直覺手術 (ISRG) 2018 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by.

女士們，先生們，謝謝你們的支持。

Welcome to the Intuitive Surgical Q2 2018 Earnings Release Call.

歡迎來到 Intuitive Surgical 2018 年第二季度收益發布電話會議。

(Operator Instructions)

（操作員說明）

As a reminder, the conference is being recorded.

提醒一下，會議正在錄製中。

I'll now turn the meeting over to our host, Calvin Darling, Senior Director of Finance, Investor Relations for Intuitive Surgical.

我現在將會議轉交給我們的主持人 Calvin Darling，他是 Intuitive Surgical 投資者關係部財務高級總監。

Please go ahead.

請繼續。

Thank you.

謝謝你。

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

下午好，歡迎來到 Intuitive Surgical 第二季度收益電話會議。

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, and 10-Q filed on April 18, 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 表格和 2018 年 4 月 18 日提交的 10-Q 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 Archives 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“音頻檔案”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 second 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二季度業績的亮點，然後是問答環節。

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

Gary 將介紹本季度的業務和運營亮點。

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

Marshall 將對我們第二季度的財務業績進行審查。

Then I will discuss procedures and clinical highlights, and provide our updated financial outlook for 2018.

然後我將討論程序和臨床亮點，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。

Our second quarter of 2018 was a strong one in pursuit of our mission to improve the availability and quality of minimally invasive surgery.

我們在 2018 年第二季度表現強勁，我們致力於提高微創手術的可用性和質量。

Customer use of our systems and procedures exceeded our expectations in the quarter, with good performance in new system placements and increased system utilization at existing customer sites.

本季度，客戶對我們系統和程序的使用超出了我們的預期，新系統部署方面表現良好，現有客戶站點的系統利用率有所提高。

We believe acceptance of da Vinci in general surgery in the United States, growth internationally and appreciation of our generation 4 platform by surgeons underpins our recent growth.

我們相信，達芬奇在美國普外科的接受度、國際增長以及外科醫生對我們第 4 代平台的讚賞是我們近期增長的基礎。

That said, we are neither satisfied nor comfortable.

也就是說，我們既不滿意也不舒服。

There is substantial opportunity for improvement in surgery and our customer base has demonstrated sustained interest in our new approaches to old problems.

手術有很大的改進機會，我們的客戶群對我們解決老問題的新方法表現出持續的興趣。

Global procedure growth was approximately 18% in the quarter -- in the second quarter of 2018 compared with the second quarter of 2017, accelerating from our Q1 growth rate.

2018 年第二季度與 2017 年第二季度相比，本季度全球程序增長率約為 18%，高於我們第一季度的增長率。

Regionally, the United States showed particular strength with healthy growth in hernia repair and colorectal procedures.

從地區來看，美國在疝修補術和結直腸手術方面表現出特別的實力，健康發展。

Mature procedure growth in the United States included -- including prostatectomy and hysterectomy continued to top our expectations.

包括前列腺切除術和子宮切除術在內的美國成熟手術的增長繼續超出我們的預期。

Our first quarter aggregate procedure growth in Japan after reimbursement listing was in line with our expectations.

我們在報銷上市後第一季度在日本的總體程序增長符合我們的預期。

European procedure growth was generally in line with our expectations with particular strength in the U.K. and mixed performance elsewhere.

歐洲程序的增長總體上符合我們的預期，英國尤其強勁，其他地方表現參差不齊。

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 second quarter of 2018 accelerated relative to 2017, with growth in total placements rising 33% from 166 to 220.

我們在 2018 年第二季度的資本配售業績相對於 2017 年有所加快，總配售量從 166 筆增長 33% 至 220 筆。

Net of trade-ins and retirements, our da Vinci installed base grew 12% over Q2 of 2017.

扣除以舊換新和報廢後，我們的達芬奇安裝基數比 2017 年第二季度增長了 12%。

The mix of system placements between our flagship Xi System, our value X System and refurbished Si systems aligned with our strategy regionally.

我們的旗艦 Xi 系統、我們的價值 X 系統和翻新的 Si 系統之間的系統佈局組合符合我們的區域戰略。

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

資本配置歷來波動較大，我們預計 2018 年剩餘時間的配置會出現波動。

Turning to operating performance.

轉向經營業績。

Our teams executed to plan, with manufacturing and quality cost meeting our goals and average selling prices within our expected ranges.

我們的團隊按計劃執行，製造和質量成本達到了我們的目標，平均售價在我們的預期範圍內。

On the investment front, we are building our organization and making targeted infrastructure investments to deepen both our technological and regional capabilities.

在投資方面，我們正在建設我們的組織並進行有針對性的基礎設施投資，以深化我們的技術和區域能力。

Fixed cost spending in the quarter was slightly lower than we anticipated, largely due to the timing issues that we anticipate will catch up in the back half of the year.

本季度的固定成本支出略低於我們的預期，這主要是由於我們預計將在今年下半年趕上的時間問題。

Highlights for our second quarter operating results are as follows: procedures grew approximately 18% over the second quarter of last year; we placed 220 da Vinci surgical systems, up from 166 in the second quarter of 2017; our installed base grew 12% from a year ago; revenue for the quarter was $909 million, up 20%; pro forma gross profit margin was 71.1% compared to 71.4% in the second quarter last year; instrument and accessory revenue increased to $476 million, up 20%; total recurring revenue in the quarter was $643 million, representing 71% of total revenue; we generated a pro forma operating profit of $389 million in the quarter, up 23% from the second quarter of last year; and pro forma net income was $327 million, up 42%.

我們第二季度經營業績的重點如下：程序比去年第二季度增長約 18%；我們放置了 220 個達芬奇手術系統，高於 2017 年第二季度的 166 個；我們的安裝基數比一年前增長了 12%；本季度收入為 9.09 億美元，增長 20%；預計毛利率為 71.1%，而去年第二季度為 71.4%；儀器及附件收入增至 4.76 億美元，增長 20%；本季度經常性總收入為 6.43 億美元，佔總收入的 71%；我們本季度的預估營業利潤為 3.89 億美元，比去年第二季度增長 23%；預計淨收入為 3.27 億美元，增長 42%。

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。

Delivery of substantive technology and service improvements are core to continued progress in surgery.

提供實質性技術和服務改進是外科手術持續進步的核心。

We measure our innovations by their ability to positively impact outcomes in the hands of our customers to be used efficiently while lowering the total cost of treatment per patient episode and for their positive impact on the experience of surgical patients.

我們通過創新對客戶手中的結果產生積極影響的能力來衡量我們的創新，以便有效使用，同時降低每個患者發作的總治療成本，以及它們對外科患者體驗的積極影響。

With increased interest in da Vinci from general surgeons, we have added our 60-millimeter SureForm surgical stapler to our product portfolio with 510(k) clearance this month joining its prior CE mark.

隨著普通外科醫生對達芬奇的興趣增加，我們在本月通過 510(k) 許可將我們的 60 毫米 SureForm 外科縫合器添加到我們的產品組合中，加入了之前的 CE 標誌。

Our second generation cut and seal instrument, Vessel Seal (sic) [Sealer] Extend, is in its first quarter of U.S. launch with outstanding customer feedback, and we have submitted our 510(k) for an enhanced grasper for hernia repair.

我們的第二代切割和密封儀器 Vessel Seal (sic) [Sealer] Extend 在美國推出的第一季度獲得了出色的客戶反饋，我們已經提交了 510(k) 用於疝修復的增強型抓緊器。

As we've said in the past, we design our product systems instruments and software to work together seamlessly as an ecosystem to enable a holistic approach to a surgical procedure.

正如我們過去所說，我們設計的產品系統儀器和軟件可以作為一個生態系統無縫協同工作，從而實現外科手術的整體方法。

The latest instruments and software releases are optimized for our generation 4 platform in general surgery.

最新的儀器和軟件版本針對我們的第 4 代普外科平台進行了優化。

We obtained FDA clearance for our da Vinci Sp Surgical System for urologic surgical procedures in Q2 this year and we are finalizing our transoral clinical IDE for Sp this quarter.

我們在今年第二季度獲得了用於泌尿外科手術的達芬奇 Sp 外科手術系統的 FDA 許可，我們將在本季度完成我們的 Sp 經口臨床 IDE。

We plan to launch the da Vinci Sp Surgical System in the United States in phases, with first customer shipments expected to begin late Q3 or early Q4 this year.

我們計劃分階段在美國推出 da Vinci Sp 手術系統，第一批客戶預計將於今年第三季度末或第四季度初開始發貨。

Our first access sites will focus on clinical data generation and customer feedback.

我們的第一個訪問站點將專注於臨床數據生成和客戶反饋。

Surge in interest in Sp is high and we believe Sp to be a platform technology with potential application in a number of surgical specialties.

對 Sp 的興趣激增，我們相信 Sp 是一種平台技術，具有在許多外科專業中的潛在應用。

Consistent with our history, we will engage surgeons and regulators in clinical assessments for new applications of Sp and anticipate filing additional 510(k) applications over the next couple of years.

與我們的歷史一致，我們將讓外科醫生和監管機構參與 Sp 新應用的臨床評估，並預計在未來幾年內提交額外的 510(k) 申請。

Our team is progressing to plan on our flexible robotics platform initially targeted to address the acute need and diagnosis of lung cancer, one of the most commonly diagnosed forms of cancer in the world, and for which early detection is important.

我們的團隊正在製定我們靈活的機器人平台的計劃，最初旨在解決肺癌的迫切需求和診斷，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 remain 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仍然強烈支持我們的努力。

We anticipate submitting our 510(k) in this back half of 2018 and are working through final design validations and the bring up of our supply chain.

我們預計在 2018 年下半年提交我們的 510(k)，並且正在進行最終設計驗證和我們供應鏈的啟動。

As our approach to surgery has gained traction, organizations, large and small, are hurrying to participate in the market.

隨著我們的手術方法越來越受歡迎，大大小小的組織都在爭先恐後地參與市場。

Their entry is an inevitable reaction to positive change in the operating room.

他們的進入是對手術室積極變化的必然反應。

Customers appreciate options from Intuitive and others, and we anticipate customers will evaluate alternatives as they appear.

客戶欣賞來自 Intuitive 和其他公司的選擇，我們預計客戶會在出現替代方案時對其進行評估。

At Intuitive, we are sharply focused on understanding our customers' world and providing them with products and services they value highly.

在 Intuitive，我們專注於了解客戶的世界並為他們提供他們高度重視的產品和服務。

To take a simple example, our systems are available to start and able to complete cases with remarkable predictability considering their wide -- their use of a wide range of sophisticated technologies.

舉一個簡單的例子，我們的系統可以開始並能夠以顯著的可預測性完成案件，考慮到他們廣泛使用各種複雜的技術。

This is a consequence of our holistic design and integration principles, the capability of our staff and our deep commitment to understanding the surgical team's world.

這是我們的整體設計和整合原則、我們員工的能力以及我們對了解外科團隊世界的堅定承諾的結果。

We believe it sets a high bar for new entrants in the eyes of the thousands of surgeons who use da Vinci weekly.

我們相信，在每週使用達芬奇的數千名外科醫生眼中，它為新進入者樹立了一個高標準。

For the balance of 2018, our focus remains in completing the tasks we've set for ourselves.

在 2018 年剩下的時間裡，我們的重點仍然是完成我們為自己設定的任務。

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.

第一，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'll now turn the call over to Marshall, who will review financial highlights.

我現在將電話轉給馬歇爾，他將審查財務亮點。

Good afternoon.

下午好。

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

我將在 GAAP 和非 GAAP 備考基礎上描述我們的業績亮點。

Our results are also posted on our website.

我們的結果也發佈在我們的網站上。

Second quarter 2018 revenue of $909 million grew 20% compared with second quarter 2017 revenue of $759 million, it increased 7% compared with first quarter revenue of $848 million.

2018 年第二季度收入 9.09 億美元，較 2017 年第二季度收入 7.59 億美元增長 20%，較第一季度收入 8.48 億美元增長 7%。

The year-over-year revenue growth benefited by approximately 100 basis points from the weaker dollar.

收入同比增長得益於美元疲軟約 100 個基點。

Second quarter 2018 procedures increased approximately 18% compared with second quarter of 2017 and increased 8% compared with last quarter.

2018 年第二季度的程序與 2017 年第二季度相比增加了約 18%，與上一季度相比增加了 8%。

Procedure growth continues to be driven by general surgery in the U.S., in neurology worldwide.

在美國，在全世界的神經病學領域，手術的增長繼續受到美國普通外科手術的推動。

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 $476 million increased 20% compared with last year, which is higher than procedure growth reflecting increased usage of our advanced instruments, partially offset by customer buying patterns.

儀器和附件收入為 4.76 億美元，與去年相比增長 20%，高於程序增長，反映了我們先進儀器的使用增加，部分被客戶購買模式所抵消。

Instrument and accessory revenue realized per procedure was approximately $1,850, an increase of 1% compared with the second quarter of 2017, and a decrease of approximately 4% compared with last quarter.

每個程序實現的儀器和附件收入約為 1,850 美元，與 2017 年第二季度相比增長 1%，與上一季度相比下降約 4%。

The increase compared with last year reflects increased advanced instrument usage and the impact of a weaker dollar, partially offset by customer buying patterns.

與去年相比的增長反映了先進儀器使用的增加和美元疲軟的影響，部分被客戶購買模式所抵消。

The decrease relative to last quarter primarily reflects customer buying patterns, partially offset by increased advanced instrument usage.

與上一季度相比的下降主要反映了客戶的購買模式，部分被高級儀器使用量的增加所抵消。

Systems revenue of $277 million increased 25% compared with the second quarter of 2017, primarily reflecting higher system placements and increased lease-related revenue partially offset by lower ASPs and an increased number of operating leases.

與 2017 年第二季度相比，系統收入為 2.77 億美元，增長 25%，主要反映了更高的系統佈局和增加的租賃相關收入，部分被較低的 ASP 和增加的經營租賃所抵消。

We placed 220 systems in the second quarter of 2018 compared with 166 systems in the second quarter of 2017 and 185 systems last quarter.

我們在 2018 年第二季度放置了 220 個系統，而 2017 年第二季度為 166 個系統，上個季度為 185 個系統。

44 operating lease transactions representing 20% of total placements were completed in the current quarter compared with 16% of total placements in the second quarter of 2017 and 23% last quarter.

本季度完成了 44 筆經營租賃交易，佔總安置的 20%，而 2017 年第二季度和上一季度分別佔總安置的 16% 和 23%。

While the number of leases is difficult to predict in the short term, we expect the proportion of these types of arrangements to increase in the 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在長期內會增加。

34% of current quarter system placements involve trade-ins, reflecting customer desire to access or standardize on our fourth generation technology.

本季度 34% 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-in transactions compared to 20% in the second quarter of 2017 and 31% last quarter.

與 2017 年第二季度的 20% 和上一季度的 31% 相比，以舊換新交易的比例有所增加。

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

然而，以舊換新活動可能起伏不定且難以預測。

72% of the systems placed in the quarter were da Vinci Xis and 21% were da Vinci X Systems compared with 76% da Vinci Xis and 16% da Vinci Xs last quarter.

本季度放置的系統中有 72% 是 da Vinci Xis，21% 是 da Vinci X Systems，上一季度為 76% da Vinci Xis 和 16% da Vinci Xs。

Our installed base of da Vinci systems increased 12% year-over-year and our average system utilization grew in the mid-single-digit range.

我們的達芬奇系統安裝基數同比增長 12%，我們的平均係統利用率在中個位數範圍內增長。

Globally, our average selling price, which excludes the impact of operating leases, lease buyouts and revenue deferrals, was approximately $1.42 million, which is lower than $1.46 million last year, and $1.49 million in the first quarter.

在全球範圍內，我們的平均售價（不包括經營租賃、租賃買斷和收入遞延的影響）約為 142 萬美元，低於去年的 146 萬美元和第一季度的 149 萬美元。

The decrease primarily reflects a higher mix of trade-in transactions.

減少主要反映了更高的以舊換新交易組合。

Outside of the U.S. results were as follows.

美國以外的結果如下。

Second quarter revenue outside of the U.S. of $265 million increased 28% compared with the second quarter of 2017 and decreased 4% compared with last quarter.

第二季度美國以外的收入為 2.65 億美元，與 2017 年第二季度相比增長 28%，與上一季度相比下降 4%。

The increase compared with the prior year reflects increased systems revenue of $25 million or 32% growth, an increased instruments and accessories revenue of $27 million or 31% growth.

與上一年相比的增長反映了系統收入增加了 2500 萬美元或增長了 32%，儀器和配件收入增加了 2700 萬美元或增長了 31%。

The increase in systems revenue was driven by an increase in the number of systems placed, partially offset by lower ASPs reflecting an increase in the number of trade-in transactions.

系統收入的增長是由放置的系統數量的增加推動的，部分被較低的平均售價所抵消，反映出以舊換新交易數量的增加。

The increase in instrument accessory revenue was primarily driven by procedure growth and customer buying patterns.

儀器配件收入的增長主要是由程序增長和客戶購買模式推動的。

The decrease in OUS revenue relative to the previous quarter reflects a higher number of system lease transactions, lower system ASPs reflecting increased trade-in transactions and customer buying patterns related to I&A.

OUS 收入相對於上一季度的減少反映了系統租賃交易數量增加，系統平均售價降低反映了以舊換新交易增加以及與 I&A 相關的客戶購買模式。

OUS procedures grew approximately 22% compared with the second quarter of 2017.

與 2017 年第二季度相比，OUS 程序增長了約 22%。

OUS procedures were positively impacted by the timing of holidays in 2018 compared to 2017.

與 2017 年相比，2018 年的假期時間對 OUS 程序產生了積極影響。

Outside the U.S., we placed 82 systems in the second quarter compared with 63 in the second quarter of 2017 and 73 in the first quarter.

在美國以外，我們在第二季度部署了 82 個系統，而 2017 年第二季度為 63 個，第一季度為 73 個。

Current quarter system placements included 39 into Europe, 13 into Japan and 9 into Australia.

當前季度系統安置包括 39 個進入歐洲、13 個進入日本和 9 個進入澳大利亞。

30 of the 82 systems placed in the second quarter were X Systems.

第二季度放置的 82 個系統中有 30 個是 X 系統。

Placements outside 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 regulations.

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

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 second quarter of 2018 was 71.1% compared with 71.4% for the second quarter of 2017 and 71.6% last quarter.

2018 年第二季度的備考毛利率為 71.1%，而 2017 年第二季度為 71.4%，上一季度為 71.6%。

The decreases primarily reflect lower system ASPs and revenue mix.

下降主要反映了較低的系統平均售價和收入組合。

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

未來的利潤率將根據我們新產品的組合、系統和儀器及配件收入的組合、系統平均銷售價格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 14% compared with the second quarter of 2017, and decreased 1% compared with last quarter.

預計營業費用與 2017 年第二季度相比增長 14%，與上一季度相比下降 1%。

The decrease relative to the first quarter primarily reflects the impact to payroll taxes.

與第一季度相比的下降主要反映了對工資稅的影響。

Overall, our spending was below our annual guidance reflecting the timing of expenditures.

總體而言，我們的支出低於反映支出時間的年度指導。

We expect spending to increase in the last half of 2018 consistent with our guidance.

我們預計 2018 年下半年的支出將按照我們的指引增加。

Our pro forma effective tax rate for the second quarter was 19.7% compared with our expectations of 20% to 21%.

我們第二季度的備考有效稅率為 19.7%，而我們的預期為 20% 至 21%。

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 one-time 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 second quarter 2018 pro forma net income was $327 million or $2.76 per share compared with $230 million or $2 per share for the second quarter of 2017 and $288 million or $2.44 per share for the first quarter of 2018.

我們 2018 年第二季度的備考淨收入為 3.27 億美元或每股 2.76 美元，而 2017 年第二季度為 2.3 億美元或每股 2 美元，2018 年第一季度為 2.88 億美元或每股 2.44 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 $255 million or $2.15 per share for the second quarter of 2018 compared with GAAP net income of $223 million or $1.94 per share for the second quarter of 2017 and GAAP net income of $288 million or $2.44 per share for the first quarter of 2018.

2018 年第二季度 GAAP 淨收入為 2.55 億美元或每股 2.15 美元，而 2017 年第二季度 GAAP 淨收入為 2.23 億美元或每股 1.94 美元，第一季度 GAAP 淨收入為 2.88 億美元或每股 2.44 美元2018.

The adjustments between pro forma and GAAP net income are outlined and quantified on our website and include excess tax benefits associated with employee stock awards, employee equity and IP charges and legal settlements, including the previously announced second quarter 2018 charge of $42.5 million.

備考和 GAAP 淨收入之間的調整在我們的網站上進行了概述和量化，其中包括與員工股票獎勵、員工股權和知識產權費用以及法律和解相關的超額稅收優惠，包括之前宣布的 2018 年第二季度 4250 萬美元的費用。

Note that the IRS has not issued final tax 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稅法。

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

因此，我們的結果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和進一步解釋而改變。

We ended the quarter with cash and investments of $4.3 billion compared with $4.1 billion at March 31, 2018.

本季度末，我們的現金和投資為 43 億美元，而 2018 年 3 月 31 日為 41 億美元。

The increase reflects cash generated from operations of $220 million.

這一增長反映了 2.2 億美元的運營產生的現金。

We did not repurchase 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。

In the quarter, we repatriated $1.4 billion of cash to the U.S. since the earnings had previously been taxed under the U.S. Tax Reform Act of 2017, and there were effectively no foreign taxes assessed under repatriation.

本季度，我們將 14 億美元的現金匯回美國，因為此前已根據 2017 年美國稅改法案對收益徵稅，而且匯回時實際上沒有評估外國稅款。

We've not changed our capital deployment strategy or plans.

我們沒有改變我們的資本部署戰略或計劃。

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 second quarter procedure growth was 18% compared to 16% during the second quarter of 2017 and 15% last quarter.

我們第二季度的總體程序增長率為 18%，而 2017 年第二季度為 16%，上一季度為 15%。

Our Q2 procedure growth was driven by 17% growth in U.S. procedures and 22% growth in OUS markets.

我們第二季度的程序增長是由美國程序增長 17% 和 OUS 市場增長 22% 推動的。

In the U.S., procedure performance across general surgery, gynecology and urology all exceeded our expectations with Q2 year-over-year growth rates accelerating modestly across these largest categories.

在美國，普外科、婦科和泌尿科的手術表現都超出了我們的預期，這些最大類別的第二季度同比增長率略有加速。

Q2 procedure performance was again driven by growth in general surgery.

第二季度的手術表現再次受到普通外科手術增長的推動。

Hernia repair and colorectal procedures continue to lead the way as these categories again added the most incremental cases.

疝修補術和結直腸手術繼續領先，因為這些類別再次增加了最多的病例。

As usage of da Vinci in the U.S. general surgery expands, other general surgery procedures contributed larger numbers of incremental cases than previous quarters.

隨著達芬奇在美國普通外科手術中的使用範圍擴大，其他普通外科手術比前幾個季度貢獻了更多的增量病例。

In U.S. gynecology, second quarter 2018 growth was consistent with 2017 and Q1 2018 trends as procedures in this mature category grew modestly year-over-year, with growth led by hysterectomy.

在美國婦科，2018 年第二季度的增長與 2017 年和 2018 年第一季度的趨勢一致，因為這一成熟類別的手術同比增長溫和，其中增長由子宮切除術帶動。

We hypothesize our growth in gynecology will be driven by favorable surgical consolidation trends as our da Vinci surgery data indicate an increasing proportion of U.S. gynecology procedures are being performed by higher volume physicians that specialize in complex, benign and cancer surgery.

我們假設我們在婦科領域的增長將受到有利的手術鞏固趨勢的推動，因為我們的達芬奇手術數據表明，越來越多的美國婦科手術由專門從事複雜、良性和癌症手術的高容量醫生執行。

Q2 U.S. urology procedures also had growth rates consistent with 2017 and Q1 2018, driven by prostatectomy volumes.

在前列腺切除術的推動下，美國第二季度泌尿外科手術的增長率也與 2017 年和 2018 年第一季度一致。

As a mature procedure category, we believe that our U.S. prostatectomy volumes have been tracking to the broader prostate 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市場，該市場受益於近期的宏觀趨勢。

In U.S. other procedures, adoption of lobectomies and other thoracic procedures was again solid during the second quarter.

在美國的其他手術中，肺葉切除術和其他胸腔手術的採用在第二季度再次保持穩定。

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

我們的達芬奇 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。

Second quarter OUS procedure volume grew approximately 22% compared with 22% for the second quarter of 2017 and 18% last quarter.

與 2017 年第二季度的 22% 和上一季度的 18% 相比，第二季度 OUS 手術量增長了約 22%。

Second 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 年第二季度 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。

As expected, Q2 OUS procedure growth was higher than Q1, benefiting from more operating days, resulting from the timing of holidays, including Easter.

正如預期的那樣，第二季度 OUS 程序增長高於第一季度，這得益於更多的手術天數，這是由於包括復活節在內的假期時間安排所致。

Procedure growth in Japan accelerated as initial cases were performed within the set of 12 additional procedures approved for reimbursement effective April 1. Procedure growth in China again moderated in Q2, as da Vinci system capacity expansion is constrained by system quota requirements.

日本的手術增長加速，因為最初的病例是在 4 月 1 日起批准報銷的 12 個額外手術中進行的。中國的手術增長在第二季度再次放緩，因為達芬奇系統容量擴張受到系統配額要求的限制。

The most recent of which expired at the end of 2015.

最近的一份於 2015 年底到期。

In Europe, procedure results vary by country with particular strength in the U.K.

在歐洲，程序結果因國家/地區而異，在英國具有特殊優勢。

Over the years, the discussion surrounding da Vinci surgery has been centered around the clinical patient benefits.

多年來，圍繞達芬奇手術的討論一直圍繞著臨床患者的利益展開。

In addition, we believe there is substantial opportunity to create surgeon value as well by improving the ergonomic characteristics of surgery.

此外，我們相信通過改善手術的人體工程學特性，也有大量機會創造外科醫生的價值。

In 2017, in the Annals of Surgery, Dr. Chantal C.J. Alleblas, et al, published an analysis entitled Prevalence of Musculoskeletal Disorders (MSDs) Among Surgeons Performing Minimally Invasive Surgery: A Systemic Review.

2017 年，Chantal C.J. Alleblas 博士等人在 Annals of Surgery 中發表了一篇題為進行微創手術的外科醫生中肌肉骨骼疾病 (MSD) 患病率：系統評價的分析。

This meta study reviewed 35 articles, including over 7,000 surgeons.

這項元研究回顧了 35 篇文章，包括 7,000 多名外科醫生。

The authors characterized the risk factors associated with lap surgery to include, "static body posture, repetitive upper extremity movements and forced exertion from adverse positions.

作者描述了與膝關節手術相關的風險因素，包括“靜態的身體姿勢、重複的上肢運動和不利位置的強迫運動。

Moreover, the workload is increased by the high level of task precision and time pressure.

此外，任務精度和時間壓力的高水平增加了工作量。

Physical demands differ between open and laparoscopic surgery and comparative studies have reported higher prevalences of physical complaints for laparoscopic surgeons.

開放手術和腹腔鏡手術對身體的要求不同，比較研究報告稱，腹腔鏡外科醫生對身體的抱怨更為普遍。

Recent studies report MSD prevalence rates of 73% to 88% among specialists at MIS.

最近的研究報告 MIS 專家的 MSD 患病率為 73% 至 88%。

Relative to the general population, these numbers are excessively high." In their study, the authors found, "a 74% prevalence of physical complaints among laparoscopic surgeons.

相對於一般人群，這些數字過高。”在他們的研究中，作者發現，“腹腔鏡外科醫生的身體不適率為 74%。

However, the low response rates and the high inconsistency across studies leaves some uncertainty, suggesting an actual prevalence of between 22% and 74%.

然而，低響應率和研究之間的高度不一致性留下了一些不確定性，表明實際患病率在 22% 到 74% 之間。

Fatigue and MSDs impact cycle motor performance.

疲勞和 MSD 會影響自行車運動性能。

Therefore, these results warrant further investigation." While pain ratings are subjective, we think there's opportunity to improve ergonomics for surgeons.

因此，這些結果值得進一步調查。”雖然疼痛評級是主觀的，但我們認為有機會改善外科醫生的人體工程學。

With our recent bariatric surgery indication and SureForm 60-millimeter stapler 510(k) clearance, we are better positioned to serve bariatric surgeons.

憑藉我們最近的減肥手術適應症和 SureForm 60 毫米吻合器 510(k) 許可，我們可以更好地為減肥外科醫生提供服務。

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 12% 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 12% 至 15% 的範圍內。

We are now increasing our forecast and estimate full year 2018 procedure growth of 14.5% to 16.5%.

我們現在增加了我們的預測，並估計 2018 年全年程序增長 14.5% 至 16.5%。

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, our actual gross profit margin will vary quarter-to-quarter depending largely on product, regional and trade-in mix and the impact of new product introductions.

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，我們的實際毛利率將隨季度變化，主要取決於產品、區域和折價組合，以及新產品推出的影響。

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 continue to expect our noncash stock compensation expense to range between $245 million and $255 million in 2018 as forecast on our last call.

正如我們上次電話會議預測的那樣，我們繼續預計 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。

We expect other income, which is comprised mostly of interest income to total between $70 million and $75 million in 2018, up from $55 million to $60 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 7000 萬美元至 7500 萬美元之間，高於我們上次電話會議預測的 5500 萬美元至 6000 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 21% of pretax income.

關於所得稅，在我們上次電話會議上，我們預測 2018 年的預估所得稅稅率將在稅前收入的 20% 至 21% 之間。

We are now shifting our estimates slightly lower to a range of between 19.5% and 20.5% of pretax income.

我們現在將我們的估計略微下調至稅前收入的 19.5% 至 20.5% 之間。

That concludes our prepared remarks.

我們準備好的發言到此結束。

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) And our first question from Tycho Peterson with JPMorgan.

（操作員說明）第谷彼得森與摩根大通的第一個問題。

Great quarter.

偉大的季度。

I want to start with the U.S. procedure growth.

我想從美國程序的增長開始。

You've had about a 300 basis point sequential acceleration.

你已經有大約 300 個基點的連續加速。

Can you maybe just talk a little bit more about that?

你能不能多談談這個？

I mean, hernia's obviously been doing well for a while, but you really seem to have an inflection here, so can you talk to maybe the sustainability of what you saw here in the quarter?

我的意思是，疝氣顯然已經好一段時間了，但你似乎真的有一個變化，所以你能談談你在本季度在這裡看到的東西的可持續性嗎？

Yes.

是的。

Our approach, we approach procedure enablement by designing system instruments and imaging and software elements with surgeon feedback and with the introduction of our Xi System and our next-generation advanced instruments and refinement imaging software.

我們的方法是通過設計系統儀器、成像和軟件元素以及外科醫生的反饋並引入我們的 Xi 系統和我們的下一代先進儀器和精細成像軟件來實現程序。

Our customers are seeing real value in general surgery particularly with the gen 4 systems.

我們的客戶看到了普通外科手術的真正價值，尤其是第 4 代系統。

You mentioned hernia repair and colorecters.

你提到了疝氣修復和結直腸癌。

They've been leading adoption and we've seen organic interest from bariatric surgeons as well.

他們一直處於領先地位，我們也看到了減肥外科醫生的有機興趣。

As our SureForm 60 stapler comes to market and with the addition of the gen 4 labeling in bariatrics, we look forward to serving those opportunities as well.

隨著我們的 SureForm 60 吻合器上市並在減肥中添加第 4 代標籤，我們也期待著為這些機會提供服務。

Tycho, it's Gary.

第谷，是加里。

One of the things we look at, as you know, is kind of the stick rates or reorder rates and -- just to see, are people trialing or are they staying with it.

如您所知，我們關注的其中一件事是堅持率或再訂購率——只是為了看看人們是在試用還是堅持下去。

And then in hernia repair and colorectal, we're seeing nice stick rates on those sides.

然後在疝氣修復和結直腸癌中，我們看到這些方面的粘附率很高。

So we feel like we're building momentum here.

所以我們覺得我們在這裡建立勢頭。

It's also about sustainability and I think, prostatectomy, urologic increases as well as gynecologic increases in the U.S. have surprised me.

這也與可持續性有關，我認為，美國的前列腺切除術、泌尿科增加以及婦科增加讓我感到驚訝。

And I don't have as much confidence that those are sustainable.

而且我對這些是可持續的沒有那麼大的信心。

Okay.

好的。

And then thinking a little bit ahead on pipeline.

然後在管道上提前考慮一下。

Can you talk a little bit about the data roadmap for flex cath?

您能談談 flex cath 的數據路線圖嗎？

Obviously, you're doing a lot of the optimization work on the manufacturing side, but how should we think about incremental data coming out ahead of the launch?

顯然，你們在製造方面做了很多優化工作，但我們應該如何考慮在發布之前出現的增量數據？

Nothing new to report for you there.

沒有什麼新鮮事要報告給你。

Certainly, as it starts coming into the market.

當然，隨著它開始進入市場。

You'll see early site start to take a broader data collection and so on, with regard to what regulators want to see.

你會看到早期網站開始收集更廣泛的數據等等，這與監管機構希望看到的有關。

We'll see what happens with regard to their feedback to our submission when that occurs.

當發生這種情況時，我們將看到他們對我們提交的反饋會發生什麼。

So I don't have anything to point you to at this time.

所以我現在沒有什麼可以指點你的。

Okay.

好的。

And then last one, Gary, you mentioned interest in Sp beyond kind of the initial opportunities that you've talked about.

最後一個，加里，你提到了對 Sp 的興趣，超出了你所說的最初機會。

Are you willing to kind of comment on some of those areas?

你願意對其中一些領域發表評論嗎？

It seems like that there's some interest in cardiology based on (inaudible), what the others have done.

似乎人們對心髒病學的興趣基於（聽不清）其他人所做的事情。

How prevalent is that in some of your early discussions?

這在您早期的一些討論中有多普遍？

I have been pleased so far with the interest that Sp is generating in our customers to explore where it can create real value.

到目前為止，我很高興 Sp 在我們的客戶中產生興趣，探索它可以創造真正價值的地方。

The things we've talked about with you earlier, clearly, some interest in urology.

我們之前和你談過的事情，顯然是對泌尿外科的一些興趣。

We think there will be real interest in colorectal surgery and transoral surgery as well.

我們認為結直腸手術和經口手術也會引起真正的興趣。

There are -- we've had early discussions in several other specialties.

有 - 我們已經在其他幾個專業中進行了早期討論。

I think it's very early to start pointing our investor base.

我認為現在開始指出我們的投資者基礎還為時過早。

I think towards one or the other is probably too soon.

我認為選擇其中之一可能為時過早。

That said, it provides access to the body that comes in fundamentally differently than an Xi brings instruments into the body.

也就是說，它提供了進入身體的通道，這與安熙將儀器帶入身體有根本不同。

And we did that because we think it will provoke interest in value creation and other places as we get more experience as these come out into the world, then we'll keep you up to date.

我們這樣做是因為我們認為它會激發人們對價值創造和其他地方的興趣，因為我們會在這些地方出現時獲得更多經驗，然後我們會讓你了解最新情況。

And we go next to Amit Hazan with Citi.

我們和花旗一起去 Amit Hazan 旁邊。

This is [Jamie] on for Amit.

這是 [傑米] 替阿米特發言。

So first, a question just on systems features, when you think about the benefits and challenges of an open console.

首先，當您考慮開放式控制台的好處和挑戰時，一個關於系統功能的問題。

And also separately, the benefits and challenges of a system with arms mounted on a table.

另外，還有將手臂安裝在桌子上的系統的好處和挑戰。

How do you guys just think about those types of features that your competitors are starting to talk about?

你們如何看待競爭對手開始談論的那些類型的功能？

Kind of just zooming out for a minute.

有點像縮小一分鐘。

I think, the way we think about it for our customers is what allows for smooth operations across a population of patients in a broad set of procedures types from urology to gynecology to general surgery to thoracic surgery and so on.

我認為，我們為客戶考慮的方式是允許在從泌尿科到婦科到普通外科再到胸外科等一系列廣泛的手術類型中順利進行手術。

And as we think about those things, we've been at this for a long time.

當我們考慮這些事情時，我們已經關注了很長時間。

The idea of mounting things to tables, the idea of mounting them to floors, of having them be modular, of using open consoles versus consoles that have immersive viewers, have been around quite a bit and we have evaluated and tried a lot of them.

將東西安裝到桌子上的想法、將它們安裝到地板上的想法、將它們模塊化、使用開放式控制台與具有身臨其境的觀眾的控制台的想法已經存在了很多，我們已經評估並嘗試了很多。

We came to these decisions not based on whiteboard analyses but on building things and talking to our customers and working through it.

我們做出這些決定不是基於白板分析，而是基於構建事物並與我們的客戶交談並完成它。

So it doesn't mean that we're right.

所以這並不意味著我們是對的。

Could absolutely mean that somebody else did something slightly different and they evaluated it differently.

絕對可能意味著其他人做了一些稍微不同的事情，他們對它的評價也不同。

But we were not casual about this.

但我們對此並不隨意。

And we did it with serving a population of patients, a population of surgeons across a procedures set in mind.

我們做到了這一點，為一群患者服務，一群外科醫生在腦海中設定了一個程序。

With that, I'm comfortable where the company has made its investments.

有了這個，我對公司進行投資的地方感到滿意。

Okay.

好的。

And then a question on the imaging side.

然後是成像方面的問題。

With what you guys are working on for the first generation launch of that, is that basically going to be pre-op images only?

你們正在為第一代發布所做的工作，基本上只是術前圖像嗎？

Or is there a possibility to do real-time imaging in that first generation launch?

或者是否有可能在第一代發射中進行實時成像？

Just help us understand the technology roadmap from here and timing expectation.

只是幫助我們從這裡了解技術路線圖和時間預期。

I'm not quite sure when you say first gen imaging.

我不太確定你說的是第一代成像。

We have done a lot of things in imaging for a lot of years, so perhaps a little clarity on what...

多年來，我們在成像方面做了很多事情，所以也許可以清楚地了解什麼......

I'm sorry.

對不起。

For the imaging onlay side of things.

對於事物的成像覆蓋面。

Overlays.

疊加。

With regard to this, I think you're talking a little bit about image fusion, the idea of using preoperative images like CT scans or MRI with endoscopic images and fusing those 2 together.

關於這一點，我認為你在談論圖像融合，即使用術前圖像（如 CT 掃描或 MRI）和內窺鏡圖像並將這兩者融合在一起的想法。

Again, ideas there have been around for many years.

同樣，這些想法已經存在多年。

Today, in existing shipping systems, customers can use something called Tile Pro to bring up preoperative images and compare them in real-time to what they're using.

如今，在現有的運輸系統中，客戶可以使用一種叫做 Tile Pro 的東西來調出術前圖像，並將它們與他們正在使用的圖像進行實時比較。

There are some other things in the works that allow for tighter integration of those images in fusion.

作品中還有一些其他的東西可以讓這些圖像更緊密地融合在一起。

We have not set expectations on timelines nor on future content yet.

我們尚未對時間表或未來內容設定預期。

We have a lot of technology capability there.

我們在那裡有很多技術能力。

We will bring something out when we feel like it really makes a difference in surgeons' lives and enables them to either create different outcomes or be more efficient.

當我們覺得它真的能改變外科醫生的生活並使他們能夠創造不同的結果或提高效率時，我們就會把它拿出來。

There's potential, nothing to update you in terms of timing.

有潛力，沒有什麼可以在時間方面更新你。

And we go to David Lewis with Morgan Stanley.

我們和摩根士丹利一起去大衛劉易斯。

Gary or team, I want to start with systems momentum in the first half of the year.

加里或團隊，我想從上半年的系統動力開始。

So last quarter, we saw increased trade outs and again, this quarter.

因此，上個季度，我們看到交易量增加，本季度再次出現。

So I just wonder how are the dynamics in your mind different this quarter than last quarter?

所以我只是想知道本季度與上一季度相比，您心目中的動態有何不同？

What are your thoughts to sustainability of these system trends?

您對這些系統趨勢的可持續性有何看法？

And any concerns on driving Sp here in the back half of the year as you're also aggressively driving customers to the gen 4 platform and then I had a quick follow-up.

以及在今年下半年在這裡推動 Sp 的任何擔憂，因為您也在積極推動客戶使用第 4 代平台，然後我進行了快速跟進。

I think we don't see a real change in terms of momentum from one quarter to another, at least in the first quarter and second.

我認為我們看不到從一個季度到另一個季度的勢頭有真正的變化，至少在第一季度和第二季度是這樣。

Other than as you indicated, you do see a higher percentage of trade-ins.

與您指出的不同，您確實看到了更高比例的以舊換新。

The fourth generation product has some features in it, I think, that we're seeing excitement from the general surgeons about utilizing for the procedures we talked about earlier, colorectal procedures, thoracic procedures.

我認為，第四代產品具有一些特點，我們看到普通外科醫生對將其用於我們之前談到的手術、結直腸手術、胸腔手術感到興奮。

And I think the hospitals and surgeons want to avail themselves to that technology so we're seeing trade outs.

而且我認為醫院和外科醫生希望利用這項技術，所以我們看到了權衡取捨。

We're also seeing some desire to have standardization within a hospital where they only have 1 set of instrumentation to manage rather than 2. And so trade-ins are difficult to predict as to where we are in a particular cycle or how much will happen in any particular quarter.

我們還看到一些希望在醫院內實現標準化的願望，他們只有 1 套儀器需要管理，而不是 2 套。因此很難預測以舊換新我們在特定週期中的位置或會發生多少在任何特定的季度。

But what we have seen is a slight increase in those trade-ins.

但我們看到的是這些以舊換新略有增加。

Two things I'd add to that.

我要補充兩件事。

One is customer use and efficiencies with generation 4 platform is quite good.

一是第 4 代平台的客戶使用和效率非常好。

So we are pleased to see their interest and to the extent that we can be flexible and help them move into gen 4, we will.

因此，我們很高興看到他們的興趣，並且我們可以靈活地幫助他們進入第 4 代，我們會的。

With regard to Sp, our initial thought here in Phase I of the launch is not to do an enormous placement -- capital placement of Sp.

關於Sp，我們在啟動的第一階段最初的想法是不做大量的配售——Sp的資本配售。

It's really to establish clinical data centers and build out the value story as we go and to really begin the early collection for next indications.

這真的是建立臨床數據中心並在我們前進的過程中構建價值故事，並真正開始為下一個適應症進行早期收集。

Over time, as we build out that experience base, the -- our interest in expanding the Sp footprint will increase.

隨著時間的推移，當我們建立經驗基礎時，我們對擴大 Sp 足蹟的興趣將會增加。

But that's a multi-quarter conversation, not a really quick turn.

但這是一個多季度的對話，而不是一個真正快速的轉變。

Sp long term -- and I think we've talked about it.

SP 長期——我想我們已經討論過了。

In the beginning Sp will go out as full systems but as we build out the evidence base, it will be a part of the gen 4 platform.

一開始，Sp 將作為完整系統推出，但隨著我們建立證據基礎，它將成為第 4 代平台的一部分。

It will be easy to upgrade and configure as part of gen 4 and that's been part of our thought process for some time.

作為第 4 代的一部分，升級和配置將很容易，這已經成為我們思考過程的一部分已有一段時間了。

Okay.

好的。

And then Gary or team, just on Asia-Pac strategy broadly.

然後是加里或團隊，就廣泛的亞太戰略而言。

Didn't hear much about Japan in this particular transcript.

在這個特定的成績單中沒有聽到太多關於日本的信息。

How are you encouraged by the early traction in Japan?

您對日本的早期牽引力感到鼓舞嗎？

Is that sort of on plan?

這樣的計劃嗎？

Ahead of plan?

提前計劃？

Maybe comments there.

也許那裡有評論。

And then Gary, you've talked about before, I think you made some statements at a certain point of the year, the absence of the China quota obviously reduces the likelihood this year.

然後加里，你之前說過，我想你在今年的某個時候發表了一些聲明，沒有中國配額顯然降低了今年的可能性。

Or any updated thoughts on the likelihood of China this year?

或者對今年中國的可能性有什麼最新的想法？

And any impact on just tariff rhetoric on getting that deal done?

關稅言論對完成該交易有何影響？

Okay.

好的。

On Japan, first quarter, here or after the listing, we're pleased with the interest of the customer base.

在日本，第一季度，在這里或上市後，我們對客戶群的興趣感到滿意。

Our training facilities are busy.

我們的訓練設施很忙。

We're pleased with that.

我們對此感到滿意。

We are really testing the capabilities now of our newly formed or newly grown team in Japan to really execute.

我們正在真正測試我們在日本新成立或新成長的團隊的實際執行能力。

So I think, a little early to tell the ultimate performance there.

所以我認為，現在說終極性能還有點早。

First steps look fine.

第一步看起來不錯。

I think there's real work to do.

我認為有真正的工作要做。

And so our team and we are focused on really execution.

因此，我們的團隊和我們專注於真正的執行。

It's not a big strategy question.

這不是一個大的戰略問題。

It's getting the training pathway to the proctoring pathway to the follow-up pathway to the support on-site, really built and operating well and that's what we've asked the team to focus on and we will be focused on.

它正在從培訓途徑到監考途徑到後續途徑到現場支持，真正構建和運行良好，這就是我們要求團隊關注的，我們將關注的。

The first step of demand generation looks really good.

需求生成的第一步看起來非常好。

So moving to China, I'll speak briefly to the quota.

談到中國，我將簡要談談配額。

I'll ask Marshall to speak briefly to the impact -- the potential impact of tariffs.

我將請馬歇爾簡要談談影響——關稅的潛在影響。

On the quota side, we have no real update to supply you with.

在配額方面，我們沒有真正的更新可以提供給您。

We are awaiting an additional quota, no news there.

我們正在等待額外的配額，目前還沒有消息。

Overall, I think the atmospherics that are going on globally do not help that conversation.

總的來說，我認為全球正在發生的氣氛無助於對話。

I don't have anything specific to tell you there, but generally speaking, I think the atmospherics of those conversations are not helping the quota generation.

我沒有什麼具體要告訴你的，但總的來說，我認為這些談話的氣氛對配額的產生沒有幫助。

You do see, as we have told you in last calls, that our procedure outside is going to require additional capital if we think the demand is there and so there's a problem we need to solve.

你確實看到，正如我們在上次電話中告訴你的那樣，如果我們認為存在需求並且我們需要解決問題，那麼我們的外部程序將需要額外的資金。

China is important to us as a market, and for our joint venture, we are committed to it.

中國作為一個市場對我們很重要，對於我們的合資企業，我們致力於此。

And we are going to have to work through current macro challenges that are out there.

我們將不得不應對當前存在的宏觀挑戰。

Marshall, you might speak to it.

馬歇爾，你可以跟它說話。

Yes, the tariff situation is obviously dynamic.

是的，關稅情況顯然是動態的。

The first round of tariffs have been imposed do impact some of the components that our suppliers use to supply us.

第一輪關稅的徵收確實影響了我們的供應商用來供應我們的一些組件。

We're under the -- we're studying that as we speak.

我們在——我們正在研究這個問題。

We think that the estimated impact will be modest in terms of the increase in product costs for our systems that's not a cost or a level that we're going to pass any of those costs on to customers at this point in time.

我們認為，就我們系統的產品成本增加而言，估計的影響將是適度的，這不是我們將在此時將任何這些成本轉嫁給客戶的成本或水平。

And we go to Bob Hopkins with Bank of America.

我們和美國銀行一起去鮑勃霍普金斯。

I wanted to start with Sp.

我想從 Sp 開始。

Gary, you characterized interest in Sp as high.

加里，你認為對 Sp 的興趣很高。

I was wondering if you could just go into a little more detail and comment maybe on which types of accounts are expressing initial levels of interest?

我想知道您是否可以更詳細地討論一下哪些類型的帳戶表達了最初的興趣？

And will you restrict the center?

你會限制中心嗎？

If they're interested in Sp, will you restrict them?

如果他們對 Sp 感興趣，你會限制他們嗎？

So I just want to kind of get a little more color on how you're thinking about Sp.

所以我只是想稍微了解一下您對 Sp 的看法。

In terms of accounts, there's a fair amount of interest that's, I think, broad across the segments.

就賬戶而言，我認為，各個細分市場都有相當多的興趣。

For us, first of all, we have a set of clearances that we have, that will allow access to it to get started and then subsequent data collection to do for additional clearances.

對於我們來說，首先，我們有一組許可，這將允許開始訪問它，然後進行後續數據收集以進行額外許可。

So that will determine the early access strategy there, is really around what clearances we have and the ones we want to pursue in the future.

因此，這將決定那裡的早期訪問策略，實際上是圍繞我們擁有的許可以及我們希望在未來追求的許可。

We will be supply limited for the first few quarters here.

我們將在這裡的前幾個季度供應有限。

So the answer there is there will be a bit of a line to put these first set out as we go.

所以答案是，在我們進行的過程中，首先要列出這些內容。

Now as we get the additional clearances and master the technologies, then I think that gets a lot easier.

現在，隨著我們獲得額外的許可並掌握技術，我認為這會變得容易得多。

But it will be a designed rollout to start.

但這將是一個設計好的開始。

Also, you made a comment in prepared remarks about the potential for volatility in capital for the rest of 2018.

此外，您在準備好的評論中就 2018 年剩餘時間的資本波動潛力發表了評論。

Is that just because there could always be volatility in capital?

這僅僅是因為資本總是會波動嗎？

Or is there something specific that you're referring to?

或者你指的是什麼具體的東西？

No, nothing specific.

不，沒有什麼特別的。

It's really the -- just in general, it's hard to predict capital, given budget cycles, given government regulations in the case of China, in the case -- and just seasonality.

這真的是——一般來說，很難預測資本，考慮到預算週期，考慮到中國的政府法規，在這種情況下——而且只是季節性。

So it's just hard to predict when hospitals will actually purchase and so you could see it be lumpy over time.

所以很難預測醫院什麼時候會真正購買，所以隨著時間的推移，你會看到它是塊狀的。

What happens also is the aggregate reporting, of course, averages a lot of lumpiness that happens underneath.

當然，聚合報告也發生了很多事情，平均發生在下面。

So even if the aggregate looks smooth, the regional variances can be reasonably high.

因此，即使總體看起來很平滑，區域差異也可能相當高。

And so it's just as Marshall properly said, nothing specific but the general dynamics that are out there.

因此，正如馬歇爾所說的那樣，沒有什麼特別的，只是那裡的一般動態。

Particularly on stapler and vessel sealing, if you're successful with those launches, shouldn't we start to see upward momentum in your revenue per procedure?

特別是在吻合器和血管密封方面，如果您在這些發布方面取得成功，我們是否應該開始看到您每次手術收入的上升勢頭？

I realized there's a lot of things that affect that line but those are 2 pretty chunky products and just curious if you're successful in those launches, should we expect that line item to start to move higher?

我意識到有很多因素會影響該產品線，但那是 2 個非常笨重的產品，如果您在這些發布中取得成功，我很好奇，我們是否應該期望該產品線開始走高？

Yes.

是的。

When you look at revenue per procedure overall, there's clearly some variance quarter-to-quarter.

當您整體查看每個程序的收入時，顯然每個季度都存在一些差異。

We talk a lot about customer timing, order timing and things like that.

我們談論了很多關於客戶時間、訂單時間和類似的事情。

So quarter-to-quarter, you see those things, but we are seeing an increasing contribution from advanced instruments, including our stapling products, which are getting more usage as well as vessel sealing.

所以每個季度，你都會看到這些東西，但我們看到先進儀器的貢獻越來越大，包括我們的吻合產品，它們的使用和容器密封越來越多。

We introduced a new version of our Vessel Seal (sic) [Sealer] Extend in the last quarter.

我們在上個季度推出了新版本的 Vessel Seal (sic) [Sealer] Extend。

And now the 60-millimeter stapler that we'll be rolling out here in the third quarter, with expanded access available in the fourth quarter.

現在，我們將在第三季度在這裡推出 60 毫米訂書機，並在第四季度擴大使用範圍。

That just serves to expand this category further -- round our product line, a little further for stapling and provides a more optimized tool within the category of bariatrics.

這只是為了進一步擴大這一類別——圍繞我們的產品線，進一步擴大縫合，並在減肥類別中提供更優化的工具。

So the simple answer is yes, that, that will just be more on our advanced instruments side of things that, that element will serve to be a tailwind for revenue per procedure.

因此，簡單的答案是肯定的，那將更多地體現在我們先進的儀器方面，該元素將成為每個程序收入的順風。

We go to Larry Biegelsen with Wells Fargo.

我們和富國銀行一起去拉里比格爾森。

You did, I think, 16.5% procedure growth in the first half of the year, if I'm doing the math right.

我認為，如果我沒記錯的話，今年上半年你確實實現了 16.5% 的程序增長。

Just my question is, the second half, the guidance implies about 12.5% to 16.5% in the second half of the year, again, if I'm doing the math right.

我的問題是，下半年，指導意味著今年下半年大約 12.5% 到 16.5%，如果我的數學計算正確的話。

But the question is, Calvin, what gets you to the low end?

但問題是，卡爾文，是什麼讓你走到了低端？

What gets you to the high end?

是什麼讓你走向高端？

What are some of the assumptions that would get you to the high and low end there and I had one follow-up.

有哪些假設可以讓你達到高端和低端，我有一個後續行動。

Yes, sure.

是的，當然。

You're sitting 6 months into the year now.

你現在已經坐了 6 個月了。

Year-to-date procedures are actually rounding up to 17% as you described.

如您所述，年初至今的程序實際上四捨五入到 17%。

And so it's pretty straightforward.

所以這很簡單。

I think you look at it right now at the high end of the range.

我想你現在在範圍的高端看它。

We are talking about a continuity of the trends we saw in the first half across geographies and procedure sets.

我們正在談論我們在上半年看到的跨地域和程序集趨勢的連續性。

Then at the lower end of the ranges, we are talking about moderation.

然後在範圍的下端，我們談論的是適度。

Marshall talked a little bit about the mature procedures and we continue to beat our expectations in these categories, urology and gynecology in the U.S. but some moderation in those categories would be considered at the low end and even in general surgery, where we've been performing very strong, just somewhat less robust growth in our largest category in the U.S. would be contemplated at the lower end.

Marshall 談到了一些成熟的手術，我們在美國的泌尿科和婦科這些類別中繼續超出我們的預期，但在這些類別中的一些適度將被考慮在低端甚至在我們一直在的普通外科中我們在美國最大的類別中表現非常強勁，只是略微不那麼強勁的增長將被考慮在低端。

And then for my follow-up, I think bariatric has been tough to convert because of good lap outcomes.

然後對於我的後續行動，我認為由於良好的圈速結果，減肥很難轉變。

What's your strategy to penetrate this market?

你進入這個市場的策略是什麼？

How meaningful is a 60-millimeter stapler driving adoption?

60 毫米訂書機推動採用有多大意義？

And what should we expect from an uptake standpoint?

從接受的角度來看，我們應該期待什麼？

Larry, it's a good question.

拉里，這是個好問題。

On bariatrics, really, our customers have pointed us here.

在減肥方面，真的，我們的客戶已經將我們指向了這裡。

This is one where, as you've said, there's a fair amount of penetration of laparoscopy.

正如您所說，這是一個腹腔鏡檢查滲透率很高的地方。

And outcomes are generally good.

結果通常很好。

And so you begin to kind of ask why, why are they asking here?

所以你開始問為什麼，他們為什麼在這裡問？

What's the organic interest?

什麼是有機利益？

Like all things, where we've said to you in earlier procedure adoptions.

就像所有事情一樣，我們在早期的程序收養中已經對您說過。

In the early days, there are clearly subsegments of a particular procedure in the case of bariatrics, sleeve gastrectomy, gastric bypass, revision procedures, are all underlying segments.

在早期，在減肥、袖狀胃切除術、胃旁路術、翻修手術等情況下，特定手術有明顯的細分，都是基礎細分。

And where we find value as an entry point, I think, will have to develop over time.

我認為，我們發現價值作為切入點的地方必須隨著時間的推移而發展。

Clearly, in revisional surgeries, in complex comorbid cases, we see real interest on the part of surgeons.

顯然，在修復手術中，在復雜的合併症病例中，我們看到了外科醫生的真正興趣。

And so that appears to be a place that they're finding some entry point.

因此，這似乎是他們正在尋找切入點的地方。

There's a wild card here as Calvin alluded to, which is there is an ergonomic benefit for laparoscopists and bariatric surgeons tend to be high-volume surgeons and it tends to be a challenging -- physically, a challenging procedure and there may be some value there, too.

正如 Calvin 所暗示的，這裡有一個未知數，即腹腔鏡醫生和減肥外科醫生往往是高手術量的外科醫生，這在人體工程學方面有好處，而且它往往是一個具有挑戰性的——在身體上，一個具有挑戰性的手術，並且可能有一些價值， 也。

So we're not ready yet to call what the market sizes of those subsegments and where exactly all the value creation will be.

因此，我們還沒有準備好稱這些子細分市場的市場規模以及所有價值創造的確切位置。

But the organic interest is pretty high, and so we're going to engage our customers and follow their lead here.

但是有機興趣非常高，所以我們要吸引我們的客戶並在這裡跟隨他們的領導。

And short answer is stay tuned.

簡短的回答是敬請期待。

We go to Rich Newitter with Leerink Partners.

我們和 Leerink Partners 一起去 Rich Newitter。

The first one, Gary or team, we picked up on a couple of institutions who have said that they're looking at new ways to kind of get increased systems into their hospitals just given the demand from general surgeons that don't have enough time on their existing footprints.

第一個，加里或團隊，我們採訪了一些機構，他們表示他們正在尋找新的方法來將更多的系統引入他們的醫院，因為普通外科醫生的需求沒有足夠的時間在他們現有的足跡上。

And I'm just curious, what are some of the ways that we can think you might get creative on placing these systems beyond the operating leases?

我很好奇，我們認為您可以通過哪些方式創造性地將這些系統置於經營租賃之外？

Would you do minimum volume commitments for kind of some upfront system placement model, whereby if the volumes aren't met over some predetermined time, you have the right to take the systems back?

您是否會為某種前期系統放置模型做出最小數量承諾，如果在預定時間內未滿足數量，您有權收回系統？

That was one model we had heard discussed.

那是我們聽說過討論的一種模式。

I was just curious, is this happening?

我只是好奇，這會發生嗎？

Or are there other creative ways that you're potentially going to kind of accelerate your footprint ahead of competition coming?

或者有沒有其他創造性的方法可以在競爭到來之前加速你的足跡？

First of all, the objective is to get systems out there and to get them productive and to provide improved surgery to patients.

首先，目標是推出系統並提高它們的生產效率，並為患者提供改進的手術。

I think we've been flexible with leases and when I say flexible, we've structured those very short-term leases, almost rentals that get them past the budget cycle to what you would call plain vanilla leases that are 5-year terms with the piece of equipment staying with the customer at the end of the lease.

我認為我們在租賃方面一直很靈活，當我說靈活時，我們已經構建了那些非常短期的租約，幾乎是讓他們度過預算週期的租金，變成了你所說的 5 年期普通租約租期結束時留在客戶那裡的設備。

We're willing to be flexible even further and so although we had talked about different models, I don't think that we've rolled anything out that is important to the results at this point, but we will be flexible.

我們願意更加靈活，所以儘管我們討論了不同的模型，但我認為我們目前還沒有推出對結果很重要的任何東西，但我們會保持靈活性。

We'll think about different models to get -- to eliminate the barrier from a capital expenditure perspective.

我們將考慮獲得不同的模型——從資本支出的角度消除障礙。

The major things we're looking for when thinking about flexibility here, really on the customer side is that they have a long-term commitment in terms of access to the system that the access matters to them.

在這裡考慮靈活性時，我們正在尋找的主要內容，實際上是在客戶方面，他們在訪問對他們很重要的系統方面有長期承諾。

We have confidence in our systems such that we're not too worried about a right of return and things like that.

我們對我們的系統有信心，因此我們不會太擔心退貨權之類的事情。

I think that if this is a group that understands robotic surgery and understands the value of robotic system surgery relative to other forms of surgery, then we're willing to take some financial risk if they really are committed in terms of how they want to implement the program, how they want to train their surgeons and so on.

我認為，如果這是一個了解機器人手術並了解機器人系統手術相對於其他形式手術的價值的群體，那麼如果他們真的致力於實施他們想要的方式，我們願意承擔一些財務風險該程序，他們想如何培訓他們的外科醫生等等。

And then just a quick follow-up.

然後只是快速跟進。

I think, Calvin, you had mentioned that Sp in the phased rollout is initially only going to be sold as a standalone console but then it will eventually be worked into your entire fourth generation package.

我想，Calvin，你曾提到分階段推出的 Sp 最初只會作為獨立控制台出售，但最終會融入你的整個第四代套裝。

How should we think about the ASP on Sp as we model out kind of maybe the initial placements?

我們應該如何考慮 Sp 上的 ASP，因為我們可能會對初始展示位置進行建模？

Is it like a 20%, 30% premium to what Sp will be as we move out beyond 2019?

隨著我們在 2019 年之後的發展，它會比 Sp 溢價 20%、30% 嗎？

How should we think about that?

我們應該如何考慮？

So as the standalone systems, they should be at a slight premium to our Xi, less than 20% to 30%, more like in the 5% range.

因此，作為獨立系統，它們應該比我們的 Xi 略有溢價，不到 20% 到 30%，更像是在 5% 的範圍內。

And we go to Isaac Ro with Goldman Sachs.

我們和高盛一起去艾薩克羅。

Just another question on Asia.

另一個關於亞洲的問題。

Curious in Japan, with the new coverage there, you talked about an acceleration.

好奇在日本，隨著那裡的新報導，你談到了加速。

Wondering how you think that accelerating curve will play out over the balance of the year as it relates to your guidance?

想知道您認為與您的指導相關的加速曲線將如何在今年餘下時間發揮作用？

What's kind of embedded in the Japan part of your outlook?

在您的展望中，日本部分包含哪些內容？

On the guidance side...

在指導方面...

Let me do a real -- just a little bit of a qualitative and you can speak to the quantitative.

讓我做一個真實的 - 只是一點點定性，你可以談談定量。

Qualitatively, while we had, I think, 12 additional procedures, some of which are subprocedures of each other, added in terms of reimbursement listing, they will not all drive at the same rate concurrently.

定性地，雖然我認為我們有 12 個額外的程序，其中一些是彼此的子程序，在報銷清單方面添加，但它們不會同時以相同的速度運行。

Some will take precedence over others in terms of priority for training and priority for development.

在優先培訓和優先發展方面，有些將優先於其他。

The team is working through that now.

該團隊現在正在努力解決這個問題。

So as we do our forecasting model, it's not a simultaneous event.

所以當我們做我們的預測模型時，它不是同時發生的事件。

It's focus and deliver and really drive high-value through our teams to the customer.

它是專注和交付，並通過我們的團隊真正為客戶帶來高價值。

Calvin, you can speak quantitatively.

卡爾文，你可以從數量上講。

Yes, I mean, just quickly as we move beyond the urologic dVPs and partial nephrectomies into this broader set, as we described in the earlier comments, it's a foundational building period.

是的，我的意思是，正如我們在之前的評論中所描述的那樣，正如我們在之前的評論中所描述的那樣，我們很快就會超越泌尿科 dVP 和部分腎切除術進入這個更廣泛的領域，這是一個基礎建設時期。

We're very pleased and satisfied with the 1 quarter's activities focused on training and new programs and all the support that they require on the field but in terms of the pure numbers, this is not a big factor in terms of the high end or low end of the guidance or where we may traject overall.

我們對第一季度以培訓和新項目為重點的活動以及他們在現場所需的所有支持感到非常高興和滿意，但就純數字而言，這不是高端或低端的重要因素指南的結尾或我們可能總體規劃的地方。

The overall proportion of procedures in -- and relative to the worldwide, something in the 2%-ish range.

程序的總體比例 - 並且相對於世界範圍內，大約在 2% 左右的範圍內。

So it's a phenomenal opportunity in the long run in Japan but in the near term, it's really more about building programs and less of the impact it will have on full year procedure growth for the company.

因此，從長遠來看，這在日本是一個非凡的機會，但在短期內，它實際上更多地是關於建設項目，而不是它對公司全年程序增長的影響。

That's helpful context.

這是有用的上下文。

Follow-up is on the hernia market.

後續是在疝氣市場上。

I think that's obviously a huge potential opportunity for you guys and I think the thinking there has evolved over the years and now that you've got, I think, a little bit of accelerated traction there, it will be helpful if you could maybe provide for us some kind of updated buckets or maybe chapters of market development that we can think through in terms of the types of procedures that you think are really driving the near-term adoption versus those that might be kind of intermediate or longer-term opportunities?

我認為這對你們來說顯然是一個巨大的潛在機會，我認為那裡的想法已經發展了多年，現在你們已經有了，我認為，那裡有一點加速的牽引力，如果你們能提供，那將會很有幫助對我們來說，我們可以根據您認為真正推動近期採用的程序類型與可能是中長期機會的程序類型來思考一些更新的桶或市場發展的章節？

And just anything to help us segment what is clearly very heterogeneous and large opportunity for you guys.

以及任何可以幫助我們細分對你們來說顯然非常多樣化和巨大機會的東西。

I think it's a good question.

我認為這是一個很好的問題。

It's not something we're prepared to do on this call.

這不是我們準備在這次電話會議上做的事情。

And it is true.

這是真的。

Just frankly, that our view of these opportunities and markets evolves over time.

坦率地說，我們對這些機會和市場的看法會隨著時間的推移而演變。

As surgeons start to explore the capabilities of these systems, find value in different places and as we get to understand really the subsegments of markets better, we do -- our view does progress.

隨著外科醫生開始探索這些系統的功能，在不同的地方發現價值，隨著我們真正更好地了解市場的細分市場，我們做到了——我們的觀點確實取得了進步。

We will think about it as to where -- what has changed and where it is.

我們將考慮它在哪裡——發生了什麼變化以及它在哪裡。

I don't think here, we're ready to tell you that we're ready to forecast something differently but it is moving to a different phase and it's worth thinking through that phase.

我不認為在這裡，我們準備好告訴你我們已經準備好以不同的方式預測一些事情，但它正在進入一個不同的階段，值得思考這個階段。

And we go to Larry Keusch with Raymond James.

我們和 Raymond James 一起去 Larry Keusch。

Gary, I couldn't help but notice that in the U.S., I think it's 87% of the systems placed were Xi, which obviously just suggests hospitals continue to go after the most capable system despite the availability of the lower-priced deck.

加里，我忍不住注意到，在美國，我認為 87% 的系統是 Xi，這顯然只是表明儘管有低價平台可用，但醫院仍在繼續追求功能最強大的系統。

So could you talk a little bit about sort of the trends there between Xi and X in the U.S.?

那麼，您能否談談美國 Xi 和 X 之間的某種趨勢？

Sure.

當然。

I think, in a sense, it comes down to how people think through this trade-off between clinical value and economic value, and where they see value on a relative to capital entry price.

我認為，從某種意義上說，這取決於人們如何看待臨床價值和經濟價值之間的這種權衡，以及他們如何看待相對於資本進入價格的價值。

In many, many places, as you kind of look at this deeply, the capital price, the capital component is not the driving determinant of cost.

在很多很多地方，當你深入觀察時，資本價格、資本成分並不是成本的驅動決定因素。

If you look at total cost to treat per patient episode, which is, in my opinion, the most relevant economic question here, the total cost of caring for that patient are absolutely dominated by outcomes and dominated by human labor.

如果您查看每位患者治療的總成本，在我看來，這是這裡最相關的經濟問題，那麼照顧該患者的總成本絕對由結果和人力主導。

And so the material cost that flow through is sort of a tiny fraction of all of it.

因此，流經的材料成本只是其中的一小部分。

And for those folks who have capital access and who see that, who have done that set of analyses, I think what they really ask themselves is what's going to give us the best outcomes and the highest efficiency and standardization and they make that set of commitments.

對於那些能夠獲得資本並看到這一點、完成了那組分析的人，我認為他們真正問自己的是什麼會給我們帶來最好的結果、最高的效率和標準化，他們做出了那組承諾.

And so that's what we see.

這就是我們所看到的。

And I think that results in the acquisitions of Xis.

我認為這導致了對 Xis 的收購。

If folks are capital constrained, and by the way, that set of criteria can vary a little bit region-to-region.

如果人們資金有限，順便說一句，那套標準可能因地區而異。

I do think total cost to treat per patient episode translates well across country boundaries but different organizations have different approval processes and capital allocation processes.

我確實認為每個患者發作的總治療成本可以很好地跨越國界，但不同的組織有不同的審批流程和資本分配流程。

They may choose to get started with a lower capital cost system if they want to do that, we're happy to support them and (inaudible) the X. So in our prepared remarks, we had talked about our allocation of these systems fitting our view of the world regionally and that's why.

如果他們想這樣做，他們可能會選擇從較低的資本成本系統開始，我們很樂意支持他們和（聽不清）X。所以在我們準備好的評論中，我們談到了我們對這些系統的分配適合我們的從區域角度看待世界，這就是原因。

Okay, perfect.

好的，完美。

That's helpful.

這很有幫助。

And I guess, the other question is, I know the Si is certainly around for a period of time and there's an ability to offer refurbished systems at a discount for those that are really looking for less expensive capital equipment.

我想，另一個問題是，我知道 Si 肯定會存在一段時間，並且有能力為那些真正在尋找更便宜的資本設備的人提供折扣的翻新系統。

But is there a place in the portfolio for a more de-featured system that would have even a lower capital cost?

但是，在投資組合中是否有一個位置可以容納一個功能更強大、資本成本更低的系統？

Do you think about that as also potentially part of the portfolio at some point?

您是否認為這在某個時候也可能成為投資組合的一部分？

We will listen extremely carefully to our customers' needs and recognize that customer needs are 3-aim, right?

我們將非常仔細地傾聽客戶的需求，並認識到客戶需求是三個目標，對嗎？

Triple aim.

三重目標。

That's outcomes, efficiencies, workflow standardization and return on investment and high responsiveness to patient need, high patients' interest need.

那就是結果、效率、工作流程標準化和投資回報以及對患者需求的高響應度、高患者的興趣需求。

Those 3 needs we're going to look for really carefully.

我們將非常仔細地尋找這 3 種需求。

If in that set of analyses, a further de-featured system makes sense, of course, we will pursue that.

如果在那組分析中，進一步去除特徵的系統是有意義的，我們當然會繼續這樣做。

And we're always looking.

我們一直在尋找。

I don't think that it is obvious right off the bat that less capable systems at lower capital prices make those 3 aims a lot better but we are constantly asking ourselves.

我不認為在較低的資本價格下能力較差的系統會使這 3 個目標變得更好，但我們一直在問自己。

Our last question will be from Brandon Henry with RBC Capital Markets.

我們的最後一個問題將來自 RBC 資本市場的 Brandon Henry。

One of your robotic flex cath competitors recently partnered with a division of J&J for its ablative technology.

您的機器人柔性導管競爭對手之一最近與 J&J 的一個部門合作開發其消融技術。

Can you spend some time discussing how you see the future direction for the flex cath platform beyond lung biopsies?

您能花點時間討論一下您如何看待 flex cath 平台在肺活檢之外的未來發展方向嗎？

And specifically, what do you think is the right modality for ablative technology?

具體來說，您認為燒蝕技術的正確方式是什麼？

And is this technology that Intuitive already has internally?

而這個技術是Intuitive內部已經擁有的嗎？

Or is it something that Intuitive will need to acquire in the future?

還是 Intuitive 將來需要獲得的東西？

First thing, we're excited -- as we've said before, we're excited about flex catheter technologies, particularly in lung, I think it can make a big difference there, but it's a platform and we think that it will have applications beyond the lung.

首先，我們很興奮——正如我們之前所說，我們對柔性導管技術感到興奮，特別是在肺部，我認為它可以在那裡產生很大的不同，但它是一個平台，我們認為它會有肺以外的應用。

We are focused on creating value in the lung to start, that does not say that our vision will not extend further, that's step one.

我們專注於在肺部創造價值，這並不是說我們的願景不會進一步擴展，這是第一步。

Step two, with regard to the idea of see and treat.

第二步，關於看到和對待的想法。

If you can go do a detection and then be in a position to treat it, I think is a very compelling vision.

如果您可以進行檢測然後能夠對其進行治療，我認為這是一個非常引人注目的願景。

And it's a vision we share.

這是我們共同的願景。

We think that's interesting.

我們認為這很有趣。

There are many different ablative technologies and approaches within technologies.

技術中有許多不同的燒蝕技術和方法。

Ablation has been around for quite some time.

消融已經存在了很長一段時間。

It's not a trivial or obvious therapeutic approach.

這不是微不足道或明顯的治療方法。

It will take serious design and serious clinical validation to really understand where those things are.

需要認真的設計和認真的臨床驗證才能真正了解這些東西在哪裡。

That's going to be a multi-year pathway for anybody.

對於任何人來說，這都將是一個多年的途徑。

So we're not surprised to see others' interest in it.

所以我們看到其他人對此感興趣並不感到驚訝。

That is not new to us, it's not a new thought to us.

這對我們來說並不新鮮，對我們來說也不是一個新想法。

We think there are opportunities there.

我們認為那裡有機會。

We think there are multiple pathways to get to good solutions.

我們認為有多種途徑可以找到好的解決方案。

We are investing in those.

我們正在投資這些。

Some of that is organic, some of it is partnered.

其中一些是有機的，一些是合作的。

As we evolve, we will share more of that with you.

隨著我們的發展，我們將與您分享更多。

All right.

好的。

Well, thank you very much.

好的，謝謝。

That was our last question.

這是我們的最後一個問題。

As we've said previously, while we focus on financial metrics such as revenues, profits and cash flow during these conference calls, our 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 we remain committed to driving a 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事情。

This concludes today's call.

今天的電話會議到此結束。

We thank you for your participation and support on this extraordinary journey to improve surgery.

我們感謝您參與和支持這一改善手術的非凡旅程。

And we look forward to talking with you again in 3 months.

我們期待在 3 個月後再次與您交談。

Thank you.

謝謝你。

Ladies and gentlemen, this concludes your teleconference.

女士們，先生們，電話會議到此結束。

We thank you for using AT&T Executive TeleConference service.

感謝您使用 AT&T Executive TeleConference 服務。

You may disconnect.

您可能會斷開連接。