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

女士們、先生們，感謝各位的耐心等待，歡迎參加直覺外科公司2017年第三季財報發布電話會議。（操作說明）提醒各位，今天的會議正在錄音。

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

現在我將把會議交給財務高級總監兼投資者關係主管卡爾文·達林。請繼續。

Thank you. Good afternoon, and welcome to Intuitive Surgical's third 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三季財報電話會議。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 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. 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已在我們的證券交易委員會文件中進行了詳細描述，包括我們最近於 2017 年 2 月 6 日提交的 10-K 表格和於 2017 年 7 月 21 日提交的 10-Q 表格。這些文件可透過我們的網站或美國證券交易委員會的EDGAR資料庫找到。潛在投資者應注意，不要過度依賴此類前瞻性陳述。

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

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

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

今天的會議形式將包括：首先向您介紹我們今天早些時候發布的新聞稿中所述的第三季度業績亮點，然後進行問答環節。Gary 將介紹本季的業務和營運亮點。馬歇爾將對我們第三季的財務表現進行回顧。Patrick 將介紹流程和臨床要點，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. Performance in the third quarter was strong with continued growth in customers' use of our systems and an increase 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 致力於大幅改善外科手術，並為了實現這項使命，讓全球用戶都能獲得我們的產品和服務。第三季業績表現強勁，客戶對我們系統的使用持續成長，系統部署量也有所增加。

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

本季全球手術量比 2016 年第三季成長了 15%。正如我們在先前的電話會議中所描述的那樣，我們預計美國以外國家的普通外科手術成長將繼續引領業績成長，而美國成熟類別的手術成長將有所放緩。本季度，我們看到了這種動態，美國和美國以外幾個國家的普通外科業務強勁增長，而美國泌尿外科和婦科業務的成長則有所放緩。成長的驅動因素包括美國腹股溝疝氣和腹壁疝氣修補術、結腸和直腸手術以及胸腔外科手術，以及美國以外的泌尿科和婦科手術。

Procedure performance in Asia showed continued strength with solid growth in China, Japan and Korea. Overall, European procedure growth moderated slightly from its first half of 2017 performance with trends varying by country. Patrick will take you through these factors in more detail later in the call.

亞洲地區的手術業務表現持續強勁，在中國、日本和韓國均實現了穩健成長。整體而言，歐洲手術量成長較 2017 年上半年略有放緩，各國趨勢不盡相同。派崔克稍後會在通話中更詳細地向您介紹這些因素。

Turning to capital placement performance. The third quarter was a strong one with growth in total placements from 134 in Q3 of '16 to 169 this quarter. Customers in the United States again showed strong interest in our systems as capital placements grew quarter-over-quarter. Asia, Europe and other market system placements were roughly in line with prior quarter trends. Capital placements can be hard to forecast, and we expect this lumpiness to continue given conditions in the market.

接下來分析資本配置績效。第三季表現強勁，總安置人數從 2016 年第三季的 134 人增加到本季的 169 人。美國客戶對我們的系統再次表現出濃厚的興趣，資金投入環比增長。亞洲、歐洲和其他市場體系的配置與上一季的趨勢大致一致。資金配置很難預測，鑑於目前的市場狀況，我們預期這種波動性還會持續下去。

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

我們的第四代系統達文西X和達文西Xi持續表現良好，佔本季安裝系統的85%以上。馬歇爾和派崔克將帶你更詳細地了解系統動力學。

Turning to profitability for the quarter. Our Q3 pro forma gross margins rose slightly relative to Q2 and are slightly above our expected range for the year. This is due to strength in procedures and improvements in our operational efficiency. 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.

接下來談談本季的獲利情況。第三季備考毛利率較第二季略有上升，略高於我們全年的預期範圍。這是由於流程的完善和營運效率的提升。今年迄今為止，我們的固定成本成長符合計劃，這得益於研發支出增加、歐洲和亞洲市場員工增加、臨床試驗投資以及企業運算能力提升。

Our third quarter pro forma operating results are as follows: procedures grew approximately 15% over the third quarter of last year. We shipped 169 da Vinci Surgical Systems, up from 134 in the third quarter of 2016. 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. Instrument and accessory revenue increased to $401 million, up 15%. Total recurring revenue in the quarter was $548 million, representing 68% of total revenue. 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.

我們第三季的準備業績如下：手術量比去年第三季成長了約 15%。我們交付了 169 台達文西手術系統，高於 2016 年第三季的 134 台。該季度營收為 8.06 億美元，比上年同期增長 18%，其中包括釋放與達文西 X 手術系統置換要約相關的 2,100 萬美元儲備金。儀器及配件收入增至 4.01 億美元，成長 15%。本季經常性收入總額為 5.48 億美元，佔總營收的 68%。經調整後的毛利率為 71.8%，而去年第三季為 73.1%，這一差異主要是由於 2016 年的醫療器材稅退款造成的。

Pro forma operating profit was $347 million in the quarter, up 13% over Q3 of 2016. Pro forma net income was $324 million, aided by onetime favorability in tax items. And lastly, we completed our 3:1 share exchange announced last quarter. Marshall will take you through our finances in greater detail shortly.

本季備考營業利潤為 3.47 億美元，較 2016 年第三季成長 13%。受一次性稅收優惠政策的推動，備考淨收入為 3.24 億美元。最後，我們完成了上個季度宣布的 3:1 換股計畫。馬歇爾稍後會更詳細地向您介紹我們的財務狀況。

Turning to operations. We believe that substantial opportunity exists to enable more minimally invasive surgery, better outcomes and to expand access to our technologies globally. Our investments in new products and services are built on this belief. 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.

接下來是營運環節。我們相信，透過進行更多微創手術、改善手術效果以及在全球擴大我們技術的應用範圍，存在著巨大的機會。我們對新產品和服務的投資正是基於這種信念。首先，從我們的多埠產品組合來看，我們已經在達文西系統中建立了分級產品系列，以滿足客戶對內容和價格點的選擇需求，同時保持了通往我們領先的機器人輔助手術產品和服務生態系統的合理升級途徑。

We continue to bring our da Vinci X systems to new regions in the world. In the quarter, we enabled launch in 9 additional countries for da Vinci X and anticipate adding 4 more in this fourth quarter. 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.

我們將繼續把達文西X手術系統推廣到世界各地的新地區。本季度，我們已在 9 個國家/地區成功推出達文西 X 手術系統，預計在第四季度還將新增 4 個國家。這套方案受到了客戶的熱烈歡迎，其中達文西 Xi 佔新植入量的約 75%，達文西 X 在其有限的早期推廣中佔新植入量的約 10%，其餘部分則由 Si 技術構成。

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

我們也正在推進第四代系統（達文西X、達文西Xi以及達文西Sp）的成像儀器和配件產品組合。雖然機械手臂是手術系統中最顯眼的部分，但正是機器人、軟體、影像、器械和配件組成的整個生態系統與手術室團隊在其工作環境中的協同運作，才創造了一個高效的手術方案。我們的團隊致力於了解整個手術環境及其工作流程，並設計能夠為客戶無縫運作的產品。這促使我們投資於成像、裝訂以及最近的先進能源領域的合作和技術，致力於開發高效易用的整體產品。

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. We anticipate that our da Vinci Sp program will complete patient enrollment in surgery for its round of clinical trials this quarter. As we mentioned last call, 4 clinical trial sites participated, 3 in the United States and 1 in Asia. Cases in Asia included transoral, urologic and colorectal surgery while those in the U.S. focused on transoral surgery.

本季度，我們將達文西 X 和 Xi 的 2 款新增儀器和配件的上市範圍擴大到 7 個不同的國家，並在歐洲啟動了改良型血管密封器的有限上市。我們預計，我們的達文西Sp計畫將在本季完成臨床試驗的患者招募工作。正如我們上次電話會議中提到的，共有 4 個臨床試驗中心參與，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手術上。

Our teams are finalizing product validations. We're working to establish manufacturing capability in support of regulatory submissions that enable launch. We plan to file our first 510(k) for the current Sp design by year-end with follow-on submissions for additional indications thereafter.

我們的團隊正在完成產品驗證工作。我們正在努力建立生產能力，以支持監管申報，從而實現產品上市。我們計劃在年底前提交目前 Sp 設計的第一個 510(k) 申請，之後再提交其他適應症的後續申請。

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

對於我們的柔性機器人項目，我們將繼續改進產品設計、發展供應鏈、完善監管策略並啟動測試。我們與合作夥伴正在推進和建立我們在中國成立的合資企業，並聘請了第一批關鍵員工，包括合資企業執行長和財務長。

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.

綜上所述，2017 年第三季業績強勁，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文西手術系統；第二，繼續拓展歐洲市場，並進入亞洲市場；第三，推進我們的新平台、成像技術、先進儀器、達文西手術系統和柔性技術的發展；最後，支持全球各區域開展更多的臨床驗證機器人工作。

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

現在我將把電話交給馬歇爾，他將回顧財務要點。

Thank you, Gary. I'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. We provide pro forma information because we believe that business trends and operating results are easier to understand on a pro forma basis. I will also summarize our GAAP results later in my script. We've posted reconciliations of our pro forma results to our GAAP results on our website.

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。

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. 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. Excluding the $21 million, revenue would have increased 15% compared with 2016. We expect the remaining $2 million of deferred revenue under the first quarter trade-out program to be recognized by year-end.

2017 年第三季營收為 8.06 億美元，比 2016 年第三季的 6.83 億美元成長了 18%，比第二季的 7.56 億美元成長了 7%。第三季營收包含了 2,100 萬美元的遞延收入——這筆收入是與我們向某些第一季客戶提供的達文西 X 以舊換新計畫相關的遞延收入。如果扣除 2,100 萬美元，營收將比 2016 年成長 15%。我們預計第一季以舊換新計畫下剩餘的 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. Procedure growth relative to last year was driven by general surgery in the U.S. and urology worldwide. The decline in procedures relative to the second quarter primarily reflects seasonality. Patrick will provide more detail concerning procedure adoption.

2017 年第三季手術量比 2016 年第三季成長約 15%，比上一季下降約 2%。與去年相比，手術量的成長主要由美國的普通外科手術和全球的泌尿外科手術所推動。與第二季相比，手術量下降主要反映了季節性因素。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 $401 million increased 15% compared with last year and increased 1% compared with the second quarter of 2017, which closely reflects procedure growth. Instrument and accessory revenue realized per procedure was approximately $1,880 per procedure compared with $1,870 last year and $1,830 last quarter. The increases reflect increased sales of our stapling and vessel sealing products and variations in customer buying patterns. Excluding the recognition of deferred revenue, systems revenue of $237 million increased 15% compared with the third quarter of 2016. It increased 9% compared with last quarter.

營收亮點如下：儀器及配件收入為 4.01 億美元，比去年同期增長 15%，比 2017 年第二季度增長 1%，這很好地反映了手術量的增長。每台手術的器械和配件收入約為 1,880 美元，而去年同期為 1,870 美元，上一季為 1,830 美元。這些增長反映了我們訂書釘和容器密封產品的銷售增加以及客戶購買模式的變化。不計入遞延收入，系統收入為 2.37 億美元，比 2016 年第三季成長 15%。與上一季相比成長了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. The quarter-over-quarter increase reflects higher average selling prices and fewer lease placements. 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. 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.

與去年同期相比，成長主要反映了系統部署量的增加，但部分被經營租賃部署量的增加和平均售價的下降所抵消。季度環比成長反映出平均售價上漲和租賃數量減少。2017 年第三季共安裝了 169 套系統，而 2016 年第三季為 134 套，上一季為 166 套。本季共有 20 套系統透過經營租賃交易進行租賃，而 2016 年第三季為 15 套系統，上季為 27 套系統。

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

截至 2017 年第三季末，共有 134 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 700 萬美元的收入，而 2016 年第三季為 400 萬美元，上季約為 600 萬美元。本季我們從租賃收購中獲得了約 1,100 萬美元的收入，而 2016 年第三季為 1,300 萬美元，上一季為 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. 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.

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 147 萬美元，而去年同期為 153 萬美元，上一季為 146 萬美元。與 2016 年第三季相比，平均售價下降主要反映了以舊換新交易比例較高、向對成本敏感的市場區隔銷售價格較低的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. 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.

我們相信，像經營租賃這樣的彈性融資方案對我們擴大用戶群的能力產生了正面影響。雖然短期內租賃數量難以預測，但我們預計隨著時間的推移，這類安排的比例將會增加。

Service revenue of $147 million increased 13% year-over-year. It increased approximately 3% compared with the second quarter of 2017. The year-over-year and quarter-over-quarter increases reflect growth in our installed base of da Vinci systems.

服務收入達 1.47 億美元，年增 13%。與 2017 年第二季相比，成長了約 3%。年比和環比增長反映了我們達文西手術系統安裝量的增長。

Outside of the U.S., results were as follows: third quarter revenue outside of the U.S. of $213 million increased 13% compared with $189 million for the third quarter of 2016. It increased 4% compared with $205 million for the second quarter. 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. 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. 4 of the system placements in the current quarter were operating leases compared with 1 last year and 5 last quarter.

在美國以外，業績如下：第三季美國以外地區的營收為 2.13 億美元，比 2016 年第三季的 1.89 億美元成長了 13%。與第二季的 2.05 億美元相比，成長了 4%。本季確認的遞延收入中約有 500 萬美元來自美國境外。若不計入遞延收入，與去年同期相比的成長主要反映了扣除租賃後的系統安裝量增加以及儀器和配件收入增加。在美國以外，我們第三季安裝了 62 套系統，而 2016 年第三季為 49 套，上一季為 63 套。本季系統部署中有 4 個是經營租賃，而去年同期為 1 個，上季為 5 個。

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

在當前季度製度下的就業分配包括：25人進入歐洲，14人進入日本，5人進入印度，4人進入墨西哥，1人進入中國。美國境外的系統部署將繼續呈現參差不齊的局面，因為一些美國境外的系統部署仍將受到影響。市場尚處於早期應用階段。有些市場具有很強的季節性，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 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. The da Vinci X trade-out program had little impact on our margins. 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. The increase compared with the second quarter primarily reflects leverage achieved with higher production levels. 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.

接下來來看損益表的其餘部分。2017 年第三季的備考毛利率為 71.8%，而 2016 年第三季為 73.1%，2017 年第二季為 71.3%。達文西X的以舊換新計畫對我們的利潤率影響甚微。與 2016 年第三季相比，下降主要反映了 2016 年收到的 700 萬美元醫療器材稅退款以及與內視鏡維修成本上升相關的服務利潤率下降。與第二季度相比，成長主要反映了產量提高帶來的槓桿效應。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生產效率的能力以及2018年醫療器械稅的恢復情況而波動。

Pro forma operating expenses increased 21% compared with the third quarter of 2016. It increased 2% compared with last quarter. 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. markets. Our operating expenses for 2017 may grow slightly greater than previous guidance, reflecting higher revenue growth. As we have indicated, we are committed to reducing the growth rate of operating expenses in 2018 compared with 2017. 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.

與 2016 年第三季相比，以備考計算的營運費用增加了 21%。與上季相比成長了2%。這些成長反映了我們計劃對產品開發的投資，特別是達文西手術機器人（da Vinci Sp），它靈活適用於機器人、成像和先進儀器，以及我們海外業務的擴張。市場。由於營收成長較高，我們 2017 年的營運費用可能會略高於先前的預期。正如我們所指出的，我們致力於降低 2018 年營運費用的成長率，使其低於 2017 年的成長率。然而，由於 2017 年的營收成長以及由此帶來的經營槓桿效應超出了我們的預期，因此我們 2018 年的經營槓桿效應可能不會超過 2017 年的實際業績。

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

我們第三季的預估稅額－實際稅率為 9.5%，而 2016 年第三季的實際稅率為 22.7%，上一季為 29.2%。2017 年和 2016 年第三季分別減少了 6,800 萬美元和 1,600 萬美元的儲備金，原因是某些納稅年度的訴訟時效到期。如果沒有這些減免，我們 2017 年第三季和 2016 年第三季的預計稅率將分別為 28.6% 和 27.7%。我們的稅率會隨著美國和美國境外資產組合的變化而波動。收入以及一次性項目的影響。

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. All per-share amounts reflect the 3:1 stock split effected in October. 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. The income tax reserve reversal of $68 million increased GAAP and pro forma net income per diluted share by approximately $0.59. As I indicated earlier, pro forma income provides an easier comparison of our financial results and business trends. I will now summarize our GAAP results.

我們 2017 年第三季的備考淨收入為 3.24 億美元，即每股 2.77 美元，而 2016 年第三季為 2.46 億美元，即每股 2.06 美元，2017 年第二季為 2.28 億美元，即每股 1.98 美元。所有每股金額均已反映 10 月實施的 3:1 股票分割。確認遞延收入 2,100 萬美元（扣除成本和所得稅後），使 GAAP 和備考每股攤薄淨收益增加約 0.09 美元。所得稅準備金衝回 6,800 萬美元，使 GAAP 和備考每股攤薄淨收入增加了約 0.59 美元。正如我之前提到的，預測收入可以更方便地比較我們的財務表現和業務趨勢。現在我將總結一下我們的GAAP業績。

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. 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 net income for the second quarter of 2017 also included a charge of $6 million associated with purchased IP. These costs are excluded from our pro forma results.

2017 年第三季 GAAP 淨收入為 2.98 億美元，即每股 2.55 美元，而 2016 年第三季為 2.11 億美元，即每股 1.77 美元，2017 年第二季為 2.22 億美元，即每股 1.92 美元。GAAP 淨收入包括與法律和解相關的 1,000 萬美元淨支出，而 2016 年第三季未記錄任何支出，並且上季記錄了 500 萬美元淨收益。2017 年第二季的 GAAP 淨收入還包括與購買智慧財產權相關的 600 萬美元費用。這些成本不包含在我們的模擬結果中。

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

從 2017 年開始，根據 GAAP，我們必須在所得稅準備金中報告與員工股票獎勵相關的超額稅收優惠或稅收不足，而不是像以前期間那樣作為實收資本的調整。第三季GAAP業績包含的超額稅收優惠為2,000萬美元，每股收益為0.17美元，而2017年第二季為3,100萬美元，每股收益為0.27美元。我們已將這些福利從我們的模擬結果中排除。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。

We ended the quarter with cash and investments of $3.8 billion, up from $3.4 billion as of June 30, 2017. The increase generally reflects cash generated from operations. The accelerated stock buyback agreement we entered into in the first quarter will close in the fourth quarter. Based on our current stock price, we'll be required either to deliver shares or pay cash to close out the arrangement.

本季末，我們的現金和投資總額為 38 億美元，高於 2017 年 6 月 30 日的 34 億美元。此成長通常反映了經營活動產生的現金流。我們在第一季達成的加速股票回購協議將於第四季完成。根據我們目前的股價，我們將需要交付股票或支付現金來完成這項交易。

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

接下來，我將把發言權交給派崔克，他將介紹我們的流程和臨床要點。

Thanks, Marshall. Of our third quarter procedure growth, 15%, U.S. procedures grew approximately 12%. And outside of the United States, procedures grew approximately 23%. Procedure trends were consistent with the first half of the year with growth led by U.S. general surgery and global urology.

謝謝你，馬歇爾。第三季手術量增加了 15%，其中美國手術量增加了約 12%。在美國以外，手術量增加了約 23%。手術趨勢與上半年一致，其中美國普通外科和全球泌尿外科引領成長。

During the quarter, in the United States, strength in general and thoracic surgery continued. Growth in mature procedure categories moderated. There was one fewer weekday, and we estimate that hurricanes impacted U.S. procedure growth rates by less than 1%. In U.S. urology, the third quarter growth rate for da Vinci Prostatectomy was similar to the first half of 2017. We believe that our U.S. prostatectomy volumes have been tracking to the broader prostate surgery market. During the quarter, growth in kidney procedures moderated compared to the first half of the year.

本季度，美國一般外科和胸腔外科業務持續強勁成長。成熟手術項目類別的成長速度有所放緩。工作日少了一天，我們估計颶風對美國手術成長率的影響不到 1%。在美國泌尿外科領域，達文西前列腺切除術第三季的成長率與 2017 年上半年的成長率相似。我們認為，我們在美國進行的前列腺切除手術量與更廣泛的前列腺手術市場趨勢一致。本季腎臟手術量的成長速度較上半年放緩。

In U.S. gynecology, third quarter procedure growth was flat compared to the prior year. Compared to the first half of 2017, the moderation in third quarter procedure growth was due to benign procedures. Third quarter U.S. general and thoracic surgery procedure adoption remained strong, led by growth in hernia repair. Hernia repair continues to contribute the largest volume of new procedures in the United States with solid contributions from colorectal and thoracic procedures.

美國婦科手術量第三季與去年同期相比持平。與 2017 年上半年相比，第三季手術量成長放緩是由於良性手術所致。第三季美國一般外科和胸腔外科手術的普及率依然強勁，其中疝氣修補手術的成長尤為顯著。在美國，疝氣修補術仍然是新增手術量最大的手術，其中結直腸手術和胸腔外科手術也貢獻了相當可觀的份額。

Turning abroad. 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. Procedure growth was strong in Asia and variable by country in Europe. The one fewer weekday compared to the third quarter of 2016 was partially offset by the timing of certain regional holidays.

轉向國外。第三季度，美國以外地區的手術量增加了約 23%，這主要得益於達文西前列腺切除術在全球範圍內的普及，腎臟手術、子宮切除術和結直腸切除術也做出了可觀的貢獻。亞洲的手術量成長強勁，而歐洲各國的成長情況則不盡相同。與 2016 年第三季相比，工作日減少了一天，但部分被某些地區性假日的安排所抵消。

Outside of the United States, procedure growth was led by China, South Korea, Germany and Japan. Procedure growth rates in China moderated despite continued strong expansion in system utilization. System placements remained constrained, pending the issuance of a new quota for civilian hospitals. We have no update regarding the status of the quota. In South Korea, growth was led by gynecology and urology, including contribution from Single-Site use in gynecology. 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.

在美國以外，手術量成長主要由中國、韓國、德國和日本引領。儘管中國醫療系統利用率持續強勁成長，但手術量成長率有所放緩。由於民用醫院的新配額尚未出台，系統安置仍受到限制。我們目前沒有關於配額狀態的最新消息。在韓國，婦科和泌尿科引領了成長，其中婦科單中心使用的貢獻尤為顯著。在德國和日本，第三季的手術成長率與 2017 年上半年相似，這主要得益於泌尿外科手術的普及。

During the quarter, recently placed da Vinci X systems generated solid utilization. The systems were largely used in urology and gynecology procedures with general surgery procedures in the United States. Globally, evidence continues to build in support of clinical and economic validation of da Vinci surgery. During the quarter, an economic analysis studying the impact of da Vinci Hysterectomy in Denmark was published in the Journal of Robotic Surgery. The work was completed by a team of researchers from Aarhus University and Odense University.

本季度，新安裝的達文西X系統實現了良好的利用率。在美國，這些系統主要用於泌尿、婦科手術以及一般外科手術。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，《機器人手術雜誌》發表了一篇關於達文西子宮切除術在丹麥影響的經濟分析文章。這項工作是由奧胡斯大學和歐登塞大學的研究團隊完成的。

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

作者對 7600 多名接受子宮切除術的患者（包括開放式手術、腹腔鏡手術和達文西手術）進行了比較，比較了良性或惡性疾病子宮切除術前一年和後一年的綜合醫療費用。作者發現，對於良性手術，達文西子宮切除術比開放式手術或腹腔鏡手術更便宜。對於較不複雜的惡性腫瘤手術，達文西子宮切除術比腹腔鏡手術更貴，但比開腹手術便宜。

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. 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."

在這一人群中，作者確定達文西手術患者群體比腹腔鏡手術患者群體更為複雜，並且在大多數機構中已基本取代了開放性手術。作者總結道：“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有可能節省成本。”

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 14% to 15% above the approximately 753,000 procedures performed in 2016. We are now increasing our estimate for 2017. We now anticipate full year 2017 procedure growth within a range of 15% to 16%.

首先從流程入手。在我們上次的電話會議中，我們估計 2017 年全年手術量將比 2016 年的約 753,000 例手術量增加 14% 至 15%。我們現在提高了對 2017 年的預估。我們現在預計 2017 年全年手術量成長將在 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. With increasing placements in the cost-sensitive market segments, we expect that our average system selling price will continue to trend gradually lower. 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. We expect to recognize the remaining $2 million in Q4 and close out the program.

就係統部署而言，雖然第三季度以經營租賃方式部署的系統比例略低於第二季度，但我們仍然預計，隨著時間的推移，以經營租賃方式部署的系統比例總體上將呈上升趨勢。隨著產品在對成本敏感的市場區隔領域投放量不斷增加，我們預期我們的平均係統售價將繼續呈現逐步下降趨勢。正如馬歇爾所提到的，與我們的達文西 X 手術系統置換計畫相關的 2,300 萬美元在第一季遞延的款項中，有 2,100 萬美元在第三季得到確認。我們預計將在第四季度確認剩餘的 200 萬美元，並結束該專案。

Turning to gross profit. 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. 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.

接下來討論毛利。在上次電話會議上，我們預測 2017 年的備考毛利率將佔淨收入的 70% 至 71.5%。我們現在預計業績將達到預期範圍的上限，預計毛利率（按淨收入計算）將在 71% 至 71.5% 之間。

Turning to operating expenses. As we have described previously, we've accelerated our investments in several strategic areas that will benefit the company over the long term. Accordingly, we've 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 17% and 18% above 2016 levels. We now expect pro forma 2017 operating expenses to grow between 18% and 19%.

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 年的水準成長 17% 至 18%，處於該區間的較高水準。我們現在預計 2017 年的備考營運費用將成長 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. We expect 2017 other income to be at the top end of the $35 million to $40 million range forecast on our last call.

我們繼續預測，2017 年的非現金股票補償支出將在 2 億至 2.1 億美元之間，正如我們在上次電話會議上所溝通的那樣。我們預計 2017 年其他收入將達到上次電話會議預測的 3,500 萬美元至 4,000 萬美元區間的上限。

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 年第四季的備考所得稅率將在稅前收入的 26.5% 至 28.5% 之間，而我們先前的預期為 28% 至 29.5%。

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) 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銀行的 Amit Hazan。

Let me start with your new thoughts on 2018, actually, and just hit that to make sure we have it clear. So I think in the past, you were talking about higher OpEx spending this year and then normalizing in '18. That's how we started the year. What are you thinking about OpEx spending for '18 in the comments that you made? And historically, it would've been -- high single digits would've been normal. What do you consider to be the new target?

實際上，我想先從你對 2018 年的新想法開始，就先說到這裡，確保我們理解一致。所以我覺得你之前說過今年的營運支出會更高，然後在 2018 年恢復正常。我們就是這樣開始新的一年的。您在評論中對2018年的營運支出有何看法？從歷史上看，個位數的高位數字是正常的。你認為新的目標是什麼？

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

是的。我認為我們已經說過，正如你所說，我們預計明年支出將恢復正常水平，而正常水平的定義是指與收入成長更加相符的水平。我認為我們今年看到的是，我們在營收方面表現出色，最終獲得了比預期更高的槓桿率，因此利潤率也更高。所以，如果我們繼續目前的支出水準——即使我們明年降低支出速度或成長率，最終也無法實現我們之前可能已經指出的槓桿效應。所以這一切都與我們今年的最終結果相對於明年的結果有關。總的來說，如果你從去年到明年兩年的計畫來看，它與實際情況非常吻合。

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

好的。然後，就美國市場的裝機量而言，已經連續三個季度取得了非常強勁的成長，尤其是新增裝機量。我認為這個數字幾乎是去年的兩倍。所以我覺得你們總是會把流程當作關鍵的領先指標，但我很想知道，對於為什麼今年到目前為止流程如此強勁，還有什麼其他見解。美國現有用戶數量的成長，在多大程度上增強了您對未來 12 個月美國手術量成長的信心？

Yes. You took some of the words right out of our mouth. Procedure growth really does drive placement growth, so we kind of think of it in that order. And procedure growth, we've talked about what that's been. It's been strong over the last few quarters. 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. So what we're seeing is hospitals growing procedures, having a need for additional capacity and therefore buying systems. 90% of the systems we've sold are fourth generation, as Gary had indicated. 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. So it's a number of factors that are driving it. It's hard to predict. We don't give you guidance on systems going forward, but that's what's driven it so far.

是的。你簡直說出了我們心聲。手術量的增長確實會帶動手術量的增長，所以我們基本上是按照這個順序來考慮的。至於手術量的成長，我們已經討論過它的發展了。過去幾季表現一直很強勁。迄今為止，我們85%的系統安裝都已在現有醫院進行，其中約2/3用於擴大已安裝的基礎。所以我們看到的是，醫院的手術量不斷增加，需要更多的容量，因此需要購買系統。正如 Gary 所指出的那樣，我們售出的系統中 90% 都是第四代產品。所以 Xi 和 X。我們看到的是，人們希望利用最新的功能，包括電腦輔助設定、優化的先進儀器和工作台運動、多像限存取。所以，這是由多種因素共同作用的結果。很難預測。我們不會就未來的系統發展方向提供指導，但這正是它目前為止的發展方向。

And I'll sneak in one quick one on physicians trained. I'm just curious. 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?

我再快速補充一點關於受過專業訓練的醫生的問題。我只是好奇而已。所以基本上，具體到普通外科領域，如果你大致了解一下你的增長有多少是由新醫生培訓推動的，有多少是由同店銷售額的提高推動的，以及我們還有多少空間留給接受過普通外科培訓的新外科醫生作為增長動力？

Amit, it's Patrick. 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.

阿米特，我是派崔克。我們看到，無論是首次開始使用達文西機器人進行普通外科手術的新外科醫生，還是透過在現有手術範圍內增加患者數量以及在現有手術項目列表中添加新手術來不斷擴展業務的外科醫生，都呈現出相當均衡的增長。

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

下一個問題來自摩根士丹利的戴維·劉易斯。

Gary, one quick question on some pipeline dynamics. And I may come back to the cost after that. But just 2 things. You reiterated the Sp regulatory timing end of this year. Is there good estimate for us, full commercial launch for Sp first quarter '18? And the second part of that question was just on flexible catheter, you talked about the regulatory pathway. 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?

Gary，關於管道動態方面，我有個問題想問一下。之後我可能會再談到成本問題。但只有兩件事。您重申了Sp監管時間表將於今年底生效。我們能否大致估計一下，Sp 能在 2018 年第一季全面商業化上市？問題的第二部分是關於柔性導管的，你談到了監管途徑。但是您能否給我們一些關於 510(k) PMA 的資訊？我們一直假設是 510(k) PMA，您能否分享一下商業化時程？

Sure. So on Sp, we don't know exactly the launch date, just given what questions we might get back from FDA. So we have that as well as finalizing some of the supply chain work we want to do. But we're working hard and solving the problems that we think we need. So I don't have any additional update for you on the Sp commercialization ramp. We'll report to you when 510(k) goes in and what we think about it.

當然。所以，關於 Sp，我們還不知道確切的上市日期，只能根據 FDA 可能提出的問題來決定。所以，我們除了要完成這些工作外，還要最終敲定一些我們想做的供應鏈工作。但我們正在努力工作，解決我們認為需要解決的問題。所以，關於Sp商業化進程，我沒有其他更新資訊可以提供給您。510(k)計畫實施後，我們會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. We believe it's a 510(k). We'll find out. FDA has a say on all of that, but our plans are such that it's 510(k). We do not -- we have not set a launch date yet for public consumption.

在靈活方面，正如我們在腳本中所描述的那樣，我們在技術開發和最終確定監管方法方面取得了良好進展。我們認為這是 510(k) 條款。我們會查清楚的。FDA 對此有發言權，但我們的計劃是按照 510(k) 條款進行的。我們還沒有——我們還沒有確定面向公眾的發布日期。

Okay. And then just coming back to spending, either for Gary or Marshall. The thing about 2017 was you wanted to invest at a greater level because you had a lot going on in the pipeline. 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. Can you give us any sense of the spending [provided]? I think investors are totally comfortable with increased spending if they think that spending is going to generate a high return. So the kind of things you're working on for next year and why that level of spending is necessary.

好的。然後，我們再回到消費問題上來，無論是給 Gary 或 Marshall 的消費。2017 年的情況是，你想加強投資力度，因為你有很多專案正在籌備中。根據我們的計算，您對明年利潤率持平的預測與我們的模型一致，但這基本上意味著研發和銷售、管理及行政費用總計約為 10 億美元，這是一個相當大的整數。您能大致介紹一下[所提供的]支出狀況嗎？我認為，如果投資者認為增加支出會帶來高回報，他們完全可以接受增加支出。所以，你們明年正在著手處理哪些事情，以及為什麼需要這種程度的支出。

Sure, and it's a good question. The -- as Marshall said, we haven't really changed our view of what kind of spending is required in '18. Just a little bit of the math of '17 changes relative to what the total operating margins look like. 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.

當然，這是個好問題。正如馬歇爾所說，我們對 2018 年需要什麼樣的支出並沒有真正改變看法。2017 年的一些數學計算結果與總營業利潤率相比略有不同。就我們的投資而言，我們從現場單一平台和多端口；達文西手術系統轉向 SP，這是一個新的患者側系統，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. And we think those are important because they don't get developed in a year. They take both technology development as well as technique development and all the commercialization steps that you all are well aware of. So that's kind of one side.

因此，在研發方面，平台方向正不斷拓寬。我們認為這些很重要，因為它們不是一年就能發展出來的。他們既進行技術開發，也進行工藝開發，以及你們都非常清楚的所有商業化步驟。這是其中一方面。

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. 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. I think it makes a lot of sense. Those are really the investment priorities. 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. Probably not a surprise to you at all.

另一方面，我們需要進行一系列投資，以確保我們能夠支持多港口領域的業務規模，這與確保你的工廠運作良好、你已經投資了工廠和設備，並且隨著你的發展獲得規模優勢有關。我們已經開始看到，在毛利率方面，業績的改善和超越我們先前的預期，是生產效率提高方面辛勤工作的結果，我認為，作為股東，我會支持這種做法。我覺得很有道理。這些才是真正的投資重點。其中稍微提到了一些關於在本地市場產生數據以支持我們客戶在其營運所在市場的需求的內容，無論是臨床數據還是經濟數據，所以這部分內容就展開了——這完善了我們的投資概況。這大概一點也不讓你感到意外。

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

下一個問題來自美國銀行的鮑伯霍普金斯。

So the first question I wanted to ask is for Gary. I noticed, obviously, that TransEnterix has got a FDA approval. And what struck me as interesting, they got approval for 23 different indications, 23 different types of surgeries, some without data. And I was just curious, does this suggest that FDA might be willing to approve multiple indications? 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?

所以我首先想問的是加里。我注意到，TransEnterix 顯然已經獲得了 FDA 的批准。令我感到有趣的是，他們獲得了 23 種不同適應症、23 種不同類型手術的批准，其中一些甚至沒有數據支持。我只是好奇，這是否意味著FDA可能願意批准多種適應症？這是否有可能加快您針對 Sp 和其他一些技術的不同適應症的研發進度？

Yes. Fair question. So the first thing is the use of kind of a one set of data to get additional procedures. That's something that was discussed with FDA in their workshop a couple years ago and has been employed by us and by others. 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. Something that we have worked with FDA on, and we're not surprised that others are likewise using it.

是的。問得好。所以首先是利用一組資料來取得額外的程序。這是幾年前我們在與 FDA 的研討會上討論過的問題，我們和其他公司都採用了這個問題。因此，有些程式是關鍵資料產生器，為其他程式提供保障，這種觀點對我們來說並不令人驚訝。這是我們與FDA合作開發的，所以其他機構也在使用這項技術，我們並不感到驚訝。

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

我認為，關於證據要求是什麼，這有點超出你的問題範圍，問題在於 FDA 如何看待你提出的標籤和聲明要求，以及支持這些要求的相關證據，這兩者是相關的。而這是否預示著FDA態度的轉變，你真的需要仔細閱讀標籤上的具體內容以及提交的數據。等結果出來後，我們會仔細研究，評估他們的立場是否有改變。但就表面而言，僅從你目前所看到的——我們目前所看到的——來看：a，我們並不驚訝於有一套程序，而魔鬼藏在細節裡，這取決於他們如何看待這件事。

Okay. Fair enough. So we'll follow up after we get more details there. And then I apologize, Marshall, just one more on the 2018 comment. 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. Is that a fair assumption?

好的。很公平。等我們掌握更多細節後，我們會跟進此事。然後，馬歇爾，我再就2018年的評論再道歉一次。從評論和一些計算來看，我推測你的意思是 2018 年營運支出將出現兩位數的成長。這種假設合理嗎？

Well, we'll provide you guidance when we get to next quarter. We're not ready to commit to what the increase would be. It's just that, as we sit here today, we would imagine that we would not be adding leverage to the model.

我們會等到下個季度再提供指導。我們目前還無法確定具體的漲幅。只是，就我們今天所處的位置而言，我們認為我們不會為這個模型增加槓桿。

Our spend in '17 is -- to date, has been right where we thought it would be. Revenue has come in pretty well, and our margins and other costs have been where we expected them. And so it just changes the profitability relative to what we were thinking 9 months ago.

到目前為止，我們在 2017 年的支出與我們的預期完全一致。營收情況相當不錯，利潤率和其他成本也都在預期之內。因此，與我們 9 個月前的預期相比，獲利能力發生了變化。

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

是的，我的意思是，這才是問題的真正基礎。我想了解的是，這其中有多少百分比實際上是——僅僅與對明年收入成長前景的信心增強有關？

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

是的。所以我們會在下個季度為您提供指導意見。

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

下一個問題來自摩根大通的泰科彼得森。

First question on dVP. I want to make sure I heard this right. I think you said 3Q volumes in the U.S. similar to the first half of the year. 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. So can you clarify that?

關於 dVP 的第一個問題。我想確認一下我沒聽錯。我想你之前說過，美國第三季的銷售與上半年類似。如果情況屬實，這似乎與你一個月前所說的成長放緩至個位數低點的情況截然相反。你能解釋一下嗎？

Yes, Tycho. 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. So inclusive of other procedures like kidney procedures.

是的，第谷。澄清一下，關於 dVP 的評論是，今年上半年成長率非常穩定，但泌尿科類別的成長率與上半年相比有所放緩。因此也包括其他手術，例如腎臟手術。

Okay. And then thinking a little bit ahead on Sp as we think about the initial urology rollout. This is really about improved clinical outcome maybe versus market expansion, I guess. Can you maybe just talk to how you think about that factoring into these option cycles? 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?

好的。然後，當我們考慮泌尿科的初步推廣時，也要稍微展望一下 Sp。我想，這其實可能是為了改善臨床療效，而不是為了擴大市場。您能否談談您如何看待這些因素對選擇權週期的影響？由於這是一種透過程序獲得 FDA 批准的新方法，那麼當您將其推廣到泌尿科時，這在多大程度上會成為對現有客戶的追加銷售，又有多少會成為潛在的市場擴張呢？

Yes. 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. We think that it has multi-specialty implications. And so part of this will be to follow-through and get multi-specialty indications with FDA. And you see some of the trial data doing that.

是的。在推廣的早期階段，我們計劃以穩健的方式進行，初期將圍繞臨床出版物和證據累積。我們認為這具有多學科意義。因此，其中一部分工作就是跟進並獲得 FDA 的多專科適應症批准。一些試驗數據也證實了這一點。

I don't know that Sp harkens a different regulatory pathway for FDA. You had implied that in your question, and I'm not sure that I agree with that implication. So far, it doesn't look like a foundationally different way to communicate with FDA.

我不知道 Sp 是否意味著 FDA 會採取不同的監管途徑。你在問題中暗示了這一點，但我不太同意這種暗示。目前看來，這似乎不是與FDA溝通的一種根本不同的方式。

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. I think we're going to see some of both, and it's a little bit early to size exactly which. 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. So I think that's why we're excited about it is the potential to do both. And I just say, stay tuned there as we get more experience and put these in the field.

至於這其中有多少是——我們正在反向推演，研究我們現有的程序基礎，以追求更好的結果，以及我們將在多大程度上擴大機會。我認為我們會看到這兩種情況都有一些出現，現在判斷具體是哪一種還為時過早。外科醫生對這兩類事物都表現出了濃厚的興趣，這給我留下了深刻的印象。他們既致力於改進現有的技術，也積極嘗試他們尚未接觸過的技術和應用。所以我覺得我們感到興奮的原因在於它有可能同時做到這兩點。我只想說，請繼續關注，我們會累積更多經驗，並將這些技術應用到實際工作中。

Okay. And then just lastly, on thinking about clinical data readout 2 weeks from now. You will have the data coming out at CHEST. Any preview you can give us for those that don't want to go to Toronto?

好的。最後，我想談談兩週後公佈的臨床數據。您將在 CHEST 會議上看到相關數據。對於那些不想去多倫多的人，您能提供一些預覽資訊嗎？

No, no, I cannot.

不，不，我不能。

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

下一個問題來自富國銀行的 Larry Biegelsen。

Maybe I'll just start with the flex catheter, then I had one on the competition. So the data at CHEST, is that going to be enough for 510(k) clearance in the U.S.? Will you have to do another trial for 510(k) clearance? 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. Is that a fair characterization? I'd be curious if you had any comments on that. I had one follow-up.

也許我會先用柔性導尿管，我之前在比賽裡用過。那麼，CHEST 的數據是否足以獲得美國 510(k) 許可？您是否需要再次參加 510(k) 許可的試驗？在上次通話中，有人問到您的柔性導管系統與美敦力Super D相比如何。我們聽說目前還有另一種正在研發中的機器人系統與您的系統類似。這種描述是否恰當？我很想知道你對此有何看法。我還有一次後續跟進。

Okay. So on the sufficiency of data, thus far, to date, vis-à-vis 510(k) clearance, don't know yet. So we'll see. Can't give you a positive or a negative indication. With regard to other folks working on flex approaches that are robotic, we have heard, likewise, indications that people are interested in pursuing that. Very little publicly available out there, and we won't speculate as to what their plans are ahead of whatever their public releases are. But we remain vigilant. 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. And so I worry a lot less about what others are doing and a lot more about what we're doing. And our team is highly focused in satisfying customer need in that space, and we feel good about where we are.

好的。所以，就目前而言，就 510(k) 許可而言，資料的充分性尚不清楚。我們拭目以待。無法給出肯定或否定的答案。對於其他從事機器人靈活方法研究的人，我們也聽到了一些跡象，顯示有人對此感興趣。目前公開的資訊非常少，我們不會對他們即將發布的任何公開內容妄加猜測。但我們仍保持警惕。我想，我的主要觀點是，滿足客戶的最佳方式是了解他們的需求，真正了解他們想要什麼以及他們使用的技術。因此，我不再那麼擔心別人在做什麼，而是更擔心自己在做什麼。我們的團隊高度專注於滿足該領域的客戶需求，我們對目前的狀況感到滿意。

And then just for my follow-up on the competition. I guess I'll ask one broad question on the TransEnterix approval. Any just comments, Gary, from a technology or an IP standpoint and potential for this elongating the selling cycle in the U.S.?

然後，我還要跟進一下比賽的狀況。我想問一個關於 TransEnterix 審批的比較廣泛的問題。加里，從技術或智慧財產權的角度來看，你有什麼看法？這是否有可能延長美國的銷售週期？

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

至於其他即將推出或已推出的系統，我們的經驗可以追溯到很久以前。因此，我們經歷了混合手術方法的演變過程，包括一些機器人手術、一些手動手術、三臂系統手術，有些是整合式手術，有些則不是。我們已經經歷了這一切，正是我們的客戶真正把我們帶到瞭如今的地位，實現了整合系統，讓各個系統能夠很好地協同工作。

Simple examples. 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. So the workflow of getting up and sitting down is really challenging. The challenge of integrating multiple different technologies from multiple different vendors at the OR is a headache, and they tell us that. We'd like this all to work together as if it was designed with a whole thought. We didn't choose those things out of the blue. And so with our own systems, with systems we competed against 20 years ago, we've kind of seen this. And so I think that customers will think that through and evaluate it.

簡單的例子。如果你使用的是手動縫合器，而你使用的是機器人系統，那麼外科醫生通常（幾乎總是）需要洗手入場和退場，因為醫生助理很少會操作縫合器。所以，起身坐下來的工作流程真的很有挑戰性。在手術室中整合來自多個不同供應商的多種不同技術是一項令人頭痛的挑戰，他們也告訴我們這一點。我們希望這一切能夠協調運作，就像是經過深思熟慮精心設計的一樣。我們並非一時興起選擇了這些東西。所以，在我們自己的系統中，在我們20年前與之競爭的系統中，我們已經看到了這一點。所以我認為顧客會仔細考慮並進行評估。

You had asked, could it delay sales cycles? And the answer to that is yes, it can in the near term. Now we are facing some of these concepts and competitive systems in Europe, and customers are evaluating these things and making decisions. 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. And again, I think we didn't end up where we are by accident. That's true in our IP portfolio as well. 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. So that's something that is an asset for the company as we go forward.

你曾問，這會不會延緩銷售週期？答案是肯定的，短期內可以實現。現在我們在歐洲面臨這些概念和競爭體系，客戶正在評估這些事物並做出決定。我認為他們的決策依據相當充分，因此可能會造成一些短期波動，但我們會準備好與醫院展開對話。而且，我認為我們走到今天這一步並非偶然。我們的智慧財產權組合也是如此。身為市場領導者，你必須先解決這些問題，然後才能申請專利，而我們已經做到了。所以這對公司未來的發展來說是一項優勢。

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

關於中國，我有個問題想問一下。你們提到，儘管每台儀器或每個系統的使用量增加了，但手術量的成長卻放緩了。您能否簡單談談，在我們獲得配額系統的最新資訊之前，是否應該考慮讓現有安裝基礎達到滿載利用率？

Yes, Isaac, I think we've been surprised by the levels of utilization that we see across many of the civilian hospitals within China. And to date this year, they've surpassed levels we thought that we would start to see faster slowdown. Now you're starting to see the law of large numbers catch up, but still strong growth in utilization. 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.

是的，艾薩克，我認為我們對中國許多民用醫院的利用率之高感到驚訝。今年迄今為止，它們的增速已經超過了我們之前認為增速會開始加速放緩的水平。現在大數定律開始發揮作用了，但利用率仍然保持強勁增長。所以我認為簡而言之，我們還不確定上限在哪裡，因為中國對機器人手術的需求很大，而且他們一直在尋找有效利用每週機器人手術時間的方法。

Okay. And then just a follow-up, on the new areas of investment for 2018, as it relates to your comments on operating leverage. 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? Just trying to get a sense of where those resources are being deployed.

好的。然後，我想就您關於經營槓桿的評論，進一步詢問 2018 年的新投資領域。您能否就一些新增投資領域（這些領域是對您已計劃的基礎項目的一種補充）發表一些看法，哪怕只是定性地談談？我只是想了解這些資源都部署在哪裡了。

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. Those things peak. 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. And so you have 2 platforms that are heavily in design and moving toward commercialization. And that's the bulk of the delta.

從研發產品線的角度來看，平台投資的高峰期是在產品發布前幾個季度。這些事物都達到頂峰。然後，在完成所有啟動活動後的幾個季度裡，股價會一直保持在峰值水平，然後開始從峰值回落。因此，現在有兩個平台正處於設計階段，並朝著商業化方向發展。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. 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. And as scale changes, we have an opportunity to tweak what we do to get lower cost. And I think that helps everybody. I think it helps Intuitive. It helps our customers and it allows us to take advantage of scale. That's a really good thing. And so where we see those opportunities, they are pretty easy to evaluate and we move forward on them.

至於其他一些支出，往往是小幅增加的，而且都與優化生產製造有關。隨著流程的不斷增長和規模的擴大，我們生產和處理系統的大部分成本都歸結於製造過程。隨著規模的變化，我們有機會調整我們的做法以降低成本。我認為這對大家都有好處。我認為這有助於提高直覺能力。它既能幫助我們的客戶，又能讓我們利用規模優勢。那真是件好事。因此，一旦我們發現這些機會，就很容易對其進行評估，然後我們就會著手推進。

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

我有兩個簡短的問題。就像——你以前提到過，而且你，Gary，再次強調了你一直在研究的一些成像技術發展和進步。您能否大致說明一下，將這些功能整合到您現有平台中的大概時間安排？

Sure. So you think of imaging as kind of having 3 elements of it. There's the hardware part, the optics, the electronics, the physical stuff. 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. There are software improvements, image processing, image integration, those kinds of things. We also launch those. 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.

當然。所以你可以把成像想像成由三個要素組成。包括硬體部分、光學元件、電子元件和物理部件。我們一直在不斷改進這些功能，並定期以改進或升級的形式推出它們，你可以把它們的生命週期看作是幾個季度，6 到 8 個季度。軟體方面也有改進，例如影像處理、影像整合等等。我們也推出了這些產品。這些要么是作為升級項目，要么是與其他機會相結合的項目，而且這些項目也是按年或隔年推出的。

And then there's molecules, targeting agents. The molecules are viewed by the world as drugs, and those go on drug timelines, which are long. So we're progressing. But it doesn't look like stasis. It is continuously improving our gen 4 imaging, as we speak. The gen 4 scopes of today are better than the scopes of 2 years ago. The gen 4 software is better today than it was years ago. And we continue to progress on the molecular front.

還有分子，即靶向劑。世人將這些分子視為藥物，而藥物的作用時間是漫長的。所以我們正在取得進展。但這看起來並不像是停滯狀態。我們正在不斷改進第四代成像技術。如今的第四代瞄準鏡比兩年前的瞄準鏡好。第四代軟體現在比幾年前好得多。我們在分子層面也持續取得進展。

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

好的。至於分子層面，目前還沒有具體的時間表嗎？

No. 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.

不。鑑於一些試驗活動必須進行，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看待手術中的這些診斷標誌物，這給預測模型帶來了很多不確定性。

Got it. And then just one follow-up. You mentioned some moderation in EU or European procedures in the third quarter. Can you just elaborate on that a little bit?

知道了。然後只有一次後續跟進。您提到歐盟或歐洲的程序在第三季有所緩和。能再詳細解釋一下嗎？

Yes, there was a moderation in certain markets, not in all. We still had strong growth in some like Germany. It was in a handful of markets. 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.

是的，某些市場出現了緩和，但並非所有市場都是如此。我們在德國等一些市場仍然保持了強勁的成長。它只在少數市場銷售。有些我會將其描述為一些良性手術的放緩，因為這些手術的報銷額度很低；而另一些市場，例如泌尿科、dVP、dVP，其滲透率很高，新興手術規模仍然很小，無法影響成長率。

Next question comes from the line of Tao Levy.

下一個問題來自 Tao Levy 的問題。

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? 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?

或許我們可以從颶風的影響說起，我想，如果美國少做一天手術，理論上，如果當季手術量減少，美國經濟成長是否會額外增加 2%？或者，您是否期望能夠從颶風中挽回一些損失，而您希望能夠彌補第四季度因颶風造成的業務延誤？

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. And what you can look at is just what happens in those markets during those periods of time and give best estimate. Our best estimate in the U.S. is that the hurricanes caused somewhere less than 1% impact to the U.S. growth rate. 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. Overall, the U.S. didn't feel dramatically different though compared to prior years, particularly in the areas of general surgery and thoracic surgery.

是的，陶，這些事情真的很難計算，因為肯定有一些病人需要立即手術，他們恢復得更快，而另一些病人則可以推遲更長時間。你可以觀察這些市場在這些時期內發生的事情，並給出最佳估計。美國方面的最佳估計是，颶風對美國經濟成長率的影響不到 1%。工作日減少一天也產生了一些影響，因為週一到週五少了一天，但很難準確評估它對業務的影響程度。整體而言，與往年相比，美國的情況並沒有顯著變化，尤其是在一般外科和胸腔外科領域。

Got you. 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. What's a -- are these countries being supported directly? Are you using distributors? Are there opportunities where these countries will start to buy multiple systems? Or are these kind of more one-offs?

抓到你了。然後您提到，如果我沒聽錯的話，今年下半年將有大約 13 個新的國家開始進行達文西手術。什麼是──這些國家是否直接獲得支持？你們是否使用分銷商？這些國家是否有可能開始購買多套系統？或者這些只是個案？

Tao, it's Gary. Just a clarification from the script. They're not new countries to us in da Vinci. It's X, da Vinci X availability in those countries. So the ability for us to sell the X system there.

陶，我是加里。簡單澄清一下劇本內容。對我們達文西來說，這些國家並不陌生。在這些國家，達文西X手術系統是可用的。因此，我們有能力在那裡銷售 X 系統。

Okay. Got you. And then just one last one. 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? 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?

好的。抓到你了。最後還有一個。展望明年泌尿科的 Sp 手術，您是否了解—您是否知道在這種臨床評估階段已經進行了多少次 Sp 手術？Sp獲得批准後，需要多久才能有一些外科醫生開始更有系統地使用它？

We'll put out a first set of systems after clearance. We're selecting sites that we think have multi-specialty potential. And once -- and that will be limited at our discretion in the beginning so that we get those sites up and running. I want them to be highly efficient. So we won't have a huge number. I think the demand will oversubscribe the supply in those early launch quarters. I think it's a highly capable system. 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.

獲得許可後，我們將推出第一批系統。我們選擇的是我們認為具有多專科發展潛力的地點。而且只有一次——而且在初期，我們會酌情限制次數，以便讓這些網站能夠順利上線運行。我希望他們效率極高。所以數量不會很多。我認為在產品上市初期幾個季度，需求將超過供應。我認為這是一個非常強大的系統。我認為一旦獲得許可，就會有相當多的使用，但這需要循序漸進的許可才能幫助我們實現目標。

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. I remember, a couple calls ago, you said, hey, with some uncertainty around reform. Maybe we're going to see some gun-shy buyers. But that clearly has not been the case this year on capital. So just any update you can provide on the market and what your customers are saying.

您之前也提到過這一點，但我還是想更直接地問一下，您能否大致介紹一下您在市場上觀察到的關於資本利用率或購買意願方面的一些情況？我記得，就在前幾次通話中，你說過，嘿，改革方面存在一些不確定性。或許我們會看到一些對槍枝支持謹慎態度的買家。但就今年的資本而言，情況顯然並非如此。所以，請您提供任何關於市場和客戶回饋的最新資訊。

Yes, you're right. We haven't seen broad impact of potential reform or changes in ACA. The feel of the market is pretty similar over the last few quarters. And as I said earlier, really, what we think is driving the strength of system placements has to do with procedure growth.

是的，你說得對。我們尚未看到潛在的改革或對《平價醫療法案》的修改產生廣泛的影響。過去幾個季度，市場氛圍相當相似。正如我之前所說，我們認為推動系統部署實力增強的真正原因是手術量的成長。

Great. And the U.S., clearly, is all about general surgery with some of the slowdown that you're talking about in the mature procedures. And I was wondering if you could provide some more color on areas in general that have kind of sprouted more recently. You talked about hernia for a while, ventral and colorectal. Are there any new areas that you're seeing start to grow as surgeons adapt and begin to use the technology in new ways?

偉大的。顯然，美國主要以普通外科手術為主，而你提到的那些成熟手術的發展速度則有所放緩。我想請您詳細介紹一下最近興起的一些領域。你剛才談到了疝氣，包括腹疝氣和直腸疝氣。隨著外科醫生們適應並開始以新的方式使用這項技術，您是否看到有哪些新的領域開始發展？

We do see new opportunities and surgeons interested in advancing. But before I get there, I think that, just from our company's focus, we have not taken the ball off general surgery. I think that the ones we're in are still relatively early in their total adoption. You think about hernia repair and colon surgery and rectal surgery, thoracic surgery. These are major categories. We think that we can bring real value, and our teams are really focused there. And I focus you there. I don't think we're past that in thinking there's the next thing.

我們確實看到了新的機遇，也看到了有興趣晉升的外科醫生。但在此之前，我認為，僅從我們公司的關注點來看，我們並沒有放鬆對一般外科的重視。我認為我們目前所處的階段還處於全面普及的早期階段。你會想到疝氣修補、結腸手術、直腸手術和胸腔外科手術。這些是主要類別。我們認為我們能夠帶來真正的價值，我們的團隊也專注於此。我讓你把注意力集中在那裡。我不認為我們已經擺脫了那種認為會有下一個目標的想法。

We do see surgeons asking for additional opportunities. They are not yet material. And so I think we have a long pipeline. 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. So we stay focused on finishing the opportunities that we've started and we still are...

我們確實看到外科醫生們要求獲得更多機會。它們尚未成為物質實體。所以我認為我們還有很長的研發流程。我現在還不能把它們描述成你們的機會，因為我不知道它們是否會實現，但它們確實有這種願望。所以我們會繼續專注於完成我們已經開始並且仍在進行的項目…

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

最後一個問題來自加拿大皇家銀行資本市場的布蘭登亨利。

Can you talk about the trends you're seeing in the U.S. gynecology market? And then I think you mentioned there was a moderation in benign procedures. Can you just talk about what led to that? And I have a couple of follow-ups.

您能談談您觀察到的美國婦科市場的發展趨勢嗎？然後我想你有提到過，良性手術的數量減少。你能說說導致這件事的原因嗎？我還有幾個後續問題。

Yes, Brandon, it's -- overall, in U.S. GYN, we saw pretty flat growth year-to-year. The deceleration compared to the first half of the year was entirely attributed to benign procedures that declined moderately. Malignant procedures continued to grow in the quarter. The trend there is, in part, because, a, it's a very low-growth area in general. You see high penetration rates of minimally invasive surgery. And in any given period, you're going to have little movements here and there. So nothing notable to call out specifically as it relates to a trend there in the market.

是的，布蘭登，總體而言，在美國婦科領域，我們看到年增長率相當平穩。與上半年相比，成長放緩完全歸因於良性手術數量的適度下降。本季惡性手術數量持續成長。出現這種趨勢的部分原因是，a，這是一個整體成長非常緩慢的領域。微創手術的普及率很高。在任何特定時期內，都會出現一些小的波動。所以，就市場趨勢而言，沒有什麼特別值得一提的。

Yes, I think we've talked in the past about consolidation trends, right? More cases being done by gynecologic oncologists or other surgical specialists. And that's been a positive trend for us, and that's largely continued here in the third quarter.

是的，我想我們之前討論過整合趨勢，對吧？越來越多的病例由婦科腫瘤醫師或其他外科專家進行手術。這對我們來說一直是一個積極的趨勢，而且在第三季度也基本延續了下來。

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

布蘭登，我們再給你最後一次後續詢問。

Sure. And then in terms of new instrumentation, I think you mentioned a refined vessel sealer launch in Europe. Can you talk a little bit about the refinements made there and when you expect to launch in the U.S.? And then also, do you have any update on the timeline for new stapling technology? I think you mentioned a 60 millimeter stapler in the past.

當然。至於新的儀器設備，我想您提到了歐洲推出的改良型血管密封器。您能否談談在那方面所做的改進，以及預計何時在美國推出？另外，關於新型裝訂技術的研發時間表，您有什麼最新消息嗎？我想你以前有提到60毫米的訂書機。

Yes. The vessel sealer is really a refinement in jaw geometry. It allows surgeons to get to spaces that were more difficult than prior. It's kind of a family member of the technology we have today. I don't have the launch date for U.S. in front of me. But we continue to build out our stapling line, as we've talked about in the past. Likewise, we have not projected yet the launch time line of additional staplers. But we think stapling is important. So that's kind of where we are there.

是的。血管封閉器實際上是對鉗口幾何形狀的改進。它使外科醫生能夠進入以前更難到達的區域。它算是我們今天所擁有科技的某種衍生性商品。我手頭上沒有美國地區的上市日期。但正如我們之前討論過的，我們將繼續擴大我們的訂書機生產線。同樣，我們尚未預測其他訂書機的上市時間表。但我們認為裝訂很重要。所以，我們目前的情況大概就是這樣。

Let me go ahead and close. That was our last question. 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. We've built our company to take surgery beyond the limits of the human hand. And I assure you, we remain committed to driving the vital few things that truly make a difference.

讓我來結束今天的分享。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，但我們的組織仍然專注於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讓外科手術超越人手的極限。我向你們保證，我們將繼續致力於推進那些真正能產生影響力的關鍵少數幾件事。

This concludes today's call. 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.

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

Okay, ladies and gentlemen, that does conclude today's conference. Thank you for your participation. You may now disconnect.

好了，女士們先生們，今天的會議到此結束。感謝您的參與。您現在可以斷開連線了。