直覺手術 (ISRG) 2018 Q1 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Surgical Q1 2018 Earnings Release Call.

女士們，先生們，感謝您的支持，歡迎來到 Intuitive Surgical 2018 年第一季度收益發布電話會議。

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

（操作員說明）提醒一下，今天的會議正在錄製中。

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

我現在想將會議轉交給投資者關係財務高級總監 Calvin Darling。

Please go ahead.

請繼續。

Thank you.

謝謝你。

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

下午好，歡迎來到 Intuitive Surgical 第一季度收益電話會議。

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。

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

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

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

由於某些風險和不確定性，實際結果可能與明示或暗示的結果存在重大差異。

These risks and uncertainties are described in detail in the company's Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 2, 2018.

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 2018 年 2 月 2 日提交的最新 10-K 表格。

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

我們的 SEC 文件可以通過我們的網站或 SEC 的 EDGAR 數據庫找到。

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

提醒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 first quarter results as described in our press release announced earlier today followed by a question-and-answer session.

今天的形式將包括為您提供我們今天早些時候發布的新聞稿中描述的第一季度業績的亮點，然後是問答環節。

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

Gary 將介紹本季度的業務和運營亮點。

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

Marshall 將對第一季度的財務業績進行審查，然後我將討論程序和臨床重點，並提供我們對 2018 年的最新財務展望。

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

最後，我們將舉辦問答環節。

With that, I'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。

Intuitive is dedicated to the mission of improving the availability and quality of minimally invasive surgery.

Intuitive 致力於提高微創手術的可用性和質量。

We had a strong first quarter in pursuit of our mission with customer use of our systems at the top of our growth range, continued momentum in new system placements and stepwise progress in the development of markets outside the United States.

我們在第一季度實現了我們的使命，客戶對我們系統的使用處於我們增長范圍的頂端，新系統佈局的持續勢頭以及美國以外市場開發的逐步進展。

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

雖然我們對本季度的表現感到滿意，但手術方面的改進機會很大，還有很多工作要做。

Global procedure growth was approximately 15% in the first quarter of 2018.

2018 年第一季度全球手術量增長約 15%。

Underpinning this growth was increased use of da Vinci in general surgery in the United States, continued growth in urology in Europe and Asia and multi-specialty growth in China.

支持這一增長的是達芬奇在美國普外科的使用增加、歐洲和亞洲泌尿外科的持續增長以及中國多專業的增長。

General surgery growth was led by hernia repair and colon resection.

普通外科手術的增長由疝修補術和結腸切除術帶動。

Mature procedures in the United States, including prostatectomy and hysterectomy for malignant conditions, grew above expected rates again in the quarter.

美國的成熟手術，包括針對惡性疾病的前列腺切除術和子宮切除術，在本季度的增長率再次高於預期。

European procedure growth was mixed by country, partially as a result of headwinds in the number of business days relative to Q1 2017.

歐洲程序的增長因國家/地區而異，部分原因是相對於 2017 年第一季度的工作日數量不利。

Lastly, additional procedures were granted reimbursement by the Ministry of Health in Japan, effective April 1, 2018, at reimbursement rates equivalent to laparoscopy.

最後，自 2018 年 4 月 1 日起，日本衛生部批准額外手術報銷，報銷率與腹腔鏡檢查相當。

Calvin will review procedure trends in greater detail later in the call.

Calvin 將在稍後的電話會議中更詳細地審查程序趨勢。

Our capital placement performance in the first quarter of 2018 accelerated relative to 2017 with growth in total placements rising 39% from 133 to 185.

我們在 2018 年第一季度的資本配售業績相對於 2017 年有所加快，總配售量增長 39%，從 133 筆增至 185 筆。

Net of trade-ins and retirements, our da Vinci installed base grew by 13% over Q1 2017 from approximately 4,023 to approximately 4,528.

扣除以舊換新和報廢後，我們的達芬奇安裝基數比 2017 年第一季度增長了 13%，從大約 4,023 台增加到大約 4,528 台。

Placement performance was strong globally, particularly in the United States.

安置表現在全球範圍內都很強勁，尤其是在美國。

Capital placements have been lumpy, and we anticipate volatility in placements for the remainder of 2018.

資本配售一直起伏不定，我們預計 2018 年剩餘時間的配售將出現波動。

Turning to operations.

轉向運營。

Our performance in the first quarter met our expectations with good performance in product quality and cost reductions while average selling prices were stable.

我們在第一季度的表現符合我們的預期，在產品質量和成本降低方面表現良好，同時平均售價穩定。

Investments to deepen our regional capabilities and to develop new technologies and services continued to be important in the first quarter.

第一季度，用於深化我們的區域能力和開發新技術和服務的投資仍然很重要。

They will be so for the next several quarters as we progress through the launch of several products and build capability country by country.

在接下來的幾個季度中，隨著我們通過推出多種產品並逐個國家建立能力而取得進展，它們將如此。

We are also investing to strengthen our corporate infrastructure and position us to benefit from increased scale.

我們還在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。

Highlights of our first quarter operating results are as follows: Procedures grew approximately 15% over the first quarter of last year.

我們第一季度經營業績的要點如下： 程序比去年第一季度增長了約 15%。

We placed 185 da Vinci Surgical Systems, up from 133 in the first quarter of 2017.

我們放置了 185 個達芬奇手術系統，高於 2017 年第一季度的 133 個。

Our installed base grew 13% from a year ago.

我們的安裝基數比一年前增長了 13%。

Revenue for the quarter was $848 million, up 25%.

本季度收入為 8.48 億美元，增長 25%。

Pro forma gross profit margin was 71.6% compared to 72% in the first quarter of last year.

預計毛利率為 71.6%，而去年第一季度為 72%。

Instrument and accessory revenue increased to $460 million, up 21%.

儀器和附件收入增加到 4.6 億美元，增長 21%。

Total recurring revenue in the quarter was $623 million, representing 73% of total revenue.

本季度經常性總收入為 6.23 億美元，佔總收入的 73%。

We generated a pro forma operating profit of $346 million in the quarter, up 30% from the first quarter of last year.

本季度我們的預估營業利潤為 3.46 億美元，比去年第一季度增長 30%。

And pro forma net income was $288 million, up 46%.

預計淨收入為 2.88 億美元，增長 46%。

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。

Our da Vinci Xi Surgical System is our most capable multiport platform.

我們的 da Vinci Xi 手術系統是我們功能最強大的多端口平台。

We added our da Vinci X Surgical System in 2017, which offers fourth-generation imaging, robotics and instrumentation for focused-quadrant surgeries at an attractive value.

我們在 2017 年添加了 da Vinci X 手術系統，它以極具吸引力的價格為聚焦象限手術提供第四代成像、機器人和儀器。

The da Vinci X Surgical System received regulatory clearance by PMDA in Japan this month and was showcased at a large surgical society meeting, JSS, shortly thereafter.

da Vinci X 手術系統本月在日本獲得了 PMDA 的監管許可，並在此後不久在大型外科學會會議 JSS 上進行了展示。

Combined with reimbursement approvals mentioned above, we're pleased with recent progress in Japan.

結合上述報銷批准，我們對日本最近取得的進展感到滿意。

As we've discussed on prior calls, we plan to expand our Gen 4 family with a new capability in the form of da Vinci SP.

正如我們在之前的電話會議上所討論的那樣，我們計劃使用達芬奇 SP 形式的新功能來擴展我們的第 4 代產品系列。

We submitted our 510(k) for our current SP design in Q4 of '17 and have received questions back from FDA.

我們在 17 年第 4 季度提交了當前 SP 設計的 510(k)，並收到了 FDA 的回复。

We're preparing our response.

我們正在準備我們的回應。

And overall, SP is progressing to plan with a phased launch anticipated in 2018.

總體而言，SP 正在製定計劃，預計將於 2018 年分階段推出。

Also in the fourth quarter of 2017, we submitted our 510 application -- 510(k) application for our 60-millimeter surgical stapler for Gen 4 systems.

同樣在 2017 年第四季度，我們提交了 510 申請——用於 Gen 4 系統的 60 毫米外科縫合器的 510(k) 申請。

We've received the first round of questions from FDA and are in the process of responding to their requests.

我們已經收到了來自 FDA 的第一輪問題，並且正在回應他們的要求。

Our Gen 4 systems have received growing use by surgeons globally and by general surgeons, in particular.

我們的第 4 代系統越來越多地被全球外科醫生使用，尤其是普通外科醫生。

Including the 60-millimeter stapler, we're hard at work completing our advanced instrument offerings.

包括 60 毫米訂書機，我們正在努力完善我們的先進儀器產品。

We continue to make 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.

我們繼續在我們的靈活機器人平台上取得進展，首先是為了解決肺癌診斷的迫切需求，肺癌是世界上最常見的癌症之一，早期檢測對其很重要。

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

評估我們的技術相對於現有和最近宣布的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 to incorporate their 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他們的反饋，完成其生產設計和供應鏈優化，並完成監管提交的驗證。

We anticipate our 510(k) submission in 2018, and we have initiated the build of our commercial team, an outstanding and focused team of professionals.

我們預計在 2018 年提交 510(k)，我們已經啟動了我們的商業團隊的建設，這是一支優秀且專注的專業團隊。

I believe the opportunity for innovation in support of physicians in the flexible interventional space is substantial.

我相信在靈活的介入空間中支持醫生的創新機會是巨大的。

That said, adoption will require clinical and economic validation given the availability of multiple competing approaches in the market.

也就是說，鑑於市場上存在多種競爭方法，採用將需要臨床和經濟驗證。

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

最後，我們的成像團隊繼續開發識別組織的新方法，包括分子成像計劃的進展以及內窺鏡和圖像處理算法的改進。

We have been introducing improvements in our imaging hardware routinely and expect to continue to do so in the remainder of 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 年剩餘時間繼續這樣做。

We expect our lead molecular agent to enter Phase II trials in the second half of the year.

我們預計我們的主要分子藥物將在今年下半年進入 II 期試驗。

Stepping back and looking at the broader marketplace, our team's experience in robot-assisted surgery started decades ago at research groups predating the formation of the company.

退一步看看更廣闊的市場，我們團隊在機器人輔助手術方面的經驗始於幾十年前的研究小組，早於公司的成立。

Over this period, the rise of mechatronics, powerful computing, improved sensing, microfabrication and molecular imaging has enabled new approaches to old problems.

在此期間，機電一體化、強大的計算能力、改進的傳感、微細加工和分子成像技術的興起為解決老問題提供了新方法。

Intuitive has been investing in innovation, both incremental and revolutionary, with this in mind since our inception and with increased intensity for the past several years.

自成立以來，Intuitive 一直在投資於漸進式和革命性的創新，並在過去幾年中加大力度。

This opportunity to improve surgery using advanced technologies is now being recognized broadly, particularly in the past several years, and we anticipate the entry of additional systems by competitors into some regions of the world over the next several quarters.

這種使用先進技術改進手術的機會現在得到了廣泛認可，尤其是在過去幾年中，我們預計在接下來的幾個季度中，競爭對手將進入世界某些地區的其他系統。

To help our customers, Intuitive products and services are organized in generational families.

為了幫助我們的客戶，Intuitive 的產品和服務在世代相傳的家庭中進行組織。

Shared design principles, operating methods, user interfaces and product training allow surgical teams and hospitals to more quickly integrate new technologies and can deliver a significantly improved framework to training environments.

共享的設計原則、操作方法、用戶界面和產品培訓使外科團隊和醫院能夠更快地整合新技術，並可以為培訓環境提供顯著改進的框架。

As consolidation has progressed in health systems, standardization across surgical platforms can decrease variability and inefficiency from residency and fellowship programs to academic and community settings.

隨著衛生系統的整合取得進展，跨手術平台的標準化可以減少從住院醫師和研究金計劃到學術和社區環境的可變性和低效率。

Our fourth generation of surgical platforms offer our customers a fully enabled ecosystem of products and services in support of their programs.

我們的第四代手術平台為我們的客戶提供了一個完全可用的產品和服務生態系統，以支持他們的項目。

In closing, during 2018, our focus remains in completing the tasks we 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 flexible catheter platform; and finally, support for additional clinical and economic validation by global region.

最後，在 2018 年，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 和我們的柔性導管平台；最後，支持全球區域進行額外的臨床和經濟驗證。

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

我現在將把電話轉給馬歇爾，他將審查財務亮點。

Good afternoon.

下午好。

I will describe the highlights of our performance on a GAAP and non-GAAP or pro forma basis.

我將在 GAAP 和非 GAAP 或備考基礎上描述我們業績的亮點。

Our results are also posted on our website.

我們的結果也發佈在我們的網站上。

First quarter 2018 revenue of $848 million grew 25% compared with the first quarter 2017 revenue of $680 million and decreased 5% compared with the seasonally stronger fourth quarter revenue of $892 million.

2018 年第一季度收入 8.48 億美元，與 2017 年第一季度收入 6.8 億美元相比增長 25%，與季節性強勁的第四季度收入 8.92 億美元相比下降 5%。

In the first quarter of 2017, we deferred approximately $23 million of revenue associated with the da Vinci X trade-out program that we offered certain first quarter customers.

2017 年第一季度，我們遞延了與我們為某些第一季度客戶提供的達芬奇 X 交易計劃相關的大約 2300 萬美元的收入。

This revenue and the related costs are recognized in the third and fourth quarters of 2017.

該收入和相關成本於 2017 年第三和第四季度確認。

Our comparisons to 2017 results reflect the deferral as recorded.

我們與 2017 年結果的比較反映了記錄的延期。

We also have adopted the new revenue standard as required under GAAP and retroactively restated prior period results.

我們還按照 GAAP 的要求採用了新的收入標準，並追溯重述了前期業績。

We have updated the supplementary financial tables posted on our website to reflect this restatement.

我們更新了我們網站上發布的補充財務表以反映這一重述。

The adoption of the revenue standard had the effect of increasing first quarter 2017 total revenue by approximately $5 million and net income by approximately $1 million.

收入標準的採用使 2017 年第一季度的總收入增加了約 500 萬美元，淨收入增加了約 100 萬美元。

The impact on the annual results for 2017 was insignificant, increasing total 2017 revenue by approximately $9 million and increasing net income by $11 million.

對 2017 年年度業績的影響微乎其微，使 2017 年總收入增加約 900 萬美元，淨收入增加 1100 萬美元。

Revenue also benefited by approximately 2.5 percentage points from a weaker dollar.

收入也因美元疲軟而受益約 2.5 個百分點。

Excluding the impact of the revenue deferral and currency changes, revenue grew 18% relative to the restated 2017 first quarter.

排除收入遞延和貨幣變化的影響，收入相對於 2017 年第一季度重述後增長了 18%。

First quarter 2018 procedures increased approximately 15% compared with the first quarter of 2017 and were flat with last quarter.

與 2017 年第一季度相比，2018 年第一季度的程序增加了約 15%，與上一季度持平。

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 $460 million increased 21% compared with last year, which is higher than procedure growth, primarily reflecting increased usage of our advanced instruments and customer buying patterns.

儀器和附件收入為 4.6 億美元，比去年增長 21%，高於程序增長，主要反映了我們先進儀器的使用增加和客戶購買模式。

Instrument and accessory revenue realized per procedure was approximately $1,930, an increase of 5% compared with last year, primarily reflecting advanced instrument usage, customer buying patterns and the impact of a weaker U.S. dollar.

每個程序實現的儀器和配件收入約為 1,930 美元，比去年增長 5%，主要反映了先進儀器的使用、客戶購買模式和美元疲軟的影響。

Systems revenue of $235 million increased 46% compared with the first quarter of 2017, primarily reflecting higher system placements, the revenue deferral of $23 million in the first quarter of 2017 and a weaker U.S. dollar, particularly offset -- partially offset by an increase in the number of operating leases.

系統收入為 2.35 億美元，與 2017 年第一季度相比增長 46%，主要反映了更高的系統佈局、2017 年第一季度 2300 萬美元的收入遞延以及美元疲軟，特別是抵消了——部分被經營租賃的數量。

We placed 185 systems in the first quarter of 2018 compared with 133 systems in the first quarter of 2017 and 216 systems last quarter.

我們在 2018 年第一季度放置了 185 個系統，而 2017 年第一季度為 133 個系統，上個季度為 216 個系統。

43 operating lease transactions representing 23% of total placements were completed in the current quarter compared with 16% of total placements in the first quarter of 2017 and 19% last quarter.

本季度完成了 43 筆經營租賃交易，佔總安置的 23%，而 2017 年第一季度和上一季度分別佔總安置的 16% 和 19%。

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

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在長期內增加。

31% of the current quarter system placements involve trade-ins, reflecting customer desire to access or standardize on our fourth-generation technology.

本季度 31% 的系統佈置涉及以舊換新，反映出客戶希望訪問或標準化我們的第四代技術。

This is an increase in the proportion of trade-ins compared to 21% in the first quarter of 2017 and 26% last quarter.

與 2017 年第一季度的 21% 和上一季度的 26% 相比，以舊換新的比例有所增加。

However, trade-in activity is lumpy and difficult to predict.

然而，以舊換新活動起伏不定且難以預測。

76% of systems placed in the quarter were da Vinci Xis and 16% were da Vinci X systems compared with 67% da Vinci Xis and 24% da Vinci Xs last quarter.

本季度放置的系統中有 76% 是 da Vinci Xis，16% 是 da Vinci X 系統，而上一季度為 67% da Vinci Xis 和 24% da Vinci Xs。

Our installed base of da Vinci systems ended the quarter at 4,528 systems, up 13% year-over-year and average system utilization grew in the low single-digit range.

我們的達芬奇系統安裝基數在本季度結束時為 4,528 個系統，同比增長 13%，平均係統利用率在較低的個位數範圍內增長。

Globally, our average selling price, which excludes the impact of operating leases, lease buyouts and revenue deferrals, was approximately $1.49 million, which is slightly higher than the $1.47 million in the fourth quarter.

在全球範圍內，我們的平均售價（不包括經營租賃、租賃收購和收入遞延的影響）約為 149 萬美元，略高於第四季度的 147 萬美元。

The increase reflects a higher mix of Xi systems, a weaker U.S. dollar, partially offset by geographic mix.

這一增長反映了 Xi 系統的更高組合、美元疲軟，部分被地域組合所抵消。

Outside of the U.S., results were as follows: First quarter revenue outside of the U.S. of $275 million increased 49% compared with the first quarter of 2017 and increased 11% compared with last quarter.

在美國以外，業績如下：第一季度美國以外的收入為 2.75 億美元，與 2017 年第一季度相比增長 49%，與上一季度相比增長 11%。

The increase compared to the prior year reflects increased systems revenue of $55 million or nearly 100% growth and increased instruments and accessories revenue of $30 million or 32% growth.

與上一年相比的增長反映了系統收入增加 5500 萬美元或近 100% 的增長以及儀器和配件收入增加 3000 萬美元或 32% 的增長。

Systems revenue was driven by an increase in the number of systems placed, a lower number of operating leases, favorable product and geography mix and a weaker dollar.

系統收入的推動因素包括系統放置數量的增加、經營租賃數量的減少、有利的產品和地理組合以及美元疲軟。

Instrument and accessory revenue was primarily driven by procedure growth, a weaker dollar and customer buying patterns.

儀器和配件收入主要受程序增長、美元疲軟和客戶購買模式的推動。

OUS procedures grew approximately 18% compared with the first quarter of 2017.

與 2017 年第一季度相比，OUS 程序增長了約 18%。

OUS procedures were somewhat negatively impacted by the timing of holidays in 2018 compared with -- to 2017.

與 2017 年相比，2018 年的假期時間對 OUS 程序產生了一定的負面影響。

Outside of the U.S., we placed 73 systems in the first quarter compared with 56 in the first quarter of 2017 and 86 in the seasonally strong fourth quarter.

在美國以外，我們在第一季度部署了 73 個系統，而 2017 年第一季度為 56 個，季節性強勁的第四季度為 86 個。

Current quarter system placements included 45 into Europe, 9 in Japan.

當前季度系統安置包括 45 個進入歐洲，9 個在日本。

63% of the systems placed were da Vinci Xis compared with 54% in the first quarter of 2017 and 48% last quarter.

放置的系統中有 63% 是 da Vinci Xis，而 2017 年第一季度為 54%，上一季度為 48%。

Placements outside of the 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 regulation.

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監管的限制，因此美國境外的安置將繼續不穩定。

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 first quarter was 71.6% compared with 72% for the first quarter of 2017 and 72.4% last quarter.

第一季度的備考毛利率為 71.6%，而 2017 年第一季度為 72%，上一季度為 72.4%。

The decrease relative to the fourth quarter primarily reflects higher fixed costs spread over lower volumes.

與第四季度相比的下降主要反映了較高的固定成本分佈在較低的銷量上。

The decrease compared with the prior year primarily reflects product mix.

與上一年相比的減少主要反映了產品結構。

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

未來的利潤率將根據我們新產品的組合、系統和配件收入的組合、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 17% compared with the first quarter of 2017 and were flat compared with last quarter.

預計營業費用與 2017 年第一季度相比增長 17%，與上一季度持平。

Our spending is consistent with our plan, reflecting investments in da Vinci SP, catheter-based robotics, image 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、圖像和先進儀器的投資以及我們 OUS 市場的擴張。

These investments involve multiyear commitments.

這些投資涉及多年承諾。

Our pro forma effective tax rate for the first quarter was 20.1% compared with our expectations of 20% to 22%.

我們第一季度的備考有效稅率為 20.1%，而我們的預期為 20% 至 22%。

Our tax rates will fluctuate with changes in the mix of U.S. and OUS income, changes in taxation 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、地方當局稅收的變化以及一次性項目的影響而波動。

Our first quarter 2018 pro forma net income was $288 million or $2.44 per share compared with $197 million or $1.71 per share for the first quarter of 2017 and $305 million or $2.60 per share for the fourth quarter of 2017.

我們 2018 年第一季度的備考淨收入為 2.88 億美元或每股 2.44 美元，而 2017 年第一季度為 1.97 億美元或每股 1.71 美元，2017 年第四季度為 3.05 億美元或每股 2.60 美元。

First quarter 2017 GAAP pro forma net income per diluted share excluded $0.09 per share from the deferral of $23 million of revenue net of cost and income tax.

2017 年第一季度 GAAP 備考每股攤薄淨收益從 2300 萬美元扣除成本和所得稅的遞延收入中扣除每股 0.09 美元。

I will now summarize our GAAP results.

我現在將總結我們的 GAAP 結果。

GAAP net income was $288 million or $2.44 per share for the first quarter of 2018 compared with GAAP net income of $181 million or $1.57 per share for the first quarter of 2017 and a GAAP net loss of $32 million or $0.28 per share for the fourth quarter of 2017.

2018 年第一季度 GAAP 淨收入為 2.88 億美元或每股 2.44 美元，而 2017 年第一季度 GAAP 淨收入為 1.81 億美元或每股 1.57 美元，第四季度 GAAP 淨虧損為 3200 萬美元或每股 0.28 美元2017 年。

The adjustments between pro forma and GAAP net income are outlined and quantified in our website and include fourth quarter charges related to the U.S. Tax Cuts and Jobs Act, excess tax benefits associated with employee stock awards, employee equity and IP charges and legal settlements.

備考淨收入和 GAAP 淨收入之間的調整在我們的網站上進行了概述和量化，包括與美國減稅和就業法案相關的第四季度費用、與員工股票獎勵相關的超額稅收優惠、員工股權和知識產權費用以及法律和解。

Note that the IRS has not issued final regulations 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法規。

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

因此，我們第四季度和第一季度業績中反映的美國減稅和就業法案的影響以及我們對未來稅率的預測代表了我們對美國減稅和就業法案影響的最佳估計，並且可能會隨著稅收法規的最終確定而改變並進一步解讀。

We ended the quarter with cash and investments of $4.1 billion compared with $3.8 billion at December 31, 2017.

本季度末，我們的現金和投資為 41 億美元，而 2017 年 12 月 31 日為 38 億美元。

The increase reflects cash generated from operations of $280 million.

這一增長反映了 2.8 億美元的運營產生的現金。

We had not repurchased any shares in the quarter and have approximately $718 million remaining under the board buyback authorization.

我們在本季度沒有回購任何股票，董事會回購授權剩餘約 7.18 億美元。

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 first quarter procedure growth was 15% compared to 18% during the first quarter of 2017 and 17% last quarter.

我們第一季度的總體程序增長率為 15%，而 2017 年第一季度為 18%，上季度為 17%。

Our year-over-year Q1 procedure growth was driven by 14% growth in U.S. procedures and 18% growth in OUS markets.

我們第一季度程序的同比增長是由美國程序增長 14% 和 OUS 市場增長 18% 推動的。

In the U.S., overall, Q1 procedure performance by specialty closely aligned with patterns present in 2017.

在美國，總體而言，按專業劃分的第一季度程序性能與 2017 年的模式密切相關。

In U.S. general surgery, first quarter 2018 growth was consistent with 2017.

在美國普通外科，2018 年第一季度的增長與 2017 年持平。

Q1 growth was again driven by hernia repair, which continued to provide the most incremental cases and continued da Vinci adoption in colorectal procedures.

第一季度的增長再次受到疝修補術的推動，疝修補術繼續提供最多的增量病例，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 breadth of the general surgery category also contributed to growth.

減肥手術的早期採用和普外科類別的廣泛發展也促進了增長。

In U.S. gynecology, first quarter 2018 growth was consistent with 2017 trends as procedures grew modestly year-over-year with growth led by hysterectomy.

在美國婦科，2018 年第一季度的增長與 2017 年的趨勢一致，因為在子宮切除術的帶動下，手術量同比溫和增長。

We believe gynecologic procedure consolidation continues to drive modest growth as an increasing proportion of U.S. gynecology procedures are being performed by physicians that specialize in complex benign and cancer surgery, who tend to be users of da Vinci systems.

我們認為婦科手術合併繼續推動適度增長，因為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。

Q1 U.S. urology procedures had growth rates consistent with 2017, driven by prostatectomy volumes.

第一季度美國泌尿外科手術的增長率與 2017 年一致，受前列腺切除術數量的推動。

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 solid during the first quarter.

在美國的其他手術中，第一季度採用肺葉切除術和其他胸部手術的情況再次穩定。

Utilization of our da Vinci Xi systems and surgical staplers, which help to optimize robotic thoracic procedures, has been increasing.

我們的 da Vinci Xi 系統和外科吻合器有助於優化機器人胸腔鏡手術，其使用率一直在增加。

First quarter OUS procedure volume grew approximately 18% compared with 23% for the full year of 2017.

與 2017 年全年的 23% 相比，第一季度 OUS 手術量增長了約 18%。

First quarter 2018 OUS procedure growth was driven by continued growth in dVP procedures and earlier-stage growth in kidney cancer procedures, general surgery and gynecology.

2018 年第一季度 OUS 手術的增長是由 dVP 手術的持續增長和腎癌手術、普通外科和婦科的早期增長推動的。

The Q1 2018 OUS procedure growth rate was lower than the previous year, in part due to fewer operating days in Q1 2018 from the timing of holidays, including Easter.

2018 年第一季度 OUS 手術增長率低於上一年，部分原因是 2018 年第一季度的手術天數因節假日（包括復活節）而減少。

Procedure growth in China moderated meaningfully in the quarter, in part because da Vinci system capacity expansion is constrained by the system quota requirements, the most recent of which expired at the end of 2015.

中國的程序增長在本季度顯著放緩，部分原因是達芬奇系統產能擴張受到系統配額要求的限制，最新的配額要求已於 2015 年底到期。

We believe core demand for robotic surgery in China is meaningful.

我們認為中國對機器人手術的核心需求是有意義的。

In Japan, Q1 procedure growth in prostatectomy and partial nephrectomy moderated as these procedures have achieved high levels of adoption.

在日本，前列腺切除術和腎部分切除術的 Q1 手術增長放緩，因為這些手術的採用率很高。

As Gary indicated, effective April 1, 2018, 12 additional procedures have been approved for reimbursement in Japan with reimbursement equivalent to laparoscopic surgery.

正如 Gary 指出的那樣，自 2018 年 4 月 1 日起，日本批准了 12 項額外的報銷手術，報銷等同於腹腔鏡手術。

The applicable opportunity for da Vinci adoption within the set of procedures is difficult to estimate at this time due to the uncertainty of the perceived value of da Vinci relative to alternative surgical approaches.

由於達芬奇相對於替代手術方法的感知價值的不確定性，目前很難估計在一系列手術中採用達芬奇的適用機會。

With nearly 300 systems installed in Japan, the level and pace of system expansion in Japan over the next year is difficult to predict, but it will likely be modest.

日本安裝了近 300 個系統，明年日本系統擴展的水平和速度很難預測，但可能會適度。

Last week, we participated in the annual Society of American Gastrointestinal and Endoscopic Surgeons or SAGES meeting in Seattle.

上週，我們參加了在西雅圖舉行的美國胃腸和內窺鏡外科醫生協會或 SAGES 年度會議。

General surgery is our largest and fastest-growing specialty -- surgical specialty in the U.S., and this event represents one of the largest gatherings of general surgery practitioners and thought leaders.

普通外科是我們規模最大、發展最快的專業——美國的外科專業，這次活動代表了普通外科從業者和思想領袖最大的聚會之一。

As more general surgeons adopt robotics in their practices, at this year's conference, we continued to see increased numbers of robotic surgery presentations, clinical papers and podium speakers.

隨著越來越多的普通外科醫生在他們的實踐中採用機器人技術，在今年的會議上，我們繼續看到越來越多的機器人手術演示、臨床論文和講台演講者。

Included in the clinical data presented at SAGES were results from a study recently accepted for publication in the Hernia Journal titled, Open versus robotic-assisted transabdominal preperitoneal inguinal hernia repair: a multicenter matched analysis of clinical outcomes.

SAGES 上提供的臨床數據包括一項最近接受發表在疝氣雜誌上的研究結果，該研究題為“開放與機器人輔助經腹腹膜前腹股溝疝修補術：臨床結果的多中心匹配分析”。

Data from this study was presented by lead author, Dr. Reza Gamagami from New Lenox, Illinois.

這項研究的數據由伊利諾伊州新萊諾克斯的主要作者 Reza Gamagami 博士提供。

This study is one of the largest multicenter evaluations of outcomes associated with robotic-assisted inguinal hernia repair cases compared to more experienced open cases from the same surgeons.

與來自同一外科醫生的更有經驗的開放病例相比，這項研究是與機器人輔助腹股溝疝修復病例相關的結果的最大多中心評估之一。

In the matched analysis of 444 subjects in each cohort, robotic-assisted inguinal hernia repair cases demonstrated statistically significant lower post-discharge complication rates through 30 days with no reoperations related to the inguinal repair.

在對每個隊列中 444 名受試者的匹配分析中，機器人輔助腹股溝疝修補術病例顯示出院後並發症發生率在 30 天內顯著降低，並且沒有與腹股溝修補術相關的再次手術。

A multivariate analysis showed the open repair approach as a risk factor for complications within 30 days of the inguinal repair procedure.

多變量分析顯示，開放修復方法是腹股溝修復手術後 30 天內出現並發症的危險因素。

This study confirmed the robotic-assisted approach to inguinal hernia repair may provide patients with the benefits of minimally invasive surgery with the authors who had variable laparoscopic experience among them concluding that the robotic-assisted repair approach is a promising and reproducible approach which may facilitate the adoption of MIS repairs of inguinal hernia.

這項研究證實了機器人輔助腹股溝疝修補術可以為患者提供微創手術的好處，作者在腹腔鏡手術方面的經驗各不相同，他們得出結論認為機器人輔助修補術是一種有前途且可重複的方法，可以促進採用MIS修復腹股溝疝。

This study adds to the growing body of evidence demonstrating comparable or improved outcomes for subjects undergoing a robotic-assisted inguinal hernia repair independent of a surgeon's laparoscopic experience.

這項研究增加了越來越多的證據，表明接受機器人輔助腹股溝疝修補術的受試者的結果可比或改善，而與外科醫生的腹腔鏡經驗無關。

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。

On our last call, we forecast full year 2018 procedure growth within a range of 11% to 15%.

在我們的最後一次電話會議上，我們預測 2018 年全年程序增長在 11% 至 15% 的範圍內。

We are now refining the range and estimate full year 2018 procedure growth of 12% to 15%.

我們現在正在細化範圍並估計 2018 年全年程序增長 12% 至 15%。

With respect to revenue, as we have mentioned previously, capital placements 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，資本配置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 placements can vary substantially from period to period based upon many factors, including U.S. health care policy, hospital capital spending cycles, reimbursement and 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、報銷和政府配額、產品週期和競爭因素，資本配置在不同時期可能會有很大差異。

We had strong first quarter capital placements driven by customer capacity expansion and bolstered by a higher volume of capital upgrade transactions involving trade-ins of older da Vinci models than in recent quarters.

在客戶產能擴張的推動下，我們第一季度的資本配置表現強勁，並且涉及舊達芬奇模型以舊換新的資本升級交易量高於最近幾個季度。

In addition, as anticipated, a higher proportion of Q1 system placements were under operating lease terms, 23%.

此外，正如預期的那樣，更高比例的第一季度系統配售是根據經營租賃條款進行的，佔 23%。

This proportion may fluctuate some in the near term, but may trend further upwards in the long term.

這一比例在短期內可能會有所波動，但從長期來看可能會進一步上升。

Turning to gross profit.

轉向毛利。

We continue to expect our pro forma gross profit margin to be within a range of between 70% and 71.5% of net revenue.

我們繼續預計我們的備考毛利率將在淨收入的 70% 至 71.5% 之間。

This is modestly lower than our Q1 result of 71.6%, primarily reflecting higher costs associated with new products we expect to introduce later in the year.

這略低於我們第一季度 71.6% 的結果，主要反映了與我們預計在今年晚些時候推出的新產品相關的更高成本。

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

我們的實際毛利率將在很大程度上取決於產品和區域組合，每個季度都會有所不同。

Turning to operating expenses.

轉向運營費用。

We continue to expect to grow pro forma 2018 operating expenses between 16% and 18% above 2017 levels as we follow through on investments in several strategic areas intended to benefit the company over the long term.

我們繼續預計 2018 年的備考運營費用將比 2017 年的水平增長 16% 至 18%，因為我們會繼續在幾個旨在使公司長期受益的戰略領域進行投資。

We expect our noncash stock compensation expense to range between $245 million and $255 million in 2018 compared to $225 million to $235 million forecast on our last call.

我們預計 2018 年我們的非現金股票補償費用將在 2.45 億美元至 2.55 億美元之間，而我們上次電話會議預測的為 2.25 億美元至 2.35 億美元。

We expect other income, which is comprised mostly of interest income, to total between $55 million and $60 million in 2018, up from $45 million to $55 million forecast on our last call.

我們預計 2018 年主要包括利息收入的其他收入總額將在 5500 萬美元至 6000 萬美元之間，高於我們上次電話會議預測的 4500 萬美元至 5500 萬美元。

With regard to income tax, on our last call, we forecast our 2018 pro forma income tax rate to be between 20% and 22% of pretax income.

關於所得稅，在我們上次電話會議上，我們預測 2018 年預估所得稅稅率將在稅前收入的 20% 至 22% 之間。

We are now refining our estimate to the lower half of the range, between 20% and 21% of pretax income.

我們現在將我們的估計細化到範圍的下半部分，即稅前收入的 20% 到 21% 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。

That concludes our prepared comments.

我們準備好的評論到此結束。

We will now open the call to your questions.

我們現在將打開您的問題的電話。

(Operator Instructions) Our first question will come from the line of David Lewis with Morgan Stanley.

（操作員說明）我們的第一個問題將來自 David Lewis 與摩根士丹利的合作。

Congrats on quite a good quarter.

祝賀一個很好的季度。

So Gary, a couple of strategic questions for you.

加里，有幾個戰略問題要問你。

The first is on leasing.

首先是租賃。

So there -- there's more operating leases in the last 2 quarters than the prior 4 quarters, and it feels like the 23% number is frankly going higher.

因此，過去 2 個季度的經營租賃比前 4 個季度多，而且坦率地說，23% 的數字感覺更高。

So it's starting to feel this is much more company-driven than customer-driven.

所以它開始覺得這是公司驅動的，而不是客戶驅動的。

So the question is really, to what extent does leases make a lot more sense as competitors are coming to market, sort of in what way can leasing be very powerful defense?

所以真正的問題是，隨著競爭對手進入市場，租賃在多大程度上更有意義，租賃在何種程度上可以成為非常強大的防禦？

Yes.

是的。

So I -- first, thank you.

所以我 - 首先，謝謝。

I think to the extent that we can help customers access robotics for their programs and do it in a way that fits their needs, we're happy to do it with leasing.

我認為，就我們可以幫助客戶為他們的程序訪問機器人技術並以適合他們需求的方式進行操作而言，我們很樂意通過租賃來做到這一點。

I don't think it's a massive strategic change one way or another vis-à-vis competition.

我不認為這是針對競爭的一種或另一種方式的巨大戰略變化。

From our point of view, we're confident in our products.

從我們的角度來看，我們對我們的產品充滿信心。

We understand and are confident in the value they bring.

我們理解並相信它們帶來的價值。

If we can be flexible with customers and allow them to get access to the products they need when they need it, if we can make it a little easier for them to do it sooner rather than later in terms of their finances, that helps us.

如果我們能夠靈活對待客戶並允許他們在需要時獲得他們需要的產品，如果我們能夠讓他們更容易早日而不是晚些時候在他們的財務方面做到這一點，那對我們有幫助。

And we're willing.

我們願意。

I think over time customers are going to evaluate competitive systems.

我認為隨著時間的推移，客戶將評估有競爭力的系統。

They're going to go look at them.

他們要去看看他們。

And if somebody brings out a product that meets their needs better, I don't know that leasing one way or the other is going to make a difference.

如果有人推出更能滿足他們需求的產品，我不知道以這種或那種方式租賃是否會有所作為。

For us, it really is kind of a first principles thing.

對我們來說，這確實是一種首要原則。

Do you believe in robotic surgery as a way to increase the availability and quality of minimally invasive surgery?

您是否相信機器人手術可以提高微創手術的可用性和質量？

If you do and you're committed to it and we can find a way to help you get a system, then we're happy to do it.

如果您這樣做並且您致力於它，並且我們可以找到一種方法來幫助您獲得一個系統，那麼我們很樂意這樣做。

Okay.

好的。

And then curious, a question on the flexible catheter system as well.

然後很好奇，還有一個關於柔性導管系統的問題。

So based on your time line, I'm kind of assuming you're 9 months behind a recent competitive launch.

因此，根據您的時間表，我假設您比最近的競爭性發布晚了 9 個月。

So I just wonder, how concerned are you about this window?

所以我想知道，您對這個窗口的關注程度如何？

And you talked a lot about the ecosystem both at SAGES and again in this call.

你在 SAGES 和這次電話會議上都談到了很多關於生態系統的問題。

In what ways can sort of the multisystem ecosystem approach be sort of a barrier to entry for new robotic entrants in this segment?

多系統生態系統方法在哪些方面可以成為該領域新機器人進入者的進入障礙？

Yes.

是的。

I think in terms of any of the systems that we're going to place or somebody else places, I think the robot itself or the product itself is just the first step.

我認為就我們要放置的任何系統或其他人放置的系統而言，我認為機器人本身或產品本身只是第一步。

You have to provide the robot, but you also need the instruments and accessories.

你必須提供機器人，但你還需要儀器和配件。

You need to be able to help do product training.

您需要能夠幫助進行產品培訓。

You need to build proctoring networks.

您需要建立監考網絡。

You want to be able to help your customer do benchmarking and analytic analysis of usage patterns relative to what the rest of the world is doing.

您希望能夠幫助您的客戶對與世界其他地方正在做的事情相關的使用模式進行基準測試和分析分析。

And so I think they expect support beyond the dropping off of a system at the backdoor.

所以我認為他們希望得到支持，而不是在後門掉落一個系統。

And we have built that over years.

我們已經建立了多年。

We've come to understand it deeply.

我們已經深入了解它。

And I think it is valuable to our customer.

我認為這對我們的客戶很有價值。

And I think that helps us.

我認為這對我們有幫助。

I think other companies have various degrees of enablement in that space.

我認為其他公司在該領域有不同程度的支持。

With regard to flex catheter, in particular, we have been investing in it, as you know, for years and years.

特別是關於柔性導管，如您所知，我們多年來一直在對其進行投資。

This has been a long-term investment.

這是一項長期投資。

We have built technologies and made decisions about our architectures based on first principles, not by looking over our shoulder at what other people are doing, but by really engaging customers deeply and understanding their clinical needs.

我們已經根據第一原則構建技術並就我們的架構做出決策，不是通過我們的肩膀看其他人在做什麼，而是通過真正深入地吸引客戶並了解他們的臨床需求。

That has driven us -- continues to drive us.

這推動了我們——繼續推動著我們。

We have connections into the customer base because of those first principle investigations.

由於這些首要原則調查，我們與客戶群建立了聯繫。

And those folks visit us.

那些人來拜訪我們。

They look at our technologies.

他們看我們的技術。

They visit others and look at technologies on the market or soon to be on the market, and they make decisions.

他們拜訪他人，研究市場上或即將上市的技術，然後做出決定。

We're going to make decisions based on clinical value and demonstrable outcomes.

我們將根據臨床價值和可證明的結果做出決定。

You've seen the early parts of that with regard to the publications at CHEST.

您已經看到了與 CHEST 出版物相關的早期部分。

I think there are advantages for people who are first-movers, but I think they're short-lived.

我認為先行者有優勢，但我認為他們是短暫的。

I think that in this space because there are a lot of alternatives in the marketplace and because it's going to be a market that's driven by clinical data, over time, the best solutions are going to win.

我認為在這個領域，因為市場上有很多替代品，而且因為它將成為一個由臨床數據驅動的市場，所以隨著時間的推移，最好的解決方案將會獲勝。

And I'm confident in our technology and even more confident in our team.

我對我們的技術很有信心，對我們的團隊更有信心。

Our next question comes from the line of Bob Hopkins with Bank of America.

我們的下一個問題來自美國銀行的 Bob Hopkins。

Great.

偉大的。

So as I looked at your print, obviously, there's lots of big impressive numbers in this first quarter report, but one that really caught my eye was the system sales number.

因此，當我查看您的印刷品時，顯然，第一季度報告中有很多令人印象深刻的數字，但真正引起我注意的是系統銷售數字。

And I know, historically, that's primarily driven by procedure volumes and procedure volumes have been very strong.

而且我知道，從歷史上看，這主要是由手術量和手術量驅動的。

But I was wondering, given this is really the best growth, I think, you've seen in system placement since 2010, was there anything in particular that drove the strength this quarter.

但我想知道，鑑於這確實是最好的增長，我認為，自 2010 年以來你在系統佈局中看到的，是否有什麼特別推動了本季度的實力。

Just wondering if we can sort of tease out a little bit more what happened in systems placements this quarter.

只是想知道我們是否可以梳理出本季度系統佈局中發生的更多事情。

Bob, you're absolutely right.

鮑勃，你完全正確。

Systems placements are driven primarily by procedure growth.

系統佈局主要由程序增長驅動。

And you have to look at it over a period of time because systems can be lumpy in any particular quarter.

而且您必須在一段時間內查看它，因為系統在任何特定季度都可能不穩定。

So if you look at 2017, the installed base grew 13% and procedures grew 16%.

所以如果你看看 2017 年，安裝基數增長了 13%，程序增長了 16%。

So it was procedures that were really driving that installed base growth.

因此，真正推動安裝基數增長的是程序。

This quarter, we had a little bit higher proportion of trade-outs.

本季度，我們的交易比例略高。

That reflects, I think, as I said in my script, customers wanting to avail themselves to fourth-generation capabilities.

我認為，正如我在腳本中所說，這反映了客戶希望利用第四代功能。

And we also saw high sales of Xi validating that, that system has features that really are driving adoption.

我們還看到 Xi 的高銷量證實了這一點，該系統具有真正推動採用的功能。

So I think it's lumpy.

所以我認為它是塊狀的。

I think it's hard to make conclusions based on one quarter of increased trade-in volume.

我認為很難根據四分之一增加的以舊換新量來下結論。

And I just would be cautious there.

我只是會在那裡保持謹慎。

And we expect to see some volatility.

我們預計會出現一些波動。

But overall, over a longer period of time, systems will follow procedure growth.

但總的來說，在較長一段時間內，系統將跟隨程序增長。

Great.

偉大的。

And then I wanted to follow up also -- one more question on flex catheter.

然後我也想跟進——關於柔性導管的另一個問題。

Just curious, what's left to do before you file with the FDA?

只是好奇，在您向 FDA 提交申請之前還需要做什麼？

And just maybe thinking a little bit longer term, but when do you think we might start to hear a little bit more about other potential indications for flex catheter beyond lung?

也許只是考慮更長遠一點，但你認為我們什麼時候可能會開始聽到更多關於肺以外的柔性導管的其他潛在適應症？

Sure.

當然。

For now, as we said in the -- earlier in the script, the teams are really doing the product validations.

目前，正如我們在腳本前面所說的那樣，團隊確實在進行產品驗證。

They're doing the testing that supports our submissions.

他們正在進行支持我們提交的測試。

And we're stabilizing the supply chain.

我們正在穩定供應鏈。

And that's important.

這很重要。

When we launch, we want to feel good about our ability to make the products and our suppliers' ability to make their parts.

當我們啟動時，我們希望對我們製造產品的能力和我們的供應商製造他們的零件的能力感到滿意。

We're progressing.

我們在進步。

I think the team is doing a very good job.

我認為團隊做得很好。

So there, we're progressing against our plan.

因此，我們正在按照我們的計劃進行。

For starters, I -- as I've said I think in the past, I'm excited about the flex catheter technology because I think it's a platform and will have other opportunities outside of the lung.

對於初學者，我——正如我過去所說的那樣，我對柔性導管技術感到興奮，因為我認為它是一個平台，並且在肺部之外還有其他機會。

Where we are today is highly focused on bringing this first product to market and satisfying the needs of the interventional pulmonologists and thoracic surgeons.

我們今天所處的位置高度專注於將第一個產品推向市場並滿足介入肺科醫生和胸外科醫生的需求。

I think that is a major opportunity.

我認為這是一個重大機遇。

I think the -- perfecting the clinical pathways, the use of the product and data generation is important for us to focus on.

我認為——完善臨床路徑、產品的使用和數據生成對我們來說很重要。

And so our organization is tightly focused on that mission now.

因此，我們的組織現在正專注於該使命。

Perfect.

完美的。

And then, Gary, any update on China at all or?

然後，加里，關於中國的最新消息是什麼？

Marshall, you might speak to kind of where -- I think you're implying the quota, but why don't you speak to that?

馬歇爾，你可能會說到什麼地方——我認為你是在暗示配額，但你為什麼不說呢？

Yes.

是的。

We really don't have much of an update on the quota.

我們真的沒有太多關於配額的更新。

I mean, we still sit here awaiting the finalization of that quota.

我的意思是，我們仍然坐在這裡等待最終確定該配額。

Again, just to give you the background, the quota really applies to the years 2016 through 2020.

再次說明一下背景，配額實際上適用於 2016 年到 2020 年。

It's part of the 5-year planning -- budgeting process that the Chinese government goes through.

這是 5 年計劃的一部分——中國政府正在經歷的預算編制過程。

Central government has finalized its budget, but has not yet done its -- completed its negotiations with provinces and hospitals about who will get how many systems.

中央政府已經確定了預算，但尚未完成與各省和醫院就誰將獲得多少系統進行的談判。

And so we wait.

所以我們等待。

I think, in general, what's going on there doesn't appear to be Intuitive-specific.

我認為，總的來說，那裡發生的事情似乎並不是 Intuitive 特有的。

I think it's more rolling through the centralized government processes.

我認為它更多地通過中央政府流程滾動。

We think that the core interest by Chinese customers in our products and the company and robotic surgery more broadly is strong.

我們認為，中國客戶對我們的產品、公司和更廣泛的機器人手術的核心興趣是濃厚的。

And we feel slight forward progress in terms of the way the process has been moving.

就流程的推進方式而言，我們感到略有進步。

We just can't call what the time lines are.

我們只是不能說時間線是什麼。

And so we are at the limits of our ability to influence that outcome.

因此，我們影響該結果的能力已達到極限。

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

下一個問題將來自富國銀行的 Larry Biegelsen。

It looks like you guys had a 99% or almost 100% increase in the international system revenue, but about a 30% increase in the year-over-year systems shipped.

看起來你們的國際系統收入增長了 99% 或幾乎 100%，但係統出貨量同比增長了約 30%。

Marshall, what drove the difference in those growth rates?

Marshall，是什麼導致了這些增長率的差異？

Sure.

當然。

So a couple of things that I pointed out.

所以我指出了幾件事。

One was that in 2017 we had 6 leases.

一是在 2017 年，我們有 6 個租約。

In 2018, we had one.

2018 年，我們有一個。

Obviously, when you have an operating -- these are operating leases.

顯然，當你有經營時——這些就是經營租賃。

Operating leases, you don't have revenue.

經營租賃，你沒有收入。

So some of that is attributable to it.

所以其中一些歸因於它。

Also have a foreign exchange or currency exchange that was a wind at our back here as the U.S. dollar has weakened over the year.

由於美元在過去一年中走軟，我們還可以進行外匯或貨幣兌換。

And we also had a favorable mix of product.

我們也有一個有利的產品組合。

As I said in my script, we had a high mix of Xi around the world.

正如我在我的劇本中所說，我們在世界各地都有大量的 Xi。

That also included OUS.

這也包括 OUS。

And we also had a favorable geographic mix.

而且我們還有一個有利的地理組合。

If you notice, there was substantive sales into Europe.

如果您注意到，歐洲有大量銷售。

And again, these are lumpy.

再一次，這些是塊狀的。

So you can't take one geography and extrapolate that forward.

所以你不能把一個地理區域向前推算出來。

But in Europe, we did well.

但在歐洲，我們做得很好。

We did a little bit lower sales relative to the prior year in some of our distribution markets where we sell at a lower price.

在我們以較低價格銷售的一些分銷市場，我們的銷售額與上一年相比略有下降。

So you just put all those factors together and it adds up to increasing revenue to the extent that it did.

所以你只要把所有這些因素放在一起，它就會增加收入。

And then for my follow-up, we've been increasingly hearing that India could present itself as a large opportunity, potentially even becoming the #1 international market.

然後對於我的後續行動，我們越來越多地聽到印度可以將自己展示為一個巨大的機會，甚至有可能成為第一大國際市場。

Could you talk a little bit about how you see that market developing this year and over the next few years?

你能談談你如何看待今年和未來幾年這個市場的發展嗎？

We're optimistic that India will represent a good market long term, but I think, in the short term, to think that it's just going to snap to our second-largest market or our first-largest market is not going to happen.

我們樂觀地認為印度將長期代表一個良好的市場，但我認為，在短期內，認為它會迅速成為我們的第二大市場或我們的第一大市場是不會發生的。

We have a distributor there that we've been working with for years.

我們在那裡有一個合作多年的經銷商。

We've made -- I think we have around 40, 50 systems installed in India.

我們已經——我想我們在印度安裝了大約 40、50 個系統。

The total -- but the total number of procedures that they generate is maybe 1% of our total -- of our total procedures, so it's not consequential yet.

總數——但他們生成的程序總數可能占我們總數的 1%——我們所有程序的總數，所以這還不是很重要。

We are making investments in it.

我們正在對它進行投資。

We do think it's a -- again, long term, that it's a viable market and a good one for us, but we're at the very, very, very early stages.

我們確實認為這是一個——再一次，從長遠來看，這是一個可行的市場，對我們來說是一個很好的市場，但我們正處於非常、非常、非常早期的階段。

Yes.

是的。

We're actually at 68 systems in India currently.

我們目前在印度實際上有 68 個系統。

Our next question comes from the line of Tycho Peterson with JPMorgan.

我們的下一個問題來自摩根大通的第谷彼得森。

I'll add my congrats on the quarter.

我將對本季度表示祝賀。

Maybe first question on emerging procedures.

也許是關於新興程序的第一個問題。

Bariatric got a little bit more attention at SAGES this year.

Bariatric 在今年的 SAGES 上受到了更多關注。

And I know, Calvin, you called that out in your comments.

我知道，卡爾文，你在評論中提到了這一點。

I know you're in the process of getting back to FDA with the questions on the stapler.

我知道您正帶著有關訂書機的問題返回 FDA。

But Gary, can you maybe just talk a little bit about how you think about this market evolving and how much market development you guys need to put behind it once you get the stapler out?

但是加里，你能不能談談你如何看待這個市場的發展，以及一旦你把訂書機拿出來，你們需要在它背後投入多少市場發展？

It's going to be an interesting one to see evolve.

看到它的發展將是一件有趣的事情。

I think it's early for us to put much commentary on it.

我認為現在對它進行大量評論還為時過早。

We see interest by surgeons.

我們看到外科醫生的興趣。

Having said that, it's a highly penetrated procedure with laparoscopy.

話雖如此，這是一個高度穿透的腹腔鏡手術。

And there are a lot of highly skilled laparoscopists in that market and has a -- in that sense, it stands in contrast to prostatectomy or hysterectomy for malignant conditions which were predominantly open procedures.

在那個市場上有很多高技能的腹腔鏡醫生，並且有一個 - 從這個意義上說，它與主要是開放手術的惡性疾病的前列腺切除術或子宮切除術形成對比。

So we see some core demand and interest.

所以我們看到了一些核心需求和興趣。

Certainly, we want to complete the product offering and the stapler.

當然，我們要完成產品供應和訂書機。

I think the real question there of where could it go over time, I'd like to answer in future calls as we get a few quarters underneath our belt.

我認為真正的問題是隨著時間的推移它會去哪裡，我想在未來的電話中回答，因為我們有幾個季度的時間。

Okay.

好的。

And then thinking a little bit about Japan with reimbursement coming out at parietal lap, does that change your view on the adoption curve at all?

然後稍微考慮一下日本，在頂骨圈出現報銷，這是否完全改變了您對採用曲線的看法？

And are there steps you can take to try to increase the codes over time?

您是否可以採取一些措施來嘗試隨著時間的推移增加代碼？

Presumably, that will require additional studies.

據推測，這將需要額外的研究。

Yes.

是的。

I think that, in general, I think the reimbursement decision is a positive for us.

我認為，總的來說，我認為報銷決定對我們來說是積極的。

It's not an unalloyed positive.

這不是純粹的積極因素。

I think that it will concentrate adoption into the bigger centers.

我認為它將集中在更大的中心採用。

That's okay.

沒關係。

I think we're in a position to support that, and we will do so.

我認為我們有能力支持這一點，我們也會這樣做。

We will make investments for data collection in Japan.

我們將在日本進行數據收集投資。

And the use of that data collection will be certainly something we can share with surgical societies and with the government as time goes on.

隨著時間的推移，我們當然可以與外科學會和政府分享這些數據收集的使用。

And to the extent that we show additional value, I think it's something that the government will consider for future reimbursements.

就我們顯示出的附加價值而言，我認為政府會考慮將其用於未來的報銷。

I wouldn't ink anything on your calendars yet as to changes in reimbursement from this base level, I think that there's some water to go under the bridge here.

我不會在你的日曆上寫下任何關於從這個基本水平開始的報銷變化，我認為這裡有一些水可以通過橋下。

I think the interest, having just been in Japan, I think the interest is high.

我覺得興趣，剛來過日本，我覺得興趣很高。

I think the surgical society is seeing it as a positive step and an endorsement by the government.

我認為外科學會將其視為積極的一步和政府的認可。

I think that the economics in the right centers will work well for them.

我認為正確中心的經濟學對他們來說會很好。

And it's an exciting time for us and our team in Japan.

對於我們和我們在日本的團隊來說，這是一個激動人心的時刻。

And I'm looking forward to seeing them have a chance to broaden their base of business and get to know more customers.

我期待看到他們有機會擴大業務基礎並結識更多客戶。

Okay.

好的。

And then lastly on SP, are you willing to comment, were there any surprises in the FDA questions from your perspective?

最後關於 SP，您是否願意發表評論，從您的角度來看，FDA 的問題是否有任何意外？

And then as we think about the rollout, obviously, you've talked about the 3 initial application areas.

然後當我們考慮推出時，顯然，您已經談到了 3 個初始應用領域。

It seems like there's already some interest in other use cases.

似乎已經有人對其他用例感興趣了。

So I'm just curious about how much pent-up demand you think there is out there today.

所以我很好奇你認為今天有多少被壓抑的需求。

In terms of the nature of the questions that came back, I think it's within the kinds of conversations we've had with FDA over the years.

就返回的問題的性質而言，我認為這是我們多年來與 FDA 進行的各種對話。

And so I think our teams are working on it.

所以我認為我們的團隊正在努力。

I don't see commentary that I would signal to you one way or another, either particularly small questions or particularly big ones.

我沒有看到評論說我會以某種方式向您發出信號，無論是特別小的問題還是特別大的問題。

I think it's right down the middle.

我認為它就在中間。

With regard to potential applications over time, I think general interest in SP is high.

關於隨著時間推移的潛在應用，我認為對 SP 的普遍興趣很高。

What's exciting to me and I think one of the things that made us excited to invest in it in the first place is that it allows an approach to -- entry into the body that's a little more flexible than multiport approaches.

讓我興奮的是，我認為首先讓我們興奮地投資它的一件事是它允許一種方法——進入比多端口方法更靈活的身體。

And I think that will open some opportunities in the future for surgeons who are looking for alternatives.

我認為這將為正在尋找替代方案的外科醫生在未來打開一些機會。

Of course, that takes time.

當然，這需要時間。

We'll have to do protocol development and data collection to get additional clearances as needed.

我們必須進行協議開發和數據收集，以便根據需要獲得額外的許可。

But that is anticipated.

但這是意料之中的。

That was not unanticipated.

這並非出乎意料。

That was part of what we had thought in terms of investing in the platform.

這是我們在投資平台方面的想法的一部分。

This year will be a limited launch as we build volume and as we start to do things like enabling the proctor network and pursuing the sequential indications that we've talked about.

今年將是一個有限的發布，因為我們建立了數量，並且我們開始做一些事情，比如啟用代理網絡和追求我們已經討論過的順序指示。

So far, so good.

到目前為止，一切都很好。

I think the team is on plan.

我認為團隊正在計劃中。

I think the clinical response we've been getting from surgeons who are evaluating the data and looking at the basic architecture looks really good.

我認為我們從評估數據和查看基本架構的外科醫生那裡得到的臨床反應看起來非常好。

Our next question comes from the line of Amit Hazan with Citi.

我們的下一個問題來自花旗銀行的 Amit Hazan。

Just want to ask a couple guidance questions and then one other for Gary.

只想問幾個指導問題，然後再問一個問題給加里。

First, on the procedure guidance, just trying to understand the changes that you've moved the numbers modestly, but not too much, that this was the toughest comp you had all year.

首先，在程序指南上，只是試圖了解您適度移動數字的變化，但不要太多，這是您全年遇到的最艱難的比賽。

You put up a nice 15% right at the top of your prior guide.

您在之前指南的頂部設置了 15% 的比例。

Your installed base growth is still at 13% here, holding really nicely.

您的安裝基數增長率仍為 13%，保持得非常好。

Just trying to understand what you're thinking about at the midpoint and low end of that guidance now.

只是想了解您現在在該指南的中點和低端的想法。

Is it OUS returning to 20%-type growth or what else should we be thinking about towards the low to mid end of procedure guide?

是 OUS 恢復到 20% 類型的增長還是我們應該考慮到程序指南的中低端？

Yes.

是的。

The elimination of the low end of the range reflects our Q1 performance, including the continued growth in general surgery, colorectal, OUS kind of on pace with the trends we saw in 2017.

範圍低端的消除反映了我們第一季度的表現，包括普通外科、結直腸癌、OUS 的持續增長，與我們在 2017 年看到的趨勢同步。

We also benefited from growth in -- again, mature gynecology, urology procedures.

我們還受益於成熟的婦科、泌尿外科手術的增長。

Our current guidance assumption, at the low end on the U.S. side, probably in gynecology, shifting over to a low single-digit decline, which we think is aligned with the overall benign hysterectomy market, moving to low single digit in urology growth and then some moderation within general surgery, mostly reflecting law of big numbers with some modest contributions in thoracic, bariatrics and other earlier-stage procedures.

我們目前的指導假設，在美國方面的低端，可能是婦科，轉向低個位數下降，我們認為這與整體良性子宮切除術市場一致，泌尿科增長轉向低個位數，然後普通外科手術中的一些適度，主要反映了大數定律，在胸科、減肥和其他早期手術中有一些適度的貢獻。

We -- OUS, no system quota in China to the extent it's going to add capacity and kind of a slower ramp in Japan with the new procedure set.

我們 - OUS，中國沒有系統配額，在一定程度上它將增加容量，並且在日本採用新程序設置時速度會變慢。

On the high end, still maintaining the trends in gynecology with low single-digit growth.

在高端，婦科仍保持低個位數增長的趨勢。

Urology maybe some, just minor moderation there to mid-single-digit growth and very slight moderation in U.S. general surgery and continued nice trends in bariatrics and the emerging procedures.

泌尿外科可能有一些，只是輕微放緩至中個位數增長，美國普通外科手術略有放緩，減肥和新興手術的持續良好趨勢。

We do expect some moderation in China, but probably less so at the high end of the range.

我們確實預計中國會有所放緩，但在範圍的高端可能不會那麼嚴重。

Good color.

好顏色。

And then kind of burning question here that we haven't asked in a while for Gary, I just want to ask.

然後這裡有一個我們已經有一段時間沒有問加里的緊迫問題了，我只想問一下。

So given the success you've been experiencing, what's the biggest risk you see for the Intuitive story today?

那麼，鑑於您所取得的成功，您今天看到的 Intuitive 故事最大的風險是什麼？

I guess I'd start with -- I think the opportunity for the use of advanced technologies to help surgery is really substantial.

我想我會開始——我認為使用先進技術來幫助手術的機會真的很大。

And there are both a lot of interesting scientific advances in the space we're in and there's a lot of need.

在我們所處的空間中，有很多有趣的科學進步，也有很多需求。

I think there's -- as always, there's kind of 2 or 3 risks that an organization like ours, I think, has to manage.

我認為，與往常一樣，像我們這樣的組織必須管理 2 或 3 種風險。

One of them is, I think the day-to-day operations that are required to supply your customers can keep you from making the long-term investments you need to keep advancing the [yard].

其中之一是，我認為為客戶供貨所需的日常運營可能會阻止您進行持續推進 [yard] 所需的長期投資。

And so we manage that firmly, but I think that you need to do both.

所以我們堅定地管理它，但我認為你需要兩者兼顧。

And I think that we'll have missed a serious opportunity if the systems that are in the world a decade from now look like today's.

而且我認為，如果十年後世界上的系統看起來像今天的系統，我們將錯失一個重要的機會。

So I think that there's real opportunity for advancement.

所以我認為有真正的進步機會。

So that's one.

這就是一個。

I think the second thing that's just vital is that these things are complex technologies.

我認為第二件至關重要的事情是這些東西是複雜的技術。

They absolutely require outstanding human beings and human capital.

他們絕對需要優秀的人才和人力資本。

And they need to be built -- brought into a company that has a culture of satisfying the customer and of performance.

他們需要被建立——被帶入一個擁有滿足客戶和績效文化的公司。

And so I think washing out culture with growth can be something that is a problem, and we need to attend to it.

因此，我認為隨著增長淘汰文化可能是一個問題，我們需要關注它。

And I think the last thing is that health care is local.

我認為最後一件事是醫療保健是本地的。

I think that when we want to make progress outside the United States, it takes a deep understanding of the countries that we're working in and real skill and capability there.

我認為，當我們想要在美國以外取得進展時，需要深入了解我們正在開展工作的國家以及那裡的真正技能和能力。

The metal may look the same, but the health care system and the way it values products differs.

金屬可能看起來相同，但醫療保健系統及其對產品的估值方式不同。

And I think that being too shallow in those assessments can lead to risk in underperformance.

而且我認為，在這些評估中過於膚淺可能會導致表現不佳的風險。

And if we underperform, then others will satisfy the need.

如果我們表現不佳，那麼其他人就會滿足需求。

So those are kind of the big 3 for me.

所以這些對我來說是三巨頭。

Our next question comes from the line of Richard Newitter with Leerink Partners.

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

Congrats on the quarter.

祝賀這個季度。

I just wanted to clarify, on the comments with respect to guidance and how China fits in.

我只是想澄清有關指導意見以及中國如何融入的評論。

I think, Calvin, you said China utilization or growth slowed in 1Q as you had called out previously.

我想，卡爾文，你說過中國第一季度的利用率或增長放緩，正如你之前所說的那樣。

If that -- if the current level of China growth were to hold and persist for the rest of the year, is there still a way for you to get to the upper end of your guidance assuming no quota?

如果那樣——如果中國目前的增長水平在今年餘下時間保持並持續下去，假設沒有配額，你是否還有辦法達到指導的上限？

In other words, how dependent on China with where your run rate is now, your latest data point, to hit the upper end of your guidance?

換句話說，你現在的運行率、你的最新數據點對中國的依賴程度如何達到你的指導上限？

No.

不。

I think it'd be possible.

我認為這是可能的。

Again, I think we are calling for some moderation in China.

同樣，我認為我們呼籲中國採取一些溫和措施。

And just order of magnitude, right, the U.S. business, general surgery is our largest category, and the U.S. gynecology is a large set of procedures in that mature category as is urology.

只是一個數量級，對，美國商業，普通外科是我們最大的類別，美國婦科是成熟類別中的一大套程序，泌尿外科也是如此。

So I think those just have larger bases of business that kind of -- things impacting them are going to have a bigger impact, at least on this year, in terms of the growth rates and guidance.

所以我認為那些只是擁有更大的業務基礎——影響他們的事情將產生更大的影響，至少在今年，就增長率和指導而言。

Okay.

好的。

And maybe just one follow-up on an earlier question on bariatric.

也許只是對先前關於減肥的問題的後續行動。

One of the things that we continue to see in this market is the adoption of sleeve gastrectomy at the expense of gastric bypass.

我們在這個市場上繼續看到的一件事是以胃旁路術為代價採用袖狀胃切除術。

And I was just wondering, are you guys feeling like the application of the robot has a bigger appeal or a bigger unmet need in either 1 of those 2?

我只是想知道，你們是否覺得機器人的應用在這兩個中的任何一個中具有更大的吸引力或更大的未滿足需求？

And can you succeed if the world goes the way of sleeve gastrectomy?

如果世界走袖狀胃切除術，你能成功嗎？

If I understand the question right, the difference in suturing is a lot in terms of the amount of suturing between those 2. I think it's too soon to tell right now what the -- kind of the value statements are going to be in bariatric surgery over time.

如果我對這個問題的理解是正確的，那麼就這兩者之間的縫合量而言，縫合的差異很大。我認為現在判斷減重手術中的價值陳述是什麼還為時過早隨著時間的推移。

Like I said, I think there's some core interest here.

就像我說的，我認為這裡有一些核心利益。

The procedures are taxing on surgeons.

這些程序對外科醫生來說很費力。

They're a demanding procedure.

他們是一個要求很高的程序。

And there are differences between those 2 techniques.

這兩種技術之間存在差異。

I think stay tuned is really the short answer here.

我認為敬請期待真的是這裡的簡短答案。

We'll let it play out over the next few quarters and report back.

我們將讓它在接下來的幾個季度中發揮作用並報告。

Our next question comes from the line of Rick Wise with Stifel.

我們的下一個問題來自 Rick Wise 與 Stifel 的對話。

Thanks for the awesome quarter.

感謝精彩的季度。

Just 2 questions for me and maybe just a little more color on hernia adoption, hernia outlook.

對我來說只有 2 個問題，也許只是關於疝氣收養、疝氣前景的更多顏色。

Obviously, continues to go great.

顯然，繼續走得很好。

Just curious, from your perspective, what inning do you think we're in, in terms of robotic adoption?

只是好奇，從你的角度來看，你認為我們在機器人採用方面處於什麼階段？

How sustainable is this kind of growth you're seeing over the next few years?

您在未來幾年看到的這種增長的可持續性如何？

And maybe a little color on -- is this -- I assume largely driven by incisional at this point or is inguinal catching up?

也許有點顏色——這是——我假設在這一點上主要是由切口驅動的還是腹股溝趕上了？

Just help us reflect on the drivers as you look out over the next few years.

在您展望未來幾年時，請幫助我們反思驅動因素。

Sure.

當然。

This is Gary.

這是加里。

The -- I think we're still in the early part of the game.

- 我認為我們仍處於遊戲的早期階段。

I don't know exactly what inning and whether there'll be extra innings or not, but we're not in the first inning.

我不知道具體是哪一局，是否會有加時賽，但我們不在第一局。

It's now becoming evaluated fairly broadly.

它現在得到相當廣泛的評估。

Inguinal is -- has been the primary driver in the hernia space to date.

迄今為止，腹股溝一直是疝空間的主要驅動力。

We think incisional hernias are also an opportunity and that may rise in the future relative to inguinal.

我們認為切口疝也是一個機會，未來相對於腹股溝疝可能會增加。

So, so far, so good.

所以，到目前為止，一切都很好。

We look at, of course, clinical publications and presentations and value statements as reported by clinicians.

當然，我們會查看臨床醫生報告的臨床出版物和演示文稿以及價值聲明。

We also look at reorder patterns and use.

我們還研究了重新排序模式和使用。

Are they trialing?

他們在試煉嗎？

Are they sticking with it?

他們堅持嗎？

And so far, the performance in terms of ongoing use and stickiness -- sticking with the procedure once they've tried it is quite good in inguinal hernia repair.

到目前為止，在持續使用和粘性方面的表現——一旦他們嘗試過就堅持這個程序在腹股溝疝修補術中非常好。

And that's a good sign for us.

這對我們來說是一個好兆頭。

So we think we bring real value here and customers seem to report back as much.

所以我們認為我們在這裡帶來了真正的價值，客戶似乎也反饋了很多。

We look forward to the next several quarters.

我們期待接下來的幾個季度。

Yes.

是的。

And just last for me, Gary.

最後對我來說，加里。

The -- you've been kind enough in the past to be, I think, very frank and direct about the competition -- looming competition.

我認為，你過去一直很友善，對競爭非常坦率和直接 - 迫在眉睫的競爭。

And just -- I'd be curious to hear your latest thoughts.

只是——我很想听聽你的最新想法。

The 2 larger companies since we last spoke in this kind of context, one of the competitors seems to be delayed.

自從我們上次在這種情況下發言以來，兩家較大的公司，其中一個競爭對手似乎被推遲了。

You now have a smaller competitor approved in the U.S. and in Europe.

您現在有一個較小的競爭對手在美國和歐洲獲得批准。

Just curious how all this is changing or affecting the market or selling discussions.

只是好奇這一切如何改變或影響市場或銷售討論。

Is it slowing down or is it a positive?

是放緩還是積極？

Is there a slowdown?

有放緩嗎？

Again, any updated perspective would be very welcome.

同樣，我們非常歡迎任何更新的觀點。

Yes.

是的。

As we said before, I think that the need is clear, and I think that the opportunity afforded by the kind of the core technologies that are available are also clear now -- have become clear.

正如我們之前所說，我認為需求很明確，而且我認為可用的核心技術所提供的機會現在也很明確 - 已經變得清晰。

I think customers are always interested in choice.

我認為客戶總是對選擇感興趣。

We can provide them choice within our ecosystem, but they'll look for choice outside that ecosystem also.

我們可以在我們的生態系統內為他們提供選擇，但他們也會在該生態系統之外尋找選擇。

And I anticipate it.

我預料到了。

And my response to customers when they ask is, they should evaluate the alternatives.

當客戶詢問時，我的回答是，他們應該評估備選方案。

I guess what I would say is, the hardest thing to compete with is the PowerPoints that don't yet exist in a product.

我想我要說的是，最難與之競爭的是產品中尚不存在的 PowerPoint。

There are concepts that can't really be evaluated.

有些概念無法真正評估。

I think, in general, the existence of competition validates the space.

我認為，總的來說，競爭的存在驗證了空間。

I think that it signals to surgical societies the broader acceptance of the concept itself.

我認為它向外科學會發出了對概念本身更廣泛接受的信號。

I think that's generally positive.

我認為這通常是積極的。

I think these organizations out there that are large and small are staffed by capable people.

我認為這些大大小小的組織都配備了有能力的人。

And I think that they're going to work hard and look at alternatives.

而且我認為他們會努力工作並尋找替代方案。

And to the extent that they come up with some really strong ones, I think that will change what's happening at our customer base.

就他們提出一些非常強大的問題而言，我認為這將改變我們客戶群的現狀。

But so far, so good.

但到目前為止，還不錯。

I haven't seen product concepts so far that Intuitive hasn't either considered and built or considered and consciously passed on.

到目前為止，我還沒有看到 Intuitive 沒有考慮並構建或考慮並有意識地傳遞的產品概念。

It doesn't mean that we're not wrong.

這並不意味著我們沒有錯。

We could be.

我們可能是。

But I feel like we have a good team.

但我覺得我們有一個很好的團隊。

I think our team thinks about these problems holistically and from the customer's perspective.

我認為我們的團隊從客戶的角度整體考慮這些問題。

And if we continue to do that, I think we'll be well positioned vis-à-vis competition.

如果我們繼續這樣做，我認為我們將在競爭中處於有利地位。

And the last question will come from the line of Isaac Ro with Goldman Sachs.

最後一個問題將來自高盛的 Isaac Ro。

So a quick follow-up on the outlook in Asia, specifically, Japan and China.

因此，快速跟進亞洲，特別是日本和中國的前景。

So in Japan, wondering if you're expecting any meaningful uptick in system placements with the new reimbursement in place?

所以在日本，想知道隨著新的報銷到位，您是否期望系統安置有任何有意義的上升？

And the reason for asking is, it seems like you had a fair amount of what I would call idle capacity for existing placements prior to the updated reimbursement.

詢問的原因是，在更新報銷之前，您似乎有相當多的我稱之為現有展示位置的閒置容量。

So I'm wondering if you could help us map back what the new reimbursement means for incremental system demand.

所以我想知道你是否可以幫助我們重新規劃新的報銷對增量系統需求的意義。

Yes.

是的。

I mean, we mentioned in our comments, Isaac, we're expecting it will probably be modest.

我的意思是，我們在評論中提到，艾薩克，我們預計它可能會適度。

We've got nearly 300 systems in Japan currently.

目前，我們在日本擁有近 300 個系統。

And so there's a lot of capacity that can be applied to this new set of procedures.

因此，有很多能力可以應用於這套新程序。

These set of procedures is going to involve a process here of bringing up the teams and going through training and gradually building as we gain experience and confidence.

這些程序將在這裡涉及一個過程，即組建團隊並進行培訓並隨著我們獲得經驗和信心而逐漸建立。

So I don't think there's going to be a tremendous need to expand capacity here in the early days.

所以我認為在早期這裡不會有擴大產能的巨大需求。

It is true that some of these new procedures in the general surgery and thoracic categories can definitely benefit from our fourth-generation technology, Xi technology.

誠然，普外科和胸科的一些新手術絕對可以受益於我們的第四代技術 Xi 技術。

There'll be some interest in -- on the part of some folks to upgrade to the newer models.

有些人會對升級到較新的型號感興趣。

But for us right now, I think it's really about building the foundation clinically in the market.

但現在對我們來說，我認為這真的是在市場上建立臨床基礎。

And like we always say, eventually, the capital will follow, but we're not predicting anything too dramatic this year.

就像我們常說的那樣，最終，首都將隨之而來，但我們並沒有預測今年會發生什麼太戲劇性的事情。

Okay.

好的。

And then on China, just a follow-up there.

然後是關於中國的後續行動。

You -- it sounds to us like there will be, hopefully, some kind of update at the federal, national level, with essentially a number, if you will, for the new quota.

你 - 在我們看來，希望在聯邦和國家層面進行某種更新，如果你願意的話，基本上會有一個新配額的數字。

But can you help us think through your understanding of how that number will then disseminate to the provincial level and eventually convert to orders and revenue?

但是您能否幫助我們思考一下您對這個數字將如何傳播到省級並最終轉化為訂單和收入的理解？

Whether it be the order process, how it varies, time line, anything to help us understand the translation of the quota to actual action.

無論是訂單流程、變化方式、時間表，還是任何有助於我們理解將配額轉化為實際行動的事情。

It's a negotiation that occurs between the central government and the provinces.

這是中央政府與各省之間的談判。

So we're not privy to that negotiation.

所以我們不知道那次談判。

And I don't really understand or know what the timetable is.

我真的不明白或不知道時間表是什麼。

I can tell you the last time a quota was approved that it took several quarters for it to translate into any kind of sale to us.

我可以告訴你，上次批准配額需要幾個季度才能轉化為對我們的任何形式的銷售。

So it -- if you recall, the last quota we got was around 2013 and yet we sold most of the systems at the end of 2015.

所以它——如果你還記得的話，我們最後一次獲得配額是在 2013 年左右，但我們在 2015 年底售出了大部分系統。

So you go through that negotiation between central government and the provinces and then you also then have a tender process with each hospital at the end of it and that takes time.

所以你要經歷中央政府和各省之間的談判，然後你還要在最後與每家醫院進行招標，這需要時間。

All right.

好的。

Well, that was our last question.

嗯，這是我們的最後一個問題。

As we've said previously, while we focus on financial metrics such as revenues, profits and cash flow during these conference calls, our 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中關注收入、利潤和現金流等財務指標，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 today's conference.

女士們，先生們，今天的會議到此結束。

Thank you for your participation.

感謝您的參與。

You may now disconnect.

您現在可以斷開連接。