直覺手術 (ISRG) 2017 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by.

女士們，先生們，謝謝你們的支持。

Welcome to the Intuitive Surgical Q4 2017 Earnings Release Conference Call.

歡迎來到 Intuitive Surgical 2017 年第四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 would now like to turn the conference over to your first speaker, Calvin Darling, the Senior Director of Finance and Investor Relations.

我現在想將會議轉交給您的第一位發言人，財務和投資者關係高級總監 Calvin Darling。

Please go ahead, sir.

請繼續，先生。

Thank you.

謝謝你。

Good afternoon, and welcome to Intuitive Surgical's Fourth Quarter Earnings Conference Call.

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

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

今天和我在一起的是我們的總裁兼首席執行官 Gary Guthart；和我們的首席財務官 Marshall Mohr。

Note that Patrick Clingan, who has participated on these calls in the past, will not be joining us today.

請注意，過去參加過這些電話會議的 Patrick Clingan 今天不會加入我們。

Patrick's scope of responsibilities in the company has grown over the past couple of years, and going forward, he will be dedicating less time to Investor Relations.

帕特里克在公司的職責範圍在過去幾年有所擴大，今後他將更少地花在投資者關係上。

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

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

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

由於某些風險和不確定性，實際結果可能與明示或暗示的結果存在重大差異。

These risks and uncertainties are described in detail in the company's Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 6, 2017, and 10-Q filed on October 20, 2017.

這些風險和不確定性在公司提交給美國證券交易委員會的文件中有詳細描述，包括我們於 2017 年 2 月 6 日提交的最新 10-K 表格和 2017 年 10 月 20 日提交的 10-Q 表格。

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

這些文件可以通過我們的網站或 SEC EDGAR 數據庫找到。

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

告誡潛在投資者不要過分依賴此類前瞻性陳述。

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

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

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

此外，今天的新聞稿和補充財務數據表已發佈到我們的網站上。

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

今天的形式包括向您提供我們今天早些時候發布的新聞稿中所述的第四季度業績要點，然後是問答環節。

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

Gary 將介紹本季度的業務和運營亮點。

Marshall will provide a review of our fourth quarter financial results, then I will discuss procedures and clinical highlights and provide our financial outlook for 2018.

Marshall 將回顧我們第四季度的財務業績，然後我將討論程序和臨床重點，並提供我們 2018 年的財務展望。

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

最後，我們將舉辦問答環節。

With that, I'll 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 dedicated to the mission of expanding the availability of minimally invasive surgery, increasing its efficacy and decreasing its invasiveness.

如您所知，Intuitive 致力於擴大微創手術的可用性、提高其療效並降低其侵入性的使命。

The fourth quarter concluded a solid year in pursuit of this mission.

第四季度結束了為實現這一使命而紮實的一年。

During the year, we made progress in several areas, including accelerated use of our systems and the related growth in our installed base, along with the achievement of significant milestones and regional market access and product development.

在這一年中，我們在多個領域取得了進展，包括我們系統的加速使用和安裝基礎的相關增長，以及重要里程碑的實現以及區域市場准入和產品開發。

While we're pleased with our progress in the year, the opportunity for improvement in surgery is substantial, and much work remains to be done.

雖然我們對這一年取得的進展感到滿意，但外科手術的改進機會很大，還有很多工作要做。

Global procedure growth was strong at approximately 17% in the fourth quarter and 16% for the full year.

全球手術增長強勁，第四季度約為 17%，全年增長 16%。

Growth patterns in procedures were largely consistent through the year with increased use of da Vinci in general surgery in the United States, continued growth in urology in Europe and Japan and multispecialty growth in Korea and China.

隨著達芬奇在美國普外科的使用增加、歐洲和日本泌尿外科的持續增長以及韓國和中國的多專業增長，程序的增長模式在這一年中基本保持一致。

General surgery growth was led by hernia repair and colon resection, while mature procedures in the United States, particularly prostatectomy, outperformed our expectations, predominantly due to macro trends in the prostate cancer market.

普通外科手術的增長由疝修補術和結腸切除術帶動，而美國的成熟手術，尤其是前列腺切除術，表現超出了我們的預期，這主要是由於前列腺癌市場的宏觀趨勢。

Procedure growth in several countries, including Germany, Korea and China, was healthy through the year, and adoption in Japan was solid for those procedures that have been reimbursed.

包括德國、韓國和中國在內的幾個國家的手術增長全年都很健康，日本對那些已報銷的手術的採用率很高。

This month, the Ministry of Health in Japan listed for reimbursement 12 procedures in which da Vinci could be used in addition to prostatectomy and nephrectomy, which are already reimbursed.

本月，除了已經報銷的前列腺切除術和腎切除術之外，日本衛生部還列出了 12 種可以使用達芬奇的手術報銷。

While this is clearly a positive step regarding interest in da Vinci procedures in Japan, the final level of reimbursement has not been communicated.

雖然這顯然是日本對達芬奇程序感興趣的積極步驟，但最終報銷水平尚未公佈。

Calvin will review procedure trends and Marshall, our progress in Japan in greater detail later in the call.

卡爾文將在稍後的電話會議中更詳細地審查程序趨勢和馬歇爾，我們在日本的進展。

Turning to capital placements.

轉向資本配置。

We expanded our da Vinci system offering this year with the launch of our da Vinci X Surgical System, a response to customer need.

今年，我們推出了 da Vinci X 手術系統，以響應客戶的需求，擴大了我們的 da Vinci 系統產品範圍。

da Vinci X delivers our fourth generation robotics, imaging and fully articulated instrumentation, an attractive -- at an attractive entry price and procedure capability with logical upgrade pathways.

da Vinci X 提供了我們的第四代機器人技術、成像和全鉸接式儀器，具有吸引力——以極具吸引力的入門價格和程序能力以及合理的升級途徑。

Reception to the -- to X has been positive, catalyzing interest in robotics programs in price-sensitive markets.

對--to X 的接受是積極的，激發了對價格敏感市場中機器人程序的興趣。

Taken together, our generation 4 products, da Vinci X, da Vinci Xi and our future da Vinci SP, which is not yet cleared, represent a balanced and upgradable portfolio of choices for customers building or expanding their robotics surgery programs.

總而言之，我們的第 4 代產品 da Vinci X、da Vinci Xi 和我們尚未確定的未來 da Vinci SP 代表了一個平衡且可升級的選擇組合，供客戶構建或擴展其機器人手術計劃。

Overall, our capital placement performance in 2017 accelerated relative to 2016, with growth in total placements rising 27% from 537 in 2016 to 684 in 2017.

總體而言，我們 2017 年的資本配售業績相對於 2016 年有所加快，總配售量增長 27%，從 2016 年的 537 筆增至 2017 年的 684 筆。

Net of trade-ins and retirements, our da Vinci installed base grew 13% over 2016 from 3,919 to 4,409.

扣除以舊換新和報廢後，我們的達芬奇安裝基數比 2016 年增長了 13%，從 3,919 台增加到 4,409 台。

U.S. capital placements stood out in the year and the fourth quarter, largely driven by growth in general surgery.

美國的資本配置在今年和第四季度表現突出，主要是受到普通外科手術增長的推動。

European placement performance in the fourth quarter was strong.

第四季度的歐洲安置表現強勁。

Placements in the fourth quarter in Japan were also healthy, perhaps a onetime uptick in anticipation of broader reimbursement.

日本第四季度的安置也很健康，也許是預期更廣泛的報銷的一次性上升。

Capital placements overall have been lumpy, and we anticipate volatility in placements in 2018.

資本配售整體波動較大，我們預計 2018 年的配售將出現波動。

Operating performance in the fourth quarter and for the full year exceeded our expectations, with strong performance in manufacturing efficiency, product quality and cost-reduction projects and with average selling prices as expected.

第四季度和全年的經營業績超出了我們的預期，在製造效率、產品質量和成本降低項目方面表現強勁，平均售價符合預期。

Investments to deepen our regional capabilities and to develop new technologies and services were important in the past year.

在過去的一年裡，為深化我們的區域能力以及開發新技術和服務而進行的投資非常重要。

As our business strengthened, we increased some investment through 2017 to strengthen our corporate infrastructure and position us to benefit from increased scale.

隨著我們業務的加強，我們在 2017 年增加了一些投資，以加強我們的企業基礎設施，並使我們能夠從擴大的規模中獲益。

Turning to highlights of our fourth quarter operating results.

轉向我們第四季度經營業績的亮點。

Procedures grew approximately 17% over the fourth quarter of last year.

程序比去年第四季度增長了約 17%。

We shipped 216 da Vinci Surgical systems, up from 163 in the fourth quarter of 2016.

我們出貨了 216 台達芬奇手術系統，高於 2016 年第四季度的 163 台。

Revenue for the quarter was $892 million, up 18%.

本季度收入為 8.92 億美元，增長 18%。

Pro forma gross profit margin was 72.3% compared to 71.1% in the fourth quarter last year.

預計毛利率為 72.3%，而去年第四季度為 71.1%。

Instrument and accessory revenue increased to $457 million, up 18%.

儀器和附件收入增加到 4.57 億美元，增長 18%。

Total recurring revenue in the quarter was $618 million, representing 69% of total revenue.

本季度經常性總收入為 6.18 億美元，佔總收入的 69%。

We generated a pro forma operating profit of $384 million in the quarter, up 20% from the fourth quarter of last year.

本季度我們的預估營業利潤為 3.84 億美元，比去年第四季度增長 20%。

Pro forma net income was $298 million, up 23%.

預計淨收入為 2.98 億美元，增長 23%。

And we concluded our accelerated share buyback program initiated in Q1 of 2017 at a weighted average price of $310 per share.

我們以每股 310 美元的加權平均價格結束了 2017 年第一季度啟動的加速股票回購計劃。

Highlights of the full year 2017 are as follows: Procedures grew approximately 16% over 2016.

2017 年全年的亮點如下： 程序比 2016 年增長了約 16%。

We installed 684 systems in 2017, up from 537 in 2016.

我們在 2017 年安裝了 684 個系統，高於 2016 年的 537 個。

Revenue for the year was $3.1 billion, up 16%.

全年收入為 31 億美元，增長 16%。

Pro forma gross margin was 71.9% for the full year compared with 71.6% for 2016.

全年預計毛利率為 71.9%，而 2016 年為 71.6%。

Total recurring revenue for the year was $2.2 billion, representing 72% of total revenue.

全年經常性收入總額為 22 億美元，佔總收入的 72%。

Pro forma operating profit for the year was $1.3 billion, up 13% from 2016.

全年預計營業利潤為 13 億美元，比 2016 年增長 13%。

And pro forma net income was $1 billion, up 19%.

預計淨收入為 10 億美元，增長 19%。

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。

While Intuitive completed its 22nd year in 2017, I firmly believe that computer-assisted medical interventions are in their infancy.

雖然 Intuitive 在 2017 年完成了第 22 個年頭，但我堅信計算機輔助醫療干預仍處於起步階段。

A careful read of the clinical literature makes clear the need for more effective, less invasive and lower total cost to treat solutions to many disease states.

仔細閱讀臨床文獻可以明確需要更有效、侵入性更小且總成本更低的治療方案來治療許多疾病狀態。

The rise of robotic technology, powerful computing, improved sensing, microfabrication and molecular imaging enable new approaches to old problems.

機器人技術的興起、強大的計算能力、改進的傳感、微細加工和分子成像為解決老問題提供了新方法。

We have been investing in improvements, both incremental and revolutionary, towards the same and anticipate continuing this investment trajectory in 2018.

我們一直在投資於漸進式和革命性的改進，以實現同樣的目標，並預計在 2018 年繼續這一投資軌跡。

The opportunity to improve surgery using advanced technologies is now recognized broadly, and we anticipate the entry of additional competitive systems into some regions of the world over the next several quarters.

使用先進技術改進手術的機會現已得到廣泛認可，我們預計在未來幾個季度內，世界某些地區將有更多具有競爭力的系統進入。

Customers appreciate choice, and it is possible that sales cycles lengthen in some countries as customers evaluate more options.

客戶喜歡選擇，並且隨著客戶評估更多選擇，某些國家/地區的銷售週期可能會延長。

Our company has anticipated increased competition, and we are focused on understanding the market's needs and excelling in delivering products and services today and in the future that meet them.

我們公司已經預料到競爭將加劇，我們專注於了解市場需求，並在今天和未來提供滿足這些需求的產品和服務。

Turning to our da Vinci SP system.

轉向我們的達芬奇 SP 系統。

We submitted our 510(k) for urology last month.

我們上個月提交了泌尿外科的 510(k)。

We call SP as a platform technology that allows high dexterity access with great 3D vision to confined surgical spaces.

我們將 SP 稱為平台技術，它允許以出色的 3D 視覺靈活地進入狹窄的手術空間。

As we've discussed on prior calls, we plan first markets to include urologic surgery, head and neck surgery and colorectal surgery.

正如我們在之前的電話會議上所討論的那樣，我們計劃將首批市場包括泌尿外科、頭頸外科和結直腸外科。

In 2017, SP was used in human trials in the United States and Hong Kong, completing cases spanning initial target procedures.

2017年，SP在美國和香港進行了人體試驗，完成了跨越初始目標程序的案例。

We anticipate a phased launch of SP in 2018, pending clearance.

我們預計 SP 將在 2018 年分階段推出，等待審批。

We are also making good progress on our flexible robotics platform, first targeted to address the acute need in diagnosis of lung cancer, one of the most commonly diagnosed forms of cancer in the world and for which early detection is important.

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

Our program hit its milestones in 2017, completing its first clinical experience in Australia.

我們的計劃在 2017 年達到了里程碑，完成了在澳大利亞的首次臨床體驗。

Preliminary results were reported at the CHEST conference in Q4 of 2017.

初步結果已在 2017 年第四季度的 CHEST 會議上公佈。

Feedback from physicians evaluating our technology relative to existing and emerging alternatives has been strongly supportive of our efforts.

評估我們的技術相對於現有和新興替代方案的醫生的反饋強烈支持我們的努力。

Our design and operations teams are working hard to incorporate feedback, complete its production design and supply chain optimization and complete validations for regulatory submissions.

我們的設計和運營團隊正在努力整合反饋，完成其生產設計和供應鏈優化，並完成監管提交的驗證。

We do not expect revenue from our flexible robotics program in 2018.

我們預計 2018 年我們的柔性機器人項目不會帶來收入。

Our fourth generation product platform has enabled greater access to our latest advanced instruments.

我們的第四代產品平台使我們能夠更方便地使用我們最新的先進儀器。

Use and satisfaction with our stapling and energy products has been rising as gen 4 products have increased in the installed base.

隨著第 4 代產品在安裝基礎上的增加，我們的裝訂和能量產品的使用和滿意度一直在上升。

Both stapling and energy instruments are important to surgeons, and we've been investing in broadening our product line and incorporating customer feedback in both areas.

吻合器和能量器械對外科醫生都很重要，我們一直在投資擴大我們的產品線，並在這兩個領域整合客戶反饋。

In the fourth quarter of 2017, we submitted our 510(k) application for our 60-millimeter stapler for da Vinci X and Xi.

2017 年第四季度，我們提交了用於達芬奇 X 和 Xi 的 60 毫米訂書機的 510(k) 申請。

Lastly, our imaging teams continue to explore new ways to identify tissue, including good progress in our molecular imaging program as well as improvements to our endoscopes and image processing algorithms.

最後，我們的成像團隊繼續探索識別組織的新方法，包括我們的分子成像計劃取得良好進展以及改進我們的內窺鏡和圖像處理算法。

We have been introducing improvements in our imaging hardware routinely and expect to continue to do so in 2018.

我們一直在定期對我們的成像硬件進行改進，並希望在 2018 年繼續這樣做。

Molecular imaging agents are long-term investments.

分子顯像劑是長期投資。

We expect our lead agent to enter Phase II trials in 2018.

我們預計我們的主要代理人將在 2018 年進入 II 期試驗。

In closing, as we start 2018, our focus remains in completing the task we've set for ourselves: 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 our diagnostic platform; and finally, support for additional clinical and economic validation by global region.

最後，在我們開始 2018 年之際，我們的重點仍然是完成我們為自己設定的任務：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 和我們的診斷平台；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 will review financial highlights.

我現在將電話轉給馬歇爾，他將審查財務亮點。

Good afternoon.

下午好。

Overall, our fourth quarter financial performance was strong.

總體而言，我們第四季度的財務表現強勁。

I will start by describing highlights of this performance on a GAAP and non-GAAP or pro forma basis.

我將首先在 GAAP 和非 GAAP 或備考基礎上描述這一業績的亮點。

I will also take you through our analysis of the impact of the U.S. 2017 Tax Cuts and Jobs Act on our financial results.

我還將帶您了解我們對美國 2017 年減稅和就業法案對我們財務業績的影響的分析。

As a reminder, our results are also posted on our website.

提醒一下，我們的結果也發佈在我們的網站上。

Consistent with our preliminary press release on January 10, fourth quarter 2017 revenue was $892 million, an increase of 18% compared with $757 million for the fourth quarter of 2016, an increase of 11% compared with the third quarter revenue of $806 million.

與我們在 1 月 10 日發布的初步新聞稿一致，2017 年第四季度收入為 8.92 億美元，與 2016 年第四季度的 7.57 億美元相比增長 18%，與第三季度 8.06 億美元的收入相比增長 11%。

In the fourth quarter, we completed the da Vinci X trade-up program offered to certain first quarter customers.

第四季度，我們完成了向某些第一季度客戶提供的達芬奇 X 換購計劃。

The impact of this program was to increase fourth quarter revenue by approximately $2 million and third quarter revenue by approximately $21 million.

該計劃的影響是使第四季度收入增加約 200 萬美元，使第三季度收入增加約 2100 萬美元。

As mentioned earlier in the call, fourth quarter 2017 procedures increased approximately 17% compared with the fourth quarter 2016 and increased 12% compared with last quarter.

正如電話中提到的那樣，2017 年第四季度的程序與 2016 年第四季度相比增加了約 17%，與上一季度相比增加了 12%。

Procedure growth continues to be driven by general surgery in the U.S. and urology worldwide.

美國的普外科和全世界的泌尿外科繼續推動手術的增長。

Calvin will review details of procedure growth later in this call.

卡爾文將在本次電話會議的稍後部分審查程序增長的細節。

Instrument and accessory revenue of $457 million increased 18% compared with last year, which is slightly higher than procedure growth.

儀器和配件收入為 4.57 億美元，比去年增長 18%，略高於程序增長。

Instrument and accessory revenue realized per procedure was approximately $1,910, which is relatively unchanged compared to last year, reflecting increased advanced instrument usage, mostly offset by customer buying patterns.

每個程序實現的儀器和附件收入約為 1,910 美元，與去年相比基本沒有變化，反映了先進儀器使用量的增加，這主要被客戶購買模式所抵消。

Systems revenue of $283 million increased 20% compared with the fourth quarter of 2016, primarily reflecting higher system placements.

與 2016 年第四季度相比，系統收入為 2.83 億美元，增長 20%，主要反映了更高的系統佈局。

We placed 216 systems in the fourth quarter of 2017 compared with 163 systems in the fourth quarter of 2016 and 169 systems last quarter.

我們在 2017 年第四季度放置了 216 個系統，而 2016 年第四季度為 163 個系統，上一季度為 169 個系統。

40 systems were placed under operating lease transactions in the current quarter compared with 13 systems in the fourth quarter of 2016.

本季度有 40 個系統被置於經營租賃交易之下，而 2016 年第四季度為 13 個系統。

Systems placed under operating leases represented 19% of system placements compared with 8% last year.

根據經營租賃放置的系統佔系統放置的 19%，而去年為 8%。

Our installed base of da Vinci systems ended the year at 4,409 systems, up 13% year-over-year.

我們的達芬奇系統安裝基數在年底達到 4,409 個系統，同比增長 13%。

Consistent with recent trends, average system utilization continues to grow in the middle -- mid-single-digit range.

與最近的趨勢一致，平均係統利用率繼續在中等個位數範圍內增長。

Globally, our average selling price, which excludes the impact of operating leases and lease buyouts and revenue deferrals, was approximately $1.47 million, which is similar to the fourth quarter of 2016 and the same as 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）約為 147 萬美元，與 2016 年第四季度和上一季度持平。

51, or 24% of systems placed in the quarter, were da Vinci X systems compared with 16 or 9% systems last quarter.

本季度有 51 個或 24% 的系統是達芬奇 X 系統，而上一季度為 16 個或 9% 的系統。

We are seeing demand for da Vinci X from cost-sensitive customers as well as customers wishing to upgrade to, or standardize on, our fourth-generation technology.

我們看到對成本敏感的客戶以及希望升級到我們的第四代技術或對其進行標準化的客戶對達芬奇 X 的需求。

We believe that flexible financing programs like operating leases have allowed us to be more agile in meeting customer needs for systems.

我們相信，經營租賃等靈活的融資計劃使我們能夠更靈活地滿足客戶對系統的需求。

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。

Outside of the U.S., results were as follows: Fourth quarter revenue outside of the U.S. of $248 million increased 17% compared with both the fourth quarter of 2016 and the third quarter of 2017.

美國以外地區的業績如下： 第四季度美國以外地區的收入為 2.48 億美元，與 2016 年第四季度和 2017 年第三季度相比增長了 17%。

OUS procedures grew approximately 21% compared with the fourth quarter of 2016.

與 2016 年第四季度相比，OUS 程序增長了約 21%。

Outside the U.S., we placed 86 systems in the fourth quarter compared with 63 in the fourth quarter of 2016 and 62 systems last quarter.

在美國以外，我們在第四季度部署了 86 個系統，而 2016 年第四季度為 63 個，上季度為 62 個系統。

Current quarter system placements included 47 into Europe and 22 into Japan.

當前季度系統安置包括 47 個進入歐洲和 22 個進入日本。

25 of the 47 systems placed into Europe were X systems.

部署到歐洲的 47 個系統中有 25 個是 X 系統。

Placements outside of U.S. will continue to be lumpy as some of the OUS markets are in early stages of adoption, some markets are highly seasonal, reflecting budget cycles or vacation patterns, and sales into some markets are constrained by government regulations.

由於一些 OUS 市場處於採用的早期階段，一些市場具有很強的季節性，反映了預算週期或假期模式，並且一些市場的銷售受到政府法規的限制，因此美國境外的安置將繼續不穩定。

As Gary indicated, a committee of the MHLW in Japan has recommended 12 procedures for reimbursement.

正如 Gary 所指出的，日本 MHLW 的一個委員會推薦了 12 種報銷程序。

It is anticipated that by the end of this quarter, MHLW will determine the reimbursement levels for each procedure.

預計到本季度末，MHLW 將確定每個程序的報銷水平。

The applicable opportunity for da Vinci surgery within this set of procedures is difficult to estimate at this time due to the uncertainty in reimbursement levels as well as the perceived value of da Vinci relative to alternative surgical approaches.

由於報銷水平的不確定性以及達芬奇相對於替代手術方法的感知價值，目前很難估計這組手術中達芬奇手術的適用機會。

With nearly 300 systems installed in Japan, the level of system expansion over the year or so -- over the next year or so is difficult to predict.

日本安裝了近 300 個系統，一年左右的系統擴展水平 - 未來一年左右的時間很難預測。

We expect system expansion in Japan to be modest in 2018.

我們預計 2018 年日本的系統擴張將適度。

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 fourth quarter of 2017 was 72.3% compared with 71.1% for the fourth quarter of 2016 and 71.8% for the third quarter of 2017.

2017 年第四季度的備考毛利率為 72.3%，而 2016 年第四季度為 71.1%，2017 年第三季度為 71.8%。

The increase compared with the third quarter primarily reflects lower manufacturing costs, partially offset by seasonally higher proportion of systems revenue.

與第三季度相比的增長主要反映了較低的製造成本，部分被系統收入的季節性較高比例所抵消。

Future margins will also fluctuate based on the mix of our newer products, the mix of systems and instrument and accessory revenue, system ASPs and our ability to further reduce product costs and improve manufacturing efficiency.

未來的利潤率也將根據我們新產品的組合、系統和儀器及附件收入的組合、系統 ASP 以及我們進一步降低產品成本和提高製造效率的能力而波動。

Pro forma operating expenses increased 19% compared with the fourth quarter 2016 and increased 13% compared with last quarter.

預計營業費用與 2016 年第四季度相比增長 19%，與上一季度相比增長 13%。

The increase compared with the third quarter reflects increased variable compensation.

與第三季度相比的增長反映了可變薪酬的增加。

Our spending was consistent with our plan, reflecting investments in da Vinci SP, catheter-based robotics, imaging and advanced instrumentation and expansion of our OUS markets.

我們的支出與我們的計劃一致，反映了對達芬奇 SP、基於導管的機器人、成像和先進儀器的投資以及我們 OUS 市場的擴張。

These investments involve multiyear commitment.

這些投資涉及多年承諾。

Our pro forma effective tax rate for the fourth quarter was 24.9% compared with our expectations of 26.5% to 28.5%.

我們對第四季度的備考有效稅率為 24.9%，而我們的預期為 26.5% 至 28.5%。

I will take you through the items included in our GAAP tax rate, including the impacts of the U.S. Tax Act in a minute.

我將在一分鐘內帶您了解我們的 GAAP 稅率中包含的項目，包括美國稅法的影響。

Our tax rates will fluctuate with changes in the mix of U.S. and OUS income, changes in tax rates made by local authorities and with the impact of onetime items.

我們的稅率將隨著美國和美國收入組合的變化、地方當局製定的稅率變化以及一次性項目的影響而波動。

Our fourth quarter 2017 pro forma net income was $298 million, or $2.57 per share, compared with $242 million, or $2.03 per share, for the fourth quarter of 2016, and $324 million, or $2.77 per share, for the third quarter of 2017.

我們 2017 年第四季度的備考淨收入為 2.98 億美元，即每股 2.57 美元，而 2016 年第四季度為 2.42 億美元，即每股 2.03 美元，2017 年第三季度為 3.24 億美元，即每股 2.77 美元。

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

所有每股金額都反映了 10 月份生效的 1 股 3 股拆分。

Third quarter 2017 GAAP and pro forma net income per diluted share benefited by $0.09 per share from the recognition of $21 million of deferred revenue, net of costs and income tax, and by $0.59 per share related to the tax reserve reversal of $68 million.

2017 年第三季度 GAAP 和備考每股攤薄淨收入受益於確認 2100 萬美元遞延收入（扣除成本和所得稅）後每股收益 0.09 美元，以及與 6800 萬美元稅收儲備金沖回相關的每股收益 0.59 美元。

I will now summarize our GAAP results.

我現在將總結我們的 GAAP 結果。

Inclusive of the impacts of the U.S. Tax Act, we incurred a GAAP net loss of $39 million or $0.35 per share for the fourth quarter of 2017 compared with GAAP net income of $204 million or $1.71 per share in the fourth quarter of 2016 and GAAP net income of $298 million or $2.55 per share for the third quarter of 2017.

考慮到美國稅法的影響，我們 2017 年第四季度的 GAAP 淨虧損為 3900 萬美元或每股 0.35 美元，而 2016 年第四季度的 GAAP 淨收入為 2.04 億美元或每股 1.71 美元，GAAP 淨虧損為2017 年第三季度的收入為 2.98 億美元或每股 2.55 美元。

The following items are excluded from our fourth quarter pro forma net income but included in our GAAP net loss: $270 million or $2.41 per share, reflecting a 14% onetime tax for historical OUS earnings and profits under the U.S. Tax Act; $48 million or $0.42 per share for the write-down of net deferred assets to reflect the reduction in corporate tax rates under the U.S. Tax Act; $20 million or $0.18 per share of excess tax benefits associated with employee stock awards; and $57 million of net charges or $0.51 per share associated with employee equity charges, IP charges and legal settlements.

以下項目不包括在我們第四季度的備考淨收入中，但包含在我們的 GAAP 淨虧損中：2.7 億美元或每股 2.41 美元，反映根據美國稅法對歷史 OUS 收益和利潤徵收 14% 的一次性稅； 4800 萬美元或每股 0.42 美元用於減記淨遞延資產，以反映美國稅法下公司稅率的降低；與員工股票獎勵相關的 2000 萬美元或每股 0.18 美元的超額稅收優惠；與員工股權費用、知識產權費用和法律和解相關的 5700 萬美元淨費用或每股 0.51 美元。

Note that the IRS has not issued final tax rate regulation associated with the recent U.S. tax legislation.

請注意，美國國稅局尚未發布與最近的美國稅法相關的最終稅率法規。

Therefore, impacts of the U.S. Tax Act reflected in our fourth quarter results and our projection of future tax rates represent our best estimates of the impact of the U.S. Tax Act and could change as tax regulations are finalized and interpreted.

因此，我們第四季度業績中反映的美國稅法的影響和我們對未來稅率的預測代表了我們對美國稅法影響的最佳估計，並且可能會隨著稅法的最終確定和解釋而改變。

We ended the quarter with cash and investments of $3.8 billion, approximately the same as at September 30, 2017.

本季度末，我們的現金和投資為 38 億美元，與 2017 年 9 月 30 日大致相同。

During the quarter, cash generated from operations were mostly offset by a final payment of $274 million associated with the accelerated share repurchase agreement we entered in the first quarter.

本季度，運營產生的現金大部分被我們在第一季度簽訂的加速股票回購協議相關的最終付款 2.74 億美元所抵消。

Under that agreement, we repurchased 7.3 million shares at approximately $310 per share.

根據該協議，我們以每股約 310 美元的價格回購了 730 萬股股票。

We have approximately $718 million remaining under the board buyback authorization.

根據董事會回購授權，我們還有大約 7.18 億美元。

As a result of the 2017 Tax Act, we have the option to repatriate OUS cash with minimal tax impact.

根據 2017 年稅法，我們可以選擇以最小的稅收影響將 OUS 現金匯回國內。

We have significant opportunity for growth outside of the U.S. We will evaluate the need to repatriate cash relative to our business and overall environment over time.

我們在美國以外有很大的增長機會。隨著時間的推移，我們將根據我們的業務和整體環境評估匯回現金的必要性。

And with that, I'd like to turn it over to Calvin, who will go over procedure performance and our outlook for 2018.

有了這個，我想把它交給卡爾文，他將審查程序性能和我們對 2018 年的展望。

Thank you, Marshall.

謝謝你，馬歇爾。

Our overall fourth quarter procedure growth was 17% compared to 15% during the fourth quarter of 2016 and 15% last quarter.

與 2016 年第四季度的 15% 和上一季度的 15% 相比，我們第四季度的總體程序增長率為 17%。

Our Q4 procedure growth was driven by strong results globally and 16% growth in U.S. procedures, reflecting broad-based strength across our procedure categories.

我們第四季度的程序增長受到全球強勁業績和美國程序增長 16% 的推動，反映了我們程序類別的廣泛實力。

Q4 likely benefited modestly from cases deferred out of Q3 due to hurricanes.

第 4 季度可能從因颶風而推遲到第 3 季度的案件中適度受益。

In total, approximately 877,000 da Vinci procedures were performed in 2017, up about 16% for the year.

2017 年總共進行了約 877,000 次達芬奇手術，同比增長約 16%。

In the U.S., general surgery, on a run rate basis, has surpassed gynecology as our largest specialty.

在美國，按運行率計算，普通外科已經超過婦科成為我們最大的專科。

Approximately 246,000 U.S. general surgery procedures were performed in 2017, up 32% compared to 2016.

2017 年美國進行了大約 246,000 例普通外科手術，比 2016 年增長了 32%。

2017 growth was again driven by hernia repair, ventral and inguinal combined, which continue to drive the most incremental cases and continued da Vinci adoption in colorectal procedures.

2017 年的增長再次受到疝氣修復、腹側和腹股溝聯合的推動，這繼續推動最多的增量病例，並繼續在結直腸手術中採用達芬奇。

Early-stage adoption in bariatric procedures and growth across the general surgery category also contributed to growth.

減肥手術的早期採用和普通外科類別的增長也促進了增長。

In U.S. gynecology, fourth quarter and full year 2017 procedures grew modestly year-over-year, with growth led by hysterectomy.

在美國婦科，2017 年第四季度和全年手術量同比溫和增長，其中子宮切除術帶動了增長。

We continue to see an increasing proportion of U.S. gynecology procedures being performed by physicians that specialize in complex, benign and cancer surgery who tend to be users of da Vinci systems.

我們繼續看到越來越多的美國婦科手術由專門從事複雜、良性和癌症手術的醫生執行，他們往往是達芬奇系統的用戶。

U.S. urology procedures exceeded our expectations for the fourth quarter and the year, driven by prostatectomy volumes.

在前列腺切除手術量的推動下，美國泌尿外科手術超出了我們對第四季度和全年的預期。

As a mature procedure category, we believe that our U.S. prostatectomy volumes have been tracking to the broader prostate surgery market, which has benefited from recent macro trends.

作為一個成熟的手術類別，我們認為我們的美國前列腺切除術量一直在追踪更廣泛的前列腺手術市場，該市場受益於近期的宏觀趨勢。

In other U.S. procedures, adoption of lobectomies and other thoracic procedures was again strong during the fourth quarter and full year.

在美國的其他手術中，肺葉切除術和其他胸部手術的採用在第四季度和全年再次強勁。

This set of procedures is particularly well-served by our da Vinci Xi System and surgical staplers.

我們的達芬奇 Xi 系統和外科吻合器特別適合這套程序。

Outside of the United States, approximately 233,000 procedures were performed in 2017, up approximately 21% in the fourth quarter and approximately 23% for the full year.

在美國以外，2017 年進行了約 233,000 次手術，第四季度增長約 21%，全年增長約 23%。

Growth was driven by the continued adoption of da Vinci Prostatectomy, with solid contributions from kidney procedures and earlier-stage growth in general surgery and gynecology.

達芬奇前列腺切除術的持續採用推動了增長，腎臟手術以及普通外科和婦科的早期增長做出了堅實貢獻。

Fourth quarter OUS procedure growth was slightly lower, largely reflecting leveling system utilization and moderating growth in China as we anticipate future system sales quota.

第四季度 OUS 程序增長略有下降，這主要反映了由於我們預計未來系統銷售配額，中國的系統利用率趨於平穩和增長放緩。

The value proposition regarding any da Vinci procedure is based upon the differentiated clinical value that can be offered to patients compared to other treatment alternatives, including economic factors.

任何達芬奇手術的價值主張都基於與其他治療方案相比可以為患者提供的差異化臨床價值，包括經濟因素。

Since the introduction of the da Vinci system, over 15,000 clinical papers have been published involving da Vinci surgery, including approximately 2,300 in 2017 alone.

自引入達芬奇系統以來，已發表超過 15,000 篇涉及達芬奇手術的臨床論文，其中僅 2017 年就發表了約 2,300 篇。

As I mentioned in my procedure discussion, lung procedures in the U.S. have contributed to recent procedure growth.

正如我在手術討論中提到的，美國的肺部手術促進了近期手術的增長。

In November 2017, a team of investigators from the University of Southern California, the University of Michigan Ann Arbor, Penn State Health and Intuitive published a large-scale study titled Robotic-Assisted, Video-Assisted Thoracic and Open Lobectomy: Propensity-Matched Analysis of Recent Premier Data in The Annals of Thoracic Surgery.

2017 年 11 月，來自南加州大學、密歇根大學安娜堡分校、賓夕法尼亞州立大學健康和直覺的一組研究人員發表了一項名為機器人輔助、視頻輔助胸腔和開放肺葉切除術：傾向匹配分析的大規模研究胸外科年鑑中最新的主要數據。

In this study, the Premier Healthcare Database was analyzed for open, video-assisted thoracic or VATS and robotic-assisted lobectomies performed between January 1, 2011, and September 30, 2015.

在這項研究中，對 2011 年 1 月 1 日至 2015 年 9 月 30 日期間進行的開胸、視頻輔助胸腔鏡或 VATS 和機器人輔助肺葉切除術的 Premier Healthcare 數據庫進行了分析。

The results from this study show a continual increase in the number of robotic-assisted lobectomies during the study period.

這項研究的結果表明，在研究期間，機器人輔助肺葉切除術的數量持續增加。

The combined total of robotic-assisted and VATS approaches accounted for more of half -- more than half of the lobectomies in the U.S. database, indicating a strong trend towards adoption of minimally invasive approaches.

機器人輔助和 VATS 方法的總和占一半以上——超過美國數據庫中一半的肺葉切除術，表明採用微創方法的強烈趨勢。

While a proportion of VATS remained virtually unchanged during the study period, the robotic rate grew as open declined.

雖然 VATS 的比例在研究期間幾乎保持不變，但隨著開放率的下降，機器人的比率有所增加。

After propensity score matching, which controls for heterogeneity of patients in hospitals, the robotic-assisted cases were compared to VATS procedures in a sample size of 2,775 in each group, and robotic-assisted cases were compared to open with 2,951 patients in each group.

在控制醫院患者異質性的傾向評分匹配後，將機器人輔助病例與每組 2,775 例樣本量的 VATS 程序進行比較，並將機器人輔助病例與每組 2,951 例患者的開放病例進行比較。

Compared to open surgery, robotic-assisted lobectomy demonstrated statistically significant lower postoperative complication rate, shorter hospital stay, higher percentage of patients discharged to home and lower hospital mortality rate.

與開放手術相比，機器人輔助肺葉切除術的術後並發症發生率更低、住院時間更短、出院率更高、住院死亡率更低，具有統計學意義。

Compared to VATS, robotic-assisted surgery demonstrated statistically significant lower rate of conversion to thoracotomy, lower post-operative complication rate, shorter hospital stay and a higher percentage of patients discharged to home.

與 VATS 相比，機器人輔助手術的中轉開胸率、術後並發症發生率較低、住院時間較短以及出院回家的患者比例較高，具有統計學意義。

As we've said in the past, we continue to invest in clinical research in our key geographic markets to assess da Vinci surgery outcomes and help educate the market.

正如我們過去所說，我們繼續在我們的主要地理市場投資臨床研究，以評估達芬奇手術的結果並幫助教育市場。

We support large-scale data registries, including those managed by the American Hernia Society Quality Collaborative and the Society of Gynecological Oncology Clinical Outcomes Registry.

我們支持大規模數據註冊，包括由美國疝氣協會質量協作和婦科腫瘤臨床結果註冊協會管理的數據。

As large da Vinci data sets accumulate in these registries and are compared to baseline results, the value of da Vinci surgery can be evaluated.

隨著大型達芬奇數據集在這些登記處積累並與基線結果進行比較，可以評估達芬奇手術的價值。

We also support clinical research grants at SAGES, ASCRS and the European Coloproctology Society as well as da Vinci fellowship programs, which several -- with surgical societies, which often yield clinical studies.

我們還支持 SAGES、ASCRS 和歐洲結腸直腸學會的臨床研究資助以及達芬奇研究金計劃，其中有幾個與外科學會合作，通常會產生臨床研究。

I will now turn to our financial outlook for 2018.

我現在將談談我們 2018 年的財務展望。

Starting with procedures.

從程序開始。

As described in our announcement earlier this month, 2017 total da Vinci procedures grew approximately 16% to roughly 877,000 procedures performed worldwide.

正如我們在本月早些時候的公告中所述，2017 年達芬奇手術總數增長了約 16%，在全球範圍內執行了約 877,000 例手術。

During 2018, we anticipate full year procedure growth within a range of 11% to 15%.

2018 年，我們預計全年手術增長率將在 11% 至 15% 之間。

We expect 2018 procedure growth to continue to be driven by U.S. general surgery and procedures outside of the United States, where we are still in earlier stages of adoption.

我們預計 2018 年的程序增長將繼續受到美國普通外科和美國以外程序的推動，我們仍處於採用的早期階段。

We expect similar seasonal timing of procedures in 2018, as we've experienced in previous years, with Q1 being the seasonally weakest quarter as patient deductibles are reset.

我們預計 2018 年手術的季節性時間與往年類似，第一季度是季節性最弱的季度，因為患者免賠額被重置。

In Q1, we expect a modest procedure headwind compared to Q1 2017 as a result of our estimates of working days, mostly due to the timing of the Good Friday holiday.

在第一季度，由於我們對工作日的估計，我們預計與 2017 年第一季度相比，程序會出現適度的逆風，這主要是由於耶穌受難日假期的時間安排。

With respect to revenue, as we've mentioned previously, capital sales are ultimately driven by procedure growth, catalyzing hospitals to establish or expand robotic system capacity.

關於收入，正如我們之前提到的，資本銷售最終是由程序增長驅動的，從而促使醫院建立或擴大機器人系統容量。

Capital sales can vary substantially from period-to-period based upon many factors, including U.S. health care policy, hospital capital spending cycles, reimbursement in government quotas, product cycles and competitive factors.

根據許多因素，包括美國醫療保健政策、醫院資本支出週期、政府配額的報銷、產品週期和競爭因素，資本銷售在不同時期可能會有很大差異。

Within this framework, we'd expect 2018 capital placement seasonality to generally follow historical patterns by quarter.

在此框架內，我們預計 2018 年的資本配售季節性將總體上按季度遵循歷史模式。

During the fourth quarter of 2017, 40 of the 216 systems shipped or 19% were under operating leases.

2017 年第四季度，出貨的 216 個系統中有 40 個或 19% 屬於經營租賃。

In 2018, we'd expect the proportion of systems placed under operating leases to trend modestly up from there with variation by quarter.

2018 年，我們預計經營租賃下的系統比例將略有上升，但每個季度都會有所不同。

Turning to gross profit.

轉向毛利。

Our full year 2017 gross -- pro forma gross profit margin was 71.9%.

我們 2017 年全年毛利率 - 備考毛利率為 71.9%。

In 2018, we expect our pro forma gross profit margin to be within a range of between 70% and 71.5% net revenue.

2018 年，我們預計我們的備考毛利率將在 70% 至 71.5% 的淨收入範圍內。

We're projecting a modestly lower gross profit margin in 2018, reflecting higher costs associated with new products.

我們預計 2018 年的毛利率會小幅下降，反映出與新產品相關的成本較高。

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

我們的實際生產總值——毛利率將隨季度變化，主要取決於產品和地區組合。

Turning to operating expenses.

轉向運營費用。

As Gary and Marshall described, in 2018, we will continue to make substantive investments in several strategic areas that are poised to benefit the company over the long run.

正如 Gary 和 Marshall 所描述的那樣，2018 年，我們將繼續在幾個有望使公司長期受益的戰略領域進行實質性投資。

As a result, we expect to grow 2018 pro forma operating expenses between 16% and 18% above 2017 levels.

因此，我們預計 2018 年的備考運營費用將比 2017 年增長 16% 至 18%。

We expect our noncash stock compensation expense to range between $225 million and $235 million in 2018 compared to $209 million in 2017.

我們預計 2018 年我們的非現金股票補償費用將在 2.25 億美元至 2.35 億美元之間，而 2017 年為 2.09 億美元。

We expect other income, which is comprised mostly of interest income, to total between $45 million and $55 million in 2018.

我們預計 2018 年主要由利息收入組成的其他收入總額將在 4500 萬美元至 5500 萬美元之間。

With regard to income tax, incorporating projected impacts of the new U.S. tax law, we expect our 2018 pro forma income tax rate to be between 20% and 22% of pretax income.

在所得稅方面，考慮到美國新稅法的預期影響，我們預計 2018 年的預估所得稅稅率將在稅前收入的 20% 至 22% 之間。

Note that in the future, as the IRS issues additional guidance and interpretation of the new tax law, our estimated rate may be impacted.

請注意，在未來，隨著美國國稅局對新稅法發布額外的指導和解釋，我們的估計稅率可能會受到影響。

Our share count for calculated diluted EPS pro forma EPS in Q4 was 117.4 million shares.

我們計算的第四季度稀釋每股收益備考每股收益為 1.174 億股。

In Q1, we expect our diluted share count to range between 117.6 million and 118.4 million shares.

在第一季度，我們預計我們的稀釋股數將在 1.176 億至 1.184 億股之間。

The actual diluted share count will depend on several factors, including the share price.

實際稀釋後的股份數量將取決於幾個因素，包括股價。

That concludes our prepared comments.

我們準備好的評論到此結束。

We will now open the call to your questions.

我們現在將打開您的問題的電話。

(Operator Instructions)

（操作員說明）

And our first question today comes from the line of Bob Hopkins with Bank of America.

我們今天的第一個問題來自美國銀行的 Bob Hopkins。

Appreciate the opportunity to ask a few questions here.

感謝有機會在這裡問幾個問題。

So maybe just to start out on the product side, I just want to make sure I have a good sense for what you're saying.

所以也許只是從產品方面開始，我只是想確保我對你所說的有很好的理解。

So Gary, I guess, on the flexible endoscope platform, I realize you said no revenues in 2018.

所以加里，我想，在靈活的內窺鏡平台上，我知道你說 2018 年沒有收入。

But is there a scenario where you have any regulatory approvals for flexible endoscope?

但是是否存在您對柔性內窺鏡有任何監管批准的情況？

Any major country maybe towards the end of 2018?

任何主要國家可能會在 2018 年底出現？

We're not -- hi, Bob.

我們不是——嗨，鮑勃。

We're not calling the clearance date yet of the flex platform.

我們還沒有宣布 flex 平台的清算日期。

I'm pleased with where we are.

我對我們的現狀感到滿意。

We're working the plan.

我們正在製定計劃。

Our tradition with you has been to let you know when we do a submission, and that gives us a little bit better estimate of time lines, and I'd rather not guess in this setting.

我們的傳統是在提交時通知您，這讓我們對時間線有了更好的估計，在這種情況下我不想猜測。

So we're feeling good about it, but I don't have a date for you yet.

所以我們感覺很好，但我還沒有給你約會。

Okay.

好的。

Feeling good about it.

感覺很好。

Does that mean the potential for submissions in '18?

這是否意味著 18 年提交的可能性？

No.

不。

I'm feeling good about the progress of the team and their ability to deliver on what we think this is capable of doing.

我對團隊的進步以及他們實現我們認為能夠做到的事情的能力感到滿意。

Okay.

好的。

And then on your comments on Japan, I'm just curious, what do you assume for Japan in the current 11% to 15%?

然後關於你對日本的評論，我很好奇，你對日本目前 11% 到 15% 的假設是什麼？

And maybe said another way, if reimbursement comes in the way you would hope, does that suggest the potential for the higher end of that 11% to 15%?

也許換句話說，如果報銷以您希望的方式進行，這是否表明 11% 到 15% 的較高端有潛力？

The -- we haven't baked a lot of growth in there.

- 我們還沒有在那裡實現很多增長。

Again, we don't really know at this point what the reimbursement levels are going to be.

同樣，我們現在真的不知道報銷水平是多少。

And therefore, that could vastly impact the number of -- the procedure adoption curve.

因此，這可能會極大地影響程序採用曲線的數量。

So there's not a lot in there.

所以里面的東西不多。

But even then, the magnitude of Japan relative to the total world is not substantial.

但即便如此，日本相對於整個世界的規模也並不大。

And the highest growth drivers for the -- for us for next year really are general surgery procedures in the U.S. and urological procedures outside of the U.S.

對我們來說，明年增長最快的驅動因素確實是美國的普通外科手術和美國以外的泌尿外科手術。

And with these clearances, Bob, or reimbursements, I should say, it's really -- it's going to be building a foundation time for us.

有了這些許可，鮑勃，或報銷，我應該說，這真的是——這將為我們建立一個基礎時間。

There's going to be large investments made or we have been making, and we're going to follow through on things like training surgeons and building the teams up to speed.

將會進行大量投資，或者我們一直在進行大量投資，我們將繼續進行培訓外科醫生和加快團隊建設等工作。

So it's really more about building a foundation here for the future in 2018 than a substantive contribution to the growth.

因此，這實際上更多的是在這里為 2018 年的未來打下基礎，而不是對增長做出實質性貢獻。

And then Gary, just real quickly, given the success you've had as a company in 2017 on the procedure side, I wanted to ask one quick question on how you view the market opportunity because in 2016 to 2017, your slide decks talked about 4 million accessible procedures worldwide for approved technologies.

然後加里，很快，考慮到你作為一家公司在 2017 年在程序方面取得的成功，我想問一個關於你如何看待市場機會的快速問題，因為在 2016 年到 2017 年，你的幻燈片談到了全球 400 萬個可訪問的程序，用於批准的技術。

And I'm just curious if you could update us on your latest thoughts on kind of the addressable procedures, where you stand today relative to that 4 million, given that you've got SP coming along with, obviously, other technologies.

我很好奇你是否可以向我們更新你對可尋址程序的最新想法，你今天相對於那 400 萬，考慮到你已經有了 SP，顯然還有其他技術。

Yes.

是的。

Yes, fair question.

是的，公平的問題。

As you described, I think the -- for current products in the market and current countries in which we operate, I think our estimates are that we're under -- we're not yet 1/4 penetrated.

正如你所描述的，我認為 - 對於市場上的當前產品和我們運營所在的當前國家/地區，我認為我們的估計是我們低於 - 我們尚未滲透 1/4。

So even with what our commercial teams have to do, we have plenty of upside.

因此，即使我們的商業團隊必須做的事情，我們也有很多優勢。

I think as you move time -- whenever you talk about total available market, I'll tell you how we think about it.

我認為隨著時間的推移——每當你談論總可用市場時，我都會告訴你我們是如何看待它的。

We look out and start with, where do we see differentiated clinical value by procedure given what we can bring and try to get an estimate of what segment or population of our customer base that can make a positive impact.

我們著眼於從哪裡開始，考慮到我們可以帶來什麼，我們在哪裡可以看到不同程序的臨床價值，並嘗試估計我們客戶群的哪些部分或人群可以產生積極影響。

And we, you know us, start conservatively.

而我們，你知道我們，開始保守。

And what tends to happen over time as we get into those, history has been that, as we get clinical data and our customers use our products, we get a better, clearer view of TAM.

當我們進入這些領域時，隨著時間的推移往往會發生什麼，歷史是，當我們獲得臨床數據並且我們的客戶使用我們的產品時，我們對 TAM 有了更好、更清晰的了解。

Often, the TAM has increased.

通常，TAM 會增加。

Not always.

不總是。

Some TAMs have decreased.

一些 TAM 已經減少。

But mostly, they have increased.

但大多數情況下，它們有所增加。

And so that's how we look at it.

這就是我們的看法。

SP is clearly an opportunity for us to explore some procedures in patient populations that we have not done a lot in, and that, I think, is why we're excited about it.

SP 顯然為我們提供了一個機會，讓我們可以在患者人群中探索一些我們沒有做太多的程序，我認為，這就是我們對此感到興奮的原因。

And flex, I think, opens a new set of opportunities for us that's why we have done the investments.

我認為 flex 為我們打開了一系列新的機會，這就是我們進行投資的原因。

I think flexible technologies we are pursuing in the pulmonology space and the thoracic cavity, and we'll be focused on that for the next few years.

我認為我們正在肺病學空間和胸腔中追求靈活的技術，我們將在未來幾年專注於此。

But as you know, we're really excited about platform ideas, things that have generic capability that can be broadened over time.

但如您所知，我們對平台創意非常興奮，這些創意具有可以隨時間擴展的通用功能。

And we think flex robotics, diagnostics and other interventions can do that as well.

我們認為柔性機器人、診斷和其他干預措施也可以做到這一點。

We don't have a crystal ball as to those TAMs, and we're not ready yet to describe how big we think they can be in part because our estimates are large ranges.

我們沒有關於這些 TAM 的水晶球，我們還沒有準備好描述我們認為它們有多大，部分原因是我們的估計範圍很大。

It could be quite a lot of variability.

它可能有很大的可變性。

But we invest in them because we think they bring the real opportunities for outcome improvements in the hands of our customers, decreases in variability across the customer base, and as a result, an opportunity to grow the footprint of Intuitive going forward.

但我們投資於它們是因為我們認為它們為我們的客戶帶來了改善結果的真正機會，減少了整個客戶群的可變性，因此有機會擴大 Intuitive 的足跡。

And we do have a question from the line of David Lewis with Morgan Stanley.

我們確實有 David Lewis 和 Morgan Stanley 的問題。

A few quick questions for me.

問我幾個簡單的問題。

First, Gary, just coming back to the pipeline.

首先，加里，剛剛回到管道。

Just on SP, is there a chance we get additional label approvals or submissions for head, neck and colorectal this year on SP?

就 SP 而言，今年我們是否有機會在 SP 上獲得額外的頭部、頸部和結直腸標籤批准或提交？

And is second half of the year a decent time for them to think about the 40-millimeter stapler approval?

今年下半年是否是他們考慮批准 40 毫米訂書機的合適時機？

Yes.

是的。

So let's go to the -- I think you meant 60-millimeter stapler.

那麼讓我們來看看——我想你的意思是 60 毫米訂書機。

On the SP front, not ready to call timing on labeling -- additional indications.

在 SP 方面，還沒有準備好在標籤上調用時間——額外的指示。

We'll pursue them with FDA over time.

隨著時間的推移，我們將與 FDA 一起追查它們。

And it depends a lot on what kind of data requirements we have and how that conversation goes.

這在很大程度上取決於我們有什麼樣的數據要求以及對話的進行方式。

We're focused right now on the first one.

我們現在專注於第一個。

And in terms of clinical capability and customer feedback, we're feeling quite positive.

在臨床能力和客戶反饋方面，我們感覺非常積極。

And so I think the conversation with FDA should be pretty direct and grounded.

所以我認為與 FDA 的對話應該非常直接和有根據。

Predicting the time line, we're not ready to do yet at this time.

預測時間線，我們現在還沒有準備好。

On the 60-millimeter, that's a set of products that we have gone back and forth over the years with approvals.

在 60 毫米上，這是我們多年來獲得批准的一系列產品。

I don't think it's wildly different in terms of what we can expect.

我認為就我們的預期而言，這並沒有太大的不同。

And I think historical time lines for approvals for us are probably good predictors of what happens on the 60-millimeter.

而且我認為我們批准的歷史時間線可能很好地預測了 60 毫米上發生的事情。

So I'm hopeful that we'll see it this year.

所以我希望我們能在今年看到它。

Okay.

好的。

And just a couple more for me, Gary.

加里，我還有幾個。

Just one on spending.

只有一個關於支出。

I think you're wisely investing away some of the tax benefit, but year-on-year, it's probably $150 million of incremental OpEx and probably $50 million more than we expected for 2018.

我認為你明智地投資了一些稅收優惠，但與去年同期相比，它可能增加了 1.5 億美元的運營支出，可能比我們 2018 年的預期多 5000 萬美元。

If you could just sort of give us a sense of where some of the key investment dollars are going here in '18.

如果你能讓我們了解一下 18 年一些關鍵投資資金的去向。

And then you mentioned this last quarter but not this quarter, in terms of hiring the management team for the China JV, where are you on CEO, CFO?

然後你提到了上個季度而不是這個季度，在為中國合資企業聘請管理團隊方面，你在 CEO 和 CFO 的位置在哪裡？

And what are their near-term priorities?

他們的近期優先事項是什麼？

Yes.

是的。

Fair question.

公平的問題。

On the investment side, as the business has strengthened over the last couple of years, we've increased our investments I think rationally.

在投資方面，隨著過去幾年業務的加強，我們增加了投資，我認為這是合理的。

They have been focused on a couple of things.

他們一直專注於幾件事。

One has been building depth in OUS markets.

一個是在 OUS 市場建立深度。

Our market presence and penetration in places like Japan and China and Germany, France, U.K. and so on are less than they are in the U.S. We think there is real opportunity for value creation in those markets.

我們在日本、中國、德國、法國、英國等地的市場佔有率和滲透率低於美國。我們認為這些市場存在創造價值的真正機會。

We want to make sure that we're not underinvesting there relative to the opportunity.

我們要確保相對於機會我們不會在那裡投資不足。

So that's one segment.

這是一個片段。

The next segment is, I really believe computer-assisted surgery, I think, has moved from an interesting part of minimally invasive surgery department to kind of an essential part of the portfolio.

下一個部分是，我真的相信計算機輔助手術，我認為，已經從微創手術部門的一個有趣部分轉變為投資組合的一個重要部分。

And as that happens, I think more and more opportunities, competitors and interest is being generated.

隨著這種情況的發生，我認為會產生越來越多的機會、競爭者和興趣。

And we want to make sure that Intuitive is investing for the long term.

我們希望確保 Intuitive 進行長期投資。

And I think you all will hold us to the quality of those investments.

我認為你們都會堅持這些投資的質量。

Mostly, the challenge here has not been identifying opportunity.

大多數情況下，這裡的挑戰並不是識別機會。

It's been making sure that if we invest in something, that we have the skill and capabilities to deliver it with excellence.

它一直在確保，如果我們投資某件事，我們就有能力以卓越的方式交付它。

And so we've been investing behind things that we think are good opportunities.

因此，我們一直在投資我們認為是好機會的事情。

And I think, over time, the wisdom of those decisions will play out.

而且我認為，隨著時間的推移，這些決定的智慧將會發揮作用。

So that's kind of mark, too.

所以這也是一種標記。

I think the last thing for us has been, as the business has accelerated, we see opportunities for taking advantage of scale and efficiency, and we think that will serve the company well and our customer base well in the future.

我認為對我們來說最後一件事是，隨著業務的加速發展，我們看到了利用規模和效率的機會，我們認為這將在未來為公司和我們的客戶群提供良好的服務。

So as volumes go up, we can convert some capital investments into operating efficiency.

因此，隨著銷量的增加，我們可以將一些資本投資轉化為運營效率。

You've seen us doing that, and I think that, that allows us to share with the customer some of those efficiencies that drives better quality performance in our products.

你已經看到我們這樣做了，我認為，這使我們能夠與客戶分享一些效率，這些效率可以推動我們產品的質量表現更好。

We think that's important as well.

我們認為這也很重要。

And so we've -- as we've seen strengthening, we've loosened some of those dollars, and I have to thank our operations team who've done a beautiful job investing for them wisely.

因此，我們已經——正如我們看到的那樣，我們已經放鬆了其中的一些美元，我必須感謝我們的運營團隊，他們為他們明智地進行了出色的投資。

Marshall, why don't you take the JV and China question, and I'll fill in behind.

Marshall，你為什麼不回答 JV 和中國的問題，我會在後面補上。

Sure.

當然。

In China, we have hired a CEO.

在中國，我們聘請了一位首席執行官。

We actually have also hired a CFO and a few other key members of the management team.

實際上，我們還聘請了首席財務官和管理團隊的其他幾位主要成員。

Right now, they are focused on building out that management team and getting prepared for eventual launch of the business itself.

現在，他們專注於組建管理團隊並為最終啟動業務本身做好準備。

Of course, the gating factor there is we're still working on the development of the catheter-based product here in the United States.

當然，這裡的門控因素是我們仍在美國致力於開發基於導管的產品。

And as that's completed, then elements of it in the business will start to be handed over to the JV.

完成後，業務中的元素將開始移交給合資企業。

Yes.

是的。

The early performance of that team, as they've entered our organization, is encouraging.

該團隊進入我們組織後的早期表現令人鼓舞。

The human capital that they're bringing to board looks pretty strong.

他們帶來的人力資本看起來非常強大。

So that has been a positive step for us in '17.

所以這對我們在 17 年邁出了積極的一步。

And we do have a question from the line of Tycho Peterson with JPMorgan.

我們確實有來自摩根大通第谷彼得森的問題。

I guess first question on Japan.

我想第一個問題是關於日本的。

I know you don't want to comment on reimbursement levels at this point.

我知道你現在不想評論報銷水平。

It's bit of a waiting game here.

這是一個等待遊戲。

But if we think about the 12 procedures that you got approval for, are there ones you want to call out that may be more exciting than others?

但是，如果我們考慮一下您獲得批准的 12 個程序，您是否想說出哪些可能比其他程序更令人興奮？

And maybe could you talk about what percentage of those are done open versus lapped across the 12 that have been approved?

也許你能談談在已批准的 12 個項目中，有多少百分比是開放完成的？

Well, it's hard to characterize which ones we're most excited about when you don't know what reimbursements are going to be.

嗯，當你不知道報銷是什麼時，很難描述我們最興奮的是哪些。

So I -- we can -- you've seen the list, and I think you can size yourself what you think the market opportunity might be.

所以我——我們可以——你已經看到了這份清單，我認為你可以自己衡量你認為市場機會可能是什麼。

But again, caution you that until reimbursements are announced, we're really not going to know.

但再次提醒您，在宣布報銷之前，我們真的不會知道。

And as Calvin said, there's also an element of adoption in terms of -- that will take place in terms of building out the sales force, building training capabilities and so forth.

正如卡爾文所說，在建立銷售隊伍、建立培訓能力等方面也有採用的因素。

There's also the -- as I said in my script, there's the alternate surgical approaches that may be used that you also have to deal with in adoption.

還有——正如我在我的腳本中所說的，還有可能使用的替代手術方法，您在收養過程中也必須處理這些方法。

So I think once we understand reimbursements and we start to dig into a little bit more after April 1 is when we'll know that, maybe we can start to talk a little bit more about the specific procedures.

所以我認為，一旦我們了解了報銷，並在 4 月 1 日之後開始深入研究，我們就會知道，也許我們可以開始更多地討論具體程序。

For me, just looking at the clinical side, I think there are a few things that are pretty exciting in the underlying dynamic in conversations that surgical societies have been having.

對我來說，僅從臨床方面來看，我認為在外科學會一直在進行的對話中，有一些潛在的動態非常令人興奮。

First, Marshall had mentioned that a laparoscopy is fairly penetrated in some of the markets in Japan.

首先，馬歇爾提到腹腔鏡在日本的一些市場相當普及。

Laparoscopic surgeons are quite capable and skilled in that market.

腹腔鏡外科醫生在那個市場上非常有能力和熟練。

And yet, we continue to have quite strong interest in use of our technologies there.

然而，我們仍然對在那裡使用我們的技術抱有濃厚的興趣。

And I think that's a positive development for us.

我認為這對我們來說是一個積極的發展。

It indicates that they are looking for clinical improvements and tool improvements over time.

這表明他們正在尋求隨著時間的推移進行臨床改進和工具改進。

And so things like hysterectomy, I think, are interesting for us.

所以我認為像子宮切除術這樣的事情對我們來說很有趣。

Hard for us to predict exactly what will happen.

我們很難準確預測會發生什麼。

It's a highly penetrated laparoscopic procedure with very skilled surgeons in Japan.

這是一種高度穿透的腹腔鏡手術，由日本非常熟練的外科醫生進行。

And yet, the interest is quite high.

然而，興趣相當高。

And that was one of the things that was studied pretty deeply.

那是非常深入研究的事情之一。

So I personally am excited to see how that unfolds over time.

所以我個人很高興看到隨著時間的推移會發生什麼。

It will change, as to Bob Hopkins' earlier question, how do you think about TAM?

關於 Bob Hopkins 之前的問題，您如何看待 TAM，這將會改變？

Japan is a great example of thinking through how do you do these TAM calculations because we'll see what the mix is with regard to laparoscopy versus robotics.

日本是思考如何進行這些 TAM 計算的一個很好的例子，因為我們將看到腹腔鏡與機器人技術的混合情況。

But I'm excited to see how that unfolds.

但我很高興看到它是如何展開的。

There are thoracic opportunities in the reimbursement as well that include -- and other things, GYN oncology.

報銷中也有胸部機會，包括——以及其他東西， GYN 腫瘤學。

So I think there are several things in there that, in the mid- to long term, I think will be really exciting for us in Japan.

所以我認為其中有幾件事，從中長期來看，我認為對我們日本來說真的很令人興奮。

I think the Japanese surgical societies and Japanese surgeons are thoughtful and deep, and that will be a great market to serve.

我認為日本外科學會和日本外科醫生深思熟慮，這將是一個很好的服務市場。

The one caution you've heard us say several times is that, it's more than reimbursement.

您已經多次聽到我們說過的一個警告是，它不僅僅是報銷。

We have to have the technology training pathways and resources in place.

我們必須擁有適當的技術培訓途徑和資源。

The proctoring networks will be built over time.

監考網絡將隨著時間的推移而建立。

Our sales team has to get deep with our customer.

我們的銷售團隊必須深入了解我們的客戶。

And so the near term, there is some hard work and sleeve-rolling to go do.

因此，在短期內，有一些艱苦的工作和袖手旁觀的事情要做。

I would -- that would not diminish my enthusiasm for the long term.

我會——從長遠來看，這不會削弱我的熱情。

Okay.

好的。

That's helpful.

這很有幫助。

And then a question on older systems, kind of 2 parts here: One, you had a big OUS trade-in number.

然後是關於舊系統的問題，這裡有兩部分：第一，你有一個很大的 OUS 折價號碼。

Was that just a function of the end of the X trading program?

這只是 X 交易程序結束的功能嗎？

And then you're still sort of selling a number of Si systems.

然後你仍然在銷售一些 Si 系統。

I think it was 20 this quarter.

我認為本季度是 20。

Why are customers opting for that versus the X?

為什麼客戶選擇那個而不是 X？

For -- so last one first.

因為 - 所以最後一個先。

For Si product, there are countries where we do not yet have regulatory approval for X, and therefore, we're still selling Sis.

對於 Si 產品，在某些國家/地區，我們尚未獲得 X 的監管批准，因此，我們仍在銷售 Sis。

There's also -- some customers have Sis already, and they don't want yet to move away from -- move in with a world where they have 2 sets of inventory and 2 sets of training protocol and so forth, and so they would rather step into an Si.

還有——一些客戶已經有了 Sis，他們還不想離開——進入一個他們有 2 套庫存和 2 套培訓協議等等的世界，所以他們寧願步入安思。

And then there are some countries where reimbursements are not so high, and they're looking for the cheapest product they can get, and an Si refurb fits that bill.

還有一些國家的報銷不是那麼高，他們正在尋找他們可以獲得的最便宜的產品，而 Si 翻新符合該要求。

But you probably will see the number of Sis we sell decline over time going forward as we get regulatory approvals and we're able to move Xs.

但是你可能會看到我們銷售的 Sis 數量隨著時間的推移而下降，因為我們獲得了監管批准並且我們能夠移動 Xs。

Yes.

是的。

On the system retirement side, I think there were 21 total, 18 retired in the field plus 3 that were in lease returns.

在系統退休方面，我認為總共有 21 人，其中 18 人在現場退休，另外 3 人在租賃回報中。

It's been higher than we've been running, but it's really an expected part of our business cycle.

它比我們一直運行的要高，但這確實是我們商業周期的預期部分。

And as you know, when a customer elects to stop using a particular system, they're usually going to trade it in, purchase a new system or just retire it out there in the field.

如您所知，當客戶選擇停止使用某個特定係統時，他們通常會以舊換新、購買新系統或乾脆在現場報廢。

And most of them end up being traded in, but some will end up being retired in the field and we saw that.

他們中的大多數人最終被交易，但有些人最終會在該領域退役，我們看到了這一點。

In Q4, we're able to confirm that there were 18 of these over 4,400 systems in the field, mostly older models, that are no longer being used.

在第 4 季度，我們能夠確認現場的 4,400 多個系統中有 18 個系統不再使用，其中大部分是舊型號。

So we just removed them from our installed base count.

所以我們只是將它們從我們的安裝基數中刪除。

Yes.

是的。

I think you were also asking about Europe and the trade-ins in Europe.

我想你也在問歐洲和歐洲的以舊換新。

Is that correct?

那是對的嗎？

Yes.

是的。

The trade-ins in Europe, even -- despite what I said about some customers want to -- don't want to enter into a world where they have 2 sets of inventory, there are those customers that want to standardize in the fourth generation product.

歐洲的以舊換新，甚至——儘管我說過一些客戶想要——不想進入一個他們有兩套庫存的世界，有些客戶想要在第四代中標準化產品。

And there's also a larger installed base of Ss and Sis in Europe in terms of mix relative to, let's say, the United States.

就混合而言，比方說，美國，在歐洲也有更大的 Ss 和 Sis 安裝基數。

And so we did see a number of customers in Europe trade out their Sis for X product so to get into the fourth generation product and have access into the latest instrumentation.

因此，我們確實看到許多歐洲客戶將他們的 Sis 換成 X 產品，以便進入第四代產品並獲得最新的儀器。

Okay.

好的。

And then last one, thinking about the mature procedures, in particular the dVP in the U.S. Anything in '18 that will change the trajectory relative to what you saw in '17?

然後是最後一個，考慮成熟的程序，特別是美國的 dVP。18 年的任何事情都會改變相對於你在 17 年看到的軌蹟的軌跡？

I think you kind of mentioned you're back to kind of the market growth rate there.

我想你有點提到你回到了那裡的市場增長率。

But just curious, I mean, I think there's been this expectation that it will decelerate a little bit for a while.

但只是好奇，我的意思是，我認為人們一直期望它會在一段時間內稍微減速。

I'm curious as to your thoughts.

我很好奇你的想法。

Yes.

是的。

I mean, the results in 2017 exceeded our expectation.

我的意思是，2017 年的結果超出了我們的預期。

Urology was up 8% for the year, and DVP is a big piece of that.

泌尿外科今年增長了 8%，而 DVP 是其中的重要組成部分。

So as kind of the standard for the surgical treatment of prostate cancer, we think that we'd be moving with the overall incidence rate, which is more like low single digits.

因此，作為前列腺癌手術治療的標準，我們認為我們會隨著整體發病率而變化，這更像是低個位數。

So our expectation within our guidance range at the low end of the high end is some moderation in the U.S. on prostatectomy in 2018.

因此，我們在高端低端指導範圍內的預期是美國在 2018 年對前列腺切除術有所緩和。

And we do have a question from the line of Larry Biegelsen with Wells Fargo.

我們確實有來自拉里·比格爾森與富國銀行的問題。

One on China, one in the flex catheter and just on the tax rate as well.

一個關於中國，一個關於柔性導管，還有一個關於稅率。

So on the Chinese quota, where are you guys in the process there?

那麼關於中國的配額，你們在那裡的過程在哪裡？

Do you have any visibility?

你有知名度嗎？

And is it still -- is it too late at this point to impact 2018?

它仍然 - 在這一點上影響 2018 年是否為時已晚？

On the flex catheter, Gary, on the last call, you sounded maybe optimistic that the CHEST data would be enough for FDA clearance in the U.S. Do you have confirmation of that at this point or any clarification?

關於柔性導管，加里，在上次電話會議上，您聽起來可能很樂觀，認為 CHEST 數據足以在美國獲得 FDA 批准。您目前對此有確認或任何澄清嗎？

And just lastly, Marshall, on the tax rate.

最後，馬歇爾，關於稅率。

I thought it would be a little bit lower than 20% to 22%.

我認為它會比 20% 到 22% 低一點。

Is there some conservatism there given the uncertainty?

鑑於不確定性，是否存在一些保守主義？

Or is there something else that we maybe didn't factor into some of the estimates we had?

或者是否有其他因素我們可能沒有考慮到我們的一些估計中？

Thanks, Larry.

謝謝，拉里。

Why don't you take that first one, Marshall?

你為什麼不拿第一個，馬歇爾？

Quota?

配額？

There's no new news on the quota.

沒有關於配額的新消息。

I mean, we sit here waiting, as do you, for news as to what the quota will be.

我的意思是，我們和你們一樣坐在這裡等待有關配額的消息。

On China, we don't have any indication that is either, a, intuitive-specific or something that we should be foundationally worried about.

關於中國，我們沒有任何跡象表明，直覺特定或我們應該從根本上擔心的事情。

So we're not looking at it and thinking something's wrong here or there's an Intuitive-specific indication.

所以我們不是在看著它並認為這裡有問題或者有一個特定於直覺的指示。

Nothing looks like that.

沒有什麼看起來像那樣。

If you ask the question, is it too late to impact 2018, I don't think so yet.

如果你問這個問題，影響 2018 年是否為時已晚，我認為還沒有。

Marshall, looking at you, I don't know how you feel about it.

馬歇爾，看著你，我不知道你是什麼感覺。

Yes.

是的。

I -- it's hard to know how long the tender process will take at the hospitals.

我——很難知道醫院的招標過程需要多長時間。

Last time we got a quota approved, quota was approved in 2013, and we didn't see many of the systems sold until the end of 2015.

上次我們批准了配額，配額是在 2013 年批准的，直到 2015 年底我們才看到很多系統售出。

I don't know whether that same time line will apply here.

我不知道同樣的時間線是否適用於此。

Moving to the flex question.

轉到彈性問題。

No change in my opinion about data requirements.

我對數據要求的看法沒有改變。

Either way, I wouldn't read anything in my comments last time or this time that would indicate a change.

無論哪種方式，上次或這次我都不會在我的評論中閱讀任何表明更改的內容。

And go to tax...

然後去報稅...

Tax, the tax rate, the range that Calvin gave is our best estimate.

加爾文給出的稅收、稅率和範圍是我們最好的估計。

You said that you thought it would have been lower.

你說你認為它會更低。

Clearly, a greater portion of our revenue is still generated in the United States, so more at the higher end.

顯然，我們收入的很大一部分仍然來自美國，因此更多來自高端市場。

There are -- there's the rate itself, the 21%, but then there are other elements of the Tax Act that add additional taxation on top of that.

有 - 有稅率本身，即 21%，但還有稅法的其他要素，在其之上增加了額外的稅收。

And so we've given you the range that we think will -- is the best estimate of what it is.

因此，我們為您提供了我們認為的範圍 - 是對它的最佳估計。

I don't -- I wouldn't call it conservative.

我不——我不會稱之為保守。

And we do have the question from the line of Amit Hazan with Citi.

我們確實收到了 Amit Hazan 與 Citi 的問題。

Let me start with gross margin guidance.

讓我從毛利率指導開始。

I think the last 2 years, you've kind of been nearing that 72% range.

我認為在過去的兩年裡，你已經接近 72% 的範圍。

FX is now kind of in your favor.

外匯現在對你有利。

You had pretty big capital year last year at lower margin.

去年你以較低的利潤率獲得了相當大的資本。

You're kind of implying that might not repeat again in '18, which is understandable.

你有點暗示 18 年可能不會再重複，這是可以理解的。

It seems like very little revenue is from new products, like the SP this year, as you're talking about how we should think about that brand.

似乎很少有收入來自新產品，比如今年的 SP，因為你在談論我們應該如何看待這個品牌。

So why shouldn't that gross margin number, at the very least, stay consistent with '17, if not go up a bit?

那麼，為什麼這個毛利率數字至少不能與 17 年保持一致，如果不上升一點呢？

Yes.

是的。

I think, like we said in the prepared comments, Amit, the primary driver there is going to be impact of new products.

我認為，就像我們在準備好的評論中所說的那樣，Amit 是新產品的主要驅動力。

And yes, we are going to do a phased launch of SPs as soon as we get clearance there in 60-millimeter like we talked about.

是的，我們將在獲得 60 毫米的許可後立即分階段發射 SP，就像我們談到的那樣。

And you have the direct margin on the product, but there's investments we make in the line and the teams and kind of the structure to make these things that kind of run through on the cost line.

你在產品上有直接利潤，但我們在生產線、團隊和結構上進行了投資，以使這些東西在成本線上貫穿始終。

It's -- a lot of that runs ahead of the higher revenue amounts.

它是 - 很多都在更高的收入之前運行。

Yes.

是的。

And then just a follow-up on the U.S. trade-in.

然後只是美國以舊換新的後續行動。

I'm kind of looking at the year.

我有點看年份。

Maybe a little bit surprised how, I think, trade-ins ended the year and the U.S. market actually down 50 units year-over-year, below even 2016 levels.

也許有點驚訝，我認為，以舊換新結束了今年，美國市場實際上同比下降了 50 個單位，甚至低於 2016 年的水平。

And I realize that's actually a positive for the installed base and for procedures.

我意識到這實際上對安裝基礎和程序來說是積極的。

But in terms of just thinking about the replacement opportunity, given an aging installed base in the U.S., how do we best think about the next couple of years for trade-ins?

但就更換機會而言，考慮到美國老舊的安裝基礎，我們如何最好地考慮未來幾年的折價？

Yes.

是的。

That's -- it's hard to estimate when the customers will get to where they want to, either standardized on fourth generation product or avail themselves to latest generation.

那就是——很難估計客戶何時會到達他們想要的地方，無論是標準化第四代產品還是利用最新一代產品。

I mean, the Si drives a substantial amount of our procedures.

我的意思是，Si 驅動著我們大量的程序。

It's a very capable system.

這是一個非常有能力的系統。

And in fact, even in situations where customers have suggested that they want to do a trade-in, at the end of the day, they're keeping the Si for either an outpatient care meeting other than the surgery center or they've decided that they've just got volume such that they want to keep it.

事實上，即使在客戶建議他們想要以舊換新的情況下，在一天結束時，他們也會將 Si 保留在手術中心以外的門診護理會議上，或者他們已經決定他們剛剛獲得了想要保留的音量。

So I don't know how to predict what the trade-in cycle would do over the next couple of years.

所以我不知道如何預測未來幾年的以舊換新周期。

Directionally, in terms of our intent, we think gen 4 is quite strong.

在方向上，就我們的意圖而言，我們認為第 4 代非常強大。

We think X is a good product, and we can deliver X to the installed base in attractive economic packages.

我們認為 X 是一個好產品，我們可以以極具吸引力的經濟包裝將 X 交付給安裝基礎。

And so that's an opportunity for us.

所以這對我們來說是一個機會。

It's just really a question -- I think directionally, we know where it's headed.

這真的是一個問題——我認為方向性的，我們知道它的發展方向。

I think the question is just how long it takes.

我認為問題在於需要多長時間。

And we want to -- we'll support our customers in their needs, but I think we have a good offer for them.

我們希望——我們將支持我們的客戶滿足他們的需求，但我認為我們為他們提供了一個很好的報價。

And just last one.

而只是最後一個。

Maybe I heard you wrong, just on imaging hardware for this year how much more you can tell us on what to expect in terms timing of new products, if it's possible that they'd be introduced in '18 like augmented reality, et cetera, and what we might expect there in terms of potentiality?

也許我聽錯了，就今年的成像硬件而言，如果有可能在 18 年引入增強現實等新產品，您可以告訴我們更多有關新產品時間的期望，以及我們在潛力方面可能期望的是什麼？

Yes.

是的。

Fair question.

公平的問題。

So when we think about imaging, there's 3 buckets that we think about in investments we make.

因此，當我們考慮成像時，我們會考慮 3 個方面的投資。

There's the hardware endoscope side, the sensors, the chips, the optics, the package.

有硬件內窺鏡方面、傳感器、芯片、光學器件和封裝。

And we have been investing in that and routinely improving those things, sometimes in big steps, sometimes in small steps.

我們一直在這方面進行投資，並定期改進這些東西，有時是大步，有時是小步。

Just as you would imagine each release of a cellphone has better camera systems, we follow a similar idea.

就像您想像的每個手機版本都有更好的相機系統一樣，我們遵循類似的想法。

And that's been powerful.

這很強大。

Those compound effects of improvements are pretty impressive.

這些改進的複合效果令人印象深刻。

Second thing is image processing software.

第二件事是圖像處理軟件。

The algorithms themselves to shape the image have also been improving over time, and also we can release in patches and updates.

隨著時間的推移，塑造圖像的算法本身也在不斷改進，我們也可以發布補丁和更新。

And then there's the contrast agents and molecules.

然後是造影劑和分子。

And we work all of them.

我們為所有這些工作。

And we often talk about molecules.

我們經常談論分子。

They're kind of the big thing to see.

他們是值得一看的大事。

They are long-term investments.

它們是長期投資。

And I was reminding everybody here, there are other things going on, too, that the hardware and the underlying software is good.

我在這裡提醒大家，還有其他事情也在發生，硬件和底層軟件都很好。

Augmented reality and -- or mix reality, the idea that you can take pre-opted images, manage them and get them in, we are making nice progress there.

增強現實和——或者說混合現實，你可以拍攝預先選擇的圖像、管理它們並讓它們進入的想法，我們在這方面取得了不錯的進展。

I don't expect material revenue in the year, but I do think that we'll start getting increased customer feedback over the year.

我預計今年不會有實質性收入，但我確實認為我們會在這一年開始獲得更多的客戶反饋。

And at least as we get close to the customer, we'll inform you more of where we are.

至少當我們接近客戶時，我們會更多地告知您我們的位置。

And we do have a question from the line of Isaac Ro with Goldman Sachs.

我們確實有來自 Isaac Ro 和 Goldman Sachs 的問題。

Two questions on Asia, one on China.

兩個關於亞洲的問題，一個關於中國。

Just curious what you guys are doing to try and drive penetration while we wait for the quota.

只是好奇在我們等待配額時你們正在做什麼來嘗試推動滲透。

Are you better off waiting for the government to give official order?

您最好等待政府下達正式命令嗎？

Are there other avenues that you're pursuing to try and drive access?

您是否正在尋求其他途徑來嘗試和推動訪問？

And then secondly on Japan.

其次是日本。

Just appreciate all the comments you made earlier, but I'm wondering how we should think about market development in that region as you get new applications.

感謝您之前發表的所有評論，但我想知道在您獲得新應用程序時我們應該如何考慮該地區的市場開發。

Are there a couple of obvious ways in which position training and so forth need to be different?

是否有一些明顯的方式需要不同的位置培訓等？

And how we should think about your process there?

我們應該如何考慮您在那裡的流程？

So for China, we have a number of systems -- 38 systems I think it is installed in the public hospitals that were subject to the quota.

所以對於中國，我們有很多系統——我認為是在受配額限制的公立醫院安裝了 38 個系統。

But our distributor is driving clinical adoption there, training surgeons and moving it up.

但是我們的分銷商正在那裡推動臨床採用，培訓外科醫生並將其提升。

That's why you see -- why you've heard us talk about increased utilization of those systems and increased number of procedures.

這就是為什麼你看到 - 為什麼你聽到我們談論增加這些系統的利用率和增加程序的數量。

The systems that are not subject to the quota really are those in military hospitals in Hong Kong.

不受配額限制的系統實際上是香港軍隊醫院的系統。

We actually sold 3 systems this quarter.

本季度我們實際上售出了 3 個系統。

That's not nearly the market of the public hospitals, but nonetheless, we're making progress in those markets and continue to try to drive expansion.

這幾乎不是公立醫院的市場，但儘管如此，我們正在這些市場取得進展，並繼續努力推動擴張。

And we think demand from Chinese surgeons and Chinese hospitals is very high, and so education and engagement is something that we can continue to do.

我們認為中國外科醫生和中國醫院的需求非常高，因此教育和參與是我們可以繼續做的事情。

I'll answer the Japan question, and operator, this will be our last question after that answer.

我將回答日本的問題，接線員，這將是我們在回答之後的最後一個問題。

With regard to Japan, I'd like to quote, "History doesn't repeat, but it does rhyme." I think about what we need to do in Japan in terms of market development.

關於日本，我想說一句，“歷史不會重複，但會押韻”。我在思考我們在日本市場開發方面需要做些什麼。

We -- our team in Japan is quite capable.

我們——我們在日本的團隊非常有能力。

They are engaged deeply with -- in communication with surgical societies around what training pathways look like, what educational and courseware kind of look like, things like fellowship programs and so on.

他們深入參與 - 與外科學會圍繞培訓途徑的樣子，教育和課件的樣子，獎學金計劃等進行溝通。

And so I don't think the work is a mystery.

所以我不認為這項工作是一個謎。

But it does take time in education, education of our own team and education of the market.

但是教育確實需要時間，教育我們自己的團隊，教育市場。

I think we have a senior leader in our General Manager in Japan.

我認為我們在日本的總經理中有一位高級領導。

I think this is a team that's capable.

我認為這是一支有能力的球隊。

So we will give them time to make progress here.

所以我們會給他們時間在這裡取得進展。

But I think they have a playbook they can work down.

但我認為他們有一本可以寫下來的劇本。

And while it's not identical to the playbook that we use in the U.S. or the ones that we use in Germany, the main elements of engagement are present.

雖然它與我們在美國使用的劇本或我們在德國使用的劇本不同，但參與的主要元素是存在的。

As we conclude this call -- that was our last question.

在我們結束本次電話會議時——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 and profits and cash flow during these conference calls, our organizational focus remains on increasing value by enabling surgeons to improve surgical outcomes and reduce surgical trauma.

正如我們之前所說，雖然我們在這些電話會議上關注收入和利潤以及現金流等財務指標，但我們的組織重點仍然是通過使外科醫生能夠改善手術結果和減少手術創傷來增加價值。

We have built our company to take surgery beyond the limits of the human hand, and I assure you that we remain committed to driving the vital few things that truly make a difference.

我們已經建立了我們的公司，以超越人手的極限進行手術，我向您保證，我們將繼續致力於推動真正有所作為的重要少數事情。

This concludes today's call.

今天的電話會議到此結束。

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

感謝您參與和支持這一非凡的手術改進之旅，我們期待在 3 個月後再次與您交談。

And ladies and gentlemen, that does conclude your conference for today.

女士們，先生們，今天的會議到此結束。

Thank you for your participation and for using the AT&T Executive TeleConference service.

感謝您的參與和使用 AT&T Executive TeleConference 服務。

You may now disconnect.

您現在可以斷開連接。