑戰。因應之策主要是加強在地化佈局，增加在地資料收集，並與政府和私人支付者保持密切聯繫。

Okay. Thank you very much.

好的，非常感謝。

Tycho Peterson, JPMorgan.

泰科·彼得森，摩根大通。

Thanks. Actually, I wanted to follow up on Dave's question earlier on margins. If we think about the Xi experience and the impact that had on gross margins as we think forward to SP, is that a fair proxy in terms of the magnitude of the impact on the gross margins when that does roll out?

謝謝。實際上，我想就Dave之前提出的關於毛利率的問題做個後續討論。如果我們回顧Xi的經驗及其對毛利率的影響，再展望SP的未來，這是否可以作為SP正式推出時毛利率受影響程度的合理參考？

We're not at the stage where we've introduced the product and we're manufacturing them in bulk. But I think it's fair to say that SP's margins will be lower than our existing product portfolio, and we will work on it and over time to try to reduce those costs.

我們目前還沒有達到產品上市和大量生產的階段。但可以肯定的是，SP產品的利潤率會低於我們現有的產品組合，我們會努力逐步降低成本。

But in terms of magnitude, Tycho, you look at the Xi, that was our next generation multi-port system and it quickly took off to a very high proportion of the sales. What we're talking about with SP is a more controlled type of launch lower overall quantity. So just based on magnitude, it's probably not going to have as big an impact on the overall margin.

但就規模而言，Tycho，看看我們的下一代多端口系統Xi，它迅速佔據了非常高的銷售份額。而SP的推出方式則更為可控，整體銷量也更低。因此，僅從規模來看，它可能不會對整體利潤率產生那麼大的影響。

Understood. And then can you comment on trade-ins? I know you called it out in the footnotes. You had 58 in the US, highest number ever. Was this a one-time thing where you went and scrubbed systems in the field?

明白了。那麼您能談談以舊換新嗎？我知道您在腳註裡提到了。您在美國完成了58筆交易，這是有史以​​來的最高紀錄。這是一次性的，您去現場徹底清理了系統嗎？

There was a footnote in our data tables that we referenced in the beginning. During the third quarter, we actually implemented a new system and some processes for tracking our da Vinci systems out in the field.

我們在數據表中有一個腳註，我們在開頭提到過。第三季度，我們實際實施了一套新的系統和一些流程，用於追蹤我們在現場使用的達文西手術系統。

As part of the transition process, we performed a verification audit of our installed base records which identified 43 system, mostly older standard and S models which had been retired. So we went and removed those retired systems from our installed base during the quarter. So I think the trade-out number was 33 and then most of the rest here was just this adjustment we made to the base. So the trade-ins were pretty in line with previous periods.

作為過渡流程的一部分，我們對已安裝系統的記錄進行了核查，發現其中有 43 套系統已停用，主要是較舊的標準型和 S 型。因此，我們在本季度將這些已停用的系統從已安裝系統中移除。所以，我認為以舊換新的系統數量為 33 套，其餘大部分都是我們對系統基數的調整。因此，以舊換新的系統數量與前幾季基本一致。

Okay. Last one I'll just ask the obligatory capital deployment question because you're over $4.5 billion now. Obviously you're stepping up your own spending, but could you talk a little bit about capital deployment at this point?

好的。最後一個問題，我問一個關於資本部署的例行問題，因為你們目前的資產已經超過45億美元了。顯然，你們正在加大支出，但能否談談目前階段的資本部署？

Yes, sure. I think we think about capital deployment consistent with how we've talked about it before. We're in a period where there is now -- we're facing future competition, and we want to have the ability to expand and to deal with the competition. We're also going to see additional opportunities as companies get into this game for acquisition of technologies that may expand our marketplace and enhance our products.

當然。我認為我們對資本部署的考量與先前討論的方式一致。我們正處於一個充滿競爭的時期——我們面臨未來的競爭，我們希望有能力擴張並應對競爭。隨著更多公司進入這個領域，我們也將看到更多收購技術的機會，這些技術可能會擴大我們的市場並增強我們的產品。

And those technologies, it's nice to do tuck-ins and small licensing arrangements that we've done in the past and we'll try to do those. But it may the that we have to pay a greater dollar to get some of that technology in the future, so we want to have money for those things. Beyond that, to the extent that we have the right opportunity to buy back stock and return money to shareholders, we will take that opportunity. But we will do that opportunistically as we have in the past.

對於這些技術，我們過去曾進行過一些小規模的收購和授權協議，現在依然會繼續這樣做。但未來我們可能需要支付更高的價格才能獲得某些技術，所以我們需要為此預留資金。此外，如果出現合適的股票回購機會，我們會抓住機會回購股票並返還給股東。但我們會像過去一樣，根據市場情況靈活運用這些措施。

Okay, thank you.

好的，謝謝。

Ben Andrew, William Blair.

本安德魯，威廉布萊爾。

Good afternoon. Thanks for taking the questions.

午安.感謝您回答問題。

Gary, looking at the Fosun relationship, does this give you a demonstrably closer relationship over in China that may influence the tender process? And as a second piece to that, from a regulatory perspective, what time frames would you be looking at to get something through once you finish development and you've done some human testing to approval? Is it quicker there, or is it similar to the US?

Gary，就復星集團的關係而言，這是否意味著你們在中國擁有更緊密的聯繫，從而可能影響招標流程？其次，從監管角度來看，完成研發和人體試驗後，從研發到獲得批准，你們預計需要多長時間？在中國更快，還是與美國類似？

On the first question, I think in the long term I think it deepens our relationships with customers and regulators in China. I don't -- I wouldn't assume that it's a magic switch in the near term.

關於第一個問題，我認為從長遠來看，這有助於加深我們與中國客戶和監管機構的關係。但我並不認為這會在短期內起到神奇的效果。

With regard to regulatory approvals for various products in China, typically in our past, it has been a little bit longer process than it has in the US. What that looks like going forward, in particular for the new products we're talking about, I can't speak to at this time. We just don't have enough information on it.

關於中國各類產品的監管審批流程，以往的經驗表明，其耗時通常比美國要長一些。至於未來，特別是我們正在討論的新產品，目前我無法給出確切的答案。我們掌握的資訊還不夠。

Okay. And then you talked about international procedures being up about 25%, which was a strong number. But I thought I heard you say that parts of Europe were weaker than a year ago.

好的。您剛才提到國際手術量增加了約25%，這是一個相當可觀的數字。但我好像聽到您說，歐洲部分地區的手術量比一年前有所下降。

Was there a particular geographic pattern there? Was China demonstrably or that plus the ROW placements got my attention relative to some emerging opportunities overseas?

是否存在某種特定的地域分佈模式？是中國市場明顯佔據主導地位，還是中國市場加上其他地區的市場佈局，讓我注意到了一些海外新興機會？

Hey, Ben, this is Patrick. In certain international markets, we're pretty deeply penetrated in urology. And where you've seen those penetration rates increase over time the rate of growth has decelerated, and emerging procedures things like colorectal and gynecologic oncology are still fairly small. So countries like the Nordic countries, places like the UK where we're pretty deep you see those growth rates slow.

嗨，本，我是派崔克。在某些國際市場，我們在泌尿科領域的滲透率相當高。雖然這些領域的滲透率隨著時間推移而提高，但成長速度卻放緩，而像大腸直腸癌和婦科腫瘤等新興手術的市場規模仍然相對較小。因此，像北歐國家、英國這樣我們滲透率很高的地區，其成長速度也會放緩。

Okay. And then this may be for Patrick as well, but a competitor this morning talked about seeing some of the general surgery cases and calling out hernia being down something like 10%. Give us your state of the state in terms of where you are in hernia and the trajectory of adoption relative to some of the historical fast adopting procedures if you would?

好的。這個問題可能也問到了帕特里克，今天早上有一位競爭對手提到，他看到一些普通外科手術病例，說疝氣手術量下降了大約10%。請您談談您所在州的疝氣手術現狀，以及與一些歷史上快速普及的手術相比，疝氣手術的普及趨勢如何？

Hernia continues to be encouraging. The rates of both procedure adoption, surgeon retention and utilization within the existing surgeon population as they continue to do more procedures has been a strong point in the way in which the technology has been adopted.

疝氣手術的發展動能依然令人鼓舞。無論是手術方式的普及率、外科醫師的留任率，或是現有外科醫師群體中手術量不斷增加，都充分體現了這項技術的良好應用前景。

Hernia repair is not one thing, so there's a variety of patient subsets within, a variety of different physician perspectives around the value that our technology can bring in the procedure. And so it's probably not quite like DVP in terms of the way you would think of it as being adopted, maybe a little more like benign hysterectomy given the alternative therapies and the heterogeneous landscape out there in terms of how they address these patients.

疝氣修補術並非單一手術，其中包含多種患者群體，醫生們對於我們這項技術在該手術中能帶來的價值也持有不同的看法。因此，就其應用方式而言，它可能不像傳統腹腔鏡疝氣修補術（DVP）那樣普及，考慮到其他療法的存在以及目前針對這類患者的治療方案的多樣性，它或許更類似於良性子宮切除術。

Okay. And then the last question for me is the question is around the INA, the revenue beat there with the procedures being roughly in line with our target was quite noticeable. And, Marshall, you did go through some of the math there. But was other than stapling and vessel sealing, was there anything in particular in there that caught your attention relative to mix?

好的。最後一個問題是關於INA的，收入超出預期，手術量基本上符合我們的目標，這一點非常明顯。馬歇爾，你確實做了一些計算。除了縫合和血管封閉之外，還有其他方面引起了你的注意嗎？

Just giving a little historical perspective, if you look at prior to Q2 of 2016, our INA revenue per procedure has been running within a really tight narrow range $1,830 to $1,840 per procedure. You probably recall last quarter it actually dropped down to $1,810, and we talked about timing of orders being the main factor here.

簡單回顧一下歷史數據，在2016年第二季之前，我們的INA手術單次收入一直穩定在1830美元到1840美元之間。您可能還記得，上個季度單次收入實際上下降到了1810美元，我們當時討論過訂單時機是造成這一現象的主要原因。

So as expected here in Q3, we saw an orders rebound to offset Q2. And if you take the average of Q2 and Q3, you're right back at the $1,840. It's in line with those trends over the past couple of years.

正如預期，第三季訂單量反彈，抵消了第二季的下滑。如果取第二季和第三季的平均值，剛好回到1840美元。這與過去幾年的趨勢一致。

As we said though, we continue to see increasing utilization of the advanced instruments, including the stapler and vessel sealer. And moving forward as we anticipate continued growth in the procedure volumes in colorectal and thoracic surgery, areas where these products are more widely used, we would anticipate a slightly higher contribution to revenue per procedure on an organic consumption model, if you will.

正如我們之前所說，我們持續看到包括吻合器和血管封閉器在內的先進器械的使用量不斷增長。展望未來，我們預期大腸直腸外科和胸腔外科手術量將持續成長，而這些產品在這些領域應用更為廣泛，因此我們預計，按照自然消費模式計算，每例手術的收入貢獻將略有提高。

But it is important to remember that a variety of factors impact revenue per procedure, including the type of procedure performed, the efficiency of use and optimization, use of advanced instruments, stocking orders, timing and distributors. There's a lot of factors here. So as a result, INA it can be lumpy and future trends can be difficult to forecast in the end.

但要注意的是，影響每次手術收入的因素很多，包括手術類型、使用效率和優化程度、先進儀器的使用、庫存訂單、手術時間以及分銷商等。影響因素眾多。因此，INA 的收入可能波動較大，未來趨勢最終難以預測。

Thank you very much.

非常感謝。

Ahmed Hassan, Citi.

艾哈邁德·哈桑，花旗銀行。

Good afternoon, guys. Let me maybe start with prostate, just thinking through the trend this year just going from low double-digit growth in the first quarter for DVP all the way down the low single digits it sounds like for this quarter. It seems like a pretty fast change in what otherwise would seem to me to be something that would be a slower trendline. Any more color you can add as to what's happening now, why it's happening, and maybe more importantly just the confidence you guys have that this quarter march that bottom and that incidents rate growth is your right rate of growth for prostate?

下午好，各位。我想先談談前列腺癌。我一直在思考今年的趨勢，第一季DVP的成長率還維持在兩位數左右，而到了本季似乎已經跌至個位數。這似乎與我印像中較為緩慢的趨勢線相比，變化過於迅速。各位能否進一步解釋一下目前的情況，以及造成這種變化的原因？更重要的是，你們對本季能否觸底反彈以及攝護腺癌發生率成長率是否符合預期有多大信心？

Hey, Ahmed. As you know, predicting how the patient treatment trends across prostate cancer in a mature procedure like DVP is difficult. And we have highlighted for a period of time the rates of growths that we've seen were not rates of growth that we thought were consistent with the rate of diagnoses.

嗨，艾哈邁德。如你所知，預測像DVP這樣成熟的手術方式下前列腺癌患者的治療趨勢非常困難。而且我們之前也注意到，我們觀察到的腫瘤生長速度與診斷率並不一致。

It's hard to say in the quarter or the rate at which we've seen growth change over the course of this year. The specifics behind it, that data typically comes to us years down the road. But we feel about that what we saw in the quarter was probably more consistent with the rate of diagnoses than perhaps what we've seen over the past and four quarters.

很難說本季或今年以來的成長速度發生了怎樣的變化。具體數據通常需要幾年時間才能統計出來。但我們認為，本季的數據可能比過去四個季度的數據更能反映出確診病例的成長速度。

Okay. Let me move to gynecology. It sounds like there things are still like you described in the first half of the year, maybe slightly better than what we've seen in the past. And I wanted to -- I don't think we've asked this in a while, so I'll just throw this question out just as one possible avenue.

好的。那我來說說婦科方面。聽起來情況和你上半年的描述差不多，可能比我們過去看到的略好。我想——我想我們好久沒問這個問題了，所以我就拋出這個問題，作為一個可能的切入點。

Just thinking about outpatient centers, ambulatory surgery centers, is there -- to what extent or is there any increase in the success that you're having in being able to place da Vincis in outpatient centers? Is that becoming more of a focus for you at all? And is that at all a part of maybe the slightly better rates of growth we are seeing in gynecology in the US?

僅就門診中心、日間手術中心而言，您在門診中心部署達文西手術系統方面是否取得了更大的成功？這是否已成為您工作的重點？這是否與美國婦科領域略微加快的成長速度有關？

I think you are connecting two things I'm not quite sure I'd connect. So the relative health of the gynecology business seems to me to be driven by a few factors, among them concentration of patients into higher volume surgeons and higher volume centers. Separately there is a trend toward more outpatient work.

我認為你把兩件事聯繫起來了，但我不太確定它們之間有什麼聯繫。婦科產業的相對健康發展在我看來是由幾個因素驅動的，其中包括患者集中到手術量較大的外科醫生和醫療中心。此外，門診手術量增加也是一個趨勢。

We do see utilization of our systems in outpatient environments that tends to be more in existing integrated delivery networks, hospital loaned outpatient departments as part of our integrated plan. It's not something I would call out as a major trend at this point. I'm not sure that I would quite link it to gyn. It's possible but I think there are a lot of factors there that sorting them it's not possible yet.

我們確實看到一些門診環境也在使用我們的系統，尤其是在現有的整合式醫療服務網絡中，以及醫院借調的門診部，這些都是我們整合計畫的一部分。目前來看，這還算不上什麼主要趨勢。我也不確定這是否與婦科直接相關。雖然有可能，但其中涉及諸多因素，目前還無法一一釐清。

But if you look at gyn overall and you look at the history of benign hysterectomy adoption, the entrance of da Vinci surgery into benign hysterectomy, has enabled the majority of patients to now be treated on an outpatient basis. So when minimally invasive surgery is adopted with a technology, it will enable hospitals to manage these patients in a more outpatient-oriented way.

但從婦科整體來看，回顧良性子宮切除術的發展歷程，達文西手術系統的引進使得大多數患者能夠在門診接受治療。因此，當微創手術與相關技術結合應用時，醫院就能以更注重門診治療的方式管理這些病人。

Just one last question for me on the systems side. Just thinking through not just the fourth quarter but just a little bit longer term, maybe call it 2017 if you want, but thinking about the installed base. It's been really consistently growing now 10% a year.

關於系統方面，我還有一個問題。我不僅考慮第四季度，還考慮更長遠的未來，例如2017年，主要考慮的是已安裝系統的數量。目前，已安裝系統的數量一直維持著每年10%的穩定成長。

Almost every quarter it seems like it grows about then on that 10% rate on an annual basis. Can you maybe just talk through the key drivers and maybe pressure points as we think about that number and the sustainability of that 10% growth in the installed base growth figure as we think through the next year or two?

幾乎每個季度，這個數字似乎都以每年10%的速度成長。您能否談談推動這一數字成長的關鍵因素和潛在壓力點，以及在未來一兩年內，這種10%的裝置容量成長率能否持續？

The way I think about it kind of puts and takes. So the major factor is anticipated procedure growth by the customer. Customers are making capital placements based on what they think will happen in future procedure trends.

我的理解是，這有點像是投入與回報的關係。所以，主要因素是客戶對未來手術量成長的預期。客戶會根據他們對未來手術量趨勢的預測來進行資金配置。

So that is the biggest driver, and where they see growth I think that they move forward. The places where that can be a little bit different or disconnected is in a very early market where you are just getting started.

所以這是最大的驅動力，我認為他們會在看到增長點的地方前進。但在剛起步的早期市場，情況可能會有所不同或脫節。

So a new reimbursement clearance or a new quota or a new procedure clearance doesn't follow the more mature trend. So those are the two things that are rolling around. I think the biggest one for us is customer belief and utilization for future procedures is the best predictor of capital.

因此，新的報銷審批、新的配額或新的流程審批並不符合較成熟的趨勢。目前主要關注這兩方面。我認為對我們來說，最重要的因素是客戶信任度和未來流程的使用率，這才是預測資金的最佳指標。

Thanks, guys.

謝謝各位。

Rick Wise, Stifel Nicolaus.

Rick Wise，Stifel Nicolaus。

Afternoon, everybody. Hello, Gary. Maybe just coming back to Fosun briefly, obviously you have alluded several times to this notion of building out the ecosystem and how important and valuable it is to Intuitive.

大家下午好。你好，Gary。我想簡單回到復星的話題，你顯然多次提到建構生態系這個概念，以及它對Intuitive的重要性和價值。

Are there other similar opportunities to Fosun, whether it be geographic or technology, or is this a direction we should expect Intuitive to push looking for other technologies to bring in to the ecosystem? Is that the right way to think about it?

是否存在其他與復星類似的機遇，無論是在地理上或技術上？或者，這是否是Intuitive未來會努力的方向，尋找其他技術引進其生態系統？這種思考方式是否正確？

I think the idea that if there are technologies or other assets that we can bring that we think will increase the value of a robotic surgery program or a minimally invasive surgery program based on the computation to one of our customers. Is that an opportunity for us, yes?

我認為，如果我們能提供一些技術或其他資源，我們認為這些技術或其他資源能夠提升基於計算的機器人手術專案或微創手術專案對客戶的價值，那麼這對我們來說就是一個機會，對嗎？

They tend to develop in time. The underlying catheter-based technologies that we are talking about now, as you know having followed us for some time, were really first acquired by us years ago.

它們往往會隨著時間的推移而發展。正如您關注我們一段時間以來所知，我們現在所討論的基於導管的基礎技術，實際上是我們多年前就已獲得的。

So the answer to that is yes. We are out looking, Fosun has been a good partner. They have both a relationship with us through Chindex, but they also understand the healthcare space extremely well in multiple dimensions. And so short answer to that is we have been doing it, and expect to continue to do it.

所以答案是肯定的。我們一直在尋找合適的合作夥伴，復星集團一直是很好的合作夥伴。他們不僅透過Chindex與我們建立了合作關係，而且對醫療保健領域的各個方面都非常了解。簡而言之，我們一直在這樣做，並且希望繼續這樣做。

Thanks. A couple more. Just a general question about the general surgery adoption, particularly in the US.

謝謝。還有幾個問題。只是想問一下關於普通外科手術普及情況，尤其是在美國的情況。

Maybe just can you talk a little bit more about where we are just in terms of that adoption process? Are these still earnings -- or early innings rather?

您能否再詳細談談我們目前在產品推廣上所處的階段？這些還算是獲利階段嗎？還是說還處於早期階段？

And maybe particularly on colorectal, how do you accelerate colorectal adoption? Do we need more clinical data? Can you talk through some of those issues?

尤其是在大腸直腸癌領域，如何加速大腸直腸癌治療的普及？我們需要更多臨床數據嗎？您能否談談這些問題？

As we've said in the past, adoption is really a per procedure and per procedure is really segmented. So for example, colorectal is probably really four or five underlying procedures that are a little bit different. And adoption goes quickly when there is a large value, a distinct value for the procedure relative to alternatives, and when the procedure is pretty well-concentrated in the hands of well-trained surgeons.

正如我們之前所說，技術的普及實際上是按手術類型進行的，而每種手術類型又細分為多個部分。例如，結直腸手術可能實際上包含四到五種略有不同的特定手術。當某種手術相對於其他替代方案具有顯著價值，而這種價值主要集中在訓練有素的外科醫生手中時，技術的普及速度就會很快。

So take colorectal and separate it a little bit. In the case of rectal cancer, that is a complex set of procedures. Oncologic, of course in nature, has been growing steadily. Not a super rapid rise relative to some prior adoptions, but a steady adoption for us. And data collection has been occurring, data publication has been occurring, and we are doing okay there.

所以，我們以大腸癌為例，稍微細分一下。就直腸癌而言，這是一系列複雜的治療程序。腫瘤學領域，當然，一直在穩步發展。雖然相對於先前的一些應用領域而言，成長速度不算特別快，但對我們來說，這是一個穩定成長的過程。數據收集和數據發布一直在進行，我們在這方面做得很好。

I think in other parts of colon, sometimes it is for benign, sometimes it is oncology, those are typically done by different surgeons and so they adopt at a little bit different rates. And you look at hernia, again, it's sub segmented. Ventral hernia versus inguinal and sub segments within inguinal.

我認為在結腸的其他部位，有時是良性病變，有時是腫瘤，這些手術通常由不同的外科醫生進行，因此他們的手術率略有不同。再看看疝，它也是細分的。腹壁疝氣與腹股溝疝，以及腹股溝疝氣內部的亞段。

So we look at it, ventral hernia and inguinal hernia as we define the available markets for procedures for which we bring value have adopting pretty nicely relative to past trends. Rectal has been on a slower adoption, but a steady one, and colon is in the middle.

因此，我們觀察發現，腹壁疝氣和腹股溝疝，作為我們能夠提供價值的手術項目，其市場接受度相對於以往趨勢而言相當不錯。直腸疝氣的接受度增長速度較慢，但一直保持穩定，而結腸疝氣則介於兩者之間。

Just last for me on the procedure side. Obviously a lot of moving pieces here. Urology, maybe now a little more slower growth now the -- rebounded gynecology recovering. General surgery continuing to grow dramatically.

就手術方面而言，我最後要說的就是這個。顯然，這裡面有很多變數。泌尿外科的成長速度可能比之前慢了一些——婦科正在復甦。普通外科則持續保持著強勁的成長動能。

When we roll up that math with what we are seeing internationally, should we feel reasonably optimistic that something like mid-teens procedure growth, again with some variation. Is that the right sustainable growth rate from here given the growing installed base, given the geographic penetration and given the continuing evolution of Intuitive's technology?

當我們把這些數據與我們在國際上看到的情況結合起來考慮時，我們是否應該對15%左右的手術量增長率（當然會有一些波動）保持合理的樂觀態度？考慮到不斷增長的裝機量、地理覆蓋範圍以及Intuitive技術的持續發展，這是否是目前可持續的合適成長率？

Thanks, Gary.

謝謝你，加里。

Yes. We're not ready to give our 2017 forecast yet, and we'll see how we close here in the fourth quarter and roll up our estimates and answer that very question in our next call in January.

是的。我們目前還無法給出2017年的預測，我們會看看第四季末的情況，總結我們的預測，並在1月的電話會議上回答這個問題。

Thank you.

謝謝。

Larry Biegelsen, Wells Fargo.

拉里·比格爾森，富國銀行。

Good afternoon, thanks for taking the question. I am new to these calls, so just maybe a couple basic ones here.

下午好，感謝您回答我的問題。我對這類電話會議不太熟悉，所以可能只能問幾個基本問題。

So SG&A as a percent of sales was relatively low, I apologize if I missed it. Any reason for SG&A to be relatively low this quarter? And the R&D spending of about 7% of sales, is that -- it sounds like -- is that a good rate to use going forward? And I had a couple of follow-ups.

所以，本季銷售、管理及行政費用佔銷售額的比例相對較低，如果我漏掉了什麼，請見諒。請問本季銷售、管理及行政費用相對較低的原因為何？研發支出約佔銷售額的7%，這個比例──聽起來──未來是否該繼續沿用？我還有幾個後續問題。

There's going to be variability quarter to quarter, lumpiness if you will, between SG&A and R&D. We've talked a lot about our R&D investments, Gary went through them on the SG&A side. I think we are investigating a little heavier disproportionally for international to support the earlier phase growth there.

銷售、管理及行政費用 (SG&A) 和研發費用之間會存在季度波動，或者說存在一定的波動性。我們已經多次討論研發投資，Gary 也詳細講解了 SG&A 部分的相關內容。我認為，為了支持國際業務早期階段的成長，我們正在加大對國際市場的投入。

So you look at it overall, we are within our guidance range. We refined our full-year guidance to that 13% to 14%. So again, there will be some quarter variability. But I think we are tracking to the overall plan.

總的來說，我們目前處於預期範圍內。我們將全年預期調整為13%至14%。因此，每個季度都會有一些波動。但我認為我們正朝著總體計劃穩步前進。

Larry, given the lumpiness in some of our capital revenue from period to period, we typically talk about operating expenses in terms of growth rates, which [Pat] will walk you through.

Larry，鑑於我們某些資本收入在不同時期存在波動，我們通常會用增長率來討論營運費用，[Pat]會為你詳細講解。

Got it, thanks. And then when we think about the pipeline and potential launches of new products and functionality, should we be expecting any meaningful product introductions later either later this year or in 2017 excluding SP?

明白了，謝謝。那麼，當我們考慮新產品和功能的未來發展方向和潛在發布計劃時，除了SP之外，我們是否應該期待今年稍後或2017年會有任何重要的產品推出？

We've been launching a number of instruments and accessories, various things in various markets. We tend to tell you when they come out. We have not tagged a launch date either for SP or other major systems at this time.

我們一直在各個市場推出一系列儀器和配件，產品種類繁多。通常情況下，我們會在產品上市時通知大家。目前，我們尚未確定SP或其他主要係統的上市日期。

All right. And then lastly for me, Gary, you talked about the growth you've seen in hernia and you talked about ventral and inguinal. Are you seeing anything different in terms of the penetration or ramp in ventral versus inguinal or are both of them equally strong? Thanks for taking the questions.

好的。最後一個問題，Gary，你談到了你觀察到的疝氣生長情況，也談到了腹壁疝氣和腹股溝疝氣。你認為腹壁疝氣和腹股溝疝氣在穿透力或傾斜度上有什麼不同嗎？還是說兩者強度相同？謝謝你回答這些問題。

It's a good question. I think the dynamics are little bit different in both in terms of procedure complexity and a little bit of practice patterns, so they don't track exactly the same. Having said that, I don't think there's anything about adoption that I'd call out strongly at this time.

這是一個很好的問題。我認為，無論是在流程複雜性還是實踐模式方面，兩者的動態都略有不同，因此它們的趨勢並不完全相同。話雖如此，就目前而言，我認為在採納方面沒有什麼特別值得特別強調的。

I think both of them are moving through that first set of adopters, generating additional data. We're seeing more data now, generally supportive, it looks pretty good.

我認為它們都正在經歷首批用戶階段，從而產生更多數據。我們現在看到的數據更多了，整體來說都是支持性的，看起來相當不錯。

I think that technique refinement and data generation is, it's what the next round of surgeons rely upon to evaluate and so we're seeing that transition right now really in both those hernia [deleans].

我認為技術改進和數據生成是下一代外科醫生賴以評估的依據，因此我們現在確實在這兩種疝氣手術中看到了這種轉變。

We will just take one more question for one more caller, please.

我們再接受一位聽眾的最後一個問題。

Brandon Henry, RBC Capital Markets.

Brandon Henry，加拿大皇家銀行資本市場。

Thanks for taking my question.

謝謝您回答我的問題。

So Intuitive again posted strong growth for the operating margins this quarter. Can you discuss some of the product and cost initiatives that are driving these better margins, and in what inning you are in with some of these cost initiatives?

Intuitive本季再次實現了強勁的營業利潤率成長。您能否談談推動利潤率提升的產品和成本控制舉措，以及這些成本控制舉措目前進展到什麼階段？

And then separately, the Company's headcount has increased meaningfully over the last couple quarters. Can you discuss where you are making the investments in headcount, and then how much of that increase in headcount can be attributed to the Fosun JV versus some other initiatives? And then I have a follow-up.

此外，公司近幾季的員工人數也顯著增加。能否談談公司在員工人數上的投入，以及這些成長中有多少是由於復星合資企業，又有多少是由於其他措施？我還有一個後續問題。

That was to questions already, and I gave you one. I think I will choose one. No, we'll go fast.

已經問了兩個問題，我給了你一個。我想我會選一個。不，我們快點。

On the first one in terms of cost reductions, it's a careful and long list of activities that goes on. So you shouldn't so much think of it as one thing as it is a routine discipline of scanning through both operating processes and manufacturing processes and parts costs, and working them down as they come.

就降低成本而言，這涉及一系列細緻而繁瑣的活動。因此，你不應該把它看作是一個單一的過程，而應該把它看作是一項常規的、需要逐一審查營運流程、製造流程和零件成本的工作，並逐一降低成本。

You do get the greatest help on those things in the first few years of a platform release, and then after that it starts getting increasingly hard. It not to say that isn't possible to do it.

在平台發布的前幾年，你確實能在這方面獲得最大的幫助，之後就會越來越難。但這並不意味著完全不可能做到。

On terms of headcount growth, it's a mixture of commercial growth, a little bit more weighted outside the US then the US. Some manufacturing growth to cover volumes of things like instruments and accessories and other things that have been increasing, as well as some design help.

就員工人數成長而言，這主要得益於商業成長，其中美國以外的成長略多於美國本土。此外，製造業的成長也推動了部分成長，以滿足儀器、配件等產品日益增長的需求，同時設計方面的人員也得到了提升。

The headcount growth as it relates to Fosun, we are not really ready to break out at this time. We have certainly made headcount investments over the last few years into the technologies that have underpinned that relationship. But I wouldn't call it out as Fosun just yet.

就復星集團而言，我們目前還沒有做好公開宣布員工人數成長的準備。過去幾年，我們確實在支撐雙方合作關係的技術方面進行了大量人員投入。但我現在還不會稱之為復星集團。

With that, I will go ahead and close the call and then we'll catch your next question on the next conference call. That was the last question.

那麼，我就結束這通通話了，我們下次電話會議再討論您的下一個問題。這是最後一個問題。

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

正如我們之前所說，雖然我們在電話會議中會專注於收入、利潤和現金流等財務指標，但我們組織的重點始終是提升價值，幫助外科醫生改善手術效果，減少手術創傷。我們創立這家公司的目的是為了突破人手的限制，讓手術成為可能。我向各位保證，我們將持續致力於推動那些真正能帶來改變的關鍵措施。

This concludes today's call. 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.

今天的電話會議到此結束。感謝您參與並支持我們這段旨在改進外科手術的非凡旅程，我們期待三個月後再次與您交流。

That does conclude your conference, you may now disconnect.

會議到此結束，您可以斷開連線了。