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，感謝你們的支持，歡迎來到 Intuitive Surgical 2016 年第三季度財報電話會議。

(Operator Instructions)

（操作員說明）

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.

提醒一下，這次會議正在錄製中。我現在想將會議轉交給投資者關係財務高級總監 Calvin Darling。請繼續。

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.

謝謝你。下午好，歡迎來到 Intuitive Surgical 第三季度收益電話會議。今天和我在一起的有我們的總裁兼首席執行官 Gary Guthart、我們的首席財務官 Marshall Mohr 和財務和銷售運營副總裁 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. 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.

在我們開始之前，我想通知您，今天電話會議中提到的評論可能被視為包含前瞻性陳述。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存在重大差異。這些風險和不確定性在公司提交給美國證券交易委員會的文件中有詳細描述，包括我們於 2016 年 2 月 2 日提交的最新 10-K 表格和 2016 年 7 月 20 日提交的 10-Q 表格。這些文件可以通過以下方式找到我們的網站或 SEC 的 EDGAR 數據庫。告誡潛在投資者不要過分依賴此類前瞻性陳述。

Please note that this conference call will be available for audio replay on our website at intuitivesurgical.com on the audio archive section under our Investor Relations page. In addition, today's press release and supplementary financial data tables have been posted to our website.

請注意，本次電話會議的音頻重播將在我們網站 intuitivesurgical.com 的投資者關係頁面下的音頻存檔部分提供。此外，今天的新聞稿和補充財務數據表已發佈到我們的網站上。

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.

今天的形式包括為您提供我們今天早些時候發布的新聞稿中描述的第三季度業績的亮點，然後是問答環節。 Gary 將介紹本季度的業務和運營亮點，Marshall 將回顧我們第三季度的財務業績，Patrick 將討論程序和臨床亮點，然後我將提供我們 2016 年的最新財務展望。最後，我們將主持一個問題- 和回答會議。

With that, I will turn it over to Gary.

有了這個，我會把它交給加里。

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，感謝您今天加入我們的電話會議。我們公司在本季度的表現穩健，客戶越來越多地採用程序，系統安置也有所增長。

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.

本季度全球程序同比增長超過 14%。增長的驅動力集中在美國普通外科手術和美國以外地區使用達芬奇手術系統的增長。在美國，腹股溝疝修補術的同比增長繼續強勁。美國結腸切除術和肺切除術也促進了穩健增長。正如我們在之前的電話會議中所說，我們預計美國成熟程序的增長率將放緩，並且在前列腺癌診斷和治療的宏觀經濟環境的推動下，美國 DVP 開始遵循這種模式。

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，本季度手術增長放緩，一些國家表現穩健，而其他國家增長放緩。我們對亞洲程序的增長感到高興，尤其是韓國和中國展示了持續的實力。 Patrick 將在稍後的電話會議中更詳細地審查程序趨勢。

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.

我們在本季度放置了 134 台達芬奇系統，高於 2015 年第三季度的 117 台。雖然我們提供一系列型號和價位，但我們最強大的型號 da Vinci Xi 再次佔新資本配置的大約四分之三。正如我們在之前的電話會議上所說，資本配置不穩定，本季度也不例外。

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.

健康的安置在美國脫穎而出，而我們歐洲地區的安置相對於一年前有所緩和。鑑於日本的報銷和中國的配額等環境限制，亞洲的資本配置尤其難以預測。亞洲的安置與前幾個季度一致。

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.

談到收入和毛利率動態，我們在本季度經歷了一些一次性順風，導致淨收入高於預期。 Marshall 將在稍後的電話會議中更詳細地向您介紹這些事件和我們的一般財務狀況。

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.

轉向我們第三季度經營業績的亮點。程序比去年第三季度增長了約 14%。我們出貨了 134 台達芬奇手術系統，高於 2015 年第三季度的 117 台。

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%.

本季度收入為 6.83 億美元，同比增長 16%。預計毛利率為 73.1%，而去年第三季度為 69.3%。儀器和附件收入增加到 3.48 億美元，增長 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.

本季度經常性總收入為 4.78 億美元，佔總收入的 70%。本季度我們的預估營業利潤為 3.08 億美元，比去年第三季度增長 28%。預計淨收入為 2.46 億美元，比 2015 年第三季度增長 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上與您討論的那樣，隨著我們業務的加強，我們增加了中長期投資以創造我們的下一代產品和服務。我們一直在增加這些投資，因為我們相信存在大量機會來實現更好的結果並在全球範圍內擴大對我們技術的訪問。

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.

我們繼續增強功能並擴大對我們的 Xi 儀器、配件和成像產品套件的訪問。在第三季度，我們增加了向多個國家運送 Xi 單點、Xi 30 毫米訂書機和 Firefly 的能力。此外，手術台運動吸收和性能符合我們的預期。我們將繼續投資擴展和改進我們的 Xi 平台的基礎儀器、吻合和血管密封產品。

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.

新系統平台繼續取得良好進展。我們的達芬奇單一端口正在推進其內部臨床評估和預計本季度晚些時候進行的人體臨床試驗的準備工作。正如我們在之前的電話會議上所討論的那樣，我們計劃將首批市場包括頭頸外科、泌尿外科和結直腸外科。 SP 是一種平台技術，允許以出色的 3D 視覺高度靈活地進入狹窄的手術空間。外科醫生在內部評估後的評論表明對該平台的臨床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.

在本季度，我們還宣布與復星醫藥成立合資企業，復星醫藥是我們目前在中國的達芬奇合作夥伴的所有者。該合資企業的首要目標是與 ISI 和復星合作，生產滿足肺癌診斷和經濟高效治療的迫切需求的產品。世界上最常見的癌症之一，早期發現和治療非常重要。

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.

支撐該系統的技術基於計算機控制的導管、先進的圖像處理和精密的傳感技術。它包含了 Intuitive 在過去幾年中開發、擁有或許可的大量專有知識產權。該系統處於我們人類臨床經驗的早期階段，最終的許可和啟動目標尚未確定。也就是說，該技術的原始能力是引人注目的。隨著時間的推移，它有可能成為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。迄今為止，我們已經增加了大約 400 名員工，並且隨著這些平台通過設計、驗證、數據收集和早期啟動，我們預計未來幾個季度的固定投資和支出會有所增加。

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.

在我們結束 2016 年之際，我們重點關注以下內容。首先，擴大達芬奇在普外科和胸外科的應用，尤其是結直腸外科和疝修補術。其次，推進我們的生態系統，包括新的許可、額外的臨床和經濟驗證、培訓中心和我們產品供應的擴展。第三，提升我們在歐洲和亞洲市場的組織能力。最後，協助我們的客戶努力最大化其項目的綜合價值。

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

我現在將電話轉給 Marshall，他將審查財務亮點。

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.

謝謝你，加里。我將在非 GAAP 或備考基礎上描述我們的結果，其中不包括應計索賠、基於股票的補償和所購買 IP 的攤銷中的特定法律解決方案。我們提供備考信息是因為我們相信業務趨勢和經營成果在備考基礎上更容易理解。我還將在稍後的腳本中總結我們的 GAAP 結果。我們已經在我們的網站上發布了備考結果與 GAAP 結果的對賬，以免造成混淆。

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年第三季度營收為6.83億美元，較2015年第三季度的5.9億美元增長16%，較第二季度的6.7億美元營收增長2%。 2016 年第三季度的程序與 2015 年第三季度相比增長了 14%，與上一季度相比下降了 1%。手術相對於去年的增長是由美國的普通外科和全球的泌尿外科推動的。與上一季度相比的下降主要反映了季節性。

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.

收入亮點如下。器械及配件收入為 3.48 億美元，與去年相比增長 17%，與 2016 年第二季度相比增長 3%。器械和配件收入的增長通常反映了程序增長以及縫合和血管密封產品銷售額的增長。

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.

每個程序實現的儀器和附件收入（包括初始庫存訂單）約為每個程序 1,870 美元，而去年為 1,840 美元，上季度為 1,810 美元。相對於 2015 年第三季度和上一季度的增長反映了吻合器和血管密封產品的銷售額增長。與 2016 年第二季度相比的增長也反映了客戶購買模式的影響。

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.

系統收入為 2.05 億美元，較 2015 年第三季度增長 18%，較上一季度增長 1%。同比和環比增長反映了更高的系統安置和更高的與租賃買斷相關的收入，部分被較低的平均係統售價所抵消。

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.

我們在本季度從租賃買斷中獲得了大約 1300 萬美元的收入，而 2015 年第三季度為 300 萬美元，上一季度為 1300 萬美元。雖然租賃買斷很難預測，但我們預計第四季度的租賃買斷水平將低於第三季度。

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 年第三季度部署了 134 個系統，而 2015 年第三季度為 117 個系統，上季度為 130 個系統。本季度有 15 個系統被置於經營租賃交易之下，而上一季度為 15 個，2015 年第三季度為 13 個系統。提醒一下，經營租賃交易的收入在租賃期限內按比例確認。

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.

截至第三季度末，現場有 74 個系統處於經營租賃狀態。我們在本季度產生了約 400 萬美元與經營租賃相關的收入，而 2015 年第三季度為 200 萬美元，上一季度約為 400 萬美元。我們在系統 ASP 計算中排除了經營租賃和租賃收購的影響。

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.

在全球範圍內，我們的平均係統價格為 153 萬美元，而去年為 161 萬美元，上季度為 156 萬美元。與前期相比的下降主要反映了雙控制台系統組合的減少，部分被 2016 年第三季度以舊換新系統的組合減少所抵消。

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.

1.3 億美元的服務收入同比增長 10%，與 2016 年第二季度相比增長約 1%。同比和環比增長反映了我們達芬奇系統安裝基數的增長。

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%.

在美國以外，結果如下。第三季度美國以外的收入為 1.89 億美元，較 2015 年第三季度的 1.51 億美元增長 25%，較第二季度的 1.85 億美元增長 2%。與上一年相比的增長包括經常性收入增長 26%，這是由 25% 的程序增長和 24% 的系統收入增長推動的。

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.

與第二季度相比的增長反映了在季節性放緩的季度中系統收入增長了 2%，經常性收入增長了 2%。在美國以外，我們在第三季度部署了 49 個系統，而 2015 年第三季度為 37 個，上季度為 51 個系統。

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.

當前季度的系統銷售額包括 18 個進入歐洲、2 個進入中國、11 個進入日本以及 18 個進入世界其他市場。美國以外的系統佈局將繼續起伏不定，因為一些 OUS 市場正處於採用的早期階段。一些市場具有很強的季節性，反映了預算週期或假期模式，並且某些市場的銷售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%.

繼續討論損益表的其餘部分。 2016 年第三季度的預估毛利率為 73.1%，而 2015 年第三季度為 69.3%，2016 年第二季度為 71.9%。2016 年第三季度的預估毛利率包括 710 萬美元的醫療設備退稅。如果沒有醫療器械退稅，我們的備考毛利率將與第二季度相同，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 年第三季度相比，較高的毛利率反映了產品成本的降低、醫療器械退稅和製造效率的提高。未來的利潤率將根據我們新產品的組合、系統和儀器及配件收入的組合、與我們的範圍交換計劃相關的成本、我們進一步降低產品成本和提高製造效率的能力以及從長遠來看，可能恢復醫療器械稅。

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.

與 2015 年第三季度相比，備考運營費用增加了 14%，與上一季度相比增加了約 600 萬美元。增加反映了員工人數的增加、產品開發活動的增加以及對我們 OUS 商業組織的投資。我們在過去一年中增加了 400 多名員工，主要是在產品運營領域。與上一季度相比的增長主要反映了員工成本的增加。

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.

我們第三季度的備考有效稅率為 22.7%，而 2015 年第三季度的有效稅率為 18.4%，上一季度為 27.8%。 2016 年第三季度的預估稅率反映了 1600 萬美元的稅收優惠或每股 0.40 美元，這是由於各個司法管轄區的訴訟時效到期而實現的。 2015 年第三季度的稅率反映了 2900 萬美元或每股 0.77 美元與涉及獨立第三方的稅收優惠法院裁決有關。我們的稅率會隨著 OUS 和美國收入組合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 年第三季度的備考淨收入為 2.46 億美元或每股 6.19 美元，而 2015 年第三季度為 1.99 億美元或每股 5.24 美元，2016 年第二季度為 2.20 億美元或每股 5.62 美元。不包括一次性所得稅和醫療器械稅收優惠，預計淨收入為 2.25 億美元或每股 5.65 美元。正如我之前指出的那樣，備考收入可以更輕鬆地比較我們的財務結果和業務趨勢。

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.

我現在將總結我們的 GAAP 結果。 2016 年第三季度 GAAP 淨收入為 2.11 億美元或每股 5.31 美元，而 2015 年第三季度為 1.67 億美元或每股 4.40 美元，2016 年第二季度為 1.85 億美元或每股 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.

本季度結束時，我們的現金和投資為 46 億美元，高於 2016 年 6 月 30 日的 42 億美元。增長主要是由運營產生的現金和股票期權行使收益推動的。隨著我們的現金積累，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.

有了這個，我想把它交給帕特里克，他將回顧我們的程序和臨床亮點。

Thanks, Marshall.

謝謝，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.

在我們第三季度 14% 的程序增長中，美國程序增長了約 11%，美國以外的程序增長了約 25%。 2016 年前三個季度，全球手術量增長近 16%。在美國，與上半年相比，第三季度我們成熟程序的增長放緩。一般和胸腔鏡手術生長保持健康。

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，達芬奇前列腺切除術的第三季度增長放緩至較低的個位數增長，我們認為這一水平與新前列腺癌的總體診斷率相似。我們相信我們的美國前列腺切除術量一直在追踪更廣泛的前列腺手術市場。

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，第三季度手術量同比略有增長，其中惡性和復雜的良性子宮切除術帶動了增長。繼續最近的趨勢，我們估計第三季度婦科腫瘤學家進行了更大比例的達芬奇子宮切除術。良性婦科疾病的手術在第三季度溫和增長，延續了今年上半年的趨勢。

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.

第三季度美國普外科和胸外科手術的採用率仍然很高，這主要得益於疝修補術的穩健增長和結直腸手術的持續採用。疝氣修復繼續為普通外科手術中的新手術做出最大貢獻，現有外科醫生的保留率和利用率仍然令人鼓舞。

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.

本季度膽囊切除術有所下降，多端口手術的增長被單點手術的下降所抵消。早期採用肺葉切除術和其他胸部手術是令人鼓舞的。

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.

上個月在機器人輔助和微創疝修補術全球研討會上，提出了幾個比較達芬奇與開放式和腹腔鏡疝修補術的新數據集。在最著名的演講中，來自克利夫蘭診所的 Rosen 醫生展示了美國疝氣協會質量協作組織 (American Hernia Society's quality collaborative, 簡稱 AHSQC) 關於逆行肌肉腹疝修補術的新數據。

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.

在對 400 多名患者進行達芬奇手術和開放手術匹配的前瞻性隊列中，與開放手術相比，達芬奇手術顯示住院時間縮短了兩天半。具有相似水平的傷口結果、再入院和再手術。 Intuitive 是 AHSQC 的創始合作夥伴，我們支持其擴展以包括腹股溝疝修補術的數據。

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.

轉向國外，第三季度美國以外的手術增長了約 25%，這主要得益於全球採用達芬奇前列腺切除術以及腎臟手術的堅實貢獻。歐洲和亞洲的手術總量增長與上半年相似，但手術表現因國家/地區而異。中國、韓國、日本和德國繼續保持強勁增長。

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.

雖然在泌尿外科採用達芬奇是美國以外手術增長的主要驅動力，但我們看到某些國家採用了多專業。在中國，今年迄今手術增長的大約一半來自泌尿外科以外的類別。在韓國，今年迄今大約 60% 的手術來自泌尿外科以外的類別。

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.

我們正在投資開發臨床證據，以支持在全球市場採用達芬奇手術。在全球範圍內，我們支持多項證據倡議和註冊，包括 AHSQC、美國和歐洲的婦科腫瘤社會註冊以及歐洲的結直腸註冊。

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，我們還支持多項關於疝氣修復、結直腸手術和胸外科手術的比較視角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，我們為結直腸、胸部和婦科腫瘤學研究提供支持。我們致力於在主要市場開發本地證據，以支持採用達芬奇手術，我們的技術可以為醫院、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.

第三季度是另一個有大量臨床出版物評估達芬奇手術的季度。其中，我選擇了一些您可能會感興趣的研究。

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.

印第安納大學的 [Delush] 博士及其同事在《外科內窺鏡檢查》雜誌上發表了一項研究，比較了 2011 年至 2014 年美國外科醫師學會國家外科質量改進項目 (NSQIP) 數據庫中捕獲的達芬奇與腹腔鏡結直腸手術。包括 27,000 多個手術一系列結腸和直腸切除術，以換取大約 45 分鐘的更長手術時間，達芬奇低位前切除術和右結腸切除術顯示轉化率降低。

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.

左結腸切除術傾向於降低轉化率，但沒有統計學意義。低位前切除術也顯示出較低的敗血症發生率，以及較高的轉移造口率。在所有隊列中，達芬奇手術縮短了住院時間。

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布爾 Acibadem 大學的 Ozben 博士及其同事發表在《外科腹腔鏡、內窺鏡和經皮技術雜誌》上。在一個小型病例係列中，作者比較了他們在 da Vinci Xi 和 da Vinci Si 上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.

他們發現 da Vinci Xi 與減少大約 40 分鐘的手術時間有關。手術時間的減少歸因於 da Vinci Xi 隊列中混合手術中雙對接的消除。外科醫生還發現，da Vinci Xi 患者群體的淋巴結收穫量增加，腸功能恢復更快，住院時間延長一天。

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.

作者總結說，Xi 一代似乎允許更短的 [console] 時間，其更廣泛的功能有望使外科醫生更容易執行這種複雜的機器人手術，關閉引用。雖然該研究強調了 da Vinci Xi 在直腸切除等多像限手術中增強的工作流程能力，但我們的 da Vinci Si 安裝基數在 2016 年保持穩定，因為客戶繼續發現其利用價值。總的來說，在達芬奇 Si 和 Xi 平台上執行的程序占我們第三季度程序的 95% 以上。

This concludes my remarks, I'll now turn the call over to Calvin.

我的發言到此結束，我現在將電話轉給卡爾文。

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

謝謝你，帕特里克。我將為您提供 2016 年最新的財務展望。

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.

從程序開始。在我們上次電話會議中，我們估計 2016 年全年手術量增長 14% 至 15%，高於 2015 年執行的約 652,000 次手術。現在，隨著我們進入第四季度，我們繼續預測全年手術量增長 14% 至 15%。 15%，可能接近該範圍的高端。

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 年第四季度的系統佈局，我們預計該季度的系統佈局將遵循近期的季節性趨勢。然而，我們預計美國以外的系統佈局將繼續不穩定，因為我們的一些美國 OUS 市場處於採用的早期階段，並且向子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.

回想一下，我們在 2015 年第四季度在中國部署了 13 個系統，在巴西部署了 7 個系統。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正處於早期階段, 我們預計 2016 年第四季度不會有可比公司和這些市場的配售。

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，我們以經營租賃的形式為客戶提供的靈活性受到了好評。因此，與前期相比，我們預計 2016 年第 4 季度有更高比例的配售將根據經營租賃進行，並在未來期間確認收入。最後，我們預計第四季度的租賃收購數量將低於前兩個季度，因為此時未償還的短期租賃數量較少。

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.

談到毛利，在我們上次電話會議上，我們預測 2016 年備考毛利率將在淨收入的 70% 至 71% 之間。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.

正如馬歇爾指出的那樣，第三季度受益於 710 萬美元的醫療器械退稅。排除該收益，我們的毛利率將為 72%。我們預計第四季度的利潤率將低於第三季度，這主要是由於產品組合。

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%.

談到運營費用，根據我們在關鍵業務領域的投資，我們預計費用增長將繼續加速。在我們上次電話會議中，我們預計 2016 年備考運營費用將比 2015 年水平增長 12% 至 15%。我們現在將這個範圍細化到 13% 到 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.

與我們上次電話會議一致，我們預計 2016 年我們的非現金股票補償費用將在 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 年其他收入總額約為 3300 萬美元，高於 3000 萬美元的預測在我們上次電話會議上，主要是由於利息收入增加。關於所得稅，與之前的指引一致，我們預計 2016 年第四季度的預估所得稅稅率將在稅前收入的 26.5% 至 28.5% 之間，這主要取決於美國和國際利潤的組合。

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

我們準備好的評論到此結束。我們現在將打開您的問題的電話。

(Operator Instructions)

（操作員說明）

Bob Hopkins, Bank of America.

美國銀行的鮑勃·霍普金斯。

Thanks, good afternoon. Can you hear me okay?

謝謝，下午好。你能聽到我說話嗎？

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.

偉大的。所以我有兩個問題。首先是馬歇爾，只是為了澄清提到的與第四季度有關的幾件事，然後是加里關於復星協議的問題。

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.

但是，馬歇爾，我將從你開始。只是兩個快速的澄清。第一，關於醫療器械稅和 700 萬美元，你能解釋一下為什麼是一次性的嗎？然後關於您提供的系統銷售指導，這是否實質上表明系統將在第四季度在全球範圍內大致持平？謝謝你。

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。所以醫療器械稅是結果——退款是結果——當你最初計算稅收時，有一些主觀領域，我們修改了我們之前提交的內容。所以我們得到了一次性退款，就結束了。他們已經 - 我們已經收到了錢並且進行了審計，所以我們都完成了。

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.

第二個問題與系統的級別有關。我認為 Calvin 所說的是系統在第四季度季節性更強。然而，他試圖建立的是，相對於前一年，鑑於我們有一些像中國和巴西這樣相當不穩定的市場，因此有一些硬的可比性。

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.

你還有關於復星的第二個問題？我認為鮑勃在開始之前對複星提出了一個問題。如果您還有它們，如果沒有，我們將重新排隊。

I'm here. Can you hear me?

我在這。你能聽到我嗎？

I can. Go.

我可以。去。

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，太棒了。非常感謝你。所以我只是 - 是的，我想知道你是否可以給我們一些關於活檢平台和合資企業的看法？因為在我看來，您在這裡宣布的是一個全新的平台。

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?

所以我想知道你是否可以給我們更多關於這是什麼的顏色？這是一個全新的系統還是只是對 Xi 的補充？

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.

我們應該將其視為距離商業化還有幾年的時間，還是它真的是一個長期項目？我只是想知道你是否可以提供一些觀點。

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.

我會給你一點概述。我們當然會在未來幾個季度為您提供更多詳細信息。它目前未設計為附加組件。正如我所說，這項技術是基於計算機控制導管的準備好的評論以及一些特殊的傳感技術和一些圖像分析。

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，它所處的當前配置是獨立的。未來這些類型的技術可以集成到其他東西中，我們不會排除自己這樣做。

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.

我們確實將其視為一種通過自然孔道和其他方式進入身體的方式，您希望按照規定的路徑到達身體的某個深處並做某事。我們的第一個臨床興趣是對肺癌進行活檢或對肺部可疑病變進行活檢。

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很重要，在中國尤其重要。因此，與復星的合作夥伴關係對我們來說非常有意義，我們通過他們的 Chindex 公司認識了復星多年，我們對此感到很興奮。

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.

我們還沒有準備好為您提供商業時間表。該技術已經足夠成熟，我們正處於最初的人類臨床經驗階段。這對我們來說真的是一個開始，隨著我們對發佈時間表和想法的了解越來越清晰，我們將與您分享。

Thank you.

謝謝你。

David Lewis, Morgan Stanley.

戴維劉易斯，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.

下午好。加里，我想從一個戰略問題開始，然後可能有兩個後續無聊的問題。在這次電話會議上，我突然想到 Intuitive 的故事實際上已經準備好進行相當重大的改變。

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.

我真的認為 Intuitive 一直都是關於一個系統的。我知道你有多種配置。但僅在本季度，Xi 仍佔新職位的 75%。但如果我考慮未來兩年，你仍然會擁有 Xi 和所有那些之前的系統，擁有 XSP，你現在也會擁有這種基於導管的傳感系統。

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.

所以我想知道你是否可以幫助我們理解，我們認為這家公司在未來兩年內發生變化是否正確？支持多個平台現在如何影響您可以服務的可尋址市場、您加速增長的能力以及顯然只是平攤跨這些平台的研發支出？我知道這是一個大問題，但我認為這是一個重要的問題。

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，很公平。我想當你想到 SP 時，SP 與 Xi 平台在架構和底層技術上有很多共同之處。我們確實認為它把我們分為兩個地方，這兩個地方很難用其他方式到達，實際上很難到達，用傳統技術、開放手術、傳統腹腔鏡或 Xi。

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 可以在臨床上拓寬外科醫生的工作範圍。我認為這將從利基市場開始，然後隨著我們獲得臨床經驗，我們將轉向更廣泛的應用。

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.

就 SP 的複雜性而言，它確實稍微增加了我們的支持負載，只是因為它是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.

當您開始考慮基於導管的技術時，這又是一組新技術。所以你已經設定了兩年的時間範圍；我會把地平線拉遠一點。我不會把我們停在那裡。

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.

我確實認為這會將我們帶到不同的地方。我認為它可以接觸到您可能不會想到的手術部位。它可能更多地圍繞診斷，我認為這將為從業者打開他們以前從未想過的接近組織的方法。

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。你已經看到我們增加了研發支出，我們一直在談論它並在做它，其中一部分一直在投資這些技術。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，正如人們所看的那樣——當我們從腳底往頭頂看，尋找機會獲得更好的結果時，我們認為有各種各樣的技術。從訪問技術，到成像技術，再到能夠真正發揮作用的計算技術，我們正在把錢花在嘴上。

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。而且，馬歇爾，公司一直不願談論未來的利潤率。顯然，今年的利潤率是故事的重要組成部分，坦率地說，它們有點不同尋常。

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?

所以當你進入 2017 年時，就你所做的許多支出評論而言，我認為投資者期望 2017 年利潤率擴張 200 個基點是不現實的。根據你對支出的評論和你的看法為了支持這些平台，我們明年應該如何在 2016 年的非凡擴張和更溫和的 2015 年利潤率擴張之間調整我們的想法？我們是否應該考慮介於這兩個極點之間的東西比我們今年看到的看起來非常大的東西更合適？

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，我們將在 1 月份為您提供有關 2017 年情況的指導。但一些可能發生的變數顯然與產品組合有關。當您推出新產品時，新產品的利潤率就其性質而言低於現有產品。

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.

因此，如果有，例如我們引入裝訂，我們最初會看到利潤率下降。隨著我們提高製造過程的可製造性和效率，我們看到了利潤率的提高。

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.

所以我不打算預測我們明年要做什麼。我只想說有很多活動部件。地理上的混合也有影響。系統與儀器和附件之間的混合會產生影響。

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.

其中只有很多變量。我認為你去年看到的是我們的製造團隊在降低一年前利潤率較低的新產品成本方面的出色表現。

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。然後，加里，最後真的很快。關於系統上的前美國業務，我認為對巴西和中國的評論，這些評論本質上似乎是非常短期的。

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，這些標書將被提高。但就歐洲業務而言，您是否看到英國退歐的任何影響，或者您只是認為這是您業務中普遍存在的問題？謝謝你。

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.

我認為尤其是英國的動態，我們很難區分什麼是英國退歐和什麼不是。相對於這些事情，資本收購管道相當長，很明顯，在英國，他們是 NHS，無論如何，NHS England 一直在研究如何花錢並試圖彌補預算短缺。所以一段時間以來一直存在壓力，英國脫歐可能無濟於事。

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.

就更廣泛的歐洲而言，它確實因國家/地區而異。一些地方我們看到了合理的增長和支持，而其他國家則有點掙扎。對此的回應實際上是增加本地存在，增加本地數據生成並與政府付款人和私人付款人保持密切聯繫。

Okay. Thank you very much.

好的。非常感謝你。

Tycho Peterson, JPMorgan.

摩根大通第谷彼得森。

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，我想跟進戴夫早些時候關於邊距的問題。如果我們考慮 Xi 的經驗以及我們對 SP 的預期對毛利率的影響，那麼當它推出時，就毛利率影響的大小而言，這是一個公平的代理嗎？

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.

我們還沒有進入推出產品的階段，我們正在批量生產它們。但我認為可以公平地說 SP 的利潤率將低於我們現有的產品組合，我們將努力解決這個問題，並隨著時間的推移努力降低這些成本。

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，你看看 Xi，那是我們的下一代多端口系統，它很快就佔據了很高的銷售額比例。我們談論的 SP 是一種更受控制的發射類型，總體數量較低。因此，僅基於幅度，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。然後你能評論以舊換新嗎？我知道你在腳註中提到了這一點。你在美國有 58 個，有史以來最高的數字。這是你去現場清理系統的一次性事情嗎？

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.

我們在開始時引用的數據表中有一個腳註。在第三季度，我們實際上實施了一個新系統和一些流程，用於在現場跟踪我們的達芬奇系統。

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.

作為過渡過程的一部分，我們對已安裝的基礎記錄進行了驗證審核，確定了 43 個系統，其中大部分是已退役的舊標準和 S 型號。因此，我們在本季度從我們的安裝基礎中移除了那些已退役的系統。所以我認為交易數量是 33，然後這裡剩下的大部分就是我們對基礎所做的調整。因此，以舊換新與之前的時期非常一致。

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。最後一個我只問強制性資本部署問題，因為你現在超過 45 億美元。顯然你正在增加自己的支出，但你現在能談談資本配置嗎？

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.

是的，當然。我認為我們考慮的資本部署與我們之前討論的方式一致。我們正處在一個時期——我們面臨著未來的競爭，我們希望有能力擴張和應對競爭。我們還將看到更多的機會，因為公司進入這場遊戲以獲得可能擴大我們的市場和增強我們的產品的技術。

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.

而那些技術，很高興做我們過去所做的插入和小型許可安排，我們將嘗試這樣做。但未來我們可能需要支付更多的錢才能獲得某些技術，因此我們希望有錢購買這些東西。除此之外，只要我們有合適的機會回購股票並向股東返還資金，我們就會抓住這個機會。但我們將像過去一樣機會主義地這樣做。

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.

下午好。感謝您提出問題。

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?

加里，看看與復星的關係，這是否讓你們在中國建立了明顯更密切的關係，這可能會影響招標過程？作為第二部分，從監管的角度來看，一旦完成開發並完成一些人體測試以獲得批准，您會考慮什麼時間框架來完成某些事情？那裡更快，還是與美國相似？

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，我認為這加深了我們與中國客戶和監管機構的關係。我不——我不認為這是短期內的神奇轉變。

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.

關於在中國對各種產品的監管批准，通常在我們過去，這個過程比在美國要長一點。未來會是什麼樣子，特別是對於我們正在談論的新產品，我現在無法談論。我們只是沒有足夠的信息。

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。然後你談到國際程序增加了大約 25%，這是一個很大的數字。但我想我聽到你說歐洲部分地區比一年前更弱。

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?

那裡有特定的地理模式嗎？相對於海外一些新興機會，中國是否明顯或加上 ROW 安置引起了我的注意？

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.

嘿，本，這是帕特里克。在某些國際市場，我們對泌尿外科的了解相當深入。在你看到這些滲透率隨著時間的推移而增加的地方，增長率已經放緩，而結直腸癌和婦科腫瘤學等新興手術仍然相當小。所以像北歐國家這樣的國家，像英國這樣我們非常深入的地方，你會看到這些增長率放緩。

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。然後這可能也適用於帕特里克，但今天早上的一位競爭對手談到看到一些普通手術病例並稱疝氣下降了大約 10%。如果您願意，請根據您在疝氣中的位置以及相對於某些歷史快速採用程序的採用軌跡向我們介紹您的狀態？

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.

疝氣繼續令人鼓舞。隨著他們繼續做更多的手術，現有外科醫生人群的手術採用率、外科醫生保留率和利用率一直是該技術採用方式的一個重點。

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.

疝氣修復不是一回事，因此其中有各種各樣的患者子集，圍繞我們的技術可以在手術中帶來的價值的各種不同的醫生觀點。因此，就您認為它被採用的方式而言，它可能不太像 DVP，考慮到替代療法和治療這些患者的異質性景觀，它可能更像是良性子宮切除術。

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。然後對我來說最後一個問題是關於 INA 的問題，那裡的收入與程序大致符合我們的目標是非常明顯的。而且，馬歇爾，你確實在那裡進行了一些數學運算。但是除了吻合和容器密封之外，還有什麼特別引起您對混合的注意的嗎？

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.

僅提供一點歷史視角，如果您查看 2016 年第二季度之前，我們的 INA 每個程序收入一直在非常狹窄的範圍內運行，從每個程序 1,830 美元到 1,840 美元。您可能還記得上個季度它實際上跌至 1,810 美元，我們談到訂單時間是這裡的主要因素。

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.

因此，正如我們在第三季度預期的那樣，我們看到訂單反彈以抵消第二季度的影響。如果你取第二季度和第三季度的平均值，你就會回到 1,840 美元。這符合過去幾年的趨勢。

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.

正如我們所說，我們繼續看到越來越多地使用先進儀器，包括吻合器和血管封口機。隨著我們預計結直腸和胸外科手術量的持續增長，這些產品在這些領域得到更廣泛的使用，我們預計有機消費模式對每個手術的收入貢獻會略高，如果你願意的話。

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.

但重要的是要記住，有多種因素會影響每個程序的收入，包括所執行程序的類型、使用和優化的效率、先進儀器的使用、庫存訂單、時間安排和分銷商。這裡面有很多因素。因此，INA 可能會起伏不定，最終可能難以預測未來趨勢。

Thank you very much.

非常感謝你。

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，伙計們。讓我從前列腺開始，想想今年的趨勢，從第一季度 DVP 的低兩位數增長一直下降到本季度聽起來的低個位數。這似乎是一個非常快速的變化，否則在我看來會是一個較慢的趨勢線。關於現在正在發生的事情，為什麼會發生，您還可以添加更多顏色，也許更重要的是，你們有信心本季度達到底部，並且事件率增長率是您前列腺的正確增長率？

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.

嘿，艾哈邁德。如您所知，很難預測像 DVP 這樣的成熟手術中前列腺癌患者的治療趨勢。一段時間以來，我們一直強調我們所看到的增長率不是我們認為與診斷率一致的增長率。

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.

很難說在本季度或今年我們看到的增長變化率。它背後的細節，這些數據通常會在幾年後出現在我們面前。但我們認為，我們在本季度看到的情況可能比我們在過去和四個季度看到的情況更符合診斷率。

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。讓我轉到婦科。聽起來今年上半年的情況仍然像你描述的那樣，可能比我們過去看到的要好一些。我想——我認為我們已經有一段時間沒有問過這個問題了，所以我只是把這個問題作為一種可能的途徑拋出。

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?

僅考慮門診中心、門診手術中心，是否有——在多大程度上或是否有任何成功將達芬奇置於門診中心？這對你來說越來越重要了嗎？這是否完全是我們在美國看到的婦科增長率略高的一部分？

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.

我認為你正在連接兩件我不太確定我會連接的東西。因此，在我看來，婦科業務的相對健康似乎是由幾個因素驅動的，其中包括患者集中到更高容量的外科醫生和更高容量的中心。另外，還有更多門診工作的趨勢。

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.

我們確實看到我們的系統在門診環境中的利用率往往更多地出現在現有的綜合交付網絡中，醫院借出的門診部門是我們綜合計劃的一部分。在這一點上，我不會將其稱為主要趨勢。我不確定我是否會將它與 gyn 聯繫起來。這是可能的，但我認為有很多因素導致目前還不可能對它們進行排序。

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.

但是，如果你從整體上看婦科，看看採用良性子宮切除術的歷史，達芬奇手術進入良性子宮切除術，使大多數患者現在可以在門診接受治療。因此，當採用一種技術進行微創手術時，它將使醫院能夠以更面向門診的方式管理這些患者。

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.

關於系統方面的最後一個問題。不僅要考慮第四季度，還要考慮更長的時間，如果你願意，可以稱之為 2017 年，但要考慮安裝基礎。現在它一直以每年 10% 的速度持續增長。

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?

幾乎每個季度它似乎都以每年 10% 的速度增長。當我們考慮這個數字以及我們在未來一兩年內考慮安裝基數增長數字的 10% 增長的可持續性時，您能否談談關鍵驅動因素和壓力點？

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.

我的思考方式有點像推拿。因此，主要因素是客戶預期的程序增長。客戶根據他們認為未來程序趨勢會發生什麼來進行資本配置。

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，他們看到增長的地方我認為他們會前進。可能有點不同或不連貫的地方是在您剛剛起步的非常早期的市場中。

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，新的報銷許可或新的配額或新的程序許可並沒有遵循更成熟的趨勢。因此，這就是正在滾動的兩件事。我認為對我們來說最重要的是客戶對未來程序的信任和利用是資本的最佳預測指標。

Thanks, guys.

多謝你們。

Rick Wise, Stifel Nicolaus.

里克·懷斯，斯蒂菲爾·尼古拉斯。

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，加里。也許只是簡單地回到復星，顯然你已經多次提到構建生態系統的概念以及它對 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?

復星是否還有其他類似的機會，無論是地理上還是技術上，或者這是我們應該期望 Intuitive 推動尋找其他技術以引入生態系統的方向嗎？這是正確的思考方式嗎？

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?

我認為如果有技術或其他資產我們可以帶來我們認為會增加機器人手術程序或基於計算的微創手術程序對我們的一個客戶的價值。這對我們來說是一個機會，是嗎？

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.

他們往往會及時發展。我們現在談論的基於導管的基礎技術，正如您關注我們一段時間所知道的，實際上是我們幾年前首先獲得的。

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。我們在外面看，復星一直是很好的合作夥伴。他們通過美中互利與我們建立了關係，但他們也從多個方面非常了解醫療保健領域。對此的簡短回答是我們一直在這樣做，並希望繼續這樣做。

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

謝謝。還有幾個。只是關於一般手術採用的一般性問題，特別是在美國。

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?

也許你能多談談我們在採用過程中所處的位置嗎？這些仍然是收益——還是早期的收益？

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?

也許特別是在結直腸癌方面，您如何加速結直腸癌的採用？我們需要更多的臨床數據嗎？你能談談其中的一些問題嗎？

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.

正如我們過去所說，採用實際上是按程序進行的，每個程序實際上是分段的。因此，例如，結直腸癌可能實際上是四五個略有不同的基礎程序。當有很大的價值時，採用率會很快，相對於替代方案而言，該程序具有明顯的價值，並且該程序非常集中在訓練有素的外科醫生手中。

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.

所以取結直腸，稍微分開一點。在直腸癌的情況下，這是一套複雜的程序。當然，在自然界中，腫瘤學一直在穩步增長。相對於之前的一些採用來說，這並不是一個超快速的增長，但對我們來說是一個穩定的採用。數據收集一直在進行，數據發布一直在進行，我們在那裡做得很好。

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，有時是良性的，有時是腫瘤學的，這些通常由不同的外科醫生完成，因此他們採用的速度略有不同。你再看看疝氣，它是細分的。腹疝與腹股溝內的腹股溝和亞段。

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，我們著眼於腹疝和腹股溝疝，因為我們為我們帶來價值的程序定義了可用市場，相對於過去的趨勢而言，這些程序已經很好地採用了。直腸的採用速度較慢，但穩定，結腸在中間。

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.

在程序方面對我來說只是最後一次。顯然這裡有很多動人的作品。泌尿科，也許現在增長稍微慢一點——婦科正在恢復。普通外科繼續急劇增長。

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?

當我們將這個數學與我們在國際上看到的情況相結合時，我們是否應該對像十幾歲的過程增長這樣的事情感到合理樂觀，同樣有一些變化。考慮到不斷增長的安裝基礎、地理滲透率以及 Intuitive 技術的持續發展，這是正確的可持續增長率嗎？

Thanks, Gary.

謝謝，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。我們還沒有準備好給出我們的 2017 年預測，我們將看到我們如何在第四季度結束這裡並彙總我們的估計並在 1 月份的下一次電話會議中回答這個問題。

Thank you.

謝謝你。

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，謝謝你提出這個問題。我是這些電話的新手，所以這裡可能只有幾個基本電話。

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 SG&A 佔銷售額的百分比相對較低，如果我錯過了，我深表歉意。本季度 SG&A 相對較低的原因是什麼？研發支出約佔銷售額的 7%，這聽起來是不是一個很好的未來使用率？我有幾個後續行動。

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.

在 SG&A 和 R&D 之間，每個季度都會有變化，如果你願意的話，會出現波動。我們已經談了很多關於我們的研發投資，加里在 SG&A 方面進行了討論。我認為我們正在對國際進行不成比例的調查，以支持那裡的早期階段增長。

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.

所以你整體來看，我們在我們的指導範圍內。我們將全年指引細化為 13% 至 14%。同樣，會有一些季度變化。但我認為我們正在跟踪總體計劃。

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.

拉里，鑑於我們的一些資本收入在不同時期之間存在波動，我們通常會根據增長率來討論運營費用，[帕特] 將向您介紹這一點。

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?

知道了謝謝。然後，當我們考慮新產品和功能的管道和潛在發佈時，我們是否應該期待在今年晚些時候或 2017 年推出任何有意義的產品（SP 除外）？

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.

我們已經在不同的市場推出了許多儀器和配件，各種各樣的東西。我們傾向於在他們出來時告訴您。目前我們還沒有為 SP 或其他主要係統標記發布日期。

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。最後對我來說，加里，你談到了你在疝氣中看到的生長，你談到了腹側和腹股溝。您是否看到腹側與腹股溝的穿透力或斜坡有什麼不同，或者兩者是否同樣強？感謝您提出問題。

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.

這是個好問題。我認為在程序複雜性和一些實踐模式方面，動態略有不同，因此它們不會完全相同。話雖如此，我認為此時我不會強烈呼籲採用任何內容。

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.

我認為他們都在經歷第一批採用者，產生額外的數據。我們現在看到更多的數據，總體上是支持的，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輪外科醫生所依賴的評估，因此我們現在確實在這兩種疝氣 [deleans] 中看到了這種轉變。

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

請再問一位來電者一個問題。

Brandon Henry, RBC Capital Markets.

加拿大皇家銀行資本市場的布蘭登亨利。

Thanks for taking my question.

感謝您提出我的問題。

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?

因此，本季度 Intuitive 再次公佈了營業利潤率的強勁增長。您能否討論一些推動這些更高利潤率的產品和成本計劃，以及您在其中一些成本計劃中處於哪一局？

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.

然後，在過去幾個季度中，公司的員工人數顯著增加。您能否討論一下您在哪些方面對員工進行了投資，以及與其他一些舉措相比，員工人數的增加有多少可以歸因於復星合資企業？然後我有一個後續行動。

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

那已經是問題了，我給了你一個。我想我會選擇一個。不，我們會走得很快。

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.

在降低成本方面的第一個方面，這是一個仔細而漫長的活動清單。所以你不應該把它看作一件事，因為它是一個例行的紀律，掃描操作過程和製造過程以及零件成本，並在它們出現時進行處理。

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.

在平台發布的頭幾年，你確實在這些事情上得到了最大的幫助，然後開始變得越來越困難。這並不是說不可能做到。

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.

就員工人數增長而言，它是商業增長的混合體，在美國以外比在美國更受重視。一些製造業的增長涵蓋了儀器和配件等數量不斷增加的東西，以及一些設計幫助。

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.

與復星相關的員工人數增長，我們目前還沒有真正準備好突破。在過去的幾年裡，我們當然對支撐這種關係的技術進行了人員投資。但我現在還不會把它稱為複星。

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.

有了這個，我將繼續結束電話會議，然後我們將在下一次電話會議上回答你的下一個問題。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，雖然我們在這些電話會議中關注收入、利潤和現金流等財務指標，但我們的組織重點仍然是通過使外科醫生能夠改善手術結果和減少手術創傷來增加價值。我們建立我們的公司是為了超越人手的極限進行手術，我向你保證，我們將繼續致力於推動真正有所作為的重要少數事情。

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。我們感謝您參與和支持這一改善手術的非凡旅程，我們期待在三個月後再次與您交談。

That does conclude your conference, you may now disconnect.

這確實結束了您的會議，您現在可以斷開連接。