直覺手術 (ISRG) 2016 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Surgical Q4 2016 earnings release call. (Operator Instructions). As a reminder, today's conference is being recorded.

女士們、先生們，感謝各位的耐心等待，歡迎參加 Intuitive Surgical 2016 年第四季財報發布電話會議。（操作說明）提醒各位，今天的會議正在錄影。

I would now like to turn the conference over to Senior Director of Finance and Investor Relations Calvin Darling. Please go ahead.

現在我將把會議交給財務和投資者關係高級總監卡爾文·達林。請繼續。

Thank you. Good afternoon and welcome to Intuitive Surgical's fourth-quarter earnings conference call. With me today we have Gary Guthart, our President and CEO, and Marshall Mohr, our Chief Financial Officer. Note that Patrick Clingan, who routinely participates on these calls, will not be on the call today to attend to personal matters. We look forward to his return next time.

謝謝。下午好，歡迎參加直覺外科公司第四季財報電話會議。今天和我在一起的是我們的總裁兼執行長 Gary Guthart，以及我們的財務長 Marshall Mohr。請注意，經常參加這些電話會議的帕特里克·克林根今天將因處理個人事務而缺席。我們期待他下次再來。

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 October 19, 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.

在開始之前，我想告知各位，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於存在某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定性在公司向美國證券交易委員會提交的文件中均有詳細描述，包括我們最近於 2016 年 2 月 2 日提交的 10-K 表格和於 2016 年 10 月 19 日提交的 10-Q 表格。這些文件可透過我們的網站或美國證券交易委員會的EDGAR資料庫找到。潛在投資者應注意，不要過度依賴此類前瞻性陳述。

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

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

Today's format will consist of providing you with highlights of our fourth-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 fourth-quarter financial results, then I will discuss procedures and clinical highlights and provide our financial outlook for 2017. And finally, we will host a question-and-answer session.

今天的會議形式將包括：首先向您介紹我們今天早些時候發布的新聞稿中所述的第四季度業績亮點，然後進行問答環節。Gary 將介紹本季的業務和營運亮點。馬歇爾將回顧我們第四季的財務業績，然後我將討論流程和臨床亮點，並提供我們對 2017 年的財務展望。最後，我們將舉行問答環節。

With that, I will turn it over to Gary.

接下來，我將把麥克風交給蓋瑞。

Good afternoon and thank you for joining us on the call today.

下午好，感謝各位今天參加我們的電話會議。

Intuitive was founded on the mission to expand the availability of minimally invasive surgery, increase its efficacy, and decrease its invasiveness, and the fourth quarter capped a strong year in pursuit of this mission, led by continued growth in da Vinci procedures and expansion of our installed base. Annualized global procedure growth was approximately 15% in the fourth quarter and 15% for the full year.

Intuitive 的創立宗旨是擴大微創手術的普及範圍，提高其療效，並降低其創傷性。在達文西手術持續成長和設備安裝量擴大的推動下，Intuitive 在實現這一宗旨的道路上，於第四季度取得了強勁的業績。第四季全球手術量年化成長率約 15%，全年成長率約 15%。

Trends in procedures were consistent through the year, with increased use of da Vinci in general surgery in the United States, continued growth in urology in Japan and Europe, and multispecialty growth in Korea and China. Mature procedures in the United States, including prostatectomy and hysterectomy, outperformed our initial expectations, largely due to macro trends in diagnosis of prostate cancer and treatment patterns for hysterectomy.

全年手術趨勢保持一致，美國普通外科手術中達文西手術的使用量增加，日本和歐洲泌尿外科手術持續增長，韓國和中國多專科手術持續增長。在美國，包括前列腺切除術和子宮切除術在內的成熟手術，其效果超出了我們最初的預期，這主要是由於前列腺癌診斷的宏觀趨勢和子宮切除術的治療模式。

Procedure growth in Europe, Korea, and China were healthy through the year. Procedure adoption in Japan was solid for those procedures that have been reimbursed. Calvin will review procedure trends in greater detail later in the call.

今年，歐洲、韓國和中國的手術量成長勢頭良好。在日本，那些可以獲得報銷的醫療程序，其執行情況相當穩定。卡爾文將在稍後的通話中更詳細地回顧手術流程的發展趨勢。

Our capital placement performance in 2016 strengthened over 2015, resulting in a growth of total placements from 492 in 2015 to 537 this year. Net of trade-ins and retirements, our clinical installed base grew from 3,597 to 3,919 in the year. Our range of capabilities and price points and our ability to be flexible with acquisition methods has allowed us to meet varying customer needs in a competitive capital environment. Customers have chosen our most capable system, da Vinci Xi, in roughly three-quarters of new capital placements for the full year. Da Vinci Xi is well matched with procedure opportunities in thoracic and general surgical procedures, such as colon and rectal surgeries.

2016 年，我們的資本配置績效比 2015 年有所增強，導致總配置數量從 2015 年的 492 筆成長到今年的 537 筆。扣除以舊換新和退役設備後，我們的臨床設備安裝基礎在這一年內從 3,597 台增加到 3,919 台。我們豐富的產品功能、靈活的價格體係以及採購方式，使我們能夠在競爭激烈的資本環境中滿足客戶的各種需求。在今年新增的資金投入中，客戶大約四分之三都選擇了我們功能最強大的系統－達文西 Xi。達文西 Xi 手術系統非常適合胸腔外科和一般外科手術，例如結腸和直腸手術。

US capital placement stood out in the year, while capital placements in Asia were consistent with prior trends. As we have said in prior calls, system quotas in China and reimbursements in Japan temper placement growth and make it hard to predict.

今年美國資本配置表現突出，而亞洲資本配置與以往趨勢保持一致。正如我們在先前的電話會議中所說，中國的系統配額和日本的報銷機制抑制了安置成長，使得安置成長難以預測。

Turning to Europe, while procedure growth was solid in 2016, system placements declined versus 2015 for reasons that vary by country. In our largest European markets, we believe the long-term procedure and system opportunity is significant, with further adoption benefiting from additional economic validation in mature procedures like prostatectomy and from country-specific clinical and economic data for emerging procedures like colorectal surgery.

再來看歐洲，雖然 2016 年手術量成長穩健，但係統植入量與 2015 年相比有所下降，原因因國家而異。在我們最大的歐洲市場，我們認為長期的手術和系統機會很大，成熟的手術（如前列腺切除術）的進一步經濟驗證以及新興手術（如結直腸手術）的特定國家臨床和經濟數據將有利於進一步的採用。

Overall, despite the slowdown in capital in 2016, we are positive about our long-term prospects in Europe and continue to develop our organization and invest in European clinical and economic data to support our customers.

總體而言，儘管 2016 年資本成長放緩，但我們對在歐洲的長期前景持樂觀態度，並將繼續發展我們的組織，投資歐洲臨床和經濟數據，以支持我們的客戶。

Turning to highlights of our fourth-quarter operating results, procedures grew approximately 15% over the fourth quarter of last year. We shipped 163 da Vinci Surgical Systems, up from 158 in the fourth quarter of 2015.

回顧我們第四季的經營業績，手術量比去年同期成長了約 15%。我們交付了 163 台達文西手術系統，高於 2015 年第四季的 158 台。

Revenue for the quarter was $757 million, up 12% from prior year. Pro forma gross profit was 71.1%, compared to 69.6% in the fourth quarter of last year. Instrument and accessory revenue increased to $386 million, up 19%. Total recurring revenue in the quarter was $521 million, representing 69% of total revenue. We generated a pro forma operating profit of $320 million in the quarter, up 9% from the fourth quarter of last year, and pro forma net income was $242 million, up 8% from Q4 of 2015.

本季營收為7.57億美元，較上年同期成長12%。以備考基準計算，毛利率為 71.1%，而去年第四季為 69.6%。儀器及配件收入增至 3.86 億美元，成長 19%。本季經常性收入總額為 5.21 億美元，佔總營收的 69%。本季度，我們實現了 3.2 億美元的備考營業利潤，比去年第四季度增長了 9%；備考淨利潤為 2.42 億美元，比 2015 年第四季度增長了 8%。

Highlights of the full year of 2016 are as follows. Procedures grew approximately 15% over full-year 2015. We shipped 537 systems in 2016, up from 492 in the prior year. Revenue for the year was $2.7 billion, up 13%. Pro forma gross margin was 71.6% for the full year, compared to 68.2% in 2015. Total recurring revenue for the year was $1.9 billion and represented 71% of total revenue. Pro forma operating profit for the year was $1.2 billion, up 22% from 2015, and pro forma net income was $879 million, up 20%.

2016 年全年亮點如下。與 2015 年全年相比，手術量增加了約 15%。2016 年我們共出貨 537 套系統，比前一年的 492 套有所增加。本年度營收為27億美元，成長13%。全年以備考毛利率計算為 71.6%，而 2015 年為 68.2%。該年度經常性收入總額為 19 億美元，佔總收入的 71%。該年度的備考營業利潤為 12 億美元，較 2015 年成長 22%；備考淨利為 8.79 億美元，成長 20%。

As we mentioned in mid-December, our Board of Directors increased our stock buyback authorization to $3 billion and we announced today an accelerated repurchase program in the amount of $2 billion. We retain the flexibility to act on the remaining $1 billion in authorization in parallel with the ASR. Overall, we are committed to the thoughtful return of excess capital to shareholders and believe our buyback program will serve shareholders well. Marshall will take you through our finances in greater detail shortly.

正如我們在 12 月中旬提到的，我們的董事會將股票回購授權額度提高到 30 億美元，今天我們宣布了一項金額為 20 億美元的加速回購計畫。我們保留靈活處理剩餘 10 億美元授權資金的權力，與 ASR 並行運作。總而言之，我們致力於將多餘的資本以審慎的方式返還給股東，並相信我們的股票回購計畫將對股東大有裨益。馬歇爾稍後會更詳細地向您介紹我們的財務狀況。

As our business has strengthened, we have increased our mid- and long-term investments in creating our next generation of products and services. These investments are based on our belief that substantial opportunity exists to enable more minimally invasive surgery, better outcomes, and to expand access to our technologies globally.

隨著業務的增強，我們增加了對下一代產品和服務的研發投入，包括中長期投資。這些投資基於我們的信念：存在著巨大的機會，可以實現更多微創手術，獲得更好的治療效果，並在全球範圍內擴大我們技術的應用範圍。

Our current da Vinci Sp system met its development goals in the fourth quarter and we initiated its first clinical feasibility study. As we have 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 3-D vision to confined surgical spaces. Early surgeon response to Sp in the trials has been very positive. We anticipate initiating an Sp IDE trial in the United States for transoral robotic surgery, as well as submitting a 510-K for urologic applications, both in the first half of 2017.

我們目前的達文西Sp系統在第四季度達到了其開發目標，我們啟動了其首次臨床可行性研究。正如我們在之前的電話會議中討論的那樣，我們計劃首先開拓的市場包括頭頸外科、泌尿外科和結直腸外科。Sp 是一種平台技術，它能夠以極高的靈敏度和出色的 3D 視覺進入狹小的手術空間。早期外科醫師對Sp在試驗中的反應非常正面。我們預計將於 2017 年上半年在美國啟動經口機器人手術的 Sp IDE 試驗，並提交泌尿外科應用的 510-K 申請。

We're also making good progress on our flexible robotics platform, first targeted to address the acute need and diagnosis of lung cancer, one of the most commonly diagnosed forms of cancer in the world and for which early detection is important. The technology underpinning this system is based on computer-controlled catheters, advanced image processing, and sophisticated sensing.

我們的柔性機器人平台也取得了良好進展，該平台最初的目標是解決肺癌的迫切需求和診斷問題，肺癌是世界上最常見的癌症之一，早期發現至關重要。該系統所採用的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。

As we mentioned previously, the system is in its early stages of our human clinical experience. This experience has been compelling, and our design and operations teams are working hard to incorporate feedback and complete its production design and supply-chain optimization. Given the long-term opportunity for this system in lung cancer detection and other potential applications, we have been growing our team in this space. We do not anticipate revenue from this product in 2017.

正如我們之前提到的，該系統目前仍處於人體臨床應用的早期階段。這次經驗令人難忘，我們的設計和營運團隊正在努力將回饋融入其中，並完成生產設計和供應鏈優化。鑑於該系統在肺癌檢測和其他潛在應用方面具有長期發展前景，我們一直在擴大我們在該領域的團隊。我們預計該產品在 2017 年不會產生收入。

Imaging and intelligent algorithms offers significant opportunities to enhance surgeon capabilities. Our investments include hardware and imaging -- image processing updates to our Xi platform to enhance imaging performance and reduce costs. We are also investing in contrast agents for specific anatomical structures, recently announcing our plan to commence Phase I trials of a ureter imaging agent compatible with our Firefly imaging hardware and software.

成像技術和智慧演算法為提升外科醫生的能力提供了巨大的機會。我們的投資包括硬體和成像——對我們的 Xi 平台進行影像處理更新，以提高成像性能並降低成本。我們也正在投資研發用於特定解剖結構的造影劑，最近宣布了我們啟動與我們的 Firefly 成像硬體和軟體相容的輸尿管成像劑 I 期試驗的計劃。

Imaging and intelligent algorithms work also includes processing and presentation of preoperative imaging and other off-line data for use during surgery, sometimes called augmented reality or mixed reality technology. We have been working on these technologies for several years and more recently with our partner InTouch Health. Our next step in mixed reality technology is working in prototype form in laboratory settings today and we will move towards first human use in 2018.

影像和智慧演算法工作還包括處理和呈現術前成像和其他離線數據，以便在手術過程中使用，有時稱為擴增實境或混合實境技術。我們多年來一直在研究這些技術，最近更是與合作夥伴 InTouch Health 共同推進。我們混合實境技術的下一步發展方向是目前在實驗室環境中進行原型開發，我們將在 2018 年實現首次人體應用。

Bringing new platforms to the market represents a significant investment and we expect to invest up to $80 million more in 2017 than our typical operating expense run rate growth. These investments are focused on clinical and economic data, particularly in Europe and Asia; expansion of our operations capability to include da Vinci Sp; investments in our diagnostics platform; and continued investments in imaging. Calvin will take you through the spending implications later in the call.

將新平台推向市場是一項重大投資，我們預計 2017 年的投資金額將比我們通常的營運支出成長率高出 8,000 萬美元。這些投資主要集中在臨床和經濟數據方面，尤其是在歐洲和亞洲；擴大我們的營運能力，包括達文西手術系統；投資我們的診斷平台；以及持續投資影像技術。稍後，Calvin 將在電話會議中詳細講解支出的影響。

In closing, entering 2017 we are focused on the following. First, continued adoption of da Vinci in general surgery. Second, continued development of European markets and access to customers in Asia. Third, advancing our new platforms -- imaging, advanced instruments, da Vinci Sp, and diagnostic platform progress. And finally, support for additional clinical and economic validation by global region.

最後，展望2017年，我們將重點放在以下方面。首先，達文西手術系統在一般外科手術中繼續被應用。第二，繼續開拓歐洲市場並接觸亞洲客戶。第三，推動我們的新平台—影像、先進儀器、達文西手術系統和診斷平台的發展。最後，支援按全球區域進行額外的臨床和經濟驗證。

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

現在我將把電話交給馬歇爾，他將回顧財務要點。

Thank you, Gary.

謝謝你，加里。

I will describe our results on a non-GAAP or pro forma basis, which exclude specified legal settlements and 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 in our website so that there is no confusion.

我將以非GAAP或備考方式描述我們的業績，其中不包括特定的法律和解和索賠提列、股票選擇權補償以及購買智慧財產權的攤銷。我們提供預測性訊息，因為我們相信，以預測性資訊為基礎，更容易理解業務趨勢和經營績效。我稍後會在腳本中總結我們的 GAAP 結果。為了避免混淆，我們已在網站上公佈了備考業績與 GAAP 業績的調整表。

Consistent with our preliminary press release on January 11, fourth-quarter 2016 revenue was $757 million, an increase of 12% compared with $677 million for the fourth quarter of 2015 and an increase of 11% compared with the third-quarter revenue of $683 million.

與 1 月 11 日的初步新聞稿一致，2016 年第四季營收為 7.57 億美元，比 2015 年第四季的 6.77 億美元成長了 12%，比第三季的 6.83 億美元成長了 11%。

Fourth-quarter 2016 procedures increased 15% compared with fourth quarter of 2015 and increased 9% compared with last quarter. Procedure growth relative to last year and the third quarter has been driven by general surgery in the US and urology worldwide. The increase relative to the prior quarter also reflects procedure seasonality.

2016 年第四季手術量比 2015 年第四季成長 15%，比上一季成長 9%。與去年同期和第三季相比，手術量的成長主要得益於美國普通外科手術和全球泌尿外科手術的發展。與上一季相比的增長也反映了手術的季節性特徵。

Revenue highlights are as follows. Instrument and accessory revenue of $386 million increased 19% compared with last year and increased 11% compared with the third quarter of 2016. Instrument and accessory revenue realized per procedure, including initial stocking orders, was approximately $1,900 per procedure, compared with $1,840 last year and $1,870 last quarter. The increase relative to the fourth quarter of 2015 primarily reflects increased sales of our stapling and vessel sealing products. The increase compared with the third quarter of 2016 primarily reflects the impact of customer buying patterns.

以下是營收亮點。儀器及配件營收為 3.86 億美元，較去年同期成長 19%，較 2016 年第三季成長 11%。每台手術的器械和配件收入（包括初始庫存訂單）約為每台手術 1,900 美元，而去年同期為 1,840 美元，上一季為 1,870 美元。與 2015 年第四季相比，成長主要反映了我們訂書釘和容器密封產品的銷售增加。與 2016 年第三季相比，成長主要反映了顧客購買模式的影響。

System revenue of $236 million increased 2% compared with the fourth quarter of 2015 and increased 15% compared with last quarter. The year-over-year increase reflects higher system placements and higher revenue associated with lease buyouts and operating leases, partially offset by lower average selling prices. The quarter-over-quarter increase reflects higher system placements, partially offset by lower lease buyout revenue and lower average selling prices. 163 systems were placed in the fourth quarter of 2016, compared with 158 systems in the fourth quarter of 2015 and 134 systems last quarter. 13 systems were placed under operating lease transactions in the quarter, including our first two into Germany, compared with 16 in the fourth quarter of 2015 and 15 last quarter.

系統營收為 2.36 億美元，比 2015 年第四季成長 2%，比上一季成長 15%。與去年相比，成長反映了系統安裝量的增加以及與租賃買斷和經營租賃相關的收入增​​加，但部分被平均售價的下降所抵消。環比成長反映了系統安裝量的增加，但部分被租賃買斷收入下降和平均售價下降所抵消。2016 年第四季共安裝了 163 套系統，而 2015 年第四季為 158 套系統，上一季為 134 套系統。本季我們透過經營租賃交易部署了 13 套系統，其中包括我們在德國的首批兩套系統，而 2015 年第四季為 16 套，上季為 15 套。

As a reminder, revenue on operating lease transactions is recognized ratably over the life of the lease. As of the end of the fourth quarter, there were 79 systems out in the field under operating leases. We generated approximately $5 million of revenue associated with operating leases in the quarter, compared with $3 million in the fourth quarter of 2015 and approximately $4 million last quarter.

再次提醒，經營租賃交易的收入應在租賃期間內按比例確認。截至第四季末，共有 79 套系統以經營租賃的方式投入使用。本季我們透過經營租賃獲得了約 500 萬美元的收入，而 2015 年第四季為 300 萬美元，上一季約為 400 萬美元。

We generated approximately $7 million of revenue during the quarter from lease buyouts, compared with $3 million in the fourth quarter of 2015 and $13 million last quarter. We exclude the impact of operating leases and lease buyouts from our system ASP calculation. Globally, our ASP was $1.48 million, compared with $1.55 million last year and $1.53 million last quarter. We sold a higher proportion of Si refurbished systems in India and Europe in the quarter, as we see cost sensitivities in certain segments of these markets.

本季我們透過租賃買斷獲得了約 700 萬美元的收入，而 2015 年第四季為 300 萬美元，上一季為 1300 萬美元。我們在系統平均售價計算中排除了營業租賃和租賃買斷的影響。全球平均售價為 148 萬美元，去年同期為 155 萬美元，上季為 153 萬美元。本季度，我們在印度和歐洲銷售的 Si 翻新系統比例較高，因為我們發現這些市場某些細分領域對成本較為敏感。

Service revenue of $135 million increased 12% year over year and increased approximately 4% compared with the third 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 1.35 億美元，年增 12%，與 2016 年第三季相比成長約 4%。年比和環比增長反映了我們達文西手術系統安裝基礎的增長。

Outside of the US, results were as follows. Fourth-quarter revenue outside of the US of $212 million decreased 4% compared with $219 million for the fourth quarter of 2015 and increased 12% compared with $189 million for the third quarter. Recurring revenue increased 24% compared with the previous year and 10% compared with the third quarter, reflecting procedure growth and distributor buying patterns.

美國以外地區的結果如下。第四季美國以外的營收為 2.12 億美元，與 2015 年第四季的 2.19 億美元相比下降了 4%，與第三季的 1.89 億美元相比成長了 12%。與去年同期相比，經常性收入成長了 24%，與第三季相比成長了 10%，這反映了手術量的成長和經銷商的購買模式。

Systems revenue decreased 27% compared with the fourth quarter of 2015 and increased 14% compared with the previous quarter. Outside of the US, we placed 63 systems in the fourth quarter, compared with 75 systems in the fourth quarter of 2015 and 49 systems last quarter. The increase in system placements relative to the prior quarter reflects seasonality. The decrease in system placements relative to the prior year reflected 10 fewer systems into China, where we await a new quota, and four fewer systems into Brazil, where we are in the early stages of market adoption.

系統營收與 2015 年第四季相比下降了 27%，與上一季相比成長了 14%。在美國以外，我們在第四季度安裝了 63 套系統，而 2015 年第四季安裝了 75 套系統，上一季安裝了 49 套系統。與上一季相比，系統安裝量的增加反映了季節性因素。與前一年相比，系統部署數量的減少反映出，在中國的部署數量減少了 10 套，我們正在等待新的配額；在巴西的部署數量減少了 4 套，我們在巴西的市場採用還處於早期階段。

Current-quarter systems sales included 26 into Europe, three into China, 15 into Japan, and 19 into rest of world markets. System placements outside of the US will continue to be lumpy, as some of the OUS markets are in early stages of adoption; some markets are highly seasonal, reflecting budget cycles or vacation patterns; and sales into some markets are constrained by government regulations.

本季系統銷售額包括歐洲 26 套、中國 3 套、日本 15 套以及世界其他地區 19 套。美國以外地區的系統部署仍將不均衡，因為一些美國以外市場仍處於早期採用階段；一些市場具有很強的季節性，反映了預算週期或假期模式；而且一些市場的銷售受到政府法規的限制。

Moving on to the remainder of the P&L, total pro forma gross margin for the fourth quarter was 71.1%, compared with 69.6% for the fourth quarter of 2015 and 73.1% for the third quarter of 2016. The pro forma gross margin for the third quarter of 2016 included $7.1 million of medical device tax refunds, which benefited the third quarter gross margin by approximately 100 basis points. Excluding this impact, the decrease in gross margin relative to the third quarter reflects a higher mix of systems revenue and higher scope repair costs. Compared with the fourth quarter of 2015, the higher gross margin reflects reduced product costs and manufacturing efficiencies.

接下來來看損益表的其餘部分，第四季的總備考毛利率為 71.1%，而 2015 年第四季為 69.6%，2016 年第三季為 73.1%。2016 年第三季的備考毛利率包括 710 萬美元的醫療器材稅收退款，這使第三季的毛利率提高了約 100 個基點。排除這一影響，毛利率相對於第三季的下降反映了系統收入佔比上升和維修成本上升。與 2015 年第四季相比，更高的毛利率反映了產品成本的降低和生產效率的提高。

Future margins will fluctuate based on the mix of our newer products, the mix of systems 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.

未來的利潤率將根據我們新產品的組合、系統、儀器和配件收入的組合、與我們的內視鏡更換計劃相關的成本、我們進一步降低產品成本和提高生產效率的能力，以及從長遠來看，醫療器械稅的潛在恢復情況而波動。

Pro forma operating expenses increased 23% compared with the fourth quarter of 2015 and increased 14% compared with last quarter. The increases primarily reflect increased headcount, increased product development activities, and investments in our OUS commercial organization. We accelerated some operating expenses into the fourth quarter in anticipation of spending growth in 2017.

與 2015 年第四季相比，以備考計算的營運費用成長了 23%，與上一季相比成長了 14%。這些成長主要反映了員工人數的增加、產品開發活動的增加以及對我們海外商業組織的投資。我們提前將部分營運支出計入第四季度，以因應 2017 年的支出成長。

Our pro forma effective tax rate for the fourth quarter was 26.9%, compared with an effective tax rate of 24.9% for the fourth quarter of 2015 and 22.7% last quarter. The pro forma third-quarter 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 fourth quarter of 2015 tax rate reflected a full-year benefit associated with the reinstatement of the R&D tax credit whereas R&D -- the R&D credit has been recognized ratably during 2016. Our tax rate will fluctuate with changes in the mix of US and OUS income and with the impact of one-time items.

我們第四季的預期實際稅率為 26.9%，而 2015 年第四季的實際稅率為 24.9%，上一季為 22.7%。2016 年第三季的備考稅率反映了 1,600 萬美元的稅收優惠，即每股 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 年第四季的稅率反映了與研發稅收抵免恢復相關的全年收益，而研發稅收抵免在 2016 年已按比例確認。我們的稅率會隨著美國境內和境外收入組成的變化以及一次性項目的影響而波動。

Our fourth-quarter 2016 pro forma net income was $242 million, or $6.09 per share, compared with $224 million, or $5.89 per share, for the fourth quarter of 2015 and $246 million, or $6.19 per share, for the third quarter of 2016. Excluding the one-time income tax and medical device tax benefits, pro forma net income for the third quarter of 2016 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.

2016 年第四季，我們的備考淨收入為 2.42 億美元，即每股 6.09 美元；而 2015 年第四季為 2.24 億美元，即每股 5.89 美元；2016 年第三季為 2.46 億美元，即每股 6.19 美元。如果排除一次性所得稅和醫療器材稅收優惠，2016 年第三季的備考淨收入將為 2.25 億美元，即每股 5.65 美元。正如我之前提到的，預測收入可以更方便地比較我們的財務表現和業務趨勢。

I will now summarize our GAAP results. GAAP net income was $204 million, or $5.13 per share, for the fourth quarter of 2016, compared with $190 million, or $4.99 per share, for the fourth quarter of 2015 and $211 million, or $5.31 per share, for the third quarter of 2016.

現在我將總結一下我們的GAAP業績。2016 年第四季，GAAP 淨收入為 2.04 億美元，即每股 5.13 美元；而 2015 年第四季為 1.9 億美元，即每股 4.99 美元；2016 年第三季為 2.11 億美元，即每股 5.31 美元。

We ended the quarter with cash and investments of $4.8 billion, up from $4.6 billion as of September 30, 2016. The increase was primarily driven by cash generated from operations and proceeds from stock option exercises. During the quarter, we repurchased 55,000 shares for $34 million.

本季末，我們的現金和投資總額為 48 億美元，高於 2016 年 9 月 30 日的 46 億美元。成長主要由經營活動產生的現金流量和股票選擇權行使所得收益所推動。本季度，我們以 3,400 萬美元的價格回購了 55,000 股股票。

In mid-December, the Board of Directors increased the amount of authorized -- the amount authorized for stock buybacks to $3 billion. Today, we entered into a $2 billion accelerated stock buyback program with Goldman Sachs. The total number of shares repurchased will be based on a negotiated discount to the volume weighted average price of the stock over the contract period, which is expected to end in the fourth quarter, unless terminated earlier by Goldman Sachs.

12月中旬，董事會將授權金額（即授權用於股票回購的金額）增加到30億美元。今天，我們與高盛達成了一項20億美元的加速股票回購計畫。回購的股票總數將根據合約期間股票成交量加權平均價格的協商折扣計算，該合約預計將於第四季度結束，除非高盛提前終止合約。

Goldman is expected to deliver approximately 2.4 million shares, representing the initial delivery, within the next week. We will retire these shares as soon as practical thereafter. A final delivery of shares under the program, if any, will be delivered at the end of the contract period. Under our agreement with Goldman Sachs, we have reserved the ability to repurchase additional shares in the open market up to the Board's authorization during the accelerated stock buyback period.

高盛預計將在下週交付約 240 萬股，這是首批交付量。我們將在切實可行的情況下盡快贖回這些股份。該計劃下的最終股份交付（如有）將在合約結束時進行。根據我們與高盛的協議，在加速股票回購期內，我們保留在公開市場上回購額外股票的權利，但須經董事會授權。

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

接下來，我將把發言權交給卡爾文，他將介紹我們的流程和臨床要點。

Thank you, Marshall.

謝謝你，馬歇爾。

Our overall fourth-quarter procedure growth was approximately 15%, as US procedures grew approximately 13% and outside-the-US procedures grew approximately 23%. For the full year 2016, global procedure growth was also 15% overall, 13% US and 24% OUS.

我們第四季的整體手術量成長約為 15%，其中美國手術量成長約 13%，美國以外地區的手術量成長約 23%。2016 年全年，全球手術量整體成長 15%，美國成長 13%，美國以外地區成長 24%。

In the United States, fourth-quarter procedure trends were similar to the third quarter, characterized by strong general surgery growth, continued relative strength in gynecology, and modest dVP growth. Full-year 2016 US procedures totaled approximately 563,000, growing approximately 13%, compared to 11% in 2015.

在美國，第四季度的手術趨勢與第三季度相似，其特點是普通外科手術強勁增長，婦科手術持續保持相對強勢，以及dVP手術適度增長。2016 年全年美國手術總數約為 563,000 例，比 2015 年的 11% 增加了約 13%。

Fourth-quarter US general 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, as surgeon retention and expansion remains encouraging. Full-year 2016 US general surgery procedures totaled approximately 186,000, reflecting growth of approximately 33%, compared to 31% in 2015.

美國第四季一般外科手術的普及率依然強勁，這主要得益於疝氣修補手術的穩定成長以及大腸直腸手術的持續普及。疝氣修補術仍然是一般外科手術中新增手術量最大的手術，外科醫師的留任率和擴張速度仍然令人鼓舞。2016 年全年美國普通外科手術總數約為 186,000 例，與 2015 年的 31% 相比增長了約 33%。

In US gynecology, fourth-quarter procedures again grew modestly year over year, with growth led by malignant and complex benign hysterectomy. Procedures for other benign gynecologic conditions also grew modestly. Full-year 2016 US gynecology procedures totaled about 246,000, up approximately 3%, compared to growth of approximately 1% in 2015.

在美國婦科領域，第四季度手術量再次同比增長，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。其他良性婦科疾病的手術量也略有增加。2016 年全年美國婦科手術總數約為 246,000 例，比 2015 年的約 1% 增加了約 3%。

In US urology, fourth-quarter da Vinci Prostatectomy procedures grew at low single-digit rates, consistent with the third quarter. We believe that our US prostatectomy volumes have been tracking to the broader prostate surgery market. Approximately 70,000 dVPs were performed in the US in 2016, up approximately 5%, compared to 11% growth in 2015. Full-year 2016 US urology procedure volume of approximately 109,000 grew approximately 7%, compared to approximately 12% in 2015.

在美國泌尿外科領域，第四季度達文西前列腺切除術的手術量以較低的個位數成長率成長，與第三季的情況一致。我們認為，我們在美國進行的前列腺切除手術量與更廣泛的前列腺手術市場趨勢一致。2016 年美國進行了約 70,000 例 dVP 手術，比 2015 年的 11% 增長了約 5%。2016 年美國泌尿外科手術量約為 109,000 例，比 2015 年的約 12% 增加了約 7%。

In other US procedures, early-stage adoption of lobectomies and other thoracic procedures was strong during the quarter and year. These set of procedures are particularly well served by our da Vinci Xi product and 30-millimeter stapler products.

在美國其他手術方面，肺葉切除術和其他胸腔外科手術的早期應用在本季度和本年度表現強勁。我們的達文西 Xi 產品和 30 毫米縫合器產品尤其適用於這些手術流程。

Turning abroad, procedure growth outside of the United States was approximately 23% in the fourth quarter and approximately 24% for the full year 2016. Growth was driven by the continued adoption of da Vinci Prostatectomy, with solid contributions from kidney procedures.

從海外來看，2016 年第四季美國以外地區的手術量增加了約 23%，全年成長了約 24%。成長主要得益於達文西前列腺切除術的持續普及，腎臟手術也做出了穩健的貢獻。

Total procedure growth in Asia overall was strong, notably so in key strategic markets of China, Japan, and Korea. In Europe, procedure performance varied by country. Approximately 190,000 procedures were performed outside of the US in 2016.

亞洲整體手術量成長強勁，尤其是中國、日本和韓國等主要戰略市場。在歐洲，手術效果因國家而異。2016 年，約有 19 萬例手術在美國境外進行。

As Marshall mentioned earlier, our average instrument and accessory revenue realized per procedure increased on a year-over-year basis, largely attributable to the adoption of our stapling and vessel sealing technologies.

正如馬歇爾先前提到的，我們每次手術的平均器械和配件收入逐年增長，這主要歸功於我們縫合和血管密封技術的採用。

During the fourth quarter, one of the first studies on our EndoWrist stapler was published in the Journal of Laparoendoscopic & Advanced Surgical Techniques by Dr. Holzmacher and colleagues from the George Washington University School of Medicine. In their small case series comparing an EndoWrist to a laparoscopic 45-millimeter stapler for colorectal procedures, the authors found that the EndoWrist stapler was safe and effective while using fewer stapler fires, reducing the cost per procedure by approximately $150.

第四季度，喬治華盛頓大學醫學院的霍爾茲馬赫博士及其同事在《腹腔鏡和高級外科技術雜誌》上發表了關於我們 EndoWrist 縫合器的首批研究之一。在他們比較 EndoWrist 與 45 毫米腹腔鏡吻合器在結直腸手術中的小型病例係列中，作者發現 EndoWrist 吻合器安全有效，同時使用的吻合器擊發次數更少，每次手術的成本降低了約 150 美元。

The authors stated advantages of the robotic stapler include large range of motion and nine degree articulation. The robotic stapler has a comparable level of safety as a 45-millimeter laparoscopic stapler and is more cost effective.

作者指出，機器人訂書機的優點包括活動範圍大、可進行九度關節活動。機器人縫合器與 45 毫米腹腔鏡縫合器具有相當的安全性能，而且更具成本效益。

Beyond the stapler study, Q4 was another quarter with a large number of clinical publications evaluating da Vinci surgery. Dr. Cigdem Benlice and colleagues from the Cleveland Clinic of colorectal surgery digestive disease institute recently published a study titled Robotic Laparoscopic and Open Colectomy, a case-matched comparison from the ACS NSQIP. The study aimed to compare perioperative outcomes of patients undergoing robotic, laparoscopic, and open colectomy using the procedure-targeted database of the American College of Surgeons National Surgical Quality Improvement Program, ACS NSQIP.

除了縫合器研究之外，第四季度還有大量臨床出版物評估了達文西手術。克利夫蘭診所結直腸外科消化疾病研究所的 Cigdem Benlice 博士及其同事最近發表了一項題為「機器人腹腔鏡和開放式結腸切除術」的研究，這是一項來自 ACS NSQIP 的病例匹配比較。該研究旨在利用美國外科醫師學會國家外科品質改進計畫 (AC​​S NSQIP) 的手術目標資料庫，比較接受機器人、腹腔鏡和開放式結腸切除術的患者的圍手術期結果。

Robotic, laparoscopic, and open groups were matched 1 to 1 to 1 based on age, gender, body mass index, surgical procedure, diagnosis, and ASA classification. Out of the 12,790 patients, 387 fulfilled criteria per group after matching. Univariate comparisons showed operating time was longer and hospital stay was shorter in the robotic group. Important complication rates, including morbidity, superficial SSI, bleeding requiring transfusion, ventilator dependency, and [iliates] rates were demonstrably lower in the robotic group.

機器人手術組、腹腔鏡手術組和開放性手術組按年齡、性別、體重指數、手術方式、診斷和 ASA 分級進行 1:1:1 匹配。在 12,790 名患者中，經過匹配，每組有 387 名患者符合標準。單變量比較顯示，機器人手術組的手術時間較長，住院時間較短。機器人手術組的重要併發症發生率，包括發生率、表淺手術部位感染、需要輸血的出血、呼吸器依賴和[髂骨]發生率，均明顯低於其他組別。

The authors concluded that the ACS NSQIP data demonstrated several short-term advantages of robotic surgery, compared with laparoscopic and open surgery.

作者們得出結論，ACS NSQIP 數據表明，與腹腔鏡手術和開放手術相比，機器人手術具有幾個短期優勢。

I will now be providing you with our financial outlook for 2017. Starting with procedures, as described in our announcement last week, 2016 total da Vinci procedures grew approximately 15% to roughly 753,000 procedures performed worldwide. During 2017, we anticipate full-year procedure growth within a range of 9% to 12%. We expect 2017 procedure growth to continue to be driven by US general surgery and procedures outside the United States while we're still in early stages of adoption.

接下來我將為大家介紹我們2017年的財務展望。先從手術量說起，正如我們上週的公告中所述，2016 年達文西手術總量增長了約 15%，達到全球約 753,000 例手術。2017 年，我們預計全年手術量成長幅度在 9% 到 12% 之間。我們預計 2017 年手術量的成長將繼續由美國普通外科手術以及美國以外的手術推動，因為我們仍處於早期採用階段。

Our 2017 procedure growth expectations are directionally lower than the 2016 results, based upon the following assumptions for 2017 -- moderating growth in our mature US dVP and gynecology procedures that benefited from favorable macro trends in 2016, moderating international procedure growth as we await additional da Vinci procedure reimbursement in Japan and additional system sales quota in China, and lower percentage growth in US general surgery off a larger base of procedures. We expect similar seasonal timing of procedures in 2016 as we have experienced in previous years, with Q1 being the seasonally weakest quarter as patient deductibles are reset.

基於以下 2017 年的假設，我們對 2017 年手術量增長的預期方向低於 2016 年的結果——受益於 2016 年有利的宏觀趨勢，我們成熟的美國達文西手術和婦科手術的增長將有所放緩；由於我們等待日本達文西手術的額外報銷和額外手術百分比，中國的系統銷售成本將有所降低；我們預計 2016 年的手術季節性時間表與往年類似，第一季通常是季節性最弱的季度，因為患者的自付額會重新計算。

With respect to revenue, as we have mentioned previously, capital sales by their nature can vary from period to period based upon many factors, including hospital response to the evolving healthcare environment under the new US administration, hospital capital spending cycles, reimbursement in government quotas, and competitive factors. Within this construct, we would expect 2017 capital sales to follow historical seasonal patterns.

關於收入，正如我們之前提到的，資本銷售本質上會因多種因素而隨時間變化，包括醫院對美國新政府下不斷變化的醫療保健環境的反應、醫院資本支出週期、政府配額報銷以及競爭因素。在這種框架下，我們預期 2017 年的資本銷售將遵循歷史季節性模式。

Turning to gross profit, as Marshall described our full-year 2016 pro forma gross profit margin was 71.6%, as we ended the year at 71.1% in Q4. In 2017, we expect our pro forma gross profit margin to be within a range of between 69% and 71% of net revenue. We are projecting a modestly lower gross profit margin in 2017, reflecting the unfavorable impact of the stronger US dollar on OUS revenue and margin, non-recurrence of the medical device tax refund recognized in 2016, higher costs associated with new products, and directionally lower system ASPs as we see incremental market interest in our lower-priced offerings in certain geographic markets. Our actual gross profit margin will vary quarter to quarter, depending largely upon product and regional mix.

談到毛利，正如馬歇爾所描述的，我們 2016 年全年的備考毛利率為 71.6%，而我們在第四季結束時毛利率為 71.1%。2017 年，我們預計我們的備考毛利率將佔淨收入的 69% 至 71%。我們預計 2017 年毛利率將略有下降，這反映了美元走強對美國境外收入和利潤率的不利影響、2016 年確認的醫療器械稅收退款不再發生、新產品相關成本增加，以及由於我們看到某些地區市場對我們價格較低的產品越來越感興趣，系統平均售價將呈下降趨勢。我們的實際毛利率會因季度而異，主要取決於產品和地區組合。

Turning to operating expenses, as Gary and Marshall described we are accelerating up to $80 million in investment in several strategic areas that will benefit the Company over the long term. Consistent with that direction, we expect to grow pro forma 2017 operating expenses between 15% and 18% above 2016 levels. We expect our non-cash stock compensation expense to range between $190 million and $200 million in 2017, compared to $178 million in 2016.

談到營運費用，正如 Gary 和 Marshall 所描述的那樣，我們正在加快對幾個戰略領​​域的投資，投資額將高達 8000 萬美元，這將使公司長期受益。與此方向一致，我們預計 2017 年的備考營運費用將比 2016 年的水準成長 15% 至 18%。我們預計 2017 年的非現金股票補償支出將在 1.9 億美元至 2 億美元之間，而 2016 年為 1.78 億美元。

We expect other income, which is comprised mostly of interest income, to total between $25 million and $30 million in 2017.

我們預計 2017 年其他收入（主要包括利息收入）總額將在 2,500 萬美元至 3,000 萬美元之間。

With regard to income tax, consistent with our 2016 guidance we expect our 2017 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.

關於所得稅，根據我們 2016 年的指導意見，我們預計 2017 年的預計所得稅稅率將在稅前收入的 26.5% 至 28.5% 之間，主要取決於美國和國際利潤的組合。

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

我們的發言到此結束。現在開始回答各位的問題。

(Operator Instructions). Margaret Kaczor, William Blair.

（操作說明）瑪格麗特·卡佐爾，威廉·布萊爾。

The first question for me is you guys have been pretty busy announcing, obviously, the R&D spend. You have got the ASR, so clearly you guys are seeing a ton of opportunity. And so to that end, how should we think about the composition of the business three years from now, five years from now, whether it is based on disease state or sales channels, ASCs versus hospitals, or even product categories, so diagnostics, surgery, or even postop?

我的第一個問題是，顯然，你們一直忙著宣布研發支出。你們已經擁有了ASR，顯然你們看到了大量的機會。因此，為了達到這個目的，我們應該如何看待三年後、五年後的業務組成，無論是基於疾病狀態還是銷售管道，門診手術中心與醫院，甚至是產品類別，例如診斷、手術，甚至是術後護理？

This is Gary. I think in the next few years I would expect the business categories to be more or less as we describe them now. I think over time as Sp comes into the market it will feel like a surgical device in the kind of settings that you're used to. We do see increasing use of our products in ASCs. It's not a dominant part of the business at this time. I do think it will grow over time.

這是加里。我認為在未來幾年內，業務類別應該會與我們現在描述的大致相同。我認為隨著 Sp 進入市場，在您所熟悉的醫療環境中，它會逐漸像外科手術器械一樣發揮作用。我們看到，我們的產品在門診手術中心的使用量正在增加。目前它還不是公司業務的主要組成部分。我認為它會隨著時間推移而發展壯大。

And then on the diagnostic segment, too early to tell what those segments will break out into. I think it is a platform. I think over time it will broaden. In the early stages, we will be talking to you about lung cancer diagnosis as it comes out.

至於診斷部分，現在判斷這些部分會細分成什麼還為時過早。我認為它是一個平台。我認為隨著時間的推移，它會不斷擴大。在早期階段，我們會隨時向您介紹肺癌的診斷。

Great, and then on the imaging side, there is a few angles to come at it. And so, I think, Gary, you have talked about delivering therapy through energy, potentially, so I guess what would that mean to you? And then, has anything changed on your view of your willingness to bring in house either radio or chemiluminescent agents or do you prefer partnerships, and that would include the ureter agent that you talked about earlier?

很好，接下來在成像方面，還有幾個角度要考慮。所以，Gary，我想你之前談過透過能量進行治療的可能性，那麼這對你來說意味著什麼？那麼，您對引進放射性或化學發光劑的看法是否有改變？或者您更傾向於合作，這其中也包括您之前提到的輸尿管藥物？

Yes, so there are two different concepts in the question, so I will just tease them apart a little bit. On the imaging side of showing surgeons more of what's going on during surgery, we really view that in three different buckets. There is better hardware, better imaging sensors and endoscopes. We have been working on that diligently and releasing updates to that product line on a pretty regular cadence.

是的，這個問題包含了兩個不同的概念，所以我將稍微區分它們。在影像方面，為了讓外科醫師更清楚地了解手術過程中發生的情況，我們將其分為三個不同的類別。有更好的硬體、更好的成像感測器和內視鏡。我們一直在努力研發該產品線，並定期發布更新。

There is analytics and image processing that is more software based. We have also been working hard on that and have been increasing our investments.

還有一些分析和影像處理技術更多是基於軟體的。我們在這方面也一直在努力，並增加了投資。

And the last one are better sensors, better contrast agents, like the ureter agent.

最後一種是更好的感測器，更好的造影劑，例如輸尿管造影劑。

In some of them, we do the primary part of the design in house. In other places, for example in agents, we have an active licensing and co-development effort going on, so we really partner that activity with others. And a little bit of everything in between.

其中一些項目的主要設計工作都是在我們內部完成的。在其他領域，例如代理商領域，我們正在積極進行許可和合作開發工作，因此我們確實與其他機構合作進行這項活動。以及介於兩者之間的各種元素。

So, that was the imaging side. On the therapeutic side, pretty early to tell. I do think the flexible robotics platform, the computer-controlled catheters have the ability to ultimately deliver therapy. What exactly that looks like will be disease state dependent and is likely to involve different kinds of technology over time. Too early for us yet to call where that ends up.

以上就是成像方面的部分。從治療效果來看，現在下結論還為時過早。我認為靈活的機器人平台和電腦控制的導管最終能夠實現治療。具體情況將取決於疾病狀態，並且隨著時間的推移，可能涉及不同類型的技術。現在判斷最終結果還為時過早。

Great, and then one more, maybe for Marshall. How should we think about the cadence of the $80 million in spending? And why shouldn't we continue to expect it to go up in 2018 and beyond, given the opportunities in this long-term horizon that we've been talking about? Thank you.

太好了，那再來一個吧，也許給馬歇爾。我們該如何看待這8000萬美元支出的節奏？鑑於我們一直在討論的長期機遇，我們為什麼不應該繼續期待它在 2018 年及以後繼續上漲？謝謝。

Yes, so to be clear, what we said was we would accelerate spending of $80 million. We would expect to more normalize our margins in future years.

是的，所以說清楚點，我們說過我們會加快支出 8000 萬美元。我們預計未來幾年利潤率將更加正常化。

As far as the cadence within the year, spending, particularly as it relates to engineering and prototypes and so forth, can be pretty lumpy, so we haven't given you specific guidance, but I think you should expect it will go up as we go through the year.

至於一年中的節奏，支出，特別是與工程和原型等相關的支出，可能會出現相當大的波動，所以我們沒有給你具體的指導，但我認為你應該預料到，隨著時間的推移，支出會增加。

Thank you.

謝謝。

Tycho Peterson, JPMorgan.

泰科·彼得森，摩根大通。

A question on expectations around Xi for the year. For starters, you mentioned historical seasonal patterns. It sounds like you are not factoring any ACA-associated slowdown in the first half of the year. And then in the back half of the year, how should we think about maybe incremental placements ahead of the Sp rollout?

關於今年人們對習近平的期望的問題。首先，你提到了歷史上的季節性模式。聽起來你似乎沒有考慮到《平價醫療法案》（ACA）可能在上半年造成的經濟放緩。那麼在今年下半年，我們該如何考慮在 Sp 正式推出之前進行一些增量部署呢？

For starters, the first question on ACA, our sense here is that utilization probably won't change very much. We don't have a crystal ball, but so far the early indications are that will be stable.

首先，關於《平價醫療法案》(ACA) 的第一個問題，我們的感覺是，使用率可能不會有太大變化。我們沒有水晶球，但就目前來看，早期跡象顯示情況會比較穩定。

On the capital placement side, highly uncertain for us. We don't know. Early indications are that it is pretty stable, but depending on how policy ultimately is implemented, that uncertainty may roll through some capital planning processes for some of our customers. I wouldn't call it out yet, not clear that's happening, but it is a potential.

資金配置方面，對我們來說存在很大的不確定性。我們不知道。初步跡象顯示市場相當穩定，但根據政策最終的實施方式，這種不確定性可能會影響我們一些客戶的資本規劃流程。我現在不會妄下斷言，還不清楚是否真的發生了，但這確實是一種可能性。

With regard to timing in the year and Sp, I will let Marshall answer that question.

至於一年中的具體時間安排以及Sp，我會讓馬歇爾來回答這個問題。

From an Sp perspective, what we have been communicating is consistent with what I will say now, which is that Sp will contribute very little in terms of revenue in 2017 and will be more of a factor in 2018.

從 Sp 的角度來看，我們一直以來所傳達的訊息與我現在要說的一致，那就是 Sp 在 2017 年的收入貢獻將非常小，但在 2018 年將發揮更大的作用。

But in terms of driving incremental upgrades to Xi ahead of the rollout, should we think about any dynamic there?

但是，在正式發布前推動 Xi 的逐步升級方面，我們是否應該考慮任何動態因素？

Not really, no.

其實不是。

And will we get Sp data at SAGES? When can we start to think about some early user feedback?

我們能在SAGES上取得Sp數據嗎？我們什麼時候可以開始考慮收集一些早期用戶回饋？

We should have the opportunity to close this clinical feasibility trial and then initiate the IDE head and neck trial in the first half of the year. And as the one closes and the other opens, we will be in a better position to share with you that feedback.

我們應該有機會完成這項臨床可行性試驗，然後在上半年啟動 IDE 頭頸部試驗。隨著一家店關門歇業，另一家店開業，我們將能更好地與您分享這些回饋。

Okay, and then last one on hernia. Can you just give us an update of where we are from a penetration standpoint in terms of both inguinal and ventral and how you think about the relative growth rates this year?

好的，最後一個問題是關於疝氣的。能否請您介紹一下目前在腹股溝和腹股溝滲透率方面的情況，以及您對今年相對增長率的看法？

Yes, generally speaking, we think we are still in fairly early stages on both the ventral and the inguinal opportunity. You saw we talked about the results in general surgery, again, up over 30% this year. Obviously, we added a lot of new procedures and we gained confidence as the year went on, I think, regarding our opportunity on the inguinal side with demonstrated stickiness on surgeons and growth in that category.

是的，總的來說，我們認為無論是腹側還是腹股溝手術，我們都還處於相當早期的階段。您也看到了，我們討論了普通外科手術的成果，今年再次成長超過 30%。顯然，我們增加了許多新的手術項目，隨著時間的推移，我們對腹股溝手術的機會也越來越有信心，這反映在外科醫生對該領域的忠誠度和增長。

But it is still difficult for us to assess how many of, let's call it, the close to 300,000 ventral hernias and 700,000 inguinals will ultimately be robotic candidates, but we feel pretty confident that it is going to be driving growth for us into 2017 and beyond.

但我們仍然很難評估，在近 30 萬例腹壁疝氣和 70 萬例腹股溝疝氣中，最終有多少例會成為機器人手術的候選病例，但我們相當有信心，這將推動我們在 2017 年及以後實現增長。

Okay, thank you.

好的，謝謝。

Bob Hopkins, Bank of America.

鮑伯霍普金斯，美國銀行。

So Gary, I have a question for you. From a signaling perspective, this quarter is very interesting because you are accelerating $80 million expend and you are announcing a $2 billion ASR, so those are two very positive signaling events, in my view. I was just wondering, can you just help us understand why now is the time to be doing these things? What are the things you are seeing to give you confidence in the business, or am I not phrasing it correctly, that the $2 billion ASR is really just to offset the spending?

加里，我有個問題想問你。從訊號傳遞的角度來看，本季非常有趣，因為你們正在加速支出 8000 萬美元，並且宣布了 20 億美元的 ASR，所以在我看來，這是兩個非常積極的信號事件。我只是想問一下，您能否幫我們理解為什麼現在是做這些事情的時候？您看到了哪些方面讓您對這項業務充滿信心？或者，如果我的措辭不正確，您認為這 20 億美元的 ASR 實際上只是為了抵消支出嗎？

I think -- our process to get to both of these, I will just describe how did we get to accelerating investment and how do we get to the ASR. With regard to accelerated investment, I think we are feeling good and increasing confidence in the use of our products in general surgery. I think while we are still in early innings, I think the early results have been really strong, so that has been positive for us.

我認為——為了實現這兩個目標，我將描述我們是如何加速投資的，以及我們是如何達到 ASR 的。關於加速投資，我認為我們感覺良好，並且對我們產品在普通外科手術中的應用越來越有信心。我認為雖然我們還處於比賽初期，但目前的成績非常出色，這對我們來說是個好消息。

As we look at where we sit on the competitive landscape with regard to technologies and opportunities both here at home and abroad, we also are feeling confident that we have a very good technology pipeline and our positioning is quite good.

當我們審視自身在國內外技術和機會的競爭格局時，我們也對自身擁有非常優秀的技術儲備和良好的市場地位充滿信心。

And so as we look at then the opportunity to invest, our first priority is fund the existing business. The second priority is look for organic growth opportunities that can drive profitable growth in the future. That's where that $80 million is going, and we evaluate platforms and we look at total available market for those platforms, estimate what the profitability might be, and stack rank them and then invest.

因此，當我們考慮投資機會時，我們的首要任務是為現有企業提供資金。第二要務是尋找能夠在未來推動獲利成長的內生成長機會。這就是這 8,000 萬美元的用途，我們會評估各個平台，考察這些平台的總可用市場，估算可能的獲利能力，對它們進行排名，然後進行投資。

We look for acquisitions as a third priority or things that can add to our Company, and if we have excess capital, then opportunities to return it to shareholders.

我們將收購視為第三優先事項，或者說是能夠為公司帶來成長的事項；如果我們有多餘的資金，那麼我們會考慮將其返還給股東。

And so, we walked through that process this year carefully and robustly, and that led to both the pull forward of investment because we think there is opportunity and momentum and the opportunity to return some cash through the buybacks. And so, those time together more by process than by some algorithm.

因此，今年我們謹慎而有力地完成了這一過程，這不僅促成了提前投資，因為我們認為存在機會和勢頭，也促成了透過股票回購返還部分現金的機會。因此，我們在一起的時間更多是透過過程而不是某種演算法來實現的。

Great, that's very helpful. And then, just the one thing I wanted to follow up on is -- not asking you to commit here, but at least is there the potential for 2018 to be a year where you have three new product platforms, Sp, potentially biopsy, and then on the new imaging agent side? Does that potential at least exist?

太好了，這很有幫助。最後，我還有一件事想跟進——我不是要你在這裡做出承諾，但至少2018年是否有可能成為你推出三個新產品平台的一年，分別是Sp、潛在的活檢以及新的成像劑？這種可能性至少是存在的嗎？

I think Sp is the furthest along of the new platforms, and I think that Sp in 2018 has the opportunity to do some interesting things, should we execute well on a regulatory pathway.

我認為Sp是所有新平台中發展最快、最有潛力的，而且我認為，如果我們在監管路徑上執行得當，Sp在2018年有機會做一些有趣的事情。

Molecules -- the molecule side of imaging is further out than 2018. There are some interesting things in imaging that are in 2018. They are more software and hardware related as opposed to the molecular component.

分子成像－分子成像的發展遠超過 2018 年。2018 年成像領域有一些有趣的事情發生。它們更多地與軟體和硬體相關，而不是與分子成分相關。

On the diagnostic platform, we are not ready yet to anchor revenue expectations. I would not expect much in the 2018 time frame, although I think we're going to make great progress on the technology and the learning on it.

在診斷平台方面，我們目前還無法給出收入預期。雖然我認為我們在技術和相關學習方面會取得巨大進步，但我對 2018 年期間不會有太大期望。

Wonderful, thanks very much.

太好了，非常感謝。

David Lewis, Morgan Stanley.

大衛路易斯，摩根士丹利。

Gary, I am just trying to put the spending into perspective here. It seems hard to us that on individual trials you could pull forward the magnitude of spending you are pulling forward. So is it safe to assume that at least some significant component of this pull forward does relate to a new platform that you are working on? That is number one.

加里，我只是想讓大家更客觀地看待這筆開支。我們認為，在單次試驗中，很難提前支付你現在提前支付的金額。那麼，我們可以合理地假設，這種推進至少有相當一部分與您正在開發的新平台有關嗎？這是第一點。

And then not just the R&D spending, Gary; the other piece was there is commercial spending. Can you help us understand the areas that you are spending on commercially that are different than the true R&D investment?

而且不只是研發支出，加里；還有商業支出。您能否幫助我們了解您在商業支出方面有哪些領域與真正的研發投資不同？

Yes, yes, fair questions. On the first one, absolutely the incremental spend relates to building out second platforms. Sp has a lot of shared components with Xi, but not entirely shared components, and so bringing that out. It has a new supply chain, a new set of testing and manufacturing resources that have to get invested in, in addition to some of the trial work, so that's the platform.

是的，是的，問得好。第一個方面，新增支出絕對與建立第二個平台有關。Sp 與 Xi 有許多共用元件，但並非完全共用元件，因此需要指出這一點。它需要建立新的供應鏈，需要投入新的測試和製造資源，此外還需要進行一些試驗工作，這就是平台。

The diagnostics side we're really excited about and we think there is great opportunity at home and abroad, and so we are earlier in that platform, but we are doing what amounts to the design and early trial investments there. And then there are clinical and economic data investments on our existing platforms, particularly in Europe and in Asia where we think reimbursement or access, other kinds of access, payer access are important, and that's been data that we are happy to go invest and collect.

我們對診斷方面感到非常興奮，我們認為國內外都存在巨大的機會，因此我們在這個平台上處於早期階段，但我們正在進行相當於設計和早期試驗的投資。此外，我們也對現有平台進行臨床和經濟數據投資，尤其是在歐洲和亞洲，我們認為報銷或准入、其他類型的准入、支付方准入都很重要，而我們很樂意投資和收集這些數據。

So, it really is a mix of those elements, as you called out in the question.

所以，正如你在問題中提到的那樣，它確實是這些因素的混合。

Moving on to your second piece, remind me the second half of your question.

接下來是你的第二個問題，請你提醒我你問題的後半部。

Just commercial, the non-developmental piece (multiple speakers) the commercial development.

僅商業用途，非開發部分（多位發言人）商業開發。

Yes, yes, commercial investment. A good example of that is we think there is real opportunity for us in the major markets in Europe if we can increase our total business footprint.

是的，是的商業投資。一個很好的例子是，我們認為，如果我們能夠擴大業務規模，歐洲主要市場將為我們帶來真正的機會。

It is not just commercializing sales folks. But some of it is sales staff. We have added a seasoned executive in Germany as a German general manager. We are adding some clinical resources into Germany as well to round out the team there. I think it makes a lot of sense. Early returns on that are strong in terms of just their ability to get things done. And so, those kinds of investments have been going on.

這不僅僅是把銷售人員商業化。但其中一部分是銷售人員。我們聘請了一位經驗豐富的德國高階主管擔任德國總經理。我們也向德國增派了一些臨床資源，以完善那裡的團隊。我覺得很有道理。從他們完成任務的能力來看，初步結果非常顯著。因此，這類投資一直在進行。

Likewise in places like Japan, where we have been investing in reimbursements. Anticipating additional reimbursements in 2018, there is some prep work to get done in terms of both the customer base and commercial, as well as the government side.

同樣，在日本等地，我們也一直在投資賠償。預計 2018 年將有額外的報銷，因此在客戶群、商業以及政府方面都需要做一些準備。

And Gary, just a quick second question. On Sp, just to be clear, there are three approvals you talked about in this call, head and neck, urological, as well as TORS. Is it safe to assume those are the three clinical opportunities here near term? What I'm trying to get at is can you not launch Sp in more of a full commercial way until you have one of those three approvals, or that's not necessarily true?

加里，我還有一個問題。Sp，需要明確的是，您在這次通話中談到了三項批准，分別是頭頸部、泌尿科以及 TORS。是否可以認為這三點是近期內主要的臨床應用機會？我的意思是，在獲得這三項批准中的一項之前，是否就不能以更全面的商業方式推出 Sp，或者這不一定是正確的？

So, those are the first ideas. Which one comes first will depend on how regulatory bodies view it. I suspect urology will actually be earlier than the other ones, just based on existing data and past history.

以上就是最初的想法。哪個先發生，取決於監管機構的看法。根據現有數據和歷史經驗，我懷疑泌尿科的發生率實際上會比其他科室低。

We think those are good opportunities for the platform. They are not the only opportunities for the platform. So we are pursuing those, the work up to those in parallel, because we think it gives our customers the best financial flexibility to take advantage of the capital investment they would make in the platform. Does that make sense?

我們認為這些都是該平台的良好機會。這些並非該平台的唯一機會。因此，我們正在並行推進這些工作，因為我們認為這能讓我們的客戶擁有最大的財務靈活性，從而充分利用他們在平台上的資本投資。這樣說得通嗎？

It makes perfect sense. Thank you so much.

完全合情合理。太感謝了。

Amit Hazan, Citi.

Amit Hazan，花旗銀行。

I want to just come back to the R&D spend, the increased investment spend, for one second, just to clarify 2018 in particular. And this goes off, Gary, what I think you talked about earlier this month at the investor conference, that tailing off in 2018.

我想花一秒鐘時間，回到研發支出和增加的投資支出上來，特別是針對 2018 年的情況進行澄清。加里，我想你本月早些時候在投資者大會上談過，這種情況在 2018 年有所減弱。

And I think about that as I think about Sp, maybe that launch coming out so you get some savings there, but diagnostics, certainly imaging, seems like new and ongoing spend. So I wanted to maybe try to get you to clarify why that increased spending is just one year and not more than that. And in terms of just the R&D as a percent of sales, why wouldn't that just continue into next year? It seems like a lot of your spending is actually going to be ongoing.

我思考 Sp 的時候也想到了這一點，也許即將推出的產品可以節省一些費用，但診斷，尤其是成像，似乎是一項新的、持續的支出。所以我想請您解釋一下，為什麼增加的支出僅限於一年，而不是更長。如果僅從研發支出佔銷售額的百分比來看，為什麼這種情況不會延續到明年？看來你的很多支出其實都會是持續性的。

Yes, so what we are describing is that we are growing R&D spend, and it is really operations, not just R&D, so operating expenses unusually in 2017 as a run rate. And we think it will return to more normal growth rates in 2018.

是的，我們所描述的是，我們的研發支出正在成長，而且實際上是營運支出，而不僅僅是研發支出，因此 2017 年的營運支出按年率計算異常增長。我們認為，2018年經濟成長率將恢復到較正常的水準。

There is a couple of reasons that we think that is so. One of them is the biggest spend on a platform launch is actually the year before launch. That is where both you are building a lot of product, you are doing a lot of validations, you're getting ready, you are doing a lot of the staging. So that bolus will go through.

我們認為情況確實如此，原因有二。其中之一是，平台發布前一年的支出實際上是最大的支出。在那裡，你們既要建立大量產品，又要進行大量驗證，還要做好準備，進行大量測試。這樣，藥物就能通過。

We have been investing sequentially over time a fair amount more in imaging, so imaging in 2017 isn't a huge bolus; it is a ratable growth. And you are right; we expect revenue growth 2017 to 2018. So we expect growth in total OpEx expense in 2018. It is just that the growth rate will modulate relative to 2017.

隨著時間的推移，我們在影像技術方面持續加大投入，因此 2017 年影像技術的投入並非大幅成長，而是穩定成長。您說得對；我們預計 2017 年至 2018 年收入將實現成長。因此，我們預計 2018 年營運總支出將有所成長。只是成長率會相對於 2017 年有所調整。

So what we are trying to communicate to everybody here is that the growth rate in 2017 is unusual. We would expect revenue growth in 2018. We would expect op expense growth rate in 2018 as well, but more aligned with historical norms. In other words, the growth rate in 2017 is not the new normal.

所以，我們想傳達給大家的意思是，2017 年的成長率是不尋常的。我們預計2018年營收將實現成長。我們預計 2018 年營運費用成長率也將保持穩定，但會更符合歷史正常水準。換句話說，2017 年的成長率並不是新的常態。

That's helpful. And then, gynecology would be my second question. The 3.5% growth for the year, that is better than we expected, too. I think that is another year of improving growth for your second year in a row.

那很有幫助。那麼，我的第二個問題就是婦科方面的問題。今年的成長率為3.5%，這也比我們預期的要好。我認為這是你們連續第二年實現成長。

And you seem to be cautioning a little bit that some of this is not sustainable, that something like migration of procedures to GYN oncologists might run into [force]. And it strikes me as just a little bit too early or a little bit early to be to be concerned about that trend. And so, it seems like a newer trend to me. I am wanting to get you a little bit to comment on whether that is a real concern for 2017 or whether you are just putting out potential risk factors for the year.

你似乎也略帶警告說，其中一些做法是不可持續的，例如將手術轉移到婦科腫瘤醫生那裡可能會遇到阻礙。我覺得現在就擔心這種趨勢還太早。所以，在我看來，這似乎是比較新的趨勢。我想請您稍微評論一下，這是否是 2017 年一個真正令人擔憂的問題，或者您只是提出了這一年的潛在風險因素。

Gynecology is one of those mature procedure categories in the United States. If you look at benign hysterectomy, the largest procedure in the category, over 80% of those procedures are performed in some minimally invasive fashion, whether it be with laparoscopy, vaginal techniques, or robotic, and it has been that way the last two or three years.

在美國，婦科是較成熟的醫療程序之一。如果觀察良性子宮切除術（該類別中最大的手術），會發現超過 80% 的此類手術都是以某種微創方式進行的，無論是腹腔鏡手術、陰道手術還是機器人手術，而且在過去的兩三年裡一直如此。

So in that sense, we would expect -- our starting thought would be we are likely to move with the market in that scenario. So if you look back a couple of years ago at 2014, that's what happened. We declined low single digits. We think the total number of benign hysterectomies being performed is probably gradually declining in response to payer pushbacks on that procedure, encouraging other treatment modalities.

因此，從這個意義上講，我們預計——我們最初的想法是，在這種情況下，我們可能會隨市場而動。所以，如果你回顧一下幾年前的2014年，那就是當時發生的事。我們下降了個位數。我們認為，由於支付方對良性子宮切除術的抵制，良性子宮切除術的總例數可能正在逐漸下降，從而鼓勵採用其他治療方式。

So 2015, that moved to the other side of 1% growth, like I said in the comments. This year, it ramped up to about 3% growth. And you are right. I think it is largely reflecting a trend towards a higher proportion of the cases being performed by the gynecologic oncologist, a set of surgeons that are more aligned with robotics. So that has been a benefit.

所以，就像我在評論裡說的那樣，2015年，成長率突破了1%。今年，增速加快至約3%。你說得對。我認為這在很大程度上反映了一種趨勢，即越來越多的手術是由婦科腫瘤醫生完成的，而婦科腫瘤醫生這群人更傾向於使用機器人手術。所以這算是一件好事。

So our guidance would suggest we would expect this to moderate a little bit in 2017. We don't have a perfect crystal ball in this area, but at some point we think the more complex cases are the ones being referred and you hit a certain level where you're getting very adequate clinical outcomes with the other minimally invasive approaches. So, we will see how it plays out.

因此，根據我們的判斷，預計這種情況在 2017 年會略有緩和。我們在這個領域沒有完美的水晶球，但我們認為，在某種程度上，更複雜的病例會被轉診，而當達到一定水平時，其他微創方法就能獲得非常令人滿意的臨床結果。所以，我們拭目以待。

Thanks, guys.

謝謝各位。

Tao Levy, Wedbush.

陶·利維，韋德布希。

Just maybe you could update us on the status of China and the quota, next steps there, as well as what is needed to get the Xi approved in China.

或許您可以向我們介紹中國和配額的最新情況、下一步計劃，以及讓習近平在中國獲得批准需要做些什麼。

Yes, so two parts to the question. On the quota side, the quota is dependent upon the approval of their budget, the Chinese government budget, and then allocations are then done down through MOH and then to the hospitals and so on and so forth until they get to which hospitals can buy specifically da Vinci product.

是的，這個問題包含兩個部分。在配額方面，配額取決於其預算、中國政府預算的批准，然後透過衛生部向下分配到醫院等等，直到最終確定哪些醫院可以購買達文西產品。

They have taken the first step. They have approved -- they did approve the budget at the end of 2016, so in December. However, they did not take it further to the allocations to specifics as to who gets to buy a da Vinci or how many will be bought. That process is still in motion. It is not something we can control and, frankly, we don't have great visibility as to what's going on behind the curtains to get there.

他們已經踏出了第一步。他們已經批准了——他們在 2016 年底，也就是 12 月批准了預算。然而，他們並沒有進一步討論具體的分配方案，例如誰可以購買達文西電腦，或將購買多少台。這個過程仍在進行中。這不是我們能夠控制的事情，坦白說，我們也不太清楚幕後發生了什麼才能達到目的。

And so at this point, we sit and wait for the next quota to be approved. I think what we have also told people is if you look at the last time quota was approved, it still takes some time for the hospitals to actually complete the tender process and buy product. So if you are putting together a model, looking at the last time quota was approved in 2013, most of the systems were bought near the end of 2015. So the likelihood that there is going to be a lot of revenue coming out of a quota in 2017 is not very high.

所以現在，我們只能坐等下一批配額獲得批准。我認為我們也告訴過大家，如果回顧上次配額獲得批准的情況，醫院實際上還需要一些時間才能完成招標流程併購買產品。因此，如果您正在建立一個模型，回顧上次配額批准的時間（2013 年），大多數系統是在 2015 年底附近購買的。因此，2017 年透過配額獲得大量收入的可能性並不高。

And on Xi?

那麼關於習近平呢？

Xi is in process. It is a long approval process. We will tell you when we get it, which is our typical pattern of disclosure. We don't know where it is in the process.

習近平正在籌備中。審批過程很漫長。我們收到後會立即通知您，這是我們一貫的資訊揭露方式。我們不知道它處於哪個階段。

Yes, we are encouraged. I don't see a major impediment to Xi clearance in China, and in general we are encouraged by the response of the market to robotic surgery and to Intuitive in China. So I think in general, with the caveat that Marshall has outlined, as a whole we look positively on the opportunity.

是的，我們受到了鼓舞。我認為習近平在中國獲得批准不會有重大障礙，而且總的來說，我們對中國市場對機器人手術和直覺醫療的反應感到鼓舞。所以我認為，總的來說，除了馬歇爾提出的警告之外，我們對這個機會總體上持積極態度。

Great, thanks.

太好了，謝謝。

Larry Keusch, Raymond James.

Larry Keusch，Raymond James。

Marshall, in your -- excuse me, Gary, in your prepared comments, I think I heard this correctly, but you were referencing long-term investments and you were talking about investments for products and services. And I just want to make sure I heard that correctly, and if that is correct, what were you thinking about when you were talking about past services?

馬歇爾，在你——抱歉，加里，在你準備好的發言中，我想我沒聽錯，你提到了長期投資，你談論的是產品和服務方面的投資。我只是想確認一下我是否聽錯了，如果我沒聽錯的話，你剛才談到過去的服務時，指的是什麼？

Yes, we provide a series of things now to the customer that are an ecosystem around the product itself. So the simple things you think about are things like maintenance services, but we increasingly have access to interesting data on the use of devices, our devices, benchmarking that are international and things like efficiency metrics for the use of robotic systems.

是的，我們現在為客戶提供一系列圍繞產品本身構建的生態系統。所以，你首先想到的簡單事情是維護服務之類的事情，但我們越來越多地獲得有關設備使用情況的有趣數據，包括我們自己的設備、國際基準測試以及機器人系統使用效率指標等。

In the last couple of years, we have partnered with hospitals to provide that set of data to them and to help them improve their systems, and that's been a real positive for them and for us, and so that's what I meant when I said services. I think those data opportunities and benchmarking opportunities increase in the future.

在過去的幾年裡，我們與醫院合作，向他們提供這組數據，幫助他們改善系統，這對他們和我們來說都是非常積極的，這就是我所說的服務。我認為未來這些數據機會和基準測試機會將會增加。

Okay, great. And then, I just want to pick up on some comments that you made earlier in the month and specifically get your thoughts on as you talk about, again, some of this imaging technology and the ability to perhaps be involved in pre-procedure planning. Is the way to think about that, that would really be done with the surgeon interfacing with the imaging capabilities and the machine itself, or is there an element there where Intuitive can insert itself more from a service perspective in perhaps procedure planning?

好的，太好了。然後，我想就您本月早些時候發表的一些評論談談我的看法，特別是您再次談到成像技術以及參與術前計劃的能力時，我想听聽您的想法。思考這個問題的方式是，這真的應該由外科醫生與成像功能和機器本身互動來完成嗎？還是說，Intuitive 可以從服務的角度，例如在手術計劃方面，更多地介入其中？

And then, the other question around that was just getting your thoughts on where you think machine learning goes as it relates to robotic surgery.

然後，另一個相關的問題是，您認為機器學習在機器人手術領域的發展方向是什麼？

Sure, I think to the first question of what -- does it change where we interact at the hospital, I think in the near term the answer is yes, but only a little bit.

當然，對於第一個問題——它是否會改變我們在醫院的互動方式——我認為短期內答案是肯定的，但改變的幅度不大。

I think that there is an opportunity to look at things like preoperative images that patients are required to do as part of their diagnostic workup, and to be able to use and do some postprocessing and machine learning on those preoperative images to improve surgeons' navigation or other capabilities during the case. That looks pretty interesting. That is some of the technology I showed you a few weeks ago at JPMorgan.

我認為，我們可以研究一些諸如患者在診斷過程中需要進行的術前影像之類的東西，並能夠對這些術前影像進行一些後處理和機器學習，以提高外科醫生在手術過程中的導航或其他能力。看起來很有趣。那是我幾週前在摩根大通往你們展示的部分技術。

I think in the near term that's how we think about it. In the long term, I do think that there are interesting opportunities for analytics as it relates to the workings of a robotic surgery program or a minimally invasive surgery program that are a little bit outside of what's happening in a single case, and that may change and provide an opportunity for Intuitive to engage conversations with the hospital in a little more broad manner. But I think those are -- we are in early days of those conversations.

我認為短期內我們會這樣考慮。從長遠來看，我認為在機器人手術專案或微創手術專案的運作方面，分析存在著一些有趣的機遇，這些機會與單一病例之外的情況有所不同，並且可能會發生變化，從而為 Intuitive 提供機會，以更廣泛的方式與醫院進行對話。但我認為，我們還處於這些討論的早期階段。

Okay, great. And last quick one, just, Calvin, I know you made a mention on lobectomy, but again any color that you could provide as to the uptake and perhaps the opportunity around that.

好的，太好了。最後一個問題，卡爾文，我知道你提到了肺葉切除術，但你能否再提供一些關於該手術的接受度以及相關機會的信息？

Again, like I said, I think Q4 and really throughout the year in 2016 was a positive period of time for us. It is still fairly early in that category. We are focused, the field team, more on the general surgery opportunity, but there is increasing sets of people engaging some of the key thoracic surgeons getting some of the newer technology.

正如我之前所說，我認為 2016 年第四季以及全年對我們來說都是一段正面的時期。目前還處於這個階段的早期。我們現場團隊更專注於普通外科手術的機會，但越來越多的人正在與一些關鍵的胸腔外科醫生合作，以獲得一些新技術。

I mentioned the Xi system and 30-millimeter staplers in those hands and gaining that experience and building volumes from there is something we are focused on. But I think the value is high in that procedure and the opportunity is significant in the US, but when you look outside the US to Europe and particularly Asia with higher lung cancer rates, it is pretty interesting.

我曾提到 Xi 系統和 30 毫米訂書機，我們正在努力累積經驗，並以此為基礎擴大產量。但我認為這種手術的價值很高，在美國的機會也很大，但當你把目光投向美國以外的歐洲，特別是肺癌發病率更高的亞洲時，情況就變得非常有趣了。

Great, thank you.

太好了，謝謝。

Larry Biegelsen, Wells Fargo.

拉里·比格爾森，富國銀行。

It is actually Craig Bijou on for Larry. Thanks for taking the questions. I wanted to start, Calvin, with your comments on, as part of your procedure guidance, the moderating international growth. And I want to ask what is the risk to procedure growth, given some of the slowdown in European systems sales and balancing that with the strong procedure growth that you guys have said that you are seeing in Asia.

事實上，代替拉里上場的是克雷格·比茹。謝謝您回答問題。卡爾文，我想先從你對緩和國際成長這一程序指導問題的評論開始。我想問一下，考慮到歐洲系統銷售放緩，而你們又提到亞洲的手術量增長強勁，那麼手術量增長面臨的風險是什麼？

So, I guess in the case where your European procedure -- or system sales don't pick up again and maybe the China tender or the China quota doesn't come on board as quickly as you expect, what is the risk to that international procedure growth of 20% plus?

所以，我想，如果你的歐洲手術或系統銷售沒有再次回升，而且中國的招標或配額也沒有像你預期的那樣迅速到位，那麼20%以上的國際手術增長面臨怎樣的風險呢？

Yes, I mentioned it as one of the bullet points in there for the outlook for -- a moderating outlook on overall procedure growth. Internationally, I think the areas I pointed out specifically were for China. Marshall talked a little bit about the quota there. The fact is that the systems we do have in China are some of the (technical difficulty) productive systems we have, and our ability to continue to grow procedures now is somewhat paced by our ability to get more capacity in the field. So, that can be a factor in 2017.

是的，我把它作為展望前景的要點之一提到了——整體手術成長前景趨於緩和。從國際角度來看，我認為我特別指出的那些領域指的是中國。馬歇爾簡單地談到了那裡的配額問題。事實上，我們在中國擁有的系統是（技術難度）最高的生產系統之一，而我們現在繼續擴大手術流程的能力在某種程度上取決於我們能否在現場獲得更多能力。所以，這可能是2017年的影響因素。

And then in Japan, we very successfully ramped up the procedures where we have reimbursement, the prostatectomy procedure and earlier stage of a smaller category in the partial nephrectomy. So I think as those procedures have ramped, you have got less room, and we are awaiting additional procedures in 2018, which will be required to sustain growth. Both those markets, I would say, are -- we have got very positive long-term views on, but some specific factors impacting 2017.

然後在日本，我們非常成功地擴大了可報銷的手術範圍，包括前列腺切除術和較小類別的早期部分腎切除術。所以我認為，隨著這些手術的開展，你們的空間就越來越小了，而且我們還在等待 2018 年進行更多手術，這將是維持成長所必需的。我認為，這兩個市場——我們對它們的長期前景都非常樂觀——但2017年有一些具體因素會影響它們。

Operator, we have time for one last question.

操作員，我們還有最後一個問題。

Richard Newitter, Leerink Partners.

Richard Newitter，Leerink Partners。

Thanks for squeezing me in. I had two. Just, Marshall, just on the gross margin factors in the guidance for 2017, I heard FX, I heard the med tech tax refund benefit not repeating. Could you just elaborate on the last two, and then I have one follow-up on thoracic?

謝謝你擠出時間陪我。我有兩個。馬歇爾，關於 2017 年業績指引中的毛利率因素，我聽說外匯市場，我聽說醫療技術稅收退稅優惠不會再次出現。能否詳細說明最後兩個問題？另外，我還有一個關於胸椎的問題要跟進。

I don't think we have a follow-up, so, Marshall, take that one and we'll go from there.

我認為我們沒有後續問題了，所以，馬歇爾，你先處理這個問題，我們再從那裡開始。

Yes, I think the things that can affect the gross margin are -- like we said, we had some experience in the quarter with selling the lower-cost systems in cost-sensitive markets where we saw some success, so we will see if that continues. It is an [N of 1], but we will see what happens.

是的，我認為可能影響毛利率的因素是——就像我們之前說的，本季我們在對成本敏感的市場銷售低成本系統方面取得了一些成功，所以我們將看看這種情況是否會持續下去。這是一個[N=1]的情況，但我們會看看會發生什麼。

Certainly, new product introductions and new products have lower margins that our older products and so that also has an impact as we increase the sales of vessel sealing and stapling, and even though we have cost reduced them somewhat, they are still higher -- or lower margin than our historical products. And so as we increase the sale of newer products, that will have a negative impact.

當然，新產品的推出和新產品的利潤率低於我們以前的產品，因此，隨著我們增加容器密封和釘合產品的銷量，即使我們已經在一定程度上降低了它們的成本，但它們的利潤率仍然高於——或者說低於——我們過去的產品。因此，隨著新產品銷售的增加，這將產生負面影響。

Then the other item that we mentioned was repair costs associated with scopes, and we continue to work, as Gary said, iterate the imaging capability and the hardware, and as we do, we will reduce the cost, as well as improve the repairability. But that is a little ways off and so we're -- it will happen incrementally over time.

然後，我們提到的另一項是與瞄準鏡相關的維修成本，正如 Gary 所說，我們將繼續努力，不斷改進成像能力和硬件，隨著我們的努力，我們將降低成本，並提高可維修性。但這還有一段路要走，所以——它會隨著時間的推移而逐步發生。

All right, Richard. Calvin says take your follow-up.

好的，理查德。卡爾文說，請跟進。

All right, appreciate that. Thank you. Just on thoracic, is there any -- can you just maybe talk about the type of surgeon that you need to target, the kind of -- and the phasing of it, because I know there are some general surgeons that perform the procedures and then you obviously have cardiothoracic surgeons and specialists? Can you just describe who you are targeting and when and can that potentially give us a sense as to when we might begin to see more of an inflection point in the thoracic lobectomy segment? Thanks.

好的，謝謝。謝謝。就胸腔外科而言，您能否談談需要尋找哪種類型的外科醫生，以及手術的階段安排？因為我知道有些普通外科醫生會進行這些手術，當然還有心胸外科醫生和專家。您能否描述一下您的目標族群和時間，這能否讓我們大致了解胸肺葉切除術領域何時會出現更大的轉折點？謝謝。

Yes, I will answer that one. I think that we are still in pretty early part of the market option for thoracic surgery. In general, it has been engaging thought leaders in thoracic surgery, some of whom are minimally invasive surgeons today and some of whom are predominantly open surgeons. There is a mix.

是的，我會回答這個問題。我認為我們目前仍處於胸腔外科手術市場選擇的早期階段。總的來說，它一直在與胸腔外科領域的思想領袖互動，其中一些現在是微創外科醫生，而其他人則主要從事開放式手術。兩者兼具。

It tends less to be the generalist here and more to be the thought leadership in thoracic as a whole.

它與其說是通才，不如說是胸腔外科領域的思想領袖。

Part of I think what has been pacing growth here is just completing the product set for efficiency and speed of case. I think we are very close now to having complete product sets, things like 30-millimeter staplers and so on, and that has helped. So, I think as that product set completes, as we proliferate Xis in the world, that has made adoption more likely and easier.

我認為推動成長的部分原因是完善產品線以提高案件處理效率和速度。我認為我們現在離擁有完整的產品套裝已經非常接近了，例如 30 毫米訂書機等等，這很有幫助。所以，我認為隨著該產品系列的完善，隨著我們在世界各地推廣 Xi，這使得產品的普及和普及變得更加可能和容易。

I will turn to our close. That was our last question. 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.

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

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

我們創立這家公司的目的是為了將外科手術推向人類雙手能力的極限，我向你們保證，我們將繼續致力於推動那些真正能帶來改變的關鍵因素。

This concludes today's call. We thank you for your participation and support on this extraordinary journey to improve surgery and I look forward to speaking with you again on the next call.

今天的電話會議到此結束。感謝您參與並支持我們這段非凡的外科手術改進之旅，期待在下次電話會議上再次與您交流。

Ladies and gentlemen, as you just heard, today's conference has concluded. Thank you for your participation. You may now disconnect.

女士們、先生們，正如你們剛才聽到的，今天的會議已經結束了。感謝您的參與。您現在可以斷開連線了。