直覺手術 (ISRG) 2017 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Surgical Q3 2017 Earnings Release Call.

女士們，先生們，感謝您的支持，歡迎來到 Intuitive Surgical 2017 年第三季度收益發布電話會議。

(Operator Instructions) As a reminder, today's conference is being recorded.

（操作員說明）提醒一下，今天的會議正在錄製中。

I'd now like to turn the conference over to Calvin Darling, Senior Director of Finance, Investor Relations.

我現在想將會議轉交給投資者關係財務高級總監 Calvin Darling。

Please go ahead.

請繼續。

Thank you.

謝謝你。

Good afternoon, and welcome to Intuitive Surgical's third quarter earnings conference call.

下午好，歡迎來到 Intuitive Surgical 第三季度收益電話會議。

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.

今天和我在一起的是我們的總裁兼首席執行官 Gary Guthart；我們的首席財務官 Marshall Mohr；以及財務和銷售運營副總裁 Patrick Clingan。

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

在我們開始之前，我想通知您，今天電話會議中提到的評論可能被視為包含前瞻性陳述。

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

由於某些風險和不確定性，實際結果可能與明示或暗示的結果存在重大差異。

These risks and uncertainties are described in detail in our Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 6, 2017, and 10-Q filed on July 21, 2017.

這些風險和不確定性在我們提交給美國證券交易委員會的文件中有詳細描述，包括我們於 2017 年 2 月 6 日提交的最新 10-K 表格和 2017 年 7 月 21 日提交的 10-Q 表格。

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

這些文件可以通過我們的網站或 SEC 的 EDGAR 數據庫找到。

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

告誡潛在投資者不要過分依賴此類前瞻性陳述。

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

請注意，本次電話會議的音頻重播將在我們網站 intuitivesurgical.com 的“投資者關係”頁面下的“音頻存檔”部分提供。

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

此外，今天的新聞稿和補充財務數據表已發佈到我們的網站上。

Today's format will consist of providing you with highlights of our third quarter results as described in our press release announced earlier today, followed by a question-and-answer session.

今天的形式包括為您提供我們今天早些時候發布的新聞稿中描述的第三季度業績的亮點，然後是問答環節。

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

Gary 將介紹本季度的業務和運營亮點。

Marshall will provide a review of our third quarter financial results.

Marshall 將對我們的第三季度財務業績進行審查。

Patrick will discuss procedure and clinical highlights, then I will provide our updated financial outlook for 2017.

Patrick 將討論程序和臨床亮點，然後我將提供我們 2017 年的最新財務展望。

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

最後，我們將舉辦問答環節。

With that, I will turn it over to Gary.

有了這個，我會把它交給加里。

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

下午好，感謝您今天加入我們的電話會議。

As you know, Intuitive is focused on significantly improving surgery and enabling access to our products and services in pursuit of this mission globally.

如您所知，Intuitive 專注於顯著改善手術並使人們能夠獲得我們的產品和服務，以在全球範圍內實現這一使命。

Performance in the third quarter was strong with continued growth in customers' use of our systems and an increase in system placements.

第三季度的業績表現強勁，客戶對我們系統的使用持續增長，系統安置也有所增加。

Worldwide growth in procedures for the quarter was 15% over the third quarter of 2016.

與 2016 年第三季度相比，本季度全球手術量增長了 15%。

As we've described on prior calls, we expect growth in general surgery in countries outside the United States to continue to lead performance, while procedure growth in mature categories in the United States temper.

正如我們在之前的電話會議上所描述的那樣，我們預計美國以外國家/地區的普通外科手術的增長將繼續引領業績，而美國成熟類別的手術增長會有所緩和。

In the quarter, we saw this dynamic with strength in general surgery in the U.S. and in several countries outside the U.S. lifting growth, while U.S. urologic and gynecologic growth moderated.

在本季度，我們看到這種動態在美國和美國以外的幾個國家的普通外科領域表現強勁，促進了增長，而美國泌尿科和婦科的增長放緩。

Drivers of growth include U.S. inguinal and ventral hernia repair, colon and rectal surgery and thoracic surgery as well as urology and gynecology procedures outside the United States.

增長的驅動因素包括美國腹股溝和腹疝修復、結腸和直腸手術、胸外科以及美國以外的泌尿外科和婦科手術。

Procedure performance in Asia showed continued strength with solid growth in China, Japan and Korea.

隨著中國、日本和韓國的穩健增長，亞洲的程序表現持續強勁。

Overall, European procedure growth moderated slightly from its first half of 2017 performance with trends varying by country.

總體而言，歐洲手術增長較 2017 年上半年略有放緩，趨勢因國家/地區而異。

Patrick will take you through these factors in more detail later in the call.

Patrick 將在稍後的電話會議中更詳細地介紹這些因素。

Turning to capital placement performance.

轉向資本配置績效。

The third quarter was a strong one with growth in total placements from 134 in Q3 of '16 to 169 this quarter.

第三季度表現強勁，總展示位置從 16 年第三季度的 134 個增長到本季度的 169 個。

Customers in the United States again showed strong interest in our systems as capital placements grew quarter-over-quarter.

隨著資本配置環比增長，美國的客戶再次對我們的系統表現出濃厚的興趣。

Asia, Europe and other market system placements were roughly in line with prior quarter trends.

亞洲、歐洲和其他市場的系統佈局與前一季度的趨勢大致一致。

Capital placements can be hard to forecast, and we expect this lumpiness to continue given conditions in the market.

資本配置可能難以預測，我們預計在市場條件下這種波動將持續下去。

Our fourth generation systems, da Vinci X and da Vinci Xi, continued to perform well and account for over 85% of systems placed in the quarter.

我們的第四代系統 da Vinci X 和 da Vinci Xi 繼續表現良好，佔本季度放置的系統的 85% 以上。

Marshall and Patrick will take you through system dynamics in greater detail.

Marshall 和 Patrick 將帶您更詳細地了解系統動力學。

Turning to profitability for the quarter.

轉向本季度的盈利能力。

Our Q3 pro forma gross margins rose slightly relative to Q2 and are slightly above our expected range for the year.

我們第三季度的備考毛利率相對於第二季度略有上升，略高於我們今年的預期範圍。

This is due to strength in procedures and improvements in our operational efficiency.

這是由於程序的加強和我們運營效率的提高。

Our fixed cost growth met our plan year-to-date with increases in R&D expenses, growth in staff in European and Asian markets, investments in clinical trials and growth in corporate computational capabilities.

我們的固定成本增長符合我們年初至今的計劃，包括研發費用的增加、歐洲和亞洲市場員工的增加、臨床試驗的投資以及企業計算能力的增長。

Our third quarter pro forma operating results are as follows: procedures grew approximately 15% over the third quarter of last year.

我們第三季度的備考運營結果如下：程序比去年第三季度增長了約 15%。

We shipped 169 da Vinci Surgical Systems, up from 134 in the third quarter of 2016.

我們出貨了 169 台達芬奇手術系統，高於 2016 年第三季度的 134 台。

Revenue for the quarter was $806 million, up 18% from the prior year, which included a release of reserves related to da Vinci X trade-out offers of $21 million.

本季度收入為 8.06 億美元，比去年同期增長 18%，其中包括釋放與 da Vinci X 交易報價相關的儲備金 2100 萬美元。

Instrument and accessory revenue increased to $401 million, up 15%.

儀器和附件收入增加到 4.01 億美元，增長 15%。

Total recurring revenue in the quarter was $548 million, representing 68% of total revenue.

本季度經常性總收入為 5.48 億美元，佔總收入的 68%。

Pro forma gross profit margin was 71.8% compared to 73.1% in the third quarter last year, the difference largely driven by a medical device tax refund in 2016.

預計毛利率為 71.8%，而去年第三季度為 73.1%，差異主要是由 2016 年的醫療器械退稅造成的。

Pro forma operating profit was $347 million in the quarter, up 13% over Q3 of 2016.

本季度備考營業利潤為 3.47 億美元，比 2016 年第三季度增長 13%。

Pro forma net income was $324 million, aided by onetime favorability in tax items.

預估淨收入為 3.24 億美元，這得益於曾經的稅收優惠。

And lastly, we completed our 3:1 share exchange announced last quarter.

最後，我們完成了上個季度宣布的 3:1 換股。

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

Marshall 稍後將帶您更詳細地了解我們的財務狀況。

Turning to operations.

轉向運營。

We believe that substantial opportunity exists to enable more minimally invasive surgery, better outcomes and to expand access to our technologies globally.

我們相信存在大量機會來實現更多的微創手術、更好的結果並在全球範圍內擴大對我們技術的訪問。

Our investments in new products and services are built on this belief.

我們對新產品和服務的投資就是基於這一信念。

Starting with our multiport product portfolio, recall that we have built a tiered product offering in our da Vinci systems that responds to our customers' desire for choice in content and price points while maintaining logical upgrade pathways to our leading ecosystem of robot-assisted surgery products and services.

從我們的多端口產品組合開始，回想一下，我們已經在我們的達芬奇系統中構建了一個分層的產品供應，以響應我們客戶對內容和價格點選擇的願望，同時保持我們領先的機器人輔助手術產品生態系統的邏輯升級途徑和服務。

We continue to bring our da Vinci X systems to new regions in the world.

我們繼續將我們的達芬奇 X 系統帶到世界的新地區。

In the quarter, we enabled launch in 9 additional countries for da Vinci X and anticipate adding 4 more in this fourth quarter.

在本季度，我們在另外 9 個國家啟用了 da Vinci X，並預計在第四季度再增加 4 個。

This set of options has been well received by our customers, with da Vinci Xi making up roughly 75% of our new placements, da Vinci X making up approximately 10% of new placements in its limited early launch and with the balance made up by Si technology.

這套期權受到了我們客戶的好評，da Vinci Xi 約占我們新配額的 75%，da Vinci X 在其有限的早期推出中約佔新配額的 10%，其餘部分由 Si 組成技術。

We are also advancing our imaging instruments and accessories portfolios for our generation 4 systems: the da Vinci X, da Vinci Xi as well as da Vinci Sp.

我們還在為我們的第 4 代系統改進我們的成像儀器和配件組合：da Vinci X、da Vinci Xi 以及 da Vinci Sp。

While the robotic arms are the most visible part of the surgical system, it's the performance of the whole ecosystem of robot, software, imaging, instruments and accessories in conjunction with the OR team in their working environment that creates a high-functioning program.

雖然機械臂是手術系統中最顯眼的部分，但正是機器人、軟件、成像、儀器和配件的整個生態系統的性能與 OR 團隊在其工作環境中共同創造了一個高性能程序。

Our team is committed to understanding the total surgical environment and its workflow and design products that work seamlessly for our customers.

我們的團隊致力於了解整個手術環境及其工作流程，並設計能夠為我們的客戶無縫工作的產品。

This has motivated our investment in partnerships and technologies for imaging, stapling and more recently, in advanced energy, working to develop highly effective and easy-to-use total products.

這促使我們投資於成像、裝訂的合作夥伴關係和技術，最近還投資於先進的能源，致力於開發高效且易於使用的整體產品。

In the quarter, we expanded the launch of 2 additional instruments and accessories for da Vinci X and Xi into 7 different countries and initiated a limited launch of a refined vessel sealer in Europe.

在本季度，我們將 da Vinci X 和 Xi 的另外 2 款儀器和配件的推出範圍擴大到 7 個不同的國家，並在歐洲開始限量推出精製容器封口機。

We anticipate that our da Vinci Sp program will complete patient enrollment in surgery for its round of clinical trials this quarter.

我們預計我們的 da Vinci Sp 計劃將在本季度完成其臨床試驗輪次的手術患者註冊。

As we mentioned last call, 4 clinical trial sites participated, 3 in the United States and 1 in Asia.

正如我們在上次電話會議中提到的那樣，有 4 個臨床試驗點參與其中，3 個在美國，1 個在亞洲。

Cases in Asia included transoral, urologic and colorectal surgery while those in the U.S. focused on transoral surgery.

亞洲的病例包括經口、泌尿外科和結直腸手術，而美國的病例則側重於經口手術。

Our teams are finalizing product validations.

我們的團隊正在完成產品驗證。

We're working to establish manufacturing capability in support of regulatory submissions that enable launch.

我們正在努力建立製造能力，以支持能夠啟動的監管提交。

We plan to file our first 510(k) for the current Sp design by year-end with follow-on submissions for additional indications thereafter.

我們計劃在年底前為當前的 Sp 設計提交我們的第一個 510(k)，並在之後提交其他適應症的後續提交。

For our flexible robotics program, we continue to refine product designs, develop our supply chain, finalize our regulatory strategy and initiate testing.

對於我們的靈活機器人計劃，我們繼續完善產品設計、開發我們的供應鏈、完成我們的監管策略並啟動測試。

With our partner, we are progressing and building our joint venture in China with the hire of the first key staff, including the joint venture CEO and CFO.

我們正在與我們的合作夥伴一起發展和建設我們在中國的合資企業，並聘請了第一批關鍵員工，包括合資企業的首席執行官和首席財務官。

In closing, the third quarter of 2017 was a strong one, 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 global region.

總而言之，2017 年第三季度表現強勁，我們在這一年餘下的時間裡仍將重點放在以下方面：首先，在普外科繼續採用達芬奇；二是繼續開拓歐洲市場，獲取亞洲客戶；第三，推進我們的新平台、成像、先進儀器、達芬奇 Sp 和柔性機器人技術的進步；最後，支持全球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.

我現在將電話轉給馬歇爾，他將審查財務亮點。

Thank you, Gary.

謝謝你，加里。

I'll describe our results on a non-GAAP or pro forma basis, which excludes specified legal settlements and claim accruals, excess tax benefits related to employee stock awards and charges associated with stock-based compensation and purchased IP.

我將在非 GAAP 或備考基礎上描述我們的結果，其中不包括特定的法律和解和應計索賠、與員工股票獎勵相關的超額稅收優惠以及與基於股票的補償和購買的 IP 相關的費用。

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

我們提供備考信息是因為我們相信業務趨勢和經營成果在備考基礎上更容易理解。

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

我還將在稍後的腳本中總結我們的 GAAP 結果。

We've posted reconciliations of our pro forma results to our GAAP results on our website.

我們已經在我們的網站上發布了備考結果與 GAAP 結果的對賬。

Third quarter 2017 revenue was $806 million, an increase of 18% compared with $683 million for the third quarter of 2016 and an increase of 7% compared with second quarter revenue of $756 million.

2017年第三季度營收為8.06億美元，較2016年第三季度的6.83億美元增長18%，較第二季度的7.56億美元營收增長7%。

Included in third quarter revenue was the recognition of $21 million of deferred -- of revenue deferred in conjunction with the da Vinci X trade-out program we offered to certain first quarter customers.

第三季度收入中包括 2100 萬美元的遞延收入——與我們向某些第一季度客戶提供的達芬奇 X 交易計劃相關的遞延收入。

Excluding the $21 million, revenue would have increased 15% compared with 2016.

剔除這 2100 萬美元，收入將比 2016 年增長 15%。

We expect the remaining $2 million of deferred revenue under the first quarter trade-out program to be recognized by year-end.

我們預計第一季度交易計劃下剩餘的 200 萬美元遞延收入將在年底前確認。

Third quarter 2017 procedures increased approximately 15% compared with the third quarter of 2016 and decreased approximately 2% compared with last quarter.

2017 年第三季度的程序與 2016 年第三季度相比增加了約 15%，與上一季度相比減少了約 2%。

Procedure growth relative to last year was driven by general surgery in the U.S. and urology worldwide.

與去年相比，手術的增長是由美國的普通外科和全球泌尿外科推動的。

The decline in procedures relative to the second quarter primarily reflects seasonality.

與第二季度相比，程序的減少主要反映了季節性。

Patrick will provide more detail concerning procedure adoption.

Patrick 將提供有關程序採用的更多詳細信息。

Revenue highlights are as follows: instrument and accessory revenue of $401 million increased 15% compared with last year and increased 1% compared with the second quarter of 2017, which closely reflects procedure growth.

收入亮點如下：4.01 億美元的儀器和附件收入比去年增長 15%，比 2017 年第二季度增長 1%，這密切反映了程序增長。

Instrument and accessory revenue realized per procedure was approximately $1,880 per procedure compared with $1,870 last year and $1,830 last quarter.

每個程序實現的儀器和附件收入約為每個程序 1,880 美元，而去年為 1,870 美元，上季度為 1,830 美元。

The increases reflect increased sales of our stapling and vessel sealing products and variations in customer buying patterns.

增長反映了我們的縫合和血管密封產品的銷售增加以及客戶購買模式的變化。

Excluding the recognition of deferred revenue, systems revenue of $237 million increased 15% compared with the third quarter of 2016.

不包括遞延收入的確認，系統收入為 2.37 億美元，較 2016 年第三季度增長 15%。

It increased 9% compared with last quarter.

與上一季度相比增長了 9%。

The year-over-year increase primarily reflects higher system placements, partially offset by a higher number of operating lease placements and lower average selling prices.

同比增長主要反映了更高的系統安置，部分被更多的經營租賃安置和更低的平均售價所抵消。

The quarter-over-quarter increase reflects higher average selling prices and fewer lease placements.

環比增長反映了更高的平均售價和更少的租賃安置。

169 systems were placed in the third quarter of 2017 compared with 134 systems in the third quarter of 2016 and 166 systems last quarter.

2017 年第三季度放置了 169 個系統，而 2016 年第三季度為 134 個系統，上一季度為 166 個系統。

20 systems were placed under operating lease transactions in the current quarter compared with 15 systems in the third quarter of 2016 and 27 last quarter.

本季度有 20 個系統被置於經營租賃交易之下，而 2016 年第三季度為 15 個系統，上一季度為 27 個。

As of the end of the third quarter of 2017, there were 134 systems out in the field under operating leases.

截至 2017 年第三季度末，現場有 134 個系統處於經營租賃狀態。

We generated approximately $7 million of revenue associated with operating leases in the quarter compared with $4 million in the third quarter of 2016 and approximately $6 million last quarter.

我們在本季度產生了約 700 萬美元與經營租賃相關的收入，而 2016 年第三季度為 400 萬美元，上一季度約為 600 萬美元。

We generated approximately $11 million of revenue during the quarter from lease buyouts compared with $13 million in the third quarter of 2016 and $5 million last quarter.

我們在本季度從租賃收購中獲得了大約 1100 萬美元的收入，而 2016 年第三季度為 1300 萬美元，上一季度為 500 萬美元。

Globally, our average selling price, which excludes the impact of operating leases and lease buyouts and revenue deferrals, was $1.47 million compared with $1.53 million last year and $1.46 million last quarter.

在全球範圍內，我們的平均售價（不包括經營租賃和租賃收購以及收入遞延的影響）為 147 萬美元，而去年為 153 萬美元，上季度為 146 萬美元。

The decrease in ASP compared to the third quarter of 2016 primarily reflects a higher proportion of trade-in transactions, lower-priced systems sold to cost-sensitive market segments and lower pricing offered to customers purchasing multiple systems.

與 2016 年第三季度相比，ASP 的下降主要反映了更高比例的以舊換新交易、向對成本敏感的細分市場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。

We believe that flexible financing programs like operating leases have positively impacted our ability to grow our installed base.

我們認為，經營租賃等靈活的融資計劃對我們擴大安裝基礎的能力產生了積極影響。

While the number of leases is difficult to predict in the short term, we expect the proportion of these types of arrangements will increase over time.

雖然短期內難以預測租賃數量，但我們預計此類安排的比例將隨著時間的推移而增加。

Service revenue of $147 million increased 13% year-over-year.

服務收入為 1.47 億美元，同比增長 13%。

It increased approximately 3% compared with the second quarter of 2017.

與 2017 年第二季度相比增長了約 3%。

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

同比和環比增長反映了我們達芬奇系統安裝基數的增長。

Outside of the U.S., results were as follows: third quarter revenue outside of the U.S. of $213 million increased 13% compared with $189 million for the third quarter of 2016.

美國以外地區的業績如下：第三季度美國以外地區的收入為 2.13 億美元，與 2016 年第三季度的 1.89 億美元相比增長了 13%。

It increased 4% compared with $205 million for the second quarter.

與第二季度的 2.05 億美元相比增長了 4%。

Approximately $5 million of the deferred revenue recognized in the quarter was outside the U.S. Excluding the deferred revenue recognition, the increase relative to the prior year primarily reflects increased system placements net of leases and increased instrument and accessory revenue.

本季度確認的遞延收入中約有 500 萬美元在美國境外。不包括確認的遞延收入，與上一年相比的增長主要反映了扣除租賃後系統安置的增加以及儀器和附件收入的增加。

Outside of the U.S., we placed 62 systems in the third quarter compared with 49 in the third quarter of 2016 and 63 systems last quarter.

在美國以外，我們在第三季度部署了 62 個系統，而 2016 年第三季度為 49 個，上季度為 63 個系統。

4 of the system placements in the current quarter were operating leases compared with 1 last year and 5 last quarter.

本季度的系統安置中有 4 個是經營租賃，而去年為 1 個，上個季度為 5 個。

Current quarter system placements included 25 into Europe, 14 into Japan, 5 into India, 4 into Mexico and 1 into China.

當前季度的系統部署包括 25 個進入歐洲、14 個進入日本、5 個進入印度、4 個進入墨西哥和 1 個進入中國。

System placements outside the U.S. will continue to be lumpy as some of the O.U.S.

由於一些 O.U.S.

markets are in early stages of adoption.

市場正處於採用的早期階段。

Some markets are highly seasonal, reflecting budget cycles or vacation patterns.

一些市場具有很強的季節性，反映了預算週期或假期模式。

And sales into some markets are constrained by government regulations.

某些市場的銷售受到政府法規的限制。

Moving on to the remainder of the P&L.

繼續討論損益表的其餘部分。

The pro forma gross margin for the third quarter of 2017 was 71.8% compared with 73.1% for the third quarter of 2016 and 71.3% for the second quarter of 2017.

2017 年第三季度的備考毛利率為 71.8%，而 2016 年第三季度為 73.1%，2017 年第二季度為 71.3%。

The da Vinci X trade-out program had little impact on our margins.

da Vinci X 交易計劃對我們的利潤率影響不大。

The decrease compared with the third quarter of 2016 primarily reflects a $7 million medical device tax refund received in 2016 and decreased service margins associated with higher scope repair costs.

與 2016 年第三季度相比的下降主要反映了 2016 年收到的 700 萬美元醫療器械退稅以及與更高範圍維修成本相關的服務利潤率下降。

The increase compared with the second quarter primarily reflects leverage achieved with higher production levels.

與第二季度相比的增長主要反映了更高生產水平所實現的槓桿作用。

Future margins will fluctuate based on the mix of our new products, mix of systems and instrument and accessory revenue, our ability to further reduce product costs and improve manufacturing efficiency and the reinstatement of the medical device tax in 2018.

未來的利潤率將根據我們新產品的組合、系統和儀器及配件收入的組合、我們進一步降低產品成本和提高製造效率的能力以及 2018 年醫療器械稅的恢復而波動。

Pro forma operating expenses increased 21% compared with the third quarter of 2016.

與 2016 年第三季度相比，預計營業費用增長了 21%。

It increased 2% compared with last quarter.

與上一季度相比增長了 2%。

The increases reflect our planned investments in product development, specifically da Vinci Sp, flexible for robotics, imaging and advanced instrumentation and expansion of our O.U.S.

這些增長反映了我們計劃在產品開發方面的投資，特別是 da Vinci Sp，靈活的機器人技術、成像和先進儀器以及我們 O.U.S. 的擴展。

markets.

市場。

Our operating expenses for 2017 may grow slightly greater than previous guidance, reflecting higher revenue growth.

我們 2017 年的運營費用增長可能略高於之前的指引，反映出較高的收入增長。

As we have indicated, we are committed to reducing the growth rate of operating expenses in 2018 compared with 2017.

正如我們所表明的，我們致力於降低2018年與2017年相比的營業費用增長率。

However, as 2017 revenue growth, and in turn, operating leverage have exceeded our expectations, it is likely we will not create operating leverage in 2018 over 2017 actual results.

然而，由於 2017 年的收入增長以及經營槓桿超出了我們的預期，我們很可能不會在 2018 年創造超過 2017 年實際結果的經營槓桿。

Our pro forma tax -- effective tax rate for the third quarter was 9.5% compared with an effective tax rate of 22.7% for the third quarter of 2016 and 29.2% last quarter.

我們的備考稅——第三季度的有效稅率為 9.5%，而 2016 年第三季度的有效稅率為 22.7%，上一季度為 29.2%。

The third quarter of 2017 and 2016 included reductions of $68 million and $16 million of reserves related to the expiration of statutes of limitations on certain tax years.

2017 年和 2016 年第三季度包括與某些納稅年度的訴訟時效到期相關的準備金減少 6800 萬美元和 1600 萬美元。

Without these reductions, our third quarter 2017 and 2016 pro forma tax rates would have been 28.6% and 27.7%.

如果沒有這些削減，我們 2017 年和 2016 年第三季度的備考稅率將分別為 28.6% 和 27.7%。

Our tax rate will fluctuate with changes in the mix of U.S. and O.U.S.

我們的稅率將隨著美國和美國的組合變化而波動。

income and with the impact of onetime items.

收入和一次性物品的影響。

Our third quarter 2017 pro forma net income is $324 million or $2.77 per share compared with $246 million or $2.06 per share for the third quarter of 2016 and $228 million or $1.98 per share for the second quarter of 2017.

我們 2017 年第三季度的備考淨收入為 3.24 億美元或每股 2.77 美元，而 2016 年第三季度為 2.46 億美元或每股 2.06 美元，2017 年第二季度為 2.28 億美元或每股 1.98 美元。

All per-share amounts reflect the 3:1 stock split effected in October.

所有每股金額均反映了 10 月份生效的 3:1 股票拆分。

Recognition of the $21 million of deferred revenue, net of costs and income tax, increased GAAP and pro forma net income per diluted share by approximately $0.09.

確認扣除成本和所得稅後的 2100 萬美元遞延收入，使 GAAP 和預估攤薄後每股淨收入增加約 0.09 美元。

The income tax reserve reversal of $68 million increased GAAP and pro forma net income per diluted share by approximately $0.59.

6800 萬美元的所得稅儲備金轉回使 GAAP 和備考每股攤薄淨收入增加了約 0.59 美元。

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

正如我之前指出的那樣，備考收入可以更輕鬆地比較我們的財務結果和業務趨勢。

I will now summarize our GAAP results.

我現在將總結我們的 GAAP 結果。

GAAP net income was $298 million or $2.55 per share for the third quarter of 2017 compared with $211 million or $1.77 per share for the third quarter of 2016 and $222 million or $1.92 per share for the second quarter of 2017.

2017 年第三季度 GAAP 淨收入為 2.98 億美元或每股 2.55 美元，而 2016 年第三季度為 2.11 億美元或每股 1.77 美元，2017 年第二季度為 2.22 億美元或每股 1.92 美元。

GAAP net income included $10 million of net charges associated with legal settlements compared with no charges recorded in the third quarter of 2016 and $5 million of net benefits recorded last quarter.

GAAP 淨收入包括 1000 萬美元與法律和解相關的淨費用，而 2016 年第三季度沒有記錄任何費用，以及上一季度記錄的 500 萬美元淨收益。

GAAP net income for the second quarter of 2017 also included a charge of $6 million associated with purchased IP.

2017 年第二季度的 GAAP 淨收入還包括與購買的 IP 相關的 600 萬美元費用。

These costs are excluded from our pro forma results.

這些費用不包括在我們的備考結果中。

Beginning in 2017, we are required under GAAP to report the excess tax benefits or deficiencies associated with employees' stock awards in our tax provision rather than as an adjustment to paid-in capital as in prior periods.

從 2017 年開始，根據美國通用會計準則，我們需要在我們的稅收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，而不是像往年那樣作為對實收資本的調整。

The excess tax benefit included in our GAAP results for the third quarter was $20 million, contributing $0.17 per share compared with $31 million, contributing $0.27 per share in the second quarter of 2017.

我們第三季度的 GAAP 業績中包含的超額稅收優惠為 2000 萬美元，每股貢獻 0.17 美元，而 2017 年第二季度為 3100 萬美元，每股貢獻 0.27 美元。

We've excluded these benefits from our pro forma results.

我們已經從我們的備考結果中排除了這些好處。

This amount will fluctuate quarter-to-quarter based on the volume of employee stock option exercises, number of RSUs vesting and the value of our stock.

該金額將根據員工股票期權行使量、授予的 RSU 數量和我們股票的價值每季度波動。

We ended the quarter with cash and investments of $3.8 billion, up from $3.4 billion as of June 30, 2017.

本季度末，我們的現金和投資為 38 億美元，高於 2017 年 6 月 30 日的 34 億美元。

The increase generally reflects cash generated from operations.

這一增長通常反映了經營活動產生的現金。

The accelerated stock buyback agreement we entered into in the first quarter will close in the fourth quarter.

我們在第一季度簽訂的加速股票回購協議將在第四季度結束。

Based on our current stock price, we'll be required either to deliver shares or pay cash to close out the arrangement.

根據我們當前的股價，我們將需要交付股票或支付現金以結束該安排。

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

有了這個，我想把它交給帕特里克，他將回顧我們的程序和臨床亮點。

Thanks, Marshall.

謝謝，馬歇爾。

Of our third quarter procedure growth, 15%, U.S. procedures grew approximately 12%.

在我們第三季度的程序增長 15% 中，美國程序增長了約 12%。

And outside of the United States, procedures grew approximately 23%.

在美國以外，程序增長了約 23%。

Procedure trends were consistent with the first half of the year with growth led by U.S. general surgery and global urology.

手術趨勢與上半年一致，增長由美國普通外科和全球泌尿科引領。

During the quarter, in the United States, strength in general and thoracic surgery continued.

在本季度，在美國，普通和胸外科手術繼續保持強勁勢頭。

Growth in mature procedure categories moderated.

成熟程序類別的增長放緩。

There was one fewer weekday, and we estimate that hurricanes impacted U.S. procedure growth rates by less than 1%.

工作日少了一個，我們估計颶風對美國手術增長率的影響不到 1%。

In U.S. urology, the third quarter growth rate for da Vinci Prostatectomy was similar to the first half of 2017.

在美國泌尿外科，達芬奇前列腺切除術第三季度的增長率與 2017 年上半年相似。

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

我們相信我們在美國的前列腺切除術量一直在追踪更廣泛的前列腺手術市場。

During the quarter, growth in kidney procedures moderated compared to the first half of the year.

本季度，腎臟手術的增長與上半年相比有所放緩。

In U.S. gynecology, third quarter procedure growth was flat compared to the prior year.

在美國婦科，第三季度手術增長與去年持平。

Compared to the first half of 2017, the moderation in third quarter procedure growth was due to benign procedures.

與 2017 年上半年相比，第三季度手術增長放緩是由於良性手術。

Third quarter U.S. general and thoracic surgery procedure adoption remained strong, led by growth in hernia repair.

第三季度，在疝修補術增長的帶動下，美國普外科和胸外科手術的採用率依然強勁。

Hernia repair continues to contribute the largest volume of new procedures in the United States with solid contributions from colorectal and thoracic procedures.

疝修補術繼續在美國貢獻最大數量的新手術，結直腸和胸部手術的貢獻很大。

Turning abroad.

轉向國外。

Procedure growth outside of the United States was approximately 23% in the third quarter, led by the global adoption of da Vinci Prostatectomy, with solid contributions from kidney procedures, hysterectomies and colorectal resections.

在全球採用達芬奇前列腺切除術的帶動下，第三季度美國以外的手術增長了約 23%，腎臟手術、子宮切除術和結直腸切除術做出了巨大貢獻。

Procedure growth was strong in Asia and variable by country in Europe.

亞洲的程序增長強勁，而歐洲則因國家/地區而異。

The one fewer weekday compared to the third quarter of 2016 was partially offset by the timing of certain regional holidays.

與 2016 年第三季度相比，工作日減少了一個，部分被某些地區性假期的時間所抵消。

Outside of the United States, procedure growth was led by China, South Korea, Germany and Japan.

在美國以外，中國、韓國、德國和日本引領了手術增長。

Procedure growth rates in China moderated despite continued strong expansion in system utilization.

儘管系統利用率持續強勁增長，但中國的手術增長率有所放緩。

System placements remained constrained, pending the issuance of a new quota for civilian hospitals.

系統安置仍然受到限制，等待民用醫院新配額的發布。

We have no update regarding the status of the quota.

我們沒有關於配額狀態的更新。

In South Korea, growth was led by gynecology and urology, including contribution from Single-Site use in gynecology.

在韓國，增長由婦科和泌尿科引領，包括婦科單點使用的貢獻。

In Germany and Japan, procedure growth rates in the third quarter were similar to the first half of 2017, led by the adoption of urology procedures.

在德國和日本，第三季度的手術增長率與 2017 年上半年相似，主要是採用泌尿外科手術。

During the quarter, recently placed da Vinci X systems generated solid utilization.

在本季度，最近放置的 da Vinci X 系統產生了穩定的利用率。

The systems were largely used in urology and gynecology procedures with general surgery procedures in the United States.

在美國，這些系統主要用於泌尿科和婦科手術以及普通外科手術。

Globally, evidence continues to build in support of clinical and economic validation of da Vinci surgery.

在全球範圍內，越來越多的證據支持達芬奇手術的臨床和經濟驗證。

During the quarter, an economic analysis studying the impact of da Vinci Hysterectomy in Denmark was published in the Journal of Robotic Surgery.

在本季度，一項研究丹麥達芬奇子宮切除術影響的經濟分析發表在《機器人外科雜誌》上。

The work was completed by a team of researchers from Aarhus University and Odense University.

這項工作是由奧胡斯大學和歐登塞大學的一組研究人員完成的。

Comparing more than 7,600 hysterectomy patients across open, laparoscopic and da Vinci surgery, the authors compared the comprehensive cost of care from the year preceding to the year following a hysterectomy for benign or malignant conditions.

作者比較了 7,600 多名接受開放手術、腹腔鏡手術和達芬奇手術的子宮切除術患者，比較了良性或惡性子宮切除術前一年和術後一年的綜合護理費用。

For benign procedures, the authors found that da Vinci Hysterectomy was less expensive than either open or laparoscopic procedures.

對於良性手術，作者發現達芬奇子宮切除術比開放式或腹腔鏡手術更便宜。

For less complex malignant procedures, da Vinci Hysterectomy was more expensive than laparoscopic procedures and less expensive than open surgery.

對於不太複雜的惡性手術，達芬奇子宮切除術比腹腔鏡手術更昂貴，但比開腹手術更便宜。

Within this population, the authors determined that the da Vinci patient cohort was more complex than the laparoscopic cohort and largely replaced open surgery at most institutions.

在這個人群中，作者確定達芬奇患者隊列比腹腔鏡隊列更複雜，並且在大多數機構中基本上取代了開腹手術。

In conclusion, the authors stated, "Our study demonstrates that the use of robotic technology for hysterectomy is potentially cost saving from a broad health care perspective."

總之，作者表示，“我們的研究表明，從廣泛的醫療保健角度來看，使用機器人技術進行子宮切除術可能會節省成本。”

This concludes my remarks.

我的發言到此結束。

I'll now turn the call over to Calvin.

我現在將電話轉給卡爾文。

Thank you, Patrick.

謝謝你，帕特里克。

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

我將為您提供 2017 年最新的財務展望。

Starting with procedures.

從程序開始。

On our last call, we estimated full year 2017 procedure growth of 14% to 15% above the approximately 753,000 procedures performed in 2016.

在我們上次電話會議中，我們估計 2017 年全年的手術數量比 2016 年的大約 753,000 例增長 14% 至 15%。

We are now increasing our estimate for 2017.

我們現在增加了對 2017 年的估計。

We now anticipate full year 2017 procedure growth within a range of 15% to 16%.

我們現在預計 2017 年全年手術增長率將在 15% 至 16% 之間。

In regards to system placements, although the proportion of Q3 systems placed under operating leases was slightly lower than Q2, we continue to expect that over time, the proportion of systems we place under operating leases will generally trend upwards.

在系統佈局方面，雖然 Q3 以經營租賃方式放置的系統比例略低於 Q2，但我們繼續預計，隨著時間的推移，我們以經營租賃方式放置的系統比例將總體呈上升趨勢。

With increasing placements in the cost-sensitive market segments, we expect that our average system selling price will continue to trend gradually lower.

隨著對成本敏感的細分市場的安置增加，我們預計我們的平均係統售價將繼續呈逐漸下降的趨勢。

As Marshall mentioned, $21 million of the $23 million deferred in Q1 related to our da Vinci X trade-out program was recognized in Q3.

正如 Marshall 提到的，與我們的達芬奇 X 交易計劃相關的第一季度遞延的 2300 萬美元中的 2100 萬美元在第三季度得到確認。

We expect to recognize the remaining $2 million in Q4 and close out the program.

我們希望在第四季度確認剩餘的 200 萬美元並結束該計劃。

Turning to gross profit.

轉向毛利。

On our last call, we forecast 2017 pro forma gross profit margin to be within a range of between 70% and 71.5% of net revenue.

在我們上次電話會議上，我們預測 2017 年備考毛利率將在淨收入的 70% 至 71.5% 之間。

We now expect to come in at the top end of the range and anticipate pro forma gross profit margin to be between 71% and 71.5% of net revenue.

我們現在預計將進入該範圍的高端，預計備考毛利率將在淨收入的 71% 至 71.5% 之間。

Turning to operating expenses.

轉向運營費用。

As we have described previously, we've accelerated our investments in several strategic areas that will benefit the company over the long term.

正如我們之前所描述的，我們已經加快了對幾個戰略領域的投資，這些領域將使公司長期受益。

Accordingly, we've ramped our operating expenses as we focus on execution.

因此，由於我們專注於執行，因此我們增加了運營費用。

On our last call, we forecast pro forma 2017 operating expenses to grow at the higher end of a range between 17% and 18% above 2016 levels.

在我們上次電話會議中，我們預計 2017 年備考運營費用將比 2016 年水平增長 17% 至 18% 的較高區間。

We now expect pro forma 2017 operating expenses to grow between 18% and 19%.

我們現在預計 2017 年備考運營費用將增長 18% 至 19%。

We continue to forecast our noncash stock compensation expense to range between $200 million and $210 million in 2017, as communicated on our last call.

正如我們在上次電話會議上所傳達的那樣，我們繼續預測 2017 年我們的非現金股票補償費用將在 2 億美元至 2.1 億美元之間。

We expect 2017 other income to be at the top end of the $35 million to $40 million range forecast on our last call.

我們預計 2017 年其他收入將處於我們上次電話會議預測的 3500 萬至 4000 萬美元區間的高端。

With regard to income tax, we now expect our Q4 2017 pro forma income tax rate to be between 26.5% and 28.5% of pretax income compared to our previous guidance of 28% to 29.5%.

關於所得稅，我們現在預計 2017 年第四季度的預估所得稅稅率將在稅前收入的 26.5% 至 28.5% 之間，而我們之前的指引為 28% 至 29.5%。

That concludes our prepared comments.

我們準備好的評論到此結束。

We will now open the call to your questions.

我們現在將打開您的問題的電話。

(Operator Instructions) Our first question will come from the line of Amit Hazan with Citi.

（操作員說明）我們的第一個問題將來自花旗的 Amit Hazan。

Let me start with your new thoughts on 2018, actually, and just hit that to make sure we have it clear.

實際上，讓我從你對 2018 年的新想法開始，然後點擊它以確保我們已經清楚了。

So I think in the past, you were talking about higher OpEx spending this year and then normalizing in '18.

所以我認為過去，你在談論今年更高的 OpEx 支出，然後在 18 年正常化。

That's how we started the year.

我們就是這樣開始這一年的。

What are you thinking about OpEx spending for '18 in the comments that you made?

在您發表的評論中，您如何看待 18 年的 OpEx 支出？

And historically, it would've been -- high single digits would've been normal.

從歷史上看，它本來是——高個位數是正常的。

What do you consider to be the new target?

您認為新目標是什麼？

Yes.

是的。

I think what we've said is that we would expect to, as you said, return to normal spending next year, normal being defined as something that's more in line with revenue growth.

我想我們所說的是，正如你所說，我們預計明年會恢復正常支出，正常被定義為更符合收入增長的東西。

I think that what we're seeing this year is we're outperforming on the revenue line and we wind up with much higher leverage than we had expected and therefore higher profit margins.

我認為我們今年看到的是我們在收入線上表現出色，我們最終的槓桿率比我們預期的要高得多，因此利潤率更高。

And so it's -- if we continued our spending -- even if we decreased the rate of spending next year or the rate of increase next year, you still wind up with not achieving leverage as maybe we were indicating before.

因此——如果我們繼續支出——即使我們降低了明年的支出率或明年的增長率，你最終還是不會像我們之前所說的那樣實現槓桿作用。

So it all has to do with where we're coming out this year relative to next year.

所以這一切都與我們今年相對於明年的表現有關。

In total, if you looked at our plans on a 2-year basis from last year to next year, it's really pretty consistent with that.

總的來說，如果你從去年到明年以 2 年為基礎查看我們的計劃，它確實與此非常一致。

Okay.

好的。

And then just on the installed base in the U.S. It's now 3 quarters in a row that you had really strong numbers, especially new additions to the installed base.

然後就在美國的安裝基礎上。現在連續三個季度你有非常強勁的數字，尤其是安裝基礎的新增加。

I think it's almost double what we saw last year.

我認為這幾乎是我們去年看到的兩倍。

So I think you guys will always point us to procedures as the key leading indicator, but I'm wondering if there's any additional insight as to why it's been so strong so far this year.

所以我認為你們總是會指出我們將程序作為關鍵的領先指標，但我想知道是否有任何額外的見解來說明為什麼它今年到目前為止如此強勁。

And how much does that growth in the U.S. installed base improve your confidence for U.S. procedure growth over the next 12 months?

美國安裝基數的增長在多大程度上提高了您對未來 12 個月美國程序增長的信心？

Yes.

是的。

You took some of the words right out of our mouth.

你從我們嘴裡拿走了一些話。

Procedure growth really does drive placement growth, so we kind of think of it in that order.

程序增長確實推動了安置增長，所以我們有點按這個順序來考慮它。

And procedure growth, we've talked about what that's been.

和程序增長，我們已經討論過那是什麼。

It's been strong over the last few quarters.

它在過去幾個季度表現強勁。

In the -- to date, 85% of our system placements have been to existing hospitals with roughly 2/3 of that to expand the installed base.

在 - 迄今為止，我們 85% 的系統安置已用於現有醫院，其中大約 2/3 用於擴大安裝基礎。

So what we're seeing is hospitals growing procedures, having a need for additional capacity and therefore buying systems.

因此，我們看到的是醫院在增加程序，需要額外的容量，因此需要購買系統。

90% of the systems we've sold are fourth generation, as Gary had indicated.

正如加里所說，我們售出的系統中有 90% 是第四代。

So Xi and X. And what we see there is that people want to avail themselves of the latest capabilities, including computer-aided setup, optimized advance instruments and table motion, multi-quadrant access.

所以 Xi 和 X。我們看到的是人們希望利用最新的功能，包括計算機輔助設置、優化的高級儀器和桌面運動、多像限訪問。

So it's a number of factors that are driving it.

因此，有許多因素在推動它。

It's hard to predict.

很難預測。

We don't give you guidance on systems going forward, but that's what's driven it so far.

我們不會為您提供有關未來系統的指導，但這就是迄今為止的驅動力。

And I'll sneak in one quick one on physicians trained.

我會偷偷介紹一下受過培訓的醫生。

I'm just curious.

我只是好奇。

So basically, in general surgery specifically, if you've got a sense of roughly how much of your growth is being driven by new physicians being trained and how much just kind of an improvement in the same-store sales, so to speak, and how much runway we might have left for kind of new surgeons trained in general surgery as a driver?

所以基本上，特別是在普通外科領域，如果你大致了解了你的增長有多少是由接受培訓的新醫生推動的，以及同店銷售有多少改善，可以這麼說，以及我們可能為接受普通外科培訓的新外科醫生留下多少跑道？

Amit, it's Patrick.

阿米特，我是帕特里克。

We see a pretty balanced growth across both new surgeons who are starting da Vinci general surgery for the first time as well as those who continue to expand their practice by either doing more patients within the existing procedures that they've been performing as well as adding new procedures to the list that they have been performing over time.

我們看到，無論是首次開始使用達芬奇普外科的新外科醫生，還是通過在他們一直在執行的現有手術中治療更多患者以及增加新手術來繼續擴大業務範圍的新外科醫生，我們都看到了相當均衡的增長他們一直在執行的列表中的新程序。

Next question comes from the line of David Lewis, Morgan Stanley.

下一個問題來自摩根士丹利的大衛劉易斯。

Gary, one quick question on some pipeline dynamics.

加里，一個關於管道動態的快速問題。

And I may come back to the cost after that.

之後我可能會回到成本上。

But just 2 things.

但只有兩件事。

You reiterated the Sp regulatory timing end of this year.

您重申 Sp 監管時間在今年年底。

Is there good estimate for us, full commercial launch for Sp first quarter '18?

18 年第一季度 Sp 的全面商業發布對我們有好的估計嗎？

And the second part of that question was just on flexible catheter, you talked about the regulatory pathway.

這個問題的第二部分只是關於柔性導管，你談到了監管途徑。

But can you give us any sense of 510(k) PMA, we've been assuming 510(k), and whether there is any commercial time line that you could share?

但是你能告訴我們 510(k) PMA 的任何意義嗎，我們一直在假設 510(k)，是否有任何商業時間表可以分享？

Sure.

當然。

So on Sp, we don't know exactly the launch date, just given what questions we might get back from FDA.

所以在 Sp 上，我們不知道確切的發布日期，只是考慮到我們可能會從 FDA 得到什麼問題。

So we have that as well as finalizing some of the supply chain work we want to do.

所以我們已經完成了我們想要做的一些供應鏈工作。

But we're working hard and solving the problems that we think we need.

但我們正在努力工作並解決我們認為需要的問題。

So I don't have any additional update for you on the Sp commercialization ramp.

所以我沒有任何關於 Sp 商業化坡道的額外更新。

We'll report to you when 510(k) goes in and what we think about it.

我們會在 510(k) 生效時向您報告我們的想法。

The -- on the flex side, likewise, what we described in the script, we're making good progress on developing the technologies and finalizing our regulatory approach.

同樣，在彈性方面，正如我們在腳本中所描述的那樣，我們在開發技術和最終確定監管方法方面取得了良好進展。

We believe it's a 510(k).

我們認為這是 510(k)。

We'll find out.

我們會知道的。

FDA has a say on all of that, but our plans are such that it's 510(k).

FDA 對所有這些都有發言權，但我們的計劃是 510(k)。

We do not -- we have not set a launch date yet for public consumption.

我們沒有——我們還沒有為公眾消費設定發布日期。

Okay.

好的。

And then just coming back to spending, either for Gary or Marshall.

然後回到支出上，無論是為了加里還是馬歇爾。

The thing about 2017 was you wanted to invest at a greater level because you had a lot going on in the pipeline.

2017 年的事情是你想在更高水平上進行投資，因為你有很多事情要做。

By our math and your guidance for next year for flat margins is consistent with our model, but it basically implies about $1 billion in R&D and combined SG&A, which is a nice big round number.

根據我們的計算和您對明年固定利潤率的指導與我們的模型一致，但它基本上意味著大約 10 億美元的研發和綜合 SG&A，這是一個不錯的大整數。

Can you give us any sense of the spending [provided]?

你能告訴我們[提供]的支出嗎？

I think investors are totally comfortable with increased spending if they think that spending is going to generate a high return.

我認為，如果投資者認為支出會產生高回報，他們就會完全放心地增加支出。

So the kind of things you're working on for next year and why that level of spending is necessary.

那麼你明年要做的事情是什麼，為什麼這種支出水平是必要的。

Sure, and it's a good question.

當然，這是一個很好的問題。

The -- as Marshall said, we haven't really changed our view of what kind of spending is required in '18.

正如馬歇爾所說，我們並沒有真正改變對 18 年需要什麼樣的支出的看法。

Just a little bit of the math of '17 changes relative to what the total operating margins look like.

相對於總營業利潤率，17 年的數學變化很小。

With regard to what we're investing in, we go from essentially a single platform in the field and multiport; da Vinci to SP, which is a new patient side plus accessories and instrumentation as well as flex catheter, which we think is really important.

關於我們正在投資的內容，我們基本上是從現場和多端口的單一平台開始的；達芬奇到 SP，這是一個新的患者端加上配件和儀器以及我們認為非常重要的柔性導管。

So on the R&D side, you've got kind of a broadening of platform lanes.

因此，在研發方面，平台通道有所拓寬。

And we think those are important because they don't get developed in a year.

我們認為這些很重要，因為它們不會在一年內得到開發。

They take both technology development as well as technique development and all the commercialization steps that you all are well aware of.

他們既進行技術開發，又進行技術開發，以及你們都非常了解的所有商業化步驟。

So that's kind of one side.

所以這是一方面。

The flip side is a set of investments around making sure that we can support the scale of the business in the multiport space, and that has to do with making sure your factories are right and you've invested in plants and equipment and you get the advantages of scale as you grow.

另一方面是一系列投資，以確保我們能夠支持多端口領域的業務規模，這與確保您的工廠是正確的有關，並且您已經投資了工廠和設備，並且您得到了隨著您的成長，規模優勢。

And we've started to see that at the gross margin line, the improvements and performance above some of our earlier expectations are the result of some hard work in manufacturing efficiencies, which, I think, I would be supportive of on the shareholder side.

我們已經開始看到，在毛利率線上，超出我們早期預期的改進和表現是製造效率方面的一些努力的結果，我認為，我會支持股東方面。

I think it makes a lot of sense.

我認為這很有意義。

Those are really the investment priorities.

這些才是真正的投資重點。

There's a little bit in there about data generation in local markets to support the needs of our customers in the markets in which they operate, be it clinical data or economic data, so that picks up -- that rounds out kind of the investment profile.

那裡有一些關於本地市場數據生成的內容，以支持我們客戶在他們運營的市場中的需求，無論是臨床數據還是經濟數據，因此這些數據都會有所增加——這完善了投資概況。

Probably not a surprise to you at all.

可能根本不會讓你感到驚訝。

And our next question comes from the line of Bob Hopkins, Bank of America.

我們的下一個問題來自美國銀行的鮑勃霍普金斯。

So the first question I wanted to ask is for Gary.

所以我想問的第一個問題是加里。

I noticed, obviously, that TransEnterix has got a FDA approval.

顯然，我注意到 TransEnterix 已獲得 FDA 批准。

And what struck me as interesting, they got approval for 23 different indications, 23 different types of surgeries, some without data.

讓我感到有趣的是，他們獲得了 23 種不同適應症、23 種不同類型手術的批准，其中一些沒有數據。

And I was just curious, does this suggest that FDA might be willing to approve multiple indications?

我只是好奇，這是否表明 FDA 可能願意批准多個適應症？

And could this potentially advance some of your timelines for the different indications that you're looking at for Sp and some of your other technologies?

這是否可能會提前一些您正在尋找 Sp 和其他一些技術的不同適應症的時間表？

Yes.

是的。

Fair question.

公平的問題。

So the first thing is the use of kind of a one set of data to get additional procedures.

所以第一件事是使用一組數據來獲得額外的程序。

That's something that was discussed with FDA in their workshop a couple years ago and has been employed by us and by others.

這是幾年前在他們的研討會上與 FDA 討論的內容，並且已被我們和其他人採用。

So the idea that there are some procedures that are the kind of the key data generators that create an umbrella for other procedures is not a surprise to us.

因此，有些程序是為其他程序創建保護傘的關鍵數據生成器，這一想法對我們來說並不奇怪。

Something that we have worked with FDA on, and we're not surprised that others are likewise using it.

我們已經與 FDA 合作開發了一些東西，我們對其他人也在使用它並不感到驚訝。

I think, with regard to what evidentiary requirements are, which is a little bit underneath your question, the issue there is that how FDA views this is what you ask for in terms of labeling and claims and the relative evidence to support that are linked.

我認為，關於什麼是證據要求，這在你的問題下面有一點，問題是 FDA 如何看待這就是你在標籤和聲明方面所要求的以及相關的支持證據。

And whether this signals a change in FDA's posture, you really have to read the specifics of the labeling as well as what the submitted data was.

這是否標誌著 FDA 態度的改變，你真的必須閱讀標籤的細節以及提交的數據是什麼。

We will do that carefully when it comes out, and we'll assess whether their posture has changed or not.

當它出來的時候我們會仔細地做，我們會評估他們的姿態是否改變了。

But on its surface, just reading what you've seen so far -- what we've seen so far: a, we're not surprised that there are a set of procedures and kind of the devil is in the details as to how they viewed it.

但從表面上看，只是閱讀你到目前為止所看到的——我們到目前為止所看到的：a，我們並不感到驚訝有一套程序，而細節中的魔鬼是如何運作的他們看了。

Okay.

好的。

Fair enough.

很公平。

So we'll follow up after we get more details there.

因此，我們將在獲得更多詳細信息後進行跟進。

And then I apologize, Marshall, just one more on the 2018 comment.

然後我很抱歉，馬歇爾，就 2018 年的評論再說一句。

I assume, from the comments and some of the math, that what you're implying here is a double digit level of increase in OpEx in 2018.

我假設，根據評論和一些數學，你在這裡暗示的是 2018 年 OpEx 的兩位數增長。

Is that a fair assumption?

這是一個公平的假設嗎？

Well, we'll provide you guidance when we get to next quarter.

好吧，我們會在下個季度為您提供指導。

We're not ready to commit to what the increase would be.

我們還沒有準備好承諾增加多少。

It's just that, as we sit here today, we would imagine that we would not be adding leverage to the model.

只是，當我們今天坐在這裡時，我們會想像我們不會增加模型的影響力。

Our spend in '17 is -- to date, has been right where we thought it would be.

迄今為止，我們在 17 年的支出一直在我們預期的範圍內。

Revenue has come in pretty well, and our margins and other costs have been where we expected them.

收入非常好，我們的利潤和其他成本一直在我們預期的範圍內。

And so it just changes the profitability relative to what we were thinking 9 months ago.

因此，相對於我們 9 個月前的想法，它只是改變了盈利能力。

Yes, I mean, that's really the basis for the question.

是的，我的意思是，這確實是問題的基礎。

I'm trying to get at, what percentage of this is really -- could be associated with just increased confidence in the outlook for revenue growth next year?

我試圖弄清楚，其中有多少百分比是真正的 - 可能與對明年收入增長前景的信心增強有關？

Yes.

是的。

So we'll get to the guidance for you in the next quarter.

因此，我們將在下一季度為您提供指導。

Next question comes from the line of Tycho Peterson with JPMorgan.

下一個問題來自摩根大通的第谷彼得森。

First question on dVP.

關於 dVP 的第一個問題。

I want to make sure I heard this right.

我想確定我沒聽錯。

I think you said 3Q volumes in the U.S. similar to the first half of the year.

我想你說美國第三季度的銷量與今年上半年相似。

If that's right, that seems to be in contrast to what you talked about in terms of it moderating to low-single digit growth just a month ago.

如果那是對的，那似乎與您一個月前所說的放緩至低個位數增長形成鮮明對比。

So can you clarify that?

那麼你能澄清一下嗎？

Yes, Tycho.

是的，第谷。

To clarify, the comment on dVP was that growth rates were very consistent the first half of the year, but the category of urology moderated compared to the first half of the year.

需要澄清的是，對 dVP 的評論是上半年的增長率非常一致，但與上半年相比，泌尿外科類別有所緩和。

So inclusive of other procedures like kidney procedures.

所以包括其他程序，如腎臟手術。

Okay.

好的。

And then thinking a little bit ahead on Sp as we think about the initial urology rollout.

然後在我們考慮最初的泌尿外科推出時，稍微提前考慮一下 Sp。

This is really about improved clinical outcome maybe versus market expansion, I guess.

我猜，這實際上是關於改善臨床結果，而不是市場擴張。

Can you maybe just talk to how you think about that factoring into these option cycles?

您能否談談您如何看待這些期權週期中的因素？

And since this is kind of a new approach in terms of getting FDA approval by procedure, how does that play into the mix in terms of how much of this is going to be an up-sell to the installed base versus potential market expansion, if you will, when you do roll it out for urology?

由於這是通過程序獲得 FDA 批准的一種新方法，如果這將對已安裝的基礎進行追加銷售，而不是潛在的市場擴張，那麼它如何發揮作用呢？你會的，當你把它推廣到泌尿外科時？

Yes.

是的。

In the early parts of the rollout, we expect to do that in a measured way, and the beginnings will be around clinical publication and evidentiary building -- building of evidence.

在推出的早期部分，我們希望以一種有節制的方式做到這一點，並且開始將圍繞臨床出版和證據建設——建立證據。

We think that it has multi-specialty implications.

我們認為它具有多專業意義。

And so part of this will be to follow-through and get multi-specialty indications with FDA.

因此，其中一部分將是跟進並獲得 FDA 的多專業適應症。

And you see some of the trial data doing that.

你會看到一些試驗數據是這樣做的。

I don't know that Sp harkens a different regulatory pathway for FDA.

我不知道 Sp 對 FDA 有不同的監管途徑。

You had implied that in your question, and I'm not sure that I agree with that implication.

你在你的問題中暗示了這一點，我不確定我是否同意這種暗示。

So far, it doesn't look like a foundationally different way to communicate with FDA.

到目前為止，它看起來不像是與 FDA 溝通的根本不同方式。

With regard to the question of how much of this is -- we're kind of working backward into the existing procedure base we do in pursuit of better outcomes and how much we'd expand opportunity.

關於其中有多少的問題——我們正在倒退到我們為追求更好的結果而做的現有程序基礎中，以及我們會擴大多少機會。

I think we're going to see some of both, and it's a little bit early to size exactly which.

我認為我們會看到兩者中的一些，現在確定具體大小還為時過早。

I have been impressed by surgeons' interest in both categories, both improving what they do already as well as being able to approach techniques and applications they have not yet done.

外科醫生對這兩個類別的興趣給我留下了深刻的印象，他們既改進了他們已經做的事情，也能夠接觸他們尚未完成的技術和應用。

So I think that's why we're excited about it is the potential to do both.

所以我認為這就是我們對此感到興奮的原因，因為它有可能做到這兩點。

And I just say, stay tuned there as we get more experience and put these in the field.

我只是說，隨著我們獲得更多經驗並將這些經驗投入實地，請繼續關注那裡。

Okay.

好的。

And then just lastly, on thinking about clinical data readout 2 weeks from now.

最後，考慮從現在起 2 週後讀出臨床數據。

You will have the data coming out at CHEST.

您將在 CHEST 獲得數據。

Any preview you can give us for those that don't want to go to Toronto?

您可以為那些不想去多倫多的人提供任何預覽嗎？

No, no, I cannot.

不，不，我不能。

Next question comes from the line of Larry Biegelsen with Wells Fargo.

下一個問題來自 Larry Biegelsen 與 Wells Fargo 的對話。

Maybe I'll just start with the flex catheter, then I had one on the competition.

也許我會從柔性導管開始，然後我在比賽中使用了一個。

So the data at CHEST, is that going to be enough for 510(k) clearance in the U.S.?

那麼 CHEST 的數據是否足以在美國獲得 510(k) 許可？

Will you have to do another trial for 510(k) clearance?

您是否需要再做一次 510(k) 許可試驗？

And on the last call, you were asked about how your flex catheter system compares to Medtronic Super D. There is another robotic system being developed in the field that we hear is similar to yours.

在上次通話中，您被問及您的柔性導管系統與 Medtronic Super D 相比如何。我們聽說該領域正在開發另一種機器人系統，它與您的系統相似。

Is that a fair characterization?

這是一個公平的表徵嗎？

I'd be curious if you had any comments on that.

我很好奇你是否對此有任何評論。

I had one follow-up.

我有一個跟進。

Okay.

好的。

So on the sufficiency of data, thus far, to date, vis-à-vis 510(k) clearance, don't know yet.

所以到目前為止，關於數據的充分性，到目前為止，相對於 510(k) 許可，還不知道。

So we'll see.

所以我們拭目以待。

Can't give you a positive or a negative indication.

不能給你正面或負面的指示。

With regard to other folks working on flex approaches that are robotic, we have heard, likewise, indications that people are interested in pursuing that.

關於其他從事機器人柔性方法研究的人，我們同樣聽說過人們有興趣追求它的跡象。

Very little publicly available out there, and we won't speculate as to what their plans are ahead of whatever their public releases are.

那裡很少公開可用，我們不會推測他們的計劃在他們的公開發布之前是什麼。

But we remain vigilant.

但我們保持警惕。

And I guess, my major point on this one is, the way you satisfy your customers best is by understanding their needs and being really conversant in what they want and what the technologies are.

我想，我在這方面的主要觀點是，您最好地滿足客戶的方式是了解他們的需求並真正熟悉他們想要什麼以及技術是什麼。

And so I worry a lot less about what others are doing and a lot more about what we're doing.

所以我不太擔心別人在做什麼，而更擔心我們在做什麼。

And our team is highly focused in satisfying customer need in that space, and we feel good about where we are.

我們的團隊高度專注於滿足該領域的客戶需求，我們對自己的處境感到滿意。

And then just for my follow-up on the competition.

然後只是為了我對比賽的跟進。

I guess I'll ask one broad question on the TransEnterix approval.

我想我會問一個關於 TransEnterix 批准的廣泛問題。

Any just comments, Gary, from a technology or an IP standpoint and potential for this elongating the selling cycle in the U.S.?

加里，從技術或知識產權的角度以及延長美國銷售週期的潛力，有什麼公正的評論嗎？

With regard to other systems that are coming or have come out, our experience goes back pretty far.

對於即將推出或已經推出的其他系統，我們的經驗可以追溯到很久以前。

So we have lived through the pathway of hybrid surgical approaches, some robotics, some manual, 3-armed systems, some things integrated, some things not integrated.

所以我們經歷了混合手術方法的路徑，一些機器人技術，一些手動，三臂系統，一些整合的東西，一些不整合的東西。

We have lived through that, and it's our customers who have really taken us to the position we're in with integrated systems, things that work very well together.

我們已經經歷了這些，是我們的客戶真正將我們帶到了集成系統所處的位置，這些系統可以很好地協同工作。

Simple examples.

簡單的例子。

If you have a manual stapler and you're using a robotic system, the surgeon has to often, almost always, scrub in and scrub out because it's unusual for a physician's assistant to fire a stapler.

如果你有一個手動訂書機並且你正在使用一個機器人系統，外科醫生必須經常，幾乎總是，擦洗和擦洗，因為醫生助理開動訂書機是不尋常的。

So the workflow of getting up and sitting down is really challenging.

所以起床和坐下的工作流程真的很有挑戰性。

The challenge of integrating multiple different technologies from multiple different vendors at the OR is a headache, and they tell us that.

在 OR 中集成來自多個不同供應商的多種不同技術的挑戰令人頭疼，他們告訴我們這一點。

We'd like this all to work together as if it was designed with a whole thought.

我們希望這一切能夠協同工作，就好像它是經過深思熟慮設計出來的一樣。

We didn't choose those things out of the blue.

我們沒有突然選擇那些東西。

And so with our own systems, with systems we competed against 20 years ago, we've kind of seen this.

因此，對於我們自己的系統，以及我們 20 年前與之競爭的系統，我們已經看到了這一點。

And so I think that customers will think that through and evaluate it.

所以我認為客戶會仔細考慮並評估它。

You had asked, could it delay sales cycles?

您曾問過，它會延遲銷售週期嗎？

And the answer to that is yes, it can in the near term.

答案是肯定的，它可以在短期內實現。

Now we are facing some of these concepts and competitive systems in Europe, and customers are evaluating these things and making decisions.

現在我們在歐洲面臨這些概念和競爭系統中的一些，客戶正在評估這些東西並做出決定。

I think they make them based on a pretty good basis, and so it may cause some short-term ripples, but we'll be ready to engage those conversations with hospitals.

我認為他們是在一個很好的基礎上製定的，所以這可能會引起一些短期的漣漪，但我們會準備好與醫院進行這些對話。

And again, I think we didn't end up where we are by accident.

再一次，我認為我們並不是偶然地結束了我們現在的位置。

That's true in our IP portfolio as well.

我們的知識產權組合也是如此。

And one of the things about being the market leader is you have to solve these problems first and you get to patent them and we have.

成為市場領導者的其中一件事是你必須首先解決這些問題，然後你才能為它們申請專利，而我們已經做到了。

So that's something that is an asset for the company as we go forward.

因此，隨著我們的前進，這對公司來說是一項資產。

Next question comes from the line of Isaac Ro with Goldman Sachs.

下一個問題來自高盛的 Isaac Ro。

Just a quick question on China.

只是一個關於中國的快速問題。

You guys mentioned that procedure growth decelerated even though utilization per instrument went -- or per system went up.

你們提到，即使每台儀器或每台系統的利用率上升，程序增長也會放緩。

Can you just talk a little bit about whether or not we should be thinking about your existing installed base sort of hitting full capacity utilization until we get more of an update on the quota system?

在我們獲得更多有關配額系統的更新之前，您能否談談我們是否應該考慮您現有的安裝基礎是否達到全部產能利用率？

Yes, Isaac, I think we've been surprised by the levels of utilization that we see across many of the civilian hospitals within China.

是的，艾薩克，我認為我們對中國許多民用醫院的利用率水平感到驚訝。

And to date this year, they've surpassed levels we thought that we would start to see faster slowdown.

今年到目前為止，它們已經超過了我們認為我們將開始看到更快放緩的水平。

Now you're starting to see the law of large numbers catch up, but still strong growth in utilization.

現在你開始看到大數法則迎頭趕上，但利用率仍然強勁增長。

So I think the short answer is, we're not sure exactly where the ceiling is because the demand for robotic surgery in China is large, and they continue to find ways to efficiently maximize the time they have on the robots each week.

所以我認為簡短的回答是，我們不確定天花板到底在哪裡，因為中國對機器人手術的需求很大，而且他們繼續尋找方法來有效地最大化他們每週在機器人身上的時間。

Okay.

好的。

And then just a follow-up, on the new areas of investment for 2018, as it relates to your comments on operating leverage.

然後是關於 2018 年新投資領域的後續行動，因為它與您對運營槓桿的評論有關。

Can you comment, maybe even just qualitatively, on some of the biggest areas of new investment that are incremental to the underlying programs you already had planned?

您能否對新投資的一些最大領域發表評論，甚至只是定性評論，這些領域是您已經計劃的基礎計劃的增量？

Just trying to get a sense of where those resources are being deployed.

只是想了解這些資源的部署位置。

The way to think about it, in terms of the -- just kind of an R&D product pipeline side, the peak in platform investment is several quarters before launch.

考慮它的方式，就研發產品管道方面而言，平台投資的高峰期出現在發布前的幾個季度。

Those things peak.

那些事情達到頂峰。

And then they stay at that peak for a couple of quarters as you process through the -- all the launch activities and then you start to come off that peak.

然後，當您處理所有啟動活動時，他們會在那個高峰停留幾個季度，然後您開始脫離那個高峰。

And so you have 2 platforms that are heavily in design and moving toward commercialization.

因此，您有 2 個平台，它們在設計上投入了大量精力，並且正在走向商業化。

And that's the bulk of the delta.

這就是三角洲的大部分。

With regard to some of the other spending, that tends to be in little bit smaller increments, and it's around things that give us manufacturing optimizations.

關於其他一些支出，這往往會以較小的增量增加，並且圍繞著讓我們優化製造的事情。

As procedure growth has continued to grow and we get additional scale, a lot of the costs in our production and handling of our systems comes down to manufacturing process.

隨著程序的增長持續增長並且我們獲得了更大的規模，我們生產和處理系統的很多成本都歸結為製造過程。

And as scale changes, we have an opportunity to tweak what we do to get lower cost.

隨著規模的變化，我們有機會調整我們所做的事情以降低成本。

And I think that helps everybody.

我認為這對每個人都有幫助。

I think it helps Intuitive.

我認為這有助於直覺。

It helps our customers and it allows us to take advantage of scale.

它可以幫助我們的客戶，並使我們能夠利用規模優勢。

That's a really good thing.

這真是一件好事。

And so where we see those opportunities, they are pretty easy to evaluate and we move forward on them.

因此，在我們看到這些機會的地方，它們很容易評估，我們會繼續前進。

Next question comes from the line of Richard Newitter, Leerink Partners.

下一個問題來自 Leerink Partners 的 Richard Newitter。

I have 2 quick ones.

我有2個快速的。

Just -- you've mentioned in the past and you again, Gary, highlighted some of the imaging developments and advancements that you've been working on.

只是 - 你過去曾提到過，加里，你再次強調了你一直致力於的一些成像發展和進步。

Can you give us a sense as to what the timing might be on the integration of some of those into your current platforms?

您能否告訴我們將其中一些集成到您當前平台的時間安排？

Sure.

當然。

So you think of imaging as kind of having 3 elements of it.

所以你認為成像有 3 個元素。

There's the hardware part, the optics, the electronics, the physical stuff.

有硬件部分，光學，電子，物理的東西。

We are consistently improving those things and launch them as either improvements or as upgrades periodically, and you sort of think of those as having life cycles of multiple quarters, 6 to 8 quarters.

我們一直在改進這些東西，並定期將它們作為改進或升級發布，你可以將它們視為具有多個季度的生命週期，6 到 8 個季度。

There are software improvements, image processing, image integration, those kinds of things.

有軟件改進、圖像處理、圖像集成等等。

We also launch those.

我們也推出那些。

These are either as upgrades or as in conjunction with other opportunities, and those go out also on a kind of a yearly or every-other-year basis.

這些要么是作為升級，要么是與其他機會相結合，而且這些機會也是每年或每隔一年進行一次。

And then there's molecules, targeting agents.

然後是分子，靶向劑。

The molecules are viewed by the world as drugs, and those go on drug timelines, which are long.

這些分子被世界視為藥物，而這些分子的藥物時間表很長。

So we're progressing.

所以我們正在進步。

But it doesn't look like stasis.

但它看起來不像停滯。

It is continuously improving our gen 4 imaging, as we speak.

正如我們所說，它正在不斷改進我們的第 4 代成像。

The gen 4 scopes of today are better than the scopes of 2 years ago.

今天的第 4 代示波器比 2 年前的示波器更好。

The gen 4 software is better today than it was years ago.

今天的第 4 代軟件比幾年前更好。

And we continue to progress on the molecular front.

我們繼續在分子前沿取得進展。

Okay.

好的。

And on the molecular, there's no concrete time line?

在分子方面，沒有具體的時間線？

No.

不。

Given some of the trial activity that has to go on, we have not yet published what we think the long-term timelines are, in part because we're in conversation with the agency about how they want to view these diagnostic markers in surgery and that creates a lot of uncertainty as to what the forecast models would be.

鑑於一些必須繼續進行的試驗活動，我們尚未公佈我們認為的長期時間表，部分原因是我們正在與該機構討論他們希望如何在手術中查看這些診斷標記，以及這對預測模型會產生很多不確定性。

Got it.

知道了。

And then just one follow-up.

然後只是一個跟進。

You mentioned some moderation in EU or European procedures in the third quarter.

你在第三季度提到了歐盟或歐洲程序的一些緩和。

Can you just elaborate on that a little bit?

你能詳細說明一下嗎？

Yes, there was a moderation in certain markets, not in all.

是的，某些市場有所放緩，但並非全部。

We still had strong growth in some like Germany.

我們在德國等一些國家仍然有強勁的增長。

It was in a handful of markets.

它在少數幾個市場中。

Some I would characterize as slowdowns in some benign procedures where reimbursements are tight and other markets where you've had high levels of penetration in urology, dVP, dVP, and where the emerging procedures are still small and not able to influence the growth rate.

有些我認為是一些良性程序的放緩，在這些程序中，報銷很緊，而在其他市場，你在泌尿外科、dVP、dVP 的滲透率很高，而新興程序仍然很小，無法影響增長率。

Next question comes from the line of Tao Levy.

下一個問題來自Tao Levy 的台詞。

Maybe we can start with the impact from hurricanes, and I guess, the less -- the one less surgery day in the U.S. So theoretically, if you had all that back in the quarter, I mean, are we talking about another 2% potentially on that U.S. growth?

也許我們可以從颶風的影響開始，我想，颶風的影響更少——美國手術日減少了。所以從理論上講，如果你在本季度恢復了所有這些，我的意思是，我們是否正在談論另外 2% 的可能性關於美國的增長？

And -- or do you expect to capture some of that business, at least from the hurricane, and you've got more of a delay that you can pick up in the fourth quarter?

並且 - 或者您是否希望至少從颶風中獲得一些業務，並且您可以在第四季度獲得更多的延遲？

Yes, Tao, it's really hard to calculate these things because certainly there are some patients who need surgery right away who come back faster and others that can defer longer.

是的，Tao，計算這些東西真的很難，因為肯定有一些需要立即手術的患者恢復得更快，而另一些則可以推遲更長時間。

And what you can look at is just what happens in those markets during those periods of time and give best estimate.

你可以看到的是那些市場在那些時間段內發生的事情，並給出最佳估計。

Our best estimate in the U.S. is that the hurricanes caused somewhere less than 1% impact to the U.S. growth rate.

我們對美國的最佳估計是颶風對美國經濟增長率的影響不到 1%。

The 1 fewer week day had some effect as well just because you have one less Monday through Friday, but really hard to be precise about exactly how much it impacted business.

工作日減少 1 天也有一些影響，只是因為周一到週五少了一個工作日，但很難準確說明它對業務的影響到底有多大。

Overall, the U.S. didn't feel dramatically different though compared to prior years, particularly in the areas of general surgery and thoracic surgery.

總的來說，與前幾年相比，美國並沒有太大的不同，特別是在普通外科和胸外科領域。

Got you.

明白了

And then you mentioned, you're going to have, if I heard you correctly, about 13 sort of new countries starting to do da Vinci procedures here in the second half of the year.

然後你提到，如果我沒聽錯的話，今年下半年將有大約 13 個新國家開始在這裡進行達芬奇手術。

What's a -- are these countries being supported directly?

什麼是——這些國家是否得到直接支持？

Are you using distributors?

你在使用分銷商嗎？

Are there opportunities where these countries will start to buy multiple systems?

這些國家是否有機會開始購買多個系統？

Or are these kind of more one-offs?

或者這些都是一次性的？

Tao, it's Gary.

濤，是加里。

Just a clarification from the script.

只是劇本的澄清。

They're not new countries to us in da Vinci.

他們對達芬奇的我們來說不是新國家。

It's X, da Vinci X availability in those countries.

它是 X，da Vinci X 在這些國家/地區的可用性。

So the ability for us to sell the X system there.

所以我們有能力在那裡銷售 X 系統。

Okay.

好的。

Got you.

明白了

And then just one last one.

然後就是最後一個。

As you look at the Sp for next year, again, in urology, do you have a -- do you have a sense of how many Sp surgeries have been performed sort of in this kind of clinical evaluation phase?

當您再次查看明年的 Sp 時，在泌尿外科，您是否知道在這種臨床評估階段進行了多少 Sp 手術？

And how long will it take before some of the surgeons really start using the Sp in sort of a more consistent fashion once it gets approved?

一旦獲得批准，一些外科醫生真正開始以更一致的方式使用 Sp 需要多長時間？

We'll put out a first set of systems after clearance.

我們將在許可後推出第一套系統。

We're selecting sites that we think have multi-specialty potential.

我們正在選擇我們認為具有多專業潛力的網站。

And once -- and that will be limited at our discretion in the beginning so that we get those sites up and running.

並且一次 - 開始時我們會自行決定限制，以便我們啟動並運行這些站點。

I want them to be highly efficient.

我希望他們高效。

So we won't have a huge number.

所以我們不會有很多。

I think the demand will oversubscribe the supply in those early launch quarters.

我認為需求將在那些早期發布季度超額認購供應。

I think it's a highly capable system.

我認為這是一個功能強大的系統。

I think once we have clearance, there will be a fair amount of use, but it's going to be sequential clearances that help us get there.

我認為一旦我們獲得許可，就會有相當大的使用量，但這將是幫助我們實現目標的連續許可。

Next question comes from the line of Matt Taylor with Barclays.

下一個問題來自巴克萊銀行的馬特泰勒。

You touched on this before, but I guess I just wanted to ask a little bit more directly, if you could give us a flavor for anything that you're seeing kind of broadly in the market with regards to utilization or appetite for capital purchases.

你之前談到過這個問題，但我想我只是想更直接地問一點，如果你能給我們介紹一下你在市場上廣泛看到的關於資本購買的利用率或胃口的任何事情。

I remember, a couple calls ago, you said, hey, with some uncertainty around reform.

我記得，幾個電話前，你說，嘿，對改革有些不確定。

Maybe we're going to see some gun-shy buyers.

也許我們會看到一些怕槍的買家。

But that clearly has not been the case this year on capital.

但今年的資本顯然並非如此。

So just any update you can provide on the market and what your customers are saying.

因此，您可以在市場上提供任何更新以及您的客戶在說什麼。

Yes, you're right.

你是對的。

We haven't seen broad impact of potential reform or changes in ACA.

我們還沒有看到 ACA 的潛在改革或變化的廣泛影響。

The feel of the market is pretty similar over the last few quarters.

過去幾個季度的市場感覺非常相似。

And as I said earlier, really, what we think is driving the strength of system placements has to do with procedure growth.

正如我之前所說，實際上，我們認為推動系統安置實力的因素與程序增長有關。

Great.

偉大的。

And the U.S., clearly, is all about general surgery with some of the slowdown that you're talking about in the mature procedures.

很明顯，美國完全是關於普通外科手術，你在成熟的程序中談論的一些放緩。

And I was wondering if you could provide some more color on areas in general that have kind of sprouted more recently.

我想知道您是否可以在最近發芽的一般區域上提供更多顏色。

You talked about hernia for a while, ventral and colorectal.

你剛才談到了疝氣，腹側和結直腸。

Are there any new areas that you're seeing start to grow as surgeons adapt and begin to use the technology in new ways?

隨著外科醫生適應並開始以新方式使用該技術，您是否看到任何新領域開始發展？

We do see new opportunities and surgeons interested in advancing.

我們確實看到了新的機會和對進步感興趣的外科醫生。

But before I get there, I think that, just from our company's focus, we have not taken the ball off general surgery.

但在我到達那里之前，我認為，僅從我們公司的重點來看，我們還沒有把球從普通外科手術中拿走。

I think that the ones we're in are still relatively early in their total adoption.

我認為我們所處的那些在完全採用方面還處於相對較早的階段。

You think about hernia repair and colon surgery and rectal surgery, thoracic surgery.

你想想疝修補術、結腸手術、直腸手術、胸外科。

These are major categories.

這些是主要類別。

We think that we can bring real value, and our teams are really focused there.

我們認為我們可以帶來真正的價值，我們的團隊也真正專注於此。

And I focus you there.

我把你集中在那裡。

I don't think we're past that in thinking there's the next thing.

我不認為我們在思考下一件事時已經過去了。

We do see surgeons asking for additional opportunities.

我們確實看到外科醫生要求更多的機會。

They are not yet material.

它們還不是物質的。

And so I think we have a long pipeline.

所以我認為我們有很長的管道。

I'm not ready to describe them as opportunities for you yet because I don't know that they'll realize, but there is real desire.

我還沒有準備好將它們描述為你的機會，因為我不知道他們會意識到，但確實有這種願望。

So we stay focused on finishing the opportunities that we've started and we still are...

所以我們繼續專注於完成我們已經開始的機會，我們仍然......

And the last question we have in queue comes from the line of Brandon Henry with RBC Capital Markets.

我們排在隊列中的最後一個問題來自 RBC 資本市場的 Brandon Henry。

Can you talk about the trends you're seeing in the U.S. gynecology market?

您能談談您在美國婦科市場看到的趨勢嗎？

And then I think you mentioned there was a moderation in benign procedures.

然後我想你提到良性程序有節制。

Can you just talk about what led to that?

你能談談導致這種情況的原因嗎？

And I have a couple of follow-ups.

我有幾個後續行動。

Yes, Brandon, it's -- overall, in U.S. GYN, we saw pretty flat growth year-to-year.

是的，布蘭登，總的來說，在美國 GYN，我們看到同比增長非常平穩。

The deceleration compared to the first half of the year was entirely attributed to benign procedures that declined moderately.

與上半年相比的減速完全歸因於適度下降的良性程序。

Malignant procedures continued to grow in the quarter.

本季度惡性手術繼續增長。

The trend there is, in part, because, a, it's a very low-growth area in general.

出現這種趨勢的部分原因是，a，它總體上是一個增長非常低的領域。

You see high penetration rates of minimally invasive surgery.

你看微創手術的普及率很高。

And in any given period, you're going to have little movements here and there.

在任何給定時期，你都會在這里和那裡進行一些小動作。

So nothing notable to call out specifically as it relates to a trend there in the market.

因此，沒有什麼值得特別指出的，因為它與市場上的趨勢有關。

Yes, I think we've talked in the past about consolidation trends, right?

是的，我想我們過去曾討論過整合趨勢，對吧？

More cases being done by gynecologic oncologists or other surgical specialists.

更多病例由婦科腫瘤學家或其他外科專家完成。

And that's been a positive trend for us, and that's largely continued here in the third quarter.

這對我們來說是一個積極的趨勢，並且在第三季度基本延續了這一趨勢。

Brandon, we'll just give you one more follow-up.

布蘭登，我們再給你一個跟進。

Sure.

當然。

And then in terms of new instrumentation, I think you mentioned a refined vessel sealer launch in Europe.

然後就新儀器而言，我想你提到了在歐洲推出的精製容器密封劑。

Can you talk a little bit about the refinements made there and when you expect to launch in the U.S.?

你能談談在那裡所做的改進以及你預計什麼時候在美國推出嗎？

And then also, do you have any update on the timeline for new stapling technology?

然後，您對新裝訂技術的時間表有任何更新嗎？

I think you mentioned a 60 millimeter stapler in the past.

我想你以前提到過 60 毫米的訂書機。

Yes.

是的。

The vessel sealer is really a refinement in jaw geometry.

容器密封器實際上是對鉗口幾何形狀的改進。

It allows surgeons to get to spaces that were more difficult than prior.

它允許外科醫生到達比以前更困難的空間。

It's kind of a family member of the technology we have today.

它有點像我們今天所擁有的技術的家庭成員。

I don't have the launch date for U.S. in front of me.

我面前沒有美國的發布日期。

But we continue to build out our stapling line, as we've talked about in the past.

但正如我們過去所討論的那樣，我們將繼續建立我們的裝訂線。

Likewise, we have not projected yet the launch time line of additional staplers.

同樣，我們還沒有預測其他訂書機的推出時間線。

But we think stapling is important.

但我們認為裝訂很重要。

So that's kind of where we are there.

所以這就是我們在那裡的地方。

Let me go ahead and close.

讓我繼續並關閉。

That was our last question.

這是我們的最後一個問題。

As we've said previously, while we focus on financial metrics such as revenues, profits and cash flow during these conference calls, our organization remains focused on increasing value by enabling surgeons to improve surgical outcomes and reduce surgical trauma.

正如我們之前所說，雖然我們在這些電話會議中關注收入、利潤和現金流等財務指標，但我們的組織仍然專注於通過使外科醫生能夠改善手術結果和減少手術創傷來增加價值。

We've built our company to take surgery beyond the limits of the human hand.

我們建立我們的公司是為了超越人手的極限進行手術。

And I assure you, we remain committed to driving the vital few things that truly make a difference.

我向你保證，我們仍然致力於推動真正有所作為的少數重要事情。

This concludes today's call.

今天的電話會議到此結束。

We thank you for your participation and support on this extraordinary journey to improve surgery, and we look forward to talking with you again in 3 months.

我們感謝您參與和支持這一改善手術的非凡旅程，我們期待在 3 個月後再次與您交談。

Okay, ladies and gentlemen, that does conclude today's conference.

好了，女士們，先生們，今天的會議到此結束。

Thank you for your participation.

感謝您的參與。

You may now disconnect.

您現在可以斷開連接。