直覺手術 (ISRG) 2018 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by. Welcome to the Intuitive Surgical Q2 2018 Earnings Release Call. (Operator Instructions)

女士們、先生們，感謝你們的耐心等待。歡迎參加直覺外科公司2018年第二季財報發布電話會議。（操作說明）

As a reminder, the conference is being recorded.

提醒各位，本次會議正在錄影。

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

現在我將把會議交給我們的主持人，直覺外科公司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 second 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二季財報電話會議。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, and 10-Q filed on April 18, 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 表格和於 2018 年 4 月 18 日提交的 10-Q 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 Archives section, under our Investor Relations page. In addition, today's press release and supplementary financial data tables have been posted to our website. 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.

請注意，本次電話會議的音訊回放可在我們網站 intentussurgical.com 的「音訊存檔」部分（位於「投資者關係」頁面下）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。今天的會議形式將包括：首先向您介紹我們今天早些時候發布的新聞稿中所述的第二季度業績亮點，然後進行問答環節。

Gary will present the quarter's business and operational highlights. Marshall will provide a review of our second 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.

Gary 將介紹本季的業務和營運亮點。馬歇爾將對我們第二季的財務表現進行回顧。然後我將討論流程和臨床亮點，並提供我們最新的 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. Our second quarter of 2018 was a strong one in pursuit of our mission to improve the availability and quality of minimally invasive surgery. 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. 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. That said, we are neither satisfied nor comfortable. There is substantial opportunity for improvement in surgery and our customer base has demonstrated sustained interest in our new approaches to old problems.

下午好，感謝各位今天參加我們的電話會議。2018 年第二季度，我們在提高微創手術的可及性和品質方面取得了顯著進展。本季客戶對我們系統和流程的使用情況超出了我們的預期，新系統部署表現良好，現有客戶現場的系統利用率也有所提高。我們認為，達文西手術系統在美國一般外科領域的普及、國際市場的成長以及外科醫生對我們第四代平台的認可，是我們近期成長的根本原因。儘管如此，我們既不滿意也不放心。外科手術方面還有很大的進步空間，我們的客戶群也對我們解決舊問題的新方法表現出了持續的興趣。

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. Regionally, the United States showed particular strength with healthy growth in hernia repair and colorectal procedures. Mature procedure growth in the United States included -- including prostatectomy and hysterectomy continued to top our expectations. Our first quarter aggregate procedure growth in Japan after reimbursement listing was in line with our expectations. European procedure growth was generally in line with our expectations with particular strength in the U.K. and mixed performance elsewhere. Calvin will review procedure trends in greater detail later in the call.

2018 年第二季全球手術量成長約 18%，與 2017 年第二季相比，成長速度較第一季有所加快。從區域來看，美國在疝氣修補術和結直腸手術方面表現尤為強勁，實現了健康成長。美國成熟手術的成長情況包括—前列腺切除術和子宮切除術繼續超出我們的預期。我們在日本獲得健保報銷後的第一個季度總手術量增長符合預期。歐洲手術量成長總體上符合我們的預期，其中英國表現尤為強勁，其他地區表現則參差不齊。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 second quarter of 2018 accelerated relative to 2017, with growth in total placements rising 33% from 166 to 220. Net of trade-ins and retirements, our da Vinci installed base grew 12% over Q2 of 2017. The mix of system placements between our flagship Xi System, our value X System and refurbished Si systems aligned with our strategy regionally. Capital placements have historically been lumpy and we anticipate volatility in placements for the remainder of 2018.

2018 年第二季度，我們的資本配置業績較 2017 年有所加快，總配置量成長了 33%，從 166 項增至 220 項。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 年第二季增加了 12%。我們的旗艦 Xi 系統、高性價比的 X 系統和翻新的 Si 系統之間的系統部署組合，符合我們在區域內的策略。資本配置歷來波動較大，我們預期 2018 年剩餘時間配置狀況仍將波動。

Turning to operating performance. Our teams executed to plan, with manufacturing and quality cost meeting our goals and average selling prices within our expected ranges. On the investment front, we are building our organization and making targeted infrastructure investments to deepen both our technological and regional capabilities. 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.

接下來談談營運績效。我們的團隊按計畫執行，製造成本和品質成本都達到我們的目標，平均售價也在我們的預期範圍內。在投資方面，我們正在建立我們的組織，並進行有針對性的基礎設施投資，以增強我們的技術和區域能力。本季固定成本支出略低於預期，主要是由於時間安排問題，我們預計這些問題將在下半年解決。

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%. Marshall will take you through our finances in greater detail shortly.

我們第二季經營業績的亮點如下：手術量較去年同期成長約 18%；我們安裝了 220 台達文西手術系統，高於 2017 年第二季的 166 台；我們的裝置量較去年同期成長 12%；本季營收為 9.09 億美元，成長 20%； 4.76 億美元，成長 20%；本季經常性收入總額為 6.43 億美元，佔總營收的 71%；本季按備考營業利潤為 3.89 億美元，較去年同期成長 23%；按備考淨利潤為 3.27 億美元，成長 42%。馬歇爾稍後會更詳細地向您介紹我們的財務狀況。

Delivery of substantive technology and service improvements are core to continued progress in surgery. 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. 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. 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. 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. The latest instruments and software releases are optimized for our generation 4 platform in general surgery.

實質技術改進和服務提升是外科手術持續進步的核心。我們衡量創新成果的標準是：它能否對客戶的實際使用效果產生正面影響，從而降低每次治療的總成本，並對病患的就醫體驗產生正面影響。隨著普通外科醫生對達文西手術系統的興趣日益濃厚，我們本月將 60 毫米 SureForm 手術縫合器添加到我們的產品組合中，該產品已獲得 510(k) 許可，此前已獲得 CE 認證。我們的第二代切割和密封器械 Vessel Seal (sic) [Sealer] Extend 在美國上市第一季度就獲得了極佳的客戶反饋，我們已經提交了用於疝修補的增強型抓鉗的 510(k) 申請。正如我們過去所說，我們設計的產品系統、儀器和軟體能夠無縫協作，形成一個生態系統，從而實現外科手術的整體方法。最新的儀器和軟體版本針對我們的第四代一般外科平台進行了最佳化。

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. 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.

今年第二季度，我們的達文西Sp手術系統獲得了FDA批准，用於泌尿外科手術；本季度，我們正在完成Sp的經口臨床IDE申請。我們計劃分階段在美國推出達文西SP手術系統，預計首批客戶出貨將於今年第三季末或第四季初開始。

Our first access sites will focus on clinical data generation and customer feedback. 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. 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. 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. Feedback from physicians evaluating our technology relative to existing and recently announced alternatives remain strongly supportive of our efforts. 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.

我們的首批造訪站點將專注於臨床數據產生和客戶回饋。人們對 Sp 的興趣激增，我們認為 Sp 是一種平台技術，在多個外科專科領域具有潛在的應用價值。與我們以往的做法一致，我們將與外科醫生和監管機構合作，對 Sp 的新應用進行臨床評估，並預計在未來幾年內提​​交額外的 510(k) 申請。我們的團隊正在推進我們靈活的機器人平台的規劃，該平台最初的目標是解決肺癌的迫切需求和診斷問題，肺癌是世界上最常見的癌症之一，早期發現至關重要。醫生們將我們的技術與現有和最近公佈的替代方案進行比較後，給予了我們強有力的支持。我們預計將於 2018 年下半年提交 510(k) 申請，目前正在進行最終設計驗證和供應鏈的建立工作。

As our approach to surgery has gained traction, organizations, large and small, are hurrying to participate in the market. Their entry is an inevitable reaction to positive change in the operating room. Customers appreciate options from Intuitive and others, and we anticipate customers will evaluate alternatives as they appear. At Intuitive, we are sharply focused on understanding our customers' world and providing them with products and services they value highly. 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. 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.

隨著我們的手術方法逐漸被接受，各種規模的機構都在爭相參與市場。他們的加入是手術室正向改變帶來的必然結果。客戶欣賞 Intuitive 和其他公司提供的選擇，我們預期客戶會隨著替代方案的出現而進行評估。在 Intuitive，我們非常注重了解客戶的世界，並為他們提供他們高度重視的產品和服務。舉個簡單的例子，考慮到我們系統廣泛應用的各種先進技術，我們的系統能夠以驚人的可預測性啟動和完成案例。這是我們整體設計和整合原則、員工的能力以及我們對了解外科團隊世界的深刻承諾所帶來的結果。

We believe it sets a high bar for new entrants in the eyes of the thousands of surgeons who use da Vinci weekly. For the balance of 2018, our focus remains in completing the tasks we've set for ourselves. First, continued adoption of da Vinci in general surgery; second, continued development of European markets and access to customers in Asia; third, advancing our new platforms, imaging, advanced instruments, da Vinci Sp and our flexible catheter platform; and finally, support for additional clinical and economic validation by global region.

我們相信，對於每週使用達文西手術系統的數千名外科醫生來說，這為新進者樹立了很高的標竿。2018 年剩餘時間裡，我們的重點仍是完成我們為自己設定的任務。首先，繼續在一般外科手術中採用達文西手術系統；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、影像技術、先進儀器、達文西Sp和我們的柔性導管平台；最後，支援全球各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.

現在我將把電話交給馬歇爾，他將回顧財務要點。

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

午安.我將按 GAAP 和非 GAAP 準備基準，介紹我們業績的亮點。我們的測試結果也會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 年第二季營收為 9.09 億美元，較 2017 年第二季營收 7.59 億美元成長 20%，比第一季營收 8.48 億美元成長 7%。

The year-over-year revenue growth benefited by approximately 100 basis points from the weaker dollar. Second quarter 2018 procedures increased approximately 18% compared with second quarter of 2017 and increased 8% compared with last quarter. Procedure growth continues to be driven by general surgery in the U.S., in neurology worldwide. Calvin will review details of procedure growth later in this call.

美元走軟使公司營收年增率提高了約 100 個基點。2018 年第二季手術量比 2017 年第二季成長約 18%，比上一季成長 8%。在美國，手術量的成長主要由一般外科手術推動；而在全球範圍內，手術量的成長主要由神經內科手術推動。Calvin將在本次通話中稍後詳細介紹手術進展。

Instrument and accessory revenue of $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. 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. The increase compared with last year reflects increased advanced instrument usage and the impact of a weaker dollar, partially offset by customer buying patterns. The decrease relative to last quarter primarily reflects customer buying patterns, partially offset by increased advanced instrument usage.

儀器及配件收入為 4.76 億美元，比去年增長 20%，高於手術量增長，這反映了我們先進儀器的使用量增加，但部分被客戶的購買模式所抵消。每台手術的器械和配件收入約為 1,850 美元，與 2017 年第二季度相比增長了 1%，與上一季相比下降了約 4%。與去年相比，成長反映了先進儀器使用量的增加和美元走軟的影響，但部分被客戶的購買模式所抵消。與上季相比，下降主要反映了客戶的購買模式，但部分被先進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. 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. 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. 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. 34% of 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-in transactions compared to 20% in the second quarter of 2017 and 31% last quarter. However, trade-in activity can be lumpy and difficult to predict.

系統收入為 2.77 億美元，比 2017 年第二季度增長了 25%，主要反映了系統安裝量增加和租賃相關收入增加，但部分被平均售價下降和經營租賃數量增加所抵消。2018 年第二季我們安裝了 220 套系統，而 2017 年第二季安裝了 166 套系統，上一季安裝了 185 套系統。本季完成了 44 筆經營租賃交易，佔總交易量的 20%，而 2017 年第二季佔總交易量的 16%，上季佔 23%。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。本季系統安裝中有 34% 涉及以舊換新，這反映出客戶希望獲得或採用我們的第四代技術。與 2017 年第二季的 20% 和上一季的 31% 相比，以舊換新交易的比例增加。然而，以舊換新活動可能波動較大，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. Our installed base of da Vinci systems increased 12% year-over-year and our average system utilization grew in the mid-single-digit range. 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. The decrease primarily reflects a higher mix of trade-in transactions. Outside of the U.S. results were as follows. 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. 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. 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. The increase in instrument accessory revenue was primarily driven by procedure growth and customer buying patterns. 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.

本季安裝的系統中，72% 為達文西 Xi 系統，21% 為達文西 X 系統；而上一季度，達文西 Xi 系統佔 76%，達文西 X 系統佔 16%。我們的達文西手術系統安裝量年增 12%，平均係統利用率也實現了中等個位數的成長。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 142 萬美元，低於去年的 146 萬美元和第一季的 149 萬美元。下降主要反映了以舊換新交易比例的增加。美國以外地區的結果如下。第二季美國以外的營收為 2.65 億美元，比 2017 年第二季成長 28%，比上一季下降 4%。與前一年相比，成長反映了系統收入增加 2,500 萬美元，成長 32%；儀器和配件收入增加 2,700 萬美元，成長 31%。系統收入的成長主要得益於系統安裝數量的增加，但部分被以舊換新交易數量增加所導致的平均售價下降所抵銷。儀器配件收入的成長主要受手術量成長和客戶購買習慣改變的推動。與上一季相比，OUS 收入的下降反映了系統租賃交易數量的增加、系統 ASP 的下降（反映了以舊換新交易的增加）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. OUS procedures were positively impacted by the timing of holidays in 2018 compared to 2017. 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. Current quarter system placements included 39 into Europe, 13 into Japan and 9 into Australia. 30 of the 82 systems placed in the second quarter were X Systems. 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.

與 2017 年第二季相比，OUS 手術量增加了約 22%。與 2017 年相比，2018 年的假日安排對 OUS 程序產生了正面影響。在美國以外，我們第二季安裝了 82 套系統，而 2017 年第二季為 63 套，第一季為 73 套。目前季度製分配方案包括：39人分配到歐洲，13人分配到日本，9人分配到澳洲。在第二季安置的 82 個系統中，有 30 個是 X Systems。美國以外的市場佈局仍將不穩定，因為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法規的限制。

Moving on to the remainder of the P&L. 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. The decreases primarily reflect lower system ASPs and revenue mix.

接下來來看損益表的其餘部分。2018 年第二季的備考毛利率為 71.1%，而 2017 年第二季為 71.4%，上一季為 71.6%。下降主要反映了系統平均售價和收入結構的降低。

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. Pro forma operating expenses increased 14% compared with the second quarter of 2017, and decreased 1% compared with last quarter. The decrease relative to the first quarter primarily reflects the impact to payroll taxes. Overall, our spending was below our annual guidance reflecting the timing of expenditures. We expect spending to increase in the last half of 2018 consistent with our guidance.

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。與 2017 年第二季相比，以備考計算的營運費用增加了 14%，與上一季相比下降了 1%。與第一季相比的下降主要反映了工資稅的影響。總體而言，我們的支出低於年度預期，這反映了支出的時間表。我們預計2018年下半年支出將與我們的預期一致成長。

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

第二季的預期實際稅率為 19.7%，而我們先前的預期為 20% 至 21%。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 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.

2018 年第二季度，我們的備考淨收入為 3.27 億美元，即每股 2.76 美元，而 2017 年第二季度為 2.3 億美元，即每股 2 美元，2018 年第一季為 2.88 億美元，即每股 2.44 美元。

I will now summarize our GAAP results. 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. 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.

現在我將總結一下我們的GAAP業績。2018 年第二季 GAAP 淨利為 2.55 億美元，即每股 2.15 美元；而 2017 年第二季 GAAP 淨利為 2.23 億美元，即每股 1.94 美元；2018 年第一季 GAAP 淨利潤為 2.88 億美元，即每股 2.44 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，包括此前宣布的 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. 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.

請注意，美國國稅局尚未發布與近期美國稅法相關的最終稅收法規。因此，我們的結果所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 $4.3 billion compared with $4.1 billion at March 31, 2018. The increase reflects cash generated from operations of $220 million. We did not repurchase any shares in the quarter and have approximately $718 million remaining under the board buyback authorization. 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. We've not changed our capital deployment strategy or plans.

截至本季末，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。此次成長反映了營運產生的現金流為 2.2 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。本季度，我們將 14 億美元的現金匯回美國，因為這些收益先前已根據 2017 年美國稅收改革法案繳納了稅款，而且匯回時實際上沒有評估任何外國稅款。我們的資本部署策略或計劃沒有改變。

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 second quarter procedure growth was 18% compared to 16% during the second quarter of 2017 and 15% last quarter. Our Q2 procedure growth was driven by 17% growth in U.S. procedures and 22% growth in OUS markets. 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.

謝謝你，馬歇爾。我們第二季的整體手術量成長了 18%，而 2017 年第二季為 16%，上一季為 15%。第二季度手術量成長主要得益於美國手術量成長 17% 和美國境外市場手術量成長 22%。在美國，一般外科、婦科和泌尿外科的手術表現均超出預期，第二季度年增速在這些最大的幾個類別中略有加快。

Q2 procedure performance was again driven by growth in general surgery. Hernia repair and colorectal procedures continue to lead the way as these categories again added the most incremental cases.

第二季手術量成長再次主要得益於一般外科手術的成長。疝氣修補術和結直腸手術繼續領先，因為這些類別再次成為新增病例最多的類別。

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. 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.

隨著達文西手術系統在美國普通外科手術中的應用日益廣泛，其他普通外科手術新增病例數也比前幾季度增加。在美國婦科領域，2018 年第二季的成長與 2017 年和 2018 年第一季的趨勢一致，此成熟類別的手術量年增率不大，其中子宮切除術的成長最為顯著。

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. Q2 U.S. urology procedures also had growth rates consistent with 2017 and Q1 2018, driven by prostatectomy volumes. 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. In U.S. other procedures, adoption of lobectomies and other thoracic procedures was again solid during the second quarter. Utilization of our da Vinci Xi Systems and surgical staplers, which help to optimize robotic thoracic procedures, has been increasing. Second quarter OUS procedure volume grew approximately 22% compared with 22% for the second quarter of 2017 and 18% last quarter.

我們假設，婦科領域的成長將受到有利的手術整合趨勢的推動，因為我們的達文西手術數據顯示，越來越多的美國婦科手術是由手術量較大的醫生進行的，這些醫生專攻複雜、良性和癌症手術。美國第二季泌尿科手術量的成長速度也與 2017 年和 2018 年第一季一致，主要受攝護腺切除術量的成長所推動。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市場趨勢一致，而前列腺市場也受益於近期的宏觀趨勢。在美國，其他手術方面，肺葉切除術和其他胸腔外科手術在第二季度再次保持穩定成長。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。第二季 OUS 手術量成長約 22%，與 2017 年第二季的 22% 和上一季的 18% 相比有所成長。

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

2018 年第二季 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。正如預期的那樣，第二季度 OUS 手術量增長高於第一季度，這得益於假日（包括復活節）帶來的更多手術日。

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. The most recent of which expired at the end of 2015. In Europe, procedure results vary by country with particular strength in the U.K.

在日本，隨著 4 月 1 日起 12 項新增手術獲準報銷，手術量成長加速。而在中國，由於達文西手術系統的產能擴張受到系統配額要求的限制，手術量成長在第二季再次放緩。最近一次到期是在 2015 年底。在歐洲，手術效果因國家而異，英國的效果特別顯著。

Over the years, the discussion surrounding da Vinci surgery has been centered around the clinical patient benefits. In addition, we believe there is substantial opportunity to create surgeon value as well by improving the ergonomic characteristics of surgery. 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. This meta study reviewed 35 articles, including over 7,000 surgeons. 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. Moreover, the workload is increased by the high level of task precision and time pressure. Physical demands differ between open and laparoscopic surgery and comparative studies have reported higher prevalences of physical complaints for laparoscopic surgeons. Recent studies report MSD prevalence rates of 73% to 88% among specialists at MIS. 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. However, the low response rates and the high inconsistency across studies leaves some uncertainty, suggesting an actual prevalence of between 22% and 74%. Fatigue and MSDs impact cycle motor performance. Therefore, these results warrant further investigation." While pain ratings are subjective, we think there's opportunity to improve ergonomics for surgeons.

多年來，圍繞達文西手術的討論一直集中在臨床患者獲益方面。此外，我們認為，透過改善手術的人體工學特性，也能為外科醫師創造巨大的價值。2017 年，Chantal C.J. Alleblas 博士等人在《外科年鑑》上發表了一篇題為《微創手術外科醫生中肌肉骨骼疾病 (MSD) 的患病率：系統性回顧》的分析文章。這項薈萃研究回顧了 35 篇文章，其中包括 7000 多名外科醫生。作者將腹腔鏡手術相關的危險因子歸納為「靜態身體姿勢、重複的上肢運動、從不利位置用力」。此外，任務精度高、時間壓力大，也增加了工作量。開放式手術和腹腔鏡手術對身體的要求不同，對比研究表明，腹腔鏡外科醫生出現身體不適的發生率更高。近期研究報告顯示，MIS 專科醫師中 MSD 的盛行率為 73% 至 88%。相對於一般人群而言，這些數字過高。 」在他們的研究中，作者發現「腹腔鏡外科醫師中身體不適的盛行率為 74%」。然而，較低的回覆率和研究間的高度不一致性造成了一些不確定性，顯示實際盛行率在 22% 到 74% 之間。疲勞和肌肉骨骼疾病會影響自行車運動表現。因此，這些結果值得進一步研究。 「雖然疼痛評分是主觀的，但我們認為外科醫生的手術操作人體工學方面還有改進的空間。

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

憑藉我們最近獲得的減肥手術適應症和 SureForm 60 毫米吻合器 510(k) 許可，我們能夠更好地為減肥外科醫生服務。

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 12% to 15%. We are now increasing our forecast and estimate full year 2018 procedure growth of 14.5% to 16.5%.

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 12% 至 15% 之間。我們現在提高了預測，預計 2018 年全年手術量成長率為 14.5% 至 16.5%。

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, 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.

接下來討論毛利。我們仍預期我們的備考毛利率將佔淨收入的 70% 至 71.5%，而我們的實際毛利率將因產品、地區和以舊換新組合以及新產品推出的影響而逐季度變化。

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. 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. 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.

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。我們仍然預計，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，正如我們在上次電話會議上所預測的那樣。我們預計 2018 年其他收入（主要包括利息收入）總額將在 7,000 萬美元至 7,500 萬美元之間，高於上次電話會議預測的 5,500 萬美元至 6,000 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. We are now shifting our estimates slightly lower to a range of between 19.5% and 20.5% of pretax income. That concludes our prepared remarks. We will now open the call to your questions.

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 21% 之間。我們現在將預估值略微下調至稅前收入的 19.5% 至 20.5% 之間。我們的發言稿到此結束。現在開始回答各位的問題。

(Operator Instructions) And our first question from Tycho Peterson with JPMorgan.

（操作員說明）我們的第一個問題來自摩根大通的泰科·彼得森。

Great quarter. I want to start with the U.S. procedure growth. You've had about a 300 basis point sequential acceleration. Can you maybe just talk a little bit more about that? 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?

很棒的季度。我想先從美國手術發展說起。你們的連續加速幅度約為 300 個基點。能再詳細談談這方面嗎？我的意思是，疝氣顯然已經持續好轉一段時間了，但你似乎真的遇到了一個轉折點，所以你能談談你在本季度看到的這種趨勢的可持續性嗎？

Yes. 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. Our customers are seeing real value in general surgery particularly with the gen 4 systems. You mentioned hernia repair and colorecters. They've been leading adoption and we've seen organic interest from bariatric surgeons as well. 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.

是的。我們的方法是透過設計系統儀器、成像和軟體元素，並結合外科醫生的回饋，以及推出我們的 Xi 系統和下一代先進儀器和改進的成像軟體，來實現手術操作的實現。我們的客戶在普通外科手術中看到了真正的價值，尤其是第四代系統。你提到了疝氣修補術和大腸癌。他們一直引領著這項技術的推廣應用，我們也看到了減重外科醫師們的濃厚興趣。隨著我們的 SureForm 60 縫合器上市，以及第四代標籤在肥胖症領域的應用，我們期待也能為這些領域提供服務。

Tycho, it's Gary. 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. And then in hernia repair and colorectal, we're seeing nice stick rates on those sides. So we feel like we're building momentum here.

泰科，我是加里。如您所知，我們關注的其中一點是續訂率或再訂購率，看看人們是在試用還是會繼續使用。在疝氣修補和結直腸手術方面，我們看到這兩方面的成功率都相當不錯。所以我覺得我們正在積蓄力量。

It's also about sustainability and I think, prostatectomy, urologic increases as well as gynecologic increases in the U.S. have surprised me. And I don't have as much confidence that those are sustainable.

這也關乎永續性，我認為，美國前列腺切除術、泌尿科手術以及婦科手術數量的增長讓我感到驚訝。我對這些措施的可持續性並沒有太多信心。

Okay. And then thinking a little bit ahead on pipeline. Can you talk a little bit about the data roadmap for flex cath? 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?

好的。然後稍微考慮一下管道建設方面的問題。能談談柔性導管的數據路線圖嗎？顯然，你們在製造方面做了很多優化工作，但是我們應該如何看待產品發布前陸續出現的增量資料呢？

Nothing new to report for you there. Certainly, as it starts coming into the market. You'll see early site start to take a broader data collection and so on, with regard to what regulators want to see. We'll see what happens with regard to their feedback to our submission when that occurs. So I don't have anything to point you to at this time.

沒什麼新的消息要向你報告。當然，隨著它開始進入市場。你會看到早期網站開始收集更廣泛的數據等等，以滿足監管機構的要求。屆時我們會看看他們對我們提交內容的回饋如何。所以目前我沒有什麼可以提供給你的。

Okay. And then last one, Gary, you mentioned interest in Sp beyond kind of the initial opportunities that you've talked about. Are you willing to kind of comment on some of those areas? It seems like that there's some interest in cardiology based on (inaudible), what the others have done. How prevalent is that in some of your early discussions?

好的。最後，Gary，你提到除了你之前談到的那些初步機會之外，你對 Sp 還很感興趣。您願意就其中的一些方面發表一些看法嗎？根據其他人所做的工作來看，似乎有人對心臟病學感興趣。這種情況在你們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. The things we've talked about with you earlier, clearly, some interest in urology. We think there will be real interest in colorectal surgery and transoral surgery as well. There are -- we've had early discussions in several other specialties. I think it's very early to start pointing our investor base. I think towards one or the other is probably too soon. That said, it provides access to the body that comes in fundamentally differently than an Xi brings instruments into the body. 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.

到目前為止，我對 Sp 在我們的客戶中引起的興趣感到滿意，他們正在探索 Sp 能在哪些方面創造真正的價值。從我們之前和你談過的事情來看，你顯然對泌尿科很感興趣。我們認為，人們對大腸直腸手術和經口手術也會非常感興趣。確實有——我們已經在其他幾個專業領域進行過初步討論。我認為現在就開始關注我們的投資者群體還為時過早。我認為現在就斷言哪一方更合適可能還為時過早。也就是說，它提供了一種進入人體的途徑，這種途徑與 Xi 將器械帶入人體的途徑有著根本的不同。我們這樣做是因為我們認為隨著我們累積更多經驗，隨著這些產品面世，它將激發人們對價值創造和其他領域的興趣，屆時我們將隨時向您報告最新情況。

And we go next to Amit Hazan with Citi.

接下來我們來訪問花旗銀行的 Amit Hazan。

This is [Jamie] on for Amit. So first, a question just on systems features, when you think about the benefits and challenges of an open console. And also separately, the benefits and challenges of a system with arms mounted on a table. How do you guys just think about those types of features that your competitors are starting to talk about?

這是[Jamie]代替Amit上場。首先，關於系統特性，請問開放式主機有哪些優點與挑戰？此外，也要單獨討論在桌面上安裝機械手臂的系統的優點和挑戰。你們是如何看待競爭對手開始談論的那些功能類型的呢？

Kind of just zooming out for a minute. 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. And as we think about those things, we've been at this for a long time. 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. We came to these decisions not based on whiteboard analyses but on building things and talking to our customers and working through it. So it doesn't mean that we're right. Could absolutely mean that somebody else did something slightly different and they evaluated it differently. But we were not casual about this. And we did it with serving a population of patients, a population of surgeons across a procedures set in mind. With that, I'm comfortable where the company has made its investments.

稍微拉遠鏡頭看看。我認為，我們為客戶考慮的方式，使得從泌尿科到婦科，從普通外科到胸腔外科等各種手術類型，都能在眾多患者群體中順利開展手術。當我們思考這些問題時，我們已經為此努力了很久。將設備安裝到桌子上、將設備安裝到地板上、採用模組化設計、使用開放式控制台而不是帶有沉浸式顯示器的控制台等等，這些想法已經存在很長時間了，我們也評估和嘗試過其中很多。我們做出這些決定並非基於白板分析，而是基於實際操作、與客戶溝通以及不斷改進。所以這並不意味著我們是對的。這完全有可能意味著其他人做了略有不同的事情，所以他們的評價也不同。但我們對此事並非掉以輕心。我們透過服務患者群體和外科醫生群體，並圍繞既定的手術流程來實現這一目標。因此，我對公司的投資方向感到滿意。

Okay. And then a question on the imaging side. With what you guys are working on for the first generation launch of that, is that basically going to be pre-op images only? Or is there a possibility to do real-time imaging in that first generation launch? Just help us understand the technology roadmap from here and timing expectation.

好的。然後是一個關於成像方面的問題。你們正在研發的第一代產品，基本上只包含術前影像嗎？或者說，第一代發射是否有可能實現即時成像？請協助我們了解接下來的技術路線圖和時間預期。

I'm not quite sure when you say first gen imaging. We have done a lot of things in imaging for a lot of years, so perhaps a little clarity on what...

我不太確定你說的第一代影像技術具體是指什麼時候。多年來，我們在成像領域做了很多工作，所以或許需要更清晰地說明一下…

I'm sorry. For the imaging onlay side of things.

對不起。就成像貼片方面而言。

Overlays. 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. Again, ideas there have been around for many years. 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. There are some other things in the works that allow for tighter integration of those images in fusion. We have not set expectations on timelines nor on future content yet. We have a lot of technology capability there. 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. There's potential, nothing to update you in terms of timing.

疊加層。關於這一點，我認為你有點像是在談論影像融合，也就是將術前影像（如 CT 掃描或 MRI）與內視鏡影像融合在一起。這些想法其實由來已久。如今，在現有的運輸系統中，客戶可以使用名為 Tile Pro 的工具來調出術前影像，並即時與他們正在使用的影像進行比較。還有一些其他技術正在研發中，可以實現這些影像在融合過程中更緊密的整合。我們尚未就時間表或未來內容設定預期。我們在那裡擁有強大的技術能力。我們會在認為某項技術能夠真正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，才會將其推出。有發展潛力，但目前沒有具體時間安排需要更新。

And we go to David Lewis with Morgan Stanley.

接下來我們來採訪摩根士丹利的戴維·劉易斯。

Gary or team, I want to start with systems momentum in the first half of the year. So last quarter, we saw increased trade outs and again, this quarter. So I just wonder how are the dynamics in your mind different this quarter than last quarter? What are your thoughts to sustainability of these system trends? 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.

Gary或團隊，我希望在今年上半年從系統發展勢頭入手。所以上個季度我們看到交易外流增加，這個季度也是。所以我想知道，您認為本季與上季相比，您的想法有何不同？您如何看待這些系統發展趨勢的可持續性？至於今年下半年在這裡推廣 Sp 車型，您有什麼顧慮嗎？因為您也在積極地引導客戶使用第四代平台。然後我快速地跟進了這個問題。

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. Other than as you indicated, you do see a higher percentage of trade-ins. 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. And I think the hospitals and surgeons want to avail themselves to that technology so we're seeing trade outs. 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. But what we have seen is a slight increase in those trade-ins.

我認為，至少在第一季和第二季度，我們看不到成長勢頭發生真正的變化。除了你提到的情況之外，以舊換新的比例確實更高。我認為，第四代產品的一些特性引起了普通外科醫生的興奮，他們希望將這些特性應用於我們之前討論過的手術，例如結直腸手術和胸腔外科手術。我認為醫院和外科醫生都希望利用這項技術，所以我們看到了權衡取捨。我們也看到一些醫院希望標準化，只管理一套儀器設備而不是兩套。因此，很難預測在特定週期內會發生哪些設備更替，或在特定季度會發生多少設備更換。但我們看到的是，以舊換新的數量略有增加。

Two things I'd add to that. One is customer use and efficiencies with generation 4 platform is quite good. 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. 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. 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. Over time, as we build out that experience base, the -- our interest in expanding the Sp footprint will increase. But that's a multi-quarter conversation, not a really quick turn. Sp long term -- and I think we've talked about it. 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. 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.

我還要補充兩點。一是客戶對第四代平台的使用和效率都相當不錯。所以我們很高興看到他們的興趣，只要我們能夠靈活地幫助他們過渡到第四代產品，我們都會盡力而為。關於 Sp，我們在發行第一階段的初步想法是不要進行大規模的配售——Sp 的資本配售。實際上，我們的目標是建立臨床資料中心，逐步建立價值故事，並真正開始收集下一適應症的早期資料。隨著我們經驗的積累，我們對擴大 Sp 商業版圖的興趣也會隨之增加。但這需要幾個季度的時間才能討論清楚，不是一朝一夕就能解決的。從長遠來看——我想我們已經討論過這個問題了。最初，Sp 將以完整系統的形式推出，但隨著我們不斷累積證據基礎，它將成為第四代平台的一部分。作為第四代產品的一部分，它的升級和配置將非常容易，這也是我們一段時間以來一直在考慮的問題。

Okay. And then Gary or team, just on Asia-Pac strategy broadly. Didn't hear much about Japan in this particular transcript. How are you encouraged by the early traction in Japan? Is that sort of on plan? Ahead of plan? Maybe comments there. 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. Or any updated thoughts on the likelihood of China this year? And any impact on just tariff rhetoric on getting that deal done?

好的。然後是 Gary 或他的團隊，就亞太戰略的整體情況進行討論。這份記錄稿裡沒怎麼提到日本。日本市場早期的成功如何讓您感到鼓舞？這算是照計劃進行嗎？比計劃提早了嗎？或許那裡會有評論。加里，你之前也談過，我想你在今年某個時候發表過一些聲明，中國配額的取消顯然降低了今年的可能性。或者您對今年中國參賽的可能性有什麼新的看法？那麼，僅僅圍繞關稅問題展開的言論會對達成協議產生什麼影響呢？

Okay. On Japan, first quarter, here or after the listing, we're pleased with the interest of the customer base. Our training facilities are busy. We're pleased with that. We are really testing the capabilities now of our newly formed or newly grown team in Japan to really execute. So I think, a little early to tell the ultimate performance there. First steps look fine. I think there's real work to do. And so our team and we are focused on really execution. It's not a big strategy question. 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. The first step of demand generation looks really good. So moving to China, I'll speak briefly to the quota. I'll ask Marshall to speak briefly to the impact -- the potential impact of tariffs. On the quota side, we have no real update to supply you with. We are awaiting an additional quota, no news there. Overall, I think the atmospherics that are going on globally do not help that conversation. 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. 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. China is important to us as a market, and for our joint venture, we are committed to it. And we are going to have to work through current macro challenges that are out there. Marshall, you might speak to it.

好的。在日本，無論是上市前還是上市後，我們對第一季客戶群的興趣感到滿意。我們的訓練設施非常繁忙。我們對此感到滿意。我們現在正在真正考驗我們在日本新組建或新壯大的團隊的執行能力。所以我覺得，現在就斷言最終表現還為時過早。初步結果看起來不錯。我認為還有很多實際工作要做。因此，我們的團隊專注於真正執行。這不是什麼重大的戰略問題。關鍵在於建立並完善從培訓途徑到監考途徑再到後續途徑以及現場支援的整個流程，使其有效運作。這是我們要求團隊重點關注的，也是我們將重點關注的。需求產生的第一步看起來非常好。接下來，我將簡單談談中國配額問題。我將請馬歇爾簡要談談關稅的影響——潛在的影響。配額方面，我們目前沒有什麼實質的更新資訊可以提供給您。我們正在等待額外的配額，目前還沒有消息。總的來說，我認為目前全球的氛圍不利於這場討論。我沒有什麼具體的事情要告訴你，但總的來說，我認為那些對話的氛圍不利於完成配額。正如我們在上次電話會議中告訴你們的那樣，如果我們認為市場有需求，那麼我們在外部開展業務的流程將需要額外的資金，因此我們需要解決這個問題。中國市場對我們而言非常重要，對於我們的合資企業，我們也會全力以赴。我們還必須努力應對當前存在的宏觀挑戰。馬歇爾，你可以跟它談談。

Yes, the tariff situation is obviously dynamic. The first round of tariffs have been imposed do impact some of the components that our suppliers use to supply us. We're under the -- we're studying that as we speak. 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.

是的，關稅情勢顯然是動態變化的。第一輪關稅已經對我們的供應商用來向我們供貨的一些零件產生了影響。我們正在研究這個問題。我們認為，就我們系統的產品成本增加而言，預期的影響將比較溫和，目前我們不會將這些成本轉嫁給客戶。

And we go to Bob Hopkins with Bank of America.

接下來我們來訪問美國銀行的鮑伯霍普金斯。

I wanted to start with Sp. Gary, you characterized interest in Sp as high. 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? And will you restrict the center? If they're interested in Sp, will you restrict them? So I just want to kind of get a little more color on how you're thinking about Sp.

我想先從Sp開始。Gary，你認為人們對Sp的興趣很高。我想請您更詳細地介紹一下，例如哪些類型的帳戶表現出了初步的興趣？你會限制中心區域嗎？如果他們對Sp有興趣，你會限制他們嗎？所以我想更詳細地了解你對Sp的看法。

In terms of accounts, there's a fair amount of interest that's, I think, broad across the segments. 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. 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. We will be supply limited for the first few quarters here. So the answer there is there will be a bit of a line to put these first set out as we go. Now as we get the additional clearances and master the technologies, then I think that gets a lot easier. But it will be a designed rollout to start.

就帳戶而言，我認為各個細分市場都表現出了相當大的興趣。首先，我們有一系列權限，可以讓我們進入系統開始工作，然後進行後續的資料收集，以獲得額外的權限。因此，這將決定我們未來的早期准入策略，實際上取決於我們目前擁有的許可和我們將來想要追求的許可。未來幾個季度，我們的供應量將受到限制。所以答案是，我們會先排好隊，把第一批東西陸續放出來。現在，隨著我們獲得更多許可並掌握相關技術，我認為這將變得容易得多。但初期會採取有計劃的推廣方式。

Also, you made a comment in prepared remarks about the potential for volatility in capital for the rest of 2018. Is that just because there could always be volatility in capital? Or is there something specific that you're referring to?

此外，您在事先準備好的發言稿中也提到了 2018 年剩餘時間裡資本市場可能出現的波動性。難道只是因為資本市場總是存在波動嗎？還是您指的是某個具體的事情？

No, nothing specific. 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. So it's just hard to predict when hospitals will actually purchase and so you could see it be lumpy over time.

不，沒什麼特別的。總的來說，資本很難預測，因為預算週期、政府監管（例如中國的情況）以及季節性因素都會影響資本流動。因此很難預測醫院何時會真正購買，所以隨著時間的推移，價格可能會出現波動。

What happens also is the aggregate reporting, of course, averages a lot of lumpiness that happens underneath. So even if the aggregate looks smooth, the regional variances can be reasonably high. And so it's just as Marshall properly said, nothing specific but the general dynamics that are out there.

當然，總結報告也會掩蓋許多底層存在的波動情況。因此，即使整體看起來平滑，區域差異也可能相當高。所以正如馬歇爾所說，沒有什麼具體的事情，只是普遍存在的一些動態。

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? 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?

尤其是在縫合器和血管封閉方面，如果這些產品的推出成功，我們是否應該看到你們的單次手術收入出現上升趨勢？我意識到有很多因素會影響這條產品線，但這兩款產品都相當重，我只是好奇，如果這兩款產品的上市成功，我們是否可以預期該產品線的銷售額會開始上升？

Yes. When you look at revenue per procedure overall, there's clearly some variance quarter-to-quarter. We talk a lot about customer timing, order timing and things like that. 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. We introduced a new version of our Vessel Seal (sic) [Sealer] Extend in the last quarter. 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. 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. 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.

是的。從整體來看，每次手術的收入會發現，季度之間顯然存在一些差異。我們經常討論客戶的時間表、訂單的時間表等等。因此，從季度來看，你會看到這些變化，但我們看到先進儀器的貢獻越來越大，包括我們的縫合產品，這些產品的使用量以及血管密封的使用量都在增加。我們在上個季度推出了新版本的 Vessel Seal (sic) [Sealer] Extend。現在，我們將在第三季推出 60 毫米訂書機，並在第四季擴大供應範圍。這進一步擴展了這個類別——完善了我們的產品線，進一步拓展了縫合領域，並在肥胖症類別中提供了更優化的工具。所以簡單的答案是肯定的，這更體現在我們先進的儀器設備方面，這一因素將有助於提高每次手術的收入。

We go to Larry Biegelsen with Wells Fargo.

我們採訪了富國銀行的拉里·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. 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. But the question is, Calvin, what gets you to the low end? What gets you to the high end? What are some of the assumptions that would get you to the high and low end there and I had one follow-up.

如果我沒算錯的話，你們上半年的手術量增加了16.5%。我的問題是，下半年，指導意見暗示下半年成長率約為 12.5% 至 16.5%，如果我的計算沒錯的話。但問題是，卡爾文，是什麼讓你陷入低谷？什麼能讓你達到高端水準？有哪些假設可以讓你得到最高值和最低值？我還有一個後續問題。

Yes, sure. You're sitting 6 months into the year now. Year-to-date procedures are actually rounding up to 17% as you described. And so it's pretty straightforward. I think you look at it right now at the high end of the range. We are talking about a continuity of the trends we saw in the first half across geographies and procedure sets. Then at the lower end of the ranges, we are talking about moderation. 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.

當然可以。現在已經過去六個月了。正如你所描述的，今年迄今為止的手術量實際上向上取整為 17%。所以很簡單。我認為你現在把它看作是這個價位區間的高端產品。我們指的是上半年在不同地區和不同手術流程中出現的趨勢的延續性。那麼，在範圍的較低端，我們談論的是適度。馬歇爾稍微談到了成熟的手術流程，我們在美國泌尿外科和婦科領域繼續超出預期，但這些領域的增長可能會有所放緩，即使在我們表現非常強勁的普通外科領域，我們在美國最大的類別的增長也可能略顯疲軟。

And then for my follow-up, I think bariatric has been tough to convert because of good lap outcomes. What's your strategy to penetrate this market? How meaningful is a 60-millimeter stapler driving adoption? And what should we expect from an uptake standpoint?

至於我的後續研究，我認為由於腹腔鏡手術效果良好，減重手術很難被其他手術方式取代。你們打入這個市場的策略是什麼？60毫米訂書機對推動產品普及有多大意義？那麼從市場接受度來看，我們該期待什麼呢？

Larry, it's a good question. On bariatrics, really, our customers have pointed us here. This is one where, as you've said, there's a fair amount of penetration of laparoscopy. And outcomes are generally good. And so you begin to kind of ask why, why are they asking here? What's the organic interest? Like all things, where we've said to you in earlier procedure adoptions. 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. And where we find value as an entry point, I think, will have to develop over time. Clearly, in revisional surgeries, in complex comorbid cases, we see real interest on the part of surgeons. And so that appears to be a place that they're finding some entry point. 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. So we're not ready yet to call what the market sizes of those subsegments and where exactly all the value creation will be. But the organic interest is pretty high, and so we're going to engage our customers and follow their lead here. And short answer is stay tuned.

拉里，問得好。關於減重手術，實際上，是我們的客戶把我們引薦到這裡來的。正如你所說，腹腔鏡技術在這個領域得到了相當程度的普及。結果通常都不錯。於是你開始想，為什麼，他們為什麼要在這裡問這個問題？有機成長的動力是什麼？就像我們在之前的程序採納中告訴你們的所有事情一樣。在早期，特定手術中顯然存在多個子部分，例如減重手術、袖狀胃切除術、胃繞道手術、修復手術等等，這些都是潛在的組成部分。我認為，我們找到價值切入點的地方，需要時間慢慢發展。顯然，在翻修手術和複雜的合併症病例中，我們看到了外科醫生們的真正興趣。所以，這似乎是他們找到的切入點。正如卡爾文所暗示的那樣，這裡有一個不確定因素，那就是腹腔鏡手術對人體工學有益，而減肥外科醫生往往是手術量很大的外科醫生，而且這往往是一個具有挑戰性的——從身體上來說，這是一個具有挑戰性的手術，這其中可能也有一些價值。因此，我們還無法確定這些細分市場的規模，也無法準確預測所有價值創造將在哪裡發生。但消費者的自發性興趣非常高，所以我們將與客戶互動，並聽從他們的引導。簡而言之，敬請期待。

We go to Rich Newitter with Leerink Partners.

我們去找 Leerink Partners 的 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. 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? 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? That was one model we had heard discussed. I was just curious, is this happening? Or are there other creative ways that you're potentially going to kind of accelerate your footprint ahead of competition coming?

第一個，Gary 或他的團隊，我們注意到一些機構表示，鑑於普通外科醫生在現有工作空間內沒有足夠的時間，他們正在尋找新的方法來增加醫院的系統數量。我很好奇，除了經營租賃之外，您認為在安置這些系統方面有哪些創意的方法？你們是否會採用某種預先部署系統模式，並設定最低銷售承諾？如果在預定時間內銷售未達承諾，你們是否有權收回系統？那是我們之前聽過的模式。我只是好奇，這事真的發生了嗎？或者，您是否還有其他創意的方法，可以在競爭對手到來之前加快您的市場擴張步伐？

First of all, the objective is to get systems out there and to get them productive and to provide improved surgery to patients. 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. 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. We'll think about different models to get -- to eliminate the barrier from a capital expenditure perspective.

首先，目標是讓系統投入使用並發揮作用，為患者提供更好的手術。我認為我們在租賃方面一直很靈活。我所說的靈活，是指我們調整了那些非常短期的租賃方式，幾乎就是短期租賃，以幫助他們度過預算週期，然後過渡到所謂的普通租賃方式，即 5 年期租賃，租賃期滿後設備仍歸客戶所有。我們願意進一步保持靈活性，因此，儘管我們討論過不同的模型，但我認為目前我們還沒有推出任何對結果至關重要的方案，但我們會保持靈活。我們將考慮不同的模式來消除資本支出的障礙。

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

我們在考慮靈活性時，真正從客戶角度出發，主要關注的是他們對系統存取權限的長期承諾，以及這種存取權限對他們的重要性。我們對我們的系統充滿信心，所以我們並不太擔心退貨權之類的問題。我認為，如果這是一個了解機器人手術並了解機器人手術系統相對於其他手術方式的價值的團隊，那麼如果他們真的致力於如何實施該計畫、如何培訓他們的外科醫生等等，我們願意承擔一些財務風險。

And then just a quick follow-up. 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. How should we think about the ASP on Sp as we model out kind of maybe the initial placements? Is it like a 20%, 30% premium to what Sp will be as we move out beyond 2019? How should we think about that?

然後還有一個簡短的後續問題。卡爾文，我想你之前提到過，Sp在分階段推出時，最初只會作為一款獨立遊戲機出售，但最終會融入到你們的整個第四代主機套裝中。在模擬初始部署情況時，我們應該如何考慮 Sp 上的平均售價 (ASP)？相對於2019年以後的標普500指數，這是否會有20%到30%的溢價？我們該如何看待這個問題？

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，它們的價格應該比我們的 Xi 略高，不到 20% 到 30%，更像是 5% 左右。

And we go to Isaac Ro with Goldman Sachs.

接下來我們來採訪高盛的艾薩克·羅。

Just another question on Asia. Curious in Japan, with the new coverage there, you talked about an acceleration. Wondering how you think that accelerating curve will play out over the balance of the year as it relates to your guidance? What's kind of embedded in the Japan part of your outlook?

關於亞洲的另一個問題。在日本，隨著新的報導出現，你談到了加速發展，這引起了我的好奇。想知道您認為這種加速成長的趨勢將在今年剩餘時間內如何發展，以及這會對您的業績指引產生怎樣的影響？在你的日本觀中，有哪些根深蒂固的觀念？

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. 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. Some will take precedence over others in terms of priority for training and priority for development. The team is working through that now. So as we do our forecasting model, it's not a simultaneous event. It's focus and deliver and really drive high-value through our teams to the customer. Calvin, you can speak quantitatively.

讓我先做一些定性分析，然後你再來談談定量分析。從定性角度來看，雖然我們在報銷清單上增加了 12 項額外的程序（其中一些是彼此的子程序），但它們不會同時以相同的速度推進。在培訓和發展方面，有些人會比其他人享有優先權。團隊正在努力解決這個問題。因此，當我們建立預測模型時，它並不是一個同步事件。關鍵在於專注、交付，並透過我們的團隊真正為客戶創造高價值。卡爾文，你擅長用量化方法說話。

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

是的，我的意思是，正如我們在前面的評論中所描述的那樣，當我們從泌尿外科的dVP和部分腎切除術過渡到更廣泛的手術領域時，這是一個基礎建設期。我們對第一季以培訓和新專案為重點的活動以及他們在現場所需的所有支援感到非常滿意，但就純粹的數字而言，這對於指導的上限或下限，或者我們整體的發展方向來說，並不是一個重要因素。總體而言，手術比例在——相對於全球而言，大約在 2% 左右。從長遠來看，這對日本來說是一個絕佳的機會，但就短期而言，更多的是建立項目，而不是對公司全年手術量成長的影響。

That's helpful context. Follow-up is on the hernia market. 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? And just anything to help us segment what is clearly very heterogeneous and large opportunity for you guys.

提供的背景資訊很有幫助。後續工作將進入疝氣市場。我認為這顯然是你們的巨大潛在機會，而且我認為這些年來你們的想法已經發生了變化，現在你們在這方面取得了一些進展，如果你們能為我們提供一些更新的市場發展分類或章節，以便我們思考哪些類型的程序真正推動了近期採用，哪些程序可能是中期或長期機會，這將非常有幫助？還有，任何能幫助我們細分這個顯然非常異質且對你們來說蘊藏著巨大機會的市場的方法都行。

I think it's a good question. It's not something we're prepared to do on this call. And it is true. Just frankly, that our view of these opportunities and markets evolves over time. 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. We will think about it as to where -- what has changed and where it is. 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.

我認為這是一個很好的問題。我們不打算在這次電話會議上討論這個問題。這是真的。坦白說，我們對這些機會和市場的看法會隨著時間而改變。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，隨著我們對市場區隔領域的了解越來越深入，我們的觀點也隨之進步。我們會思考一下──究竟發生了什麼變化，以及變化發生在哪裡。我認為，我們現在還不能說我們已經準備好做出不同的預測，但它正在進入一個不同的階段，值得我們認真思考這個階段。

And we go to Larry Keusch with Raymond James.

我們去找拉里·科伊什和雷蒙德·詹姆斯。

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

Gary，我注意到在美國，我認為安裝的系統中有 87% 是 Xi 系統，這顯然表明，儘管有價格更低的系統可供選擇，醫院仍然會繼續追求功能最強大的系統。那麼，您能否談談習近平和美國X之間的一些趨勢？

Sure. 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. 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. 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. And so the material cost that flow through is sort of a tiny fraction of all of it. 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. And so that's what we see. And I think that results in the acquisitions of Xis. If folks are capital constrained, and by the way, that set of criteria can vary a little bit region-to-region. 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. 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.

當然。我認為，從某種意義上說，這取決於人們如何權衡臨床價值和經濟價值，以及他們認為相對於資本投入價格而言，價值體現在哪裡。在很多地方，當你深入研究這個問題時，你會發現資本價格，資本成分，並不是成本的主要決定因素。如果你看一下每次病人治療的總成本（在我看來，這是這裡最相關的經濟問題），那麼照顧該病人的總成本完全取決於治療結果和人力勞動。因此，實際的材料成本只佔總成本的一小部分。對於那些擁有資金管道並看到這一點，並且已經進行過一系列分析的人來說，我認為他們真正問自己的是，什麼才能為我們帶來最佳結果、最高效率和標準化，然後他們會做出相應的承諾。這就是我們看到的。我認為這導致了 Xis 的收購。如果人們資金有限，順便說一句，這套標準在不同地區可能會略有不同。我認為每次病患治療的總成本在各國之間具有良好的可比性，但不同的組織有不同的審批流程和資金分配流程。如果他們願意，可以選擇從資本成本較低的系統著手，我們很樂意支持他們，還有（聽不清楚）X。所以，在我們準備好的演講稿中，我們談到了這些系統的分配符合我們對區域世界的看法，這就是原因。

Okay, perfect. That's helpful. 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. But is there a place in the portfolio for a more de-featured system that would have even a lower capital cost? Do you think about that as also potentially part of the portfolio at some point?

好的，完美。那很有幫助。我想，另一個問題是，我知道 Si 肯定會存在一段時間，而且對於那些真正想購買價格更低廉的資本設備的人來說，可以以折扣價提供翻新系統。但是，對於功能更少、資本成本更低的系統，產品組合中是否有一席之地呢？您是否認為這在未來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? Triple aim. That's outcomes, efficiencies, workflow standardization and return on investment and high responsiveness to patient need, high patients' interest need. Those 3 needs we're going to look for really carefully. If in that set of analyses, a further de-featured system makes sense, of course, we will pursue that. And we're always looking. 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.

我們將非常認真地傾聽客戶的需求，並認識到客戶的需求是 3 個目標，對嗎？三重瞄準。這包括結果、效率、工作流程標準化、投資回報率以及對患者需求的快速反應和對患者興趣的高度關注。我們會非常仔細地考察這三項需求。如果經過一系列分析，進一步簡化系統是合理的，我們當然會繼續研究。我們一直在尋找。我不認為很明顯，性能較差、資本價格較低的系統就能更好地實現這三個目標，但我們一直在問自己這個問題。

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

最後一個問題來自加拿大皇家銀行資本市場的布蘭登亨利。

One of your robotic flex cath competitors recently partnered with a division of J&J for its ablative technology. Can you spend some time discussing how you see the future direction for the flex cath platform beyond lung biopsies? And specifically, what do you think is the right modality for ablative technology? And is this technology that Intuitive already has internally? Or is it something that Intuitive will need to acquire in the future?

你們的一個機器人柔性導管競爭對手最近與強生公司的一個部門合作，利用其消融技術。您能否花點時間談談您如何看待柔性導管平台在肺部切片之外的未來發展方向？具體來說，您認為消融技術的正確模式是什麼？Intuitive公司內部是否已經擁有這項技術？或者說，這是 Intuitive 未來需要收購的東西嗎？

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. 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. Step two, with regard to the idea of see and treat. If you can go do a detection and then be in a position to treat it, I think is a very compelling vision. And it's a vision we share. We think that's interesting. There are many different ablative technologies and approaches within technologies. Ablation has been around for quite some time. It's not a trivial or obvious therapeutic approach. It will take serious design and serious clinical validation to really understand where those things are. That's going to be a multi-year pathway for anybody. So we're not surprised to see others' interest in it. That is not new to us, it's not a new thought to us. We think there are opportunities there. We think there are multiple pathways to get to good solutions. We are investing in those. Some of that is organic, some of it is partnered. As we evolve, we will share more of that with you. All right. Well, thank you very much. 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. 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. This concludes today's call. We thank you for your participation and support on this extraordinary journey to improve surgery. And we look forward to talking with you again in 3 months.

首先，我們感到興奮——正如我們之前所說，我們對柔性導管技術感到興奮，尤其是在肺部，我認為它可以在那裡產生很大的影響，但它是一個平台，我們認為它將在肺部以外的領域得到應用。我們首先專注於在肺部創造價值，但這並不意味著我們的願景不會進一步擴展，這只是第一步。第二步，關於觀察和治療的理念。如果你能夠進行檢測，然後能夠進行治療，我認為這是一個非常有吸引力的想法。這也是我們所認同的願景。我們覺得這很有趣。燒蝕技術有很多不同的種類和方法。消融術已經存在很久了。這不是一種微不足道或顯而易見的治療方法。要真正了解這些東西在哪裡，需要嚴謹的設計和嚴格的臨床驗證。對任何人來說，這將是一條需要多年才能走完的路。所以，看到其他人對此感興趣，我們並不感到驚訝。這對我們來說並不新鮮，這並不是什麼新想法。我們認為那裡蘊藏著機會。我們認為有多種途徑可以找到好的解決方案。我們正在對這些領域進行投資。其中一些是自然產生的，一些是合作產生的。隨著我們的發展，我們會與您分享更多相關資訊。好的。非常感謝。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。我們創立這家公司的目的是為了突破人手所能達到的手術極限，我向你們保證，我們將繼續致力於推動幾項真正能帶來改變的關鍵舉措。今天的電話會議到此結束。感謝您參與並支持這段旨在改進外科手術的非凡旅程。我們期待三個月後再次與您交談。

Thank you. Ladies and gentlemen, this concludes your teleconference. We thank you for using AT&T Executive TeleConference service. You may disconnect.

謝謝。女士們、先生們，本次電話會議到此結束。感謝您使用AT&T高階主管電話會議服務。您可以斷開連線。