直覺手術 (ISRG) 2018 Q3 法說會逐字稿

And ladies and gentlemen, thank you for standing by. Welcome to the Initiative (sic) [Intuitive] Surgical Third Quarter 2018 Earnings Release Conference Call. (Operator Instructions) As a reminder, this conference is being recorded.

女士們、先生們，感謝你們的耐心等待。歡迎參加[Intuitive] Surgical 2018 年第三季收益發布電話會議。（操作說明）提醒各位，本次會議正在錄音。

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

現在，我謹將會議交給我們的東道主，直覺外科公司財務投資者關係高級總監卡爾文·達林先生。請繼續。

Thank you. Good afternoon, and welcome to Intuitive Surgical's Third 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三季財報電話會議。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 July 20, 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 7 月 20 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 intuitive.com on the Latest Events section, under our Investor Relations page. In addition, today's press release and supplementary financial data tables have been posted to our website.

請注意，本次電話會議的音訊回放可在我們網站intuitive.com的「最新動態」欄位下的「投資者關係」頁面中找到。此外，今天的新聞稿和補充財務數據表已發佈在我們的網站上。

Today's format will consist of providing you with highlights of our third quarter results as described in our press release announced earlier today, followed by a question-and-answer session.

今天的會議形式將包括：首先向您介紹我們今天早些時候發布的新聞稿中所述的第三季度業績亮點，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 third 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。馬歇爾將對我們第三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 will 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. The third quarter of 2018 was a strong one for Intuitive with continued clinical adoption of our products and positive steps in product launches. 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. 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.

下午好，感謝各位今天參加我們的電話會議。2018 年第三季對於 Intuitive 來說是強勁的一年，我們的產品在臨床上持續得到應用，產品發布也取得了積極的進展。正如我們上個季度所提到的，我們認為達文西手術系統在美國普通外科手術中的接受度，以及國際上對我們第四代平台的認可，支撐了我們近期的業績。本季度，我們的團隊向市場推出了先進的新產品，以期推進我們提高手術品質和降低手術變異性的目標。

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.

2018 年第三季全球手術量較 2017 年第三季成長約 20%，較第二季成長率略有成長。

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

今年上半年的趨勢仍在繼續，美國在疝氣修補術、結直腸手術和與實踐相關的普通外科手術（包括膽囊切除術）方面表現尤為強勁。本季度，美國成熟手術（包括攝護腺切除術和子宮切除術）的成長依然穩健。

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. 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.

在日本，業務量年增超過 40%，同時我們的團隊正在招募面向客戶的員工並優化培訓後勤，以支持市場成長。本季歐洲手術量表現總體上再次符合我們的預期，其中英國表現尤為強勁。 Calvin 將在稍後的電話會議中更詳細地回顧手術趨勢。

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. Net of trade-ins and retirements, our da Vinci installed base grew to 13% over Q3 2017. The mix of system placements between our flagship Xi System and our value X System aligned with our strategy regionally. Capital placements have been historically lumpy and we anticipate variability in placements going forward.

第三季我們的資本配置表現強勁，總配置量較 2017 年第三季成長 37%，從 169 增至 231。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 年第三季增加了 13%。我們的旗艦產品 Xi 系統和經濟型 X 系統之間的系統部署組合符合我們在區域內的策略。歷史上，資本配置一直波動較大，我們預期未來配置狀況仍將有波動。

As we indicated on prior calls, we are seeing increased customer interest in alternative capital acquisition approaches, including leasing and usage-based models. This quarter, the proportion of new systems placed under lease increased over prior quarters. We believe that it is in both our customers' interest and Intuitive's to offer alternative financing models for qualified hospitals. We have expanded these programs accordingly.

正如我們在先前的電話會議中指出的那樣，我們看到客戶對替代資本取得方式的興趣日益濃厚，包括租賃和按使用量計費的模式。本季度，新租賃系統的比例較前幾個季度增加。我們認為，為符合條件的醫院提供替代融資模式，既符合我們客戶的利益，也符合 Intuitive 的利益。我們已相應地擴展了這些項目。

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

在投資方面，我們正在建立我們的組織並進行投資，以深化我們的技術和區域能力。本季固定成本支出略低於我們的計劃，主要是由於時間安排問題，我們預計這些問題將在未來幾季得到解決。

Use of our products has increased over the past year and we are in the early stages of several important product launches. Speaking directionally, we are investing to drive technology strength and to build operating and supply capability in support of our future growth.

過去一年，我們產品的使用量增加，目前我們正處於幾個重要產品上市的早期階段。從方向上看，我們正在投資以增強技術實力，並建立營運和供應能力，以支持我們未來的成長。

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

我們第三季度的財務亮點如下：本季度營收為9.21億美元，增長14%；按備考基準計算的毛利率為71.5%，而去年同期為71.8%；儀器及配件收入增長至4.86億美元，增長21%；本季度經常性收入總額為6.6億美元，佔總收入的72%；本季以備考基準計算的營業利潤為3.91億美元，較去年同期增長12%；按備考基準計算的淨利潤為3.37億美元，增長4%，營業利潤與淨利潤增長率的差異主要源於2017年第三季度的一次性稅收優惠。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 and the professionals who treat them.

實質技術改進和服務提升是外科手術持續進步的核心。我們衡量創新的標準是：創新能否對客戶的實際治療效果產生正面影響，能否高效利用，降低每次治療的總成本，以及創新能否對外科患者和治療他們的專業人員的體驗產生積極影響。

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. 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. We shipped 3 da Vinci SP Surgical Systems in the quarter all in the United States. These first access sites will focus on clinical data generation and customer feedback.

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性方法。今年第二季度，我們的達文西 SP 手術系統獲得了 FDA 批准，可用於泌尿外科手術；本季度，我們提交了 SP 經口手術的 510(k) 申請。本季我們共出貨 3 台達文西 SP 手術系統，全部銷往美國。首批造訪站點將專注於臨床數據產生和客戶回饋。

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

外科醫生和團隊對首批病例的回饋非常令人鼓舞。也就是說，我們目前還處於 Sp 多年發展路徑的早期階段，我們的重點是滿足早期客戶的需求，擴大臨床適應症，改進我們的流程和技術，並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. As we announced last month, we submitted our 510(k) for its first indication. We showcased our ION system at the CHEST conference this month. Feedback from physicians relative to existing and recently announced alternatives has been strongly supportive of our efforts. Our team is focused on working towards clearance in readying the product for its first phase of launch.

我們的團隊正在推動 ION 的規劃，ION 是我們開發的靈活機器人平台，最初的目標是解決肺癌的迫切需求和診斷問題。肺癌是世界上診斷率最高、致死率最高的癌症之一，早期發現尤其重要。正如我們上個月宣布的那樣，我們提交了 510(k) 申請，用於首次適應症研究。本月我們在 CHEST 會議上展示了我們的 ION 系統。醫生們對現有和最近公佈的替代方案的回饋意見，對我們的努力給予了強有力的支持。我們的團隊正全力以赴爭取審批，為產品的第一階段上市做好準備。

We also initiated our early launch of our SureForm 60-millimeter stapler for use with our fourth generation systems this summer. Customer feedback has been encouraging at these early sites with hundreds of procedures performed today. The SureForm 60 brings the surgeons class-leading articulation and precision with computer-measured and controlled staple firing. 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. Our Vessel Sealer Extend launched in Q2 this year and our force bipolar instrument launched in Q3. Feedback on these instruments has been outstanding. We anticipate expanding our rollout of SureForm 60 in 2019, broadening the set of tools available to general surgeons on our fourth-generation platform.

今年夏天，我們也提前推出了 SureForm 60 毫米訂書機，用於我們的第四代系統。在這些早期試點地區，客戶回饋令人鼓舞，今天已經進行了數百例手術。SureForm 60 為外科醫生帶來一流的靈活性和精確度，並採用電腦測量和控制的釘合裝置進行擊發。我們的 SureForm 60 毫米吻合器接頭、我們的強力雙極抓鉗和 Vessel Sealer Extend 先進能量器械共同為普通外科醫生提供了一套優化的工具，尤其適用於疝氣、減肥和結直腸手術。我們的 Vessel Sealer Extend 於今年第二季推出，我們的力雙極儀器於第三季推出。這些樂器的回饋非常出色。我們預計將在 2019 年擴大 SureForm 60 的推廣範圍，擴大我們第四代平台上一般外科醫師可用的工具組。

For the balance of 2018, our focus remains in completing the tasks we set for ourselves. First, continued adoption of da Vinci in general surgery. Second, continued development of European markets and access to customers in Asia. Third, advancing our new platforms, imaging, advanced instruments, da Vinci SP and our ION platform. And finally, support for additional clinical and economic validation by global region.

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，達文西手術系統在一般外科手術中繼續被應用。第二，繼續開拓歐洲市場並接觸亞洲客戶。第三，推進我們的新平台、成像、先進儀器、達文西 SP 和我們的 ION 平台。最後，支援按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.

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 or pro forma basis. Our results are also posted to our website. 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.

午安.我將分別按 GAAP 和非 GAAP 或備考基準，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。2018 年第三季營收為 9.21 億美元，較 2017 年第三季營收 8.08 億美元成長 14%，比第二季營收 9.09 億美元成長 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. Excluding the $21 million, revenue grew 17%.

2017 年第三季營收包括 2,100 萬美元，這筆款項此前因公司向 2017 年第一季部分客戶提供的客戶以舊換新計畫而被遞延。剔除 2,100 萬美元後，營收成長了 17%。

Third quarter 2018 procedures increased approximately 20% compared with the third quarter of 2017, who were relatively flat compared with last quarter. Procedure growth continues to be driven by general surgery in the U.S. and urology worldwide. Calvin will review details of procedure growth later in this call.

2018 年第三季的手術量比 2017 年第三季增加了約 20%，而 2017 年第三季的手術量與上一季相比則基本持平。手術量的成長主要由美國的普通外科手術和全球的泌尿外科手術所推動。Calvin將在本次通話中稍後詳細介紹手術進展。

Instrument and accessory revenue of $486 million increased 21% compared with last year, which is higher than procedure growth, reflecting increased usage of our advanced instruments. 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. These increases primarily reflect increased advanced instrument usage and customer buying patterns.

儀器及配件收入為 4.86 億美元，比去年增長 21%，高於手術量增長，反映出我們先進儀器的使用量增加。每台手術的器械和配件收入約為 1900 美元，比 2017 年第三季成長 1%，比上一季成長約 3%。這些成長主要反映了先進儀器使用量的增加和客戶購買模式的轉變。

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，比 2017 年第三季度增長 5%，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 2017 年第三季度確認的 2100 萬美元先前遞延的系統收入、大量根據經營租賃安排安裝的系統以及略低的平均售價所抵消。

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. 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. 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.

2018 年第三季我們安裝了 231 套系統，而 2017 年第三季安裝了 169 套系統，上一季安裝了 220 套系統。本季完成了 58 筆經營租賃交易，佔總交易量的 25%，而 2017 年第三季完成了 20 筆，佔總交易量的 12%，上個季度完成了 44 筆，佔總交易量的 20%。我們為在市場中佔據有利地位的醫院提供融資替代方案，包括一些基於使用量的方案，因為我們相信這些替代方案符合客戶的目標，能夠更快地擴大市場。

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

截至 9 月 30 日，我們有 279 項經營租賃和按使用量計費的安排尚未到期，其未來收入流的淨現值約為 2.5 億美元。我們預期這類安排的比例會在長期內增加。

28% of current quarter system placements in bulk trade-ins reflecting customer desire to access or standardize on our fourth-generation technology. This is an increase compared with 26% in the third quarter of 2017, and lower than the 34% trade-in rate realized last quarter. Trade-in activity could be lumpy and difficult to predict.

本季系統安裝中有 28% 是透過批量以舊換新實現的，這反映出客戶希望獲得或採用我們的第四代技術。與 2017 年第三季的 26% 相比有所成長，但低於上季實現的 34% 的以舊換新率。以舊換新活動可能波動較大，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. 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. Three of the systems placed in the U.S. were Sp systems.

本季安裝的系統中，68% 為達文西 Xi 系統，28% 為達文西 X 系統；而上一季度，達文西 Xi 系統佔 72%，達文西 X 系統佔 21%。許多 X 系統已交付給歐洲對成本較為敏感的客戶以及日本的客戶，我們在今年 5 月獲得了日本的 X 系統認證。在美國安裝的三套系統中，有三套是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. 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. The changes compared with prior periods primarily reflects the mix of X Systems and trade-in transactions.

我們的達文西手術系統安裝量年增 13%，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 145 萬美元，而去年同期為 147 萬美元，上一季為 142 萬美元。與前期相比，這些變化主要反映了 X 系統和以舊換新交易的組合。

Outside of the U.S., results were as follows. 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. Compared with the prior year, instruments and accessories revenue increased $30 million or 34% and systems revenue decreased $5 million or 6%. The increase in instrument and accessory revenue relative to the prior year was primarily driven by procedure growth and customer buying pattern. 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. 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.

美國以外地區的結果如下。第三季美國以外的營收為 2.44 億美元，比 2017 年第三季成長 15%，比上一季下降 8%。與前一年相比，儀器和配件收入增加了 3,000 萬美元，增幅達 34%；系統收入減少了 500 萬美元，降幅達 6%。與前一年相比，儀器和配件收入的成長主要得益於手術量的成長和顧客購買模式的改變。系統收入下降的原因是經營租賃數量增加、反映產品組合的 ASP 下降以及以舊換新交易的影響。與上一季相比，OUS 收入的下降反映了季節性因素，主要原因是系統安裝數量減少、系統租賃交易數量增加以及手術量下降，但部分被客戶的 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. Outside U.S., we placed 75 systems in the third quarter compared with 62 in the third quarter of 2017 and 82 last quarter.

與 2017 年第三季相比，OUS 手術量增加了約 23%，與第二季相比下降了 1%。在美國以外，我們第三季安裝了 75 套系統，而 2017 年第三季為 62 套，上一季為 82 套。

Current quarter system placements included 30 into Europe and 30 into Japan. 36 of the 75 systems placed in the third quarter were X Systems. 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.

目前的季度分配方案包括30個職位分配到歐洲，30個職位分配到日本。第三季入選的 75 個系統中，有 36 個是 X Systems。由於一些美國以外的市場仍處於早期發展階段，一些市場具有很強的季節性，反映了預算週期或度假模式，而且一些市場的銷售受到政府法規的限制，因此美國以外地區的市場佈局仍將不穩定。

Moving on to the remainder of the P&L. The pro forma gross margin for the third quarter of 2018 was 71.5% compared with 71.8% for the third quarter of 2017 and 71.1% last quarter. The decrease compared with the third quarter of 2017 primarily reflects lower system ASPs partially offset by higher mix of I&A. The increase compared with last quarter, primarily reflects higher system ASPs and higher production levels. 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.

接下來來看損益表的其餘部分。2018 年第三季的備考毛利率為 71.5%，而 2017 年第三季為 71.8%，上一季為 71.1%。與 2017 年第三季相比，下降主要反映了系統 ASP 的降低，但部分被 I&A 佔比的提高所抵消。與上一季相比，成長主要反映了系統平均售價和生產水準的提高。未來的利潤率將根據我們新產品的組合、系統、儀器和配件收入的組合、系統平均售價以及我們進一步降低產品成本和提高生產效率的能力而波動。

Pro forma operating expenses increased 16% compared with the third quarter of 2017 and increased 4% compared with last quarter. Overall, our spending was below our annual guidance reflecting the timing of expenditure. We expect to continue to invest in key technologies and OUS market expansion and expect spending to increase next quarter and into 2019.

與 2017 年第三季相比，以備考計算的營運費用成長了 16%，與上一季相比成長了 4%。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。我們預計將繼續投資於關鍵技術和海外市場擴張，並預計下一季及2019年支出將會增加。

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

第三季的預期實際稅率為 18.5%，而我們先前的預期為 19.5% 至 20.5%。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。我們 2017 年第三季的模擬稅率為 9.7%，反映了與訴訟時效到期相關的 6,800 萬美元稅收優惠。

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. 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.

2018 年第三季淨收入為 3.37 億美元，即每股 2.83 美元，而 2017 年第三季淨收入為 3.25 億美元，即每股 2.78 美元，2018 年第二季淨收入為 3.27 億美元，即每股 2.76 美元。2017 年第三季淨收入受惠於 2,100 萬美元的遞延收入（扣除成本後）以及與訴訟時效到期相關的 6,800 萬美元稅收優惠，總計每股收益 0.68 美元。

I will now summarize our GAAP results. 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. The adjustments between pro forma and GAAP net income are outlined and quantified on our website. It included excess tax benefits associated with stock -- employee stock awards, employee equity and IP charges and legal settlements. Note that the IRS has not issued final tax regulations associated with 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.

現在我將總結一下我們的GAAP業績。2018 年第三季 GAAP 淨利為 2.93 億美元，即每股 2.45 美元；而 2017 年第三季 GAAP 淨利為 2.99 億美元，即每股 2.56 美元；2018 年第二季 GAAP 淨利為 2.55 億美元，即每股 2.15 美元。網站上列出了備考淨收入與GAAP淨收入之間的調整情況，並進行了量化說明。其中包括與股票相關的超額稅收優惠——員工股票獎勵、員工股權和智慧財產權費用以及法律和解。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，我們的結果和對未來稅率的預測所反映的美國減稅和就業法案的影響，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，可能會發生變化。

We ended the quarter with cash and investments of $4.6 billion compared with $4.3 billion at June 30, 2018. The increase generally reflects cash generated from operation. We did not repurchase any shares in the quarter and have approximately $718 million remaining under the board buyback authorization.

截至本季末，我們的現金和投資為 46 億美元，而 2018 年 6 月 30 日為 43 億美元。此成長通常反映了經營活動產生的現金流。本季我們沒有回購任何股票，根據董事會授權的回購計劃，我們還有大約 7.18 億美元的資金。

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

接下來，我將把發言權交給卡爾文，他將介紹流程、績效以及我們對 2018 年的展望。

Thank you, Marshall. Our overall third quarter procedure growth was 20% compared to 15% during the third quarter of 2017 and 18% last quarter. Our Q3 procedure growth was driven by 19% growth in U.S. procedures and 23% growth in OUS markets.

謝謝你，馬歇爾。我們第三季的整體手術量成長了 20%，而 2017 年第三季為 15%，上一季為 18%。第三季手術量成長主要得益於美國手術量成長 19% 和美國境外市場手術量成長 23%。

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，一般外科、婦科和泌尿外科的手術表現都超出預期，第三季這些最大類別的年成長率與第二季一樣略有上升。

Q3 procedure performance was again driven by growth in general surgery led by hernia repair and colorectal procedures. Hernia repair, both ventral and inguinal, continued to contribute the most incremental cases in the quarter. Cholecystectomy, bariatric and other practice-based general surgery procedures all had strong growth in the third quarter.

第三季手術量成長再次主要得益於一般外科手術的成長，其中疝氣修補術和大腸直腸手術尤為突出。本季度，腹股溝疝氣和腹股溝疝氣修補術仍然是新增病例最多的手術。第三季度，膽囊切除術、減肥手術和其他以診所為基礎的普通外科手術均實現了強勁增長。

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

在美國婦科領域，2018 年第三季年增率增至個位數中段，這主要得益於良性子宮切除術數量的增加。第三季度，我們繼續看到手術整合的良好趨勢，我們的達文西手術數據顯示，執業達文西外科醫生進行了更多達文西子宮切除術，而且越來越多的美國婦科手術是由專門從事複雜良性和癌症手術的高手術量醫生進行的。

Q3 U.S. urology procedures had growth rates consistent with 2017 and year-to-date 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 surgery market, which has benefited from recent macro trends.

第三季美國泌尿外科手術量與 2017 年和 2018 年年初至今的成長率一致，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手術市場的發展趨勢相符，而前列腺手術市場也受益於近期的宏觀趨勢。

In other U.S. procedures, adoption of lobectomies and other thoracic procedures was again solid during the third quarter. Our overall U.S. procedure growth rate likely benefited from a weaker Q3 2017 comparison.

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三季再次保持穩定。我們整體的美國手術量成長率可能受益於 2017 年第三季較低的年比基數。

Q3 OUS procedure growth trends were largely consistent with Q2. Third quarter OUS procedure volume grew approximately 23% compared to 23% for the third quarter of 2017 and 22% last quarter. 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.

第三季 OUS 手術量成長趨勢與第二季基本一致。第三季 OUS 手術量成長約 23%，與 2017 年第三季的 23% 和上一季的 22% 相比有所成長。2018 年第三季 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早期手術、一般外科手術和婦科手術量的成長。

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

隨著 4 月 1 日起新增 12 項獲準報銷的手術項目，日本的手術量再次加速成長。而中國的手術量成長在第三季再次放緩，因為達文西手術系統的產能擴張受到系統配額要求的限制，最近一次配額已於 2015 年底到期。在歐洲，手術效果因國家而異，但英國的效果一直很好。

Adoption of our products is ultimately based upon differentiated patient outcomes and procedure economics compared to alternative therapies. Intuitive supports the generation of high-quality clinical evidence through collaborative research initiatives. We work with clinicians, hospitals and medical and surgical societies to study da Vinci clinical outcomes while maintaining a patients-first mindset. Intuitive's currently supporting comparative multicenter studies for several key procedures, including hernia repair, lobectomy and right colectomy.

我們的產品最終能否被市場接受，取決於與替代療法相比，其在患者療效和手術經濟性方面是否存在差異。Intuitive 透過合作研究計畫支持高品質臨床證據的產生。我們與臨床醫生、醫院以及醫學和外科協會合作，研究達文西手術的臨床結果，同時堅持以病人為中心的理念。Intuitive 目前正在支持幾項關鍵手術的比較多中心研究，包括疝氣修補術、肺葉切除術和右半結腸切除術。

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. 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.

在疝氣修補術方面，我們正在支持一項前瞻性多中心比較研究，該研究評估了多達 900 名受試者接受開放式、腹腔鏡式和機器人輔助腹股溝疝氣和切口疝氣修補術的相關結果。本研究旨在收集術後長達 3 年的與疼痛、生活品質和復發相關的結果，透過直接電子或電話追蹤收集患者報告的結果。

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. Intracorporeal anastomosis by the robotic approach may be amenable to more surgeon skill sets than the laparoscopic counterpart. Indeed, the degree of difficulty of the sutured laparoscopic anastomosis has limited wide application of this approach.

我們正在支持一項針對右半結腸切除術的前瞻性比較研究，比較多達 300 名受試者的體外和體內吻合技術的結果，收集與患者生活品質參數相關的信息，包括但不限於胃腸道生活品質和切口疝發生率。與腹腔鏡手術相比，機器人輔助體內吻合術可能對外科醫生的技能要求更高。事實上，縫合式腹腔鏡吻合術的困難度限制了此方法的廣泛應用。

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

今年，肺癌是美國男性和女性癌症死亡的主要原因，肺癌手術採用開放式手術的比例從 2015 年的 43% 逐漸下降到 2017 年的 31%。支持以微創方法（包括胸腔鏡輔助手術和機器人輔助手術）進行肺葉切除的文獻越來越多，其中大部分都與早期肺癌的治療有關。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 名早期和局部晚期肺癌患者的短期和長期療效。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. Starting with procedures. On our last call, we forecast full year 2018 procedure growth within a range of 14.5% to 16.5%. We are now increasing our forecast and estimate full year 2018 procedure growth of 17% to 18%. In regards to Q4 system placements, consistent with historical patterns, we anticipate seasonally strong fourth quarter system placements. However, we do expect some moderation from the 30-plus percent growth in system placements we have realized in recent quarters. Furthermore, we expect that the proportion of systems placed via operating leases in Q4 will increase further from the 25% in Q3.

接下來，我將談談我們對2018年的財務展望。首先從流程入手。在上次電話會議上，我們預測 2018 年全年手術量成長率將介於 14.5% 至 16.5% 之間。我們現在提高了預測，預計 2018 年全年手術量成長將達到 17% 至 18%。關於第四季系統安裝情況，根據歷史規律，我們預期第四季系統安裝量將出現季節性強勁成長。不過，我們預期系統部署量成長率將比近幾季的 30% 以上放緩。此外，我們預計第四季透過經營租賃方式部署的系統比例將從第三季的 25% 進一步增加。

Turning to gross profit. 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. 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. 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.

接下來計算毛利。在上一次電話會議上，我們預測 2018 年的備考毛利率將佔淨收入的 70% 至 71.5%。我們現在將停產該系列產品的低階產品，預計調整後的毛利率將佔淨收入的 70.5% 至 71.5%。我們的實際毛利率會因產品、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. Last quarter, we guided 2018 operating expense growth of between 16% and 18%. 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. 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. We continue to expect other income, which is comprised mostly of interest income to total between $70 million and $75 million in 2018.

接下來談談營運費用。上個季度，我們預計 2018 年營運費用成長將在 16% 至 18% 之間。我們現在將這一範圍下調，預計 2018 年的營運費用將比 2017 年的水準成長 15.5% 至 17%。我們將 2018 年非現金股票補償費用的預估值上調至 2.55 億美元至 2.6 億美元之間，而上次電話會議的預測為 2.45 億美元至 2.55 億美元。我們繼續預期 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。

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

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 19.5% 至 20.5% 之間。我們現在將預估值略微下修至稅前收入的 19% 至 20% 之間。

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

我們的發言到此結束。現在開始回答各位的問題。

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

（操作員指示）我們收到來自美國銀行的鮑勃霍普金斯的提問。

I actually wanted to start, if okay, with a question on capital allocation. Obviously, the business trends are very strong right now. I think you mentioned that you got $4.6 billion in cash and the authority to buy back stock. 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?

如果可以的話，我其實想先問一個關於資本配置的問題。顯然，目前商業趨勢非常強勁。我想你提到你獲得了 46 億美元的現金以及回購股票的授權。如果可以的話，您能否解釋為什麼您目前不回購股票？這是否意味著市場上存在一些併購機會？

Bob, it's Marshall. We have not modified our capital deployment priorities and -- so they're consistent with what we said before. First, organic investment and substantial growth opportunities that are available to us. Second, acquiring technologies and talent that will ensure that we can accelerate our growth. And then third, using efficient long-term focus vehicles to return cash to shareholders. In that regard, we have done stock buybacks. You've seen us doing it periodically, we do them opportunistically based on our assessment of the market. I think the market will continue to be volatile as is has been recently. And as it provides opportunities to purchase at the right price, you will see us do something.

鮑勃，我是馬歇爾。我們沒有改變資本部署優先事項，因此與我們之前所說的一致。首先，我們擁有有機投資和實質的成長機會。其次，取得能夠確保我們加速發展的技術和人才。第三，利用高效率的長期投資工具向股東回饋現金。在這方面，我們已經進行了股票回購。你們已經看到我們時不時地這樣做，我們會根據對市場的評估，伺機而動。我認為市場將繼續像最近一段時間一樣波動。當出現以合適價格購買的機會時，您將會看到我們採取行動。

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

我們收到摩根士丹利的戴維·劉易斯提出的問題。

Gary, a couple questions for me. 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. Both those numbers are the best we've seen in years. And 20% procedure growth, obviously, reflects another quarter, I think the third straight quarter of momentum acceleration. 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?

加里，我有幾個問題想問你。我想，首先是馬歇爾提到了這一點，但顯然，租賃業務抑制了本季度的收入，但美國的淨安裝量是我們所見過的最好的，系統利用率也是如此。這兩個數字都是我們多年來見過的最佳水平。20% 的手術量成長，顯然反映了另一個季度，我認為這是連續第三個季度的成長勢頭加速。所以，考慮到美國的手術室和手術流程趨勢，您能否為我們介紹一下您觀察到的，特別是美國，導致這些趨勢的一些驅動因素？

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. And I think the box placements then are in response to that increased procedure demand. From our perspective, we're happy to see utilization go up. We really view capital placements in mature markets as a way to enable the procedure market, and so you're seeing that. Leases are then kind of a fallout of that philosophy. 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.

我認為手術需求當然是最重要的，正如我們在腳本中提到的，一些成熟領域的持續強勁增長，例如泌尿外科、婦科以及普通外科，都表現得非常出色。我認為手術室的設置是為了應對不斷增長的手術需求。從我們的角度來看，我們很高興看到利用率上升。我們確實將成熟市場的資本配置視為促進程序市場發展的一種方式，所以你現在也看到了這一點。租賃制度可以說是這種理念的產物。或者對於那些在市場中地位良好且運作良好的醫院，我們認為，在他們需要的時候，以對他們和我們都適用的條件，為他們提供所需的醫療服務，有助於促進市場發展，我們也一直願意這樣做。

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...

看來我們每個人大概只會收到一個問題，所以我打算…

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

我們稍後會給大衛一個重新排隊的機會，但你先開始吧。抱歉。

No problem. I'll ask mine on Japan. 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. 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.

沒問題。我會問我在日本的同胞。顯然，日本的一些數據有所改善，這要歸功於相關程序和設施的改進，所以我只是好奇，這樣的報銷金額是否會讓你感到驚訝。如果您能再詳細談談您如何看待新報銷政策實施後市場的反應和發展情況，以及您認為本季度過後，目前這種增長的可持續性是否更加現實，那就太好了。

We're pleased with progress in Japan. The -- kind of the settle-down growth rates are going to be a little bit hard to predict. 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. Some of that is training capacity and logistics. Some of it is field support on our side. Some of it is the depth of the surgeon proctoring network. Not all of the procedures that were reimbursed will adopt at the same rates, nor will we pursue them all at the same rate. And so there's a little bit of shakeout here as the priorities firm up. 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. And if you have a follow-up, go ahead.

我們對日本的進展感到滿意。穩定下來後的成長率很難預測。目前來看，需求確實很好，我認為——真正起決定性作用的是從需求到臨床病例再到啟動運行的專案的整個流程。其中一些是培訓能力和後勤保障方面的問題。一部分是我們這邊的現場支援工作。部分原因在於外科醫生導師網絡的深度。並非所有獲得報銷的程序都會以相同的費率實施，我們也不會以相同的費率對所有程序都進行追究。因此，隨著優先事項的確定，這裡會出現一些調整。到目前為止一切順利，但我真的認為還需要幾個季度的時間，才能讓比賽節奏趨於穩定，變得更加可預測。如果您還有後續問題，請儘管提出。

Sure. Yes. So I'm going to maybe ask about hiring take. So from the numbers that you guys reported, it's obviously really strong, it's up to 5,200 headcount now. That's about a 700 increase so far this year. So maybe just some color on where the heavy areas are in which those heads are being allocated. And how you're thinking about that headcount growth as we think about the next year or 2.

當然。是的。所以我可能會問問招募方面的狀況。根據你們公佈的數據來看，情況顯然非常強勁，目前員工人數已達 5,200 人。今年到目前為止，這比之前增加了約700人。所以，或許可以稍微標示一下那些人才集中分佈的重地。展望未來一兩年，您如何看待人員成長問題？

Good question. The -- some of the headcount growth is -- roughly tracks to the procedure momentum that we're seeing. 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. 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. So that's where you see the bulk of the hiring in. As procedure growth goes, we expect a little leverage there but not a ton. 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. It may well be the right limiting step for growth of the company is really the onboarding capability of really good people. So we watch it really carefully and care about it.

問得好。人員成長的部分原因與我們看到的流程發展動能大致吻合。因此，需要現場支援、儀器和配件的生產以及產品培訓所需的培訓資源。所以這些因素是可以評估的，我們可以從中獲得一些優勢，但我們希望確保我們能夠真正為客戶提供支援。所以，大部分招募工作都集中在這個區域。就手術量成長而言，我們預期會有一些槓桿作用，但不會有太大作用。劇本中也提到了即將推出的新平台，例如 Sp 和 ION，這些都是深度技術研發和供應鏈的努力，因此一些負責人也投入支援這些活動。公司發展的最大限制因素或許在於其吸引優秀人才的能力。所以我們非常仔細地觀察它，也很關心它。

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

接下來，我們將向摩根大通的泰科彼得森提出一個問題。

I'll ask a couple on some of the emerging procedures. 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. And how should we think about sleeve gastrectomy versus bypass versus maybe other procedures? And then separately, I noticed you both, Calvin and Gary, talked about chole. I'm wondering if that's coming back a little bit, typical to what we've seen in the past.

我會問其中幾位關於一些新興手術流程的問題。關於減重手術，我想請您談談現在 SureForm 吻合器上市後，您在市場開發方面所做的一些努力。那我們該如何看待袖狀胃切除術、胃繞道手術以及其他手術方式呢？然後，我注意到你們倆，Calvin 和 Gary，分別談到了膽固醇。我懷疑這種情況是否正在逐漸恢復，就像我們過去看到的那樣。

Yes, on the bariatric front, long term, we're really enthusiastic about it. In the near term, we're optimizing a few things. 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. 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. That will start to expand into 2019. It will be a measured launch. 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. So I wouldn't overbuild the near term on it. I think in the long term, it looks quite good. With regard to resolution on the kind of the clinical approach question you asked and are these -- sleeves versus bypass. It's a little too soon for us to work through it. Clearly, there's a mix in the market. How that mix applies to robotics, I think that's a question for future quarters. On cholecystectomy, just touching that. 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. 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. There's clearly a mix of both. And separating those 2 in terms of intent is very hard. So we mentioned it because the growth numbers have been substantive. The sustainability of that growth, we're not ready to call yet.

是的，從長遠來看，我們對減肥手術充滿熱情。短期內，我們將優化一些方面。我們正在優化產品組合，包括我在腳本中提到的一些儀器，例如 Vessel Seal Extend 和 SureForm 60。我們目前仍處於第一階段的啟動階段，即在供應方面建立產能，並根據客戶的偏好回饋進行調整。這種情況將在2019年開始擴大。這將是一次有計劃的發布。一方面是為了確保我們的供應能力與需求相匹配，另一方面是為了確保我們的銷售團隊在支持普通外科客戶方面保持平衡，尤其是在疝氣（增長良好）和結直腸（增長良好）方面，以便我們對普通外科市場採取平衡的方法。所以，我不會過度看好它短期內的表現。我認為從長遠來看，情況相當不錯。關於您提出的臨床治療方法的問題，即袖套手術與旁路手術，解決方案是什麼？現在討論這個問題還為時過早。顯然，市面上的產品種類繁多。這種組合如何應用於機器人領域，我認為這是未來幾季需要探討的問題。關於膽囊切除術，只是稍微提一下。我們看到多孔膽囊切除術的優勢，單孔膽囊切除術的減少被多孔膽囊切除術的優勢所彌補——而且彌補得更多。對我們來說，很難知道這其中有多少是新來的普通外科醫生帶來的，又有多少是外科醫生為了他們認為適合機器人手術的患者而採用或改變他們的診療模式造成的。顯然兩者兼而有之。要從意圖區分這兩者是非常困難的。我們之所以提到這一點，是因為成長數據相當可觀。這種成長的可持續性，我們現在還無法下結論。

Okay. And then if I can just ask one more clarification. 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?

好的。然後，我能再問一個問題嗎？您能否就採用按使用量計費模式或經營租賃模式的系統，談談這兩種模式的差異？

Sure. Marshall.

當然。馬歇爾。

Sure. Operating leases -- frankly, we structure these things to meet customer needs. And operating leases come in various flavors, including that we will do your traditional 4-year lease with a bargain buyout at the end. We also do short-term rentals that get them over budget cycles. And again, so we're ultimately pretty flexible on the leasing programs. The usage-based programs, really are based on time usage over a period. And we've done that with a few hospitals, as we said, that are well positioned in the market and are serious robotics users.

當然。經營租賃－坦白說，我們設計這些租賃方式是為了滿足客戶的需求。經營租賃有多種形式，包括我們可以提供傳統的 4 年租賃期，並在期末以優惠價格買斷。我們也提供短期租賃服務，幫助他們度過預算週期。再次強調，我們在租賃方案方面最終還是相當彈性的。這些按使用量計費的方案，實際上是根據一段時間內的使用時間來製定的。正如我們所說，我們已經與幾家在市場上佔據有利地位且認真使用機器人技術的醫院合作。

And in terms of our reporting, Tycho, we are including these alternative structures in with the operating leases, right? So they're all included in the overall operating lease number. They're just -- think of it as another form of operating lease.

泰科，就我們的報告而言，我們會將這些替代結構與經營租賃一起納入其中，對嗎？所以它們都包含在整體經營租賃數量中。它們其實就是──你可以把它看作是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拉里·比格爾森。

Two for me. I'll just ask them upfront. Gary, on the Q2 call, you said hernia is moving to a different phase, and it's worth thinking through that phase. Can you elaborate that? Maybe talk about some themes you're seeing in hernia. And then separately, obviously, with the CHEST meeting at AATS, the 2 robotic bronchoscopy platforms got more Wall Street attention. Gary, the differences seem to be, between the 2 systems, in camera capability and the size of the working channel. How would you compare and contrast the 2 systems with respect to those differences?

我兩個。我直接問他們就行了。Gary，你在第二季電話會議上說疝氣正在進入一個不同的階段，值得我們認真思考這個階段。能詳細解釋一下嗎？或許可以談談你在疝氣病例中觀察到的一些共同點。此外，很顯然，在 AATS 的 CHEST 會議上，兩種機器人支氣管鏡平台也引起了華爾街的更多關注。Gary，這兩個系統之間的差異似乎在於攝影機功能和工作通道的大小。你會如何比較和對比這兩個系統在這些差異上的表現？

Okay. 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. And why do I say that? 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. And we're seeing a fair amount of reorders from existing customers that does not appear that a lot of it is just trialing. It looks like it's a -- for those who have adopted their commitment to it appears to be pretty good. 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. Some of the segments of the underlying market are not yet resolved, and so that's uncertain. We'll see as we go forward. But the data, so far in the surgeons taking this has been good. So that's what we were seeing last quarter. I think that holds up this quarter. Turning to our ION platform as it relates to other products in the market. 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. And to do that, you needed really good sensing, which we did. That was through our shape sensing technology and some of the first partnering then acquisition and development of the Luna sensor. And then it was dependent strongly on the size of the catheter. 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. That's what drove our architecture. We feel good about it. It is possible, technologically feasible to make a bigger catheter. Making a bigger one is easier than making a smaller one. Putting a permanent camera in, if we needed to do that, was all something that could be done and we chose not to. We chose to make it small, and time will tell whether that was the right decision. I feel good about it. 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. So I don't think it's a market that will move on what's said. I think it's a market that will move based on true capability and clinical evidence, and that's where our focus is. We feel good about where we are and we show what we think we can. And I think that will determine success for us.

好的。我認為我們上個季度討論的問題有點像是我們現在處於比賽的哪個局，我認為我們還在比賽的上半場，但已經過了前幾局。我為什麼這麼說呢？我認為你開始看到相當多的數據被收集起來，以及像註冊登記這樣的機制能夠顯示臨床益處。我們看到相當多的現有客戶再次下單，這似乎不像是在試用。看起來，對於那些堅持下去的人來說，這似乎相當不錯。就疝氣的總數而言，這在整個市場中的影響有多大，我們仍然很難理解，就疝氣的大小、雙側與單側腹股溝疝氣修補術等因素而言，疝氣市場總量中有多少比例的患者會選擇機器人輔助手術。基礎市場的部分組成部分尚未確定，因此存在不確定性。我們走著瞧吧。但到目前為止，服用這種藥物的外科醫生的數據都很好。這就是我們上個季度看到的情況。我認為這個季度的情況就是這樣。接下來，我們將探討我們的 ION 平台與其他市場上的產品之間的關係。我們早期做出了一些決定，這些決定實際上是圍繞我們認為肺病學中的臨床問題而製定的，即早期發現遠端（即肺的外周，肺內更遠的分支）可疑病變，這些病變的大小大約為一厘米。要做到這一點，你需要非常好的感測技術，而我們做到了。這是透過我們的形狀感測技術以及一些最早的合作，然後收購和開發 Luna 感測器來實現的。然後，它很大程度取決於導管的尺寸。因此，我們根據對肺部生理的了解、對結節位置的了解以及希望了解介入性肺科醫生和胸腔外科醫生真正需要什麼來做出決定。這就是我們架構設計的驅動力。我們對此感到滿意。製造較大的導管在技術上是可能的。製作一個更大的比製作一個更小的容易。如果需要的話，安裝永久攝影機是可以做到的，但我們選擇不這樣做。我們選擇小規模經營，時間會證明這是否是正確的決定。我感覺很好。關於肺癌領域，我最後一點要說的是，這個領域已經研究肺癌的早期診斷一段時間了，一些商業團隊也進入這個領域推廣產品，其中一些產品令人失望。所以我認為市場不會因為外在言論而波動。我認為這是一個會根據真正的能力和臨床證據而發展的市場，而這正是我們關注的重點。我們對目前的狀況感到滿意，並展現了我們認為自己的能力。我認為這將決定我們能否成功。

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

下一個問題將來自加拿大皇家銀行資本市場部門的布蘭登亨利。

Can you discuss any challenges you expect to face with the ION rollout? And who will be selling these systems to pulmonologists? Will it be a separate salesforce or the existing Intuitive salesforce? And I just have a follow-up.

您能否談談在 ION 推廣過程中預計會遇到哪些挑戰？那麼誰會把這些系統賣給肺科醫生呢？會組建一支獨立的銷售團隊，還是沿用現有的 Intuitive 銷售團隊？我還有一個後續問題。

I would anticipate the kinds of challenges that are related to the sort of complex product launches that we specialize in. So I think the early launches will be a couple of things. It will be engaging with sites that have a long-term commitment to clinical progress, data collection that's associated with that clinical progress. Stabilizing supply chains for these kinds of technologies is nontrivial. It's hard and it's important. And so we will do that for ION for sure. And stable supply chain allows you to support a larger customer base and also get your costs in line. And so that is routinely an exercise we need to do. And then building your technology training pipelines and the partnering networks that are required to really expand launch. So those things are all in front of us in terms of ION. That's the challenge. The good news is that we have a history of engaging those challenges, and I think we'll work it through. And I missed the second part of the question.

我預料到會面臨與我們擅長的複雜產品發布相關的各種挑戰。所以我認為早期推出的產品會有兩方面。它將與那些長期致力於臨床進展、收集與臨床進展相關的數據的機構合作。穩定這類技術的供應鏈並非易事。這很難，但也很重要。所以，我們一定會為ION這樣做。穩定的供應鏈可以讓你服務更大的客戶群，同時也能控製成本。所以，這是我們日常需要做的練習。然後建立你的技術培訓管道和合作夥伴網絡，這是真正擴大產品發布規模所必需的。所以，就 ION 而言，這些都是擺在我們面前的事。這就是挑戰所在。好消息是，我們有應對這些挑戰的經驗，我相信我們能夠克服困難。我漏看了問題的第二部分。

And then who's the salesforce? Will it be the existing salesforce or we have to build out a completely new salesforce? And just how will that look?

那麼銷售團隊由誰組成呢？是沿用現有的銷售團隊，還是需要組成全新的銷售團隊？那會是什麼樣子呢？

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

是的。我們目前在現有團隊中有一個小型專業團隊，他們接受過這方面的深入培訓，並與我們其他重點客戶的領導和管理團隊保持聯繫。所以，他們在需要深入的地方深入，在需要聯繫的地方建立聯繫。

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

好的。其次，能否請您單獨介紹一下增強 Intuitive 的願景和資訊科技產品組合的一些機會？具體來說，您能否談談最近與 InTouch Health 達成的協議，以及該公司在擴增實境技術方面的進展？

Sure. On -- as we've said before, for the last several years, we've increased our investments in imaging. I think imaging is important. I think it can really help change outcomes and we do that routinely. We do it in the image sensors, in the endoscopes. We do it in the software that we use to process those images and the way we tune images. We do it in our displays and our user interface. We are investing in molecules to expand our Firefly platform, as you know. Molecules are just a way to increase the signal to noise for surgeons to detect structures they care about. Whether they are things they want to take out or things they want to leave in and not disturb. Informatics works hand-in-hand with that, certainly in OR informatics. So we have built cloud capabilities over the years. As you know, we've been in Internet of Things for surgical robots for a decade now. Over 90% of our systems are Internet connected. So we have Big Data capabilities that we built and we'll continue to build that allows us to do off-line informatic processing. And increasingly, we can use machine learning techniques and other things to do real-time capabilities. And of course, over time, that will give us the opportunity to do mixed reality or augmented reality features. How fast they come and where the first markets are, we're not prepared to discuss yet. I think it's interesting in the long term pathway. And so that's a step in that direction. 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.

當然。正如我們之前所說，在過去的幾年裡，我們增加了對成像技術的投資。我認為影像學很重要。我認為這確實有助於改變結果，而我們也經常這樣做。我們在影像感測器和內視鏡中實現了這一點。我們在用於處理這些影像的軟體以及我們調整影像的方式中實現這一點。我們在顯示器和使用者介面中都實現了這一點。如您所知，我們正在投資研發分子，以擴展我們的螢火蟲平台。分子只是外科醫生提高信噪比，從而檢測他們關注的結構的一種方式。無論是他們想取出的東西，還是他們想留在裡面不動的東西。資訊學與此密切相關，尤其是在運籌學資訊學領域。因此，多年來我們一直在建立雲端能力。如您所知，我們從事手術機器人物聯網技術已經十年了。我們超過 90% 的系統都連接到了網路。因此，我們已經建立了大數據能力，並將繼續建立這種能力，使我們能夠進行離線資訊處理。而且，我們越來越多地可以利用機器學習技術和其他技術來實現即時功能。當然，隨著時間的推移，這將使我們有機會實現混合實境或擴增實境功能。它們何時到來以及首批市場在哪裡，我們目前還不便討論。我認為從長遠來看，這很有趣。所以這是朝著那個方向邁出的一步。我們認識 InTouch 並與他們合作多年，這只是加深了這種關係，也使我們能夠在 Intuitive 內部建立一些真正的實力，同時加速我們的雲端能力發展。

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

接下來，我們將向美國銀行的鮑伯霍普金斯提問。

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

我只是想問一個關於ION和柔性導管肺的問題。Gary，產品核准後需要多久才能產生所需的療效數據，從而真正推動該療法的廣泛應用？

Good question. I don't really know the answer right now. I think we'll get some early data that will be out of a few sites, that will be quarters, not years. There are multicenter studies that integrate that up and go through peer review cycle, of course, will be years not quarters. 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.

問得好。我現在還不知道答案。我認為我們會得到一些早期數據，這些數據來自幾個站點，時間跨度為幾個季度，而不是幾年。當然，有一些多中心研究會整合這些訊息，並經過同儕審查週期，這需要數年而不是幾季。所以我認為你會看到，就像我們過去所做的那樣，出版頻率會逐漸提高，這在一定程度上取決於過程的複雜程度。

And then if demand for Sp is really high. Do you have the capacity to meet that demand? I mean, I know you want to go slow and focus on the long term. But if demand is high, can you meet it?

如果Sp的需求真的很高的話。你們有能力滿足這個需求嗎？我的意思是，我知道你想慢慢來，專注於長遠發展。但如果需求量很大，你能滿足嗎？

Yes, I think the focus upfront is 2 things. One, it's to work on expanded indication site. As you know, Sp is a platform technology from our point of view. We have the first set of indications in urology. We've submitted for the second set in transoral robotic surgery. We think there are other indications that will be important. So the first thing is to really make sure that we're putting systems out that will help us develop those indications over time. So that is important to us. 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. 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. 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. 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.

是的，我認為前期重點是兩件事。第一，是為了擴大適應症範圍。如您所知，從我們的角度來看，Sp 是一種平台技術。我們擁有泌尿科的第一套適應症。我們已提交第二組經口機器人手術申請。我們認為還有其他一些重要的指標。所以，首先要做的就是確保我們推出的系統能夠幫助我們隨著時間的推移發展出這些指標。所以這對我們來說很重要。第二點是，Sp 是我個人接觸過的最精密的產品之一，當然也是 Intuitive 公司推向市場的產品之一。確保我們在出國之前真正了解並充分描述我們的技術，並擁有非常穩定的供應鏈，這對我們來說非常重要。我對公司的長期發展充滿熱情，客戶也對公司的功能充滿熱情，但我認為在接下來的幾個季度裡，我們會保持謹慎。隨著情勢的發展和信心的增強，我們當然可以加快供應鏈產能，但我們會循序漸進地進行。

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

接下來，我們將向摩根士丹利的戴維·劉易斯提問。

The suspense was killing me. I don't know that my question will live up to the suspense. This is terrible. But Calvin had mentioned in the prepared remarks the systems moderation in the fourth quarter. Just is there anything fundamental behind that other than just harder comps and obviously, the increased implications of higher leases?

懸念快把我逼瘋了。我不知道我的問題能否不負眾望，不至於讓人感到懸念。這太糟糕了。但加爾文在事先準備好的演講中提到了第四季度的系統調整。除了更難進行比較以及租金上漲的影響之外，這背後還有什麼根本原因嗎？

Yes, I think it's really -- I mentioned comparisons in the prepared remarks. We actually kind of crossed over that 30% growth in placements threshold last Q4. And so now, this is the first quarter we're comparing against that kind of comparison. And so it just is a little tougher. But like I said, we still expect a seasonally strong fourth quarter.

是的，我認為確實如此——我在準備好的演講稿中提到了比較。事實上，我們在上個季度就突破了30%的就業成長門檻。所以現在，這是我們第一次將這個季度與這類比較進行比較。所以確實有點難。但正如我所說，我們仍然預計第四季度將保持強勁的季節性成長。

And Gary, just -- you got a lot a questions on this call on Sp and ION. I wondered just -- a lot of investors are focused on these platforms. From a commercial perspective, if I compare Sp and ION, which one is going to require greater channel development? And how would you compare the near and long-term opportunity for system placements and revenue across these 2 systems?

加里，你這次電話會議有很多關於 Sp 和 ION 的問題。我很好奇——很多投資人都關注這些平台。從商業角度來看，如果比較 Sp 和 ION，哪一個需要更多的通路開發？那麼，您如何比較這兩個系統在近期和長期內的系統部署和收入機會？

As I think about it, Sp is a more familiar customer base. I think it has really interesting core clinical capability, which is the ability to work in small spaces and parallel access. 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. But I think that, that's -- our visibility on that is probably a little better because we know the customer base quite well. 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. I think the platform itself will have long legs. If you think about the ability to navigate tortuous pathways and inspect things using preoperative images, which is kind of the core technology underneath. There are a lot of things that in the body could be interesting there. But it will take some time to develop it. 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. So that's a more nascent market. I think very interesting and long-term possibility. 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. Those are highly uncertain. We, of course, have models on them. We look at them. But as you know, with us, for years here that capability ultimately determines the total opportunity in the market. And as capability is established with these things, we'll know better. 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.

仔細想想，Sp 的客戶群比較熟悉一些。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存取的能力。我對外科醫生的反應感到滿意，他們表示——既然我現在擁有了這樣的原始能力，我們就可以採用一些不同的方法，他們也有興趣發展有助於此的數據。但我認為，我們在這方面的可見度可能更好一些，因為我們對客戶群非常了解。我認為，從 ION 的角度來看，首先，ION 是一個診斷性的初始應用程序，隨著時間的推移，它對我們公司來說將具有略微不同的動態。我認為這個平臺本身會有很長的發展週期。如果你想想能夠利用術前影像來導航曲折路徑和檢查事物的能力，這可以說是底層的核心技術。人體內有很多東西都可能很有趣。但開發它需要一些時間。鑑於這些是一套不同的流程，對我們來說是不同的呼叫點，這需要我們進行更多的開發，坦白說，隨著該領域的發展，對競爭對手來說也是如此。所以這是一個比較新興的市場。我認為這非常有趣，而且具有長遠發展潛力。你問的是這兩種不同事物的總可用市場規模有多大，以及我們應該如何看待未來的市場容量。這些都存在著很大的不確定性。我們當然有相關的模型。我們看看它們。但正如您所知，多年來，在我們這裡，這種能力最終決定了市場上的整體機會。隨著這些能力的建立，我們會更了解。隨著我們對它們有了更多經驗，當不確定性開始減少時，我們會開始與你們分享我們的想法。

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 與 Raymond James 的合作系列。

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

Gary，我想了解一下，自從第二季財報電話會議以來的三個月裡，你對中國的情況有什麼觀察或心得體會嗎？

Generally, no big change. 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. We think the macro trade environment is pressured. And we think that, that pressure does not help us. 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.

總體而言，沒有太大變化。正如我們之前所說，我們認為中國市場對我們產品的需求是真實存在的，我們對此感到非常興奮，我們認為中國市場的長期發展機會巨大。我們認為宏觀貿易環境面臨壓力。我們認為，這種壓力對我們沒有幫助。因此，儘管在微觀層面上遇到了一些阻力，但在實際操作層面上，我們仍在逐步取得進展，並繼續在我們必須工作的環境中努力。

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

所以，我的理解是，流程和配額本身並沒有增加太多透明度？

Correct.

正確的。

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

好的。其次，我知道你顯然在準備好的評論中會仔細斟酌用詞，而且我認為在關於 60 毫米訂書機的那部分，你表示最初的反饋令人鼓舞。我聽著，心想這是否意味著，你看，這個技術正在傳播開來，人們開始使用它了。你需要一些時間才能建立起將產品推向市場並推動更大需求的相應能力。或者，鼓勵是否意味著你可能發現了一些需要稍作調整的地方，才能讓它真正準備好在 2019 年達到黃金時期？

I -- in terms of customer response has been quite good. The things that were -- if you ask -- another way to answer your question is, what's pacing launch? And there are really 2 things that are pacing this. 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. The second one is that we don't want to overwhelm our salesforce with enormous amounts of new and different products simultaneously. We want to give them time to be deep and be able to address customer interest and demand as it happens. Those are really the 2 pacing items.

就客戶回饋而言，我的情況相當不錯。如果你問的話，另一個回答你問題的方法是：什麼是啟動節奏？實際上，有兩個因素在推動這件事的進展。一是訂書機是製造精密的設備，你希望在擴大供應能力的同時，確保產品品質非常高，而我們正在這樣做。第二點是，我們不想同時用大量的新產品和不同的產品來讓我們的銷售人員感到不知所措。我們希望給他們時間進行深入研究，並且能夠隨時應對客戶的興趣和需求。這兩個因素確實至關重要。

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

我們收到來自 Leerink Partners 的 Richard Newitter 的提問。

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. 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——鑑於今年的營運費用成長比您預測的要低一些，顯然今年的營運槓桿作用會更大一些。我想請您就您所說的那些被推遲或存在時間問題的項目提供一些看法，以及關於我們應該如何看待 2019 年在支出方面的經營槓桿潛力，您能否也談談您的看法。

Sure. My preference would have been that we had spent our full allotment now rather than underspent. On the other hand, I'd rather spend it wisely, spend it because I have it. Most of the spending has to do with human capital, bringing on staff, and we're doing well. But there's kind of a natural rate for bringing on staff. And we'll do it where we are bringing on outstanding people and integrating them well. 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. There's a little bit of that but that isn't the dominant effect. The dominant effect is really modulating the growth of headcount, and that has to do with pipelines for bringing in talent. 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. 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. Now we haven't finished all of that, and we'll do our spending models for '19 at the end of the next call. But directionally speaking, we want to make sure we can satisfy market demand here.

當然。我寧願我們現在就把預算全部用完，而不是用不完。另一方面，我寧願明智地花錢，因為我有錢就應該花掉它。大部分支出都與人力資本有關，用於招募員工，我們在這方面做得很好。但招募員工的速度其實是比較自然的。我們會招募優秀人才，並讓他們很好地融入團隊。受影響的並非某個特定的產品或項目，也不是某個原型產品裡的錢從一個地方流向了另一個地方。這方面確實有一些影響，但這並不是主要影響因素。主要影響在於調節員工人數的成長，而這與人才引進管道有關。您問到這對 2019 年意味著什麼，正如我們在準備好的演講稿中所說，我們看到市場上的程序發展勢頭良好，需求旺盛。我們希望確保能夠高品質地滿足這一需求，我們不會試圖在 2019 年的車型中利用槓桿效應。我們還沒有完成所有這些工作，我們將在下次電話會議結束時制定 2019 年的支出模型。但從方向上來說，我們希望確保能夠滿足這裡的市場需求。

Okay. And just following up on one comment you made earlier. You said China, as expected, without increased capacity, is moderating, the growth in China continues to moderate. 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. Is it not slowing as fast as you would have thought? Or is it in line with your expectations? Maybe just a little color there so we can think about kind of how much of a headwind that might present going forward.

好的。我只是想補充你之前提到的一個評論。你說過，正如預期的那樣，中國在沒有增加產能的情況下，經濟成長正在放緩，中國的成長速度繼續放緩。我只是好奇，您能否描述一下您觀察到的成長放緩速度與您預期的速度相比如何。它的速度是不是沒有你想像的那麼快放緩？或者，它符合你的預期嗎？或許可以加點色彩，這樣我們就能思考一下這可能會在未來造成多大的阻力。

We continue to make progress on utilization on the systems that are in China. 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. We're at a stage now where the moderation is at a moderate pace, if you will. And so you're gradually moving down from there.

我們持續推進對中國現有系統的利用。上個季度，我們討論了中國的成長率和流程與美國整體成長率基本一致，都在 20% 左右。我們現在所處的階段，可以說是進入了一個循序漸進的階段。所以你就是從那裡逐漸往下走的。

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

接下來，我們將向高盛的 Isaac Ro 提出一個問題。

Two questions, one on equipment and one on investment in the business. 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. You said to us you have still a fair amount of opportunity. 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. 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. I'd be interested in sort of some of the things you're doing on the training side.

兩個問題，一個關於設備，一個關於企業投資。第一個問題是，我對 Xi 升級週期感到好奇，您能否說明您認為我們目前處於流程的哪個階段。你曾對我們說你仍然有很多機會。其次，關於費用方面，Gary，你剛才提到了一些培訓機會，我認為這對你們來說是一個競爭優勢。因此，如果您能對比一下您認為您的流程培訓將如何發展，不僅是針對新的應用程序，而且隨著您擴展到其他國家（例如，實踐不同的國家），在全球範圍內的發展，那就太好了。我對你在培訓方面所做的一些事情很感興趣。

Sure. 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.

當然。關於 Xi 升級週期，或者說第四代升級週期，粗略地說，我不知道世界上有多少系統整合商，但大概是這樣。

2,500.

2500。

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. I think your -- the implication behind your training question is exactly right. Building training capability is heavy lifting. 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. And proctoring networks are your customers, our customers who are deeply experienced and have teaching capability and willing to teach others. And so we developed those things. 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. And so that helps us. And we think that doing that well and doing that efficiently is something that has worked for the investment and we have done so. What is its long-term competitive advantage? I don't know exactly, but I believe it's important for our customer and therefore, important for the company. Perhaps, just one last question and then we'll close here.

所以——我不知道完成的時候我會怎麼說，但Xi的安裝用戶群超過2000，這對我們來說是一個機會。我認為你——你提出的培訓問題背後的含義完全正確。建立訓練能力是一項艱鉅的任務。它是人力資本、擅長培訓的人員及其培訓方式、一套有效且經過驗證的流程以及監考網絡的結合。監考網絡就是你們的客戶，我們的客戶，他們經驗豐富，有教學能力，並且願意教導別人。於是我們就開發了這些東西。我們在內部開發了一套工具，可以提高我們將這種能力推廣到新市場的效率。這對我們有幫助。我們認為，把這件事做好、把這件事有效率地做好，對投資來說是有益的，而我們也確實做到了。它的長期競爭優勢是什麼？我不太清楚，但我認為這對我們的客戶很重要，因此對公司也很重要。或許，最後一個問題，然後我們就結束今天的討論。

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

最後一個問題來自 Evercore 公司的 Vijay Kumar。

Really impressive procedure number. So maybe, Gary or Marshall, just starting on the procedure number. The guidance is '18, right? 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? Should we be thinking of a really strong number? You made some comments on hernia. We're still at the very early stages of this hernia pickup. You have a couple of new products coming in. So I'm just curious on how that number should trade in. Just given lease, it looks like lease -- the percentage of lease is going to increase next year, right? 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.

手術數量真是驚人。所以，或許是 Gary 或 Marshall，剛開始計算手術編號。指導意見是“18”，對吧？所以，當你展望明年，考慮到許多因素，你認為手術數量會是什麼樣子？我們是否應該考慮一個非常高的數字？你對疝氣發表了一些評論。我們目前仍處於疝氣檢測的早期階段。你們有幾款新品即將到貨。所以我很好奇這個數字應該要如何改變。僅就租賃而言，看起來租賃——明年租賃比例會增加，對嗎？所以，當我們考慮為明年的收入建立模型時，如果您能解釋流程，以及我們應該如何考慮，我認為這將非常有幫助。

Vijay, it's Calvin. Obviously, we'll give our specific procedure guidance on our next call in January. 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. 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. And even earlier stages for some of the broader practice-based procedures. On the OUS side, we're investing in growth in larger European countries. Japan, China, Korea, OUS driving growth. 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. And then in Japan, the pace of adoption on the 12 new reimbursement procedures.

維傑，我是卡爾文。顯然，我們將在1月的下次電話會議上給予具體的流程指導。但我們預計 2019 年手術量成長的驅動因素將與 2018 年和 2017 年的情況基本一致，即美國普通外科手術、美國胸腔外科手術和 OUS 手術，總的來說，這些手術將推動大部分成長。美國一般外科現在是我們最大的專科，但是，正如我們剛才所描述的，我們在疝氣修補術、腹股溝疝氣修補術以及結直腸手術方面仍處於相當早期的階段。甚至在一些更廣泛的實踐程序中，還需要更早的階段。在海外美國方面，我們正在投資歐洲較大國家的成長。日本、中國、韓國、美國等國推動成長。當我們談到可能導致一些差異和潛在增長範圍的原因時，顯然是美國普通外科手術的增長速度和廣度、美國成熟手術的趨勢，以及中國系統配額的任何變化，無論是積極的還是消極的。然後是日本，12項新的報銷程序的採納速度。

All right. Well, thanks, Calvin. Thanks, Vijay. 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 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. This concludes today's call.

好的。謝謝你，卡爾文。謝謝你，維傑。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的限制，實現外科手術的目標。我向你保證，我們將繼續致力於一些真正能帶來改變的事情。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. And we look forward to talking to you again in 3 months.

感謝您參與並支持這段非凡的外科手術改進之旅。我們期待三個月後再次與您交談。

Ladies and gentlemen, that does conclude our conference for today. Thank you for your participation and for using the AT&T Executive TeleConference service. You may now disconnect.

女士們、先生們，我們今天的會議到此結束。感謝您的參與以及使用 AT&T 高階主管電話會議服務。您現在可以斷開連線了。