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.

女士們，先生們，感謝你們的支持，歡迎來到 Intuitive Surgical 2016 年第四季度財報電話會議。

(Operator Instructions).

（操作員說明）。

As a reminder, today's conference is being recorded.

提醒一下，今天的會議正在錄製中。

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

我現在想將會議轉交給財務和投資者關係高級總監 Calvin Darling。

Please go ahead.

請繼續。

Thank you.

謝謝你。

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

下午好，歡迎來到 Intuitive Surgical 的第四季度收益電話會議。

With me today we have Gary Guthart, our President and CEO, and Marshall Mohr, our Chief Financial Officer.

今天和我一起的有我們的總裁兼首席執行官 Gary Guthart 和我們的首席財務官 Marshall Mohr。

Note that Patrick Clingan, who routinely participates on these calls, will not be on the call today to attend to personal matters.

請注意，經常參加這些電話會議的帕特里克·克林根 (Patrick Clingan) 今天不會參加電話會議來處理個人事務。

We look forward to his return next time.

我們期待他下次回歸。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements.

在我們開始之前，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。

Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties.

由於某些風險和不確定性，實際結果可能與明示或暗示的結果存在重大差異。

These risks and uncertainties are described in detail in the Company's Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 2, 2016, and 10-Q filed on October 19, 2016.

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 10 月 19 日提交的 10-Q 表格。

These filings can be found through our website or at the SEC's EDGAR database.

這些文件可以通過我們的網站或 SEC 的 EDGAR 數據庫找到。

Prospective investors are cautioned not to place undue reliance on such forward-looking statements.

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.

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。

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

此外，今天的新聞稿和補充財務數據表已發佈到我們的網站上。

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.

今天的形式將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四季度業績的亮點，然後是問答環節。

Gary will present the quarter's business and operational highlights.

Gary 將介紹本季度的業務和運營亮點。

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.

Marshall 將回顧我們第四季度的財務業績，然後我將討論程序和臨床重點，並提供我們 2017 年的財務展望。

And finally, we will host a question-and-answer session.

最後，我們將舉辦問答環節。

With that, I 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.

下午好，感謝您今天加入我們的電話會議。

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.

Intuitive 的使命是擴大微創手術的可用性、提高其療效並降低其侵入性，第四季度在達芬奇程序的持續增長和我們的擴張的帶動下，為實現這一使命而取得了強勁的一年安裝基礎。

Annualized global procedure growth was approximately 15% in the fourth quarter and 15% for the full year.

第四季度全球手術年增長率約為 15%，全年增長率為 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.

手術趨勢全年保持一致，達芬奇在美國普外科的使用增加，日本和歐洲泌尿外科持續增長，韓國和中國的多專業增長。

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.

美國成熟的手術，包括前列腺切除術和子宮切除術，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.

歐洲、韓國和中國的手術增長全年都很健康。

Procedure adoption in Japan was solid for those procedures that have been reimbursed.

對於那些已報銷的程序，日本的程序採用率很高。

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

Calvin 將在稍後的電話會議中更詳細地審查程序趨勢。

Our capital placement performance in 2016 strengthened over 2015, resulting in a growth of total placements from 492 in 2015 to 537 this year.

我們在 2016 年的資本配售表現優於 2015 年，導致總配售量從 2015 年的 492 筆增加到今年的 537 筆。

Net of trade-ins and retirements, our clinical installed base grew from 3,597 to 3,919 in the year.

扣除以舊換新和退休後，我們的臨床安裝基數在這一年從 3,597 增加到 3,919。

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.

我們的能力範圍和價格點以及我們靈活採用收購方法的能力使我們能夠在競爭激烈的資本環境中滿足不同的客戶需求。

Customers have chosen our most capable system, da Vinci Xi, in roughly three-quarters of new capital placements for the full year.

在全年大約四分之三的新資本配置中，客戶選擇了我們功能最強大的系統 da Vinci Xi。

Da Vinci Xi is well matched with procedure opportunities in thoracic and general surgical procedures, such as colon and rectal surgeries.

Da Vinci Xi 非常適合胸外科和普通外科手術，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.

美國的資本配置在這一年中表現突出，而亞洲的資本配置與之前的趨勢一致。

As we have said in prior calls, system quotas in China and reimbursements in Japan temper placement growth and make it hard to predict.

正如我們在之前的電話中所說，中國的系統配額和日本的報銷會抑制安置增長並使其難以預測。

Turning to Europe, while procedure growth was solid in 2016, system placements declined versus 2015 for reasons that vary by country.

轉向歐洲，雖然 2016 年手術增長穩健，但係統安置與 2015 年相比有所下降，原因因國家/地區而異。

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.

在我們最大的歐洲市場，我們相信長期的程序和系統機會是巨大的，進一步採用受益於成熟程序（如前列腺切除術）的額外經濟驗證以及針對結直腸手術等新興程序的特定國家/地區的臨床和經濟數據。

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 年資本放緩，但我們對我們在歐洲的長期前景持樂觀態度，並繼續發展我們的組織並投資於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.

談到我們第四季度經營業績的亮點，程序比去年第四季度增長了約 15%。

We shipped 163 da Vinci Surgical Systems, up from 158 in the fourth quarter of 2015.

我們出貨了 163 台達芬奇手術系統，高於 2015 年第四季度的 158 台。

Revenue for the quarter was $757 million, up 12% from prior year.

本季度收入為 7.57 億美元，比去年同期增長 12%。

Pro forma gross profit was 71.1%, compared to 69.6% in the fourth quarter of last year.

備考毛利為 71.1%，而去年第四季度為 69.6%。

Instrument and accessory revenue increased to $386 million, up 19%.

儀器和附件收入增加到 3.86 億美元，增長 19%。

Total recurring revenue in the quarter was $521 million, representing 69% of total revenue.

本季度經常性總收入為 5.21 億美元，佔總收入的 69%。

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.

本季度我們的預估營業利潤為 3.2 億美元，比去年第四季度增長 9%，預估淨收入為 2.42 億美元，比 2015 年第四季度增長 8%。

Highlights of the full year of 2016 are as follows.

2016 年全年要點如下。

Procedures grew approximately 15% over full-year 2015.

程序比 2015 年全年增長了約 15%。

We shipped 537 systems in 2016, up from 492 in the prior year.

我們在 2016 年出貨了 537 個系統，高於上一年的 492 個。

Revenue for the year was $2.7 billion, up 13%.

全年收入為 27 億美元，增長 13%。

Pro forma gross margin was 71.6% for the full year, compared to 68.2% in 2015.

全年預計毛利率為 71.6%，而 2015 年為 68.2%。

Total recurring revenue for the year was $1.9 billion and represented 71% of total revenue.

全年經常性收入總額為 19 億美元，佔總收入的 71%。

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%.

全年預計營業利潤為 12 億美元，比 2015 年增長 22%，預計淨收入為 8.79 億美元，增長 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.

正如我們在 12 月中旬提到的，我們的董事會將我們的股票回購授權增加到 30 億美元，我們今天宣布了一項 20 億美元的加速回購計劃。

We retain the flexibility to act on the remaining $1 billion in authorization in parallel with the ASR.

我們保留在 ASR 的同時對剩餘的 10 億美元授權採取行動的靈活性。

Overall, we are committed to the thoughtful return of excess capital to shareholders and believe our buyback program will serve shareholders well.

總體而言，我們致力於將超額資本周到地返還給股東，並相信我們的回購計劃將為股東提供良好的服務。

Marshall will take you through our finances in greater detail shortly.

Marshall 稍後將帶您更詳細地了解我們的財務狀況。

As our business has strengthened, we have increased our mid- and long-term investments in creating our next generation of products and services.

隨著我們業務的加強，我們增加了對創造下一代產品和服務的中長期投資。

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.

這些投資是基於我們的信念，即存在大量機會來實現更多的微創手術、更好的結果並在全球範圍內擴大對我們技術的訪問。

Our current da Vinci Sp system met its development goals in the fourth quarter and we initiated its first clinical feasibility study.

我們目前的達芬奇 Sp 系統在第四季度達到了開發目標，我們啟動了第一個臨床可行性研究。

As we have discussed on prior calls, we plan first markets to include head and neck surgery, urology, and colorectal surgery.

正如我們在之前的電話會議上所討論的那樣，我們計劃首先將市場包括頭頸外科、泌尿外科和結直腸外科。

Sp is a platform technology that allows high-dexterity access with great 3-D vision to confined surgical spaces.

Sp 是一種平台技術，允許以出色的 3-D 視覺高度靈活地進入狹窄的手術空間。

Early surgeon response to Sp in the trials has been very positive.

外科醫生在試驗中對 Sp 的早期反應非常積極。

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，並提交用於泌尿外科應用的 510-K。

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.

我們在靈活的機器人平台上也取得了良好進展，首先旨在解決肺癌的迫切需求和診斷，肺癌是世界上最常診斷的癌症形式之一，早期檢測對其很重要。

The technology underpinning this system is based on computer-controlled catheters, advanced image processing, and sophisticated sensing.

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。

As we mentioned previously, the system is in its early stages of our human clinical experience.

正如我們之前提到的，該系統處於我們人類臨床經驗的早期階段。

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.

這種體驗令人信服，我們的設計和運營團隊正在努力整合反饋並完成其生產設計和供應鏈優化。

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.

鑑於該系統在肺癌檢測和其他潛在應用方面的長期機會，我們一直在擴大我們在這一領域的團隊。

We do not anticipate revenue from this product in 2017.

我們預計 2017 年不會從該產品中獲得收入。

Imaging and intelligent algorithms offers significant opportunities to enhance surgeon capabilities.

成像和智能算法為增強外科醫生的能力提供了重要機會。

Our investments include hardware and imaging -- image processing updates to our Xi platform to enhance imaging performance and reduce costs.

我們的投資包括硬件和成像——對我們的 Xi 平台進行圖像處理更新，以提高成像性能並降低成本。

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.

我們還在投資用於特定解剖結構的造影劑，最近宣布我們計劃開始對與我們的 Firefly 成像硬件和軟件兼容的輸尿管成像劑進行 I 期試驗。

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.

成像和智能算法工作還包括術前成像和其他離線數據的處理和呈現，以供手術期間使用，有時稱為增強現實或混合現實技術。

We have been working on these technologies for several years and more recently with our partner InTouch Health.

多年來，我們一直在研究這些技術，最近還與我們的合作夥伴 InTouch Health 合作。

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.

我們在混合現實技術方面的下一步是今天在實驗室環境中以原型形式工作，我們將在 2018 年實現首次人類使用。

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.

將新平台推向市場是一項重大投資，我們預計 2017 年的投資將比我們典型的運營費用運行率增長多 8000 萬美元。

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.

這些投資側重於臨床和經濟數據，尤其是在歐洲和亞洲；擴大我們的運營能力，包括 da Vinci Sp；對我們診斷平台的投資；並繼續投資於成像。

Calvin will take you through the spending implications later in the call.

Calvin 將在稍後的電話會議中帶您了解支出影響。

In closing, entering 2017 we are focused on the following.

最後，進入 2017 年，我們將重點關注以下內容。

First, continued adoption of da Vinci in general surgery.

首先，在普外科繼續採用達芬奇。

Second, continued development of European markets and access to customers in Asia.

二是繼續開拓歐洲市場，獲取亞洲客戶。

Third, advancing our new platforms -- imaging, advanced instruments, da Vinci Sp, and diagnostic platform progress.

第三，推進我們的新平台——成像、先進儀器、達芬奇 Sp 和診斷平台的進展。

And finally, support for additional clinical and economic validation by global region.

最後，支持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.

我現在將把電話轉給馬歇爾，他將審查財務亮點。

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.

我將在非 GAAP 或備考基礎上描述我們的結果，其中不包括特定的法律和解和應計索賠、基於股票的補償以及所購買 IP 的攤銷。

We provide pro forma information because we believe that business trends and operating results are easier to understand on a pro forma basis.

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。

I will also summarize our GAAP results later in my script.

我還將在稍後的腳本中總結我們的 GAAP 結果。

We have posted reconciliations of our pro forma results to our GAAP results in our website so that there is no confusion.

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。

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.

與我們在 1 月 11 日發布的初步新聞稿一致，2016 年第四季度收入為 7.57 億美元，與 2015 年第四季度的 6.77 億美元相比增長 12%，與第三季度的 6.83 億美元收入相比增長 11% .

Fourth-quarter 2016 procedures increased 15% compared with fourth quarter of 2015 and increased 9% compared with last quarter.

2016 年第四季度的程序與 2015 年第四季度相比增加了 15%，與上一季度相比增加了 9%。

Procedure growth relative to last year and the third quarter has been driven by general surgery in the US and urology worldwide.

與去年和第三季度相比，手術的增長受到美國普通外科和全球泌尿外科的推動。

The increase relative to the prior quarter also reflects procedure seasonality.

與上一季度相比的增長也反映了程序的季節性。

Revenue highlights are as follows.

收入亮點如下。

Instrument and accessory revenue of $386 million increased 19% compared with last year and increased 11% compared with the third quarter of 2016.

儀器及附件收入為 3.86 億美元，與去年同期相比增長 19%，與 2016 年第三季度相比增長 11%。

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.

每次手術實現的儀器和配件收入（包括初始庫存訂單）約為每次手術 1,900 美元，而去年和上季度分別為 1,840 美元和 1,870 美元。

The increase relative to the fourth quarter of 2015 primarily reflects increased sales of our stapling and vessel sealing products.

與 2015 年第四季度相比的增長主要反映了我們縫合和血管密封產品的銷售額增加。

The increase compared with the third quarter of 2016 primarily reflects the impact of customer buying patterns.

與 2016 年第三季度相比的增長主要反映了客戶購買模式的影響。

System revenue of $236 million increased 2% compared with the fourth quarter of 2015 and increased 15% compared with last quarter.

系統收入為 2.36 億美元，與 2015 年第四季度相比增長 2%，與上一季度相比增長 15%。

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.

同比增長反映了更高的系統配置和更高的與租賃收購和經營租賃相關的收入，部分被較低的平均售價所抵消。

The quarter-over-quarter increase reflects higher system placements, partially offset by lower lease buyout revenue and lower average selling prices.

環比增長反映了更高的系統安置，部分被較低的租賃買斷收入和較低的平均售價所抵消。

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.

2016 年第四季度部署了 163 個系統，而 2015 年第四季度為 158 個系統，上一季度為 134 個系統。

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.

本季度有 13 個系統進行了經營租賃交易，其中包括我們進入德國的前兩個系統，而 2015 年第四季度為 16 個，上季度為 15 個。

As a reminder, revenue on operating lease transactions is recognized ratably over the life of the lease.

提醒一下，經營租賃交易的收入在租賃期內按比例確認。

As of the end of the fourth quarter, there were 79 systems out in the field under operating leases.

截至第四季度末，現場有 79 個系統處於經營租賃狀態。

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.

我們在本季度產生了約 500 萬美元與經營租賃相關的收入，而 2015 年第四季度為 300 萬美元，上一季度約為 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.

我們在本季度從租賃買斷中獲得了大約 700 萬美元的收入，而 2015 年第四季度為 300 萬美元，上一季度為 1300 萬美元。

We exclude the impact of operating leases and lease buyouts from our system ASP calculation.

我們從我們的系統 ASP 計算中排除了經營租賃和租賃買斷的影響。

Globally, our ASP was $1.48 million, compared with $1.55 million last year and $1.53 million last quarter.

在全球範圍內，我們的平均售價為 148 萬美元，而去年為 155 萬美元，上季度為 153 萬美元。

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.

我們在本季度在印度和歐洲銷售了更高比例的 Si 翻新系統，因為我們看到這些市場的某些部分對成本敏感。

Service revenue of $135 million increased 12% year over year and increased approximately 4% compared with the third quarter of 2016.

服務收入 1.35 億美元，同比增長 12%，與 2016 年第三季度相比增長約 4%。

The year-over-year and quarter-over-quarter increases reflect growth in our installed base of da Vinci Systems.

同比和環比增長反映了達芬奇系統安裝基數的增長。

Outside of the US, results were as follows.

在美國以外，結果如下。

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.

第四季度美國以外的收入為 2.12 億美元，與 2015 年第四季度的 2.19 億美元相比下降 4%，與第三季度的 1.89 億美元相比增長 12%。

Recurring revenue increased 24% compared with the previous year and 10% compared with the third quarter, reflecting procedure growth and distributor buying patterns.

經常性收入與去年同期相比增長 24%，與第三季度相比增長 10%，反映了流程增長和分銷商購買模式。

Systems revenue decreased 27% compared with the fourth quarter of 2015 and increased 14% compared with the previous quarter.

系統收入與 2015 年第四季度相比下降 27%，與上一季度相比增長 14%。

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.

在美國以外，我們在第四季度部署了 63 個系統，而 2015 年第四季度為 75 個系統，上一季度為 49 個系統。

The increase in system placements relative to the prior quarter reflects seasonality.

系統佈局相對於上一季度的增加反映了季節性。

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.

與上一年相比，系統安裝量的減少反映了進入中國的系統減少了 10 個，我們在那裡等待新的配額，進入巴西的系統減少了 4 個，我們在巴西處於市場採用的早期階段。

Current-quarter systems sales included 26 into Europe, three into China, 15 into Japan, and 19 into rest of world markets.

當前季度的系統銷售額包括 26 個進入歐洲、3 個進入中國、15 個進入日本和 19 個進入世界其他市場。

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.

美國以外的系統佈局將繼續不穩定，因為一些 OUS 市場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；某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.

轉到損益表的其餘部分，第四季度的總備考毛利率為 71.1%，而 2015 年第四季度為 69.6%，2016 年第三季度為 73.1%。

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.

2016 年第三季度的備考毛利率包括 710 萬美元的醫療器械退稅，這使第三季度毛利率受益約 100 個基點。

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.

排除這一影響，毛利率相對於第三季度的下降反映了更高的系統收入組合和更高的範圍維修成本。

Compared with the fourth quarter of 2015, the higher gross margin reflects reduced product costs and manufacturing efficiencies.

與 2015 年第四季度相比，較高的毛利率反映了產品成本和製造效率的降低。

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、系統和儀器及附件收入的組合、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 23% compared with the fourth quarter of 2015 and increased 14% compared with last quarter.

預計營業費用與 2015 年第四季度相比增長 23%，與上一季度相比增長 14%。

The increases primarily reflect increased headcount, increased product development activities, and investments in our OUS commercial organization.

這些增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 OUS 商業組織的投資。

We accelerated some operating expenses into the fourth quarter in anticipation of spending growth in 2017.

由於預期 2017 年的支出增長，我們在第四季度加快了一些運營支出。

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.

我們第四季度的備考有效稅率為 26.9%，而 2015 年第四季度的有效稅率為 24.9%，上一季度為 22.7%。

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.

2016 年第三季度備考稅率反映了 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。

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.

2015 年第四季度的稅率反映了與恢復研發稅收抵免相關的全年收益，而研發 - 研發抵免已在 2016 年得到認可。

Our tax rate will fluctuate with changes in the mix of US and OUS income and with the impact of one-time items.

我們的稅率將隨著美國和美國收入組合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.

我們 2016 年第四季度的備考淨收入為 2.42 億美元，即每股 6.09 美元，而 2015 年第四季度為 2.24 億美元，即每股 5.89 美元，2016 年第三季度為 2.46 億美元，即每股 6.19 美元。

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.

不包括一次性所得稅和醫療器械稅收優惠，2016 年第三季度的預估淨收入為 2.25 億美元，或每股 5.65 美元。

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

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.

我現在將總結我們的 GAAP 結果。

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.

2016 年第四季度 GAAP 淨收入為 2.04 億美元，即每股 5.13 美元，而 2015 年第四季度為 1.9 億美元，即每股 4.99 美元，2016 年第三季度為 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.

本季度末，我們的現金和投資為 48 億美元，高於 2016 年 9 月 30 日的 46 億美元。

The increase was primarily driven by cash generated from operations and proceeds from stock option exercises.

增加的主要原因是運營產生的現金和股票期權行使的收益。

During the quarter, we repurchased 55,000 shares for $34 million.

本季度，我們以 3400 萬美元回購了 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.

12 月中旬，董事會將授權的股票回購金額增加到 30 億美元。

Today, we entered into a $2 billion accelerated stock buyback program with Goldman Sachs.

今天，我們與高盛簽署了一項價值 20 億美元的加速股票回購計劃。

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.

回購的股份總數將基於合同期內股票成交量加權平均價的協商折扣，合同期預計將在第四季度結束，除非高盛提前終止。

Goldman is expected to deliver approximately 2.4 million shares, representing the initial delivery, within the next week.

預計高盛將在下週交付約 240 萬股股票，即首次交付。

We will retire these shares as soon as practical thereafter.

我們將在可行的情況下盡快退役這些股票。

A final delivery of shares under the program, if any, will be delivered at the end of the contract period.

該計劃下的最終股份交付（如果有）將在合同期結束時交付。

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.

根據我們與高盛的協議，我們保留在加速股票回購期間在董事會授權的情況下在公開市場上回購額外股票的能力。

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

有了這個，我想把它交給卡爾文，他將回顧我們的程序和臨床亮點。

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%.

我們第四季度的總體程序增長約為 15%，因為美國程序增長了約 13%，美國以外的程序增長了約 23%。

For the full year 2016, global procedure growth was also 15% overall, 13% US and 24% OUS.

2016 年全年，全球手術總體增長 15%，美國增長 13%，美國增長 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.

在美國，第四季度的手術趨勢與第三季度相似，其特點是普通外科增長強勁，婦科持續相對強勁，dVP 增長適度。

Full-year 2016 US procedures totaled approximately 563,000, growing approximately 13%, compared to 11% in 2015.

2016 年全年美國手術總數約為 563,000 例，增長約 13%，而 2015 年為 11%。

Fourth-quarter US general surgery procedure adoption remains strong, led by solid growth in hernia repair and continued adoption of colorectal procedures.

受疝氣修復穩健增長和繼續採用結直腸手術的帶動，第四季度美國普通外科手術的採用率依然強勁。

Hernia repair continues to contribute the largest volume of new procedures in general surgery, as surgeon retention and expansion remains encouraging.

由於外科醫生的保留和擴張仍然令人鼓舞，疝氣修復繼續為普通外科手術中的新手術做出最大貢獻。

Full-year 2016 US general surgery procedures totaled approximately 186,000, reflecting growth of approximately 33%, compared to 31% in 2015.

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.

在美國婦科，第四季度的手術再次同比小幅增長，增長由惡性和復雜的良性子宮切除術帶動。

Procedures for other benign gynecologic conditions also grew modestly.

其他良性婦科疾病的手術也適度增長。

Full-year 2016 US gynecology procedures totaled about 246,000, up approximately 3%, compared to growth of approximately 1% in 2015.

與 2015 年約 1% 的增長率相比，2016 年全年美國婦科手術總數約為 246,000 例，增長約 3%。

In US urology, fourth-quarter da Vinci Prostatectomy procedures grew at low single-digit rates, consistent with the third quarter.

在美國泌尿外科，第四季度達芬奇前列腺切除術手術以較低的個位數增長率增長，與第三季度一致。

We believe that our US prostatectomy volumes have been tracking to the broader prostate surgery market.

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。

Approximately 70,000 dVPs were performed in the US in 2016, up approximately 5%, compared to 11% growth in 2015.

2016 年美國實施了大約 70,000 例 dVP，與 2015 年 11% 的增長率相比增長了約 5%。

Full-year 2016 US urology procedure volume of approximately 109,000 grew approximately 7%, compared to approximately 12% in 2015.

與 2015 年的約 12% 相比，2016 年全年美國泌尿外科手術量約為 109,000 例，增長了約 7%。

In other US procedures, early-stage adoption of lobectomies and other thoracic procedures was strong during the quarter and year.

在美國的其他手術中，肺葉切除術和其他胸部手術的早期採用在本季度和本年度表現強勁。

These set of procedures are particularly well served by our da Vinci Xi product and 30-millimeter stapler products.

我們的 da Vinci Xi 產品和 30 毫米訂書機產品特別適合這些程序。

Turning abroad, procedure growth outside of the United States was approximately 23% in the fourth quarter and approximately 24% for the full year 2016.

轉向國外，美國以外的程序增長在第四季度約為 23%，2016 年全年約為 24%。

Growth was driven by the continued adoption of da Vinci Prostatectomy, with solid contributions from kidney procedures.

達芬奇前列腺切除術的持續採用推動了增長，腎臟手術也做出了巨大貢獻。

Total procedure growth in Asia overall was strong, notably so in key strategic markets of China, Japan, and Korea.

亞洲整體手術增長強勁，尤其是在中國、日本和韓國等關鍵戰略市場。

In Europe, procedure performance varied by country.

在歐洲，程序性能因國家/地區而異。

Approximately 190,000 procedures were performed outside of the US in 2016.

2016 年在美國境外進行了大約 190,000 次手術。

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 Marshall 之前提到的，我們每個程序實現的平均儀器和配件收入同比增長，這主要歸功於採用了我們的縫合和容器密封技術。

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.

在第四季度，喬治華盛頓大學醫學院的 Holzmacher 博士及其同事在《腹腔鏡與高級外科技術雜誌》上發表了關於我們 EndoWrist 吻合器的首批研究之一。

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.

在他們的小型案例係列中，作者將 EndoWrist 與用於結直腸手術的腹腔鏡 45 毫米吻合器進行了比較，作者發現 EndoWrist 吻合器安全有效，同時使用較少的吻合器火力，使每次手術的成本降低約 150 美元。

The authors stated advantages of the robotic stapler include large range of motion and nine degree articulation.

作者表示，機器人訂書機的優點包括大範圍的運動和九度關節。

The robotic stapler has a comparable level of safety as a 45-millimeter laparoscopic stapler and is more cost effective.

機器人吻合器具有與 45 毫米腹腔鏡吻合器相當的安全水平，並且更具成本效益。

Beyond the stapler study, Q4 was another quarter with a large number of clinical publications evaluating da Vinci surgery.

除了吻合器研究之外，第四季度還有大量評估達芬奇手術的臨床出版物。

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.

克利夫蘭結直腸外科消化疾病研究所 Cigdem Benlice 博士及其同事最近發表了一項名為機器人腹腔鏡和開腹結腸切除術的研究，這是一項來自 ACS NSQIP 的病例匹配比較。

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.

該研究旨在使用美國外科醫師學會國家外科質量改進計劃 (ACS NSQIP) 的程序目標數據庫比較接受機器人、腹腔鏡和開腹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.

機器人組、腹腔鏡組和開腹組根據年齡、性別、體重指數、手術程序、診斷和 ASA 分類按 1 對 1 對 1 匹配。

Out of the 12,790 patients, 387 fulfilled criteria per group after matching.

在 12,790 名患者中，匹配後每組有 387 名患者符合標準。

Univariate comparisons showed operating time was longer and hospital stay was shorter in the robotic group.

單變量比較顯示機器人組的手術時間更長，住院時間更短。

Important complication rates, including morbidity, superficial SSI, bleeding requiring transfusion, ventilator dependency, and [iliates] rates were demonstrably lower in the robotic group.

機器人組的重要並發症發生率，包括發病率、淺表 SSI、需要輸血的出血、呼吸機依賴性和 [髂骨病] 率明顯較低。

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

作者得出結論，與腹腔鏡和開腹手術相比，ACS NSQIP 數據證明了機器人手術的幾個短期優勢。

I will now be providing you with our financial outlook for 2017.

我現在將為您提供我們 2017 年的財務展望。

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.

從手術開始，正如我們上週的公告所述，2016 年達芬奇手術總數增長了約 15%，在全球範圍內執行了約 753,000 例手術。

During 2017, we anticipate full-year procedure growth within a range of 9% to 12%.

2017 年，我們預計全年手術增長率將在 9% 至 12% 之間。

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.

我們預計 2017 年的程序增長將繼續由美國普通外科和美國以外的程序推動，而我們仍處於採用的早期階段。

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.

我們 2017 年的程序增長預期定向低於 2016 年的結果，基於 2017 年的以下假設——我們成熟的美國 dVP 和婦科程序的增長放緩，這得益於 2016 年有利的宏觀趨勢，隨著我們等待額外的數據，國際程序增長放緩日本的 Vinci 程序報銷和中國額外的系統銷售配額，以及美國普通外科手術基數較大的較低百分比增長。

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.

我們預計 2016 年手術的季節性時間與往年類似，第一季度是季節性最弱的季度，因為患者免賠額被重置。

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.

關於收入，正如我們之前提到的，資本銷售的性質在不同時期可能會有所不同，具體取決於許多因素，包括醫院對美國新政府不斷變化的醫療環境的反應、醫院資本支出週期、政府配額的報銷和競爭因素。

Within this construct, we would expect 2017 capital sales to follow historical seasonal patterns.

在此結構中，我們預計 2017 年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.

談到毛利潤，正如馬歇爾所描述的，我們 2016 年全年的備考毛利率為 71.6%，而我們在第四季度結束時為 71.1%。

In 2017, we expect our pro forma gross profit margin to be within a range of between 69% and 71% of net revenue.

2017 年，我們預計我們的備考毛利率將在淨收入的 69% 至 71% 之間。

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.

我們預計 2017 年毛利率略有下降，反映了美元走強對 OUS 收入和利潤率的不利影響、2016 年確認的醫療器械退稅不再發生、與新產品相關的成本增加以及定向下降系統 ASP，因為我們看到市場對我們在某些地區市場的低價產品越來越感興趣。

Our actual gross profit margin will vary quarter to quarter, depending largely upon product and regional mix.

我們的實際毛利率每個季度都會有所不同，這在很大程度上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.

談到運營費用，正如加里和馬歇爾所描述的那樣，我們正在加速在幾個戰略領域投資高達 8000 萬美元，這將使公司長期受益。

Consistent with that direction, we expect to grow pro forma 2017 operating expenses between 15% and 18% above 2016 levels.

與這一方向一致，我們預計 2017 年備考運營費用將比 2016 年水平增長 15% 至 18%。

We expect our non-cash stock compensation expense to range between $190 million and $200 million in 2017, compared to $178 million in 2016.

我們預計 2017 年我們的非現金股票補償費用將在 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 年主要由利息收入組成的其他收入總額將在 2500 萬美元至 3000 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 年的指引，我們預計 2017 年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.

我們準備好的評論到此結束。

We will now open the call to your questions.

我們現在將打開您的問題的電話。

(Operator Instructions).

（操作員說明）。

Margaret Kaczor, William Blair.

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.

我的第一個問題是你們一直忙於宣布研發支出。

You have got the ASR, so clearly you guys are seeing a ton of opportunity.

你們已經獲得了 ASR，很明顯你們看到了很多機會。

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?

因此，為此，我們應該如何考慮三年後、五年後的業務構成，無論是基於疾病狀態還是銷售渠道，ASC 與醫院，甚至產品類別，診斷、手術，甚至是術後？

This is Gary.

這是加里。

I think in the next few years I would expect the business categories to be more or less as we describe them now.

我認為在接下來的幾年裡，我希望業務類別或多或少像我們現在描述的那樣。

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.

我認為隨著時間的推移，隨著 Sp 進入市場，它會感覺像是您習慣的那種設置中的外科設備。

We do see increasing use of our products in ASCs.

我們確實看到我們的產品在 ASC 中的使用越來越多。

It's not a dominant part of the business at this time.

目前，它還不是業務的主要部分。

I do think it will grow over time.

我確實認為它會隨著時間的推移而增長。

And then on the diagnostic segment, too early to tell what those segments will break out into.

然後在診斷部分，現在判斷這些部分將分解成什麼還為時過早。

I think it is a platform.

我認為這是一個平台。

I think over time it will broaden.

我認為隨著時間的推移它會擴大。

In the early stages, we will be talking to you about lung cancer diagnosis as it comes out.

在早期階段，我們將與您討論肺癌的診斷結果。

Great, and then on the imaging side, there is a few angles to come at it.

太好了，然後在成像方面，有幾個角度可以解決。

And so, I think, Gary, you have talked about delivering therapy through energy, potentially, so I guess what would that mean to you?

所以，我想，加里，你已經談到過可能通過能量來提供治療，所以我想這對你意味著什麼？

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?

然後，您是否願意引入無線電或化學發光劑，或者您更喜歡合作夥伴關係，這包括您之前談到的輸尿管劑，這有什麼改變嗎？

Yes, so there are two different concepts in the question, so I will just tease them apart a little bit.

是的，所以問題中有兩個不同的概念，所以我將把它們分開一點。

On the imaging side of showing surgeons more of what's going on during surgery, we really view that in three different buckets.

在向外科醫生展示更多手術過程中發生的事情的成像方面，我們真正地從三個不同的角度來看待它。

There is better hardware, better imaging sensors and endoscopes.

有更好的硬件、更好的成像傳感器和內窺鏡。

We have been working on that diligently and releasing updates to that product line on a pretty regular cadence.

我們一直在努力工作，並以相當規律的節奏發布對該產品線的更新。

There is analytics and image processing that is more software based.

有更多基於軟件的分析和圖像處理。

We have also been working hard on that and have been increasing our investments.

我們也一直在努力，並一直在增加我們的投資。

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

最後一個是更好的傳感器，更好的造影劑，比如輸尿管造影劑。

In some of them, we do the primary part of the design in house.

在其中一些中，我們在內部完成設計的主要部分。

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.

在其他地方，例如在代理商中，我們正在進行積極的許可和共同開發工作，因此我們真正與其他人合作開展這項活動。

And a little bit of everything in between.

以及介於兩者之間的所有內容。

So, that was the imaging side.

所以，這就是成像方面。

On the therapeutic side, pretty early to tell.

在治療方面，現在還很早。

I do think the flexible robotics platform, the computer-controlled catheters have the ability to ultimately deliver therapy.

我確實認為靈活的機器人平台，計算機控制的導管有能力最終提供治療。

What exactly that looks like will be disease state dependent and is likely to involve different kinds of technology over time.

究竟是什麼樣子將取決於疾病狀態，並且隨著時間的推移可能涉及不同種類的技術。

Too early for us yet to call where that ends up.

對我們來說還為時過早。

Great, and then one more, maybe for Marshall.

太好了，然後再寫一篇，也許是給 Marshall 的。

How should we think about the cadence of the $80 million in spending?

我們應該如何考慮 8000 萬美元支出的節奏？

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?

考慮到我們一直在談論的長期前景中的機會，我們為什麼不繼續期望它在 2018 年及以後繼續上升？

Thank you.

謝謝你。

Yes, so to be clear, what we said was we would accelerate spending of $80 million.

是的，要明確一點，我們說的是我們將加快 8000 萬美元的支出。

We would expect to more normalize our margins in future years.

我們希望在未來幾年使我們的利潤率更加正常化。

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.

就一年內的節奏而言，支出，尤其是與工程和原型等相關的支出，可能會非常不穩定，所以我們沒有給你具體的指導，但我認為你應該期望它會隨著我們的增長而上升度過這一年。

Thank you.

謝謝你。

Tycho Peterson, JPMorgan.

摩根大通第谷彼得森。

A question on expectations around Xi for the year.

一個關於今年對習近平的期望的問題。

For starters, you mentioned historical seasonal patterns.

首先，您提到了歷史季節性模式。

It sounds like you are not factoring any ACA-associated slowdown in the first half of the year.

聽起來您沒有考慮到今年上半年與 ACA 相關的任何放緩。

And then in the back half of the year, how should we think about maybe incremental placements ahead of the Sp rollout?

然後在今年下半年，我們應該如何考慮在 Sp 推出之前可能增加的展示位置？

For starters, the first question on ACA, our sense here is that utilization probably won't change very much.

首先，關於 ACA 的第一個問題，我們的感覺是利用率可能不會有太大變化。

We don't have a crystal ball, but so far the early indications are that will be stable.

我們沒有水晶球，但到目前為止，早期跡象表明這將是穩定的。

On the capital placement side, highly uncertain for us.

在資本配售方面，對我們來說非常不確定。

We don't know.

我們不知道。

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.

早期跡象表明它非常穩定，但取決於政策最終如何實施，這種不確定性可能會影響我們的一些客戶的一些資本規劃流程。

I wouldn't call it out yet, not clear that's happening, but it is a potential.

我還不會說出來，不清楚這是否正在發生，但這是一種潛力。

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

關於年份和 Sp 的時間安排，我會讓 Marshall 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，我們一直在溝通的內容與我現在要說的是一致的，即 Sp 在 2017 年的收入貢獻將非常小，而在 2018 年將是一個更大的因素。

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

但就在推出之前推動對 Xi 的增量升級而言，我們是否應該考慮其中的任何動態？

Not really, no.

不是真的，不。

And will we get Sp data at SAGES?

我們會在 SAGES 獲得 Sp 數據嗎？

When can we start to think about some early user feedback?

我們什麼時候可以開始考慮一些早期的用戶反饋？

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.

我們應該有機會結束這個臨床可行性試驗，然後在今年上半年啟動 IDE 頭頸試驗。

And as the one closes and the other opens, we will be in a better position to share with you that feedback.

隨著一個關閉另一個打開，我們將能夠更好地與您分享反饋。

Okay, and then last one on hernia.

好的，然後是關於疝氣的最後一個。

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?

您能否從腹股溝和腹側的滲透角度向我們介紹我們的最新情況，以及您如何看待今年的相對增長率？

Yes, generally speaking, we think we are still in fairly early stages on both the ventral and the inguinal opportunity.

是的，一般來說，我們認為我們在腹側和腹股溝機會方面仍處於相當早的階段。

You saw we talked about the results in general surgery, again, up over 30% this year.

你看到我們再次談到了普通外科手術的結果，今年增長了 30% 以上。

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.

顯然，我們增加了很多新程序，並且隨著時間的推移，我們獲得了信心，我認為，關於我們在腹股溝側的機會，外科醫生表現出的粘性和該類別的增長。

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，我們稱其為近 300,000 個腹疝和 700,000 個腹股溝中有多少最終將成為機器人候選人，但我們非常有信心它將推動我們進入 2017 年和超過。

Okay, thank you.

好的謝謝。

Bob Hopkins, Bank of America.

美國銀行的鮑勃·霍普金斯。

So Gary, I have a question for you.

加里，我有一個問題要問你。

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.

從信號的角度來看，這個季度非常有趣，因為你正在加速 8000 萬美元的支出，並且你宣布了 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。

I was just wondering, can you just help us understand why now is the time to be doing these things?

我只是想知道，你能不能幫助我們理解為什麼現在是做這些事情的時候了？

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?

您看到的是什麼讓您對業務充滿信心，或者我的措辭不正確，20 億美元的 ASR 真的只是為了抵消支出？

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.

我認為——我們實現這兩個目標的過程，我將描述我們如何加速投資以及我們如何實現 ASR。

With regard to accelerated investment, I think we are feeling good and increasing confidence in the use of our products in general surgery.

關於加速投資，我認為我們感覺良好，並且對我們的產品在普外科中的使用越來越有信心。

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.

我認為雖然我們還處於早期階段，但我認為早期的結果非常強勁，這對我們來說是積極的。

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.

當我們審視我們在國內外技術和機會的競爭格局中所處的位置時，我們也對我們擁有非常好的技術管道和我們的定位非常有信心。

And so as we look at then the opportunity to invest, our first priority is fund the existing business.

因此，當我們尋找投資機會時，我們的首要任務是為現有業務提供資金。

The second priority is look for organic growth opportunities that can drive profitable growth in the future.

第二個優先事項是尋找可以推動未來盈利增長的有機增長機會。

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.

這就是 8000 萬美元的去向，我們評估平台，我們查看這些平台的總可用市場，估計盈利能力可能是多少，並對它們進行堆疊排名，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.

我們將收購作為第三優先事項或可以增加我們公司的事情，如果我們有多餘的資本，那麼就有機會將其返還給股東。

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.

因此，我們今年謹慎而有力地完成了這一過程，這導致了投資的推進，因為我們認為存在機會和勢頭，並有機會通過回購返還一些現金。

And so, those time together more by process than by some algorithm.

因此，這些時間更多的是通過流程而不是某種算法。

Great, that's very helpful.

太好了，這很有幫助。

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?

然後，我想跟進的一件事是——不是要求你在這裡承諾，但至少 2018 年有可能成為你擁有三個新產品平台的一年，Sp，可能的活檢，和那麼在新顯像劑方面呢？

Does that potential at least exist?

這種潛力至少存在嗎？

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 是新平台中走得最遠的，我認為 2018 年的 Sp 有機會做一些有趣的事情，如果我們在監管途徑上執行得好的話。

Molecules -- the molecule side of imaging is further out than 2018.

分子——成像的分子方面比 2018 年更遠。

There are some interesting things in imaging that are in 2018.

2018 年成像領域有一些有趣的事情。

They are more software and hardware related as opposed to the molecular component.

與分子組件相反，它們更多地與軟件和硬件相關。

On the diagnostic platform, we are not ready yet to anchor revenue expectations.

在診斷平台上，我們還沒有準備好錨定收入預期。

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.

我對 2018 年的時間框架沒有太大期望，儘管我認為我們將在技術和學習方面取得長足進步。

Wonderful, thanks very much.

太好了，非常感謝。

David Lewis, Morgan Stanley.

戴維劉易斯，摩根士丹利。

Gary, I am just trying to put the spending into perspective here.

加里，我只是想在這裡正確看待支出。

It seems hard to us that on individual trials you could pull forward the magnitude of spending you are pulling forward.

在我們看來，在個人試驗中，你似乎很難將你正在推動的支出規模向前推進。

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?

那麼，是否可以安全地假設至少這種推動的某些重要組成部分確實與您正在使用的新平台有關？

That is number one.

那是第一。

And then not just the R&D spending, Gary; the other piece was there is commercial spending.

然後不僅僅是研發支出，加里；另一部分是商業支出。

Can you help us understand the areas that you are spending on commercially that are different than the true R&D investment?

您能否幫助我們了解您在商業上的支出與真正的研發投資不同的領域？

Yes, yes, fair questions.

是的，是的，公平的問題。

On the first one, absolutely the incremental spend relates to building out second platforms.

在第一個方面，增量支出絕對與構建第二個平台有關。

Sp has a lot of shared components with Xi, but not entirely shared components, and so bringing that out.

Sp 與 Xi 有很多共享組件，但不是完全共享組件，因此將其提出來。

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.

它有一個新的供應鏈，一套新的測試和製造資源，除了一些試驗工作外，還必須投資，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.

我們對診斷方面感到非常興奮，我們認為國內外都有很大的機會，所以我們在該平台上處於較早的階段，但我們正在做相當於設計和早期試驗投資的事情。

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.

然後在我們現有的平台上進行臨床和經濟數據投資，特別是在我們認為報銷或訪問、其他類型的訪問、付款人訪問很重要的歐洲和亞洲，這是我們樂於投資和收集的數據.

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

因此，正如您在問題中所說，它確實是這些元素的混合體。

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

繼續你的第二篇文章，提醒我你問題的後半部分。

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

只是商業，非開發片（多個揚聲器）商業開發。

Yes, yes, commercial investment.

是的，是的，商業投資。

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.

一個很好的例子是，如果我們能夠增加我們的總業務足跡，我們認為在歐洲的主要市場對我們來說是真正的機會。

It is not just commercializing sales folks.

這不僅僅是將銷售人員商業化。

But some of it is sales staff.

但其中一些是銷售人員。

We have added a seasoned executive in Germany as a German general manager.

我們在德國增加了一位經驗豐富的高管作為德國總經理。

We are adding some clinical resources into Germany as well to round out the team there.

我們還在德國增加了一些臨床資源，以完善那裡的團隊。

I think it makes a lot of sense.

我認為這很有意義。

Early returns on that are strong in terms of just their ability to get things done.

就他們完成工作的能力而言，早期的回報是巨大的。

And so, those kinds of investments have been going on.

因此，此類投資一直在進行。

Likewise in places like Japan, where we have been investing in reimbursements.

在日本這樣的地方也是如此，我們一直在投資報銷。

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.

預計 2018 年會有額外的報銷，在客戶群和商業方面以及政府方面都需要完成一些準備工作。

And Gary, just a quick second question.

加里，只是一個快速的第二個問題。

On Sp, just to be clear, there are three approvals you talked about in this call, head and neck, urological, as well as TORS.

關於 Sp，需要明確的是，您在此次電話會議中談到了三個批准，即頭頸、泌尿外科和 TORS。

Is it safe to assume those are the three clinical opportunities here near term?

假設這些是近期的三個臨床機會是否安全？

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?

我想說的是，在獲得這三個批准之一之前，您能否以更全面的商業方式啟動 Sp，或者這不一定是真的？

So, those are the first ideas.

所以，這些是第一個想法。

Which one comes first will depend on how regulatory bodies view it.

哪個先出現將取決於監管機構如何看待它。

I suspect urology will actually be earlier than the other ones, just based on existing data and past history.

我懷疑泌尿科實際上會比其他科更早，只是根據現有數據和過去的歷史。

We think those are good opportunities for the platform.

我們認為這些是該平台的好機會。

They are not the only opportunities for the platform.

它們並不是該平台的唯一機會。

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.

因此，我們正在追求這些，同時進行那些工作，因為我們認為它為我們的客戶提供了最好的財務靈活性，可以利用他們在平台上進行的資本投資。

Does that make sense?

那有意義嗎？

It makes perfect sense.

這是完全有道理的。

Thank you so much.

太感謝了。

Amit Hazan, Citi.

阿米特·哈贊，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.

我只想回到研發支出，增加的投資支出，一秒鐘，只是為了特別澄清 2018 年。

And this goes off, Gary, what I think you talked about earlier this month at the investor conference, that tailing off in 2018.

加里，我認為你本月早些時候在投資者會議上談到的事情在 2018 年結束了。

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.

當我想到 Sp 時，我會想到這一點，也許那次發布會讓你在那裡節省一些錢，但診斷，當然是成像，似乎是新的和持續的支出。

So I wanted to maybe try to get you to clarify why that increased spending is just one year and not more than that.

所以我可能想嘗試讓您澄清為什麼增加的支出只是一年而不是更多。

And in terms of just the R&D as a percent of sales, why wouldn't that just continue into next year?

就研發佔銷售額的百分比而言，為什麼不繼續到明年呢？

It seems like a lot of your spending is actually going to be ongoing.

看起來你的很多支出實際上是持續的。

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.

是的，所以我們所描述的是我們正在增加研發支出，這實際上是運營，而不僅僅是研發，所以 2017 年的運營費用異常地作為運行率。

And we think it will return to more normal growth rates in 2018.

我們認為它將在 2018 年恢復到更正常的增長率。

There is a couple of reasons that we think that is so.

我們認為是這樣的原因有幾個。

One of them is the biggest spend on a platform launch is actually the year before launch.

其中之一是平台發布的最大支出實際上是在發布前一年。

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.

那就是你們都在構建大量產品，進行大量驗證，準備就緒，進行大量分期的地方。

So that bolus will go through.

這樣推注就會通過。

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.

隨著時間的推移，我們在成像方面連續投入了相當多的資金，因此 2017 年的成像並不是一筆巨大的投資；這是一個可比的增長。

And you are right; we expect revenue growth 2017 to 2018.

你是對的；我們預計 2017 年至 2018 年的收入將增長。

So we expect growth in total OpEx expense in 2018.

因此，我們預計 2018 年總運營支出將增長。

It is just that the growth rate will modulate relative to 2017.

只是增長率將相對於 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.

所以我們想在這裡向大家傳達的是，2017 年的增長率是不尋常的。

We would expect revenue growth in 2018.

我們預計 2018 年收入將增長。

We would expect op expense growth rate in 2018 as well, but more aligned with historical norms.

我們預計 2018 年的運營費用增長率也是如此，但更符合歷史規範。

In other words, the growth rate in 2017 is not the new normal.

換句話說，2017年的增長率並不是新常態。

That's helpful.

這很有幫助。

And then, gynecology would be my second question.

然後，婦科將是我的第二個問題。

The 3.5% growth for the year, that is better than we expected, too.

今年 3.5% 的增長率，也好於我們的預期。

I think that is another year of improving growth for your second year in a row.

我認為這是連續第二年改善增長的又一年。

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].

你似乎有點警告說，其中一些是不可持續的，比如將程序遷移到 GYN 腫瘤學家可能會遇到[強制]。

And it strikes me as just a little bit too early or a little bit early to be to be concerned about that trend.

在我看來，關注這種趨勢有點為時過早或有點早。

And so, it seems like a newer trend to me.

所以，這對我來說似乎是一種新趨勢。

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.

我想讓你稍微評論一下這是否是 2017 年的真正問題，或者你是否只是提出了今年的潛在風險因素。

Gynecology is one of those mature procedure categories in the United States.

婦科是美國成熟的手術類別之一。

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.

如果你看看良性子宮切除術，這是該類別中最大的手術，超過 80% 的手術都是以某種微創方式進行的，無論是腹腔鏡檢查、陰道技術還是機器人手術，最近兩個或三年。

So in that sense, we would expect -- our starting thought would be we are likely to move with the market in that scenario.

因此，從這個意義上說，我們預計——我們最初的想法是，在這種情況下，我們可能會與市場一起行動。

So if you look back a couple of years ago at 2014, that's what happened.

因此，如果您回顧幾年前的 2014 年，就會發現事情就是這樣。

We declined low single digits.

我們拒絕了低個位數。

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.

我們認為進行良性子宮切除術的總數可能正在逐漸下降，以響應付款人對該手術的抵制，從而鼓勵其他治療方式。

So 2015, that moved to the other side of 1% growth, like I said in the comments.

所以 2015 年，就像我在評論中所說的那樣，它轉向了 1% 增長的另一邊。

This year, it ramped up to about 3% growth.

今年，它增長了約 3%。

And you are right.

你是對的。

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.

我認為這在很大程度上反映了一種趨勢，即越來越多的病例由婦科腫瘤科醫生執行，一組更符合機器人技術的外科醫生。

So that has been a benefit.

所以這是一個好處。

So our guidance would suggest we would expect this to moderate a little bit in 2017.

因此，我們的指引表明我們預計這種情況在 2017 年會有所緩和。

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.

我們在這個領域沒有完美的水晶球，但在某些時候，我們認為更複雜的病例是被轉診的，並且您達到了某個水平，您可以通過其他微創方法獲得非常充分的臨床結果。

So, we will see how it plays out.

所以，我們將看看結果如何。

Thanks, guys.

多謝你們。

Tao Levy, Wedbush.

陶利維，韋德布什。

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.

或許你可以向我們介紹中國的現狀和配額、那裡的下一步，以及讓習近平在中國獲得批准所需的條件。

Yes, so two parts to the question.

是的，問題分為兩個部分。

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.

在配額方面，配額取決於他們預算的批准，中國政府的預算，然後通過衛生部進行分配，然後分配給醫院等等，直到他們到達哪些醫院可以具體購買達芬奇產品。

They have taken the first step.

他們邁出了第一步。

They have approved -- they did approve the budget at the end of 2016, so in December.

他們已經批准——他們確實在 2016 年底，也就是 12 月批准了預算。

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.

然而，他們沒有進一步討論分配給誰購買達芬奇或購買多少的具體細節。

That process is still in motion.

該過程仍在進行中。

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.

這不是我們可以控制的事情，坦率地說，我們對幕後發生的事情沒有很好的了解。

And so at this point, we sit and wait for the next quota to be approved.

所以在這一點上，我們坐等下一個配額獲得批准。

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.

我想我們也告訴人們的是，如果你看一下上次批准配額的時間，醫院仍然需要一些時間才能真正完成招標過程併購買產品。

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.

因此，如果你正在組裝一個模型，看看上一次批准配額是在 2013 年，大部分系統是在接近 2015 年底時購買的。

So the likelihood that there is going to be a lot of revenue coming out of a quota in 2017 is not very high.

因此，2017 年從配額中獲得大量收入的可能性不是很高。

And on Xi?

而在習？

Xi is in process.

習在進行中。

It is a long approval process.

這是一個漫長的審批過程。

We will tell you when we get it, which is our typical pattern of disclosure.

我們會在收到後告訴您，這是我們典型的披露模式。

We don't know where it is in the process.

我們不知道它在這個過程中的什麼位置。

Yes, we are encouraged.

是的，我們受到鼓舞。

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.

我看不出 Xi 在中國的主要障礙，總的來說，我們對中國市場對機器人手術和 Intuitive 的反應感到鼓舞。

So I think in general, with the caveat that Marshall has outlined, as a whole we look positively on the opportunity.

所以我認為，總的來說，根據馬歇爾概述的警告，我們總體上對這個機會持積極態度。

Great, thanks.

太謝謝了。

Larry Keusch, Raymond James.

拉里·庫施，雷蒙德·詹姆斯。

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.

馬歇爾，對不起，加里，在你準備好的評論中，我想我沒聽錯，但你指的是長期投資，你在談論產品和服務的投資。

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?

我只是想確保我沒聽錯，如果那是正確的，當你談論過去的服務時你在想什麼？

Yes, we provide a series of things now to the customer that are an ecosystem around the product itself.

是的，我們現在為客戶提供了一系列圍繞產品本身的生態系統。

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.

因此，您想到的簡單事情是維護服務之類的事情，但我們越來越多地可以訪問有關設備使用、我們的設備、國際基準測試以及機器人系統使用效率指標等有趣數據。

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.

在過去的幾年裡，我們與醫院合作，向他們提供這組數據並幫助他們改進他們的系統，這對他們和我們來說都是一個真正的積極因素，所以這就是我所說的服務的意思.

I think those data opportunities and benchmarking opportunities increase in the future.

我認為這些數據機會和基準測試機會在未來會增加。

Okay, great.

好，太棒了。

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.

然後，我只想了解您在本月早些時候發表的一些評論，並在您再次談論某些成像技術以及可能參與術前計劃的能力時特別了解您的想法。

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?

考慮這一點的方式是否真的可以通過外科醫生與成像功能和機器本身的接口來完成，或者是否有一個元素讓 Intuitive 可以從服務的角度更多地在程序規劃中插入自己？

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，圍繞該問題的另一個問題只是讓您了解您認為機器學習與機器人手術相關的地方。

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，我認為第一個問題是什麼——它會改變我們在醫院互動的地方嗎，我認為在短期內答案是肯定的，但只是一點點。

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.

我認為有機會查看患者在診斷檢查中需要做的術前圖像等事情，並能夠使用這些術前圖像並對其進行一些後處理和機器學習，以改善外科醫生的導航或案件期間的其他能力。

That looks pretty interesting.

這看起來很有趣。

That is some of the technology I showed you a few weeks ago at JPMorgan.

這是我幾週前在摩根大通向您展示的一些技術。

I think in the near term that's how we think about it.

我認為在短期內這就是我們的想法。

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.

從長遠來看，我確實認為分析有一些有趣的機會，因為它與機器人手術程序或微創手術程序的運作有關，這些程序有點超出了單個案例中發生的事情，並且可能會改變並為 Intuitive 提供一個以更廣泛的方式與醫院進行對話的機會。

But I think those are -- we are in early days of those conversations.

但我認為那些是——我們還處於這些對話的早期階段。

Okay, great.

好，太棒了。

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.

最後一個快速的，只是，卡爾文，我知道你提到了肺葉切除術，但是你可以再次提供關於吸收的任何顏色以及可能的機會。

Again, like I said, I think Q4 and really throughout the year in 2016 was a positive period of time for us.

再次，就像我說的，我認為第四季度和 2016 年全年對我們來說都是積極的時期。

It is still fairly early in that category.

在該類別中還處於相當早的階段。

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.

我們專注於現場團隊，更多地關注普通外科手術的機會，但越來越多的人讓一些關鍵的胸外科醫生參與進來，以獲得一些更新的技術。

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.

我提到了他們手中的 Xi 系統和 30 毫米訂書機，從那裡獲得經驗和構建體積是我們關注的重點。

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.

但我認為該程序的價值很高，而且在美國的機會很大，但當你看看美國以外的歐洲，尤其是肺癌發病率較高的亞洲時，這很有趣。

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.

實際上是 Craig Bijou 代替 Larry。

Thanks for taking the questions.

感謝您提出問題。

I wanted to start, Calvin, with your comments on, as part of your procedure guidance, the moderating international growth.

Calvin，我想首先談談您對國際增長放緩的評論，作為您程序指南的一部分。

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.

我想問一下，考慮到歐洲系統銷售的一些放緩以及你們所說的在亞洲看到的強勁程序增長的平衡，程序增長的風險是什麼。

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，我想如果你的歐洲程序——或系統銷售沒有再次回升，也許中國招標或中國配額沒有像你預期的那樣快，那麼國際風險是什麼？程序增長 20% 以上？

Yes, I mentioned it as one of the bullet points in there for the outlook for -- a moderating outlook on overall procedure growth.

是的，我提到它是其中的要點之一——整體程序增長的緩和前景。

Internationally, I think the areas I pointed out specifically were for China.

在國際上，我認為我特別指出的領域是針對中國的。

Marshall talked a little bit about the quota there.

馬歇爾談到了那裡的配額。

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.

事實上，我們在中國擁有的系統是我們擁有的一些（技術難度）生產系統，我們現在繼續發展程序的能力在某種程度上取決於我們在該領域獲得更多能力的能力。

So, that can be a factor in 2017.

所以，這可能是 2017 年的一個因素。

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.

然後在日本，我們非常成功地增加了我們有報銷的程序，前列腺切除術和部分腎切除術中較小類別的早期階段。

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.

所以我認為隨著這些程序的增加，你的空間越來越小，我們正在等待 2018 年的額外程序，這將是維持增長所必需的。

Both those markets, I would say, are -- we have got very positive long-term views on, but some specific factors impacting 2017.

我想說，這兩個市場都是——我們對一些影響 2017 年的具體因素有非常積極的長期看法。

Operator, we have time for one last question.

接線員，我們有時間問最後一個問題。

Richard Newitter, Leerink Partners.

Leerink Partners 的理查德·紐特 (Richard Newitter)。

Thanks for squeezing me in.

謝謝你把我擠進去。

I had two.

我有兩個。

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.

只是，馬歇爾，就 2017 年指導中的毛利率因素而言，我聽說 FX，我聽說醫療技術退稅優惠沒有重複。

Could you just elaborate on the last two, and then I have one follow-up on thoracic?

你能否詳細說明最後兩個，然後我有一個關於胸部的後續行動？

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行動，所以，Marshall，接下那個，我們將從那裡開始。

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.

是的，我認為可能影響毛利率的因素是 - 就像我們所說的那樣，我們在本季度有一些在成本敏感市場銷售低成本系統的經驗，我們看到了一些成功，所以我們會看看是否繼續。

It is an [N of 1], but we will see what happens.

它是 [N of 1]，但我們將看看會發生什麼。

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.

當然，新產品的推出和新產品的利潤率低於我們的舊產品，因此隨著我們增加血管密封和吻合器的銷售，這也會產生影響，即使我們稍微降低了成本，它們仍然更高——或者利潤低於我們的歷史產品。

And so as we increase the sale of newer products, that will have a negative impact.

因此，隨著我們增加新產品的銷售，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.

然後我們提到的另一項是與範圍相關的維修成本，我們繼續工作，正如Gary所說，迭代成像能力和硬件，正如我們所做的那樣，我們將降低成本，並提高可維修性。

But that is a little ways off and so we're -- it will happen incrementally over time.

但這還有一段路要走，所以我們 - 它會隨著時間的推移逐漸發生。

All right, Richard.

好的，理查德。

Calvin says take your follow-up.

Calvin 說跟進。

All right, appreciate that.

好吧，感激不盡。

Thank you.

謝謝你。

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?

就胸部而言，有沒有——你能不能談談你需要瞄準的外科醫生的類型、種類——以及它的階段，因為我知道有一些普通外科醫生會執行這些程序，然後你顯然有心胸外科醫生和專家？

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?

您能否描述一下您的目標對像以及何時以及是否可以讓我們了解我們何時可能開始看到更多的胸肺葉切除術節段的拐點？

Thanks.

謝謝。

Yes, I will answer that one.

是的，我會回答那個。

I think that we are still in pretty early part of the market option for thoracic surgery.

我認為我們仍處於胸外科市場選擇的早期階段。

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.

總的來說，它一直在吸引胸外科領域的思想領袖，其中一些是當今的微創外科醫生，一些主要是開放式外科醫生。

There is a mix.

有一個混合。

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

它往往不是這裡的通才，而是整個胸科的思想領導者。

Part of I think what has been pacing growth here is just completing the product set for efficiency and speed of case.

我認為這裡一直在加快增長的部分原因只是為了提高效率和案例速度而完成產品集。

I think we are very close now to having complete product sets, things like 30-millimeter staplers and so on, and that has helped.

我認為我們現在非常接近擁有完整的產品集，例如 30 毫米訂書機等，這很有幫助。

So, I think as that product set completes, as we proliferate Xis in the world, that has made adoption more likely and easier.

因此，我認為隨著該產品集的完成，隨著我們在世界範圍內推廣 Xis，這使得採用的可能性和難度都更大。

I will turn to our close.

我將結束。

That was our last question.

這是我們的最後一個問題。

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.

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。

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.

今天的電話會議到此結束。

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

我們感謝您參與和支持這一改善手術的非凡旅程，我期待在下一次電話會議上再次與您交談。

Ladies and gentlemen, as you just heard, today's conference has concluded.

女士們，先生們，正如你們剛才所聽到的，今天的會議已經結束。

Thank you for your participation.

感謝您的參與。

You may now disconnect.

您現在可以斷開連接。