直覺手術 (ISRG) 2017 Q1 法說會逐字稿

Thank you for standing by, and welcome to the Intuitive Surgical Q1 2017 Earnings Release Call. (Operator Instructions) And as a reminder, this conference is being recorded. I'll now turn the conference over to Senior Director of Finance and Investor Relations, Calvin Darling. Please go ahead, sir.

感謝您的耐心等待，歡迎參加直覺外科公司2017年第一季財報發布電話會議。（操作說明）再次提醒，本次會議正在錄音。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，先生。

Thank you. Good afternoon, and welcome to Intuitive Surgical's First Quarter Earnings Conference Call. With me today, we have Gary Guthart, our President and CEO; Marshall Mohr, our Chief Financial Officer; and Patrick Clingan, Vice President of Finance and Sales Operations.

謝謝。下午好，歡迎參加直覺外科公司第一季財報電話會議。今天和我在一起的有：我們的總裁兼執行長 Gary Guthart；我們的財務長 Marshall Mohr；以及財務與銷售營運副總裁 Patrick Clingan。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are described in detail in the company's Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 6, 2017. 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 2017 年 2 月 6 日提交的 10-K 表格。這些文件可透過我們的網站或美國證券交易委員會的EDGAR資料庫找到。潛在投資者應注意，不要過度依賴此類前瞻性陳述。

Please note that this conference call will be available for audio replay on our website at intuitivesurgical.com on the Audio Archive section under our Investor Relations page.

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。

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在我們的網站上。

Today's format will consist of providing you with highlights of our first quarter results, as described in our press release announced earlier today, followed by a question-and-answer session. Gary will present the quarter's business and operational highlights. Marshall will provide a review of first quarter financial results. Patrick is rejoining us to discuss procedure and clinical highlights, then I will provide our updated financial outlook for 2017. And finally, we will host a question-and-answer session.

今天的會議形式將包括：首先向您介紹我們第一季業績的重點內容（如我們今天早些時候發布的新聞稿中所述），然後進行問答環節。Gary 將介紹本季的業務和營運亮點。馬歇爾將對第一季財務業績進行回顧。Patrick 將再次加入我們，討論流程和臨床亮點，然後我將提供我們 2017 年的最新財務展望。最後，我們將舉行問答環節。

With that, I'll 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. This first quarter of 2017 was a dynamic one for Intuitive, with strong performance in procedures and solid growth in system placements. We are making good progress in developing deeper connections to our customers worldwide and advancing technologies and offerings that fundamentally improve surgery. Procedure growth accelerated in the quarter, rounding up to 18% over the first quarter of 2016. The growth was broad-based by procedure category as well as global region.

下午好，感謝各位今天參加我們的電話會議。2017 年第一季對 Intuitive 來說是充滿活力的一年，手術量表現強勁，系統安裝也實現了穩健成長。我們在與全球客戶建立更深的聯繫以及推進技術和產品以從根本上改善手術方面取得了良好進展。本季手術量成長加速，比 2016 年第一季成長了 18%。按手術類別和全球區域劃分，成長基礎廣泛。

Starting with the United States. Procedure growth in both the emerging category of general surgery and more mature categories in urology and gynecology exceeded our expectations. General surgery growth continues to be encouraging with order of early clinical reports, surge in interest and utilization. Procedure growth in Europe, Korea and China were strong in the quarter. While reasons for quarter-to-quarter fluctuations can be hard to assess, we estimate that Q1 benefited from some tailwinds that will balance out through the remainder of the year. Patrick will take you through these factors in more detail later in the call.

先從美國開始。無論是新興的一般外科領域，或是較成熟的泌尿外科和婦科領域，手術量的成長都超出了我們的預期。一般外科的發展勢頭持續強勁，早期臨床報告不斷湧現，人們對一般外科的興​​趣和利用率也大幅上升。本季歐洲、韓國和中國的手術量成長強勁。雖然很難評估季度間波動的原因，但我們估計第一季受益於一些利好因素，這些因素將在今年剩餘的時間裡相互抵消。派崔克稍後會在通話中更詳細地為您講解這些因素。

Our capital placement performance in Q1 2017 strengthened over Q1 of 2016, resulting in a growth in total placements from 110 to 133 this quarter. As we mentioned on these calls, capital placements can be lumpy. And after a strong 2016, U.S. capital placements settled into moderate growth relative to Q1 of last year.

2017 年第一季度，我們的資本配置業績較 2016 年第一季有所增強，本季總配置金額從 110 項成長至 133 項。正如我們在這些電話會議中提到的，資金配置可能會出現波動。在經歷了強勁的 2016 年之後，美國資本配置相對於去年第一季而言，成長趨於溫和。

Outside the U.S. Placement growth in the quarter was a highlight with 56 systems sold in the quarter versus 36 in Q1 of 2016. The lack of a new system quota in China and limited reimbursements in Japan constrained placement growth in these regions. Marshall will take you through system placement dynamics in greater detail.

在美國以外，本季的銷售成長是一大亮點，本季售出 56 套系統，而 2016 年第一季售出 36 套。中國缺乏新的系統配額，日本報銷有限，限制了這些地區的安置成長。馬歇爾將更詳細地帶你了解系統佈局的動態。

Turning to profitability for the quarter. Strong procedure growth and solid system placements combined with favorable product mix and improvements in product costs to lead to gross margins at the top of our expected range and solid operating margin performance. Our fixed cost growth was as expected, with significant increases in R&D spending that reflect investments and bringing new products through clinical trials on the path to market. A summary of our first quarter pro forma operating results is as follows: Procedures grew approximately 18% over the first quarter of last year. We shipped 133 da Vinci Surgical Systems, up from 110 in the first quarter of 2016. Revenue for the quarter was $674 million, up 13% from the prior year. Instrument and accessory revenue increased to $381 million, up 18%. Total recurring revenue in the quarter was $521 million, representing 77% of total revenue. Gross profit margin was 72% compared to 70% in the first quarter of last year. We generated a pro forma operating profit of $264 million in the quarter, up 15% from the first quarter of last year. And pro forma net income was $196 million, up 15% from Q1 of 2016.

接下來談談本季的獲利情況。強勁的業務成長和穩固的系統部署，加上有利的產品組合和產品成本的改善，使得毛利率達到預期範圍的上限，並實現了穩健的營業利潤率。我們的固定成本成長符合預期，研發支出大幅增加，這反映了投資以及將新產品透過臨床試驗推向市場。我們第一季備考經營業績摘要如下：手術量比去年第一季成長約 18%。我們交付了 133 台達文西手術系統，高於 2016 年第一季的 110 台。本季營收為 6.74 億美元，比上年同期成長 13%。儀器及配件收入增至 3.81 億美元，成長 18%。本季經常性收入總額為 5.21 億美元，佔總營收的 77%。毛利率為72%，而去年第一季為70%。本季我們實現了 2.64 億美元的備考營業利潤，比去年第一季成長了 15%。經調整後的淨收入為 1.96 億美元，比 2016 年第一季成長 15%。

In the quarter, we also entered into a stock repurchase agreement in the amount of $2 billion. Marshall will take you through our finances in greater detail shortly.

本季度，我們也簽訂了一項金額為 20 億美元的股票回購協議。馬歇爾稍後會更詳細地向您介紹我們的財務狀況。

Turning to our product pipeline. As you know, we've increased our mid- and long-term investments in creating our next-generation of products and services based on our belief that substantial opportunity exists to enable more minimally invasive surgery, better outcomes and to expand access to our technologies globally. To bring these investments to market, we have developed a product pathway that responds to our customers' desire for choice in clinical capability and choice in total economics. Over the next several quarters, we plan to launch a new technology upgrade to Si, named da Vinci X, that enables a compelling entry point to our advanced technologies. Da Vinci Xi will remain our flagship, and we will provide customers with logical upgrade paths for more affordable, entry-level systems like Si and X to Si and Sp. We have submitted our documents for CE Mark review for X and anticipate it will be available in Europe in the second quarter, with clearances in other regions following over time. We'll provide you with additional information on X as it launches. The upcoming availability of da Vinci X has some accounting implications, which Marshall will describe in greater detail later in the call.

接下來，我們來看看產品線。如您所知，我們增加了對下一代產品和服務的中長期投資，因為我們相信，透過這些產品和服務，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普及範圍。為了將這些投資推向市場，我們開發了一條產品路徑，以滿足客戶對臨床能力和整體經濟效益的選擇需求。在接下來的幾個季度裡，我們計劃推出一項針對 Si 的新技術升級，名為 da Vinci X，這將為用戶提供一個極具吸引力的入門途徑，讓他們能夠體驗我們的先進技術。Da Vinci Xi 仍將是我們的旗艦產品，我們將為客戶提供更經濟實惠的入門級系統（如 Si 和 X）到 Si 和 Sp 的合理升級路徑。我們已提交 X 產品的 CE 標誌審核文件，預計產品將於第二季在歐洲上市，其他地區的核准也將陸續進行。X發布後，我們會為您提供更多資訊。達文西X手術系統的即將上市會帶來一些會計方面的影響，馬歇爾將在稍後的電話會議中對此進行更詳細的描述。

Our Sp program continues to progress in its clinical trial work and new site initiation. Cases at our active trial site in Asia have included transoral, urologic and colorectal surgery. We are also on track in initiating our U.S. IDE sites to gather clinical data in transoral surgery. In reviewing feedback from surgeons in Asia and the latest standards for human factors validations, we have elected to pull forward a software release for Sp ahead of our urology 510(k). This will push back our urology 510(k) submission into the back half of 2017 and is likely to delay the launch of Sp in the U.S. by 1 or 2 quarters. While I'm disappointed by the delay, we believe it simplifies our submission and our ultimate path to market.

我們的Sp計畫在臨床試驗工作和新站點啟動方面持續取得進展。我們在亞洲的活躍試驗點進行的病例包括經口手術、泌尿外科手術和大腸直腸手術。我們也在按計劃啟動美國 IDE 站點，以收集經口手術的臨床數據。在審查了亞洲外科醫生的回饋意見和最新的人體因素驗證標準後，我們決定在泌尿外科 510(k) 之前提前發布 Sp 的軟體版本。這將使我們的泌尿科 510(k) 申請推遲到 2017 年下半年，並可能使 Sp 在美國的上市推遲 1 到 2 個季度。雖然我對延誤感到失望，但我們相信這簡化了我們的提交流程和最終的市場推廣路徑。

In our flexible robotics program, we completed our first clinical experience in Australia in the quarter. Surgeon commentary on its performance has been enthusiastic. They are finishing patient follow-up and preparing their manuscript for publication. The overall program is now in its design for pilot production phase.

在我們的靈活機器人專案中，我們本季在澳洲完成了首次臨床實踐。外科醫生對它的表現給予了高度評價。他們正在完成患者隨訪，並準備發表論文。整個專案目前正處於試生產設計階段。

In closing, the first quarter of 2017 has been a busy one for Intuitive. We remain focused on the following for the balance of the year: 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 platform, imaging, advanced instruments, da Vinci Sp and diagnostic platform progress; and finally, support for additional clinical and economic validation by global region.

綜上所述，2017 年第一季對 Intuitive 來說是忙碌的一年。今年剩下的時間裡，我們將繼續專注於以下幾點：第一，繼續在普通外科手術中推廣達文西手術系統；第二，繼續開發歐洲市場並拓展亞洲客戶；第三，推進我們的新平台、成像、先進儀器、達文西Sp和診斷平台的發展；最後，支持全球各區域進行額外的臨床和經濟驗證。

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

現在我將把電話交給馬歇爾，他將回顧財務要點。

Thank you, Gary. I will describe our results in a non-GAAP or pro forma basis, which excludes specified legal settlements and claim accruals, stock-based compensation, excess tax benefits related to employee stock awards 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've posted reconciliations of our pro forma results to our GAAP results on our website so that there is no confusion.

謝謝你，加里。我將以非公認會計準則或備考財務報表的形式描述我們的業績，其中不包括特定法律和解及索賠計提、股票期權補償、與員工股票獎勵相關的超額稅收優惠以及購買知識產權的攤銷。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。

First quarter 2017 revenue was $674 million, an increase of 13% compared with $595 million for the first quarter of 2016 and a decrease of 11% compared with fourth quarter revenue of $757 million. As Gary outlined, we'll be launching the da Vinci X system in certain markets, pending appropriate regulatory clearances. In conjunction with the launch, we will offer customers who purchased systems in the first quarter the opportunity to upgrade or trade out their systems for the X system. As a result, we deferred 23 million of first quarter revenue. And consistent with prior deferrals, this revenue will be recognized when customers either trade out their systems or when the offers expire, whichever comes first. First quarter 2017 procedures increased nearly 18% compared with the first quarter of 2016 and increased 2% compared with last quarter. Procedure growth relative to last year and the fourth quarter has been driven by general surgery in the U.S. and urology worldwide and reflects the benefit of the Easter holiday being in the second quarter of 2017 rather than the first quarter of 2016. Patrick will provide more detail concerning procedure adoption.

2017 年第一季營收為 6.74 億美元，比 2016 年第一季的 5.95 億美元成長了 13%，比第四季的 7.57 億美元下降了 11%。正如 Gary 所概述的那樣，我們將在某些市場推出達文西 X 系統，但需獲得相應的監管批准。配合此次發布，我們將為第一季購買系統的客戶提供升級或以舊換新的X系統的機會。因此，我們推遲了第一季 2300 萬美元的收入。與先前的遞延一致，這筆收入將在客戶更換系統或優惠到期時確認，以先到者為準。2017 年第一季手術量比 2016 年第一季成長了近 18%，比上一季增加了 2%。與去年同期和第四季度相比，手術量的增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，這反映了復活節假期在 2017 年第二季度而不是 2016 年第一季帶來的好處。Patrick將提供有關程序採納的更多細節。

Revenue highlights are as follows. Instrument and accessory revenue of $381 million increased 18% compared with last year and decreased 1% compared with the fourth quarter of 2016, which closely reflects procedure growth. Instrument and accessory revenue realized per procedure, including initial stocking orders, was approximately $1,840 per procedure compared with $1,830 last year and $1,900 last quarter. The increase relative to the first quarter of 2016 primarily reflects increased sales of our stapling and vessel sealing products, mostly offset by customer buying patterns. The decrease compared with the fourth quarter of 2016 primarily reflects the impact of customer buying patterns. System revenue of $153 million, which excludes the revenue deferred in conjunction with the customer trade-out program, increased 4% compared with the first quarter of 2016 and decreased 35% compared with last quarter. The year-over-year increase reflects higher system placements and higher lease buyout and operating lease revenue, partially offset by the revenue deferral and lower average selling prices. The quarter-over-quarter decrease reflects seasonally lower number of systems, the revenue deferral and lower average selling prices, partially offset by higher lease-related revenue.

以下是營收亮點。儀器及配件收入為 3.81 億美元，比去年同期增長 18%，比 2016 年第四季下降 1%，這很好地反映了手術量的增長。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 1,840 美元，而去年同期為 1,830 美元，上一季為 1,900 美元。與 2016 年第一季相比，成長主要反映了我們訂書針和容器密封產品的銷售增加，但大部分都被客戶的購買模式所抵銷。與 2016 年第四季相比，下降主要反映了顧客購買模式的影響。系統收入為 1.53 億美元，不包括與客戶以舊換新計畫相關的遞延收入，與 2016 年第一季相比成長 4%，與上一季相比下降 35%。與去年相比，成長反映了系統安裝量增加以及租賃買斷和經營租賃收入增加，但部分被收入遞延和平均售價下降所抵消。季度環比下降反映了季節性系統數量減少、收入遞延和平均售價降低，部分被租賃相關收入增加所抵消。

133 systems were placed in the first quarter of 2017 compared with 110 systems in the first quarter of 2016 and 163 systems last quarter. 21 systems were placed under operating lease transactions in the current quarter compared with 19 systems in the first quarter of 2016 and 13 last quarter. As a reminder, revenue on an operating lease transaction is recognized ratably over the lease -- life of the lease. As of the end of the first quarter, there were 95 systems out in the field under operating leases. We generated approximately $5 million of revenue associated with operating leases in the quarter compared with $4 million in the first quarter of 2016 and approximately $5 million last quarter. We generated approximately $10 million of revenue during the quarter from lease buyouts compared with $6 million in the first quarter of 2016 and $7 million last quarter.

2017 年第一季安裝了 133 套系統，而 2016 年第一季安裝了 110 套系統，上一季安裝了 163 套系統。本季共有 21 套系統採用經營租賃方式進行交易，而 2016 年第一季為 19 套系統，上季為 13 套系統。提醒一下，經營租賃交易的收入是在租賃期間內按比例確認的－即在租賃期間內確認。截至第一季末，已有 95 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 2016 年第一季為 400 萬美元，上一季約為 500 萬美元。本季我們透過租賃收購獲得了約 1,000 萬美元的收入，而 2016 年第一季為 600 萬美元，上一季為 700 萬美元。

Globally, our average selling price, which excludes the impact of operating leases and lease buyouts and revenue deferrals, was $1.46 million compared with $1.5 million last year and $1.48 million last quarter. The decrease in ASP compared to the fourth quarter primarily reflects geographic mix. The decrease compared to last year primarily reflects a higher proportion of Si refurbished systems sold to cost-sensitive market segments. We expect lower-priced systems to be -- to cost-sensitive market segments to represent an increasing proportion of our sales in the future.

在全球範圍內，我們的平均售價（不包括營業租賃、租賃買斷和收入遞延的影響）為 146 萬美元，而去年同期為 150 萬美元，上一季為 148 萬美元。與第四季度相比，平均售價下降主要反映了地域組成的變化。與去年相比，下降主要反映了銷往對成本敏感的市場領域的矽翻新系統比例較高。我們預計，未來價格較低的系統將佔對成本敏感的市場區隔領域銷售額的越來越大比例。

Service revenue of $140 million increased 13% year-over-year and increased approximately 4% compared with the fourth 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 1.4 億美元，年增 13%，與 2016 年第四季相比成長約 4%。年比和環比增長反映了我們達文西手術系統安裝量的增長。

Outside of the U.S., results were as follows. First quarter revenue outside of the U.S. of $183 million increased 12% compared with $164 million for the first quarter of 2016 and decreased 14% compared with $212 million for the fourth quarter. Recurring revenue increased 23% compared with the previous year and 5% compared with the fourth quarter, reflecting procedure growth, partially offset by customer buying patterns. Systems revenue decreased 9% compared with the first quarter of 2016 and decreased 39% compared with the previous quarter. The decrease in OUS systems revenue relative to both the prior year and the prior quarter reflect lower system ASPs, reflecting sales of Si refurbished product to cost-sensitive market segments; revenue deferrals; operating leases, 6 in the current quarter, versus none in the prior year and 2 in the prior quarter; geographic mix; and changes in the number of systems placed. Outside the U.S., we placed 56 systems in the quarter compared with 36 in the first quarter of 2016 and 63 systems last quarter. The decrease in system placements relative to the prior quarter primarily reflects seasonality. The increase in system placements relative to the prior year reflects higher sales into Europe, Korea and India. Current quarter system placements included 21 into Europe, 7 into Korea, 6 into India, 6 into Japan and 2 into China. System placements outside of the U.S. will continue to be lumpy as some of the OUS markets are in the early stages of adoption. Some markets are highly seasonal, reflecting budget cycles or vacation patterns, and sales into some markets are constrained by government regulations.

美國以外地區的結果如下。第一季美國以外的營收為 1.83 億美元，比 2016 年第一季的 1.64 億美元成長了 12%，比第四季的 2.12 億美元下降了 14%。與上年同期相比，經常性收入增長了 23%，與第四季度相比增長了 5%，這反映了手術量的增長，但部分被客戶的購買模式所抵消。系統收入與 2016 年第一季相比下降了 9%，與上一季相比下降了 39%。與上年同期和上一季相比，OUS 系統收入的下降反映了系統 ASP 的降低，這反映了 Si 翻新產品向對成本敏感的市場細分領域的銷售；收入遞延；經營租賃，本季度有 6 項，而上年同期沒有，上一季度有 2 項；地域組合；以及系統部署數量的變化。在美國以外，本季我們部署了 56 套系統，而 2016 年第一季為 36 套，上季為 63 套。與上一季相比，系統安裝量的下降主要反映了季節性因素。與前一年相比，系統安裝量的增加反映了歐洲、韓國和印度的銷售成長。在當前季度製度下的就業分配包括：21人進入歐洲，7人進入韓國，6人進入印度，6人進入日本，2人進入中國。由於一些美國境外市場仍處於早期採用階段，美國境外的系統部署仍將不平衡。有些市場具有強烈的季節性，反映了預算週期或度假模式，而對某些市場的銷售則受到政府法規的限制。

Moving on to the remainder of the P&L. The pro forma gross margin for the first quarter of 2017 was 72% compared with 70% for the first quarter of 2016 and 71% for the fourth quarter of 2016. The increase compared to the prior year reflects reduced product costs and manufacturing efficiencies. Compared with the fourth quarter of 2016, the higher gross margin reflects a higher mix of instrument and accessory revenue relative to systems revenue. Since we deferred costs associated with the $23 million revenue deferral, the trade-out program had little impact on our margins. Future margins will fluctuate based on the mix of our newer products, the mix of systems and instrument and accessory revenue, our ability to further reduce product costs and improve manufacturing efficiency, and in the long term, the potential reinstatement of the medical device tax.

接下來來看損益表的其餘部分。2017 年第一季的備考毛利率為 72%，而 2016 年第一季為 70%，2016 年第四季為 71%。與前一年相比，成長反映了產品成本的降低和生產效率的提高。與 2016 年第四季相比，較高的毛利率反映出儀器和配件收入相對於系統收入的比例較高。由於我們將與 2,300 萬美元收入遞延相關的成本遞延，因此以舊換新計畫對我們的利潤率幾乎沒有影響。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、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 19% compared with the first quarter of 2016 and increased 1% compared with last quarter. The increases are consistent with our planned investments in product development, specifically da Vinci Sp, flexible robotics, imaging and advanced instrumentation and the expansion of our OUS markets.

與 2016 年第一季相比，以備考計算的營運費用成長了 19%，與上一季相比成長了 1%。這些成長與我們計劃在產品開發方面的投資一致，特別是達文西手術系統、柔性機器人、影像和先進儀器，以及我們海外市場的擴張。

Our pro forma effective tax rate for the first quarter was 28.1% compared with an effective tax rate of 27.4% for the first quarter of 2016 and 26.9% last quarter. Our tax rate will fluctuate with changes in the mix of U.S. and OUS income and with the impact of onetime items.

我們第一季的預期實際稅率為 28.1%，而 2016 年第一季的實際稅率為 27.4%，上一季的實際稅率為 26.9%。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 first quarter 2017 pro forma net income, which excludes income associated with the revenue deferral, was $196 million or $5.09 per share compared with $170 million or $4.42 per share for the first quarter of 2016 and $242 million or $6.09 per share for the fourth quarter of 2016. The $23 million revenue deferral, including the associated deferral of cost of sales and income tax effect, reduced GAAP and pro forma net income per diluted share by approximately $0.28 per share. Earnings per share benefited from our $2 billion stock buyback as our average shares outstanding were reduced by 1.7 million shares as we retired 2.4 million shares on January 27, 2017. A final delivery of shares under the ASR, if any, will be delivered at the end of the contract period.

2017 年第一季備考淨收入（不包括與收入遞延相關的收入）為 1.96 億美元，即每股 5.09 美元，而 2016 年第一季為 1.7 億美元，即每股 4.42 美元，2016 年第四季為 2.42 億美元，即每股 6.09 美元。2,300 萬美元的收入遞延，包括相關的銷售成本遞延和所得稅影響，使 GAAP 和備考每股攤薄淨收入減少了約 0.28 美元。由於我們在 2017 年 1 月 27 日註銷了 240 萬股股票，導致平均流通股數量減少了 170 萬股，每股收益受益於我們 20 億美元的股票回購。根據 ASR 協議，如有最終股份交付，將在合約結束時交付。

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

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 $180 million or $4.67 per share for the first quarter of 2017 compared with $136 million or $3.54 per share for the first quarter of 2016 and $204 million or $5.13 per share for the fourth quarter of 2016. GAAP net income for the first quarter included $21 million of litigation charges compared with $2 million in the first quarter of 2016 and $6 million last quarter. The first quarter charges included approximately $14 million for the estimated cost of settling product liability claims covered by tolling agreements. We have made substantive progress, resolving over 90% of the tolled cases. The remainder of the first quarter charges is related to a settlement of the dispute over license and supply agreement.

現在我將總結一下我們的GAAP業績。2017 年第一季 GAAP 淨收入為 1.8 億美元，即每股 4.67 美元，而 2016 年第一季為 1.36 億美元，即每股 3.54 美元，2016 年第四季為 2.04 億美元，即每股 5.13 美元。第一季的 GAAP 淨收入包括 2,100 萬美元的訴訟費用，而 2016 年第一季為 200 萬美元，上一季為 600 萬美元。第一季費用包括約 1,400 萬美元，用於支付根據訴訟時效中止協議解決產品責任索賠的估計成本。我們取得了實質進展，解決了超過 90% 的積壓案件。第一季剩餘的費用與許可證和供應協議糾紛的解決有關。

Beginning in 2017, we are required under GAAP to report the excess tax benefits or deficiencies associated with employee stock awards in our tax provision rather than as an adjustment to paid-in capital in prior periods. The excess tax benefit included in our GAAP results for the first quarter was $33 million, contributing $0.85 per share. We've excluded this benefit from our pro forma results. This amount will fluctuate quarter-to-quarter based on the volume of employee stock option exercises and the number of RSUs vesting.

從 2017 年開始，根據 GAAP，我們必須在所得稅準備金中報告與員工股票獎勵相關的超額稅收優惠或稅收不足，而不是在以前期間作為實收資本的調整。第一季GAAP業績包含的超額稅收優惠為3,300萬美元，每股收益為0.85美元。我們已將這項福利從我們的模擬結果中剔除。該金額將根據員工股票選擇權行使量和限制性股票單位歸屬數量而逐季度波動。

We ended the quarter with cash and investments of $3.1 billion, down from $4.8 billion as of December 31, 2016. The decrease reflects our $2 billion stock buyback, partially offset by cash generated from operations and proceeds from stock option exercises.

本季末，我們的現金和投資為 31 億美元，低於 2016 年 12 月 31 日的 48 億美元。這一降幅反映了我們 20 億美元的股票回購，部分被經營活動產生的現金和股票選擇權行使所得所抵銷。

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

接下來，我將把發言權交給派崔克，他將介紹我們的流程和臨床要點。

Thanks, Marshall. Of our first quarter procedure growth of nearly 18%, U.S. procedures grew approximately 14%, and outside of the United States, procedures grew approximately 28%. Procedure growth benefited from tailwinds from the shift of the timing of the Easter holidays from Q1 into Q2, which had the greatest impact on our European business. Excluding the benefit from these tailwinds, our procedure performance exceeded our expectations during the quarter.

謝謝你，馬歇爾。第一季手術量增加近 18%，其中美國手術量增加約 14%，美國以外地區的手術量增加約 28%。手術量增長得益於復活節假期時間從第一季推遲到第二季度這一利好因素，這對我們的歐洲業務影響最大。撇開這些利多因素不談，本季我們的手術量表現超出了預期。

In the United States, both mature and growth procedures such as general and thoracic surgery outperformed our plan. Though difficult to assess, strength in the U.S. may have been due to a short-term uptick in patients seeking care ahead of any potential health care reform. In U.S. urology, the first quarter growth rate for da Vinci Prostatectomy was similar to 2016. We believe that our U.S. prostatectomy volumes have been tracking to the broader prostate surgery market. Earlier this month, the United States Preventative Services Task Force, or USPSTF, proposed a change to its 2012 guidance around PSA screening from recommending against screening at any age to encouraging individual patients and physicians to consider PSA screening for men aged 55 to 69. We are pleased to see the USPSTF more close align its recommendation with guidelines from the American Urology Association (sic) [American Urological Association]. In U.S. gynecology, first quarter procedure growth sustained trends observed during 2016. Procedure growth in U.S. GYN appears to be driven by consolidation of surgeries towards physicians that specialize in complex cancer surgery, who tend to be users of the da Vinci system. First quarter U.S. general and thoracic surgery procedure adoption remains strong, led by solid growth in hernia repair and continued adoption of colorectal procedures. Hernia repair continues to contribute the largest volume of new procedures in the United States, and existing surgeon retention and utilization remain encouraging. Trends in lobectomies and other thoracic procedures continue to show early-stage adoption.

在美國，無論是成熟的手術或新興的手術，如一般外科手術和胸腔外科手術，其效果都優於我們的計畫。雖然難以評估，但美國疫情的強勁發展可能是由於在任何潛在的醫療改革之前，尋求治療的患者數量短期內激增所致。在美國泌尿外科領域，達文西前列腺切除術第一季的成長率與 2016 年相似。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。本月初，美國預防服務工作小組（USPSTF）提議對其 2012 年關於 PSA 篩檢的指導意見進行修改，從不建議在任何年齡段進行篩檢，改為鼓勵患者和醫生考慮對 55 至 69 歲的男性進行 PSA 篩檢。我們很高興看到美國預防服務工作小組 (USPSTF) 的建議與美國泌尿外科協會 (American Urological Association) 的指南更加緊密地保持一致。美國婦科手術量第一季的成長延續了 2016 年的趨勢。美國婦科手術量的增長似乎是由手術集中到專門從事複雜癌症手術的醫生身上所驅動的，而這些醫生往往是達文西手術系統的使用者。第一季美國一般外科和胸腔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。疝氣修補術仍然是美國新增手術量最大的手術，現有外科醫師的留任率和使用率仍然令人鼓舞。肺葉切除術和其他胸腔外科手術的趨勢持續顯示出早期應用階段。

Turning abroad. Procedures outside of the United States -- procedure growth outside of the United States was approximately 28% in the first quarter, led by the global adoption of da Vinci Prostatectomy, with solid contributions from kidney procedures, general surgery and gynecology. As I mentioned earlier, the shift of the timing of the Easter holidays from Q1 into Q2 served as a tailwind in the quarter, likely contributing an estimated 3% to our 28% procedure growth outside of the United States. Procedure growth was led by Europe, China and South Korea. In Europe, procedure growth benefited from the Q1 calendar tailwind but also showed strength on an organic basis. Procedure growth in China was driven by a strong expansion in system utilization, but system placements remain constrained pending the issuance of a new quota for civilian hospitals. In South Korea, procedure growth was driven by a mix of specialties and procedures, in addition to a recent uptick in system placements over the past several quarters. Recently, procedure growth in Japan has slowed as dVP penetration has grown above 80%. During the quarter, the clinical study being conducted to support a reimbursement submission for gastrectomy completed enrollment.

轉向國外。美國以外的手術—第一季美國以外的手術量增加了約 28%，這主要得益於達文西前列腺切除術在全球範圍內的普及，腎臟手術、普通外科手術和婦科手術也做出了穩健的貢獻。正如我之前提到的，復活節假期從第一季度轉移到第二季度，對本季度起到了推動作用，可能為我們在美國以外地區 28% 的業務增長貢獻了約 3%。手術量的成長主要由歐洲、中國和韓國引領。在歐洲，手術量成長受惠於第一季的順風，但其自然成長也表現強勁。中國手術量的成長得益於系統利用率的大幅提升，但由於民間醫院尚未獲得新的配額，系統安裝數量仍受到限制。在韓國，手術量的成長是由多種專科和手術的綜合發展所推動的，此外，過去幾個季度系統植入量的上升也是推動因素之一。最近，隨著dVP滲透率超過80%，日本的手術量成長速度已經放緩。本季度，為支持胃切除術報銷申請而進行的臨床研究完成了受試者招募。

Over the past several months, new clinical evidence has highlighted the role of da Vinci in treatment of gastric cancers in Asia. Case series comparing da Vinci to open or laparoscopic procedures have emerged from both South Korea and Japan. Dr. Yang and colleagues from Yonsei University Health System compared all 3 modalities of surgery across nearly 1,000 patients in an article published in the Annals of Surgical Oncology. The authors found that the da Vinci patient cohort had the highest rate of surgical success compared to open or laparoscopic procedures while experiencing a reduction in major in-hospital complications, a reduction in positive resection margins and improved left node yield. Dr. Uyama and colleagues from Fujita Health University published a letter in the Annals of Laparoscopic and Endoscopic Surgery, highlighting prior work on over 500 radical gastrectomies for gastric cancer. The authors found that in exchange for greater blood loss and operating time, da Vinci gastrectomy was associated with a reduction in complications and length of hospitalization compared to laparoscopic gastrectomy. In addition, the authors found that the da Vinci patient cohort included a larger proportion of advanced gastric cancers, proposing that da Vinci technology was best for these patients. Looking forward, during the second quarter, we expect our procedure growth rate outside of the United States to slow as the calendar tailwind becomes a calendar headwind of similar magnitude during Q2. As we move throughout the year, we also expect the contributions from China and Japan to moderate until we obtain a new quota and place new additional systems in China and obtain additional procedure reimbursements in Japan.

在過去的幾個月裡，新的臨床證據凸顯了達文西手術系統在亞洲胃癌治療中的作用。韓國和日本都出現了將達文西手術與開放式或腹腔鏡手術進行比較的病例係列研究。楊醫師及其來自延世大學醫療系統的同事在《外科腫瘤學年鑑》上發表文章，對近 1000 名患者進行了三種手術方式的比較。作者發現，與開放式或腹腔鏡手術相比，達文西手術患者組的手術成功率最高，同時院內主要併發症減少，陽性切緣減少，左側淋巴結數量增加。藤田保健衛生大學的宇山博士及其同事在《腹腔鏡和內視鏡外科年鑑》上發表了一封信，重點介紹了先前對 500 多例胃癌根治性胃切除術的研究。作者發現，與腹腔鏡胃切除術相比，達文西胃切除術雖然出血量和手術時間較長，但併發症和住院時間卻減少。此外，作者發現達文西手術患者群體中晚期胃癌患者的比例較高，這表明達文西技術最適合這些患者。展望未來，我們預計第二季度美國以外地區的業務成長速度將放緩，因為第二季日曆上的順風將轉變為類似規模的逆風。隨著一年時間的推移，我們也預計來自中國和日本的貢獻將會放緩，直到我們獲得新的配額，在中國部署新的系統，並在日本獲得額外的程序報銷。

The first quarter was another quarter with a large number of clinical publications evaluating da Vinci surgery. Of these, I wanted to highlight 2 additional publications. [Dr. Luwan] from Baptist Hospital of Miami and colleagues published results from nearly 300 right colectomy patients in the Journal of Surgical Laparoscopy Endoscopy & Percutaneous Techniques. Comparing da Vinci surgery with intracorporeal anastomosis to laparoscopic surgery with extracorporeal anastomosis, the authors found that while patients in the da Vinci cohort have longer operating times, they experienced less blood loss, shorter incision lengths and longer specimen lengths. Other clinical endpoints that trended towards improvements in the da Vinci patient cohort include readmissions, postoperative complications, lymph node yield and 0 incisional hernia repairs compared to 7% in the laparoscopic cohort.

第一季又有大量臨床出版品對達文西手術進行評估。其中，我想重點介紹另外兩篇出版品。[博士來自邁阿密浸信會醫院的 Luwan 及其同事在《外科腹腔鏡內鏡及經皮技術雜誌》上發表了近 300 例右半結腸切除術患者的結果。作者將達文西手術（體內吻合）與腹腔鏡手術（體外吻合）進行比較，發現雖然達文西組患者的手術時間較長，但他們的出血量較少，切口長度較短，標本長度較長。達文西手術患者組的其他臨床終點指標也呈現改善趨勢，包括再入院率、術後併發症、淋巴結清除數以及切口疝氣修補術（達文西手術組為 0 例，而腹腔鏡手術組為 7 例）。

The next publication is from [Dr. León] and colleagues from the McGill University in Montréal, Canada, published an article in the Journal of Gynecology Oncology (sic) [Journal of Gynecologic Oncology] on the impact -- to their hospital adopting da Vinci surgery for gynecologic oncology. The authors reported that the introduction of da Vinci increased the use of minimally invasive surgery from 15% to 76%, increasing the volume of patients treated by 27% and decreasing in-patient board cost by approximately $5,000 per patient. Despite a higher proportion of patients with complex comorbidities, the authors concluded, "Organizations are beginning to recognize that the economic implications of introducing a robotics program extend beyond the operating room. It is timely to evaluate the broader ripple effects robotics has on hospital departments outside of the operating room."

下一篇出版品來自[博士]León] 和來自加拿大蒙特利爾麥吉爾大學的同事在《婦科腫瘤學雜誌》（原文如此）上發表了一篇文章，講述了達文西手術對他們的醫院在婦科腫瘤治療中的影響。作者報告稱，達文西手術系統的引入使微創手術的使用率從 15% 提高到 76%，治療的患者數量增加了 27%，住院費用每位患者減少了約 5000 美元。儘管患有複雜合併症的患者比例較高，但作者總結：「各組織開始認識到，引入機器人手術計畫的經濟影響不僅限於手術室。現在正是評估機器人技術對手術室以外醫院科室產生的更廣泛影響的恰當時機。

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

我的發言到此結束。現在我將把電話交給卡爾文。

Thank you, Patrick. I will be providing you with our updated financial outlook for 2017.

謝謝你，派崔克。我將向您提供我們最新的2017年財務展望。

Starting with procedures. On our last call, we estimated full year 2017 procedure growth of 9% to 12%, above the approximately 752,000 procedures performed in 2016. Now based upon favorable trends in key markets outside of the U.S., U.S. general surgery growth and solid results in mature U.S. procedure categories, we are increasing our estimate for 2017. We now anticipate full year 2017 procedure growth within a range of 12% to 14%. We expect the Q2 procedure growth procedure rates -- procedure growth rates, particularly in Europe, will reflect fewer operating days than in the previous year.

首先從流程入手。在我們上次的電話會議上，我們估計 2017 年全年手術量將增加 9% 至 12%，高於 2016 年進行的約 752,000 例手術。現在，基於美國以外主要市場的有利趨勢、美國普通外科手術的成長以及美國成熟手術類別的穩健成果，我們提高了對 2017 年的預測。我們現在預計 2017 年全年手術量成長將在 12% 至 14% 之間。我們預計第二季度手術成長率（尤其是歐洲的手術成長率）將比前一年減少手術天數。

In regards to system placements, 21 of our 133 first quarter system placements were structured as operating leases. Going forward in 2017, we expect an increasing proportion of system placements to be under operating leases. We have recently expanded our leasing programs in Germany and Korea. And in the U.S., more customers are considering operating lease arrangements to acquire da Vinci capacity. The average selling price for systems sold outright will vary quarter-to-quarter based upon factors including product, regional and trade-in mix. With the upcoming expansion of our value-oriented system offering and increasing placements in the cost-sensitive market segments, we expect that our average system selling price will trend gradually lower in 2017.

就係統部署而言，我們第一季 133 個系統部署中有 21 個採用經營租賃方式。展望 2017 年，我們預期系統部署中將有越來越多的比例採用經營租賃方式。我們最近擴大了在德國和韓國的租賃業務。在美國，越來越多的客戶正在考慮透過經營租賃安排來取得達文西手術機的產能。系統直接銷售的平均售價會因產品、地區和以舊換新組合等因素而逐季度變動。隨著我們面向高性價比的系統產品即將推出，以及在對成本敏感的市場領域市場份額的不斷擴大，我們預計 2017 年我們的平均係統售價將呈逐漸下降的趨勢。

As we have described, approximately $23 million of product revenue was deferred in Q1 related to our da Vinci X trade-out program. In future quarters, we expect to defer additional revenue related to da Vinci X trade-out offers that we will make to customers in the U.S. and other markets ahead of the availability of the product. We will recognize revenue at the point the trade-out offers are executed or when they expire.

正如我們之前所述，由於我們的達文西 X 手術系統置換計劃，第一季約有 2300 萬美元的產品收入被推遲。未來幾個季度，我們預計將推遲與達文西 X 手術系統以舊換新相關的額外收入，這些收入將在產品上市前向美國和其他市場的客戶提供。我們將在以舊換新交易執行時或到期時確認收入。

Turning to gross profit. On our last call, we forecast 2017 pro forma gross profit margin to be within a range of between 69% and 71% of net revenue. We now expect our full year 2017 gross profit margin to be in the upper half of that range.

接下來計算毛利。在上次電話會議上，我們預測 2017 年的備考毛利率將佔淨收入的 69% 至 71%。我們現在預計 2017 年全年毛利率將處於該範圍的上半部。

Turning to operating expenses. As we have described previously, we have accelerated our investments in several strategic areas that will benefit the company over the long run. Accordingly, we have ramped our operating expenses as we focus on execution. On our last call, we forecast pro forma 2017 operating expenses to grow between 15% and 18% above 2016 levels. We now anticipate coming in at the higher end of that range. Consistent with our last call, we expect noncash stock compensation expense to range between $190 million and $200 million in 2017 compared to $178 million in 2016. We expect 2017 other income to be between $30 million and $35 million compared to the $25 million to $30 million range forecast on our last call.

接下來談談營運費用。正如我們之前所述，我們加快了在幾個策略領域的投資，這將使公司長期受益。因此，我們提高了營運支出，以專注於執行。在上次電話會議上，我們預測 2017 年的備考營運費用將比 2016 年的水準成長 15% 至 18%。我們現在預計最終結果會處於該範圍的高端。與我們上次的預測一致，我們預計 2017 年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。我們預計 2017 年其他收入將在 3,000 萬美元至 3,500 萬美元之間，而上次電話會議預測的範圍為 2,500 萬美元至 3,000 萬美元。

With regard to income tax. Consistent with previous 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 U.S. and international profits.

關於所得稅。與先前的指導意見一致，我們預計 2017 年的備考所得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。

During Q1, we had 38.5 million diluted shares outstanding for EPS calculations. As Marshall described, in connection with our accelerated share buyback program, on January 27, we took delivery and retired approximately 2.4 million shares, representing the initial delivery from Goldman Sachs. Based upon the timing of this transaction during the quarter, about 1.7 million shares were reduced from our Q1 share count. The remaining 700,000 of the 2.4 million share reduction will be realized in Q2, reflecting the full quarter impact. A final delivery of shares under the program, if any, will be delivered at the end of the contract period in November. Beyond the accelerated buyback, our actual Q2 shares outstanding will also be affected by the impacts of employee option grants, share price and other diluted share calculation inputs as well as any other buybacks.

第一季度，我們用於計算每股盈餘的稀釋後流通股為 3,850 萬股。正如馬歇爾所描述的那樣，為了配合我們加速的股票回購計劃，1月27日，我們接收並註銷了約240萬股股票，這是高盛首次交付的股票。根據本季內該交易的時間安排，我們第一季的股份數量減少了約 170 萬股。剩餘的 70 萬股減持計畫（共 240 萬股）將在第二季實現，反映出該季度的全部影響。該計劃下的最終股份交付（如有）將在11月合約結束時交付。除了加速回購之外，我們第二季實際流通股數量還將受到員工選擇權授予、股價和其他稀釋股份計算輸入以及任何其他回購的影響。

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

我們的發言到此結束。現在開始接受大家的提問。

(Operator Instructions) And our first question will come from Bob Hopkins with Bank of America.

（操作員說明）我們的第一個問題來自美國銀行的鮑伯霍普金斯。

Can you hear me okay?

你聽得清楚我說話嗎？

We can.

我們可以。

We can.

我們可以。

Great. So I guess, the first thing I'd like to ask about is your announcement on da Vinci X, and it sounds like if you're deferring revenue now that the timing of this is fairly imminent. So is it safe to assume that X will actually be launching this calendar year?

偉大的。所以我想問的第一個問題是關於你們的達文西X手術系統的公告，聽起來你們現在推遲收入分配，是因為發佈時間應該很快就要到了。那麼，我們可以合理地假設 X 將在今年內發布嗎？

We plan to launch in Europe first, and we are in the process of the CE mark review. We expect that we'll pass through that review in the next quarter or so.

我們計劃先在歐洲推出產品，目前正在進行CE認證審核。我們預計將在下個季度左右通過那次審查。

And then there are a couple of other follow-ups. In terms of U.S. timing -- and then, Gary, can you just describe this a little bit more? I think you said it was an add-on to Si. I'm just curious. Is this technology primarily a lower-priced offering? Or is it going to be positioned as a tool for new settings or new surgical markets? I just wanted to try to get a better understanding of what the kind of new market opportunity that this is addressing.

此外，還有幾個後續問題。就美國的時間安排而言——那麼，加里，你能再詳細描述一下嗎？我想你說過它是 Si 的一個附加元件。我只是好奇而已。這項技術主要以低價為主嗎？或者，它會被定位為新環境或新外科手術市場的工具嗎？我只是想更了解一下，這究竟是針對哪種類型的新市場機會而推出的。

Sure. So let me describe a little bit of what it is first. It really combines our latest instrument accessory, robotic and computing and imaging technology with an Si patient cart chassis. This brings to market advanced upgrade package for Si technology that's lost between the Si and the Xi in terms of its breadth of critical reach, and it creates an attractive entry point for either an upgrade or a new install. I think that it will do well in places that Si does well today and adds to it some of the Xi technologies at an attractive economic place. Where that goes in terms of treatment locations, we'll see. I think it will be well received.

當然。首先讓我簡單描述一下它是什麼。它將我們最新的儀器配件、機器人、電腦和成像技術與矽基病人推車底盤完美結合。這為 Si 技術帶來了先進的升級方案，彌補了 Si 和 Xi 技術在關鍵應用範圍上的不足，並為升級或新安裝創造了一個有吸引力的切入點。我認為它在 Si 目前表現良好的領域會取得好成績，並以有吸引力的經濟價格添加一些 Xi 技術。至於治療地點方面會如何安排，我們拭目以待。我認為它會受到歡迎。

And then lastly, I guess, on da Vinci X. Can you just talk about what sort of difference in price point are we talking about here? And what sort of difference in functionality, if it's primarily addressing similar kind of surgical opportunities? I'm just curious to any sense for what's the ASP difference and the functionality difference. That will be very helpful.

最後，我想問一下達文西X。您能談談它的價格差異嗎？如果主要目的是解決類似的手術問題，那麼在功能上會有什麼區別呢？我只是好奇想了解ASP和API的差異以及功能上的差異。那將非常有幫助。

Yes. You'll have to wait on ASPs. We aren't announcing it at this time. Just directionally, it'll be between Sis and Xis. And in terms of capability, again, we'll -- as we launch, we'll give you additional information in terms of future benefit. It isn't foundational in terms of the types of procedures it can do. It will make Sis more capable to more comfortably do more procedures. Xi will remain the top of the line. Xi has intraoperative table motion. It has automated help and setup and optimization and multi-quadrant functions that X will not have.

是的。你得等應用程式服務提供者（ASP）的回覆。我們目前暫不公佈。從方向上看，應該在 Sis 和 Xis 之間。至於功能方面，我們會在發佈時向您提供有關未來收益的更多資訊。就其能夠執行的手術類型而言，它並非基礎性的。這將使Sis更有能力、更輕鬆地進行更多手術。習近平仍將維持最高地位。Xi 術中手術台有移動。它具有 X 所不具備的自動化幫助、設定、最佳化和多像限功能。

And could it launch in the U.S. this year? That's my last question.

它今年能在美國上市嗎？這是我的最後一個問題。

It is possible, but we haven't yet called the end date in terms of launch timing.

這並非不可能，但我們尚未確定具體的發佈時間。

Our next question will come from Amit Hazan with Citi.

下一個問題將來自花旗銀行的 Amit Hazan。

Let me just start maybe with the da Vinci Sp delay and just ask for a little bit more color, just specifically what happened to get you to drive that delay. And then also, other than the software upgrade, are you pretty much ready for the 510(k) filing in terms of the clinical results you wanted to have?

讓我先從達文西SP延遲效果器開始，再問您一些更具體的情況，是什麼讓您決定使用這種延遲效果器。另外，除了軟體升級之外，就你想要獲得的臨床結果而言，你是否已經基本準備好提交 510(k) 申請了？

Yes. The clinical side has been really good. We're feeling great about our clinical experience and overall product performance. We do -- we did learn some things in our trial that we want to make a little easier. It has to do with making it a little bit easier to set up and a little bit smoother and optimized workflow. We decided that, given the extensive HF, human factors validations, that are required by regulators these days that we would rather do that sooner ahead of the submission than later. And so we made the decision to go ahead and pull that software release forward and do those validations on the newly released software, so I'm not foundationally upset about where we are with regard to Sp. You get out, and you learn. I'd like to take those learnings and put them back into the product and get on with it.

是的。臨床方面真的非常出色。我們對臨床經驗和整體產品性能感到非常滿意。是的——我們在試驗中確實學到了一些東西，我們希望讓事情變得更容易一些。這樣做是為了讓設定過程更簡單一些，工作流程更流暢、更優化一些。鑑於監管機構如今要求進行廣泛的人因工程驗證，我們認為最好在提交之前儘早完成這項工作，而不是拖延。因此，我們決定提前發布該軟體，並對新發布的軟體進行驗證，所以就 Sp 而言，我並沒有從根本上感到沮喪。你走出去，就會學到東西。我想把這些經驗運用到產品中，然後繼續推進產品開發。

And just 2 quick questions on guidance. First, on the gross margin side. I think I want to try to understand you had another really good gross margin quarter, and your guidance is still kind of a little bit below where we were last year. But it seems like the same drivers are in place, lower cost and new products, managing fixed costs well. So I'm just trying to understand if this is conservatism by you or if you're actually starting to think about some of the maybe da Vinci X product coming through and that's why the guidance is lower. What else is the offset versus what you've been able to achieve over the last 5 quarters?

還有兩個關於指導方面的問題想問。首先，從毛利率方面來看。我想了解的是，你們又迎來了一個毛利率表現非常出色的季度，但你們的業績預期仍然比去年略低一些。但似乎驅動因素依然存在，即降低成本、推出新產品以及有效控制固定成本。所以我想了解一下，這是你們的保守策略，還是你們實際上開始考慮達文西X產品可能上市的情況，所以才降低了預期。與過去五個季度所取得的成就相比，還有哪些不足之處？

Yes, Amit, this is Calvin. And we're definitely pleased with our Q1 gross profit results and our continued progress to reduce cost and improve efficiency, as Marshall took you through. And as such, we did take up our guidance to the upper half of the 69% to 71% range. But you look at -- specifically at Q1, the gross margin of 72% in the quarter benefited from product mixes. 77% of our revenue is from higher margin recurring revenue, and 23% came from lower margin capital. Also during the quarter, again, we had very few charges associated with field actions, excess, obsolete inventory. So as we look forward into the balance of '17, we think the margin will be impacted by things, including, of course, capital sales comprising a higher proportion of the revenue and that mix factor. There will be some costs start to build up that -- to support the manufacturers of some of the new products. We are assuming a higher field action and charges more aligned with historic ratios, and then as I talked about in the prepared comments, some directionally lower system ASPs as we expand our value-oriented system offering and increased placements in the cost-sensitive market segments. And of course, the margin will vary quarter-to-quarter.

是的，阿米特，這是卡爾文。正如馬歇爾向大家介紹的那樣，我們對第一季的毛利表現以及在降低成本和提高效率方面取得的持續進展感到非常滿意。因此，我們將預期目標上調至 69% 至 71% 區間的上半部。但具體來看第一季度，該季度的毛利率為 72%，這得益於產品組合。我們77%的收入來自高利潤率的經常性收入，23%的收入來自低利潤率的資本支出。此外，本季我們與現場作業、過剩庫存和過時庫存相關的費用也很少。展望 2017 年剩餘時間，我們認為利潤率將受到多種因素的影響，當然包括資本銷售在收入中所佔比例較高以及這種組合因素。為了支持一些新產品的製造商，會產生一些成本。我們預計現場活動將更加頻繁，收費也將更加符合歷史比例；正如我在準備好的評論中提到的，隨著我們擴大以價值為導向的系統產品，並在對成本敏感的市場領域增加部署，系統平均售價可能會有所下降。當然，利潤率每季都會有所不同。

Okay. And then just lastly for me on -- is on the procedure guidance. So if I'm kind of hearing you correctly, putting all the pieces together, you had some selling day impact that you're calling out for the first time really. I'm assuming you kind of knew that ahead of time, so I don't know how much that has an impact on your new higher guidance, but maybe a comment on that. And then in addition to that, you talked about strong kind of legacy growth, but your legacy growth was right in line with where it's been more recently. So I'm just wondering, is the net effect of this that the higher guidance for you comes really from general surgery in the U.S.? Is that what's driving the higher number?

好的。最後，對我來說，還有一點——關於操作指南。所以如果我理解沒錯的話，把所有資訊綜合起來，你第一次真正指出了銷售日的一些影響。我猜你事先應該已經知道了，所以我不知道這會對你新的更高指導產生多大影響，但或許你可以就此發表一些看法。此外，您還談到了強勁的傳統成長，但您的傳統成長與最近的成長水平完全一致。所以我想知道，最終的結果是否是，您獲得的更高指導意見實際上來自美國的普通外科？這就是導致數字上升的原因嗎？

Yes. You know there's a lot of factors. Again, overall, we're, again, very pleased with our Q1 procedure results and growth trends, and we do expect 2017 procedure growth to continue to be driven by U.S. general surgery and international procedures. We're still very early stages of adoption in these categories. And again, we've raised our guidance in the quarter from 9% to 12% to 12% to 14%, so it's reflecting our increased confidence overall. But at the end, we feel like our Q1 results were exceptional in the quarter. And going forward, we would expect some moderation in growth in Asia, as Patrick took your through, as we await additional da Vinci procedure reimbursement in Japan and sales quota in China. We'd expect moderation in the European growth rates due to timing of Easter holiday, slight moderation in U.S. mature procedures, which have continued trends, as you mentioned. But dVP and GYN, we'd assume some moderation there, and then just the overriding uncertainty in policy direction in the United States and what impact that may have.

是的。你知道，這其中有很多因素。再次重申，我們對第一季的手術結果和成長趨勢非常滿意，我們預計 2017 年的手術成長將繼續由美國普通外科手術和國際手術推動。在這些領域，我們仍處於非常早期的應用階段。此外，我們再次將本季的業績預期從 9% 上調至 12%，再上調至 12%，最終達到 14%，這反映了我們整體信心的增強。但最終，我們感覺第一季的業績非常出色。展望未來，正如 Patrick 向你介紹的那樣，我們預計亞洲的成長將有所放緩，因為我們正等待日本達文西手術報銷的增加以及中國銷售配額的提高。由於復活節假期的時間安排，我們預計歐洲的成長率會有所放緩；正如您所提到的，美國成熟手術的成長速度也會略有放緩，但這些手術仍保持著一定的趨勢。但對於 dVP 和 GYN，我們假設會有一些緩和，然後是美國政策方向的巨大不確定性以及這可能會產生的影響。

We'll go next to David Lewis with Morgan Stanley.

接下來我們來採訪摩根士丹利的戴維·劉易斯。

Just a few quick ones. Gary, just starting off with the da Vinci X for a second here. I wonder, with the upgrade electronics package in tower on da Vinci X, is it going to be possible to upgrade the X with Sp? Meaning, will that tower work with Sp? So potentially, you can bring Sp to a broader marketplace than we initially thought, which we thought maybe was limited to just Xi?

就幾個簡單的問題。Gary，我先用達文西X軟體來示範。我想知道，如果達文西 X 的塔式機殼裡配備了升級的電子設備，是否有可能將 X 升級為 Sp 版本？也就是說，那座塔能和 Sp 相容嗎？所以，Sp 有可能被推向比我們最初設想的更廣泛的市場，我們最初認為它的市場可能只限於 Xi？

Yes. So it's a good point. It's -- the answer to that is ultimately, yes. But the computational hardware platform and the basics are shared across all 3: X, Xi, and ultimately, Sp. So in addition to giving people a lower entry point on advanced technologies, it gives them logical upgrade pathways to advance technologies.

是的。所以這是一個很好的觀點。答案最終是肯定的。但是，計算硬體平台和基本原理在所有 3 個平台（X、Xi 以及最終的 Sp）中都是共享的。因此，除了降低人們接觸先進技術的門檻之外，它還為他們提供了通往先進技術的合理升級途徑。

Perfect. Very fair. And then, Gary, just 2 more quick ones. One on Sp. Does this software upgrade or software pull forward, I should say, does that impact the time of the second and third filings you were forecasting out ahead of that and others?

完美的。非常公平。然後，加里，就再來兩個快點。一個在 Sp。這次軟體升級或軟體提前發布，是否會影響您先前預測的第二份和第三份文件以及其他文件的提交時間？

It does not appear to.

似乎並非如此。

Okay. And then, Gary, the one procedure -- we talk a lot about prostate, we talk about hernia lately, but this thoracic procedure or segment has really come into the dialogue the last 6 months. Can you just talk more about what's happening in thoracic? How much of it is lung resection? How much of it is this broad category of VATS surgery? And anything you could share with us in terms of market size, stage of inflection? Because it's sort of merged from a nice place to a definitive driver. It'd be helpful to get some clarity.

好的。然後，加里，有一種手術——我們經常談論前列腺手術，最近也經常談論疝氣，但這種胸腔手術或胸段手術在過去 6 個月裡確實成為了人們討論的話題。能再詳細談談胸腔外科的情況嗎？其中有多少是肺切除手術？其中有多少是胸腔鏡輔助手術這一大類手術？您能否就市場規模、拐點階段等方面與我們分享一些資訊？因為它某種程度上是從一個美好的地方合併成了一個明確的驅動因素。如果能弄清楚情況就更好了。

Sure. I think just painting it broad strokes, the opportunity for us in thoracic surgery over time is real. There's a lot of open surgery in that space. These are complex procedures and delicate surgeries, and so we think that sets up well for a da Vinci kind of platform. As we've brought Xi to the market with its longer reach, its narrower arms and its set of Xi staplers, that has helped. So we're seeing what would amount to early interest and early growth in that category. In terms of market sizes and rate of penetration, I'll let Patrick speak to that a little bit. We still think we're early. I would also say that we've got our sales force and commercial team really focused primarily on general surgery. I think we want to support that market really well. But Patrick, take it away.

當然。我認為，從宏觀角度來看，隨著時間的推移，胸腔外科領域的機會是真實存在的。那個領域有很多開放式手術。這些都是複雜的手術和精細的操作，因此我們認為這非常適合採用達文西手術平台。我們推出的 Xi 具有更長的觸及範圍、更窄的臂桿以及一套 Xi 訂書機，這對我們有所幫助。所以我們看到的是人們對這個領域的早期興趣和早期成長。至於市場規模和滲透率，我還是讓派崔克來談談吧。我們仍然認為我們現在還處於早期階段。我還要補充一點，我們的銷售團隊和商務團隊主要專注於一般外科領域。我認為我們應該全力支持這個市場。但是派崔克，你來接棒吧。

If you look at the United States market, there's probably around 100,000 patients who receive surgery in a day, split evenly between lobectomies and other types of thoracic procedures for which we think our products can bring value to patients and surgeons. When you look outside of the United States, markets are much, much larger, particularly when you look to Asia and China in particular. So we're optimistic about the future, but we're still in very early days, and you're seeing some of the early evidence sets come out comparing robotics to open and even VATS surgeries where there are improving outcomes. And if that evidence holds up over time, we think there's a runway for us here.

如果你看看美國市場，每天大約有 10 萬名患者接受手術，其中肺葉切除術和其他類型的胸腔外科手術各佔一半，我們認為我們的產品可以為患者和外科醫生帶來價值。當你把目光投向美國以外的市場時，你會發現市場規模要大得多，尤其是亞洲市場，特別是中國市場。所以我們對未來持樂觀態度，但我們仍處於非常早期的階段，你會看到一些早期證據集出來，將機器人手術與開放式手術甚至胸腔鏡手術進行比較，結果顯示機器人手術正在改善手術效果。如果這些證據經得起時間的考驗，我們認為我們在這裡還有發展的空間。

Our next question is from Tycho Peterson with JPMorgan.

我們的下一個問題來自摩根大通的泰科·彼得森。

I'll start off with just a couple of clarifications on procedure expectations. Are you factoring in any impact from USPSTF guidelines? And then can you comment on hernia ventral versus inguinal? Are you still seeing relatively balanced growth rates between the 2?

首先，我先澄清一下流程預期方面的幾點。您是否考慮了美國預防服務工作小組（USPSTF）指引的影響？那麼，您能否談談腹壁疝氣和腹股溝疝氣的差異呢？您認為兩者之間的成長率仍然相對平衡嗎？

Tycho, it's Patrick. From a USPSTF perspective, in 2012, when the original announcement came out, you saw dVP falling into a decline over a couple of year period. However, since then, you've seen our volumes really returned to nearly the level they were in 2011, so I think a lot of it has played through. Now we're pleased to see the statement become more aligned to what the AUA society guidelines are. From a ventral and inguinal hernia perspective, we remain encouraged by the trends we're seeing. You continue to see growth in our existing surgeon populations doing more and more procedures, new surgeons coming along, and there's a lot of positive energy coming out of society meetings like the American Hernia Society and the SAGES meeting. So we continue to be pleased by the adoption that we're seeing.

泰科，我是派崔克。從美國預防服務工作小組 (USPSTF) 的角度來看，在 2012 年最初的公告發佈時，你會看到 dVP 在幾年內開始下降。不過，從那以後，我們的銷售量已經恢復到 2011 年的水平，所以我認為很多因素都已經顯現出來了。現在我們很高興看到該聲明與美國泌尿外科協會的指導方針更加一致。從腹股溝疝氣和腹股溝疝氣的角度來看，我們對目前看到的趨勢感到鼓舞。我們看到現有外科醫生群體不斷壯大，開展的手術越來越多，新的外科醫生也不斷湧現，而且像美國疝學會和SAGES會議這樣的學會會議也帶來了很多積極的能量。因此，我們對目前的市場接受度感到滿意。

And then on Sp. I know you suggested the software release wouldn't necessarily impact the timing for follow-on procedures beyond urology. Can you maybe just help us think of when you may have those filings for the follow-on procedures? And also, when can we get a readout from the first clinical experience in Australia? Is that something that would be published?

然後是 Sp。我知道您曾表示，軟體發布不一定會影響泌尿科以外的後續手術的時間表。您能否幫我們想想您大概什麼時候會提交後續手術的相關文件？另外，我們什麼時候才能獲得澳洲首次臨床試驗的結果？這是會發表的內容嗎？

Okay. So 2 other things there: one is Sp, and one is our flexible robotics program. Now just going to Sp to start. We have not yet settled on submission time lines for the additional indications on Sp beyond urology. We are imminently initiating the transoral surgery trials, and then we'll open colorectal trials thereafter, but we have not yet set dates publicly for when we expect those submissions. That said, the software update we're doing vis-à-vis the urology filing should not disrupt the time line of those 2. With regard to the work that was in Australia, that was on the flexible robotics platform. There are in patient follow-up now, so they're following patients after their treatment for the prescribed amount of time in their protocol. I'd expect them to be presenting publicly in the fall.

好的。還有兩件事：一件是Sp，另一件是我們的靈活機器人專案。現在先去Sp看看。我們尚未確定泌尿科以外的 Sp 其他適應症的提交時間表。我們即將啟動經口手術試驗，之後將啟動結直腸手術試驗，但我們尚未公開確定預計何時提交這些試驗結果。也就是說，我們正在進行的泌尿科歸檔軟體更新應該不會影響這兩個項目的進度。至於在澳洲所進行的工作，那是在柔性機器人平台上進行的。現在有住院隨訪，所以他們會在患者接受治療後，按照治療方案規定的時間對患者進行隨訪。我預計他們會在秋季公開亮相。

We now have a question from Tao Levy with Wedbush.

現在我們收到來自 Wedbush 公司的 Tao Levy 的提問。

Great. So a question on the X, on the da Vinci X. Are the instruments similar, too, to the Xi? Or is it still going to be a different core set of instruments?

偉大的。那麼，關於達文西X型縫紉機，我想問一個問題。它的儀器也和達文西X型縫紉機類似嗎？或者它仍然會採用一套不同的核心樂器？

Good question. The instruments on X are the same family as the Xi. So there are generation 2 advanced instrument kit, so things like stapling and vessel sealing or Gen 2. They are the same exact instruments, same part numbers as the Xi, likewise with imaging system. So if you're an account that has multiple systems, you have Xis and Sis, then moving to X can standardize your Si base and have one set of instruments and accessories.

問得好。X 上的儀器與 Xi 屬於同一系列。所以現在有了第二代高級儀器套件，像是縫合器和血管密封器之類的第二代產品。它們的儀器和 Xi 的完全相同，零件編號也相同，成像系統也是如此。因此，如果您擁有多個系統，例如 Xis 和 Sis，那麼遷移到 X 可以標準化您的 Si 基礎，並擁有一套儀器和配件。

Got you. And the pricing pathway for an upgrade from an Si 2 and X outside of obviously the deferral?

抓到你了。除了延期付款之外，從 Si 2 和 X 升級到新機的定價方案是什麼？

So not -- we haven't published yet what the list price steps are going to be.

所以，還沒有——我們還沒有公佈具體的定價階梯。

Got you. Okay And then just lastly. I asked this question the last quarter. Just wondering if there's any update on the quota from China? Is that still something you expect over the near term?

抓到你了。好的，最後還有一件事。我上個季度問過這個問題。請問中國配額有任何最新消息嗎？你仍然預期短期內會發生這種情況嗎？

There really isn't -- this is Marshall. There really isn't much of an update. As we previously communicated, we're still waiting for quota which would cover the civilian hospitals in China, and we'll keep you informed as we hear.

確實沒有——這裡是馬歇爾。並沒有什麼新的進展。正如我們之前溝通的那樣，我們仍在等待涵蓋中國民用醫院的配額，一旦有消息，我們會及時通知大家。

Our next question is from Brandon Henry with RBC Capital Markets.

下一個問題來自加拿大皇家銀行資本市場的布蘭登亨利。

First, can you talk about the dynamic -- you mentioned the patients coming in for surgery ahead of potential health care reform changes. And what you heard from surgeons regarding that dynamic? And then should we expect this, the more dynamic, to occur in the second quarter? And I have a couple of follow-ups.

首先，您能談談這種動態嗎？您提到了在潛在的醫療改革變化之前前來接受手術的患者。那麼，你從外科醫生那裡了解到了關於這種現象的哪些資訊呢？那麼，我們是否應該預期這種更具活力的趨勢會在第二季出現呢？我還有幾個後續問題。

I -- this is Gary. I don't think we have a deep insight there. There's been a little bit of speculation that there's been some pull forward. We have seen just in the numbers a little more buoyance kind of broadly across our procedure base, not just in a single category, but kind of across each category which leaves us to believe there's something environmental going on. I would not say that we have special insight. I think it's a little bit of speculation. We'll know on the future quarters. I cannot predict what will happen Q2, Q3 with regard to how ACA dynamics will occur.

我是加里。我認為我們對此還沒有深入的了解。有傳言說，有人提前做出了一些努力。我們從數據上看到，我們的手術量總體上出現了一些增長，不僅僅是在單一類別中，而是在每個類別中都是如此，這讓我們相信，環境方面可能存在一些問題。我不會說我們有什麼特殊的洞察力。我認為這有點像是猜測。我們將在接下來的幾個季度中得知結果。我無法預測第二季和第三季《平價醫療法案》（ACA）的動態發展。

Okay. And then separately, on the international side. I think the company breaks out international procedures by prostatectomy, hysterectomy in kind of other bucket. The other bucket is the kind of larger portion of international procedures that we don't really have a lot of visibility into the underlying trends there. So can you just spend some time discussing what specific countries or procedures are driving that continued 30%-plus growth in the other bucket and your confidence of kind of that rate of growth continuing for the other category going forward?

好的。然後，在國際方面，情況則有所不同。我認為該公司將國際手術按前列腺切除術、子宮切除術等類別進行了分類。另一類是國際手術中佔比較大的那類，我們不太了解這類手術的潛在趨勢。那麼，您能否花些時間討論一下，是哪些具體的國家或流程推動了另一類別中持續超過 30% 的增長，以及您對該類別未來能否繼續保持這種增長速度的信心？

Yes, sure, Brandon, it's Patrick. We continue to see most of our -- outside of the United States procedure growth being driven by urology, mostly prostatectomy and dVP, but also in kidney repairs, mainly through partial nephrectomies to which the system tends to be an enabler for population of patients to access partial nephrectomy for kidney cancers. We also do see encouraging signs in general surgery and gynecology, stronger in Asia and in certain markets in Europe where we've already deeply penetrated urology.

是的，布蘭登，我是派崔克。我們繼續看到，在美國以外，我們的手術成長主要由泌尿外科推動，主要是前列腺切除術和dVP，但也包括腎臟修復，主要是透過部分腎切除術，該系統往往能夠使腎癌患者群體獲得部分腎切除術。我們也看到一般外科和婦科領域出現了令人鼓舞的跡象，在亞洲和歐洲某些市場表現更為強勁，而我們在泌尿外科領域已經取得了深遠的進展。

Our next question is from Larry Biegelsen with Wells Fargo.

下一個問題來自富國銀行的拉里·比格爾森。

First, if I focus on the pipeline, any updates on the new technologies that you're working on, the imaging agent and additional instruments? And I had one follow-up.

首先，如果我專注於研發流程，關於您正在研究的新技術、顯影劑和其他儀器，有什麼最新進展嗎？我還有一個後續問題。

Imaging trial on the imaging agent is initiated. So far, so good. We're still early in the trial, but we're pleased. Otherwise, our imaging programs are progressing against our plan. Your second question was on -- I'm sorry, advanced?

啟動對顯影劑的影像試驗。到目前為止，一切都很好。試驗尚處於早期階段，但我們感到滿意。否則，我們的影像專案進度將與計畫背道而馳。你的第二個問題是關於──抱歉，是高階的嗎？

Additional instruments.

其他樂器。

Instrumentation. We have a portfolio of instruments we're working on. Nothing to really call out in terms of dates for you. We are making progress on expanding our stapler line to be a full-line stapling system, but nothing I'd call out for you on this call.

儀器儀表。我們正在研發一系列樂器。就日期而言，沒有什麼特別需要注意的。我們正在努力將訂書機產品線擴展為完整的訂書系統，但這次通話中沒有什麼特別值得一提的。

Gary, let me ask one on the competition. So Medtronic has talked about bundling their surgical portfolio to drive sales of their robot. Assuming they have a competitive offering, can you talk about things you could do, such as partnering to negate that advantage that they could have?

加里，我想問一個關於比賽的問題。因此，美敦力公司曾表示將把他們的外科手術產品組合打包出售，以推動其機器人的銷售。假設他們擁有具有競爭力的產品，你能談談你可以做些什麼，例如透過合作來抵消他們可能擁有的優勢嗎？

We think -- the way we think about it in terms of servicing our customer is to allow them to have a minimally invasive surgery program that get the outcomes they want across a broad population of patients and surgeons. We think that our technologies are outstanding, and we'll continue to be market-leading. To the extent that they need to augment a robotics system with other products, there are a plethora of other companies that are happy to sell into surgical suites. And I think as long as those are at an economically attractive price point and the products are well accepted, I think we're going to be in good shape.

我們認為—就服務客戶而言，我們的思考方式是讓他們能夠進行微創手術項目，從而在廣泛的患者和外科醫生群體中獲得他們想要的結果。我們認為我們的技術非常出色，我們將繼續保持市場領先地位。如果他們需要用其他產品來增強機器人系統，那麼有很多其他公司都樂意向手術室銷售這些產品。我認為，只要這些產品的價格在經濟上具有吸引力，並且受到市場的歡迎，我們就會處境良好。

And our next question will come from Richard Newitter with Leerink Partners.

接下來，我們將向 Leerink Partners 的 Richard Newitter 提問。

Just the first one. Coming out of SAGES, we noticed just a palpable kind of acceptance, increased acceptance of hernia procedures in general, multiple kind of podium sessions devoted to it. So I'm just wondering, is there that acceptance that you're seeing -- that we saw, do you guys feel that kind of there's been a notable inflection in the acceptance of kind of hernia -- robotic hernia surgery? And would you be willing to kind of give us an updated kind of sense of where we are on the market opportunities within ventral and hernia -- inguinal, how big they are and kind of where you think that could go from your addressable market?

就第一個。從 SAGES 會議出來後，我們明顯感覺到人們對疝氣手術的接受度有所提高，並且舉辦了多場專門討論疝氣手術的專題講座。所以我想知道，你們是否也看到了——我們看到的——人們對疝氣——機器人疝氣手術——的接受度有了顯著提高？您能否為我們介紹一下目前腹股溝疝氣和疝氣（腹股溝）的市場機會，它們有多大，以及您認為從您的目標市場來看，它們的發展前景如何？

I think in the first part of your question, where are we in acceptance, I think that you're seeing some early exploration and enthusiasm, and we're feeling that enthusiasm as well. But as you well know, the surgical population is not of one mind. And I think that we're going to see pro-con debates in hernia for some time, and I would expect that. And I think it'll be challenged and debated and discussed, variance by patient population, variance by surgical technique and variance by total economics to treat. That leads to your second question, which is, are we ready to make any changes to our thoughts on estimated market size? And I think it's really too early to try to redraw boundaries there. So the summary for us is, so far, so good. I think surgeons are finding real value and pursuing that value. They're doing what I think they should in terms of assessing it carefully and publishing the results and debating which patient groups and subgroups make sense, and we will support them in that effort.

我認為在你問題的第一部分，即「我們在接受度方面處於什麼階段」中，你看到了一些早期的探索和熱情，我們也感受到了這種熱情。但如你所知，外科醫生群體並非意見一致。我認為，關於疝氣的正反爭論還會持續一段時間，這也是我預期的。我認為這個問題會受到質疑、辯論和討論，因為患者群體、手術技術以及治療的總經濟成本都會影響結果。這就引出了你的第二個問題，那就是，我們是否準備好對估計的市場規模做出任何改變？我認為現在就試圖重新劃定界線還為時過早。所以，就目前而言，總結起來一切順利。我認為外科醫生們正在發現並追求真正的價值。我認為他們正在做他們應該做的事情，即認真評估並公佈結果，討論哪些患者群體和亞群體是合理的，我們將支持他們的這項工作。

That's helpful. And then just a follow-up on the ACA kind of -- some of the dynamics that might be playing out in the market, but I'm just wondering on the capital side and on the decision-maker side of the equation at hospitals and institutions. Any updates on what you're hearing from customers on kind of their willingness to invest in an innovation like robotics?

那很有幫助。然後，我想就《平價醫療法案》(ACA) 的後續問題進行一些探討——市場中可能正在發生的一些動態，但我只是想了解醫院和機構的資本方面和決策者方面的情況。關於客戶對投資機器人等創新技術的意願，您目前有什麼新的回饋嗎？

I think on the one hand in a good way, a lot of people understand the basic value proposition of robotics, are familiar with the kinds of things it can do. So that has led to, I think, meaningful conversations that are data-driven and effective. I think on the margins right now, the ACA has injected some caution on the part of capital buyers. So on the positive side, I think robotics, the value it can bring is pretty well understood. On the negative side, I think on the margin at the outside, it's been -- the ACA uncertainty has been a slight negative.

我認為從好的方面來看，很多人了解機器人技術的基本價值主張，也熟悉了機器人技術所能做的事情。我認為，這促成了有意義的、數據驅動的、有效的對話。我認為就目前而言，《平價醫療法案》在某種程度上促使資本買家保持謹慎。所以從正面的方面來看，我認為機器人技術及其所能帶來的價值已經得到了相當充分的理解。不利的一面是，我認為在邊緣地帶，ACA 的不確定性略微產生了負面影響。

Our next question is from Rick Wise with Stifel.

我們的下一個問題來自 Stifel 公司的 Rick Wise。

Just a big-picture question first. I mean, I would assume you'd think that the opportunity for robotics and surgery is underpenetrated. I'm just sort of fascinated with the -- several times you've mentioned -- you, Marshall, Calvin had mentioned that average selling prices will trend lower because of new products and mix here. Just stepping back from both specifics, how do we think about the opportunity for a lower-priced system perhaps driving the increased penetration? I mean, is this the next leg in robotic market penetration? And does da Vinci X and Sp, should we think about that more specifically as one of the next big opportunities as opposed to just a procedure or a geography, if you see what I'm getting at?

先問一個比較宏觀的問題。我的意思是，我猜你會認為機器人手術的市場機會還沒有充分利用。我對——你多次提到——你、馬歇爾、卡爾文都提到過，由於新產品和產品組合的出現，平均售價將呈現下降趨勢。撇開這兩個具體細節，我們如何看待價格較低的系統可能會推動市場滲透率的提升？我的意思是，這是機器人市場滲透的下一個階段嗎？那麼，達文西X和Sp，我們是否應該更具體地將其視為下一個重大機會之一，而不僅僅是一種手術或一個地域，你明白我的意思嗎？

I'll answer a little simpler question that you asked. I think we have been in close contact with our customers, particularly those outside the United States, and have been listening carefully to what kind of procedures they want to do, what the reimbursement environments are in their countries and what kind of capabilities need to match that procedure set and reimbursement set. And we think X fits that bill. And as a result, I think that it'll be well received. I don't think it's limited to a single country. I do think that we believe, and I think our customers believe, that total cost to treat is the right economic measure. That better outcomes followed by economic analysis to look at total cost to treat and to the extent that your technology offering can match that so that you get both great outcomes and lower total cost to treat, that will drive adoption. How big, how fast X goes? We don't have a crystal ball, but we invested in it based on some conversations and research we think was right. I think that it's going to hit the mark for them, and we will be delighted to report to you in future quarters how it's going.

我來回答你提出的一個比較簡單的問題。我認為我們一直與客戶保持密切聯繫，特別是與美國以外的客戶，並認真傾聽他們想要進行哪些類型的手術，他們所在國家的報銷環境如何，以及需要哪些能力來匹配這些手術和報銷方案。我們認為 X 符合這個條件。因此，我認為它會受到歡迎。我認為這並非僅限於一個國家。我認為我們相信，而且我認為我們的客戶也相信，總治療成本是正確的經濟衡量標準。在更好的治療效果之後，還需要進行經濟分析，考察治療總成本，以及您的技術產品能否滿足這些成本要求，從而既獲得良好的治療效果又降低治療總成本，這將推動技術的普及應用。X 的大小和速度有多快？我們沒有水晶球，但我們根據一些我們認為正確的對話和研究進行了投資。我認為這將達到他們的預期目標，我們將在未來幾季很高興地向您報告進度。

Yes. And Gary, just to follow on to that. So just to be very clear, I mean, this is not, "Just an upgrade for existing Xi install base." It is that, but it's definitely something much broader, potentially.

是的。然後，我還要補充一點，蓋瑞。所以為了說清楚，我的意思是，這不僅僅是「對現有 Xi 安裝基礎的升級」。它確實包含這方面的內容，但它的潛在影響範圍肯定要廣泛得多。

You can -- if one has an Si, then you can upgrade your Si to an X. If you have no system and you want to get started, then you can buy an X to get started.

可以－－如果你已經有了Si，那麼你可以將Si升級到X。如果你還沒有電腦，想入門，那你可以直接買一台X。

Yes. And you didn't mention -- I know it's small table motion this quarter. Just out of curiosity, where are we with adoption and the uptake there? Is it going as you expect and planned?

是的。而且你也沒提到——我知道這季度業績波動不大。我只是好奇，目前美國的收養率和普及率是多少？事情進展是否如你所預期和計劃的那樣？

Yes. At the top level, attach rate of table motion has exceeded our initial expectations and kind of our original business plan for that product. I think with regard to the last quarter, I would imagine, Patrick, about...

是的。從最高層面來看，工作台運動的附著率已經超出了我們最初的預期，也超出了我們最初針對該產品的商業計劃。我認為，就上個季度而言，帕特里克，大概是…

Very solid attach rates with new Xi system sales. We've worked largely through the existing population of customers, so we aren't seeing as much on a year-over-year basis as we saw when the product launched.

新Xi系統銷售的附加率非常高。我們已經基本上消化了現有客戶群，因此與產品剛推出時相比，我們現在看到的同比變化並不大。

Okay. And just last for me, on Fosun. Any milestones we should expect and, let's say, the next 12 months on the program? And maybe just more broadly, how do we think about this partnership's impact, if anything, now looking ahead on the broader high surge Chinese business, and especially given the complex geopolitical situation?

好的。最後，我想談談復星。我們應該期待哪些里程碑？比如說，該專案未來 12 個月的計畫是什麼？更廣泛地說，展望未來，考慮到中國業務的蓬勃發展，尤其是在複雜的地緣政治形勢下，我們該如何看待這種合作關係的影響（如果有的話）？

Okay. With regard to Fosun, I think I'd focus the audience on really 2 things: one is the technical progress of the flexible robotics platform because we think that's a major component, and then the other one will be our activities in building that organization, hiring staff. As the organization builds out, then we'll announce to you kind of where we are. I gave you an update on where we are in the flex robotics program. We are very bullish on the interest in and the value that robotic surgery can bring to China. We have the right partner in Fosun over time. That partnership exists today in the form of our distribution relationship with one of their subsidiaries in Chindex. That will grow into the relationship into a full JV, and we will navigate the international waters as need be.

好的。關於復星，我認為應該讓大家專注於兩件事：一是柔性機器人平台的技術進步，因為我們認為這是主要組成部分；二是我們在建立該組織、招募員工方面的活動。隨著組織的逐步發展，我們會向大家公佈我們目前的進展。我向你報告了我們在柔性機器人專案方面取得的進展。我們非常看好機器人手術在中國的發展前景及其帶來的價值。隨著時間的推移，我們找到了與復星合作的合適夥伴。目前，這種合作關係以我們與 Chindex 的子公司建立分銷關係的形式存在。這將使雙方的關係發展成為全面的合資企業，我們將根據需要處理國際事務。

So thank you for the question. That was our last one. As we've said previously, while we focus on financial metrics such as revenue, profits and cash flow during these conference calls, our organizational focus remains on increasing value by enabling surgeons to improve surgical outcomes and reduce surgical trauma. We have built our company to take surgery beyond the limits of the human hand, and I assure you that we remain committed to driving the vital few things which really make a difference.

謝謝你的提問。那是我們最後一個。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。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 look forward to talking to you again in 3 months.

今天的電話會議到此結束。感謝您參與並支持這項旨在改進外科手術的非凡旅程，並期待3個月後再次與您交流。

Thank you, and ladies and gentlemen, that does conclude our conference for today. Thank you for your participation and for using AT&T Executive Teleconference. You may now disconnect.

謝謝各位，女士們、先生們，我們今天的會議到此結束。感謝您的參與以及使用AT&T高階主管電話會議系統。您現在可以斷開連線了。