直覺手術 (ISRG) 2018 Q3 法說會逐字稿

And ladies and gentlemen, thank you for standing by.

女士們先生們，謝謝你們的支持。

Welcome to the Initiative (sic) [Intuitive] Surgical Third Quarter 2018 Earnings Release Conference Call.

歡迎來到 Initiative (sic) [Intuitive] Surgical 2018 年第三季度收益發布電話會議。

(Operator Instructions) As a reminder, this conference is being recorded.

（操作員說明）提醒一下，正在錄製此會議。

I'd now like to turn the conference over to our host, Mr. Calvin Darling, Senior Director of Financial Investor Relation, Intuitive Surgical.

我現在想把會議轉交給我們的主持人，Intuitive Surgical 財務投資者關係高級總監 Calvin Darling 先生。

Please go ahead.

請繼續。

Thank you.

謝謝。

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

下午好，歡迎來到 Intuitive Surgical 的第三季度收益電話會議。

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 July 20, 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 7 月 20 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 intuitive.com on the Latest Events 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 intuitive.com 的“投資者關係”頁面下的“最新事件”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 third quarter results as described in our press release announced earlier today, followed by a question-and-answer session.

今天的形式包括為您提供我們今天早些時候發布的新聞稿中描述的第三季度業績的亮點，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 third quarter financial results.

Marshall 將對我們的第三季度財務業績進行審查。

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 will 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。

The third quarter of 2018 was a strong one for Intuitive with continued clinical adoption of our products and positive steps in product launches.

2018 年第三季度對於 Intuitive 來說是一個強勁的季度，我們的產品繼續在臨床上得到採用，並在產品發布方面採取了積極步驟。

As we mentioned last quarter, we believe acceptance of da Vinci in general surgery in the United States, both internationally and appreciation of our generation 4 platform, underpins our recent performance.

正如我們上個季度提到的那樣，我們相信達芬奇在美國普通外科手術中的接受度，國際上以及對我們第 4 代平台的讚賞，支撐了我們最近的表現。

Our team introduced sophisticated new products into the market this quarter as we seek to advance our goals of improving the quality of surgery and decreasing its variability.

我們的團隊在本季度向市場推出了先進的新產品，因為我們尋求推進提高手術質量和減少其可變性的目標。

Global procedure growth was approximately 20% in the third quarter of 2018 compared with the third quarter of 2017, increasing modestly from our Q2 growth rate.

與 2017 年第三季度相比，2018 年第三季度全球手術量增長約 20%，與我們第二季度的增長率相比略有增長。

Trends present in the first half of the year have continued with the United States showing particular strength in hernia repair, colorectal procedures and practice-related general surgery procedures, including cholecystectomy.

今年上半年出現的趨勢仍在繼續，美國在疝修補術、結腸直腸手術和與實踐相關的普通外科手術（包括膽囊切除術）方面表現出特別的優勢。

Mature procedure growth in the United States, including prostatectomy and hysterectomy, was solid again in the quarter.

美國成熟手術的增長，包括前列腺切除術和子宮切除術，在本季度再次穩健增長。

In Japan, procedures grew above 40% year-over-year while our team is onboarding customer-facing staff and optimizing training logistics to support market growth.

在日本，程序同比增長超過 40%，同時我們的團隊正在招募面向客戶的員工並優化培訓物流以支持市場增長。

European procedure performance was generally in line with our expectations again this quarter with particular strength in the U.K. Calvin will review procedure trends in greater detail later in the call.

本季度歐洲程序的性能總體上再次符合我們的預期，在英國表現尤為突出。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 third quarter was strong with growth in total placements over Q3 of 2017 rising 37% from 169 to 231 this quarter.

我們在第三季度的資本配售表現強勁，總配售比 2017 年第三季度增長 37%，從本季度的 169 增至 231。

Net of trade-ins and retirements, our da Vinci installed base grew to 13% over Q3 2017.

扣除以舊換新和報廢後，我們的達芬奇安裝基數比 2017 年第三季度增長了 13%。

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

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

Capital placements have been historically lumpy and we anticipate variability in placements going forward.

資本配置歷來波動較大，我們預計未來的配置會發生變化。

As we indicated on prior calls, we are seeing increased customer interest in alternative capital acquisition approaches, including leasing and usage-based models.

正如我們在之前的電話中指出的那樣，我們看到客戶對替代資本收購方法的興趣越來越大，包括租賃和基於使用的模型。

This quarter, the proportion of new systems placed under lease increased over prior quarters.

本季度，租賃的新系統比例比前幾個季度有所增加。

We believe that it is in both our customers' interest and Intuitive's to offer alternative financing models for qualified hospitals.

我們認為，為合格醫院提供替代融資模式符合我們客戶和 Intuitive 的利益。

We have expanded these programs accordingly.

我們相應地擴展了這些程序。

On the investment front, we are building our organization and making 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投資，以深化我們的技術和區域能力。

Fix cost spending in the quarter was slightly lower than we planned largely due to timing issues that we anticipate will catch up in future quarters.

本季度的固定成本支出略低於我們的計劃，這主要是由於我們預計將在未來幾個季度趕上的時間問題。

Use of our products has increased over the past year and we are in the early stages of several important product launches.

我們產品的使用在過去一年中有所增加，我們正處於幾個重要產品發布的早期階段。

Speaking directionally, we are investing to drive technology strength and to build operating and supply capability in support of our future growth.

從方向上講，我們正在投資以推動技術實力並建立運營和供應能力以支持我們未來的增長。

Financial highlights for our third quarter results are as follows: Revenue for the quarter was $921 million, up 14%; pro forma gross profit margin was 71.5% compared to 71.8% in the third quarter last year; instrument and accessory revenue increased to $486 million, up 21%; total recurring revenue in the quarter was $660 million, representing 72% of total revenue; we generated a pro forma operating profit of $391 million in the quarter, up 12% from the third quarter of last year; and pro forma net income was $337 million, up 4%, with the difference in growth rate between operating profit and net income, largely driven by a onetime tax benefit in Q3 of 2017.

我們第三季度業績的財務亮點如下： 本季度收入為 9.21 億美元，增長 14%；預計毛利率為 71.5%，而去年第三季度為 71.8%；儀器及配件收入增至 4.86 億美元，增長 21%；本季度經常性總收入為 6.6 億美元，佔總收入的 72%；我們本季度的預估營業利潤為 3.91 億美元，比去年第三季度增長 12%；預計淨收入為 3.37 億美元，增長 4%，營業利潤和淨收入的增長率存在差異，這主要是由於 2017 年第三季度的一次性稅收優惠。

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 and the professionals who treat them.

我們衡量我們的創新的標準是它們對客戶手中的結果產生積極影響的能力，在降低每個患者發作的總治療成本的同時有效使用的能力，以及它們對外科患者和治療他們的專業人員的體驗的積極影響。

As we've said in the past, we design our product systems, instruments and software to work together seamlessly as an ecosystem that enables 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。

We obtained FDA clearance for our da Vinci SP Surgical System for urologic surgical procedures in Q2 this year and we submitted our 510(k) application for transoral procedures 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 手術系統的 FDA 許可，並在本季度提交了 Sp 經口手術的 510(k) 申請。

We shipped 3 da Vinci SP Surgical Systems in the quarter all in the United States.

本季度我們在美國運送了 3 台達芬奇 SP 手術系統。

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

這些首次訪問站點將專注於臨床數據生成和客戶反饋。

Surgeon and team feedback from first cases has been extremely encouraging.

來自首例病例的外科醫生和團隊的反饋非常令人鼓舞。

That said, we are in the very early stages of a multiyear pathway for Sp and our focus is on satisfying our early customers, expanding clinical indications, improving our processes and technologies and further refining our supply chain.

也就是說，我們正處於 Sp 多年路徑的早期階段，我們的重點是滿足我們的早期客戶、擴大臨床適應症、改進我們的流程和技術以及進一步完善我們的供應鏈。

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

我們的團隊正在計劃在我們的靈活機器人平台 ION 上取得進展，該平台最初旨在解決肺癌的迫切需求和診斷，肺癌是世界上最常診斷和最致命的癌症之一，早期檢測尤其重要重要的。

As we announced last month, we submitted our 510(k) for its first indication.

正如我們上個月宣布的那樣，我們提交了 510(k) 的第一個適應症。

We showcased our ION system at the CHEST conference this month.

我們在本月的 CHEST 會議上展示了我們的 ION 系統。

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

醫生對現有和最近宣布的替代方案的反饋強烈支持我們的努力。

Our team is focused on working towards clearance in readying the product for its first phase of launch.

我們的團隊專注於為產品的第一階段發布做好準備。

We also initiated our early launch of our SureForm 60-millimeter stapler for use with our fourth generation systems this summer.

今年夏天，我們還提前推出了用於第四代系統的 SureForm 60 毫米訂書機。

Customer feedback has been encouraging at these early sites with hundreds of procedures performed today.

這些早期站點的客戶反饋令人鼓舞，如今已執行數百個程序。

The SureForm 60 brings the surgeons class-leading articulation and precision with computer-measured and controlled staple firing.

SureForm 60 通過計算機測量和控制的縫合釘擊發，為外科醫生帶來一流的清晰度和精度。

Collectively, our SureForm 60-millimeter stapler joints, our force bipolar grasper and Vessel Sealer Extend advanced energy instrument to provide an optimized set of tools for general surgeons, particularly in hernia, bariatric and colorectal procedures.

我們的 SureForm 60 毫米吻合器接頭、我們的力雙極抓緊器和 Vessel Sealer Extend 先進的能量儀器共同為普通外科醫生提供了一套優化的工具，特別是在疝氣、減肥和結直腸手術中。

Our Vessel Sealer Extend launched in Q2 this year and our force bipolar instrument launched in Q3.

我們的 Vessel Sealer Extend 於今年第二季度推出，我們的力雙極儀器於第三季度推出。

Feedback on these instruments has been outstanding.

這些工具的反饋非常出色。

We anticipate expanding our rollout of SureForm 60 in 2019, broadening the set of tools available to general surgeons on our fourth-generation platform.

我們預計將在 2019 年擴大 SureForm 60 的推出範圍，擴大第四代平台上普通外科醫生可用的工具集。

For the balance of 2018, our focus remains in completing the tasks we 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.

首先，在普外科繼續採用達芬奇。

Second, continued development of European markets and access to customers in Asia.

二是繼續開拓歐洲市場，獲取亞洲客戶。

Third, advancing our new platforms, imaging, advanced instruments, da Vinci SP and our ION platform.

第三，推進我們的新平台、成像、先進儀器、達芬奇 SP 和我們的 ION 平台。

And finally, support for additional clinical and economic validation by global region.

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 or pro forma basis.

我將在 GAAP 和非 GAAP 或備考基礎上描述我們的業績亮點。

Our results are also posted to our website.

我們的結果也發佈在我們的網站上。

Third quarter 2018 revenue of $921 million grew 14% compared with third quarter 2017 revenue of $808 million and increased 1% compared with second quarter of $909 million.

2018 年第三季度收入 9.21 億美元，較 2017 年第三季度收入 8.08 億美元增長 14%，較第二季度 9.09 億美元增長 1%。

Third quarter 2017 revenue included $21 million that had previously been deferred in connection with a customer tradeout program that the company had offered certain first quarter 2017 customers.

2017 年第三季度的收入包括之前因公司向某些 2017 年第一季度客戶提供的客戶權衡計劃而推遲的 2100 萬美元。

Excluding the $21 million, revenue grew 17%.

不包括 2100 萬美元，收入增長了 17%。

Third quarter 2018 procedures increased approximately 20% compared with the third quarter of 2017, who were relatively flat compared with last quarter.

2018 年第三季度的程序與 2017 年第三季度相比增加了約 20%，與上一季度相比相對持平。

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

美國的普外科和全世界的泌尿外科繼續推動手術的增長。

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

卡爾文將在本次電話會議的稍後部分審查程序增長的細節。

Instrument and accessory revenue of $486 million increased 21% compared with last year, which is higher than procedure growth, reflecting increased usage of our advanced instruments.

儀器和附件收入為 4.86 億美元，比去年增長 21%，高於程序增長，反映了我們先進儀器的使用增加。

Instrument and accessory revenue realized per procedure was approximately $1,900, an increase of 1% compared with the third quarter of 2017 and an increase of approximately 3% compared with last quarter.

每個程序實現的儀器和附件收入約為 1,900 美元，與 2017 年第三季度相比增長 1%，與上一季度相比增長約 3%。

These increases primarily reflect increased advanced instrument usage and customer buying patterns.

這些增長主要反映了先進儀器使用和客戶購買模式的增加。

Systems revenue of $275 million increased 5% compared with the third quarter of 2017, primarily reflecting higher system placements and higher lease-related revenue, partially offset by the recognition of $21 million of previously deferred systems revenue in the third quarter of 2017, a high number of system placements under operating lease arrangements and slightly lower ASPs.

系統收入為 2.75 億美元，與 2017 年第三季度相比增長 5%，主要反映了更高的系統佈局和更高的租賃相關收入，部分被 2017 年第三季度之前遞延的 2100 萬美元系統收入的確認部分抵消，高經營租賃安排下的系統安置數量和略低的平均售價。

We placed 231 systems in the third quarter of 2018 compared with 169 systems in the third quarter of 2017, and 220 systems last quarter.

我們在 2018 年第三季度放置了 231 個系統，而 2017 年第三季度為 169 個系統，上個季度為 220 個系統。

58 operating lease transactions representing 25% of total placements were completed in the current quarter compared with 20, or 12% of total placements in the third quarter of 2017 and 44, or 20% of total placements last quarter.

本季度完成了 58 筆經營租賃交易，佔總配售量的 25%，而 2017 年第三季度為 20 筆，佔總配售量的 12%，上季度為 44 筆，佔總配售量的 20%。

We provide financing alternatives to hospitals that are well positioned in their markets, including some usage-based options as we believe these alternatives align with customer objectives, enabling faster market expansion.

我們為在其市場中處於有利地位的醫院提供融資替代方案，包括一些基於使用的選項，因為我們相信這些替代方案符合客戶目標，從而實現更快的市場擴張。

As of September 30, we had 279 operating lease and usage-based arrangements outstanding with a net present value of their future revenue stream being approximately $250 million.

截至 9 月 30 日，我們有 279 項未完成的經營租賃和基於使用的安排，其未來收入流的淨現值約為 2.5 億美元。

We expect a proportion of these types of arrangements to increase long term.

我們預計這些類型的安排中的一部分會長期增加。

28% of current quarter system placements in bulk trade-ins reflecting customer desire to access or standardize on our fourth-generation technology.

本季度 28% 的系統安置在批量折價交易中，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 compared with 26% in the third quarter of 2017, and lower than the 34% trade-in rate realized last quarter.

與 2017 年第三季度的 26% 相比有所增長，但低於上一季度實現的 34% 以舊換新率。

Trade-in activity could be lumpy and difficult to predict.

以舊換新活動可能起伏不定且難以預測。

68% of systems placed in the quarter were da Vinci Xis and 28% were da Vinci X Systems, compared with 72% da Vinci Xis and 21% da Vinci X this last quarter.

本季度放置的系統中有 68% 是達芬奇 Xis，28% 是達芬奇 X 系統，而上一季度達芬奇 Xis 為 72%，達芬奇 X 為 21%。

Many of the X Systems were placed with cost-sensitive customers in Europe and with customers in Japan, where we obtained X approval this past May.

許多 X 系統被放置在歐洲的成本敏感客戶和日本的客戶那裡，我們在去年 5 月獲得了 X 批准。

Three of the systems placed in the U.S. were Sp systems.

放置在美國的三個系統是 Sp 系統。

Our installed base of da Vinci systems increased 13% 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 13%，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 $1.45 million, compared with $1.47 million last year and $1.42 million last 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 145 萬美元，而去年為 147 萬美元，上季度為 142 萬美元。

The changes compared with prior periods primarily reflects the mix of X Systems and trade-in transactions.

與前期相比的變化主要反映了 X 系統和以舊換新交易的組合。

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

在美國以外，結果如下。

Third quarter revenue outside of the U.S. was $244 million, increased 15% compared with the third quarter of 2017 and decreased 8% compared with last quarter.

美國以外的第三季度收入為 2.44 億美元，與 2017 年第三季度相比增長 15%，與上一季度相比下降 8%。

Compared with the prior year, instruments and accessories revenue increased $30 million or 34% and systems revenue decreased $5 million or 6%.

與上一年相比，儀器和配件收入增加了 3000 萬美元或 34%，而係統收入減少了 500 萬美元或 6%。

The increase in instrument and accessory revenue relative to the prior year was primarily driven by procedure growth and customer buying pattern.

與上一年相比，儀器和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 systems revenue was driven by an increase in a number of operating leases, lower ASPs reflecting product mix and the impact of trade-in transactions.

系統收入的減少是由於一些經營租賃的增加、反映產品組合的較低平均售價以及以舊換新交易的影響。

The decrease in OUS revenue relative to the previous quarter reflects seasonality and was driven by a decrease in the number of systems placed, a higher number of system lease transactions and lower procedures, partially offset by customer I&A buying patterns.

OUS 收入相對於上一季度的減少反映了季節性，並且是由於放置的系統數量減少、系統租賃交易數量增加和程序減少導致的，部分被客戶 I&A 購買模式所抵消。

OUS procedures grew approximately 23% compared with the third quarter of 2017 and decreased 1% compared with second quarter.

OUS 程序與 2017 年第三季度相比增長了約 23%，與第二季度相比下降了 1%。

Outside U.S., we placed 75 systems in the third quarter compared with 62 in the third quarter of 2017 and 82 last quarter.

在美國以外，我們在第三季度部署了 75 個系統，而 2017 年第三季度為 62 個，上季度為 82 個。

Current quarter system placements included 30 into Europe and 30 into Japan.

當前季度的系統佈局包括 30 個進入歐洲和 30 個進入日本。

36 of the 75 systems placed in the third quarter were X Systems.

第三季度放置的 75 個系統中有 36 個是 X 系統。

Placements outside of the U.S. will continue to be lumpy as some of the OUS markets are in early stages of adoption, some markets are highly seasonal, reflecting budget cycles or vacation patterns and sales into some markets are constrained by government 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，因此美國以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 third quarter of 2018 was 71.5% compared with 71.8% for the third quarter of 2017 and 71.1% last quarter.

2018 年第三季度的備考毛利率為 71.5%，而 2017 年第三季度為 71.8%，上一季度為 71.1%。

The decrease compared with the third quarter of 2017 primarily reflects lower system ASPs partially offset by higher mix of I&A.

與 2017 年第三季度相比的下降主要反映了較低的系統平均售價被較高的 I&A 組合部分抵消。

The increase compared with last quarter, primarily reflects higher system ASPs and higher production levels.

與上一季度相比的增長主要反映了更高的系統平均售價和更高的生產水平。

Future margins will fluctuate based on the mix of our newer products, the mix of systems, 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、儀器和附件收入的組合、系統 ASP 以及我們進一步降低產品成本和提高製造效率的能力而波動。

Pro forma operating expenses increased 16% compared with the third quarter of 2017 and increased 4% compared with last quarter.

預計營業費用與 2017 年第三季度相比增長 16%，與上一季度相比增長 4%。

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

總體而言，我們的支出低於反映支出時間的年度指導。

We expect to continue to invest in key technologies and OUS market expansion and expect spending to increase next quarter and into 2019.

我們預計將繼續投資於關鍵技術和 OUS 市場擴張，並預計下個季度和 2019 年支出將增加。

Our pro forma effective tax rate for the third quarter was 18.5% compared with our expectations of 19.5% to 20.5%.

我們第三季度的備考有效稅率為 18.5%，而我們的預期為 19.5% 至 20.5%。

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 third quarter 2017 pro forma tax rate of 9.7% reflected $68 million of tax benefits associated with the expiration of statutes of limitation.

我們 2017 年第三季度 9.7% 的備考稅率反映了 6800 萬美元與訴訟時效到期相關的稅收優惠。

Our third quarter 2018 net income was $337 million or $2.83 per share, compared with $325 million or $2.78 per share for the third quarter of 2017, and $327 million or $2.76 per share for the second quarter of 2018.

我們 2018 年第三季度的淨收入為 3.37 億美元或每股 2.83 美元，而 2017 年第三季度為 3.25 億美元或每股 2.78 美元，2018 年第二季度為 3.27 億美元或每股 2.76 美元。

Our third quarter 2017 net income benefited from the $21 million of deferred revenue, net of costs, and the $68 million of tax benefits associated with the expiration of statutes of limitation for a total of $0.68 per share.

我們 2017 年第三季度的淨收入受益於 2100 萬美元的遞延收入（扣除成本）以及 6800 萬美元與時效到期相關的稅收優惠，總計每股 0.68 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 $293 million or $2.45 per share for the third quarter of 2018 compared with GAAP net income of $299 million or $2.56 per share for the third quarter of 2017 and GAAP net income of $255 million or $2.15 per share for the second quarter of 2018.

2018 年第三季度 GAAP 淨收入為 2.93 億美元或每股 2.45 美元，而 2017 年第三季度 GAAP 淨收入為 2.99 億美元或每股 2.56 美元，第二季度 GAAP 淨收入為 2.55 億美元或每股 2.15 美元2018.

The adjustments between pro forma and GAAP net income are outlined and quantified on our website.

我們的網站上概述並量化了備考和 GAAP 淨收入之間的調整。

It included excess tax benefits associated with stock -- employee stock awards, employee equity and IP charges and legal settlements.

它包括與股票相關的超額稅收優惠——員工股票獎勵、員工股權和知識產權費用以及法律和解。

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

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，美國減稅和就業法案的影響反映在我們的結果和我們對未來稅率的預測中，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 $4.6 billion compared with $4.3 billion at June 30, 2018.

本季度末，我們的現金和投資為 46 億美元，而 2018 年 6 月 30 日為 43 億美元。

The increase generally reflects cash generated from operation.

增加通常反映經營產生的現金。

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。

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、績效和我們對 2018 年的展望。

Thank you, Marshall.

謝謝你，馬歇爾。

Our overall third quarter procedure growth was 20% compared to 15% during the third quarter of 2017 and 18% last quarter.

我們第三季度的總體程序增長率為 20%，而 2017 年第三季度為 15%，上一季度為 18%。

Our Q3 procedure growth was driven by 19% growth in U.S. procedures and 23% growth in OUS markets.

我們第三季度的程序增長是由美國程序增長 19% 和海外市場增長 23% 推動的。

In the U.S., procedure performance across general surgery, gynecology and urology all exceeded our expectations with Q3 year-over-year growth rates increasing modestly across these largest categories, as they did in the second quarter.

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，與第二季度一樣，這些最大類別的第三季度同比增長率略有增長。

Q3 procedure performance was again driven by growth in general surgery led by hernia repair and colorectal procedures.

Q3 手術性能再次受到疝氣修復和結直腸手術帶動的普通外科手術增長的推動。

Hernia repair, both ventral and inguinal, continued to contribute the most incremental cases in the quarter.

腹側和腹股溝疝修補術繼續貢獻本季度最多的增量病例。

Cholecystectomy, bariatric and other practice-based general surgery procedures all had strong growth in the third quarter.

膽囊切除術、減肥和其他基於實踐的普通外科手術在第三季度都有強勁增長。

In U.S. gynecology, third quarter 2018 year-over-year growth increased to mid-single digits driven by higher benign hysterectomy volumes.

在美國婦科，2018 年第三季度同比增長增至中等個位數，這是由於良性子宮切除術數量增加所致。

In the third quarter, we continued to see favorable surgical consolidation trends as our da Vinci surgery data indicates that practicing da Vinci surgeons performed more da Vinci hysterectomies and an increasing proportion of U.S. gynecology procedures are being performed by higher volume physicians that specialize in complex benign and cancer surgery.

在第三季度，我們繼續看到有利的手術整合趨勢，因為我們的達芬奇手術數據表明執業達芬奇外科醫生進行了更多的達芬奇子宮切除術，並且越來越多的美國婦科手術由專門從事複雜良性手術的醫生進行和癌症手術。

Q3 U.S. urology procedures had growth rates consistent with 2017 and year-to-date 2018, driven by prostatectomy volumes.

在前列腺切除術的推動下，第三季度美國泌尿外科手術的增長率與 2017 年和 2018 年年初至今一致。

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

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

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

在美國的其他手術中，肺葉切除術和其他胸部手術的採用在第三季度再次穩定。

Our overall U.S. procedure growth rate likely benefited from a weaker Q3 2017 comparison.

我們的整體美國程序增長率可能受益於 2017 年第三季度較弱的比較。

Q3 OUS procedure growth trends were largely consistent with Q2.

第三季度 OUS 程序增長趨勢與第二季度基本一致。

Third quarter OUS procedure volume grew approximately 23% compared to 23% for the third quarter of 2017 and 22% last quarter.

與 2017 年第三季度的 23% 和上一季度的 22% 相比，第三季度 OUS 手術量增長了約 23%。

Third 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 年第三季度 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。

Procedure growth in Japan again accelerated as procedures were performed within the set of 12 additional procedures approved for reimbursement effective April 1. Procedure growth in China, again, moderated in Q3, as da Vinci system capacity expansion is constrained by system quota requirements, the most recent of which expired at the end of 2015.

日本的手術增長再次加速，因為在 4 月 1 日生效的 12 項額外手術中進行了手術。中國的手術增長在第三季度再次放緩，因為達芬奇系統容量擴張受到系統配額要求的限制，最最近的一份於 2015 年底到期。

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

在歐洲，程序結果因國家/地區而異，英國持續強勁。

Adoption of our products is ultimately based upon differentiated patient outcomes and procedure economics compared to alternative therapies.

與替代療法相比，我們產品的採用最終基於差異化的患者結果和程序經濟學。

Intuitive supports the generation of high-quality clinical evidence through collaborative research initiatives.

Intuitive 通過協作研究計劃支持生成高質量的臨床證據。

We work with clinicians, hospitals and medical and surgical societies to study da Vinci clinical outcomes while maintaining a patients-first mindset.

我們與臨床醫生、醫院以及內科和外科學會合作，研究達芬奇的臨床結果，同時保持患者至上的心態。

Intuitive's currently supporting comparative multicenter studies for several key procedures, including hernia repair, lobectomy and right colectomy.

Intuitive 目前支持針對幾個關鍵手術的比較多中心研究，包括疝氣修復、肺葉切除術和右結腸切除術。

In hernia repair, we are supporting a prospective multicenter comparative study evaluating outcomes associated with open, laparoscopic and robotic-assisted inguinal and incisional hernia repairs in up to 900 subjects.

在疝修補術方面，我們正在支持一項前瞻性多中心比較研究，評估多達 900 名受試者的開放、腹腔鏡和機器人輔助腹股溝和切口疝修補術的相關結果。

This study is designed to collect outcomes related to pain, quality of life and recurrence for up to 3 years post procedure, capturing patient-reported outcomes through direct electronic or phone follow-up.

本研究旨在收集與術後長達 3 年的疼痛、生活質量和復發相關的結果，通過直接電子或電話隨訪獲取患者報告的結果。

We are supporting a prospective comparative study for right colectomy, comparing outcomes associated with extra corporeal and intracorporeal and anastomotic techniques in up to 300 subjects, collecting information related to patient quality of life parameters, including but not limited to, gastrointestinal quality of life and incidence of incisional hernia rates.

我們正在支持右結腸切除術的前瞻性比較研究，比較多達 300 名受試者與體外和體內及吻合技術相關的結果，收集與患者生活質量參數相關的信息，包括但不限於胃腸道生活質量和發病率切口疝率。

Intracorporeal anastomosis by the robotic approach may be amenable to more surgeon skill sets than the laparoscopic counterpart.

通過機器人方法進行的體內吻合術可能比腹腔鏡對應物更適合外科醫生的技能組合。

Indeed, the degree of difficulty of the sutured laparoscopic anastomosis has limited wide application of this approach.

事實上，縫合腹腔鏡吻合的困難程度限制了這種方法的廣泛應用。

In this year, where lung cancer is the leading cause of cancer death among men and women in the United States, a gradual decline is noted in the percentage of lung cancer surgery performed by an open approach from 43% in 2015 to 31% in 2017.

今年，肺癌是美國男性和女性癌症死亡的主要原因，通過開放手術進行的肺癌手術比例從 2015 年的 43% 逐漸下降到 2017 年的 31% .

The literature supporting the use of minimally-invasive approach, both VATS and robotic-assisted for lobectomy, is incrementally growing with the majority of them attributed to the treatment of early-stage lung cancer.

支持使用微創方法（包括 VATS 和機器人輔助肺葉切除術）的文獻正在逐漸增加，其中大部分歸因於早期肺癌的治療。

Intuitive is conducting a retrospective comparative multicenter lobectomy study, evaluating both the short-term and long-term outcomes across both early-stage and locally-advanced lung cancer in up to 5,000 patients.

Intuitive 正在進行一項回顧性比較多中心肺葉切除術研究，評估多達 5,000 名患者的早期和局部晚期肺癌的短期和長期結果。

You can find a full description of all these studies on the Clinical Evidence page of our new website.

您可以在我們新網站的臨床證據頁面上找到所有這些研究的完整描述。

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 14.5% to 16.5%.

在我們上次電話會議上，我們預測 2018 年全年手術增長率將在 14.5% 至 16.5% 之間。

We are now increasing our forecast and estimate full year 2018 procedure growth of 17% to 18%.

我們現在正在增加我們的預測，並估計 2018 年全年程序增長 17% 至 18%。

In regards to Q4 system placements, consistent with historical patterns, we anticipate seasonally strong fourth quarter system placements.

關於第四季度系統佈局，與歷史模式一致，我們預計第四季度系統佈局季節性強勁。

However, we do expect some moderation from the 30-plus percent growth in system placements we have realized in recent quarters.

但是，我們確實預計我們在最近幾個季度實現的 30% 以上的系統安置增長會有所放緩。

Furthermore, we expect that the proportion of systems placed via operating leases in Q4 will increase further from the 25% in Q3.

此外，我們預計第四季度通過經營租賃放置的系統比例將比第三季度的 25% 進一步增加。

Turning to gross profit.

轉向毛利。

On our last call, we forecast our 2018 pro forma gross profit margin to be within a range of between 70% and 71.5% of net revenue.

在我們的最後一次電話會議上，我們預測我們 2018 年的備考毛利率將在淨收入的 70% 至 71.5% 之間。

We are now retiring the lower end of the range and expect pro forma gross profit margin to be between 70.5% and 71.5% of net revenue.

我們現在退出該範圍的下限，預計備考毛利率將在淨收入的 70.5% 至 71.5% 之間。

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

我們的實際毛利率每個季度都會有所不同，這在很大程度上取決於產品、區域和以舊換新組合以及新產品推出的影響。

Turning to operating expenses.

轉向運營費用。

Last quarter, we guided 2018 operating expense growth of between 16% and 18%.

上個季度，我們指導 2018 年的運營費用增長在 16% 到 18% 之間。

We are now adjusting this range lower and expect to grow 2018 operating expenses within the range of between 15.5% and 17% above 2017 levels.

我們現在正在將這一範圍下調，並預計 2018 年的運營支出將比 2017 年的水平增長 15.5% 至 17%。

We are adjusting upwards our estimate for non-cash stock compensation expense to a range of between $255 million and $260 million in 2018 compared to $245 million to $255 million forecast on our last call.

我們將 2018 年非現金股票補償費用的預估上調至 2.55 億美元至 2.6 億美元，而我們上次電話會議預測的為 2.45 億美元至 2.55 億美元。

We continue to expect other income, which is comprised mostly of interest income to total between $70 million and $75 million in 2018.

我們繼續預計 2018 年其他收入（主要包括利息收入）總額將在 7000 萬美元至 7500 萬美元之間。

With regard to income tax, on our last call, we forecast our 2018 pro forma income tax rates to be between 19.5% and 20.5% 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 19.5% 至 20.5% 之間。

We are now shifting our estimates slightly lower to a range between 19% and 20% of pretax income.

我們現在將我們的估計略微下調至稅前收入的 19% 至 20% 之間。

That concludes our prepared comments.

我們準備好的評論到此結束。

We will now open the call to your questions.

我們現在將打開您的問題的電話。

(Operator Instructions) We have a question from the line of Bob Hopkins with Bank of America.

（操作員說明）我們有來自美國銀行的 Bob Hopkins 的問題。

I actually wanted to start, if okay, with a question on capital allocation.

如果可以的話，我實際上想從一個關於資本配置的問題開始。

Obviously, the business trends are very strong right now.

顯然，現在的商業趨勢非常強勁。

I think you mentioned that you got $4.6 billion in cash and the authority to buy back stock.

我想你提到你有 46 億美元的現金和回購股票的權力。

Maybe, if okay, if you wouldn't just mind commenting on why you're not buying back stock right now and does that suggest potential for some M&A opportunities out there?

也許，如果可以的話，如果你不介意評論一下為什麼你現在不回購股票，這是否表明存在一些併購機會的潛力？

Bob, it's Marshall.

鮑勃，是馬歇爾。

We have not modified our capital deployment priorities and -- so they're consistent with what we said before.

我們沒有修改我們的資本部署優先級，因此它們與我們之前所說的一致。

First, organic investment and substantial growth opportunities that are available to us.

首先，我們可以獲得有機投資和大量增長機會。

Second, acquiring technologies and talent that will ensure that we can accelerate our growth.

第二，獲取技術和人才，確保我們能夠加速增長。

And then third, using efficient long-term focus vehicles to return cash to shareholders.

第三，使用高效的長期重點工具向股東返還現金。

In that regard, we have done stock buybacks.

在這方面，我們進行了股票回購。

You've seen us doing it periodically, we do them opportunistically based on our assessment of the market.

你已經看到我們定期這樣做，我們根據對市場的評估機會主義地這樣做。

I think the market will continue to be volatile as is has been recently.

我認為市場將像最近一樣繼續波動。

And as it provides opportunities to purchase at the right price, you will see us do something.

由於它提供了以合適的價格購買的機會，您會看到我們做一些事情。

We have a question from the line of David Lewis with Morgan Stanley.

摩根士丹利的 David Lewis 提出了一個問題。

Gary, a couple questions for me.

加里，有幾個問題要問我。

I guess, the first is Marshall touched on this but obviously, leases suppressed revenue in the quarter but net placement numbers in the U.S. were the best we've seen, as well as system utilization.

我想，首先是馬歇爾談到了這一點，但顯然，租賃抑制了本季度的收入，但美國的淨安置數字是我們所見過的最好的，以及系統利用率。

Both those numbers are the best we've seen in years.

這兩個數字都是我們多年來看到的最好數字。

And 20% procedure growth, obviously, reflects another quarter, I think the third straight quarter of momentum acceleration.

顯然，20% 的程序增長反映了另一個季度，我認為這是連續第三個季度的勢頭加速。

So I guess, thinking about these U.S. box and procedure trends, can you just walk us through some of the drivers that you're seeing, specifically in the U.S., for these dynamics?

所以我想，考慮到這些美國的盒子和程序趨勢，你能不能給我們介紹一下你看到的一些驅動因素，特別是在美國，對於這些動態？

I think the procedure demand is, of course, the top line and as we called out in the script, the sustained strength in some of the mature categories, in urology and gynecology as well as general surgery really rising has been strong.

我認為程序需求當然是最重要的，正如我們在劇本中所說的那樣，一些成熟類別的持續實力，在泌尿科和婦科以及真正上升的普通外科領域一直很強勁。

And I think the box placements then are in response to that increased procedure demand.

而且我認為盒子放置是為了響應增加的程序需求。

From our perspective, we're happy to see utilization go up.

從我們的角度來看，我們很高興看到利用率上升。

We really view capital placements in mature markets as a way to enable the procedure market, and so you're seeing that.

我們確實將成熟市場中的資本配售視為啟用程序市場的一種方式，所以你看到了這一點。

Leases are then kind of a fallout of that philosophy.

租賃是這種理念的一種後果。

Or hospitals that have good positions in their markets and are well run, then we think giving them access where and when they need it at the terms that work for them and work for us helps facilitate market and we've been willing to do that.

或者在市場上擁有良好地位並且運營良好的醫院，那麼我們認為讓他們在需要的時間和地點以對他們有用並為我們工作的條款訪問有助於促進市場，我們一直願意這樣做。

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

我們的下一個問題將來自花旗銀行的 Amit Hazan。

Well, it's looking like we're getting about one question each here, so I'm going to...

好吧，看起來我們每個人都在問一個問題，所以我要...

We'll give David a chance to jump back in queue a little later, but go ahead.

我們稍後會給 David 機會跳回隊列，但請繼續。

Sorry about that.

對於那個很抱歉。

No problem.

沒問題。

I'll ask mine on Japan.

我會問我的關於日本的。

That was, obviously, some improved numbers in Japan drawn on procedures and installations, and so I'm just curious if that surprises you that, that's the reimbursement.

很明顯，日本的一些改進數字是根據程序和安裝得出的，所以我很好奇這是否會讓您感到驚訝，那就是報銷。

And if you could just give us some more color on how you're seeing that market react and develop post the new reimbursement and whether sustainability of that growth that we're seeing now looks more realistic to you after this quarter.

如果你能給我們更多關於你看到市場如何反應和發展後新報銷的顏色，以及我們現在看到的這種增長的可持續性在本季度之後對你來說是否更現實。

We're pleased with progress in Japan.

我們對日本的進步感到高興。

The -- kind of the settle-down growth rates are going to be a little bit hard to predict.

那種穩定的增長率將有點難以預測。

Right now, demand looks really good and I think the -- it's really the pipeline of activities from demand to clinical cases and up and running programs that's the right limiting step.

現在，需求看起來非常好，我認為——這實際上是從需求到臨床病例以及啟動和運行程序的活動管道，這是正確的限制步驟。

Some of that is training capacity and logistics.

其中一些是培訓能力和後勤。

Some of it is field support on our side.

其中一些是我們這邊的現場支持。

Some of it is the depth of the surgeon proctoring network.

其中一些是外科醫生監督網絡的深度。

Not all of the procedures that were reimbursed will adopt at the same rates, nor will we pursue them all at the same rate.

並非所有報銷的程序都會以相同的費率採用，我們也不會以相同的費率進行。

And so there's a little bit of shakeout here as the priorities firm up.

因此，隨著優先事項的確定，這裡會出現一些調整。

So far so good, but I really think there's a few quarters to go before this settles into a kind of a more predictable cadence.

到目前為止一切順利，但我真的認為在進入一種更可預測的節奏之前還有幾個季度的時間。

And if you have a follow-up, go ahead.

如果您有後續行動，請繼續。

Sure.

當然。

Yes.

是的。

So I'm going to maybe ask about hiring take.

所以我可能會問一下關於招聘的問題。

So from the numbers that you guys reported, it's obviously really strong, it's up to 5,200 headcount now.

所以從你們報告的數字來看，它顯然非常強大，現在有 5,200 名員工。

That's about a 700 increase so far this year.

今年到目前為止，這大約增加了 700 人。

So maybe just some color on where the heavy areas are in which those heads are being allocated.

因此，也許只是在分配這些頭的重區域的一些顏色。

And how you're thinking about that headcount growth as we think about the next year or 2.

在我們考慮明年或兩年時，您如何看待員工人數的增長。

Good question.

好問題。

The -- some of the headcount growth is -- roughly tracks to the procedure momentum that we're seeing.

一些員工人數的增長大致與我們所看到的程序勢頭一致。

So there's field support that's required, there's the production side of instruments and accessories and there's training resources that go into product training.

因此，需要現場支持，儀器和配件的生產方面，以及用於產品培訓的培訓資源。

And so those things are kind of ratable and we get a little leverage out of them, but we want to make sure that we support our customer really well.

因此，這些東西是可以評價的，我們從中獲得了一些影響力，但我們希望確保我們能夠很好地支持我們的客戶。

So that's where you see the bulk of the hiring in.

所以這就是你看到大部分招聘的地方。

As procedure growth goes, we expect a little leverage there but not a ton.

隨著程序的增長，我們預計會有一點影響力，但不會很大。

There are also new platforms coming, we talked about in the script, Sp and ION, and those are deep technology efforts, supply chain efforts and so some of the heads have gone into support of that set of activities as we go.

還有新的平台即將到來，我們在腳本中談到了 Sp 和 ION，這些都是深入的技術努力、供應鏈努力，所以一些負責人在我們進行的過程中已經開始支持這一系列活動。

It may well be the right limiting step for growth of the company is really the onboarding capability of really good people.

這可能是公司發展的正確限制步驟，實際上是真正優秀人才的入職能力。

So we watch it really carefully and care about it.

所以我們非常仔細地觀察它並關心它。

And our next question will come from Tycho Peterson with JPMorgan.

我們的下一個問題將來自摩根大通的第谷彼得森。

I'll ask a couple on some of the emerging procedures.

我會就一些新出現的程序問一對夫婦。

On bariatric, I'm just wondering if you can comment on some of the market development efforts now that you've got the SureForm stapler out there.

關於減肥，我只是想知道您是否可以對一些市場開發工作發表評論，因為您已經有了 SureForm 吻合器。

And how should we think about sleeve gastrectomy versus bypass versus maybe other procedures?

我們應該如何考慮袖狀胃切除術與旁路手術以及其他手術？

And then separately, I noticed you both, Calvin and Gary, talked about chole.

然後分別地，我注意到你們倆，Calvin 和 Gary，談到了 chole。

I'm wondering if that's coming back a little bit, typical to what we've seen in the past.

我想知道這是否會恢復一點，這與我們過去所見的典型情況一樣。

Yes, on the bariatric front, long term, we're really enthusiastic about it.

是的，從長遠來看，在減肥方面，我們真的很熱心。

In the near term, we're optimizing a few things.

在短期內，我們正在優化一些事情。

We are optimizing the product portfolio in terms of some of the instruments that I mentioned in the script, so the Vessel Seal Extend and the SureForm 60.

我們正在根據我在腳本中提到的一些儀器優化產品組合，例如 Vessel Seal Extend 和 SureForm 60。

We're still in our first phase launch, which is building capacity in the supply side as well as working through our customer preference feedback.

我們仍處於第一階段啟動階段，正在建設供應方的能力以及處理我們的客戶偏好反饋。

That will start to expand into 2019.

這將開始擴展到 2019 年。

It will be a measured launch.

這將是一次有計劃的發射。

In part, to make sure that our supply capabilities match demand and in part, to make sure that our sales force is well balanced in terms of supporting general surgery customers in hernia, which is growing nicely, in colorectal, which is growing nicely so that we have a balanced approach to the general surgery market.

部分是為了確保我們的供應能力與需求相匹配，部分是為了確保我們的銷售人員在支持疝氣和結直腸癌方面的普通外科客戶方面得到很好的平衡，後者增長良好，因此我們對普通外科市場採取平衡的方法。

So I wouldn't overbuild the near term on it.

所以我不會在短期內過度構建它。

I think in the long term, it looks quite good.

我認為從長遠來看，它看起來相當不錯。

With regard to resolution on the kind of the clinical approach question you asked and are these -- sleeves versus bypass.

關於您提出的臨床方法問題的解決方案，這些是袖套還是搭橋。

It's a little too soon for us to work through it.

現在解決它還為時過早。

Clearly, there's a mix in the market.

顯然，市場上存在混合因素。

How that mix applies to robotics, I think that's a question for future quarters.

這種組合如何應用於機器人技術，我認為這是未來幾個季度的問題。

On cholecystectomy, just touching that.

關於膽囊切除術，只是觸及那個。

We have seen strength in multiport chole, a decline in Single-Site cholecystectomy made up for -- more than made up for by strength in multiport.

我們已經看到多端口膽囊的優勢，單點膽囊切除術的下降彌補了——多端口的優勢所彌補的。

For us, it's hard to know how much of that is a part of new general surgeons coming in versus how much of it is surgeons adopting or changing their practice pattern for patients that they think are well suited to robotics.

對我們來說，很難知道其中有多少是新的普通外科醫生進來的一部分，有多少是外科醫生為他們認為非常適合機器人技術的患者採用或改變他們的實踐模式。

There's clearly a mix of both.

顯然兩者兼而有之。

And separating those 2 in terms of intent is very hard.

在意圖方面將這 2 個分開是非常困難的。

So we mentioned it because the growth numbers have been substantive.

所以我們提到它是因為增長數字是實質性的。

The sustainability of that growth, we're not ready to call yet.

這種增長的可持續性，我們還沒有準備好打電話。

Okay.

好的。

And then if I can just ask one more clarification.

然後我是否可以再問一個澄清。

Can you comment on the difference between a usage-based model and an operating lease for those systems that are kind of undertaking one of those?

您能否評論一下基於使用的模型與那些正在承擔其中之一的系統的經營租賃之間的區別？

Sure.

當然。

Marshall.

馬歇爾。

Sure.

當然。

Operating leases -- frankly, we structure these things to meet customer needs.

經營租賃——坦率地說，我們構建這些東西是為了滿足客戶的需求。

And operating leases come in various flavors, including that we will do your traditional 4-year lease with a bargain buyout at the end.

經營租賃有多種形式，包括我們將為您提供傳統的 4 年租約，最後以低價買斷。

We also do short-term rentals that get them over budget cycles.

我們還進行短期租賃，讓他們在預算週期內得到幫助。

And again, so we're ultimately pretty flexible on the leasing programs.

再一次，我們最終在租賃計劃上非常靈活。

The usage-based programs, really are based on time usage over a period.

基於使用情況的程序實際上是基於一段時間內的時間使用情況。

And we've done that with a few hospitals, as we said, that are well positioned in the market and are serious robotics users.

正如我們所說，我們已經在一些醫院中做到了這一點，這些醫院在市場上處於有利地位並且是認真的機器人用戶。

And in terms of our reporting, Tycho, we are including these alternative structures in with the operating leases, right?

就我們的報告而言，第谷，我們將這些替代結構包括在經營租賃中，對嗎？

So they're all included in the overall operating lease number.

所以它們都包含在整體經營租賃數量中。

They're just -- think of it as another form of operating lease.

他們只是 - 將其視為另一種形式的經營租賃。

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

我們的下一個問題將來自富國銀行的 Larry Biegelsen。

Two for me.

兩個給我。

I'll just ask them upfront.

我會提前問他們。

Gary, on the Q2 call, you said hernia is moving to a different phase, and it's worth thinking through that phase.

加里，在第二季度的電話會議上，你說疝氣正在進入一個不同的階段，值得考慮這個階段。

Can you elaborate that?

你能詳細說明一下嗎？

Maybe talk about some themes you're seeing in hernia.

也許談談你在疝氣中看到的一些主題。

And then separately, obviously, with the CHEST meeting at AATS, the 2 robotic bronchoscopy platforms got more Wall Street attention.

然後，很明顯，隨著 AATS 的 CHEST 會議，這兩個機器人支氣管鏡檢查平台得到了華爾街更多的關注。

Gary, the differences seem to be, between the 2 systems, in camera capability and the size of the working channel.

加里，這兩個系統之間的差異似乎在於相機功能和工作通道的大小。

How would you compare and contrast the 2 systems with respect to those differences?

您如何就這些差異比較和對比這兩個系統？

Okay.

好的。

I think the conversation we had last quarter was kind of a question of what inning are we in, in hernia, and I think we're still in the first half of the game but out of the first couple of innings.

我認為我們上個季度的談話是關於我們在疝氣中處於哪一局的問題，我認為我們仍處於比賽的上半場，但在前幾局之外。

And why do I say that?

我為什麼這麼說？

I think you're starting to see a fair amount of data that's being collected and things like registries that's able to show clinical benefit.

我認為您開始看到正在收集的大量數據以及能夠顯示臨床益處的註冊表之類的東西。

And we're seeing a fair amount of reorders from existing customers that does not appear that a lot of it is just trialing.

而且我們看到現有客戶的大量重新訂購似乎並沒有很多只是在試用。

It looks like it's a -- for those who have adopted their commitment to it appears to be pretty good.

看起來這是一個——對於那些已經做出承諾的人來說，這似乎相當不錯。

How deeply that goes in the total market in terms of what the total number of hernias out there is, we still are struggling a little bit to understand what fraction of the total available market of hernias will settle into robotic-assisted surgery in terms of size of their herniation and bilateral versus unilateral inguinal hernia repair and so on.

就疝氣總數而言，這在整個市場中的影響有多深，我們仍在努力了解疝氣總可用市場中有多少比例將在規模方面適應機器人輔助手術他們的疝氣和雙側與單側腹股溝疝修補術等。

Some of the segments of the underlying market are not yet resolved, and so that's uncertain.

基礎市場的某些部分尚未解決，因此不確定。

We'll see as we go forward.

我們會看到我們前進。

But the data, so far in the surgeons taking this has been good.

但是數據，到目前為止，在外科醫生中一直很好。

So that's what we were seeing last quarter.

這就是我們上個季度所看到的。

I think that holds up this quarter.

我認為這在本季度保持不變。

Turning to our ION platform as it relates to other products in the market.

轉向我們的 ION 平台，因為它與市場上的其他產品相關。

We made some decisions early on that were really driven around what we viewed as the clinical problem in pulmonology, which was early detection of distal, meaning on the periphery of the lung, on the further distant branches within the lung, of suspicious lesions that are, give or take, a centimeter in size.

我們很早就做出了一些決定，這些決定實際上是圍繞我們認為是肺病學的臨床問題而做出的，即早期檢測遠端，即肺周圍，肺內更遠的分支上的可疑病變，這些病變是，給或拿，一厘米的大小。

And to do that, you needed really good sensing, which we did.

要做到這一點，你需要非常好的傳感，我們做到了。

That was through our shape sensing technology and some of the first partnering then acquisition and development of the Luna sensor.

那是通過我們的形狀傳感技術和一些最初的合作，然後是對 Luna 傳感器的收購和開發。

And then it was dependent strongly on the size of the catheter.

然後它在很大程度上取決於導管的尺寸。

So we make that decision based on understanding the physiology of the lung, understanding where those nodules were and hoping to understand what interventional pulmonologists and thoracic surgeons really needed.

因此，我們根據對肺部生理學的了解、了解這些結節的位置並希望了解介入肺科醫生和胸外科醫生真正需要什麼來做出決定。

That's what drove our architecture.

這就是推動我們架構的原因。

We feel good about it.

我們對此感覺很好。

It is possible, technologically feasible to make a bigger catheter.

製造更大的導管是可能的，技術上是可行的。

Making a bigger one is easier than making a smaller one.

做大的比做小的容易。

Putting a permanent camera in, if we needed to do that, was all something that could be done and we chose not to.

如果我們需要的話，安裝一個永久性的攝像頭是可以做到的，但我們選擇不這樣做。

We chose to make it small, and time will tell whether that was the right decision.

我們選擇將其縮小，時間會證明這是否是正確的決定。

I feel good about it.

我感覺很好。

Last point I'd make about the lung space is that this is a space that has been looking at early diagnosis of lung cancer for some time and for which several commercial teams have gone in and promoted products, several of which have disappointed.

關於肺部空間，我要說的最後一點是，這是一個一直在研究肺癌早期診斷的空間，並且有幾個商業團隊已經進入並推廣產品，其中有幾個令人失望。

So I don't think it's a market that will move on what's said.

所以我不認為這是一個會按照所說的那樣發展的市場。

I think it's a market that will move based on true capability and clinical evidence, and that's where our focus is.

我認為這是一個基於真實能力和臨床證據的市場，而這正是我們關注的重點。

We feel good about where we are and we show what we think we can.

我們對自己的處境感覺良好，我們展示我們認為我們可以做到的。

And I think that will determine success for us.

我認為這將決定我們的成功。

Our next question will come from Brandon Henry with RBC Capital Markets.

我們的下一個問題將來自加拿大皇家銀行資本市場的布蘭登亨利。

Can you discuss any challenges you expect to face with the ION rollout?

您能否討論一下您預計在推出 ION 時會遇到的任何挑戰？

And who will be selling these systems to pulmonologists?

誰會把這些系統賣給肺科醫生？

Will it be a separate salesforce or the existing Intuitive salesforce?

是單獨的銷售人員還是現有的 Intuitive 銷售人員？

And I just have a follow-up.

我只是有一個跟進。

I would anticipate the kinds of challenges that are related to the sort of complex product launches that we specialize in.

我預計會遇到與我們擅長的複雜產品發布相關的各種挑戰。

So I think the early launches will be a couple of things.

所以我認為早期發布將是幾件事。

It will be engaging with sites that have a long-term commitment to clinical progress, data collection that's associated with that clinical progress.

它將與長期致力於臨床進展、與臨床進展相關的數據收集的網站合作。

Stabilizing supply chains for these kinds of technologies is nontrivial.

穩定這些技術的供應鏈並非易事。

It's hard and it's important.

這很難，也很重要。

And so we will do that for ION for sure.

所以我們肯定會為 ION 這樣做。

And stable supply chain allows you to support a larger customer base and also get your costs in line.

穩定的供應鏈使您能夠支持更大的客戶群，並使您的成本保持一致。

And so that is routinely an exercise we need to do.

因此，這通常是我們需要做的一項練習。

And then building your technology training pipelines and the partnering networks that are required to really expand launch.

然後建立真正擴大發布所需的技術培訓渠道和合作網絡。

So those things are all in front of us in terms of ION.

所以這些東西在ION方面都是擺在我們面前的。

That's the challenge.

這就是挑戰。

The good news is that we have a history of engaging those challenges, and I think we'll work it through.

好消息是我們有應對這些挑戰的歷史，我認為我們會克服這些挑戰。

And I missed the second part of the question.

我錯過了問題的第二部分。

And then who's the salesforce?

然後誰是銷售人員？

Will it be the existing salesforce or we have to build out a completely new salesforce?

是現有的銷售人員還是我們必須建立一個全新的銷售人員？

And just how will that look?

那看起來怎麼樣？

Yes.

是的。

We have a small specialty team within our existing force right now that's deeply trained in this space and linked to our other key account leadership and management.

我們現有的團隊中有一個小型專業團隊，他們在這個領域接受過深入的培訓，並與我們的其他關鍵客戶領導和管理人員聯繫在一起。

So they are deep where they need to be and connected where they need to be.

因此，他們深入他們需要去的地方，並在他們需要去的地方建立聯繫。

Okay.

好的。

And then as a follow-up, separately, could you provide an update on some of the opportunities to enhance Intuitive's vision and informatics portfolio?

然後作為後續行動，您能否單獨提供有關增強 Intuitive 願景和信息學產品組合的一些機會的最新信息？

And specifically, could you touch on the recent InTouch Health agreement and where the company is at with its augmented reality technology?

具體來說，您能否談談最近的 InTouch Health 協議以及公司在增強現實技術方面的進展？

Sure.

當然。

On -- as we've said before, for the last several years, we've increased our investments in imaging.

關於 - 正如我們之前所說，在過去幾年中，我們增加了對成像的投資。

I think imaging is important.

我認為成像很重要。

I think it can really help change outcomes and we do that routinely.

我認為它真的可以幫助改變結果，我們經常這樣做。

We do it in the image sensors, in the endoscopes.

我們在內窺鏡中的圖像傳感器中這樣做。

We do it in the software that we use to process those images and the way we tune images.

我們用我們用來處理這些圖像的軟件和我們調整圖像的方式來做到這一點。

We do it in our displays and our user interface.

我們在我們的顯示器和用戶界面中這樣做。

We are investing in molecules to expand our Firefly platform, as you know.

如您所知，我們正在投資分子以擴展我們的 Firefly 平台。

Molecules are just a way to increase the signal to noise for surgeons to detect structures they care about.

分子只是一種增加外科醫生檢測他們關心的結構的信噪比的方法。

Whether they are things they want to take out or things they want to leave in and not disturb.

無論是他們想帶走的東西還是他們想留在裡面不打擾的東西。

Informatics works hand-in-hand with that, certainly in OR informatics.

信息學與此密切相關，當然是在 OR 信息學中。

So we have built cloud capabilities over the years.

因此，我們多年來構建了雲功能。

As you know, we've been in Internet of Things for surgical robots for a decade now.

如您所知，我們在手術機器人物聯網領域已有十年了。

Over 90% of our systems are Internet connected.

我們 90% 以上的系統都連接到互聯網。

So we have Big Data capabilities that we built and we'll continue to build that allows us to do off-line informatic processing.

因此，我們擁有我們構建的大數據功能，我們將繼續構建使我們能夠進行離線信息處理的功能。

And increasingly, we can use machine learning techniques and other things to do real-time capabilities.

而且，我們可以越來越多地使用機器學習技術和其他東西來實現實時功能。

And of course, over time, that will give us the opportunity to do mixed reality or augmented reality features.

當然，隨著時間的推移，這將使我們有機會進行混合現實或增強現實功能。

How fast they come and where the first markets are, we're not prepared to discuss yet.

它們來得有多快，第一個市場在哪裡，我們還不准備討論。

I think it's interesting in the long term pathway.

我認為從長遠來看這很有趣。

And so that's a step in that direction.

所以這是朝著這個方向邁出的一步。

We've known InTouch and have worked with them together for many years and this was just a deepening of that relationship and the ability for us to build some real strength internally to Intuitive as we accelerate our cloud capability.

我們認識 InTouch 並與他們一起工作多年，這只是這種關係的深化，以及我們在加速雲功能時在 Intuitive 內部建立一些真正實力的能力。

And our next question will come from Bob Hopkins with Bank of America.

我們的下一個問題將來自美國銀行的鮑勃霍普金斯。

I just wanted to ask a question on ION and flex catheter lung.

我只是想問一個關於 ION 和彎曲導管肺的問題。

Gary, how long will it take following the approval of the product to generate the kind of efficacy data that you need to really drive broad adoption of the therapy?

Gary，產品獲得批准後需要多長時間才能生成真正推動該療法廣泛採用所需的療效數據？

Good question.

好問題。

I don't really know the answer right now.

我現在真的不知道答案。

I think we'll get some early data that will be out of a few sites, that will be quarters, not years.

我認為我們會從一些站點獲得一些早期數據，這些數據將是季度而不是年。

There are multicenter studies that integrate that up and go through peer review cycle, of course, will be years not quarters.

有一些多中心研究將其整合起來並通過同行評審週期，當然，這將是幾年而不是幾個季度。

So I think you will see, as we have in the past, increasing cadence of publication just depending a little bit on what the complexity is of the process.

所以我想你會看到，正如我們過去所做的那樣，增加發布的節奏只是在一定程度上取決於流程的複雜性。

And then if demand for Sp is really high.

然後如果對 Sp 的需求真的很高。

Do you have the capacity to meet that demand?

你有能力滿足這種需求嗎？

I mean, I know you want to go slow and focus on the long term.

我的意思是，我知道您想放慢腳步並著眼於長期。

But if demand is high, can you meet it?

但是如果要求很高，你能滿足嗎？

Yes, I think the focus upfront is 2 things.

是的，我認為預先關注的重點是兩件事。

One, it's to work on expanded indication site.

一，它是在擴展的適應症網站上工作。

As you know, Sp is a platform technology from our point of view.

如您所知，從我們的角度來看，Sp 是一種平台技術。

We have the first set of indications in urology.

我們擁有泌尿外科的第一套適應症。

We've submitted for the second set in transoral robotic surgery.

我們已經提交了第二套經口機器人手術。

We think there are other indications that will be important.

我們認為還有其他重要的跡象。

So the first thing is to really make sure that we're putting systems out that will help us develop those indications over time.

因此，第一件事是真正確保我們推出的系統能夠幫助我們隨著時間的推移開發這些適應症。

So that is important to us.

所以這對我們很重要。

Second thing is that Sp is amongst the most sophisticated products I've ever been personally associated with, certainly that Intuitive has brought to market.

第二件事是 Sp 是我個人接觸過的最複雜的產品之一，當然 Intuitive 已將其推向市場。

And making sure that we really understand and well characterize what our technologies are and we have a really good stable supply chain before we go abroad is really important to us.

確保我們真正了解並很好地描述我們的技術是什麼，並且在我們出國之前我們擁有一個非常穩定的供應鏈，這對我們來說非常重要。

My enthusiasm over the long term and the customer enthusiasm for its capabilities is very good, but I think we'll be measured in this next set of quarters.

從長遠來看，我的熱情和客戶對其功能的熱情非常好，但我認為我們將在下一組季度進行衡量。

As indications come and as our confidence builds, then, of course, we can always accelerate supply chain capacity but we're going to take it in steps.

隨著跡象的出現和我們信心的建立，當然，我們總是可以加快供應鏈能力，但我們將逐步採取行動。

And our next question will come from David Lewis with Morgan Stanley.

我們的下一個問題將來自摩根士丹利的大衛劉易斯。

The suspense was killing me.

懸念要了我的命。

I don't know that my question will live up to the suspense.

我不知道我的問題會不會辜負懸念。

This is terrible.

這很糟糕。

But Calvin had mentioned in the prepared remarks the systems moderation in the fourth quarter.

但卡爾文在準備好的評論中提到了第四季度的系統節制。

Just is there anything fundamental behind that other than just harder comps and obviously, the increased implications of higher leases?

除了更難的補償和顯然更高的租約的增加影響之外，這背後還有什麼根本性的嗎？

Yes, I think it's really -- I mentioned comparisons in the prepared remarks.

是的，我認為這是真的——我在準備好的評論中提到了比較。

We actually kind of crossed over that 30% growth in placements threshold last Q4.

實際上，我們在去年第四季度的安置門檻上超過了 30%。

And so now, this is the first quarter we're comparing against that kind of comparison.

所以現在，這是我們與這種比較進行比較的第一季度。

And so it just is a little tougher.

所以它只是有點困難。

But like I said, we still expect a seasonally strong fourth quarter.

但正如我所說，我們仍然預計第四季度會出現季節性強勁。

And Gary, just -- you got a lot a questions on this call on Sp and ION.

加里，你在 Sp 和 ION 的這次電話會議上有很多問題。

I wondered just -- a lot of investors are focused on these platforms.

我只是想知道——很多投資者都關注這些平台。

From a commercial perspective, if I compare Sp and ION, which one is going to require greater channel development?

從商業的角度來看，如果我比較 Sp 和 ION，哪一個需要更大的渠道發展？

And how would you compare the near and long-term opportunity for system placements and revenue across these 2 systems?

您如何比較這兩個系統的系統佈局和收入的近期和長期機會？

As I think about it, Sp is a more familiar customer base.

在我看來，Sp是一個更熟悉的客戶群。

I think it has really interesting core clinical capability, which is the ability to work in small spaces and parallel access.

我認為它具有非常有趣的核心臨床能力，即在狹小空間內工作和並行訪問的能力。

And I have been pleased with surgeon response, which has been -- now that I have a raw capability like this, there are some different approaches that may be available to us and they're interested in developing the data that helps that.

我對外科醫生的反應很滿意，這一直是——既然我有這樣的原始能力，我們可以使用一些不同的方法，他們有興趣開發有助於實現這一目標的數據。

But I think that, that's -- our visibility on that is probably a little better because we know the customer base quite well.

但我認為，那是——我們對此的可見性可能更好一些，因為我們非常了解客戶群。

As you look at ION, I think ION, first, is a diagnostic initial application that will have a little bit different set of dynamics for us as a company over time.

當你看 ION 時，我認為 ION 首先是一個診斷性的初始應用程序，隨著時間的推移，它對我們公司來說會有一些不同的動態。

I think the platform itself will have long legs.

我認為平臺本身就會有長腿。

If you think about the ability to navigate tortuous pathways and inspect things using preoperative images, which is kind of the core technology underneath.

如果您考慮使用術前圖像導航曲折路徑和檢查事物的能力，這是底層的核心技術。

There are a lot of things that in the body could be interesting there.

身體裡有很多東西可能很有趣。

But it will take some time to develop it.

但是開發它需要一些時間。

And given that those are a different set of procedures that are different call points for us, that will take more development for us and frankly, for the competitors in the space as that develops out.

鑑於這些是一套不同的程序，對我們來說是不同的呼叫點，這將需要更多的發展，坦率地說，隨著發展，對於該領域的競爭對手來說也是如此。

So that's a more nascent market.

所以這是一個更新生的市場。

I think very interesting and long-term possibility.

我認為非常有趣和長期的可能性。

You kind of asked how big are the total available markets for these 2 different things and how do we think about future market capacity.

你有點問這兩個不同事物的可用市場總量有多大，我們如何看待未來的市場容量。

Those are highly uncertain.

這些都是高度不確定的。

We, of course, have models on them.

當然，我們有他們的模型。

We look at them.

我們看著他們。

But as you know, with us, for years here that capability ultimately determines the total opportunity in the market.

但正如您所知，在我們這裡，多年來，這種能力最終決定了市場上的全部機會。

And as capability is established with these things, we'll know better.

隨著這些東西的能力建立起來，我們會知道得更多。

As we get a little experience with them, we'll start to share with you our thoughts as the uncertainty starts to come down a little bit.

隨著我們對他們有了一些經驗，隨著不確定性開始一點點下降，我們將開始與您分享我們的想法。

Our next question will come from the line of Larry Keusch with Raymond James.

我們的下一個問題將來自 Larry Keusch 和 Raymond James 的台詞。

Gary, just wanted to see if there are any observations or learnings from China over the last 3 months since the 2Q call?

加里，只是想看看自第二季度電話會議以來的過去 3 個月中，中國是否有任何觀察或經驗教訓？

Generally, no big change.

一般不會有太大的變化。

As we've said before, we think demand in China for our products is real and we're excited about it, and we think the long-term opportunity there is great.

正如我們之前所說，我們認為中國對我們產品的需求是真實的，我們對此感到興奮，我們認為那裡的長期機會很大。

We think the macro trade environment is pressured.

我們認為宏觀貿易環境承壓。

And we think that, that pressure does not help us.

我們認為，這種壓力對我們沒有幫助。

And so incrementally, a little more headwinds on the micro side at the -- on the ground side, we continue to make incremental progress and we keep working within the environment we have to work.

因此，在地面方面，微觀方面的阻力越來越大，我們繼續取得漸進式進展，我們繼續在我們必須工作的環境中工作。

So I take it not a whole lot more visibility on just the process and the quota itself?

所以我認為它不是只對流程和配額本身有更多的了解嗎？

Correct.

正確的。

Okay.

好的。

And then secondly, I know you, obviously, choose your words carefully in the prepared comments and I think in the part around the 60-millimeter stapler, you indicated that the sort of initial feedback was encouraging.

其次，我知道你，顯然，在準備好的評論中仔細選擇你的話，我認為在 60 毫米訂書機的部分，你表示最初的反饋是令人鼓舞的。

And I guess, as I listen to that, I was wondering if that is meaning that, look, this is getting out there and people are starting to use it.

我想，當我聽到它時，我想知道這是否意味著，看，這已經開始，人們開始使用它了。

And it will take some time until you built the capabilities to get it out there to drive more demand.

並且需要一些時間才能構建出將其推向市場以推動更多需求的能力。

Or does encouraging mean that perhaps you're seeing some things where you may actually need to tweak it a little bit before it's really ready for, if you will, prime time in 2019?

還是令人鼓舞的意思是，也許你看到了一些你可能需要稍微調整一下才能真正準備好迎接 2019 年黃金時段的事情？

I -- in terms of customer response has been quite good.

我——就客戶反應而言一直相當不錯。

The things that were -- if you ask -- another way to answer your question is, what's pacing launch?

如果你問的話 - 另一種回答你問題的方法是，什麼是節奏發布？

And there are really 2 things that are pacing this.

確實有兩件事在推動這一切。

One is staplers are sophisticated devices to make and you want to make sure that as you expand your supply capacity that you're doing it at a very high-quality level, so we're doing that.

一是訂書機是製造複雜的設備，您希望確保在擴大供應能力時以非常高質量的水平進行生產，所以我們正在這樣做。

The second one is that we don't want to overwhelm our salesforce with enormous amounts of new and different products simultaneously.

第二個是我們不想同時用大量的新產品和不同的產品壓垮我們的銷售隊伍。

We want to give them time to be deep and be able to address customer interest and demand as it happens.

我們希望給他們時間深入研究，並能夠在發生時解決客戶的興趣和需求。

Those are really the 2 pacing items.

這些確實是兩個起搏項目。

We have a question from the line of Richard Newitter with Leerink Partners.

我們有來自 Leerink Partners 的 Richard Newitter 的問題。

I -- just in light of the operating expense growth coming in a little bit lighter than what you were forecasting, a little more operating leverage this year, clearly.

我——鑑於營業費用的增長比你預測的要輕一點，今年的營業槓桿明顯增加了一點。

I was wondering if you could offer some thoughts on maybe some of those projects you say were getting deferred or it's a timing issue and maybe some color on how we should be thinking about operating leverage potential in '19 with respect to spending.

我想知道你是否可以就你所說的一些項目被推遲或者這是一個時間問題提出一些想法，也許我們應該如何考慮 19 年在支出方面的運營槓桿潛力的一些顏色。

Sure.

當然。

My preference would have been that we had spent our full allotment now rather than underspent.

我的偏好是我們現在已經用完了全部撥款而不是未用完。

On the other hand, I'd rather spend it wisely, spend it because I have it.

另一方面，我寧願明智地花錢，花錢是因為我擁有它。

Most of the spending has to do with human capital, bringing on staff, and we're doing well.

大部分支出都與人力資本、招聘員工有關，我們做得很好。

But there's kind of a natural rate for bringing on staff.

但是，聘用員工有一種自然的速度。

And we'll do it where we are bringing on outstanding people and integrating them well.

我們在培養優秀人才並很好地整合他們的地方這樣做。

It's not so much a specific product or project that is impacted and it's not so much a prototype dollar has just rolled from one spot to another.

與其說是一個特定的產品或項目受到影響，不如說是原型美元剛剛從一個地方滾到另一個地方。

There's a little bit of that but that isn't the dominant effect.

有一點，但這不是主要影響。

The dominant effect is really modulating the growth of headcount, and that has to do with pipelines for bringing in talent.

主導效應實際上是在調節員工人數的增長，而這與引進人才的渠道有關。

You asked a little bit of what does that imply for '19 and as we said in our prepared remarks, we're seeing a good procedure momentum in the marketplace and good demand.

你問了一點這對 19 意味著什麼，正如我們在準備好的評論中所說，我們看到市場上的程序勢頭良好，需求良好。

And we want to make sure that we're able to meet that demand at high-quality, and we are not setting ourselves up to try to drive leverage in the '19 model.

我們希望確保我們能夠高質量地滿足這一需求，並且我們不會讓自己試圖在 19 年的模型中提高槓桿率。

Now we haven't finished all of that, and we'll do our spending models for '19 at the end of the next call.

現在我們還沒有完成所有這些，我們將在下一次電話會議結束時制定 19 年的支出模型。

But directionally speaking, we want to make sure we can satisfy market demand here.

但是從方向上來說，我們要確保我們能夠滿足這裡的市場需求。

Okay.

好的。

And just following up on one comment you made earlier.

只是跟進你之前發表的一條評論。

You said China, as expected, without increased capacity, is moderating, the growth in China continues to moderate.

你說中國正如預期的那樣，在沒有增加產能的情況下正在放緩，中國的增長繼續放緩。

I'm just curious if you can characterize kind of the pace of moderation in growth that you're seeing there relative to kind of what you would have expected.

我只是很好奇你是否可以描述你在那裡看到的相對於你所期望的那種增長的緩和速度。

Is it not slowing as fast as you would have thought?

它沒有像您想像的那樣減速嗎？

Or is it in line with your expectations?

還是符合你的預期？

Maybe just a little color there so we can think about kind of how much of a headwind that might present going forward.

也許那裡只有一點顏色，這樣我們就可以考慮未來可能出現的逆風有多大。

We continue to make progress on utilization on the systems that are in China.

我們繼續在中國系統的利用方面取得進展。

Last quarter, we talked about the China growth rate and procedures being fairly in line with the overall OUS growth rate, in the low 20s.

上個季度，我們談到了中國的增長率和程序與 OUS 的整體增長率相當一致，處於 20 多歲左右。

We're at a stage now where the moderation is at a moderate pace, if you will.

如果您願意，我們現在正處於適度節制的階段。

And so you're gradually moving down from there.

所以你逐漸從那裡向下移動。

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

我們的下一個問題將來自高盛的 Isaac Ro。

Two questions, one on equipment and one on investment in the business.

兩個問題，一個關於設備，一個關於業務投資。

On the first one, I was just curious with the Xi upgrade cycle, if you could maybe qualify where you think we are in that process.

關於第一個，我只是對 Xi 升級週期感到好奇，你是否可以確定你認為我們在那個過程中所處的位置。

You said to us you have still a fair amount of opportunity.

你對我們說你還有很多機會。

And then secondly, on the expense side, Gary, you mentioned, a little bit about the opportunity for training and I think of that as a bit of a competitive advantage for you guys.

其次，在費用方面，加里，你提到了一點關於培訓的機會，我認為這對你們來說是一種競爭優勢。

And so if you could maybe contrast how you think training for your pipeline will evolve not only for new applications but also globally as you expand to other countries where -- like where practice is different.

因此，如果你可以對比一下你認為你的管道培訓將如何發展，不僅針對新的應用程序，而且隨著你擴展到其他國家——比如實踐不同的國家——而在全球範圍內發展。

I'd be interested in sort of some of the things you're doing on the training side.

我會對您在培訓方面所做的一些事情感興趣。

Sure.

當然。

On the Xi upgrade cycle, or the generation 4 upgrade cycle, just roughly speaking, I don't know how many SIs are out in the world but give or take.

關於 Xi 升級週期，或第 4 代升級週期，只是粗略地說，我不知道世界上有多少 SI，但給予或接受。

2,500.

2,500。

So we -- I don't know exactly what I'd say when it is we're done, but there's an installed base of Xi, over 2,000, that's an opportunity for us as we go forward.

所以我們 - 我不知道當我們完成時我會說什麼，但是 Xi 的安裝基數超過 2,000，這對我們來說是一個前進的機會。

I think your -- the implication behind your training question is exactly right.

我認為你的 - 你的培訓問題背後的含義是完全正確的。

Building training capability is heavy lifting.

培養培訓能力是一項繁重的工作。

It's a combination of human capital, people who are good at training and what that looks like, a set of processes to build that are valid and you have validated and then proctoring networks.

它是人力資本、擅長培訓的人以及看起來像什麼的組合，要建立一套有效的流程，你已經驗證了網絡，然後是監督網絡。

And proctoring networks are your customers, our customers who are deeply experienced and have teaching capability and willing to teach others.

監考網絡是您的客戶，我們的客戶經驗豐富，具有教學能力並願意教別人。

And so we developed those things.

所以我們開發了那些東西。

We have built a set of tools internally that will allow us to gain some efficiency in being able to spread that capability into new markets.

我們已經在內部構建了一套工具，使我們能夠在將這種能力傳播到新市場方面獲得一定的效率。

And so that helps us.

這對我們有幫助。

And we think that doing that well and doing that efficiently is something that has worked for the investment and we have done so.

我們認為，做好並有效地做到這一點是對投資有用的事情，我們已經這樣做了。

What is its long-term competitive advantage?

它的長期競爭優勢是什麼？

I don't know exactly, but I believe it's important for our customer and therefore, important for the company.

我不太清楚，但我相信這對我們的客戶很重要，因此對公司也很重要。

Perhaps, just one last question and then we'll close here.

也許，只有最後一個問題，然後我們就會在這裡結束。

So our last question will come from Vijay Kumar with Evercore.

所以我們的最後一個問題將來自 Evercore 的 Vijay Kumar。

Really impressive procedure number.

真正令人印象深刻的程序編號。

So maybe, Gary or Marshall, just starting on the procedure number.

所以也許，加里或馬歇爾，只是從程序編號開始。

The guidance is '18, right?

指南是'18，對嗎？

So when you think about next year, number of factors at play, just how do you think the procedure number is going to look like?

所以當你考慮明年的時候，有很多因素在起作用，你認為手術數量會是什麼樣子？

Should we be thinking of a really strong number?

我們應該考慮一個非常強大的數字嗎？

You made some comments on hernia.

你對疝氣做了一些評論。

We're still at the very early stages of this hernia pickup.

我們仍處於疝氣拾取的早期階段。

You have a couple of new products coming in.

你有幾個新產品進來了。

So I'm just curious on how that number should trade in.

所以我只是好奇這個數字應該如何交易。

Just given lease, it looks like lease -- the percentage of lease is going to increase next year, right?

就租約而言，它看起來像租約——明年租約的百分比會增加，對嗎？

So when we're thinking about modeling revenues for next year, if you could just explain the procedure, how we should think about it, I think that would be extremely helpful.

因此，當我們考慮為明年的收入建模時，如果你能解釋一下程序，我們應該如何考慮它，我認為這將非常有幫助。

Vijay, it's Calvin.

維杰，是卡爾文。

Obviously, we'll give our specific procedure guidance on our next call in January.

顯然，我們將在 1 月份的下一次電話會議上提供具體的程序指導。

But we do anticipate the drivers of procedure growth in 2019 to be fairly consistent with what we saw this year in 2018 and last year in 2017, namely U.S. general surgery, U.S. thoracic surgery and OUS procedures, broadly speaking, driving the lion's share of growth.

但我們確實預計 2019 年程序增長的驅動因素與我們在 2018 年和去年 2017 年看到的情況相當一致，即美國普通外科、美國胸外科和 OUS 程序，從廣義上講，推動增長的最大份額.

U.S. general surgery is now our largest specialty, yet, as we were describing, we're in still fairly early stages for hernia repair, ventral and inguinal, colorectal procedures as well.

美國普通外科現在是我們最大的專業，然而，正如我們所描述的，我們在疝氣修復、腹側和腹股溝、結直腸手術方面仍處於相當早的階段。

And even earlier stages for some of the broader practice-based procedures.

甚至是一些更廣泛的基於實踐的程序的早期階段。

On the OUS side, we're investing in growth in larger European countries.

在 OUS 方面，我們正在投資於更大的歐洲國家的增長。

Japan, China, Korea, OUS driving growth.

日本、中國、韓國、OUS 推動增長。

And when we talk about what can lead to some of the variability and the potential range of growth, it would be, obviously, the pace and breadth of that U.S. general surgery growth, U.S. mature procedure trends, any change in the China systems quota, positive or negative.

當我們談論什麼會導致一些變化和潛在的增長范圍時，顯然是美國普通外科增長的速度和廣度、美國成熟的程序趨勢、中國系統配額的任何變化，正面或負面。

And then in Japan, the pace of adoption on the 12 new reimbursement procedures.

然後在日本，採用了 12 種新的報銷程序。

All right.

好的。

Well, thanks, Calvin.

好吧，謝謝，卡爾文。

Thanks, Vijay.

謝謝，維杰。

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

我們建立我們的公司是為了超越人手的極限進行手術，我向你保證，我們仍然致力於推動一些真正有所作為的事情。

This concludes today's call.

今天的電話會議到此結束。

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

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 to you again in 3 months.

我們期待在 3 個月後再次與您交談。

Ladies and gentlemen, that does conclude our conference for today.

女士們，先生們，我們今天的會議到此結束。

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

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

You may now disconnect.

您現在可以斷開連接。