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

女士們、先生們，感謝各位的耐心等待，歡迎參加 Intuitive Surgical 2018 年第一季財報發布電話會議。（操作說明）提醒各位，今天的會議正在錄音。

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

現在我將把會議交給財務和投資者關係高級總監卡爾文·達林。請繼續。

Thank you. Good afternoon, and welcome to Intuitive Surgical's first quarter earnings conference call. With me today, we have Gary Guthart, our President and CEO; and Marshall Mohr, our Chief Financial Officer.

謝謝。下午好，歡迎參加直覺外科公司第一季財報電話會議。今天和我在一起的還有我們的總裁兼執行長 Gary Guthart；以及我們的財務長 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. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are described in detail in the company's Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 2, 2018. Our SEC filings can be found through our website or at the SEC's EDGAR database. Investors are cautioned not to place undue reliance on such forward-looking statements.

在開始之前，我想告知各位，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於存在某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定性在公司向美國證券交易委員會提交的文件中均有詳細描述，包括我們最近於 2018 年 2 月 2 日提交的 10-K 表格。您可以透過我們的網站或美國證券交易委員會的EDGAR資料庫找到我們向美國證券交易委員會提交的文件。投資者應注意，不要過度依賴此類前瞻性陳述。

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

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

Today's format will consist of providing you with highlights of our first quarter results as described in our press release announced earlier today followed by a question-and-answer session. Gary will present the quarter's business and operational highlights. Marshall will provide a review of first quarter financial results, then I will discuss procedures and clinical highlights and provide our updated financial outlook for 2018. And finally, we will host a question-and-answer session.

今天的會議形式將包括：首先向您介紹我們今天早些時候發布的新聞稿中描述的第一季業績亮點，然後進行問答環節。Gary 將介紹本季的業務和營運亮點。馬歇爾將對第一季財務表現進行回顧，然後我將討論流程和臨床亮點，並提供我們更新的 2018 年財務展望。最後，我們將舉行問答環節。

With that, I'll turn it over to Gary.

接下來，我將把麥克風交給蓋瑞。

Good afternoon, and thank you for joining us on the call today. Intuitive is dedicated to the mission of improving the availability and quality of minimally invasive surgery. 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. 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.

下午好，感謝各位今天參加我們的電話會議。Intuitive致力於提升微創手術的可近性和品質。在實現使命的第一季度，我們取得了強勁的成績，客戶對我們系統的使用量達到了增長範圍的頂峰，新系統部署持續保持勢頭，並且在美國以外的市場開發方面也取得了穩步進展。雖然我們對本季的業績感到滿意，但手術方面仍有很大的進步空間，還有很多工作要做。

Global procedure growth was approximately 15% in the first quarter of 2018. 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. General surgery growth was led by hernia repair and colon resection. Mature procedures in the United States, including prostatectomy and hysterectomy for malignant conditions, grew above expected rates again in the quarter. European procedure growth was mixed by country, partially as a result of headwinds in the number of business days relative to Q1 2017.

2018 年第一季全球手術量成長約 15%。這一增長的背後是美國普通外科手術中達文西手術系統的使用增加、歐洲和亞洲泌尿外科的持續增長以及中國多專科領域的增長。一般外科手術的成長主要由疝氣修補術和結腸切除術引領。在美國，包括前列腺切除術和子宮切除術在內的成熟手術（用於治療惡性疾病）在本季度再次超過預期成長率。歐洲各國手術量成長情況不一，部分原因是與 2017 年第一季相比，營業天數減少。

Lastly, additional procedures were granted reimbursement by the Ministry of Health in Japan, effective April 1, 2018, at reimbursement rates equivalent to laparoscopy. Calvin will review procedure trends in greater detail later in the call.

最後，自 2018 年 4 月 1 日起，日本厚生勞動省批准了其他手術的報銷，報銷標準與腹腔鏡手術相同。卡爾文將在稍後的通話中更詳細地回顧手術流程的發展趨勢。

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. 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. Placement performance was strong globally, particularly in the United States. Capital placements have been lumpy, and we anticipate volatility in placements for the remainder of 2018.

2018 年第一季度，我們的資本配置業績較 2017 年有所加快，總配置量成長了 39%，從 133 增至 185。扣除以舊換新和退役設備後，我們的達文西手術系統安裝基礎比 2017 年第一季增長了 13%，從約 4,023 台增至約 4,528 台。全球就業安置效果強勁，尤其是在美國。資本配置一直不穩定，我們預期 2018 年剩餘時間配置狀況仍將波動。

Turning to operations. Our performance in the first quarter met our expectations with good performance in product quality and cost reductions while average selling prices were stable. Investments to deepen our regional capabilities and to develop new technologies and services continued to be important in the first quarter. They will be so for the next several quarters as we progress through the launch of several products and build capability country by country. We are also investing to strengthen our corporate infrastructure and position us to benefit from increased scale.

接下來是營運環節。第一季業績符合預期，產品品質和成本降低表現良好，平均售價維持穩定。第一季度，加大對區域能力建設和新技術、新服務開發的投資仍然十分重要。接下來的幾個季度，隨著我們陸續推出多款產品並逐個國家建立能力，這種情況還會持續下去。我們也正在加大投資，以加強公司基礎建設，從而為規模擴大帶來益處。

Highlights of our first quarter operating results are as follows: Procedures grew approximately 15% over the first quarter of last year. We placed 185 da Vinci Surgical Systems, up from 133 in the first quarter of 2017. Our installed base grew 13% from a year ago. Revenue for the quarter was $848 million, up 25%. Pro forma gross profit margin was 71.6% compared to 72% in the first quarter of last year. Instrument and accessory revenue increased to $460 million, up 21%.

我們第一季經營業績的亮點如下：手術量比去年第一季成長了約 15%。我們安裝了 185 台達文西手術系統，高於 2017 年第一季的 133 台。我們的用戶基數比一年前成長了13%。本季營收為 8.48 億美元，成長 25%。經調整後的毛利率為 71.6%，去年第一季為 72%。儀器及配件收入增至 4.6 億美元，成長 21%。

Total recurring revenue in the quarter was $623 million, representing 73% of total revenue. We generated a pro forma operating profit of $346 million in the quarter, up 30% from the first quarter of last year. And pro forma net income was $288 million, up 46%. Marshall will take you through our finances in greater detail shortly.

本季經常性收入總額為 6.23 億美元，佔總營收的 73%。本季我們實現了 3.46 億美元的備考營業利潤，比去年第一季成長了 30%。經調整後的淨收入為 2.88 億美元，成長 46%。馬歇爾稍後會更詳細地向您介紹我們的財務狀況。

Our da Vinci Xi Surgical System is our most capable multiport platform. 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. 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. Combined with reimbursement approvals mentioned above, we're pleased with recent progress in Japan.

我們的達文西Xi手術系統是我們功能最強大的多端口平台。我們在 2017 年引進了達文西 X 手術系統，該系統以極具吸引力的價格提供第四代影像、機器人技術和用於聚焦象限手術的器械。達文西 X 手術系統本月獲得了日本藥品和醫療器械管理局 (PMDA) 的監管批准，並隨後在大型外科協會會議 JSS 上進行了展示。結合上文提到的報銷審批情況，我們對近期在日本的進展感到滿意。

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. We submitted our 510(k) for our current SP design in Q4 of '17 and have received questions back from FDA. We're preparing our response. And overall, SP is progressing to plan with a phased launch anticipated in 2018.

正如我們在之前的電話會議中討論的那樣，我們計劃透過 da Vinci SP 這種新功能來擴展我們的第四代產品系列。我們在 2017 年第四季提交了我們目前 SP 設計的 510(k) 申請，並收到了 FDA 的回應。我們正在準備應對措施。整體而言，SP 正按計畫推進，預計 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. We've received the first round of questions from FDA and are in the process of responding to their requests. Our Gen 4 systems have received growing use by surgeons globally and by general surgeons, in particular. Including the 60-millimeter stapler, we're hard at work completing our advanced instrument offerings.

同樣在 2017 年第四季度，我們提交了 510 申請——針對我們用於第四代系統的 60 毫米手術縫合器的 510(k) 申請。我們已經收到FDA的第一輪問題，目前正在回覆他們的要求。我們的第四代系統已在全球範圍內被外科醫生，特別是普通外科醫生廣泛使用。包括 60 毫米訂書機在內，我們正在努力完善我們的先進儀器產品線。

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

我們不斷推動柔性機器人平台的發展，該平台最初旨在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，早期發現至關重要。醫生們對我們的技術與現有及近期公佈的替代方案進行評估後，給予了我們強有力的支持。我們的設計和營運團隊正在努力將他們的回饋納入考量，完成生產設計和供應鏈優化，並完成監管申報所需的驗證工作。我們預計將於 2018 年提交 510(k) 申請，並且我們已經開始組建我們的商業團隊，這是一支傑出且專注的專業團隊。

I believe the opportunity for innovation in support of physicians in the flexible interventional space is substantial. That said, adoption will require clinical and economic validation given the availability of multiple competing approaches in the market.

我認為，在靈活介入治療領域，為醫生提供創新支援的機會是巨大的。儘管如此，鑑於市場上存在多種相互競爭的方法，其普及應用仍需經過臨床和經濟方面的驗證。

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. We have been introducing improvements in our imaging hardware routinely and expect to continue to do so in the remainder of 2018. We expect our lead molecular agent to enter Phase II trials in the second half of the year.

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視鏡和影像處理演算法的改進。我們一直在定期改進成像硬件，並預計在 2018 年剩餘時間內繼續這樣做。我們預計我們的主導分子藥物將於今年下半年進入第二期臨床試驗。

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

退後一步，放眼更廣闊的市場，我們團隊在機器人輔助手術方面的經驗可以追溯到幾十年前，當時的研究小組甚至早於公司的成立。在此期間，機電一體化、強大的運算能力、改進的感測技術、微加工技術和分子成像技術的興起，為解決舊問題提供了新的方法。

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. 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.

自成立以來，Intuitive 一直秉持著這個理念，致力於投資創新，包括漸進式創新和革命性創新，並且在過去幾年中加強了投入力度。近年來，利用先進技術改善外科手術的機會正得到廣泛認可，尤其是在過去幾年。我們預計，在接下來的幾個季度裡，競爭對手將更多系統引入世界某些地區。

To help our customers, Intuitive products and services are organized in generational families. 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. 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. Our fourth generation of surgical platforms offer our customers a fully enabled ecosystem of products and services in support of their programs.

為了更好地服務客戶，Intuitive 的產品和服務按代際類別進行組織。共享的設計原則、操作方法、使用者介面和產品培訓，使外科團隊和醫院能夠更快地整合新技術，並為培訓環境提供顯著改進的框架。隨著醫療系統整合的推進，手術平台的標準化可以減少從住院醫師和專科醫師培訓計畫到學術和社區環境中的差異性和低效性。我們的第四代手術平台為客戶提供功能齊全的產品和服務生態系統，以支援他們的手術計畫。

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，繼續在普通外科手術中推廣達文西手術系統；其次，繼續開發歐洲市場並拓展亞洲客戶；第三，推進我們的新平台、成像技術、先進儀器、達文西 SP 和我們的柔性導管平台；最後，支持全球各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.

現在我將把電話交給馬歇爾，他將回顧財務要點。

Good afternoon. I will describe the highlights of our performance on a GAAP and non-GAAP or pro forma basis. Our results are also posted on our website. 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.

午安.我將按 GAAP 和非 GAAP 或備考基準描述我們的業績亮點。我們的測試結果也會發佈在我們的網站上。2018 年第一季營收為 8.48 億美元，比 2017 年第一季的 6.8 億美元成長了 25%，但比季節性較好的第四季的 8.92 億美元下降了 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. This revenue and the related costs are recognized in the third and fourth quarters of 2017. Our comparisons to 2017 results reflect the deferral as recorded.

2017 年第一季度，我們遞延了與達文西 X 手術系統置換計畫相關的約 2,300 萬美元收入，該計畫是為部分第一季度客戶提供的。該收入及相關成本在 2017 年第三季和第四季確認。我們與 2017 年結果的比較反映了已記錄的延期情況。

We also have adopted the new revenue standard as required under GAAP and retroactively restated prior period results. We have updated the supplementary financial tables posted on our website to reflect this restatement. 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. 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.

我們也依照公認會計原則的要求採用了新的收入標準，並追溯重述了前期績效。我們已更新網站上發布的補充財務報表，以反映此重述。採用收入準則後，2017 年第一季總收入增加了約 500 萬美元，淨收入增加了約 100 萬美元。對 2017 年年度業績的影響微乎其微，2017 年總收入增加了約 900 萬美元，淨收入增加了 1,100 萬美元。

Revenue also benefited by approximately 2.5 percentage points from a weaker dollar. Excluding the impact of the revenue deferral and currency changes, revenue grew 18% relative to the restated 2017 first quarter.

美元走軟也使營收成長了約 2.5 個百分點。剔除營收遞延和匯率變動的影響，營收較 2017 年第一季重述資料成長了 18%。

First quarter 2018 procedures increased approximately 15% compared with the first quarter of 2017 and were flat with last quarter. Procedure growth continues to be driven by general surgery in the U.S. and urology worldwide. Calvin will review details of procedure growth later in this call.

2018 年第一季手術量比 2017 年第一季成長了約 15%，與上一季持平。手術量的成長主要由美國的普通外科手術和全球的泌尿外科手術所推動。Calvin將在本次通話中稍後詳細介紹手術進展。

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. 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.

儀器及配件收入為 4.6 億美元，比去年增長 21%，高於手術量增長，主要反映了我們先進儀器的使用量增加以及客戶購買模式的改變。每台手術的器械和配件收入約為 1,930 美元，比去年增長了 5%，主要反映了先進器械的使用、客戶購買模式以及美元走軟的影響。

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，比 2017 年第一季成長 46%，主要反映了系統安裝量的增加、2017 年第一季 2,300 萬美元的收入遞延以及美元走軟，但部分被經營租賃數量的增加所抵消。

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. 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. 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.

2018 年第一季我們安裝了 185 套系統，而 2017 年第一季安裝了 133 套系統，上一季安裝了 216 套系統。本季完成了 43 筆經營租賃交易，佔總交易量的 23%，而 2017 年第一季佔總交易量的 16%，上季佔 19%。雖然短期內租賃數量難以預測，但我們預期長期來看，這類安排的比例將會增加。

31% of the current quarter system placements involve trade-ins, reflecting customer desire to access or standardize on our fourth-generation technology. This is an increase in the proportion of trade-ins compared to 21% in the first quarter of 2017 and 26% last quarter. However, trade-in activity is lumpy and difficult to predict.

本季系統安裝中有 31% 涉及以舊換新，反映出客戶希望獲得或採用我們的第四代技術。與 2017 年第一季的 21% 和上一季的 26% 相比，以舊換新的比例增加。然而，以舊換新活動波動較大，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. 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.

本季安裝的系統中，76% 為達文西 Xi 系統，16% 為達文西 X 系統；而上一季度，達文西 Xi 系統佔 67%，達文西 X 系統佔 24%。本季末，我們已安裝的達文西手術系統數量為 4,528 套，年增 13%，平均係統利用率增加了個位數百分比。

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

在全球範圍內，我們的平均售價（不包括營業租賃、租賃買斷和收入遞延的影響）約為 149 萬美元，略高於第四季的 147 萬美元。這一增長反映了Xi系統佔比的提高和美元走軟，但部分被地域構成所抵消。

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. 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.

美國以外地區的表現如下：第一季美國以外地區的營收為 2.75 億美元，比 2017 年第一季成長 49%，比上一季成長 11%。與前一年相比，成長反映了系統收入增加 5,500 萬美元，成長近 100%；以及儀器和配件收入增加 3,000 萬美元，成長 32%。

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

系統收入的成長得益於系統部署數量的增加、經營租賃數量的減少、有利的產品和地理組合以及美元走弱。儀器和配件收入主要受手術量成長、美元走軟和顧客購買習慣改變的影響。

OUS procedures grew approximately 18% compared with the first quarter of 2017. OUS procedures were somewhat negatively impacted by the timing of holidays in 2018 compared with -- to 2017. 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.

與 2017 年第一季相比，OUS 手術量增加了約 18%。與 2017 年相比，2018 年的假日安排對 OUS 程序產生了一定的負面影響。在美國以外，我們第一季安裝了 73 套系統，而 2017 年第一季為 56 套，在季節性強勢的第四季為 86 套。

Current quarter system placements included 45 into Europe, 9 in Japan. 63% of the systems placed were da Vinci Xis compared with 54% in the first quarter of 2017 and 48% last quarter. 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.

在當前季度製度下的就業分配包括 45 個歐洲就業崗位，9 個日本就業機會。在已安裝的系統中，63% 為達文西 Xi 手術系統，而 2017 年第一季為 54%，上一季為 48%。由於一些美國以外的市場仍處於早期發展階段，一些市場具有很強的季節性，反映了預算週期或度假模式，而且一些市場的銷售受到政府監管的限制，因此美國以外地區的市場佈局仍將不穩定。

Moving on to the remainder of the P&L. 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. The decrease relative to the fourth quarter primarily reflects higher fixed costs spread over lower volumes. The decrease compared with the prior year primarily reflects product mix. 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.

接下來來看損益表的其餘部分。第一季的備考毛利率為 71.6%，而 2017 年第一季為 72%，上一季為 72.4%。與第四季相比，銷售下降主要反映了較高的固定成本分攤到較低的銷售量。與前一年相比的下降主要反映了產品組合的變化。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、系統平均售價以及我們進一步降低產品成本和提高生產效率的能力而波動。

Pro forma operating expenses increased 17% compared with the first quarter of 2017 and were flat compared with last quarter. 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. These investments involve multiyear commitments.

與 2017 年第一季相比，以備考計算的營運費用增加了 17%，與上一季相比持平。我們的支出與計畫一致，反映了對達文西SP手術系統、導管機器人、影像和先進儀器的投資，以及我們OUS市場的擴張。這些投資涉及多年期承諾。

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

第一季的預期實際稅率為 20.1%，而我們先前的預期為 20% 至 22%。我們的稅率會隨著美國境內外收入組成的變化、地方政府稅收政策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. 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.

2018 年第一季度，我們的備考淨收入為 2.88 億美元，即每股 2.44 美元，而 2017 年第一季為 1.97 億美元，即每股 1.71 美元，2017 年第四季為 3.05 億美元，即每股 2.60 美元。2017 年第一季 GAAP 備考每股攤薄淨收益不包括 0.09 美元/股，該金額來自遞延 2,300 萬美元的收入（扣除成本和所得稅後）。

I will now summarize our GAAP results. 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. 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.

現在我將總結一下我們的GAAP業績。2018 年第一季 GAAP 淨利為 2.88 億美元，即每股 2.44 美元；而 2017 年第一季 GAAP 淨利為 1.81 億美元，即每股 1.57 美元；2017 年第四季 GAAP 淨虧損為 3,200 萬美元，即每股 0.28 美元。我們的網站上列出了備考淨收入與 GAAP 淨收入之間的調整，並進行了量化，其中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費用。

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

請注意，美國國稅局尚未發布與近期美國稅法相關的最終規定。因此，美國《減稅與就業法案》的影響反映在我們第四季度和第一季的業績中，我們對未來稅率的預測代表了我們對美國《減稅與就業法案》影響的最佳估計，並且隨著稅收法規的最終確定和進一步解釋，這些估計可能會發生變化。

We ended the quarter with cash and investments of $4.1 billion compared with $3.8 billion at December 31, 2017. The increase reflects cash generated from operations of $280 million. We had not repurchased any shares in the quarter and have approximately $718 million remaining under the board buyback authorization.

截至本季末，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。此次成長反映了營運產生的現金流為 2.8 億美元。本季我們沒有回購任何股票，根據董事會授權的回購計劃，我們還有大約 7.18 億美元的資金。

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

接下來，我將把發言權交給卡爾文，他將介紹手術流程的執行情況以及我們對 2018 年的展望。

Thank you, Marshall. Our overall first quarter procedure growth was 15% compared to 18% during the first quarter of 2017 and 17% last quarter. Our year-over-year Q1 procedure growth was driven by 14% growth in U.S. procedures and 18% growth in OUS markets. In the U.S., overall, Q1 procedure performance by specialty closely aligned with patterns present in 2017.

謝謝你，馬歇爾。我們第一季的整體手術量成長了 15%，而 2017 年第一季為 18%，上一季為 17%。我們第一季手術量年增率主要得益於美國手術量成長 14% 和美國境外市場手術量成長 18%。在美國，整體而言，第一季各專科的手術表現與 2017 年的模式非常吻合。

In U.S. general surgery, first quarter 2018 growth was consistent with 2017. Q1 growth was again driven by hernia repair, which continued to provide the most incremental cases and continued da Vinci adoption in colorectal procedures. Early-stage adoption in bariatric procedures and growth across the breadth of the general surgery category also contributed to growth.

美國一般外科領域，2018 年第一季的成長與 2017 年保持一致。第一季的成長再次由疝氣修補術推動，手術繼續提供最多的新增病例，達文西手術系統在結直腸手術中的應用也持續成長。減重手術的早期普及以及普通外科手術領域的全面發展也促進了成長。

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. 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.

在美國婦科領域，2018 年第一季的成長與 2017 年的趨勢一致，手術量較去年同期成長幅度不大，其中子宮切除術的成長最為顯著。我們認為，隨著越來越多的美國婦科手術由專攻複雜良性腫瘤和癌症手術的醫生進行（這些醫生往往是達文西手術系統的使用者），婦科手術的整合將繼續推動適度增長。

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

美國第一季泌尿外科手術量與 2017 年的成長率持平，主要受攝護腺切除術量成長的推動。作為一個成熟的手術類別，我們認為，我們在美國進行的前列腺切除手術量與更廣泛的前列腺手術市場的發展趨勢相符，而前列腺手術市場也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. Utilization of our da Vinci Xi systems and surgical staplers, which help to optimize robotic thoracic procedures, has been increasing.

在美國其他手術領域，肺葉切除術和其他胸腔外科手術在第一季再次取得了穩健的進展。我們的達文西 Xi 系統和手術縫合器有助於優化機器人胸腔外科手術，其使用率正在不斷提高。

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

第一季 OUS 手術量成長約 18%，而 2017 年全年成長 23%。2018 年第一季 OUS 手術量的成長主要得益於 dVP 手術量的持續成長以及腎癌手術、一般外科手術和婦科手術早期階段的成長。2018 年第一季 OUS 手術成長率低於去年同期，部分原因是 2018 年第一季因假日（包括復活節）而導致手術日減少。

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

本季中國手術量成長明顯放緩，部分原因是達文西手術系統的產能擴張受到系統配額要求的限制，而最近一次配額要求已於 2015 年底到期。我們認為中國對機器人手術的核心需求是巨大的。

In Japan, Q1 procedure growth in prostatectomy and partial nephrectomy moderated as these procedures have achieved high levels of adoption. As Gary indicated, effective April 1, 2018, 12 additional procedures have been approved for reimbursement in Japan with reimbursement equivalent to laparoscopic surgery.

在日本，由於攝護腺切除術和部分腎切除術的普及率較高，第一季這兩項手術的成長速度有所放緩。正如 Gary 所指出的，自 2018 年 4 月 1 日起，日本已批准 12 項額外的手術項目獲得報銷，報銷金額與腹腔鏡手術相同。

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. 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.

由於達文西手術系統相對於其他手術方法的價值尚不明確，因此目前很難估計達文西手術系統在手術流程中的適用機會。日本已安裝了近 300 套系統，未來一年日本系統擴張的規模和速度難以預測，但可能會比較溫和。

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

上週，我們參加了在西雅圖舉行的美國胃腸內視鏡外科醫師協會（SAGES）年會。一般外科是我們規模最大、發展最快的專科——也是美國外科專科，本次活動是一般外科從業人員和思想領袖規模最大的聚會之一。隨著越來越多的普通外科醫生在實踐中採用機器人技術，在今年的會議上，我們繼續看到機器人手術演示、臨床論文和演講者的數量不斷增加。

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

在 SAGES 會議上公佈的臨床數據中，包括最近被《疝氣雜誌》接受發表的一項研究的結果，該研究題為“開放式與機器人輔助經腹膜前腹股溝疝氣修補術：臨床結果的多中心匹配分析”。本研究的數據由主要作者、來自伊利諾州新萊諾克斯的 Reza Gamagami 博士介紹。

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

這項研究是迄今為止規模最大的多中心評估之一，旨在比較機器人輔助腹股溝疝氣修補術與同一位外科醫生經驗更豐富的開放式手術的療效。在每組 444 名受試者進行的配對分析中，機器人輔助腹股溝疝氣修補術病例在出院後 30 天內的併發症發生率顯著低於對照組，且沒有與腹股溝修補術相關的再次手術。多因素分析表明，開放式修復方法是腹股溝修復手術後 30 天內出現併發症的風險因素。

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. 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.

這項研究證實，機器人輔助腹股溝疝氣修補術可為患者帶來微創手術的益處。作者們雖然在腹腔鏡手術方面經驗不一，但他們得出結論，機器人輔助修補術是一種有前景且可重複的方法，可能會促進腹股溝疝氣微創修補術的普及。這項研究進一步證實了越來越多的證據，顯示接受機器人輔助腹股溝疝氣修補術的患者，無論外科醫生的腹腔鏡經驗如何，都能獲得相當或更好的結果。

I will now turn to our financial outlook for 2018. Starting with procedures. On our last call, we forecast full year 2018 procedure growth within a range of 11% to 15%. We are now refining the range and estimate full year 2018 procedure growth of 12% to 15%.

接下來，我將談談我們對2018年的財務展望。首先從流程入手。上次電話會議上，我們預測 2018 年全年手術量成長將在 11% 到 15% 之間。我們現在正在完善範圍，並預計 2018 年全年手術量將增加 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. 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.

就收入而言，正如我們之前提到的，資本投入最終是由手術量的成長所驅動的，這促使醫院建立或擴大機器人系統容量。資本配置會因多種因素而隨時間發生顯著變化，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。

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. In addition, as anticipated, a higher proportion of Q1 system placements were under operating lease terms, 23%. This proportion may fluctuate some in the near term, but may trend further upwards in the long term.

第一季度，由於客戶產能擴張，以及舊款達文西手術機以舊換新交易量較近幾季有所增加，我們的資本配置強勁成長。此外，如預期的那樣，第一季系統安裝中採用經營租賃條款的比例較高，達到 23%。這一比例短期內可能會有所波動，但長期來看可能會進一步上升。

Turning to gross profit. We continue to expect our pro forma gross profit margin to be within a range of between 70% and 71.5% of net revenue. 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. Our actual gross profit margin will vary quarter-to-quarter depending largely on product and regional mix.

接下來討論毛利。我們仍然預計，我們的備考毛利率將佔淨收入的 70% 至 71.5%。這比我們第一季的 71.6% 的結果略低，主要反映了我們預計在今年稍後推出的新產品的相關成本較高。我們的實際毛利率會因產品和地區組合的不同而逐季波動。

Turning to operating expenses. 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.

接下來談談營運費用。我們預計 2018 年的備考營運費用將比 2017 年的水準成長 16% 至 18%，因為我們將繼續推進在幾個策略領域的投資，這些投資旨在使公司長期受益。

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. 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 年的非現金股票補償支出將在 2.45 億美元至 2.55 億美元之間，而上次電話會議的預測為 2.25 億美元至 2.35 億美元。我們預計 2018 年其他收入（主要包括利息收入）總額將在 5,500 萬美元至 6,000 萬美元之間，高於上次電話會議預測的 4,500 萬美元至 5,500 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. We are now refining our estimate to the lower half of the range, between 20% and 21% of pretax income. Note that in the future, as the IRS issues additional guidance and interpretation of the new tax law, our estimated rate may be impacted.

關於所得稅，在上一次電話會議上，我們預測 2018 年的預計所得稅稅率將在稅前收入的 20% 至 22% 之間。我們現在將估算值調整到範圍的下半部分，即稅前收入的 20% 到 21%。請注意，未來隨著美國國稅局發布更多關於新稅法的指導和解釋，我們的預估稅率可能會受到影響。

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

我們的發言到此結束。現在開始回答各位的問題。

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

（操作員說明）我們的第一個問題將來自摩根士丹利的戴維·劉易斯。

Congrats on quite a good quarter. So Gary, a couple of strategic questions for you. The first is on leasing. 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. So it's starting to feel this is much more company-driven than customer-driven.

恭喜你本季業績相當不錯。加里，我有幾個策略性的問題想問你。第一個例子是關於租賃的。所以，過去兩個季度的經營租賃數量比前四個季度都多，而且感覺 23% 這個數字還會繼續上升。所以現在感覺這更多的是公司驅動而不是客戶驅動。

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？租賃在哪些方面可以成為非常有效的防禦手段？

Yes. So I -- first, thank you. 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.

是的。所以，首先，謝謝你。我認為，只要我們能夠幫助客戶在其專案中應用機器人技術，並以符合他們需求的方式實現，我們就很樂意透過租賃的方式來做到這一點。

I don't think it's a massive strategic change one way or another vis-à-vis competition. From our point of view, we're confident in our products. We understand and are confident in the value they bring. 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. And we're willing.

我認為這在競爭方面並不會構成巨大的策略轉變。從我們的角度來看，我們對自己的產品充滿信心。我們了解並相信它們所帶來的價值。如果我們能夠靈活對待客戶，讓他們在需要的時候獲得所需的產品，如果我們能夠讓他們在財務方面更容易儘早而不是拖延地獲得產品，這對我們很有幫助。我們願意。

I think over time customers are going to evaluate competitive systems. They're going to go look at them. 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.

我認為隨著時間的推移，客戶會評估競爭對手的系統。他們會去看看。如果有人推出更符合他們需求的產品，我不認為租賃方式會有什麼不同。

For us, it really is kind of a first principles thing. Do you believe in robotic surgery as a way to increase the availability and quality of minimally invasive surgery? 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.

對我們來說，這真的是一個基本原理的問題。您是否相信機器人手術能夠提高微創手術的普及性和品質？如果你有此意願並決心去做，而且我們也能找到辦法幫助你獲得一套系統，那麼我們很樂意這樣做。

Okay. And then curious, a question on the flexible catheter system as well. So based on your time line, I'm kind of assuming you're 9 months behind a recent competitive launch. So I just wonder, how concerned are you about this window?

好的。然後，出於好奇，我還想問一下關於柔性導管系統的問題。根據你的時間線，我估計你比最近競爭對手的產品發布晚了 9 個月。所以我想知道，你對這扇窗戶有多擔心？

And you talked a lot about the ecosystem both at SAGES and again in this call. In what ways can sort of the multisystem ecosystem approach be sort of a barrier to entry for new robotic entrants in this segment?

你在 SAGES 大會上以及這次電話會議上都多次談到了生態系統。多系統生態系統方法在哪些方面會成為新機器人企業進入該領域的障礙？

Yes. 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. You have to provide the robot, but you also need the instruments and accessories. You need to be able to help do product training. You need to build proctoring networks. 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.

是的。我認為，對於我們或其他人即將部署的任何系統而言，機器人本身或產品本身只是第一步。你需要提供機器人，但你也需要提供儀器和配件。你需要能夠協助進行產品培訓。你需要建立監考網路。您希望能夠幫助客戶進行基準測試和分析，以了解其使用模式與世界其他地區使用模式的比較。

And so I think they expect support beyond the dropping off of a system at the backdoor. And we have built that over years. We've come to understand it deeply. And I think it is valuable to our customer. And I think that helps us. I think other companies have various degrees of enablement in that space.

所以我認為他們希望得到的支援不僅僅是繞過系統就能實現的。這是我們多年來逐步建立起來的。我們已經對此有了深刻的理解。我認為這對我們的客戶很有價值。我認為這對我們有幫助。我認為其他公司在這個領域的發展程度各不相同。

With regard to flex catheter, in particular, we have been investing in it, as you know, for years and years. This has been a long-term investment. 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. That has driven us -- continues to drive us.

特別是關於柔性導管，正如您所知，我們已經對其進行了多年的投資。這是一項長期投資。我們建構技術和製定架構決策都基於第一原理，而不是透過觀察別人在做什麼，而是透過真正深入地與客戶互動並了解他們的臨床需求。這一直激勵著我們，並且將繼續激勵著我們。

We have connections into the customer base because of those first principle investigations. And those folks visit us. They look at our technologies. They visit others and look at technologies on the market or soon to be on the market, and they make decisions. We're going to make decisions based on clinical value and demonstrable outcomes. You've seen the early parts of that with regard to the publications at CHEST.

透過這些初步調查，我們與客戶群建立了聯繫。這些人會來拜訪我們。他們關注我們的技術。他們會參觀其他公司，考察市場上或即將推出的技術，然後做出決定。我們將根據臨床價值和可證明的結果來做出決定。你已經看到 CHEST 出版物的早期部分了。

I think there are advantages for people who are first-movers, but I think they're short-lived. 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. And I'm confident in our technology and even more confident in our team.

我認為先發優勢是存在的，但這種優勢是短暫的。我認為，在這個領域，由於市場上有很多替代方案，而且這是一個由臨床數據驅動的市場，隨著時間的推移，最好的解決方案將會勝出。我對我們的技術充滿信心，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鮑伯霍普金斯。

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

偉大的。當我查看你們的列印稿時，很明顯，這份第一季報告中有很多令人印象深刻的大數字，但真正引起我注意的是系統銷售。我知道，從歷史上看，這主要取決於手術量，而手術量一直非常強烈。

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

但我很想知道，鑑於這確實是自 2010 年以來系統部署方面最好的成長，是否有任何特別的因素推動了本季的強勁成長。我想知道我們能否更詳細地了解本季系統配置方面的情況。

Bob, you're absolutely right. Systems placements are driven primarily by procedure growth. And you have to look at it over a period of time because systems can be lumpy in any particular quarter.

鮑勃，你說得完全正確。系統部署主要受手術量成長的驅動。而且你必須從一段時間內來觀察，因為系統在任何一個季度都可能出現波動。

So if you look at 2017, the installed base grew 13% and procedures grew 16%. So it was procedures that were really driving that installed base growth. This quarter, we had a little bit higher proportion of trade-outs. That reflects, I think, as I said in my script, customers wanting to avail themselves to fourth-generation capabilities. And we also saw high sales of Xi validating that, that system has features that really are driving adoption.

因此，如果你看 2017 年的數據，安裝基數增加了 13%，手術量增加了 16%。所以，真正推動用戶基數成長的是操作流程。本季，我們的交易出局比例略高一些。我認為，正如我在稿子裡所說，這反映出客戶希望利用第四代技術的能力。我們也看到 Xi 的高銷量也證實了這一點，該系統確實具有推動其普及的功能。

So I think it's lumpy. I think it's hard to make conclusions based on one quarter of increased trade-in volume. And I just would be cautious there. And we expect to see some volatility. But overall, over a longer period of time, systems will follow procedure growth.

所以我覺得它表面凹凸不平。我認為僅憑一個季度的舊車置換量增長就得出結論是很難的。我建議你在這方面保持謹慎。我們預計會出現一些波動。但總體而言，從長遠來看，系統將跟隨流程的成長而發展。

Great. And then I wanted to follow up also -- one more question on flex catheter. Just curious, what's left to do before you file with the FDA? 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?

偉大的。然後我還想問一個關於柔性導尿管的問題。我只是好奇，在向FDA提交申請之前，還有什麼需要做的？或許我們應該從更長遠的角度來看待這個問題，您認為我們什麼時候才能聽到更多關於柔性導管在肺部以外的其他潛在適應症的消息呢？

Sure. For now, as we said in the -- earlier in the script, the teams are really doing the product validations. They're doing the testing that supports our submissions. And we're stabilizing the supply chain. And that's important.

當然。目前，正如我們在劇本前面部分所說，各個團隊正在進行產品驗證。他們正在進行測試，以支持我們提交的內容。我們正在穩定供應鏈。這一點很重要。

When we launch, we want to feel good about our ability to make the products and our suppliers' ability to make their parts. We're progressing. I think the team is doing a very good job. So there, we're progressing against our plan.

在產品發佈時，我們希望對自身的產品製造能力以及供應商的零件製造能力都充滿信心。我們正在取得進展。我認為團隊做得非常出色。所以，我們目前的進展與計畫背道而馳。

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. 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.

首先，正如我過去所說，我對柔性導管技術感到興奮，因為我認為它是一個平台，並且在肺部以外還有其他應用機會。我們目前的工作重點是將第一款產品推向市場，滿足介入性肺科醫生和胸腔外科醫生的需求。

I think that is a major opportunity. I think the -- perfecting the clinical pathways, the use of the product and data generation is important for us to focus on. And so our organization is tightly focused on that mission now.

我認為這是一個絕佳的機會。我認為，我們應該專注於完善臨床路徑、產品使用和數據生成。因此，我們組織目前正全力以赴地致力於完成這項使命。

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

完美的。那麼，加里，關於中國的情況有什麼最新消息嗎？

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，你或許可以談談──我想你是在暗示配額問題，但為什麼不談談這個呢？

Yes. We really don't have much of an update on the quota. I mean, we still sit here awaiting the finalization of that quota.

是的。關於配額方面，我們目前還沒有太多最新消息。我的意思是，我們現在還在等待最終確定配額。

Again, just to give you the background, the quota really applies to the years 2016 through 2020. It's part of the 5-year planning -- budgeting process that the Chinese government goes through.

再次說明一下，該配額實際上適用於 2016 年至 2020 年。這是中國政府五年規劃預算編制過程的一部分。

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. And so we wait.

中央政府已經完成了預算，但尚未完成與各省和醫院就誰將獲得多少套系統進行的談判。於是我們只能等待。

I think, in general, what's going on there doesn't appear to be Intuitive-specific. I think it's more rolling through the centralized government processes. We think that the core interest by Chinese customers in our products and the company and robotic surgery more broadly is strong.

我認為，總的來說，那裡發生的事情似乎不是 Intuitive 特有的。我認為這更多的是透過中央政府的流程來推進的。我們認為中國消費者對我們的產品、公司以及更廣泛的機器人手術領域有著濃厚的興趣。

And we feel slight forward progress in terms of the way the process has been moving. We just can't call what the time lines are. And so we are at the limits of our ability to influence that outcome.

我們感覺就目前進展而言，略有進步。我們無法確定具體時間線。因此，我們能夠影響結果的能力已經達到極限。

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拉里·比格爾森。

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. Marshall, what drove the difference in those growth rates?

看起來你們的國際系統收入成長了 99% 或接近 100%，但係統出貨量年增了約 30%。馬歇爾，造成這些成長率差異的原因是什麼？

Sure. So a couple of things that I pointed out. One was that in 2017 we had 6 leases. In 2018, we had one. Obviously, when you have an operating -- these are operating leases. Operating leases, you don't have revenue. So some of that is attributable to it.

當然。我指出了幾點。其中之一是，2017 年我們有 6 份租約。2018年，我們有過一次。顯然，當你擁有經營性租賃權時——這些都是經營性租賃。經營性租賃，你沒有收入。所以部分原因可以歸因於此。

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. And we also had a favorable mix of product. As I said in my script, we had a high mix of Xi around the world. That also included OUS. And we also had a favorable geographic mix. If you notice, there was substantive sales into Europe.

此外，外匯或貨幣兌換也對我們有利，因為美元在過去一年裡走弱。而且我們的產品組合也很有利。正如我在稿子裡說的，我們在世界各地都有很高比例的習近平。這其中也包括美國境外的機構。而我們的地域組成也很有利。如果你仔細觀察，你會發現歐洲市場銷售相當可觀。

And again, these are lumpy. So you can't take one geography and extrapolate that forward. But in Europe, we did well. 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. So you just put all those factors together and it adds up to increasing revenue to the extent that it did.

而且，這些表面凹凸不平。所以你不能把一個地區的地理情況外推到其他地區。但在歐洲，我們做得很好。與前一年相比，我們在一些銷售價格較低的分銷市場的銷售額略有下降。所以，把所有這些因素加在一起，就得到如此大幅度的收入成長。

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

然後，我的後續問題是，我們越來越多地聽到，印度可能是一個很大的機遇，甚至有可能成為第一大國際市場。您能否談談您對今年以及未來幾年該市場發展的看法？

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，從長遠來看，印度將是一個良好的市場，但我認為，在短期內，指望它迅速成為我們的第二大市場或第一大市場是不現實的。

We have a distributor there that we've been working with for years. We've made -- I think we have around 40, 50 systems installed in India. 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.

我們在當地有一家經銷商，我們已經和他們合作多年了。我們已經——我想我們在印度安裝了大約 40、50 套系統。總數——但是他們產生的手術總數可能只占我們總手術量的 1%——所以目前還沒有什麼影響。

We are making investments in it. 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.

我們正在對其進行投資。我們認為——再說一遍，從長遠來看——這是一個可行的市場，對我們來說也是一個好市場，但我們目前還處於非常非常早期的階段。

Yes. We're actually at 68 systems in India currently.

是的。目前我們在印度實際上已經部署了 68 套系統。

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泰科·彼得森。

I'll add my congrats on the quarter. Maybe first question on emerging procedures. Bariatric got a little bit more attention at SAGES this year. And I know, Calvin, you called that out in your comments. I know you're in the process of getting back to FDA with the questions on the stapler.

我謹向你們表示祝賀，祝賀你們本季取得佳績。或許第一個問題是關於新興程序的。今年在SAGES會議上，減肥手術受到了更多關注。我知道，卡爾文，你在評論裡也提到了這一點。我知道你正在就訂書機的問題向FDA提出回饋意見。

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 Gary，你能否談談你對這個市場發展的看法，以及一旦你們開始行動，需要投入多少市場開發資源？

It's going to be an interesting one to see evolve. I think it's early for us to put much commentary on it. We see interest by surgeons.

看看它會如何發展將會很有趣。我認為現在對此發表太多評論還為時過早。我們看到外科醫生對此很感興趣。

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

話雖如此，但腹腔鏡手術是一種創傷性很大的手術。市面上有許多技術高超的腹腔鏡醫生，從這個意義上講，它與前列腺切除術或子宮切除術（用於治療惡性疾病）形成了鮮明對比，後者主要採用開放式手術。

So we see some core demand and interest. Certainly, we want to complete the product offering and the stapler. 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.

所以我們看到了一些核心需求和興趣。當然，我們希望完善產品線，包括訂書機。我認為真正的問題是，隨著時間的推移，它會走向何方，我希望在以後的電話會議上，等我們積累了幾個季度的經驗後再來解答這個問題。

Okay. 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? And are there steps you can take to try to increase the codes over time? Presumably, that will require additional studies.

好的。然後，考慮到日本在頂骨手術後開始提供報銷，這是否會改變您對採用曲線的看法？那麼，有沒有什麼方法可以隨著時間的推移而增加程式碼數量呢？想必這需要進一步研究。

Yes. I think that, in general, I think the reimbursement decision is a positive for us. It's not an unalloyed positive. I think that it will concentrate adoption into the bigger centers. That's okay. I think we're in a position to support that, and we will do so.

是的。總的來說，我認為報銷決定對我們來說是件好事。這並非完全是正面的。我認為這將使收養工作集中在較大的城市地區。沒關係。我認為我們有能力支持這一點，而且我們也會這樣做。

We will make investments for data collection in Japan. 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. And to the extent that we show additional value, I think it's something that the government will consider for future reimbursements.

我們將對日本的數據收集進行投資。隨著時間的推移，我們肯定可以與外科協會和政府分享這些數據收集成果。如果我們能展現出額外的價值，我認為政府會在未來考慮給予報銷。

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. I think the interest, having just been in Japan, I think the interest is high. I think the surgical society is seeing it as a positive step and an endorsement by the government.

關於報銷金額從基本水平開始的任何變化，我建議你們現在不要在日曆上做任何標記，我認為這方面還有一些變數。我剛從日本回來，我覺得大家對日本的興趣很高。我認為外科協會將此視為積極的一步，也是政府的認可。

I think that the economics in the right centers will work well for them. And it's an exciting time for us and our team in Japan. And I'm looking forward to seeing them have a chance to broaden their base of business and get to know more customers.

我認為，在適當的中心地帶實行經濟政策對他們來說是有利的。對於我們和我們在日本的團隊來說，這是一個令人興奮的時刻。我期待看到他們有機會擴大業務範圍，並結識更多客戶。

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

好的。最後，關於SP，您能否就此發表一下看法？從您的角度來看，FDA提出的問題是否有任何出乎意料之處？

And then as we think about the rollout, obviously, you've talked about the 3 initial application areas. It seems like there's already some interest in other use cases. So I'm just curious about how much pent-up demand you think there is out there today.

然後，當我們考慮推廣時，顯然，您已經談到了最初的 3 個應用領域。看來人們對其他應用場景已經表現出了一些興趣。所以我很好奇，你認為目前市面上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. And so I think our teams are working on it. I don't see commentary that I would signal to you one way or another, either particularly small questions or particularly big ones. I think it's right down the middle.

就收到的問題的性質而言，我認為這與我們多年來與 FDA 進行的對話類型一致。所以我認為我們的團隊正在努力解決這個問題。我沒有看到任何需要我明確告知你的評論，無論是特別小的問題還是特別大的問題。我覺得剛好在中間。

With regard to potential applications over time, I think general interest in SP is high. 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. And I think that will open some opportunities in the future for surgeons who are looking for alternatives.

就其未來應用前景而言，我認為人們對SP的普遍興趣很高。讓我感到興奮的是，我認為當初讓我們興奮地投資它的原因之一是，它提供了一種比多端口方法更靈活的進入人體的方法。我認為這將為未來尋求其他治療方案的外科醫生帶來一些機會。

Of course, that takes time. We'll have to do protocol development and data collection to get additional clearances as needed. But that is anticipated. That was not unanticipated. That was part of what we had thought in terms of investing in the platform.

當然，這需要時間。我們需要製定方案並收集數據，以便根據需要獲得額外的許可。但這在預料之中。這並非意料之外。這正是我們當初考慮投資該平台的原因之一。

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. So far, so good. I think the team is on plan. 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.

今年我們將採取有限的上市策略，逐步擴大規模，並開始實施我們之前討論過的諸如啟用監考網絡和推進後續適應症等措施。到目前為止，一切都很好。我認為團隊正在按計劃行事。我認為，從評估數據並觀察基本架構的外科醫生那裡得到的臨床回饋看起來非常好。

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. 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. You put up a nice 15% right at the top of your prior guide. Your installed base growth is still at 13% here, holding really nicely.

我想問幾個指導性問題，還有一個問題想問 Gary。首先，關於程序指導，我只是想了解你們對數字的調整，雖然幅度不大，但這是你們全年遇到的最艱難的比較。你在上一份指南的開頭就給了15%的加成。你們的裝機量成長率仍維持在 13%，表現非常出色。

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

我只是想了解一下，對於該指導意見的中點和下限，您是怎麼想的。OUS 是否恢復到 20% 的成長水準？或者在手術指南的中低端階段，我們還應該考慮哪些其他因素？

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

是的。取消低端範圍反映了我們第一季的業績，包括一般外科、結直腸外科、OUS 的持續成長，與我們在 2017 年看到的趨勢基本一致。我們也受惠於婦科和泌尿科手術的成熟發展。

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. 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.

我們目前的指導假設是，美國方面，婦科可能出現低個位數下降，我們認為這與良性子宮切除術市場的整體趨勢一致；泌尿科增長將達到低個位數；普通外科的增長將有所放緩，這主要反映了大數定律，胸腔外科、減重手術和其他早期手術也有一些適度的貢獻。我們——OUS，在中國沒有系統配額，因此不會增加產能，而在日本，隨著新程序的製定，產能提升速度會比較慢。

On the high end, still maintaining the trends in gynecology with low single-digit growth. 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. We do expect some moderation in China, but probably less so at the high end of the range.

高端市場依然維持著婦科領域的低個位數成長趨勢。泌尿外科可能略有成長，但增速略有放緩，僅為個位數；美國一般外科的成長也略有放緩；而減重手術和新興手術則持續維持良好的成長趨勢。我們預期中國市場會出現一些緩和，但可能在高位區間緩和的幅度較小。

Good color. And then kind of burning question here that we haven't asked in a while for Gary, I just want to ask. So given the success you've been experiencing, what's the biggest risk you see for the Intuitive story today?

顏色不錯。然後，我有一個很迫切的問題想問 Gary，這個問題我們已經很久沒問過了。鑑於你們所取得的成功，你認為Intuitive目前面臨的最大風險是什麼？

I guess I'd start with -- I think the opportunity for the use of advanced technologies to help surgery is really substantial. And there are both a lot of interesting scientific advances in the space we're in and there's a lot of need.

我想先說——我認為利用先進技術輔助外科手術的機會非常巨大。我們所處的領域既有許多有趣的科學進步，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. 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]. And so we manage that firmly, but I think that you need to do both.

我認為，像我們這樣的組織總是會面臨兩到三種風險，需要管理。我認為，其中之一是，為客戶供貨所需的日常營運可能會讓你無法進行持續推進[船廠]發展所需的長期投資。因此我們對此採取了強硬措施，但我認為兩者都需要做到。

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

我認為，如果十年後世界上的系統和今天一樣，我們將錯失一個重要的機會。所以我認為這裡確實有很大的晉升機會。這是其中之一。

I think the second thing that's just vital is that these things are complex technologies. They absolutely require outstanding human beings and human capital. And they need to be built -- brought into a company that has a culture of satisfying the customer and of performance. And so I think washing out culture with growth can be something that is a problem, and we need to attend to it.

我認為第二點至關重要，那就是這些都是複雜的技術。他們絕對需要傑出的人才和人力資本。而且，他們需要被培養——融入到一個擁有以客戶滿意和績效為導向的企業文化中。所以我認為，用成長沖淡文化可能會成為一個問題，我們需要重視這個問題。

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

我認為最後一點是，醫療保健是地方性的。我認為，當我們想在美國以外取得進展時，需要對我們正在進行工作的國家有深刻的了解，並且具備真正的技能和能力。

The metal may look the same, but the health care system and the way it values products differs. And I think that being too shallow in those assessments can lead to risk in underperformance. And if we underperform, then others will satisfy the need. So those are kind of the big 3 for me.

金屬的外觀可能相同，但醫療保健系統及其對產品的價值評估方式卻截然不同。我認為，評估過於膚淺可能會導致表現不佳的風險。如果我們表現不佳，那麼其他人就會滿足這種需求。所以對我來說，這三點最為重要。

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. I just wanted to clarify, on the comments with respect to guidance and how China fits in. I think, Calvin, you said China utilization or growth slowed in 1Q as you had called out previously.

恭喜你本季取得佳績。我只是想澄清一下關於指導方針以及中國在其中扮演的角色等方面的評論。卡爾文，我想你之前也說過，中國第一季的產能利用率或成長速度放緩了。

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? 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?

如果——如果中國目前的成長水準能夠維持並持續到今年年底，假設沒有配額限制，你們還有辦法達到預期目標的上限嗎？換句話說，根據你目前的運行速度和最新數據，你對中國的依賴程度有多高，才能達到你預期目標的上限？

No. I think it'd be possible. Again, I think we are calling for some moderation in China. 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.

不。我認為這是有可能的。我再次強調，我認為我們應該呼籲中國採取一些克制措施。從數量級來看，美國一般外科是我們最大的類別，而美國婦科和泌尿外科都是成熟類別中規模較大的手術計畫。

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，這些公司擁有更大的業務基礎，因此，影響它們的因素至少在今年會對它們的成長率和業績指引產生更大的影響。

Okay. And maybe just one follow-up on an earlier question on bariatric. One of the things that we continue to see in this market is the adoption of sleeve gastrectomy at the expense of gastric bypass.

好的。或許還可以就之前關於減重手術的問題做一個後續提問。在這個市場上，我們不斷看到的一個現像是，袖狀胃切除術的普及取代了胃繞道手術。

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

我只是想知道，你們覺得機器人應用在這兩個領域中，哪一個更有吸引力，或者說哪個領域有更大的未滿足需求？如果世界都走袖狀胃切除這條路，你還能成功嗎？

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.

如果我理解正確的話，這兩種手術在縫合數量上的差異很大。我認為現在就斷言減肥手術的價值會隨著時間推移而如何發展還為時過早。

Like I said, I think there's some core interest here. The procedures are taxing on surgeons. They're a demanding procedure. And there are differences between those 2 techniques. I think stay tuned is really the short answer here. We'll let it play out over the next few quarters and report back.

正如我所說，我認為這裡存在一些核心利益。這些手術對外科醫生來說是一項艱鉅的任務。這是一個要求很高的過程。這兩種技術之間存在差異。我覺得「敬請期待」就是最簡單的答案了。我們將觀察接下來幾季的情況，然後再向大家報告。

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 的合作。

Thanks for the awesome quarter. Just 2 questions for me and maybe just a little more color on hernia adoption, hernia outlook. Obviously, continues to go great. Just curious, from your perspective, what inning do you think we're in, in terms of robotic adoption? How sustainable is this kind of growth you're seeing over the next few years?

感謝大家度過了一個精彩的季度。我只有兩個問題，另外，關於疝氣收養和疝氣前景，可能還需要一些更詳細的說明。顯然，一切進展順利。我很好奇，從你的角度來看，你認為我們在機器人普及上處於哪個階段？未來幾年，你所看到的這種成長動能持續多久？

And maybe a little color on -- is this -- I assume largely driven by incisional at this point or is inguinal catching up? Just help us reflect on the drivers as you look out over the next few years.

或許可以稍微補充一點──我假設目前主要是切開引流，還是腹股溝引流正在迎頭趕上？請您幫我們思考一下，在未來幾年裡，哪些因素會成為驅動因素。

Sure. This is Gary. The -- I think we're still in the early part of the game. I don't know exactly what inning and whether there'll be extra innings or not, but we're not in the first inning. It's now becoming evaluated fairly broadly.

當然。這是加里。我覺得我們還處於遊戲的早期階段。我不知道具體是哪一局，也不知道會不會有加時賽，但我們肯定不是在第一局。現在它正受到相當廣泛的評價。

Inguinal is -- has been the primary driver in the hernia space to date. We think incisional hernias are also an opportunity and that may rise in the future relative to inguinal. So, so far, so good. We look at, of course, clinical publications and presentations and value statements as reported by clinicians. We also look at reorder patterns and use. Are they trialing? Are they sticking with it?

腹股溝疝氣一直是疝氣領域迄今的主要驅動因素。我們認為切口疝氣也是一個機會，而且未來其發生率可能會高於腹股溝疝氣。目前為止，一切順利。當然，我們也會參考臨床出版物、報告以及臨床醫生報告的價值聲明。我們也會研究重新排序模式和使用情況。他們正在進行試驗嗎？他們會堅持下去嗎？

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. And that's a good sign for us. So we think we bring real value here and customers seem to report back as much. We look forward to the next several quarters.

到目前為止，就持續使用和堅持性而言，腹股溝疝氣修補術的效果相當不錯——一旦嘗試過，患者就會堅持下去。這對我們來說是個好兆頭。所以我們認為我們在這裡帶來了真正的價值，客戶似乎也回饋了同樣的看法。我們期待接下來的幾季。

Yes. And just last for me, Gary. The -- you've been kind enough in the past to be, I think, very frank and direct about the competition -- looming competition. And just -- I'd be curious to hear your latest thoughts.

是的。最後，加里。——我認為，你過去一直很友善，對即將到來的競爭非常坦率和直接。我很想聽聽你最近的想法。

The 2 larger companies since we last spoke in this kind of context, one of the competitors seems to be delayed. You now have a smaller competitor approved in the U.S. and in Europe. Just curious how all this is changing or affecting the market or selling discussions. Is it slowing down or is it a positive? Is there a slowdown? Again, any updated perspective would be very welcome.

自從我們上次就此話題進行討論以來，這兩家規模較大的公司中，有一家競爭對手似乎出現了延誤。現在，你們有了一個規模較小的競爭對手，它已獲得美國和歐洲的批准。只是好奇這一切將如何改變或影響市場或銷售討論。它是在放緩還是在好轉？是否有放緩跡象？再次強調，任何新的見解都將非常歡迎。

Yes. 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.

是的。正如我們之前所說，我認為這種需求很明確，而且我認為，現有核心技術所帶來的機會現在也很明確——已經變得很明確了。

I think customers are always interested in choice. We can provide them choice within our ecosystem, but they'll look for choice outside that ecosystem also. And I anticipate it. And my response to customers when they ask is, they should evaluate the alternatives.

我認為顧客總是對選擇感興趣。我們可以在我們的生態系統內為他們提供選擇，但他們也會在生態系統之外尋找選擇。我對此早有預料。當客戶詢問時，我的回答是，他們應該評估其他方案。

I guess what I would say is, the hardest thing to compete with is the PowerPoints that don't yet exist in a product. There are concepts that can't really be evaluated. I think, in general, the existence of competition validates the space. I think that it signals to surgical societies the broader acceptance of the concept itself. I think that's generally positive.

我想說的是，最難競爭的是那些產品中尚未存在的 PowerPoint 文件。有些概念是無法真正評價的。我認為，總的來說，競爭的存在證明了這個領域的合理性。我認為這向外科界表明，這一概念本身已被更廣泛地接受。我認為這總體上是件好事。

I think these organizations out there that are large and small are staffed by capable people. And I think that they're going to work hard and look at alternatives. 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. But so far, so good.

我認為這些機構，無論大小，都擁有能力出眾的員工。我認為他們會努力尋找其他方案。如果他們能拿出一些真正強而有力的方案，我認為這將改變我們客戶群的現狀。但目前為止，一切順利。

I haven't seen product concepts so far that Intuitive hasn't either considered and built or considered and consciously passed on. It doesn't mean that we're not wrong. We could be. But I feel like we have a good team. I think our team thinks about these problems holistically and from the customer's perspective. And if we continue to do that, I think we'll be well positioned vis-à-vis competition.

到目前為止，我還沒有看到 Intuitive 沒有考慮過並開發過的產品概念，也沒有看到 Intuitive 沒有考慮過但有意放棄的產品概念。但這並不代表我們就沒錯。我們有可能。但我感覺我們擁有一支優秀的團隊。我認為我們的團隊會從客戶的角度，全面地思考這些問題。如果我們繼續這樣做，我認為我們在競爭中將處於有利地位。

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

那麼，我們快速跟進一下亞洲，特別是日本和中國的經濟前景。所以，在日本，您認為隨著新的報銷政策實施，系統安裝量會有顯著成長嗎？

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

我這麼問的原因是，在更新報銷政策之前，你們似乎有相當多的現有職缺。所以我想知道您是否可以幫我們分析新的報銷方式對系統需求增量意味著什麼。

Yes. I mean, we mentioned in our comments, Isaac, we're expecting it will probably be modest. We've got nearly 300 systems in Japan currently. And so there's a lot of capacity that can be applied to this new set of procedures. 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.

是的。我的意思是，正如我們在評論中提到的，艾薩克，我們預計結果可能不會太好。我們目前在日本擁有近300套系統。因此，有許多資源可以應用於這套新的流程。這套流程將包括一個組建團隊、進行培訓、並在我們獲得經驗和信心的過程中逐步發展的過程。

So I don't think there's going to be a tremendous need to expand capacity here in the early days. 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. There'll be some interest in -- on the part of some folks to upgrade to the newer models.

所以我認為，在初期階段，這裡應該沒有太大的擴容需求。確實，普通外科和胸腔外科領域的一些新手術可以受益於我們的第四代技術——Xi 技術。有些人可能會對升級到新車型感興趣。

But for us right now, I think it's really about building the foundation clinically in the market. And like we always say, eventually, the capital will follow, but we're not predicting anything too dramatic this year.

但對我們來說，現在最重要的是在市場上打好臨床基礎。正如我們常說的，最終資本會跟上，但我們預計今年不會出現什麼太戲劇性的變化。

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

好的。然後是關於中國的問題，再補充一點。聽起來，我們希望聯邦、國家層級能夠推出一些更新措施，例如給出新的配額數字。

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

但是，您能否幫助我們理清思路，了解您如何理解這個數字將如何傳遞到省級層面，並最終轉化為訂單和收入？無論是訂單流程、流程變更、時間安排，或是任何有助於我們理解配額如何轉化為實際行動的資訊。

It's a negotiation that occurs between the central government and the provinces. So we're not privy to that negotiation. And I don't really understand or know what the timetable is.

這是中央政府與各省之間的談判。所以我們並不了解那次談判的內容。我不太明白也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. 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.

我可以告訴你，上次配額獲得批准後，過了好幾季才轉換成我們能獲得的銷售額。所以——如果你還記得的話，我們上次獲得配額是在 2013 年左右，然而我們在 2015 年底就賣掉了大部分系統。

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，中央政府和各省之間要進行談判，最後還要對每家醫院進行招標，這需要時間。

All right. Well, that was our last question. As we've said previously, while we focus on financial metrics such as revenues, profits and cash flow during these conference calls, our organizational focus remains on increasing value by enabling surgeons to improve surgical outcomes and reduce surgical trauma.

好的。好了，這是我們最後一個問題。正如我們之前所說，雖然我們在這些電話會議中關注的是收入、利潤和現金流等財務指標，但我們組織的重點仍然是透過幫助外科醫生改善手術結果和減少手術創傷來增加價值。

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.

我們創立這家公司的目的是為了突破人手所能達到的外科手術極限，我向你們保證，我們將繼續致力於推動那些真正能帶來改變的關鍵因素。

This concludes today's call. 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.

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

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

女士們、先生們，今天的會議到此結束。感謝您的參與。您現在可以斷開連線了。