直覺手術 (ISRG) 2017 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Surgical Second Quarter 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, Finance, Investor Relations, Calvin Darling. Please go ahead, sir.

女士們、先生們，感謝各位的耐心等待，歡迎參加直覺外科公司2017年第二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 Second 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二季財報電話會議。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, and 10-Q filed on April 19, 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 表格和於 2017 年 4 月 19 日提交的 10-Q 表格。這些文件可透過我們的網站或美國證券交易委員會的EDGAR資料庫找到。潛在投資者應注意，不要過度依賴此類前瞻性陳述。

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

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 with highlights of our second quarter results as described in our press release announced earlier today, followed by a question-and-answer session. Gary will present the quarter's business and operational highlights. Marshall will provide a review of our second quarter financial results. Patrick will discuss procedure in 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：首先介紹我們今天早些時候發布的新聞稿中所述的第二季度業績亮點，然後進行問答環節。Gary 將介紹本季的業務和營運亮點。馬歇爾將對我們第二季的財務表現進行回顧。Patrick 將在臨床亮點部分討論相關流程，然後我將提供我們 2017 年最新的財務展望。最後，我們將舉行問答環節。

With that, I will turn it over to Gary.

接下來，我將把麥克風交給蓋瑞。

Good afternoon, and thank you for joining us on the call today. As you know, Intuitive is focused on significantly improving surgery and enabling access to our products and services in pursuit of this mission globally. The momentum built over the past several quarters continued into the second quarter of 2017, with solid performance in procedures and strong growth in system placements.

下午好，感謝各位今天參加我們的電話會議。如您所知，Intuitive 致力於顯著改善外科手術，並在全球推廣我們的產品和服務，以實現這項使命。過去幾季累積的勢頭延續到了 2017 年第二季度，手術量表現穩健，系統植入量也實現了強勁增長。

Growth in procedures for the quarter was 16% over the second quarter of 2016. Overall trends in the first quarter remained stable into the second.

本季手術量比 2016 年第二季成長了 16%。第一季的整體趨勢在第二季保持穩定。

Starting with the United States. Both the emerging category of general surgery and more mature categories in urology and gynecology performed well. Hernia repair continues to stand out in the general surgery category, with additional contributions coming from colon procedures. As we mentioned last quarter, European performance in Q1 of 2017 benefited from calendar tailwinds that we expected to balance out in the second quarter. Indeed, this occurred with core growth staying roughly steady through the first half of 2017 and European second quarter growth moderating. Procedure performance in Asia was solid, with growth in China being a highlight from a constrained installed base. Patrick will take you through these factors in more detail later in the call.

先從美國開始。無論是新興的普通外科，或是較成熟的泌尿外科和婦科，都表現良好。疝氣修補術仍然是一般外科手術領域的重要組成部分，結腸手術也貢獻了一部分收入。正如我們上個季度所提到的，2017 年第一季歐洲市場的表現得益於日曆上的有利因素，我們預計這些因素將在第二季得到平衡。事實上，2017 年上半年核心成長基本上保持穩定，而歐洲第二季度成長放緩，這種情況確實發生了。亞洲地區的手術效果穩健，其中中國市場在有限的裝機量下實現了顯著增長。派崔克稍後會在通話中更詳細地向您介紹這些因素。

Our capital placement performance in Q2 of 2017 strengthened with a growth in total placements from 130 in Q2 of 2016 to 166 this quarter. As we mentioned on these calls, capital placements can be lumpy as evidenced by our performance in the first half of the year. In the United States, placements rebounded from a softer Q1 to a strong Q2, anchored in repeat purchases by existing customers and multisystem placements. System placements in Europe grew moderately, aided in part by the launch of da Vinci X. In Asia, the placements grew slightly over the prior year period and over last quarter, constrained for the time being by the lack of a new system quota in China and limited reimbursements in Japan. Marshall and Patrick will take you through system placement dynamics in greater detail.

2017 年第二季度，我們的資本配置業績有所增強，總配置數量從 2016 年第二季的 130 筆成長到本季的 166 筆。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，我們上半年的業績證明了這一點。在美國，由於現有客戶的重複購買和多系統部署，產品安裝量從疲軟的第一季反彈至強勁的第二季。歐洲的系統植入量適度成長，部分原因是達文西X的推出。亞洲的系統植入量較去年同期和上一季略有成長，但目前受到中國缺乏新系統配額和日本報銷額度有限的限制。Marshall 和 Patrick 將帶您更詳細地了解系統佈局動態。

Turning to profitability for the quarter. Strong system placements led to gross margins that are lower than last quarter. These margins are at the top of our expected range because of the strength in procedures and improvements in our operating efficiencies. Our fixed cost growth met our expectations with increases in R&D expenses, growth in staff in European and Asian markets, investments in clinical trials and growth in our corporate computational capabilities. Our second quarter pro forma operating results are as follows: procedures grew approximately 16% over the second quarter of last year; we shipped 166 da Vinci Surgical Systems, up from 130 in the second quarter of 2016; revenue for the quarter was $756 million, up 13% from the prior year; instrument and accessory revenue increased to $398 million, up 17%; total recurring revenue in the quarter was $540 million, representing 71% of total revenue; pro forma gross profit margin was 71.3% compared to 71.9% in the second quarter last year; we generated a pro forma operating profit of $313 million in the quarter, up 5% from the second quarter of last year; and pro forma net income was $228 million, up 4% from Q2 of 2016. Marshall will take you through our finances in greater detail shortly.

接下來談談本季的獲利情況。強勁的系統部署導致毛利率低於上一季。由於流程穩健和營運效率提高，這些利潤率處於我們預期範圍的上限。我們的固定成本成長符合預期，這主要得益於研發支出增加、歐洲和亞洲市場員工人數成長、臨床試驗投資以及公司運算能力提升。我們第二季度的備考經營業績如下：手術量較去年同期增長約16%；我們交付了166套達芬奇手術系統，高於2016年第二季度的130套；本季度營收為7.56億美元，較上年同期增長13%；器械及配件收入增至3.98億美元，增長1 7%；本季經常性收入總額為5.4億美元，佔總收入的71%；備考毛利率為71.3%，而去年同期為71.9%；本季備考營業利潤為3.13億美元，較去年同期增長5%；備考淨利潤為2.28億美元，較2016億美元，較去年同期增長5%；備考淨利潤為2.28億美元，較2016年第二季度增長4%。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, in the back half of 2016 and the first half of 2017, we increased our midterm and long-term investments in creating our next generation of products and services. We anchored in our belief that substantial opportunity exists to enable a more minimally invasive surgery, better outcomes and to expand access to our technologies globally.

接下來，我們來看看產品線。如您所知，在 2016 年下半年和 2017 年上半年，我們增加了對下一代產品和服務的研發投入，包括中期和長期投資。我們堅信，我們有很大的機會實現微創手術，獲得更好的治療效果，並在全球擴大我們技術的應用範圍。

Starting with our multiport portfolio. We developed a system pathway that responds to our customers' desire for choice in clinical capability and choice in total economics. In the quarter, we've received our CE Mark and 510(k) clearance for da Vinci X, our system that brings core Xi technology into a highly capable, lower entry price surgical system. We're pleased with the early reception of X by our customers and the choice it brings to those around the world who seek to build robotic-assisted surgery programs with logical upgrade pathways and affordable access to our leading robot-assisted surgery ecosystem. Our SP program continues to progress in its human clinical trial work and pilot production capability. We now have 4 clinical trial sites active, 3 in the United States and 1 in Asia. Cases in Asia have included transoral, urologic and colorectal surgery, while those in the U.S. are focused on transoral robotic-assisted surgery. As we mentioned in our last -- in our call last quarter, we anticipate filing our 510(k) for SP in urology in the back half of 2017. Surgeon feedback from our trial sites is very encouraging. Our teams continue to work on product validations and manufacturing capability to support submission and launch. Lastly, our flexible robotics program is meeting our expectations and making good progress in its product design phases and definition of regulatory pathways.

首先介紹我們的多埠產品組合。我們開發了一套系統路徑，以滿足客戶在臨床能力和整體經濟效益方面的選擇需求。本季度，我們的達文西 X 系統獲得了 CE 標誌和 510(k) 許可，該系統將核心 Xi 技術融入一個功能強大、入門價格更低的的手術系統中。我們很高興看到 X 受到客戶的早期歡迎，並為世界各地尋求構建機器人輔助手術項目、具有合理升級路徑且價格合理的領先機器人輔助手術生態系統的用戶提供了選擇。我們的SP計畫在人體臨床試驗和試點生產能力方面持續取得進展。我們目前有 4 個臨床試驗點正在運行，其中 3 個在美國，1 個在亞洲。亞洲的病例包括經口手術、泌尿外科手術和大腸直腸手術，而美國的病例則主要集中在經口機器人輔助手術。正如我們在上個季度電話會議中提到的那樣，我們預計將在 2017 年下半年提交泌尿科 SP 的 510(k) 申請。來自試驗點的外科醫生回饋非常令人鼓舞。我們的團隊繼續致力於產品驗證和生產能力建設，以支援產品提交和上市。最後，我們的柔性機器人專案達到了預期目標，並在產品設計階段和監管路徑的發展方面取得了良好進展。

In closing, the second quarter of 2017 has carried forward momentum built in prior quarters, and 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 platforms, imaging, advanced instruments, da Vinci Sp and flexible robotics progress; and finally, support for additional clinical and economic validation by region.

綜上所述，2017 年第二季度延續了前幾個季度積累的勢頭，我們將繼續專注於以下幾個方面：第一，繼續在普通外科手術中推廣達芬奇手術系統；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、成像技術、先進儀器、達芬奇手術系統和柔性機器人技術的發展；最後，支持各地區開展更多的臨床和經濟驗證工作。

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

現在我將把電話交給馬歇爾，他將回顧財務要點。

Thank you, Gary. I will describe our results on a non-GAAP or pro forma basis, which excludes specified legal settlements and claim accruals, excess tax benefits associated with employee stock awards and charges associated with stock-based compensation and purchased IP. We provide pro forma information because we believe that business trends and operating results are easier to understand on a pro forma basis. I will also summarize our GAAP results later in my script. We have posted reconciliations of our pro forma results to our GAAP results on our website, so that there is no confusion.

謝謝你，加里。我將以非公認會計準則或備考為基礎描述我們的業績，其中不包括特定的法律和解和索賠計提、與員工股票獎勵相關的超額稅收優惠以及與股票薪酬和購買的知識產權相關的費用。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。我們已在網站上公佈了備考業績與 GAAP 業績的調節表，以免造成混淆。

Second quarter 2017 revenue was $756 million, an increase of 13% compared with $670 million for the second quarter of 2016 and an increase of 12% compared with the first quarter revenue of $674 million. We launched the da Vinci X system during the second quarter in the U.S. and European countries covered by CE Mark. In conjunction with the launch, we offered certain 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, which we recognize when customers either trade-out their systems or when the offers expire, whichever comes first. None of the deferred revenue was recognized in the second quarter. We expect substantially all of the deferred revenue to be recognized by year-end.

2017 年第二季營收為 7.56 億美元，比 2016 年第二季的 6.7 億美元成長了 13%，比第一季的 6.74 億美元成長了 12%。我們於第二季在美國和歐洲CE認證國家推出了達文西X系統。配合此次發布，我們為第一季購買系統的部分客戶提供了升級或以舊換新的機會，換購 X 系統。因此，我們推遲了第一季 2,300 萬美元的收入，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。第二季未確認任何遞延收入。我們預計絕大部分遞延收入將在年底前確認。

Second quarter 2017 procedures increased approximately 16% compared with the second quarter of 2016. It increased 5% compared with last quarter. Procedure growth relative to last year and the first quarter has been driven by general surgery in the U.S. and urology worldwide. Patrick will provide more detail concerning procedure adoptions.

2017 年第二季手術量比 2016 年第二季成長了約 16%。與上一季相比成長了5%。與去年同期和第一季相比，手術量的成長主要得益於美國普通外科手術和全球泌尿外科手術的發展。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 $398 million increased 17% compared with last year and increased 4% compared with the first quarter of 2017, which closely reflects procedure growth. Instrument and accessory revenue realized per procedure was approximately $1,830 per procedure compared with $1,810 last year and $1,840 last quarter. The increase relative to the second quarter of 2016 primarily reflects increased sales of our stapling and vessel sealing products, partially offset by customer-buying patterns. The decrease compared with the previous quarter primarily reflects customer-buying patterns.

營收亮點如下：儀器及配件收入為 3.98 億美元，比去年同期增長 17%，比 2017 年第一季增長 4%，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約為 1,830 美元，而去年同期為 1,810 美元，上一季為 1,840 美元。與 2016 年第二季相比，成長主要反映了我們訂書針和容器密封產品的銷售增加，但部分被客戶的購買模式所抵銷。與上一季相比的下降主要反映了顧客的購買模式。

System revenue of $216 million increased 7% compared with the second quarter of 2016. It increased 41% compared with last quarter. The year-over-year increase reflects higher system placements and operating lease revenue, partially offset by lower average selling prices and lower lease buyout revenue. System revenue for the first quarter of 2017 excluded the $23 million of deferred revenue. Had the first quarter included that revenue, quarter-over-quarter increase would have been 23%, reflecting a higher number of system placements, partially offset by lower lease buyout revenue.

系統營收為 2.16 億美元，比 2016 年第二季成長 7%。與上一季相比成長了41%。與去年相比，成長反映了系統安裝量和經營租賃收入的增加，但部分被平均售價下降和租賃買斷收入下降所抵消。2017 年第一季的系統收入不包括 2,300 萬美元的遞延收入。如果第一季包含該收入，則季增將達到 23%，反映出系統安裝數量的增加，但部分被租賃買斷收入的減少所抵銷。

166 systems were placed in the second quarter of 2017 compared with 130 systems in the second quarter 2016 and 133 systems last quarter. 27 systems were placed under operating lease transactions in the current quarter compared with 15 systems in the second quarter of 2016 and 21 last quarter. As a reminder, revenue on operating lease transactions is recognized ratably over the life of the lease. Of the 166 second quarter systems, 11 were X systems. As of the end of the second quarter of 2017, there were 120 systems out in the field under operating leases. We generated approximately $6 million of revenue associated with operating leases in the quarter compared with $4 million in the second quarter of 2016 and approximately $5 million last quarter. We generated approximately $5 million of revenue during the quarter from lease buyouts compared with $13 million the second quarter of 2016 and $10 million last quarter. Globally, our average selling price, which excludes the impact of operating leases and lease buyouts and revenue deferrals, was $1.46 million compared with $1.56 million last year and $1.46 million last quarter. The decrease in ASP compared to the second quarter of 2016 primarily reflects lower-priced systems sold to cost-sensitive market segments and lower pricing offered to customers purchasing multiple systems. We believe that flexible financing programs, like operating leases, have positively impacted our ability to grow our installed base. We expect a proportion of these types of arrangements would increase over time.

2017 年第二季共安裝了 166 套系統，而 2016 年第二季為 130 套，上一季為 133 套。本季共有 27 套系統透過經營租賃交易進行租賃，而 2016 年第二季為 15 套系統，上季為 21 套系統。再次提醒，經營租賃交易的收入應在租賃期間內按比例確認。在第二季的 166 個系統中，有 11 個是 X 系統。截至 2017 年第二季末，共有 120 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 600 萬美元的收入，而 2016 年第二季為 400 萬美元，上季約為 500 萬美元。本季我們從租賃收購中獲得了約 500 萬美元的收入，而 2016 年第二季為 1,300 萬美元，上一季為 1,000 萬美元。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 156 萬美元，上季度為 146 萬美元。與 2016 年第二季相比，平均售價下降主要反映了對價格敏感的市場區隔領域銷售的低價系統以及向購買多個系統的客戶提供的較低價格。我們相信，靈活的融資方案，如經營租賃，對我們擴大裝機量的能力產生了積極影響。我們預期隨著時間的推移，這類安排的比例將會增加。

Service revenue of $142 million increased 11% year-over-year, it increased approximately 1% compared with the first quarter of 2017. The year-over-year and quarter-over-quarter increases reflect growth in our installed base with da Vinci systems.

服務收入為 1.42 億美元，年增 11%，與 2017 年第一季相比成長約 1%。年比和環比增長反映了我們達文西手術系統安裝基礎的增長。

Outside of the U.S., results were as follows: Second quarter revenue outside of the U.S. of $205 million increased 11% compared with $185 million for the second quarter of 2016. It increased 12% compared with $183 million for the first quarter. The increase relative to the prior year primarily reflects increased system placements net of leases and increased instruments and accessories, reflecting procedure growth, partially offset by lower system ASPs. Patrick will provide procedure growth information. The year-over-year decline in system ASPs reflects increased sales of lower-cost systems to cost-sensitive markets. The increase in revenue relative to the last quarter reflects increased system placements and increased instrument and accessory growth. Outside of the U.S., we placed 63 systems in the second quarter compared with 51 in the second quarter of 2016 and 56 last quarter. 5 of the system placements in the current quarter were operating leases compared with 2 last quarter -- last year and 6 last quarter. Current quarter system placements, including 29 into Europe, 14 into Japan, 5 into India, 5 into Australia and 3 into China. System placements outside of the U.S. will continue to be lumpy as some of the o-U. S. 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.

美國以外地區的表現如下：第二季美國以外地區的營收為 2.05 億美元，比 2016 年第二季的 1.85 億美元成長了 11%。與第一季的1.83億美元相比，成長了12%。與前一年相比，成長主要反映了扣除租賃費用後的系統安裝量增加以及儀器和配件的增加，反映了手術量的增長，但部分被系統平均售價的下降所抵消。Patrick 將提供手術進展資訊。系統平均售價較去年同期下降，反映出低成本系統在對成本敏感的市場銷售增加。與上一季相比，收入的成長反映了系統安裝量的增加以及儀器和配件數量的成長。在美國以外，我們第二季安裝了 63 套系統，而 2016 年第二季為 51 套，上一季為 56 套。本季系統部署中有 5 個是經營租賃，而上一季是 2 個，去年同期是 6 個。目前的季度製度分配情況，包括 29 個歐洲名額、14 個日本名額、5 個印度名額、5 個澳洲名額和 3 個中國名額。美國以外的系統部署將繼續呈現參差不齊的局面，因為一些 o-U。美國市場尚處於早期採用階段。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 second quarter of 2017 was 71% compared with 72% for the second quarter of 2016 and 72% for the first quarter of 2017. The decrease compared with the second quarter of 2016 primarily reflects decreased service margin associated with higher scope repair costs. The decrease compared with the first quarter reflects a higher proportion of system revenue relative to total 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. Pro forma operating expenses increased 23% compared with the second quarter of 2016. It increased 2% 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 o-U. S. markets. The year-over-year growth rates will subside over the remainder of the year with total year growth still expected to be around 18%. Our pro forma effective tax rate for the second quarter was 29.2% compared with an effective tax rate of 27.8% for the second quarter of 2016 and 28.1% last quarter. The increase in our tax rate reflects an increased proportion of U.S. income relative to total income. Our tax rate will fluctuate with changes in the mix of U.S. and o-U. S. income and with the impact of onetime items.

接下來來看損益表的其餘部分。2017 年第二季的備考毛利率為 71%，而 2016 年第二季為 72%，2017 年第一季為 72%。與 2016 年第二季相比，下降主要反映了由於維修範圍成本增加而導致的服務利潤率下降。與第一季相比，下降幅度反映出系統收入佔總收入的比例較高。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。與 2016 年第二季相比，以備考計算的營運費用增加了 23%。與上季相比成長了2%。這些增長與我們計劃在產品開發方面的投資相一致，特別是達文西手術系統、柔性機器人、成像和先進儀器以及我們 o-U 的擴張。美國市場。今年剩餘時間內，年增率將放緩，預計全年總增速仍將維持在 18% 左右。我們第二季的備考實際稅率為 29.2%，而 2016 年第二季的實際稅率為 27.8%，上一季為 28.1%。我們的稅率提高反映了美國收入佔總收入的比例增加。我們的稅率會隨著美國和海外資產組合的變化而波動。美國收入以及一次性項目的影響。

Our second quarter 2017 pro forma net income was $228 million or $5.95 per share, compared with $220 million or $5.62 per share for the second quarter of 2016 and $196 million or $5.09 per share for the first quarter of 2017. The $23 million revenue deferral, including the associated deferral of cost of sales and the income tax effects, reduced GAAP and pro forma net income per share in the first quarter of 2017 by approximately $0.28 per share.

2017 年第二季度，我們的備考淨收入為 2.28 億美元，即每股 5.95 美元；而 2016 年第二季度為 2.2 億美元，即每股 5.62 美元；2017 年第一季為 1.96 億美元，即每股 5.09 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 2017 年第一季的 GAAP 和備考每股淨收入減少了約 0.28 美元。

Earnings per share benefited from the full impact of our $2 billion stock buyback as we retired approximately 2.4 million shares in -- on January 27, 2017. At this point, given the increase in the share price since the start of the ASR, the ultimate number of shares delivered under the ASR may not change materially from the initial delivery.

2017 年 1 月 27 日，我們斥資 20 億美元回購股票，回購了約 240 萬股，每股盈餘因此受益。鑑於自 ASR 開始以來股價上漲，目前根據 ASR 交付的最終股票數量可能不會與最初交付的數量發生實質變化。

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 $222 million or $5.77 per share for the second quarter of 2017 compared with $185 million or $4.71 per share for the second quarter of 2016 and $180 million or $4.67 per share for the first quarter of 2017.

現在我將總結一下我們的GAAP業績。2017 年第二季 GAAP 淨收入為 2.22 億美元，即每股 5.77 美元，而 2016 年第二季為 1.85 億美元，即每股 4.71 美元，2017 年第一季為 1.8 億美元，即每股 4.67 美元。

GAAP net income for the second quarter included a net benefit of $5 million associated with litigation settlements, net of charges, compared with $4 million of charges in the second quarter of 2016 and $21 million of charges last quarter. GAAP net income for the second quarter of 2017 also included a charge of approximately $6 million associated with purchased IP.

第二季的 GAAP 淨收入包括與訴訟和解相關的 500 萬美元淨收益（扣除費用後），而 2016 年第二季的費用為 400 萬美元，上一季的費用為 2,100 萬美元。2017 年第二季的 GAAP 淨收入還包括與購買智慧財產權相關的約 600 萬美元費用。

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 be paid in capital as in prior periods. The excess tax benefit included in our GAAP results for the second quarter was $31 million, contributing $0.80 per share compared with $33 million, contributing $0.85 per share in the first quarter of 2017. We have excluded these benefits 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 and the value of our stock. We ended the quarter with cash and investments of $3.4 billion, up from $3.1 billion as of March 31, 2017. The increase reflects cash generated from operations and proceeds from stock option exercises.

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不足，而不是像以前期間那樣作為資本調整項進行報告。第二季GAAP業績包含的超額稅收優惠為3,100萬美元，每股收益為0.80美元，而2017年第一季為3,300萬美元，每股收益為0.85美元。我們已將這些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、限制性股票單位歸屬數量以及我們股票的價值而逐季度波動。本季末，我們的現金和投資總額為 34 億美元，高於 2017 年 3 月 31 日的 31 億美元。成長反映了經營活動產生的現金流量和股票選擇權行使所得收益。

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

接下來，我將把發言權交給派崔克，他將介紹手術流程和臨床要點。

Thanks, Marshall. Of our second quarter procedure growth of 16%, U.S. procedures grew approximately 14%. And outside of the United States, procedures grew approximately 22%. Procedure trends were consistent with the first quarter, with growth led by U.S. general surgery and global urology. In the United States, both mature and growth procedures, such as general and thoracic surgery, outperformed our plan. The majority of the outperformance was driven by continued growth in our mature procedures. In U.S. urology, the second quarter growth rate for da Vinci Prostatectomy was modestly higher than the first quarter. We believe that our U.S. prostatectomy volumes have been tracking to the broader prostate surgery market. In U.S. gynecology, second quarter procedure growth sustained trends observed during the first quarter. Procedure growth in U.S. GYN appears to be driven by consolidation of surgeries towards physicians that specialize in complex and 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 remains strong -- sound. Growth trends in lobectomies and other thoracic procedures continue to show strength off of a small base. Second quarter was another quarter with a large number of clinical publications evaluating da Vinci surgery. One that we like to highlight is from Dr. Rashidi from the University of Texas and colleagues from Providence Health and Services who published a study of more than 3,500 colorectal patients treated by 58 high-volume surgeons within the Providence Health and Services network in the American Journal of Surgery. The authors found that in exchange for a longer operating time, patients treated on the da Vinci system experienced a threefold reduction in conversion rate and nearly a day shorter length of hospital stay compared to laparoscopy. In addition, the authors found that there was no difference in total direct cost between the 2 cohorts.

謝謝你，馬歇爾。第二季度手術量增加了 16%，其中美國手術量增加了約 14%。在美國以外，手術量增加了約 22%。手術趨勢與第一季一致，其中美國普通外科和全球泌尿外科引領了成長。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。業績優異主要得益於我們成熟業務的持續成長。在美國泌尿外科領域，達文西前列腺切除術第二季度的成長率略高於第一季。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。在美國婦科領域，第二季度手術量的成長延續了第一季的成長趨勢。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手術和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。在美國，疝氣修補手術仍然是新增手術量最大的手術項目。現有外科醫生的留任率和利用率仍然很高——這很穩健。肺葉切除術和其他胸腔外科手術的成長趨勢在較小的基數上仍然保持強勁勢頭。第二季又有大量臨床出版品對達文西手術進行了評估。我們想重點介紹的是德州大學的 Rashidi 博士和 Providence Health and Services 的同事們在《美國外科雜誌》上發表的一項研究，該研究調查了 Providence Health and Services 網路內 58 位高容量外科醫生治療的 3500 多名結直腸病患者。作者發現，雖然手術時間較長，但與腹腔鏡手術相比，使用達文西系統治療的病患手術轉換率降低了三倍，住院時間縮短了近一天。此外，作者發現兩組族群的總直接成本並沒有差異。

Turning abroad. Procedure growth outside of the United States was approximately 22% in the second quarter, led by the global adoption of da Vinci Prostatectomy, with solid contributions from kidney procedures, general surgery and gynecology. As we discussed last quarter, the timing of the Easter holidays from Q1 into Q2, which provided a tailwind to our first quarter result, served as a headwind in the quarter, likely reducing our outside of the United States procedure growth by an estimated 3%. Taken together, first half procedure growth of 25% provides a better representation of procedure performance outside of the United States and either quarters' result. Procedure growth was led by China, Germany and Japan. Procedure growth in China was driven by a strong expansion in system utilization, as system placements remained constrained, pending issuance of new quota for civilian hospitals. Procedure growth in China is broad-based with a number of specialties contributing to the strong performance. In Germany, procedure growth is supported by installed base expansion that is driving strong adoption in urology with contributions from general surgery. In Japan, dVP and dVPN continued to grow, though year-to-year comparators have begun to slow, as dVP adoption has crossed 80%. During the quarter, the first clinical experience on da Vinci X occurred in Germany. Initial procedures include urology and gynecology, with strong early utilization. Commenting on the experience, Dr. [Witt], from San Antonio's Hospital (inaudible) stated, da Vinci X is "ideal add-on to our existing da Vinci Xi. Same feeling on the console." Globally, evidence continues to build in support of the clinical and economic validation of da Vinci surgery. During the quarter, an economic analysis studying the impact of da Vinci partial nephrectomy in England was published in European Urology. The work was completed by HCD Economics, an affiliate of the University of Chester. Comparing more than 4,200 partial nephrectomy patients between open and da Vinci surgery, the authors found that da Vinci surgery lowered the total cost to treat during the first year after the procedure by an average of GBP 900, primarily by reducing postoperative and patient utilization from length of stay, cancer and other readmissions and 90-day complications.

轉向國外。第二季度，美國以外地區的手術量增加了約 22%，這主要得益於達文西前列腺切除術在全球的普及，腎臟手術、一般外科手術和婦科手術也做出了穩健的貢獻。正如我們上個季度討論的那樣，復活節假期從第一季度延續到第二季​​度，這原本對我們第一季度的業績起到了推動作用，但在第二季度卻成了不利因素，可能導致我們在美國以外的業務增長減少了約 3%。綜合來看，上半年手術量成長 25%，更能代表美國以外地區的手術量表現以及兩季的業績。手術量成長主要由中國、德國和日本引領。中國手術量的成長主要得益於系統利用率的大幅提升，因為在向民間醫院發放新的配額之前，系統安裝數量仍然受到限制。中國手術量的成長基礎廣泛，許多專科都為強勁的成長做出了貢獻。在德國，手術量的成長得益於已安裝設備的擴大，這推動了泌尿外科的強勁普及，而普通外科也做出了貢獻。在日本，dVP 和 dVPN 繼續成長，儘管年增率開始放緩，但 dVP 的普及率已超過 80%。本季度，達文西X手術系統在德國進行了首次臨床試驗。初步手術包括泌尿科和婦科，早期使用率高。聖安東尼奧醫院的 [Witt] 醫生（聽不清楚）評論說，達文西 X 是「我們現有的達文西 Xi 的理想補充」。在控制台上也有同樣的感覺。 「在全球範圍內，越來越多的證據支持達文西手術的臨床和經濟有效性。本季度，《歐洲泌尿外科》雜誌發表了一篇關於達文西部分腎切除術在英國的影響的經濟分析文章。這項工作由切斯特大學的附屬機構 HCD Economics 完成。作者對 4200 多例接受開放式手術和達文西手術的部分腎切除術患者進行了比較，發現達文西手術在術後第一年平均可降低 900 英鎊的治療總成本，這主要是透過減少術後住院時間、癌症和其他再入院以及 90 天併發症等因素，從而減少患者對醫療資源的利用。

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

我的發言到此結束。現在我將把電話交給卡爾文。

Thank you, Patrick. I will be providing you with our updated financial outlook for 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 12% to 14% above the approximately 752,000 procedures performed in 2016. Now based largely upon continued strong results in U.S. growth and mature procedure categories. In China, we are increasing our estimate for 2017. We now anticipate full year 2017 procedure growth within a range of 14% to 15%. During the second half of the year, we expect our procedure growth rate to moderate, in part, due to 1 fewer operating day during the third quarter. As we move into the second half of the year, we also expect contributions from China and Japan to temper until we obtain a new quota and place additional systems in China and obtain additional procedural reimbursements in Japan.

首先從流程入手。在我們上次的電話會議上，我們估計 2017 年全年手術量將比 2016 年的約 752,000 例手術量增加 12% 至 14%。目前主要基於美國成長和成熟手術類別的持續強勁業績。在中國，我們提高了 2017 年的預測。我們現在預計 2017 年全年手術量成長將在 14% 至 15% 之間。預計下半年手術量成長率將放緩，部分原因是第三季手術日減少 1 天。隨著我們進入下半年，我們也預計來自中國和日本的貢獻將會減少，直到我們獲得新的配額，在中國部署更多系統，並在日本獲得額外的程序報銷。

With regards to system placements, a record high of 27 of the 166 second quarter system placements were structured as operating leases. In the second half of 2017, we expect a proportion of systems placed under operating leases will continue to increase. The average selling price per system sold outright will vary quarter-to-quarter based upon factors, including product, regional and trade-in mix. With increasing placements into cost-sensitive markets, we expect that our average systems selling price will continue to trend gradually lower in the back half of 2017. As Marshall mentioned, no amounts were either deferred or released in Q2 related to our da Vinci X trade-in program. Going forward, we expect to defer no further revenue related to this program and expect to release and recognize substantially all of the $23 million accrued during the first quarter by the end of this year.

就係統部署而言，第二季 166 個系統部署中有 27 個採用經營租賃方式，創歷史新高。預計 2017 年下半年，採用經營租賃方式部署的系統比例將持續增加。直接售出的每套系統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化。隨著產品在對成本敏感的市場中投放量不斷增加，我們預計 2017 年下半年我們的平均係統售價將繼續呈逐步下降趨勢。正如馬歇爾所提到的，第二季與我們的達文西 X 以舊換新計畫相關的款項既沒有延期支付也沒有發放。展望未來，我們預計不會再推遲與該計劃相關的任何收入，並預計將在今年年底前釋放和確認第一季累計的 2,300 萬美元收入的絕大部分。

Turning to gross profit. On our last call, we forecast 2017 growth pro forma gross profit margin to be within a range of between 70% and 71% of net revenue. We are now modestly raising the top end of the range and expect pro forma gross profit margin to be between 70% and 71.5% of net revenue.

接下來討論毛利。在上次電話會議上，我們預測 2017 年的成長預期毛利率將佔淨收入的 70% 至 71%。我們現在略微提高了價格區間的上限，預計調整後的毛利率將佔淨收入的 70% 至 71.5%。

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 term. 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 at the higher end of a range between 15% and 18% above 2016 levels. We continue to expect results at the high end of the range, between 17% and 18% for the year. On our last call, we forecast our noncash stock compensation expense to range between $190 million and $200 million in 2017. Now, based upon updated Black-Scholes evaluation estimates, we expect our noncash stock compensation expense to range between $200 million and $210 million. We expect 2017 other income to be between $35 million and $40 million compared to the $30 million to $35 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。在上一次電話會議上，我們預測 2017 年的備考營運費用將比 2016 年水準成長 15% 至 18%，處於該區間的較高水準。我們仍然預期全年業績將處於預期範圍的高端，介於 17% 至 18% 之間。在上一次電話會議上，我們預測 2017 年的非現金股票補償支出將在 1.9 億至 2 億美元之間。現在，根據更新後的布萊克-斯科爾斯評估估算，我們預計非現金股票補償費用將在 2 億美元至 2.1 億美元之間。我們預計 2017 年其他收入將在 3,500 萬美元至 4,000 萬美元之間，而上次電話會議預測的範圍為 3,000 萬美元至 3,500 萬美元。

With regard to income tax. We now expect our 2017 pro forma income tax rate to be between 28% and 29.5% of pretax income, higher than our previous guidance of 26.5% to 28.5% based upon a higher anticipated mix of U.S. pretax profits. During Q2, we had 38.4 million diluted shares outstanding for EPS calculations, roughly equal to the first quarter as the share reduction related to the full quarter impact of the Q1 accelerated share buyback was mostly offset by the dilutive effects of our higher stock price. As a result of our higher stock price, we don't expect the ultimate number of shares received and retired when the ASR closes later this year to vary significantly versus the 2.4 million shares already retired in January.

關於所得稅。我們現在預計 2017 年的備考所得稅率將為稅前收入的 28% 至 29.5%，高於我們先前基於美國稅前利潤預期佔比更高的 26.5% 至 28.5% 的指導值。第二季度，我們用於計算每股盈餘的稀釋後流通股為 3,840 萬股，與第一季大致相同，因為第一季加速股票回購對整個季度的影響所導致的股份減少，大部分被我們股價上漲帶來的稀釋效應所抵銷。由於我們的股價上漲，我們預計今年稍後 ASR 結束時最終收到和註銷的股票數量與 1 月份已經註銷的 240 萬股相比不會有太大變化。

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

我們的發言到此結束。現在開始回答各位的問題。

(Operator Instructions) And our first question will come from Tycho Peterson with JPMorgan.

（操作員說明）我們的第一個問題來自摩根大通的泰科·彼得森。

First, on X. I know it's early days, obviously, but any color you can provide on the funnel in terms of new versus existing customers and maybe the types of customers that are emerging?

首先，關於 X。我知道現在顯然還處於早期階段，但您能否提供一些關於銷售漏斗的信息，例如新客戶與現有客戶的區別，以及正在湧現的客戶類型？

I don't think we'd -- Tycho, I don't think we'd call out anything surprising here. We had indicated to you in prior quarters that we think cost-sensitive customers, particularly in Europe, are going to be interested in, and that remains so. It may have broader rebate than that over time.

我覺得我們──泰科，我覺得我們在這裡不會說出什麼令人驚訝的話。我們曾在前幾季向您表示，我們認為對成本敏感的客戶，特別是歐洲的客戶，將會對此感興趣，現在依然如此。隨著時間的推移，它可能會有更廣泛的退款。

Okay. And then urology continue to do well here. That hasn't reverted to lower growth rates, I think it proves the expected. Can you talk about that sequential pickup? Can you maybe just talk to the sustainability of those trends in the U.S. urology dVP market?

好的。泌尿科在這裡也持續發展良好。我認為，成長率並未回落到較低水平，這證明了預期的結果。能談談那個順序拾音器嗎？您能否談談這些趨勢在美國泌尿科dVP市場的可持續性？

Yes, Tycho. I think -- we continue to believe that our prostatectomy volumes are following broader prostate surgery trends. As you know, prostate surgery really only represents about 1/3 of all men diagnosed in the U.S. with prostate cancer. So time to time, you'll see movements between watchful waiting, radiation and surgery. We think -- mostly, you've seen the procedures recover from the prior USPSTF decision in 2012, where we worked through patients who had the disease progress. We think, at this stage, you're just seeing general small movements between populations period to period.

是的，第谷。我認為——我們仍然相信，我們的前列腺切除手術量與更廣泛的前列腺手術趨勢相符。如您所知，在美國，接受前列腺手術的男性僅佔所有被診斷患有前列腺癌的男性的大約三分之一。所以你會看到治療方案在觀察等待、放射治療和手術之間來回調整。我們認為——基本上，您已經看到這些程序從 2012 年 USPSTF 的決定中恢復過來，當時我們處理了病情惡化的患者。我們認為，在現階段，你看到的只是不同時期人口之間的一般小幅流動。

Our next question is from Bob Hopkins with Bank of America.

下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？

Bob?

鮑伯？

Okay.

好的。

Okay, great. Good afternoon. So the first thing I wanted to touch on, just kind of looking through the results, which were obviously strong pretty much across the board, but the U.S. capital number really stuck out as a strong number. And you mentioned more kind of multisystem sales and repeat customers. Is this really a function of the increase in procedure volume growth and higher utilization? Or was there something else going on this quarter?

好的，太好了。午安.所以我想先談談結果，結果顯示幾乎所有方面都表現強勁，但美國首都的數字尤其突出。您還提到了更多類型的多系統銷售和回頭客。這真的是手術量成長和利用率提高的結果嗎？或者說，這個季度還有其他事情發生嗎？

I think it's the former. I -- we're seeing -- first of all, I think the consolidation of U.S. customers into IDNs means that the negotiations are often happening one layer up. And I think they're looking across their portfolio of MIS opportunities and making decisions in broader settings. I think it's a continuation of a trend we've been seeing for the past several quarters.

我認為是前者。我看到——首先，我認為美國客戶整合到 IDN 中意味著談判通常是在上一層進行的。我認為他們正在審視其 MIS 機會組合，並在更廣泛的背景下做出決策。我認為這是過去幾個季度以來一直觀察到的趨勢的延續。

Great. The other thing I just want to follow up is, a couple of quick checks on the pipeline timelines. You mentioned China and Japan as constraining you in the back half. Is there any update at all on the China quota from a timing perspective? Or even your sense as to whether or not it could happen this year? And also, wanted to just get a quick update on the timelines for Sp beyond urology and the filings we could expect, either later this year or into 2018?

偉大的。我還要跟進一下，快速確認流程時間表。你提到中國和日本在後半程限制了你的發展。從時間安排來看，中國配額方面有任何最新消息嗎？或者，你覺得今年是否有可能發生這件事？另外，我想快速了解一下Sp在泌尿科以外的業務時間表，以及我們可以預期在今年稍後或2018年提交的文件？

Sure. Marshall, I'll let you take the China quota, and I'll take the Sp.

當然。馬歇爾，我讓你負責中國的配額，我負責西班牙的配額。

Okay. The China quota, there is no new news here. It is, as we stated before, the quota system involves, first, the government is tied up in the overall government -- the government's overall planning process. They did approve their budget in December. We -- after that, it then rolls through a series of decisions about province spending as well as hospital spending. And then eventually, we will hear something about a quota. We don't know when that will be. And what we would caution is that you put anything in the models for this year frankly because, last time, when the quota was approved, it took some time before the tender offers that the hospitals have to go through to get something done.

好的。關於中國配額，這方面沒有什麼新消息。正如我們之前所說，配額制度首先涉及政府的整體規劃過程。他們確實在12月份批准了預算。之後，它將陸續做出一系列關於省級支出和醫院支出的決定。最終，我們會聽到有關配額的消息。我們不知道那會是什麼時候。我們想提醒的是，今年的模型中最好不要包含任何內容，因為上次配額獲得批准後，醫院需要經過一段時間的招標才能完成相關工作。

On the Sp regulatory question, we are targeting (inaudible) urology in the back half of the year. There's a data collection going on at the IDE sites for transoral robotic surgery and some lab-based clinical development for other procedures as well as the trial site in Asia. We haven't yet publicly projected our timelines for submissions after the urology 510(k). There will be a set that come. It will be months, not years after the 510(k) submission. What that looks like will depend on the speed of closure of the clinical trial data and some of the conversations with FDA about what kind of submissions they'd like. And we're not ready yet to anchor down those dates.

關於 Sp 監管問題，我們將在今年下半年專注於泌尿科（聽不清楚）。目前，IDE 試驗點正在進行經口機器人手術的資料收集，以及一些其他手術的實驗室臨床開發，此外，亞洲的試驗點也在進行相關研究。我們尚未公開預測泌尿科 510(k) 之後提交申請的時間表。會有一套產品推出。提交 510(k) 申請後，需要幾個月的時間，而不是幾年。具體情況將取決於臨床試驗數據完成的速度，以及與 FDA 就他們希望收到何種類型的提交資料進行的討論。我們目前還不能確定具體日期。

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 maybe a few quick questions here. Gary, just for you. Just SP timing, I know, came up in the pipeline, but on the FC, and I know it's pretty early. Can you give us any sense of the major markets, U.S., China, Europe, which one? Our sense is U.S. and China are kind of ahead of Europe, but that's not based on a whole bunch. Which region do you think precedes the other? And is 2019 a reasonable estimate for a launch in some geographic locale?

這裡可能就問幾個簡單的問題。加里，這是專門為你準備的。我知道，SP 的時機還沒定，這在計劃之中，但在 FC 上，我知道現在還很早。您能否大致介紹一下主要市場，例如美國、中國、歐洲，具體是哪一個？我們的感覺是，美國和中國在某種程度上領先歐洲，但這並不是基於大量的研究數據。你認為哪個地區出現得更早？2019 年是某個地區推出該產品的合理時間預估嗎？

And so first, to the question of which regions matter. We think it will have global appeal, but I think you're right that United States and China and then Europe will be interesting. In terms of timing, a lot of it will be predicated on regulatory pathways and what kind of data requirements there are. We think there are real opportunities in China. We're going to make sure that we do that right with our joint venture partner. We likewise think there is in the U.S. I'm not ready yet to call when the launch dates are for both sets, because of negotiations with clinical trial results. Europe, likewise. I think there's a little bit of uncertainty right now as to what kind of submission package will be required, and that's one of the things we're in the midst of working out, both internally and with conversations with regulatory authorities over time. We will do a controlled launch when we're ready. So we've told you, don't model any revenue into '18. We have not yet published, and are not ready to publish when the final launch will be. We'll let you know as we get closer to some of the certainty on regulatory timelines.

因此，首先要回答的問題是：哪些地區比較重要？我們認為它將具有全球吸引力，但我認為你說得對，美國、中國和歐洲將會很有趣。就時間安排而言，很大程度上取決於監管路徑和資料要求。我們認為中國蘊藏著真正的機會。我們將確保與合資夥伴妥善完成這項工作。我們也認為美國也有這種情況。由於需要與臨床試驗結果進行談判，我現在還不能確定兩款產品的上市日期。歐洲也是如此。我認為目前對於需要提交什麼樣的申請資料還存在一些不確定性，這也是我們正在努力解決的問題之一，我們既在內部進行研究，也與監管機構進行溝通，以期最終解決。準備就緒後，我們將進行受控發射。所以我們已經告訴你們，不要把任何收入納入 2018 年的預測模型。我們尚未公佈最終發布日期，也暫不準備公佈。一旦監管時間表更加明確，我們會立即通知您。

Okay, very helpful. And Marshall, just two, kind of margin-related questions for you. The first is on gross margin. Given a greater systems mix, I guess I was surprised to see gross margins as strong as they were. And I wonder, who would've thought that X, which wasn't very material in the quarter, would have also pressured margins. So what's driving the margin strength? And as it relates to X, is that just because a lot of the components of X frankly are ready at scale in other places of the business? And the second question related is, you're looking at hiring. We typically don't ask about hiring, but I think your hiring level this quarter is 25% above the next highest level. That's pretty remarkable. I wonder if you would just share with us where you're hiring and where those people are being deployed.

好的，很有幫助。還有，馬歇爾，我有兩個關於利潤率的問題想問你。首先是關於毛利率。考慮到系統組合更加多元化，我對如此強勁的毛利率感到驚訝。我很好奇，誰會想到本季不太重要的 X 也會對利潤率造成壓力。那麼，是什麼因素推動了利潤率的強勁成長？至於 X，是不是因為 X 的許多組成部分在公司其他部門已經可以大規模應用了？第二個相關問題是，你們正在考慮招募。我們通常不會詢問招募情況，但我認為你們本季的招募水準比第二高的水準高出 25%。這真是太了不起了。我想請您透露您的招募地點以及這些人將被派往哪裡工作。

Sure. On the X margins. X margins that we had communicated before, typically, when we introduce a new product you see a little bit of a decrease in the margin and then we work to improve it over time. You should -- we did not expect as much of a decrease in margins due to X. X, as you said, really is the result of putting together parts that are already manufactured for other systems. And so we have worked out most of the cost effectiveness of that. As far as total margins, yes, the total margin came down a little bit due to the mix of systems. I think it exceeded our expectations just because of the overall strength of procedures and the drive of -- and it driving instrument and accessory revenue above our original expectations.

當然。在 X 邊距上。正如我們之前溝通過的，通常情況下，當我們推出新產品時，利潤率會略有下降，然後我們會努力隨著時間的推移來改善它。你應該知道——我們沒想到 X 會導致利潤率下降這麼多。正如你所說，X 實際上是將其他系統已經生產的零件組裝在一起的結果。因此，我們已經計算出了大部分的成本效益。至於總利潤率，是的，由於系統組合的不同，總利潤率略有下降。我認為它超出了我們的預期，這完全是因為流程的整體實力和推動力——它推動儀器和配件收入超過了我們最初的預期。

As far as the headcount goes, David, we ended the quarter with 4,108 employees. That was up a little over 100 from the last quarter-end, and it was 19% year-over-year. And it really does vary up with the strategic investments that we're making in the business on that side. The majority of investments were in our product operations group in the quarter.

大衛，就員工人數而言，我們本季末共有 4,108 名員工。這比上一季末增加了100多，年增了19%。而且，這確實會隨著我們在該業務領域的策略性投資而改變。本季大部分投資都投向了我們的產品營運部門。

Our next question comes from Tao Levy with Wedbush.

我們的下一個問題來自 Wedbush 公司的 Tao Levy。

America, I wanted to ask on the Sp platform. So the pathway for, I believe, filing later on, towards the end of this year, and then assuming approval sometime next year, how is the launch going to proceed? Is this a -- well -- is an experienced da Vinci surgeon going to be able to sit in front of a -- the Sp -- in front of a console and use the Sp right off the bat? Or are they going to have to go through a proctoring of different types of cases? Just any color there would be great.

我想在Sp平台上問問美國。因此，我認為，如果在今年年底提交申請，並假設明年某個時候獲得批准，那麼產品上市將如何進行？一位經驗豐富的達文西外科醫生能否坐在控制台前，立即使用Sp系統進行手術？或者他們需要接受不同類型案例的監考？任何顏色都可以。

Yes. Just in broad brushes, it's a family member in the da Vinci family, and a lot of -- we believe a lot of the learning and skills will be portable from one of the family members to the other. They're not identical. So there'll be some learning that goes through that transition. We think experienced da Vinci surgeons will find that transition to be pretty manageable. What that looks like, and how it's finally framed will evolve as we finish our clinical trials and our validations. But I'd expect a lot of that to be portable. I think, in terms of rollout, we'll be at a controlled rollout when we come out. And part of that controlled rollout will be for data generation at the first sites. And also, we'll have some constraints due to what our labeling will be at the first launch, given the regulatory sequence and pathway. Feedback from the clinical trial sites has been really good about usability of this system and it meeting the expectations they had for what they believe they could do with it clinically. So far, so good there. And we also get pretty good insight into the characteristics of the system vis-à-vis what they're used to on Si and Xi, and kind of the response to your initial question.

是的。簡單來說，他是達文西家族的一員，我們相信許多知識和技能都可以在家族成員之間傳承。它們並不完全相同。所以在這個過渡時期會有一些學習的過程。我們認為經驗豐富的達文西手術醫師會發現這種轉變相當容易應付。隨著我們完成臨床試驗和驗證工作，最終的形式和框架將會逐漸形成。但我認為其中很多都應該是便攜式的。我認為，就推廣而言，我們推出產品時會採取可控的推廣方式。而這種受控推廣的部分工作將在首批站點進行資料生成。此外，由於監管順序和途徑的限制，我們在首次上市時也會受到一些標籤方面的限制。臨床試驗中心對該系統的易用性給予了非常好的回饋，認為它滿足了他們對該系統在臨床應用方面的期望。目前為止，一切順利。我們還可以深入了解該系統的特性，以及他們過去在 Si 和 Xi 上習慣使用的系統的特性，這算是對你最初問題的回應。

Got you. Perfect. And then just lastly. What's -- anything special going on in Japan? They've got way more systems than they have -- than they need it at this point, and they keep on buying more, and I don't know if there -- is there a government incentives or any credit there, that they're using?

抓到你了。完美的。最後，還有一件事。日本最近有什麼特別的事情發生嗎？他們擁有的系統遠遠超過了他們目前的需求，而且他們還在繼續購買更多，我不知道他們是否利用了政府的激勵措施或任何信貸。

Tao, Japan has a very diffused health care system and hospital network system, so they're not very concentrated in terms of where the patients are. So while we are in that high level of penetration in dVP, you still have a lot of pockets of patients who are treated in fairly remote areas, in local hospitals and so they just continue to buy systems, even being able to access some of the mainly urology patients that are out there.

Tao，日本的醫療保健系統和醫院網路系統非常分散，因此病患分佈並不集中。雖然 dVP 的滲透率很高，但仍有許多患者在相當偏遠的地區、當地醫院接受治療，因此他們仍然會繼續購買系統，甚至能夠接觸到一些主要的泌尿科患者。

We've also been in Japan, for just some number of years here, and I think there's a little bit of built-in capacity in hopes of broader reimbursements over time.

我們也在日本待了幾年，我認為已經具備一定的內在能力，希望隨著時間的推移能夠獲得更廣泛的報銷。

And we'll go next to Amit Hazan with Citi.

接下來，我們將連線花旗銀行的 Amit Hazan。

Just one on the quarter, and then a couple of longer-term ones. So on the quarter, obviously, just going back to the U.S. system number, a really strong number. I wanted to ask about trade-ins though. They were weak again in the U.S. it's the second quarter in a row. I'm trying to kind of better understand why , on the one hand you've got this obvious growing pool of systems that need to be replaced, that you should in theory be replacing more systems every year. On the other hand, there seems to be relationship between quarters where you had really strong de novo units like this, this year so far, both quarters. And then trade-ins kind of tend to be inversely recurring in those quarters. What's kind of a correct way to be thinking about modeling trade-ins in the U.S.?

本季度只有一筆，然後還有幾筆長期交易。所以，就本季而言，顯然，回到美國系統的數據，這是一個非常強勁的數字。我想問一下以舊換新的事宜。他們在美國市場再次表現疲軟，這是連續第二季如此。我正在努力更好地理解，一方面，顯然有越來越多的系統需要更換，而理論上來說，每年都應該更換更多的系統，這是為什麼呢？另一方面，似乎存在一種關聯，即在像今年這樣擁有非常強勁的新創企業的兩個季度之間，新創企業數量非常可觀。而且，在這些季度裡，以舊換新的情況往往會呈現反向重複出現。在美國，關於以舊換新模式的比較正確的思考方式是什麼？

Let me speak to our intent a little bit, and then I'll ask Calvin to jump in on the modeling side. For us, our thought process really has been to enable accounts with technologies and support that help them get to their clinical goals and in support their MIS and MIS program goals. And if they can do that effectively with an Si, we're happy to support them in that regard. If they want to add capacity or grow their system capability in some way that is benefited by our advanced technologies that helps us and drives a new system placement or new system sale. So our incentives aren't strongly built on trade-outs. Much more interested in aligning with how they want to build their programs and giving them access to technologies that make a difference in their procedures. That leaves the lumpiness in trade-outs, and that's okay with us. Calvin, to the modeling. I just give you a little time to think about it. Go ahead.

讓我先簡單說明我們的意圖，然後我會請卡爾文來擔任模特兒。對我們來說，我們的思考過程實際上是為客戶啟用技術和支持，幫助他們實現臨床目標，並支持他們的 MIS 和 MIS 計畫目標。如果他們能用 Si 有效地做到這一點，我們很樂意在這方面支持他們。如果他們想要增加容量或以某種方式提升系統能力，而我們的先進技術能夠從中受益，那麼這對我們和推動新系統部署或新系統銷售都大有裨益。因此，我們的激勵機制並非建立在權衡取捨的基礎上。我們更感興趣的是與他們希望如何建立他們的專案保持一致，並讓他們獲得能夠改變他們工作流程的技術。這樣一來，交易中就會出現一些不平衡的情況，但我們覺得這樣沒問題。卡爾文，從事模特兒工作。我給你一點時間考慮一下。前進。

When I say -- I mean, is that you have such strong procedure growth and such demand for access to systems among the surgeon population and in a lot of cases, when hospitals are seeking to acquire new systems, they look at the procedures and the surgeons that they want to be able to do in -- within their robotics program. And the Si can still serve a broad range of patients and can help them facilitate that. So they tend to be buying more incremental systems than trading in.

我的意思是，手術量成長如此強勁，外科醫生群體對系統的需求如此之大，在許多情況下，當醫院尋求購買新系統時，他們會考慮他們希望在其機器人手術項目中開展哪些手術以及哪些外科醫生能夠開展這些手術。而且，Si 仍然可以服務廣泛的患者群體，並可以幫助他們實現這一目標。所以他們傾向於購買更多增量系統，而不是以舊換新。

As X matures in the market, X may be an opportunity for some folks who are happy with their capacity but want to upgrade up to additional capabilities, and that may provide an opportunity for us in future quarters.

隨著 X 在市場上的成熟，對於那些對自身能力感到滿意但希望升級到更高能力的人來說，X 可能是一個機會，這可能會在未來幾季為我們帶來機會。

And just quickly, from the modeling perspective that you asked. Beware of using our past experience with our Xi and previous system launches as the model for what's going to happen now, because it's a different world we have again, consolidated hospital networks that can align certain procedure characteristics with sets of procedures with a lot more ability to do so now than in the past. So could very well follow a different pattern this go-round, than it has in the past.

最後，就你問的建模角度，簡單回答一下。請注意，不要將我們過去在 Xi 系統和之前系統發布方面的經驗作為現在將要發生的事情的模型，因為我們現在所處的環境已經不同了，整合後的醫院網絡能夠將某些程序特性與一系列程序相匹配，而且現在比過去更有能力做到這一點。所以，這次很可能會遵循與以往不同的模式。

Okay. So that could maybe possibly lead me to the next question, which is on reimbursement. It looks like prostate is getting a new Medicare outpatient reimbursement code for the first time, I believe. And I realize most of these dVP procedures can't really be done in 1 day just yet. But it just got me thinking about the question of what the trigger might be for hospitals to start equipping their outpatient settings with da Vincis? I have to imagine that between hysterectomies moving that way and things like hernia now, there's already enough volume to justify it nowadays. So is something like prostate reimbursement any kind of an incur that can maybe drive boxes into outpatient setting? And if not, then what could be the trigger to do that?

好的。所以這或許會引出我的下一個問題，那就是報銷問題。看來攝護腺疾病將首次獲得新的聯邦醫療保險門診報銷代碼。我意識到目前大多數 dVP 手術還無法在一天內完成。但這讓我開始思考，促使醫院開始在門診部配備達文西手術系統的觸發因素可能是什麼？我不得不認為，隨著子宮切除術的增多以及疝氣等疾病的出現，如今的病例數量已經足夠多，足以證明這種做法的合理性。那麼，像攝護腺手術報銷這類費用是否會成為一種可能促使手術轉移到門診治療的支出呢？如果不是，那麼是什麼觸發了這種情況呢？

Two important thoughts here, Amit. One, is in order to be able to do a surgery like a dVP in an outpatient setting, first off, it has to be done in a minimally invasive fashion, so that you can have the patient be able to recover quick enough to get out of that setting. The second thing, is you -- outpatient is really a billing setting, not necessarily a site of care differentiator. What we see over time is that as programs mature in their robotics capacity, and they have an array of systems that can both serve really complex inpatient surgeries, like thoracic or colorectal, and they have sufficient volume of outpatient procedures like the ones you mentioned in hernia and gynecology and you could potentially dVP, where you have a technique and a surgeon capable of getting a result that can get the patient out in the same day. You'll see them actually put systems into multiple different types of settings. Typically still under the hospitals' umbrella because they're the ones who have the capability of treating the range of patients who come in with different complexities and might need -- be either inpatient or outpatient. But it's usually a by-product of the maturity of a program as opposed to a specific reimbursable event.

阿米特，這裡有兩點重要的想法。首先，為了能夠在門診環境下進行像 dVP 這樣的手術，必須以微創的方式進行，這樣患者才能盡快恢復，離開門診環境。第二點是－門診其實是一種計費方式，不一定是治療地點的差異化因素。隨著時間的推移，我們看到，隨著機器人手術能力的成熟，這些項目擁有了一系列系統，既可以服務於非常複雜的住院手術，例如胸腔外科或結直腸手術，也可以進行足夠數量的門診手術，例如您提到的疝氣和婦科手術，並且有可能實現dVP（即手術當天即可完成），在這種情況下，您擁有一種技術和一位外科醫生能夠獲得一種技術結果。你會看到他們實際上將系統部署到多種不同類型的環境。通常仍歸醫院管轄，因為醫院有能力治療各種病情複雜程度不同的患者，這些患者可能需要住院或門診治療。但這通常是專案成熟的副產品，而不是某個特定的可報銷事件。

Our next question comes from Isaac Ro with Goldman Sachs.

下一個問題來自高盛的 Isaac Ro。

Question for you on the X. Just trying to think through the gross margin implications of that product cycle as it plays out. Realize it's a little early, but just trying to think through some of the comments you made earlier around how purchasing is evolving for hospitals and so forth. As that product cycle plays out, could you give us some sense of what it means for your gross margin profile, based on what you know now, that would be helpful.

關於X，我有個問題。我只是想思考一下該產品週期發展過程中對毛利率的影響。我知道現在說這些可能有點早，但我只是想仔細思考一下你之前提到的關於醫院採購方式演變等方面的評論。隨著產品週期的推進，您能否根據您目前掌握的信息，大致說明一下這對您的毛利率狀況意味著什麼？這將對我們很有幫助。

Initially, the gross margin profile is not substantially different than our other products. So it kind of fits in nicely. I think what you're asking is, over time, could we see that there's pressure on the ultimate price that we charge for an X? I think we'll see. We don't know. It's only been out in the market for a quarter, and -- but what we've said in the past is that, we're about the market expansion. And if there's the opportunity to expand the market at the expense of a little bit of price, we'd do that.

最初，該產品的毛利率結構與其他產品並無太大差異。所以它還挺合適的。我認為你問的是，隨著時間的推移，我們是否會看到 X 的最終定價面臨壓力？我想我們拭目以待。我們不知道。這款產品上市才一個季度，而且──但我們過去說過，我們的目標是市場擴張。如果能以犧牲少量價格為代價來擴大市場，我們就會這麼做。

That's helpful. And then just as a follow-up on the expense side. As you move towards expanding the market, interested in sort of allocation of resources and the sales force, can you talk a little bit about, just qualitatively, how you're moving some of your top performers to help drive X conversion and then at the same time, maybe thinking about adding new heads? Just interested in the interplay on investment in sales force.

那很有幫助。然後，我想就費用方面再補充一點。隨著您逐步擴大市場，對資源分配和銷售團隊很感興趣，您能否定性地談談您是如何調動一些業績最好的員工來幫助推動 X 轉換率的，同時，您是否也在考慮增加新的銷售人員？我對銷售團隊投資的互動很感興趣。

Yes. How we think about the sales force investments really varies by region and maturity of the market. So how we're building the sales team in Germany, for example, will look, kind of qualitatively different than what's happening in the United States. In general, in the United States, we've had a stable structure growth in our key accounts teams, no surprise. And a little bit better stratification of levels in the force itself that gives us the opportunity to provoke and engage high-level salespeople, at the same time bring in people who can support high-volume accounts that are premature. So the U.S. is a well-stratified sales force. In Germany, in places like Japan, we're really at the basic building stages. And so the investments there are a little more filling empty slots and making sort of territory coverages, is right.

是的。我們對銷售團隊投資的看法會因地區和市場成熟度而異。例如，我們在德國組建銷售團隊的方式，與在美國的情況在本質上會有所不同。整體而言，在美國，我們重點客戶團隊的結構性成長一直很穩定，這並不令人意外。稍微改善一下銷售團隊內部的層級劃分，讓我們有機會激發和吸引高級銷售人員，同時也能招攬到能夠支持那些尚處於早期階段的大額客戶的人員。所以美國擁有一支層次分明的銷售團隊。在德國，在日本等地，我們仍處於基本的建設階段。因此，那裡的投資更多是為了填補空白領域，並進行某種程度的區域覆蓋，對吧。

We now have a question from Richard Newitter with Leerink Partners.

現在我們收到來自 Leerink Partners 的 Richard Newitter 的提問。

It seems like for the third quarter in a row, China, on the procedure growth side, is exceeding your expectations. And seemingly, you were at capacity, or you thought you were at capacity in the fourth quarter. And yet, this is still kind of -- your capacity utilization seems to be creeping higher. Anything to explain that? Are there certain types of procedures that are maybe just quicker? And that, as a percent of the mix in China, is different than the U.S.? Or can you explain what might be driving this?

看來中國在手術量成長方面，已經連續第三季超出預期了。看起來，到了第四季度，你們的產能已經達到極限，或者你們認為自己的產能已經達到極限。然而，這仍然有點——你的產能利用率似乎在緩慢上升。有什麼解釋嗎？是否存在某些類型的手術流程可能更快一些？而中國這一比例與美國相比有何不同？或者你能解釋一下造成這種情況的原因嗎？

So I think, at the top line, what's going on here is, a high belief in the value of the procedures and the technology and the willingness to expand the number of hours that people are able to get procedures. I think the biggest effect is that, which is a willingness to work on weekends and for them to expand to after-hours use of devices. That will dwarf underlying which procedures are in the mix. But Marshall, you can clean up that answer, if you like.

所以我認為，歸根結底，這裡發生的事情是，人們對這些程序和技術的價值抱有很高的信念，並且願意延長人們接受手術的時間。我認為最大的影響是，人們更願意在周末工作，並且會將工作時間延長到下班後使用電子設備。這將使具體包含哪些程序的複雜程度相形見絀。但是馬歇爾，如果你願意的話，可以把這個答案修改一下。

It's absolutely right. I mean, this is all about -- it's a theoretical capacity that you're quoting. And that capacity -- that theoretical capacity is based on just averages that we see around the world. Be careful of averages. And in China, they are operating on Saturdays, Sundays and late at night, and -- in order to get things done. So I think Gary's answer is right, and...

完全正確。我的意思是，這一切都與——你引用的是一種理論能力有關。而這種產能——這種理論產能只是基於我們在世界各地看到的平均值。要謹慎看待平均值。在中國，他們週六、週日和深夜都在工作，為了把事情做好。所以我認為加里的回答是正確的，而且…

I think there's also an opportunity for us to learn from their experiences, which is under capital constraint, what kinds of barriers can they remove, to get both good outcomes and high volumes. And I think that's exciting for us. And we have an open mind toward how they're approaching it.

我認為我們也有機會從他們的經驗中學習，在資金受限的情況下，他們可以消除哪些障礙，從而既獲得良好的結果又獲得高產量。我認為這對我們來說很令人興奮。我們對他們的處理方式持開放態度。

Great. Then maybe just one follow-up on Japan. That's the other area where you're kind of seeing capacity constraint. And so you get additional, on the procedure side at least, until you get additional approvals. Can you maybe just remind us the key procedures that you're hoping are up for consideration next year? And maybe -- which ones represent the biggest market opportunities? And do you feel there's any of that might be further along with the approval agencies over there?

偉大的。然後或許可以再跟進一下日本的情況。這是另一個存在產能限制的領域。因此，至少在程序方面，你會得到額外的費用，直到你獲得額外的批准為止。您能否提醒我們一下，您希望明年考慮的關鍵程序有哪些？那麼，哪些代表著最大的市場機會呢？你覺得這方面，那邊的審批機構可能會取得更大的進展嗎？

In terms of maturity, there are some that have been going through clinical trials and have a lot of data behind them and others that are using kind of existing data sources. So the one that has the most structured data so far is gastrectomy. And that is going to be exciting for us over time. It is a real market in Japan. The prevalence is quite high, and so we have good hopes and optimism that, that will go through the process. Other categories are things like (inaudible) oncology, that is of interest, salpingectomy. Calvin, there are some others that...?

就成熟度而言，有些技術已經過臨床試驗，擁有大量數據支持，而另一些技術則利用現有的數據來源。目前為止，結構化資料最完善的是胃切除手術。隨著時間的推移，這對我們來說將會是一件令人興奮的事情。這是日本一個真實存在的市場。盛行率相當高，因此我們有理由相信，這種情況會得到改善。其他類別包括（聽不清楚）腫瘤學，這很令人感興趣，還有輸卵管切除術。卡爾文，還有一些其他人…？

Yes. Lobectomy procedures and some of the lower colon LAR procedures are potential.

是的。肺葉切除術和一些下結腸低位前切除術都是可行的選擇。

Yes. So I think the interest in broad use of da Vinci in Japan is very high. We do not have assurance of that MHLW will accept it in the next insurance cycle. Although, so far, so good. And we don't have assurance that the reimbursement levels will be any particular level. And again, so far, the indicators are pretty good for us, but that's still a work in process from the government's evaluation point of view, and we stand by to support the surgical societies and answer questions for them as they need it.

是的。所以我認為日本對廣泛使用達文西技術的興趣非常高。我們無法保證厚生勞動省會在下一個保險週期接受該保險。雖然，目前為止一切都還不錯。我們無法保證報銷金額會達到某個特定水準。再次強調，到目前為止，各項指標對我們來說都相當不錯，但從政府的評估角度來看，這仍然是一個進行中的工作，我們將隨時準備為外科協會提供支持，並在他們需要時回答他們的問題。

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。

Let me just start with hernia. You received recently a specific inguinal hernia indication, which includes positive data in the label. Could you talk about the implications of that label and data? And are you pursuing other specific indications for other procedures? And I have one follow-up.

我就先從疝氣說起。您最近收到了一份針對腹股溝疝氣的特定適應症藥物說明書，其中包含積極的數據。能談談這個標籤和數據的意義嗎？您是否正在考慮其他特定適應症以進行其他手術？我還有一個後續問題。

Sure. On the first one, this really is something around what gives us a little bit of freedom of -- a little more freedom about what we can claim in our materials. And so it allows us to be a little bit more specific versus the general. And so for us, we think that, that just clarifies what our teams can speak about. And so we think it's an incremental positive -- it's a small positive. I think the data underlying it is supportive, and the interactions with FDA, I think, are ultimately helpful for the whole process. This is one of a set of specific indications that we have pursued over the last couple of years. And we do have a pipeline of the next set of things we want to do and get aligned. And we have not publicly disclosed what those are and what the order is, but I guess what I'd tell you is, I expect more to come. And again, I think it's a healthy process between us and the agency to supply data as we get it and that allows us a little more specific capability in terms of what we talk about.

當然。第一個方面，這確實給了我們一些自由——讓我們在材料中可以提出一些主張方面擁有更大的自由。因此，它使我們能夠比一般情況更加具體一些。因此，我們認為，這明確了我們團隊可以談論的內容。所以我們認為這是一個漸進的正面影響——一個小小的正面影響。我認為相關的數據是支持性的，而且我認為與FDA的互動最終對整個過程是有幫助的。這是我們近兩年來一直在追蹤的一系列具體跡象之一。我們確實有一系列接下來想要進行和協調的工作計畫。我們尚未公開披露這些內容是什麼以及順序如何，但我可以告訴你們的是，我預計還會有更多內容出台。而且，我認為我們和該機構之間保持這種健康的溝通方式，即在獲得數據後立即提供數據，這使我們能夠更具體地討論相關內容。

And then I think on the -- you're planning to file and launch a 45 millimeter stapler, which should help with bariatric procedures. Is there any update on the timing there?

然後我想到——您計劃提交並推出 45 毫米的吻合器，這應該有助於減肥手術。請問那邊的時間安排有最新消息嗎？

Sure. Yes, we are working on additional staplers besides the ones that are in the market. We have a 30 and a 45. Remember, staplers are characterized by not only their length but also the length of the staples that go in the jaw. There are set of things that we're working on beyond that. We do think that there are opportunities to build staplers that can have broader use in general surgery. We have not yet predicted or publicly disclosed what the expected time lines are. We do have to take note of the development of those things. Approach maturity, we'll share with you where we are.

當然。是的，除了市面上已有的訂書機之外，我們還在研發其他類型的訂書機。我們有30號和45號。請記住，訂書機的特點不僅在於其長度，還在於裝入訂書機卡口的訂書釘的長度。除此之外，我們還有一些其他的事情要做。我們認為，有機會研發出可在一般外科手術中更廣泛使用的縫合器。我們尚未預測或公開揭露預期時間表。我們必須關注這些事情的發展。步入成熟階段，我們會與您分享我們所處的位置。

We'll go next to Brandon Henry with RBC Capital Markets.

接下來我們連線加拿大皇家銀行資本市場的布蘭登亨利。

Can you provide an update on the Australian clinical trial for the flexible catheter platform? And any lessons you've learned from that trial? And then, when and where you think you can see that, the data from the trial being published or presented? And a couple of follow-ups.

能否提供澳洲柔性導管平台臨床試驗的最新進展？從那次審判中你學到了什麼教訓？那麼，你認為何時何地可以看到試驗數據被公佈或展示呢？還有一些後續問題。

Yes. Thanks, Brandon. I think the short answer is no. I can't provide an update. The, that data is being analyzed. The clinical teams that are there, are preparing their abstracts, and they'll decide at which meeting they want to show it. And once they've made that decision, then we're happy to share it with you. As we said last time, the results were very positive for us. We're really happy with what we saw. I think the scientific principal investigators need the chance to write their manuscripts and analyze the data and present it in a way that makes sense to them. So we will wait for that. And as we get clarity there, we're sure to share it with you.

是的。謝謝你，布蘭登。我認為簡而言之，答案是否定的。我無法提供最新消息。這些數據正在被分析。在場的臨床團隊正在準備摘要，他們將決定在哪次會議上展示這些摘要。一旦他們做出決定，我們很樂意與您分享。正如我們上次所說，結果對我們來說非常積極。我們對所看到的非常滿意。我認為，科學研究負責人需要有機會撰寫論文、分析數據，並以他們認為合理的方式呈現。所以我們會等待。一旦我們弄清楚情況，一定會第一時間與您分享。

Okay. And then -- just more broadly, can you help me understand some of the differences or the benefits for Intuitive's flexible catheter platform, relative to some of the other platforms in the market, like Medtronic with its super dimension platform?

好的。然後——更廣泛地說，您能否幫我了解一下 Intuitive 的柔性導管平台相對於市場上其他一些平台（例如 Medtronic 的超維度平台）有哪些不同之處或優勢？

Sure. I think what we can bring in our concept and our technology here is a couple of things. One is, we have novel sensing technologies that allow us to sense all the way along the catheter length with a high degree of certainty. That helps us in terms of understanding and navigating towards those pathways. That's one. The second thing is the use of robotic assistance gives you stability and navigation capabilities that are very hard to do manually. And so those are technical benefits. What could they result in, in terms of clinical benefits? The hope there is, that you can get to more distal locations that are otherwise hard to get to in tortuous pathways, and that you're more accurate in terms of tissue sampling, because you have high degree of stability and better imaging and targeting now. Those lines have to be backed up, and so that's the hypothesis. And that's the set of trials and data and analysis that we're going after. And I think people are excited about flexible technologies in general by some of the technologies that our competitors and other med companies have put out there. I think the excitement is there, and the question is, can you go little further and get a little more predictability, and we think we have technologies and capabilities that can do that.

當然。我認為我們可以將我們的理念和技術帶到這裡，具體體現在以下幾個方面。其一是，我們擁有新型感測技術，可以讓我們高度確定地感知導管的整個長度。這有助於我們理解和規劃這些道路。這是其中之一。第二點是，使用機器人輔助可以賦予你手動很難實現的穩定性和導航能力。所以這些都是技術方面的優勢。從臨床獲益的角度來看，它們可能帶來哪些結果？希望能夠到達那些在曲折路徑中難以到達的更遠端的位置，並且在組織取樣方面更加準確，因為現在具有高度的穩定性和更好的成像和靶向能力。這些說法需要被證實，所以這就是假設。這就是我們正在努力獲得的試驗、數據和分析結果。我認為，人們普遍對柔性技術感到興奮，這得益於我們的競爭對手和其他醫療公司推出的一些技術。我認為大家的興奮點在於，能否更進一步，獲得更高的可預測性，而我們認為我們擁有能夠做到這一點的技術和能力。

Our next question is from Travis Steed with Cantor Fitzgerald.

我們的下一個問題來自 Cantor Fitzgerald 的 Travis Steed。

Travis, you'll be the last questioner, so make it a good one.

崔維斯，你是最後一個提問的人，所以一定要問好。

You placed a decent amount of Si systems in the quarter. Did those customers have an option to purchase X? And just any color on how customers are deciding between the 2 systems, recognizing we're still very early on?

本季你部署了相當數量的矽系統。這些顧客可以選擇購買X嗎？那麼，我們能否就客戶在兩種系統之間如何做出選擇提供一些看法呢？畢竟，我們目前還處於非常早期的階段。

So I think the question was, there's a fair number of Sis in the system in the quarter, despite the availability of X, right?

所以我覺得問題是，儘管有 X 可用，但本季系統中仍然有相當數量的 Sis，對嗎？

Yes.

是的。

I think, first, while we were pleased with approval timelines of X in the U.S. and Europe, there are still many markets that X is not yet approved in. So some of the Sis are just purchases by folks whose choices were Si or Xi. In the case of China, it's -- their choice is Si right now, not Xi. So some of it is just that. In other cases, some of the negotiations are multi-quarter negotiations and are right at the endpoint. And so they will finish the transaction based on where they started. Those are opportunities for us to go back to those customers over time. That's one of the reasons that we have the revenue deferral and the offers for people to evaluate whether they wanted to make a change. So that's mostly what the dynamics are.

我認為，首先，雖然我們對 X 在美國和歐洲的審批時間表感到滿意，但 X 仍有許多市場尚未獲得批准。所以有些 Si 只是因為顧客在 Si 或 Xi 之間有選擇而購買的。就中國而言，他們現在的選擇是司徒然，而不是習近平。所以有些事情確實如此。在其他情況下，一些談判是持續多個季度的談判，並且已經接近尾聲。因此，他們將根據開始交易的位置完成交易。這些都是我們日後重新聯絡這些客戶的機會。這就是我們提供收入延期支付和優惠方案的原因之一，這樣人們就可以評估他們是否願意做出改變。所以，大致情況就是這樣。

And Travis, the other part to think about is just the approvals came mid-quarter, so I think Europe was in the beginning of April, and the U.S. was in the beginning of May. So you didn't really have a full quarter to get out with the team and communicate to all your customers what X is, relative to other products that may have already been in a long sales cycle.

崔維斯，還有一點要考慮的是，審批是在季度中期進行的，所以我認為歐洲是在 4 月初，美國是在 5 月初。所以你實際上並沒有一整個季度的時間和團隊一起出去，向所有客戶傳達 X 相對於其他可能已經處於較長銷售週期的產品而言意味著什麼。

Just a little color commentary on X. I think the customer base and our field understood well what X is, what its benefits are, I think, the logic of X is well understood and where it fits in the line is well understood, and we're pleased with that.

關於 X，我只想簡單補充一點。我認為客戶群和我們的第一線員工都很好地了解 X 是什麼，它的好處是什麼，我認為 X 的邏輯以及它在產品線中的定位都得到了很好的理解，對此我們感到很滿意。

Okay. And I one quick follow-up. I think I know the answer to this, but is it still your view we should be modeling in 2018 expense growth below your revenue growth?

好的。我還有一個後續問題。我認為我知道答案，但您是否仍然認為我們應該在 2018 年將支出成長設定在收入成長之下？

Actually, what we said is that expense growth -- operating expense growth will grow 18% for the year.

實際上，我們所說的是費用成長——營運費用成長將在今年成長 18%。

I'm sorry, in 2018, kind of longer-term.

抱歉，2018 年，這算是更長遠的計畫。

Do we expect to dial back

我們是否預期會減少

Sorry. In 2018, what we said is, we expect to dial it back so that we are adding leverage.

對不起。2018 年，我們說過，我們希望減少投入，以便增加槓桿作用。

Thanks, Travis. Well, that was our last question. As we've said previously, while we focus on financial metrics such as revenues, profit and cash flow during these conference calls, our organization's focus remains on increasing value by enabling surgeons to improve surgical outcomes and reduce surgical trauma. We've built our company to take surgery beyond the limits of the human hand, and I assure you that we remain committed to driving the vital few things that truly make a difference. This concludes today's call. We thank you for your participation and support on this extraordinary journey to improve the surgery, and we look forward to talking with you again in 3 months.

謝謝你，崔維斯。好了，這是我們最後一個問題。正如我們之前所說，雖然我們在這些電話會議中關注的是收入、利潤和現金流等財務指標，但我們組織的重點仍然是透過幫助外科醫生改善手術結果和減少手術創傷來增加價值。我們創立這家公司的目的是為了突破人手的極限，實現外科手術的目標。我向你們保證，我們將持續致力於推動那些真正能帶來改變的關鍵因素。今天的電話會議到此結束。感謝您參與並支持我們這項旨在改善手術的非凡歷程，我們期待在 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 choosing AT&T executive teleconference. You may now disconnect.

謝謝。女士們、先生們，我們今天的會議到此結束。感謝您的參與，並選擇參加AT&T高階主管電話會議。您現在可以斷開連線了。