直覺手術 (ISRG) 2018 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by.

女士們，先生們，謝謝你們的支持。

Welcome to the Intuitive Surgical Q4 2018 Earnings Release call.

歡迎來到 Intuitive Surgical 2018 年第四季度收益發布電話會議。

(Operator Instructions) As a reminder, today's call is being recorded.

（操作員說明）提醒一下，今天的通話正在錄音中。

I will now turn the call over to Senior Director of Finance, Investor Relations, Calvin Darling.

我現在將把電話轉給投資者關係財務高級總監 Calvin Darling。

Please go ahead, sir.

請繼續，先生。

Thank you.

謝謝。

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

下午好，歡迎來到 Intuitive Surgical 的第四季度收益電話會議。

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 October 22, 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 10 月 22 日提交的 10-Q 表格。

Our SEC filings can be found through our website or at the SEC's website.

我們的 SEC 文件可以通過我們的網站或 SEC 的網站找到。

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 fourth 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四季度業績的亮點，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 fourth quarter financial results, then I will discuss procedures and clinical highlights and provide our updated financial outlook for 2019.

Marshall 將對我們的第四季度財務業績進行審查，然後我將討論程序和臨床重點，並提供我們對 2019 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。

Thank you, Calvin.

謝謝你，加爾文。

Entering 2019, our business is showing strength.

進入2019年，我們的業務正在展現實力。

In 2018, over 1 million surgeries were performed using da Vinci systems, accompanied by approximately 1,500 peer-reviewed clinical journal articles.

2018 年，使用達芬奇系統進行了超過 100 萬次手術，並附有大約 1,500 篇經過同行評審的臨床期刊文章。

The total number of procedures performed since first launch exceeded 6 million and the total peer reviewed clinical database contains over 16,000 articles.

自首次推出以來執行的程序總數超過 600 萬，同行評審的臨床數據庫總數包含 16,000 多篇文章。

While these milestones represent a step forward, I believe that outstanding product design, robotics, advanced imaging and informatics are just starting to take their place in surgery and in acute interventions more broadly.

雖然這些里程碑代表了向前邁出的一步，但我相信出色的產品設計、機器人技術、先進的成像和信息學才剛剛開始在外科手術和更廣泛的急性干預中佔據一席之地。

Surgery and acute interventions are sophisticated interactions among highly trained professionals.

手術和急性干預是訓練有素的專業人員之間複雜的互動。

They have a common goal of delivering outstanding care to a patient in need.

他們的共同目標是為有需要的患者提供出色的護理。

Starting with a careful understanding of operating and interventional environments, engineers and interaction designers collaborate closely with physicians to develop smart, connected devices with the goal of the quadruple aim.

從對操作和介入環境的仔細了解開始，工程師和交互設計師與醫生密切合作，開發智能互聯設備，以實現四重目標。

First, decreasing complications; second, increasing patient satisfaction; third, increasing care team satisfaction; and fourth, to improve the efficiency and lowering of the total cost to treat.

第一，減少並發症；第二，提高患者滿意度；第三，提高護理團隊的滿意度；第四，提高治療效率，降低總成本。

Considering our current da Vinci systems and the procedures and countries that are our focus today, we believe applicable procedures exceed 5 million annually.

考慮到我們目前的達芬奇系統以及我們今天關注的程序和國家，我們相信適用的程序每年超過 500 萬。

As we consider our new concepts coming to market, including but not limited to: our da Vinci single port system; our advanced imaging technologies; and our Ion flexible catheter system, the long term total opportunity for our products to make a positive difference in physicians and their patients' lives is greater still.

當我們考慮將我們的新概念推向市場時，包括但不限於：我們的達芬奇單端口系統；我們先進的成像技術；和我們的 Ion 柔性導管系統，我們的產品對醫生及其患者的生活產生積極影響的長期總體機會更大。

Given the positive response of our customers and in pursuit of the substantial opportunity to improve surgery and intervention that lies ahead, we plan to accelerate some investments over the next several quarters.

鑑於我們客戶的積極響應，並且為了尋求改善未來手術和乾預的大量機會，我們計劃在未來幾個季度加快一些投資。

We'll review our guidance on spend later in the call.

我們將在稍後的電話會議中審查我們的支出指南。

Given our prerelease this month, I'll be brief in summarizing our 2018 highlights.

鑑於我們本月的預發布，我將簡要總結我們 2018 年的亮點。

Global procedure growth was strong, with approximately 19% growth in the fourth quarter and 18% for the full year.

全球手術增長強勁，第四季度增長約 19%，全年增長 18%。

Growth in procedures was largely consistent through the year, with United States showing particular strength in hernia repair, colorectal procedures and practice-related general surgery procedures, including cholecystectomy.

全年手術的增長基本保持一致，美國在疝修補術、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）方面表現出特別強勢。

Mature procedure growth in the United States, including prostatectomy and hysterectomy, was solid again in 2018, though we expect slowing in these mature procedures going forward in some countries.

美國成熟手術的增長，包括前列腺切除術和子宮切除術，在 2018 年再次穩固，儘管我們預計這些成熟手術在某些國家/地區的發展會放緩。

In Japan, procedures grew over 40% in the second half of 2018, in response to additional reimbursements granted in Q2.

在日本，2018 年下半年手術增長超過 40%，以響應第二季度授予的額外報銷。

Aggregate European procedure performance was generally in line with our expectations again this quarter, with particular strength in the U.K. and France.

本季度歐洲程序的總體表現總體上再次符合我們的預期，尤其是在英國和法國。

Calvin will review procedure trends in greater detail later in the call.

Calvin 將在稍後的電話會議中更詳細地審查程序趨勢。

Our capital placement performance in 2018 was also strong, with growth in total placements rising 35% from 684 in 2017 to 926 in 2018.

我們在 2018 年的資本配售表現也很強勁，配售總額從 2017 年的 684 筆增長 35% 至 2018 年的 926 筆。

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

扣除以舊換新和報廢後，我們的達芬奇安裝基數比 2017 年增長了 13%。

The mix of system placements between our flagship Xi System and our value X System generally 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通常與我們的區域戰略保持一致。

As we discussed on our last earnings call, customers are interested in leasing and alternative capital placement models.

正如我們在上次財報電話會議上討論的那樣，客戶對租賃和替代資本配置模式很感興趣。

The proportion of the systems placed under lease increased again in the quarter, from 25% in Q3 of 2018 to 29% in Q4.

本季度租賃系統的比例再次增加，從 2018 年第三季度的 25% 增加到第四季度的 29%。

Financial highlights of our fourth quarter results are as follows: revenue for the quarter was over $1 billion, up 17%; pro forma gross profit margin was 71.8% compared to 72.4% in the fourth quarter last year; instrument and accessory revenue increased to $539 million, up 18%; total recurring revenue in the quarter was $722 million, representing 69% of total revenue.

我們第四季度業績的財務亮點如下： 本季度收入超過 10 億美元，增長 17%；預計毛利率為 71.8%，而去年第四季度為 72.4%；儀器和附件收入增加到 5.39 億美元，增長 18%；本季度經常性總收入為 7.22 億美元，佔總收入的 69%。

We generated a pro forma operating profit of $412 million in the quarter, up 7% from the fourth quarter of last year; and pro forma net income was $353 million, up 16%.

我們本季度的預估營業利潤為 4.12 億美元，比去年第四季度增長 7%；預計淨收入為 3.53 億美元，增長 16%。

We launched the Intuitive Foundation with an initial contribution of $25 million in the quarter.

我們在本季度啟動了 Intuitive Foundation，初始捐款為 2500 萬美元。

The Intuitive Foundation's mission is to support clinical and technology research in acute interventions as well as philanthropy in the communities which we serve and in which we live.

Intuitive Foundation 的使命是支持急性干預的臨床和技術研究，以及我們所服務和生活的社區的慈善事業。

Financial highlights for the full year 2018 results are as follows: revenue for the year was $3.7 billion, up 19%; pro forma gross profit margin was 71.5% for the full year compared to 71.9% for 2017; instrument and accessory revenue increased to $2 billion, up 20%; total recurring revenue in the year was $2.6 billion, representing 71% of total revenue.

2018 年全年業績的財務亮點如下：全年收入為 37 億美元，增長 19%；全年預計毛利率為 71.5%，而 2017 年為 71.9%；儀器及配件收入增至 20 億美元，增長 20%；全年經常性收入總額為 26 億美元，佔總收入的 71%。

We generated a pro forma operating profit of $1.5 billion in the year, up 17% from 2017 and pro forma net income was $1.3 billion, up 23%, with the difference in growth rate between operating profit and net income largely driven by the 2017 Tax Act and interest income earned.

我們全年的預估營業利潤為 15 億美元，比 2017 年增長 17%，預估淨收入為 13 億美元，增長 23%，營業利潤和淨收入之間的增長率差異主要受 2017 年稅收的推動賺取的行為和利息收入。

Looking ahead, a review of clinical outcomes for complex surgery and acute interventions across large populations still highlights a substantial need for improvement.

展望未來，對複雜手術和大量人群急性干預的臨床結果的回顧仍然強調了對改進的巨大需求。

We measure our efforts by their ability to positively impact the quadruple aim.

我們通過他們對四重目標產生積極影響的能力來衡量我們的努力。

Real progress requires more than minimally invasive tools and more than digital technologies.

真正的進步需要的不僅僅是微創工具，也不僅僅是數字技術。

These technologies are necessary but not sufficient.

這些技術是必要的，但還不夠。

We believe intelligent surgery takes the integration of 3 elements: first, a deep understanding of human interactions that inform holistic system design; second, the development of high-quality smart and cloud connected robotic imaging and instrument systems; and lastly, informatics and AI to deliver relevant validated insights.

我們認為智能手術需要整合 3 個要素：首先，深入理解為整體系統設計提供信息的人際互動；第二，開發高質量的智能和雲連接的機器人成像和儀器系統；最後，信息學和人工智能提供相關的經過驗證的見解。

While we've made significant progress over our history, we believe continuous improvement is required and we've deployed our investments toward these aims.

雖然我們在歷史上取得了重大進展，但我們相信需要持續改進，並且我們已將投資用於實現這些目標。

We're bringing together several efforts in pursuit of our mission.

我們正在匯集多項努力來實現我們的使命。

We are early in our Phase I launch of da Vinci SP.

我們正處於 da Vinci SP 的第一階段啟動階段。

We've installed 15 systems in 2018 and a few hundred procedures have been performed to date.

我們在 2018 年安裝了 15 個系統，迄今為止已經執行了數百個程序。

Surgeon and patient feedback have been positive for usability and patient experience in these early days of launch.

在發布的早期，外科醫生和患者的反饋對可用性和患者體驗都是積極的。

We submitted our 510(k) for our second indication, transoral robotic surgery in Q4 of 2018 and are responding to FDA questions on this second indication.

我們在 2018 年第四季度為我們的第二個適應症、經口機器人手術提交了 510(k)，並正在回應 FDA 關於第二個適應症的問題。

We are also working through supply chain optimization, as we begin to ramp production for SP, in addition -- in anticipation of additional clearances in broader launch.

我們也在優化供應鏈，因為我們開始增加 SP 的產量，此外——預計在更廣泛的發布中會有更多的許可。

Our first step into flexible diagnostics, Ion, is nearing Phase I launch.

我們邁向靈活診斷的第一步 Ion 即將推出第一階段。

We submitted our 510(k) in 2018 and have responded to FDA questions this month.

我們在 2018 年提交了 510(k)，並於本月對 FDA 的問題做出了回應。

We anticipate a Phase I limited launch of Ion in 2019, focused on the need for definitive early diagnosis of suspicious lesions for lung cancer.

我們預計 2019 年 Ion 的 I 期有限啟動，重點是對肺癌可疑病變進行明確早期診斷的需要。

In instruments and accessories, we plan to broaden the launch of our SureForm 60-millimeter stapler for da Vinci in the first half of 2019.

在儀器和配件方面，我們計劃在 2019 年上半年擴大用於達芬奇的 SureForm 60 毫米訂書機的推出。

The 60-millimeter stapler is used primarily in abdominal surgeries, including bariatric surgery.

60 毫米訂書機主要用於腹部手術，包括減肥手術。

Surgeon response has been encouraging and our team has performed well in establishing its supply chain.

外科醫生的反應令人鼓舞，我們的團隊在建立供應鏈方面表現良好。

Over the past several years, we have been increasing our cloud computing and informatics capabilities.

在過去的幾年裡，我們一直在提高我們的雲計算和信息學能力。

Today, we routinely deliver programmatic insights to customers using our systems, which have been smart and connected for the past decade.

今天，我們定期向使用我們系統的客戶提供程序化見解，這些系統在過去十年中一直保持智能和互聯。

We believe there are opportunities to further enhance these capabilities.

我們相信有機會進一步增強這些能力。

Our advanced imaging programs and augmented reality programs are making progress.

我們的高級成像程序和增強現實程序正在取得進展。

We anticipate first clinical use of our augmented reality program in 2019.

我們預計將於 2019 年首次臨床使用我們的增強現實計劃。

As described in our pre-release, we've also been increasing investments in building our business operations in countries important to our future.

正如我們的預發布所述，我們也一直在增加投資，以在對我們的未來很重要的國家/地區建立我們的業務運營。

Our efforts in China will accelerate in 2019, with the da Vinci distribution arm of Fosun Pharma, Chindex, joining our joint venture this quarter.

我們在中國的努力將在 2019 年加速，復星醫藥的達芬奇分銷部門 Chindex 本季度將加入我們的合資企業。

Combined with the release of the next system quota and the clearance of da Vinci Xi in China, we will be accelerating investments to establish our base to serve China over the long term.

結合下一個系統配額的釋放和da Vinci Xi在中國的清關，我們將加快投資以建立我們的基地以長期服務於中國。

In 2018, we also acquired our da Vinci business in India and Taiwan and anticipate strengthening our investments and presence over the next several quarters.

2018 年，我們還收購了我們在印度和台灣的達芬奇業務，並預計在未來幾個季度加強我們的投資和業務。

We described the multiyear nature of these investments in our JPMorgan talk, using Intuitive Japan as an example.

我們在摩根大通的演講中以 Intuitive Japan 為例描述了這些投資的多年性質。

Market development in country is an arduous, multiyear process.

國內的市場開發是一個艱鉅的、多年的過程。

It involves building a strong management team and company culture, establishing strong working relationships with surgical societies, policymakers, regulators and key customers as well as building training and proctoring capability, along with a local clinical evidence base.

它涉及建立強大的管理團隊和公司文化，與外科學會、政策制定者、監管機構和主要客戶建立牢固的工作關係，以及建立培訓和監督能力，以及當地的臨床證據基礎。

As we bring these efforts together, we plan to accelerate our spend rate above our historical norms for the next several quarters.

當我們將這些努力結合在一起時，我們計劃在接下來的幾個季度中將支出率提高到高於歷史標準的水平。

As described above, the increase in spend is driven primarily by funding in growth of our joint venture in China, the ramp of our informatics efforts, infrastructure to support our procedure growth, including manufacturing lines and facilities, and the launch of our new platforms.

如上所述，支出的增加主要是由於我們在中國的合資企業增長的資金、我們信息學努力的增加、支持我們程序增長的基礎設施，包括生產線和設施，以及我們新平台的推出。

We pace the rate of investment not just by the opportunity for growth, which we believe is substantial, but by our ability to integrate talented staff and execute against our objectives.

我們不僅通過增長機會來調整投資速度，我們認為這是巨大的增長機會，而且還通過我們整合有才能的員工和執行我們的目標的能力。

In closing, as we start 2019, our focus will be on, first, supporting adoption of da Vinci in general surgery and in key procedures in global markets.

最後，隨著我們開始 2019 年，我們的重點將首先放在支持在全球市場的普外科和關鍵手術中採用達芬奇。

Second, launching our SP and Ion platforms.

其次，啟動我們的 SP 和 Ion 平台。

Third, driving intelligent surgery innovation.

三是推動智能手術創新。

And finally, supporting additional clinical and economic validation in our focus procedures and countries.

最後，支持在我們的重點程序和國家/地區進行額外的臨床和經濟驗證。

I'll now turn the call over to Marshall to review financial highlights.

我現在將電話轉給 Marshall，以審查財務亮點。

Good afternoon.

下午好。

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

我將在非 GAAP 或備考基礎上描述我們的業績亮點。

I will also summarize our GAAP performance later in my script.

稍後我還將在我的腳本中總結我們的 GAAP 表現。

A reconciliation between our pro forma and GAAP results was posted on our website.

我們的備考結果和 GAAP 結果之間的對賬已發佈在我們的網站上。

Consistent with our preliminary press release on January 9, fourth quarter 2018 revenue was $1,047,000,000, an increase of 17% compared with $892 million for the fourth quarter of 2017 and an increase of 14% compared with third quarter revenue of $921 million.

與我們在 1 月 9 日發布的初步新聞稿一致，2018 年第四季度的收入為 10.47 億美元，與 2017 年第四季度的 8.92 億美元相比增長 17%，與第三季度的 9.21 億美元收入相比增長 14%。

Fourth quarter 2018 procedures increased approximately 19% compared with the fourth quarter 2017, and increased approximately 11% compared with last quarter.

2018 年第四季度的程序與 2017 年第四季度相比增加了約 19%，與上一季度相比增加了約 11%。

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 $539 million increased 18% with last year, which is lower than procedure growth, reflecting approximately $6 million of I&A repurchased from distributors in China and Taiwan in conjunction with transactions to go direct in both geographies and customer buying patterns, partially offset by increased usage of our advanced instruments.

儀器和附件收入為 5.39 億美元，比去年增長 18%，低於程序增長，反映出從中國和台灣的分銷商回購了大約 600 萬美元的 I&A 以及直接在兩個地區和客戶購買模式中的交易，部分被我們先進儀器的使用增加所抵消。

Instrument and accessory revenue realized per procedure was approximately $1,890, a decrease of 1% compared with the fourth quarter of 2017 and relatively unchanged compared with last quarter.

每個程序實現的儀器和附件收入約為 1,890 美元，與 2017 年第四季度相比下降 1%，與上一季度相比基本沒有變化。

Excluding the buyback of inventory from China and Taiwan, instrument and accessory revenue per procedure was similar to last year.

排除來自中國大陸和台灣的庫存回購，每項手術的儀器和配件收入與去年相似。

Systems revenue of $341 million increased 20% compared with the fourth quarter of 2017, primarily reflecting higher placements and higher lease related revenue.

與 2017 年第四季度相比，系統收入為 3.41 億美元，增長 20%，主要反映了更高的安置和更高的租賃相關收入。

We placed 290 systems in the fourth quarter of 2018 compared with 216 systems in the fourth quarter of 2017 and 231 systems last quarter.

我們在 2018 年第四季度放置了 290 個系統，而 2017 年第四季度為 216 個系統，上個季度為 231 個系統。

84 operating lease transactions representing 29% of total placements were completed in the current quarter, compared with 40 or 19% of total placements in the fourth quarter of 2017 and 58 or 25% of total placements last quarter.

本季度完成了 84 筆經營租賃交易，佔總配售量的 29%，而 2017 年第四季度為 40 筆或占總配售量的 19%，上季度為 58 筆或占總配售量的 25%。

Operating leases include some usage-based financing that we provide certain large hospitals.

經營租賃包括我們為某些大型醫院提供的一些基於使用的融資。

We believe that these usage-based financing alternatives align with customer objectives, enabling faster market expansion.

我們相信，這些基於使用情況的融資方案符合客戶目標，能夠加快市場擴張。

As of December 31, we have 350 operating leases outstanding and we realized approximately $16 million of revenue related to these arrangements in the quarter.

截至 12 月 31 日，我們有 350 個未完成的經營租賃，我們在本季度實現了與這些安排相關的收入約 1600 萬美元。

The proportion of these types of arrangements could increase in the long term and will be lumpy quarter-to-quarter.

從長遠來看，這些類型的安排的比例可能會增加，並且每個季度都會出現波動。

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

本季度 28% 的系統佈置涉及以舊換新，反映出客戶希望訪問或標準化我們的第四代技術。

This is approximately the same proportion as last quarter and last year.

這與上一季度和去年的比例大致相同。

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。

73% of the systems placed in the quarter were da Vinci Xis and 18% were da Vinci X systems, compared with 68% da Vinci Xis and 28% da Vinci Xs last quarter.

本季度放置的系統中有 73% 是 da Vinci Xis，18% 是 da Vinci X 系統，而上一季度這一比例為 68% da Vinci Xis 和 28% da Vinci Xs。

12 of the systems placed were SP systems.

放置的系統中有 12 個是 SP 系統。

Our installed base for the 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 $1.46 million, compared with $1.47 million last year and $1.45 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 146 萬美元，而去年為 147 萬美元，上季度為 145 萬美元。

The changes compared with prior periods primarily reflect the mix of systems.

與前期相比的變化主要反映了系統的組合。

Outside of the U.S., results were as follows: fourth quarter revenue outside of the U.S. of $307 million, increased 24% compared with the fourth quarter of 2017 and increased 25% compared with last quarter; OUS procedures grew approximately 24% compared with the fourth quarter of 2017 and increased 10% compared with the third quarter.

在美國以外，業績如下：第四季度美國以外的收入為 3.07 億美元，與 2017 年第四季度相比增長 24%，與上一季度相比增長 25%； OUS 程序與 2017 年第四季度相比增長了約 24%，與第三季度相比增長了 10%。

Outside the U.S., we placed 115 systems in the fourth quarter compared with 86 in the fourth quarter of 2017 and 75 systems last quarter.

在美國以外，我們在第四季度部署了 115 個系統，而 2017 年第四季度為 86 個，上季度為 75 個系統。

Current quarter system placements included 55 into Europe, 31 into Japan and 9 into Brazil.

當前季度的系統佈局包括 55 個進入歐洲、31 個進入日本和 9 個進入巴西。

35 of the 115 systems placed in the fourth quarter were X systems and 15 were operating leases.

第四季度放置的 115 個系統中有 35 個是 X 系統，15 個是經營租賃。

Placements outside of the U.S. will continue to be lumpy, as some of the OUS markets are in early stages of adoption.

由於一些 OUS 市場處於採用的早期階段，美國以外的安置將繼續起伏不定。

Some markets are highly seasonal, reflecting budget cycles or vacation patterns, and sales into some markets are constrained by government regulations.

一些市場具有很強的季節性，反映了預算週期或假期模式，並且某些市場的銷售受到政府法規的限制。

Moving on to gross margin and operating expenses.

轉向毛利率和運營費用。

The pro forma gross margin for the fourth quarter of 2018 was 71.8% compared with 72.4% for the fourth quarter of 2017 and 71.5% last quarter.

2018 年第四季度的備考毛利率為 71.8%，而 2017 年第四季度為 72.4%，上一季度為 71.5%。

The decrease compared with fourth quarter of 2017 primarily reflects product mix and costs associated with the new products.

與 2017 年第四季度相比的下降主要反映了與新產品相關的產品組合和成本。

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

未來的利潤率將根據我們新產品的組合而波動；系統和儀器及配件收入的組合；系統 ASP 以及我們進一步降低成本和提高製造效率的能力。

Pro forma operating expenses increased 31% compared with the fourth quarter of 2017 and increased 27% compared with last quarter.

備考營業費用較 2017 年第四季度增長 31%，較上一季度增長 27%。

Fourth quarter 2018 operating expenses included a $25 million contribution to the newly formed Intuitive Foundation.

2018 年第四季度的運營費用包括向新成立的 Intuitive Foundation 捐款 2500 萬美元。

The foundation is a charitable organization aimed at improving patient outcomes.

該基金會是一個旨在改善患者治療效果的慈善組織。

It will donate to qualified nonprofit academic organizations, directed at surgeon training and education, including fellowships, advanced clinical research and advanced robotics research.

它將捐贈給合格的非營利性學術組織，用於外科醫生培訓和教育，包括獎學金、高級臨床研究和高級機器人研究。

The $25 million will enable the foundation to make meaningful contributions over the next several years.

2500 萬美元將使基金會能夠在未來幾年做出有意義的貢獻。

Our pattern of future contributions will vary based on various factors, including the financial performance of the company and opportunities for the foundation to make meaningful contributions within its mission.

我們未來的貢獻模式將根據各種因素而有所不同，包括公司的財務業績和基金會在其使命範圍內做出有意義貢獻的機會。

Excluding the contribution to the foundation, pro forma operating expenses increased 21% compared with the fourth quarter of 2017.

剔除對基金會的貢獻，預計運營費用較 2017 年第四季度增長 21%。

The increase in fourth quarter expenses reflect: one, increased costs that fluctuate directly with revenue, including sales and corporate incentive compensation; two, costs we elected to accelerate, including spend on infrastructure in order to scale the business; and three, investments that drive our future opportunity, including costs associated with going direct in China, Taiwan, India and cost of prototypes.

第四季度費用的增加反映：一是直接隨收入波動的成本增加，包括銷售額和企業激勵薪酬；第二，我們選擇加速的成本，包括用於擴展業務的基礎設施支出；第三，推動我們未來機會的投資，包括與直接進入中國、台灣、印度相關的成本和原型成本。

We believe that we are early in our journey to expand minimally invasive surgery and feel the fundamentals in the business are strong.

我們相信，我們在擴大微創手術的旅程中處於早期階段，並且認為該業務的基礎是強大的。

So we are accelerating our investment in selected areas, while continuing to invest in key product areas, including SP, Ion, vision, and advanced instruments.

因此，我們正在加快對選定領域的投資，同時繼續投資關鍵產品領域，包括 SP、Ion、視覺和高級儀器。

We will accelerate spending on our informatics capabilities, expansion of our OUS markets including China, India and Taiwan, and investments that enable us to scale the business, including expansion of and automation of manufacturing.

我們將加快在信息學能力方面的支出，擴大包括中國、印度和台灣在內的 OUS 市場，以及使我們能夠擴大業務規模的投資，包括製造業的擴張和自動化。

We believe these are important investments.

我們認為這些都是重要的投資。

That said, we intend to control spending and headcount growth to that which we could manage well.

也就是說，我們打算將支出和員工人數增長控制在我們可以妥善管理的範圍內。

This leads us to a broad estimate of operating expense increase of 20% to 28% in 2019.

這使我們對 2019 年的運營費用增長 20% 至 28% 進行了廣泛估計。

Some spending naturally fluctuates with revenue and procedures like sales, production expenses and corporate incentive compensation.

一些支出自然會隨著收入和程序而波動，例如銷售、生產費用和企業激勵補償。

Other spending is longer-term in nature and positions us for future growth.

其他支出本質上是長期的，並為我們未來的增長奠定了基礎。

For example, SP, Ion and imaging.

例如，SP、離子和成像。

We would target to spend the lower end of the 20% to 28% range at the bottom end of procedure growth guidance.

我們的目標是將 20% 至 28% 範圍的下限花費在程序增長指導的底部。

We are investing with an eye towards long term for the company and the market, and as such, don't intend to modulate long-term investments in response to transient conditions.

我們的投資著眼於公司和市場的長期發展，因此不打算根據瞬態情況調整長期投資。

Our pro forma effective tax rate for the fourth quarter was 20%, compared with our expectations of 19% to 20%.

我們對第四季度的備考有效稅率為 20%，而我們的預期為 19% 至 20%。

Our tax rates will fluctuate with changes in the mix of U.S. and OUS income, changes in taxation made by local authorities and with the impact of onetime items.

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 fourth quarter 2018 pro forma net income was $353 million or $2.96 per share, compared with $305 million or $2.67 -- $2.60 per share for the fourth quarter of 2017 and $337 million or $2.83 per share for the third quarter of 2018.

我們 2018 年第四季度的備考淨收入為 3.53 億美元或每股 2.96 美元，而 2017 年第四季度為 3.05 億美元或 2.67 美元 - 每股 2.60 美元，2018 年第三季度為 3.37 億美元或每股 2.83 美元。

Excluding the Intuitive Foundation contribution, pro forma net income was $373 million or $3.13 per share.

不包括 Intuitive Foundation 的捐款，預計淨收入為 3.73 億美元或每股 3.13 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 fourth quarter of 2018, compared with GAAP net loss of $32 million or $0.28 per share for the fourth quarter of 2017 and GAAP net income of $293 million or $2.45 per share for the third quarter of 2018.

2018 年第四季度 GAAP 淨收入為 2.93 億美元或每股 2.45 美元，而 2017 年第四季度 GAAP 淨虧損為 3200 萬美元或每股 0.28 美元，第三季度 GAAP 淨收入為 2.93 億美元或每股 2.45 美元2018 年。

The GAAP net loss for the fourth quarter of 2017 reflects the impact of the Tax Act, while the fourth quarter of 2018 includes the $25 million contribution to the Intuitive Foundation.

2017 年第四季度的 GAAP 淨虧損反映了稅法的影響，而 2018 年第四季度包括對 Intuitive Foundation 的 2500 萬美元捐款。

The adjustments between pro forma and GAAP net income are outlined and quantified on our website and include excess tax benefits associated with employee stock awards, employee equity and IP charges and legal settlements.

備考和 GAAP 淨收入之間的調整在我們的網站上進行了概述和量化，包括與員工股票獎勵、員工股權和知識產權費用以及法律和解相關的超額稅收優惠。

We ended the quarter with cash and investments of $4.8 billion compared with $4.6 billion at September 30, 2018.

本季度末，我們的現金和投資為 48 億美元，而 2018 年 9 月 30 日為 46 億美元。

The increase generally reflects cash generated from operations, partially offset by investments in working capital and infrastructure.

這一增長通常反映了運營產生的現金，部分被營運資本和基礎設施投資所抵消。

In the quarter, we grew inventory by approximately $40 million to $409 million, representing approximately 4 months of inventory.

本季度，我們的庫存增加了約 4000 萬美元至 4.09 億美元，相當於約 4 個月的庫存。

We continue to build inventory to address the growth in the business as well as mitigate risks of disruption that could arise from trade, supplier and other matters.

我們繼續建立庫存以應對業務增長，並降低貿易、供應商和其他事項可能引起的中斷風險。

With the growth in the business and our focus on efficiency and scale, we expect our capital expenditures will increase to over $250 million in 2019.

隨著業務的增長以及我們對效率和規模的關注，我們預計我們的資本支出將在 2019 年增加到超過 2.5 億美元。

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 2019.

有了這個，我想把它交給卡爾文，他將審查程序性能和我們對 2019 年的展望。

Thank you, Marshall.

謝謝你，馬歇爾。

Our overall fourth quarter procedure growth was 19% compared to 17% during the fourth quarter of 2017 and 20% last quarter.

與 2017 年第四季度的 17% 和上一季度的 20% 相比，我們第四季度的總體程序增長率為 19%。

Our Q4 procedure growth was driven by 18% growth in U.S. procedures and 24% growth in OUS markets.

我們第四季度的程序增長是由美國程序增長 18% 和海外市場增長 24% 推動的。

Overall procedure growth for the full year 2018 was approximately 18% compared to 16% in 2017, comprised of 17% growth in the U.S. and 22% growth in OUS markets.

與 2017 年的 16% 相比，2018 年全年的總體程序增長約為 18%，其中美國增長 17%，海外市場增長 22%。

In the U.S., Q4 and full year procedure results were consistent with recent trends.

在美國，第四季度和全年的程序結果與近期趨勢一致。

Q4 growth was again driven by growth in U.S. general surgery and thoracic procedures, augmented by continued contributions from growth in mature, gynecologic and urologic procedures.

第四季度的增長再次受到美國普通外科和胸腔手術增長的推動，成熟的婦科和泌尿外科手術增長的持續貢獻進一步推動了增長。

For the full year, approximately 753,000 procedures were performed in the U.S. For the full year, 2018 U.S. general surgery procedures increased approximately 32% to 325,000 procedures.

全年，美國進行了大約 753,000 次手術。2018 年全年，美國普通外科手術增加了約 32%，達到 325,000 次。

Hernia repair, both ventral and inguinal, continued to contribute the most incremental cases in the quarter and year, with colorectal procedures continuing to show strong growth.

腹側和腹股溝疝修補術在本季度和年度繼續貢獻最多的增量病例，結直腸手術繼續顯示強勁增長。

Growth in practice-based procedures, including cholecystectomy and bariatric surgery, increased as the year progressed.

隨著時間的推移，基於實踐的手術（包括膽囊切除術和減肥手術）的增長有所增加。

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

在美國婦科領域，2018 年全年同比增長增至中等個位數，這得益於良性子宮切除術數量的增加。

Fourth quarter 2018 U.S. gynecology procedure growth was slightly above the full year growth rate, likely reflecting increasing seasonality in these benign procedures, partially offset by modest headwinds in hysterectomy for cancer, a mature category where da Vinci surgery is standard of care.

2018 年第四季度美國婦科手術增長略高於全年增長率，可能反映出這些良性手術的季節性增加，部分被癌症子宮切除術的適度逆風所抵消，這是一個成熟的類別，達芬奇手術是護理標準。

In the fourth quarter, we continued to see favorable surgical consolidation trends as our da Vinci surgery data indicate 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.

在第四季度，我們繼續看到有利的手術鞏固趨勢，因為我們的達芬奇手術數據表明執業的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更高數量的醫生進行。

Full year 2018 U.S. urology procedures grew approximately 8%.

2018 年全年美國泌尿外科手術增長了約 8%。

Q4 2018 growth was at a rate largely consistent with the full year results, driven by prostatectomy volumes.

受前列腺切除術數量的推動，2018 年第四季度的增長速度與全年業績基本一致。

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 fourth 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四季度再次穩定。

Full year 2018 OUS procedures grew 22%, consistent overall with 23% growth in 2017.

2018 年全年 OUS 程序增長了 22%，與 2017 年 23% 的增長總體一致。

Q4 OUS procedure growth trends were mostly in line with the full year results.

第 4 季度 OUS 程序增長趨勢與全年結果基本一致。

Fourth quarter OUS procedure volume grew approximately 24% compared with 21% for the fourth quarter of 2017 and 23% last quarter.

與 2017 年第四季度的 21% 和上一季度的 23% 相比，第四季度 OUS 手術量增長了約 24%。

Fourth 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 年第四季度 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。

Q4 procedure growth in Japan was consistent with Q3, at a rate over 40% as procedures were performed within the set of 12 additional procedures approved for reimbursement, effective April 1. Procedure growth in China, again, moderated in Q4, as da Vinci system capacity expansion was constrained by system quota requirements.

日本第四季度的手術增長與第三季度一致，增長率超過 40%，因為手術是在 4 月 1 日批准報銷的 12 種額外手術中進行的。由於達芬奇系統，中國的手術增長在第四季度再次放緩擴容受制於系統配額要求。

As Gary mentioned, over 1,500 peer reviewed clinical articles regarding da Vinci surgery were published in 2018 and over 16,000 have been published to date.

正如 Gary 提到的，2018 年發表了超過 1,500 篇關於達芬奇手術的同行評審臨床文章，迄今為止已發表超過 16,000 篇。

Each quarter, on these calls, we highlight certain recently published studies that we deem to be notable.

每個季度，在這些電話會議上，我們都會強調某些我們認為值得注意的最近發表的研究。

However, to gain a more complete understanding of the body of evidence, we encourage all stakeholders to thoroughly review the extensive detail of scientific studies that have been published over the years.

然而，為了更全面地了解證據，我們鼓勵所有利益相關者徹底審查多年來發表的科學研究的廣泛細節。

In December of 2018, a manuscript was published by the Journal of Gastric Cancer titled, "Clinical advantages of robotic gastrectomy for clinical stage I and II gastric cancer: A multi-institutional prospective single-arm study." This study was one of the largest multi-center prospective studies for gastric cancer, which included 330 patients across 15 institutions in Japan.

2018 年 12 月，《胃癌雜誌》發表了一篇題為“機器人胃切除術對臨床 I 期和 II 期胃癌的臨床優勢：一項多機構前瞻性單臂研究”的手稿。這項研究是最大的胃癌多中心前瞻性研究之一，其中包括日本 15 個機構的 330 名患者。

This study was designed to show the safety, effectiveness and economic efficiency of da Vinci surgery for gastric cancer and was in support of the MHLW's Senshin Iryo B process, which led to the recent addition of gastrectomy to reimburse status in Japan.

本研究旨在展示達芬奇胃癌手術的安全性、有效性和經濟效益，並支持 MHLW 的 Senshin Iryo B 過程，該過程導致日本最近將胃切除術納入報銷狀態。

The main hypothesis of the study was to demonstrate a reduction in morbidity associated with robotic surgery compared to laparoscopy.

該研究的主要假設是證明與腹腔鏡手術相比，機器人手術相關的發病率有所降低。

The hypothesis was confirmed as the results showed a reduction in the morbidity rate to 2.45% for robotic procedures compared to 6.4% for the historical lap control group.

該假設得到證實，因為結果顯示機器人手術的發病率降低至 2.45%，而歷史膝關節對照組的發病率為 6.4%。

Patient characteristics and surgical outcomes were compared between the prospective arm, the robotic group and the historical control, the laparoscopic group.

比較前瞻性手臂、機器人組和歷史對照腹腔鏡組的患者特徵和手術結果。

Preoperative differences were noted in both groups as the robotic group contained more patients of younger age but also contained more complex patients with higher co-morbid conditions.

兩組均注意到術前差異，因為機器人組包含更多年輕患者，但也包含更多合併症更高的複雜患者。

The robotic arm had lower clinical staging while no differences were noted in pathological staging between the groups.

機械臂的臨床分期較低，而各組之間的病理分期沒有差異。

In the directional analysis, the robotic-assisted cohort was noted to have significantly lower intraoperative blood loss.

在定向分析中，注意到機器人輔助隊列的術中失血量顯著降低。

Shorter duration of hospital stay, 9 days versus 13 days, with comparable operative time.

住院時間更短，分別為 9 天和 13 天，手術時間相當。

The office of the study concluded that the significant reduction in morbidity might help demonstrate reduced total cost of care of da Vinci surgery, to be likely the same amount as for laparoscopy.

該研究辦公室得出結論，發病率的顯著降低可能有助於證明達芬奇手術的總護理成本降低，可能與腹腔鏡手術的成本相同。

In conclusion, the robotic group reduced the morbidity rate when compared to the findings of the lap group.

總之，與搭接組的結果相比，機器人組降低了發病率。

Robotic surgery might be safe, feasible and effective for gastric cancer.

機器人手術治療胃癌可能是安全、可行和有效的。

I will now turn to our financial outlook for 2019.

我現在將談談我們對 2019 年的財務展望。

Starting with procedures.

從程序開始。

As described in our announcement earlier this month, 2018 total da Vinci procedures grew approximately 18% to roughly 1,037,000 procedures performed worldwide.

正如我們在本月早些時候的公告中所述，2018 年達芬奇手術總數增長了約 18%，在全球範圍內執行了約 1,037,000 例手術。

As communicated previously, during 2019, we anticipate full year procedure growth within a range of 13% to 17%.

如前所述，在 2019 年期間，我們預計全年手術增長率將在 13% 至 17% 之間。

We expect 2019 procedure growth to continue to be driven by U.S. general surgery and procedures outside of the United States, where we are still in the early stages of adoption.

我們預計 2019 年的程序增長將繼續受到美國普通外科和美國以外程序的推動，我們仍處於採用的早期階段。

We expect similar seasonal timing of procedures in 2019 as we've experienced in previous years, with Q1 being the seasonally weakest quarter as patient deductibles are reset.

我們預計 2019 年的程序季節性時間與往年類似，第一季度是季節性最弱的季度，因為患者免賠額被重置。

With respect to revenue, as we have mentioned previously, capital sales are ultimately driven by procedure growth, catalyzing hospitals to establish or expand robotic system capacity.

關於收入，正如我們之前提到的，資本銷售最終是由程序增長驅動的，從而促使醫院建立或擴大機器人系統容量。

Capital sales can vary substantially from period-to-period based upon many factors, including U.S. health care policy, hospital capital spending cycles, reimbursement and government quotas, product cycles, economic cycles and competitive factors.

根據許多因素，包括美國醫療保健政策、醫院資本支出週期、報銷和政府配額、產品週期、經濟周期和競爭因素，資本銷售在不同時期可能會有很大差異。

Within this framework, we'd expect 2019 capital placement seasonality to generally follow historical patterns by quarter.

在此框架內，我們預計 2019 年的資本配售季節性將總體上按季度遵循歷史模式。

During the fourth quarter of 2018, 84 of the 290 or 29% of the systems shipped were under operating leases.

2018 年第四季度，290 個系統中有 84 個或 29% 屬於經營租賃。

We expect that the proportion of systems placed via operating leases will vary from quarter-to-quarter and could trend up in the future.

我們預計通過經營租賃放置的系統比例將因季度而異，並可能在未來呈上升趨勢。

Turning to gross profit.

轉向毛利。

Our full year 2018 pro forma gross profit margin was 71.5%.

我們 2018 年全年的備考毛利率為 71.5%。

In 2019, we expect our pro forma gross profit margin to be within a range of between 70% and 71% of net revenue.

2019 年，我們預計我們的備考毛利率將在淨收入的 70% 至 71% 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。

As Gary and Marshall outlined, we will be following through on and expanding our investments in 2019.

正如 Gary 和 Marshall 所概述的那樣，我們將在 2019 年繼續並擴大我們的投資。

We expect to grow pro forma 2019 operating expenses between 20% and 28%, above 2018 levels.

我們預計 2019 年的備考運營費用將比 2018 年增長 20% 至 28%。

We expect our noncash stock compensation expense to range between $310 million and $340 million in 2019 compared to $261 million in 2018.

我們預計 2019 年我們的非現金股票補償費用將在 3.1 億美元至 3.4 億美元之間，而 2018 年為 2.61 億美元。

We expect other income, which is comprised mostly of interest income, to total between $120 million and $130 million in 2019.

我們預計 2019 年主要由利息收入組成的其他收入總額將在 1.2 億美元至 1.3 億美元之間。

With regard to income tax, consistent with our 2018 results, we estimate our 2019 pro forma income tax rate to be between 19% and 20% of pretax income.

關於所得稅，與我們 2018 年的結果一致，我們估計我們 2019 年的備考所得稅稅率在稅前收入的 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) And our first question will be from the line of David Lewis, Morgan Stanley.

（操作員說明）我們的第一個問題將來自摩根士丹利的大衛劉易斯。

Maybe I'll start financial then work to Gary for strategic.

也許我會開始財務工作，然後為 Gary 工作以進行戰略工作。

So just, Marshall, and maybe a little bit for Gary as well.

所以，馬歇爾，也許加里也有一點。

Just thinking about the spending breakdown for 2019, 2 questions and then I'll just do one follow-up.

想想 2019 年的支出細目，2 個問題，然後我會做一個跟進。

On financial pieces, Marshall, any sense of R&D relative to SG&A?

在財務方面，Marshall，與 SG&A 相關的研發有何意義？

We're sort of assuming you continue to grow R&D at a similar rate to 2018 and the material step-up in spending relative to our model's more SG&A?

我們假設您繼續以與 2018 年相似的速度增長研發，並且相對於我們模型的更多 SG&A 而言，支出的實質性增加？

And can you just sort of walk us through a couple of the components there in R&D and SG&A that are driving the majority of the spend.

你能不能給我們介紹一下研發和 SG&A 中推動大部分支出的幾個組成部分。

And then I had a quick follow up for Gary.

然後我對加里進行了快速跟進。

Yes, I think the step-up in spend is maybe slightly weighted towards SG&A but pretty even across the categories.

是的，我認為支出的增加可能略微偏重於 SG&A，但在各個類別中相當均衡。

The elements of SG&A are, as I discussed, the expansion OUS and the investments we're making in China, India and Taiwan, those are commercial organizations and that appears in SG&A.

正如我所討論的，SG&A 的要素是 OUS 的擴張以及我們在中國、印度和台灣進行的投資，這些都是商業組織，並且出現在 SG&A 中。

Of course, SG&A will grow a lot of the costs that fluctuate with revenue such as sales compensation and incentive compensations flow through SG&A.

當然，SG&A 會增加很多隨收入波動的成本，例如通過 SG&A 流動的銷售補償和激勵補償。

However, in the R&D area, we will continue to invest in SP, Ion, and vision and advanced instruments.

但在研發方面，我們會繼續在SP、Ion、Vision和先進儀器上進行投資。

And then as I said, we'll be accelerating some of our investments in digital capabilities or informatics.

然後正如我所說，我們將加快對數字能力或信息學的一些投資。

Okay, very helpful, Marshall.

好的，很有幫助，馬歇爾。

And then Gary, there's been some media reports about one of your competitors drawing [instruments] from a much larger company and I'd say barriers to entry is perhaps the most common incoming question we get from investors.

然後加里，有一些媒體報導說你的一個競爭對手從一家更大的公司那裡獲得[工具]，我想說進入壁壘可能是我們從投資者那裡得到的最常見的問題。

So I wonder if you could help us articulate what is the Intuitive moat as you see it?

所以我想知道您是否可以幫助我們闡明您所看到的直覺護城河是什麼？

Or are investors asking the wrong question?

還是投資者問錯了問題？

And they should be more focused on TAM expansion?

他們應該更專注於 TAM 擴張？

I think a little bit of both that are going on, I think in the competitive world.

我認為在競爭激烈的世界中，兩者都在發生。

On the first side, how are customers are going to choose, I think customers appreciate choice and will expect it from us and from others and I think they'll evaluate competitive offerings.

在第一方面，客戶將如何選擇，我認為客戶喜歡選擇，並期望我們和其他人提供選擇，我認為他們會評估競爭產品。

For us, we focus a lot on understanding what the workflow environment is, understanding the total cost, not just the constituent cost of price of the system or price of the instruments and accessories, it's really total cost to use the product.

對我們來說，我們非常注重了解什麼是工作流程環境，了解總成本，而不僅僅是系統價格或儀器和配件價格的組成成本，它實際上是使用產品的總成本。

Stability, usability, supply chain stability, all of those things, I think, are valued when people are putting a fair amount of their surgical volume onto a platform and I think it will take some time for folks to fully absorb and understand that.

穩定性、可用性、供應鏈穩定性，我認為，當人們將相當數量的手術量放到平台上時，所有這些都會受到重視，我認為人們需要一些時間才能完全吸收和理解這一點。

And I think also, there's some nice effects about surgeons training surgeons.

我還認為，外科醫生培訓外科醫生有一些很好的效果。

There's a large installed base of surgeons, they interact with each other through surgical societies.

有大量的外科醫生，他們通過外科協會相互交流。

They proctor each other and I think that, that allows a compound cycle of learning that's been effective.

他們互相督促，我認為，這可以形成一個有效的複合學習循環。

To the question of, what does it do as some of the other larger competitors declare their desire to enter.

對於這個問題，當其他一些較大的競爭對手宣布他們希望進入時，它會做什麼。

I do think it validates, for the broader market, the things we believed for many years, and have been investing towards for many years.

我確實認為，對於更廣闊的市場，它證實了我們多年來相信的事情，並且多年來一直在投資。

So I think it's a signal to everybody that these technologies and approaches are going to be important to the future.

所以我認為這向每個人發出信號，表明這些技術和方法對未來很重要。

That said, there are smart people in all these organizations and outside of our company.

也就是說，所有這些組織和我們公司之外都有聰明人。

And we'll see.

我們拭目以待。

We have evaluated many of the competitive concepts that we see out there, often making them for ourselves and evaluating them over the years.

我們已經評估了我們在那裡看到的許多競爭概念，經常為我們自己製作它們並在多年來進行評估。

We really make our decisions based on what we think the customer needs in as a forward look, and as a result, I think we may be wrong about some of our decisions but we've tried to be well informed about our decisions.

我們確實是根據我們認為客戶需要的前瞻性來做出決定，因此，我認為我們的某些決定可能是錯誤的，但我們已經盡力了解我們的決定。

And our next question is from the line of Bob Hopkins, Bank of America.

我們的下一個問題來自美國銀行的鮑勃霍普金斯。

I have sort of 2 similar lines of questioning here.

我在這裡有兩條類似的問題。

First, just to follow-up a little bit on the comments on spend in 2019.

首先，只是跟進一下關於 2019 年支出的評論。

For '18, there was a 17% increase.

對於 18 年，增長了 17%。

For '19, you're talking about a -- at the midpoint, a 24% increase.

對於 19 年，你說的是——在中點，增長 24%。

I mean, that's roughly $75 million.

我的意思是，這大約是 7500 萬美元。

I was wondering if you could kind of lay out, how much of that is the investment in China and Taiwan and going direct?

我想知道你是否可以佈局一下，其中有多少是在中國大陸和台灣的投資以及直接投資？

And then also, how would you just sort of characterize that incremental $75 million and the growth rate you're experiencing this year?

然後，您如何描述增加的 7500 萬美元和您今年的增長率？

Is this more of kind of onetime increase in the growth of expenses?

這是否更像是一種一次性的支出增長？

Or could this be sort of a growth rate that we'd experience for another couple of years?

或者這可能是我們未來幾年會經歷的某種增長率嗎？

Yes.

是的。

So I think, Bob, these are multiyear investments and as Gary referred to in his script, if you go back and you look at sort of what we said we did in Japan, the investments were made early on and -- but you continue to make those investments over time to get to a point of where you might see a real return from them.

所以我認為，鮑勃，這些是多年投資，正如加里在他的劇本中所提到的，如果你回頭看看我們所說的我們在日本所做的事情，這些投資是在早期進行的——但你會繼續隨著時間的推移進行這些投資，以達到您可能會從中看到真正回報的程度。

And in the case of Japan, we've been investing in Japan for 10 years and we're now seeing the fruits of that investment in terms of a 12-procedure reimbursement.

就日本而言，我們已經在日本投資了 10 年，現在我們看到了 12 項程序報銷方面的投資成果。

So I wouldn't characterize these as a onetime event.

所以我不會將這些描述為一次性事件。

I think, we'll continue to invest in some of those things for quite some time.

我認為，我們將在相當長的一段時間內繼續投資其中的一些東西。

As far as how this -- you came up with $75 million, how the -- how you would proportion the pieces, I think I pretty much laid it out for David.

至於這個 - 你想出了 7500 萬美元，你如何 - 你將如何分配這些部分，我想我已經為大衛做好了準備。

There's a chunk of spending associated with the expansion OUS in China, India and Taiwan that will -- you'll see that primarily in the SG&A line.

與中國、印度和台灣的 OUS 擴張相關的大量支出將——您將主要在 SG&A 系列中看到。

But there's an equal set of investments being made in terms of informatics as well as investments to scale the business, investments in expansion and automation of the manufacturing group, so.

但是，在信息學方面進行了一系列投資，以及擴大業務的投資、對製造集團擴張和自動化的投資，所以。

Okay, I appreciate that.

好的，我很感激。

And then one for Gary.

然後一個給加里。

Just a question on competition, I'll frame it just a little bit differently.

只是一個關於競爭的問題，我會稍微改變一下。

J&J, Medtronic both continue to suggest that sometime late in 2020, they'll bring some sort of technology to the market in robotic form.

強生、美敦力都繼續表示，在 2020 年晚些時候，他們將以機器人的形式將某種技術推向市場。

They both suggested they're going to have lower-cost systems.

他們都表示他們將擁有成本更低的系統。

They haven't given us much details but in my view, both have sort of implied that their systems will be geared towards converting lap-focused surgeons to robotic platform.

他們沒有給我們提供太多細節，但在我看來，兩者都暗示他們的系統將致力於將專注於大腿的外科醫生轉變為機器人平台。

So my question to you is, I realize you don't comment much on your pipeline, but I was just curious if you could comment, do you see potential value in advancing lap through robotics?

所以我要問你的問題是，我知道你對你的管道沒有太多評論，但我只是想知道你是否可以發表評論，你是否看到通過機器人技術推進單圈的潛在價值？

And is this a priority for Intuitive today?

這是今天 Intuitive 的優先事項嗎？

I do believe that some advanced MIS surgeons are becoming increasingly open to the use of robotic surgery and intelligent surgery.

我相信一些先進的 MIS 外科醫生對機器人手術和智能手術的使用越來越開放。

And we see it today in the market.

我們今天在市場上看到了它。

We see bariatric surgeons interested in our technologies and that's a domain that is high laparoscopic penetration.

我們看到減肥外科醫生對我們的技術感興趣，這是一個高腹腔鏡滲透率的領域。

So I believe there's an opportunity there.

所以我相信那裡有機會。

I would separate the idea of capital being the only thing to think about as an opportunity to pursue that growing idea in advanced laparoscopy.

我會把資本的想法分開考慮，作為在高級腹腔鏡檢查中追求不斷發展的想法的機會。

And what I'd say is that I think physicians are going to balance multiple criteria.

我要說的是，我認為醫生會平衡多個標準。

They're going to look at total cost to treat.

他們將研究治療的總成本。

So the capital, the cost to the service that capital, the instruments and accessories, the outcomes that they get from it, efficiencies in human capital time -- or human labor time in the OR and they're going to balance that.

因此，資本、資本、儀器和配件的服務成本、他們從中獲得的結果、人力資本時間的效率——或 OR 中的人力勞動時間，他們將平衡這些。

And I think all of those are up for discussion when you think about trade-offs between advanced laparoscopy and intelligent surgery.

當您考慮在先進的腹腔鏡檢查和智能手術之間進行權衡時，我認為所有這些都值得討論。

We think there's an opportunity there.

我們認為那裡有機會。

We will pursue that opportunity.

我們將抓住這個機會。

When I hear folks kind of over-rotate to just capital costs on systems, I kind of think about how excited are people to jump aboard a just-good-enough commercial airliner.

當我聽到人們有點過度轉向系統的資本成本時，我有點想人們跳上一架剛好夠用的商業客機是多麼興奮。

For sure, if you're flying commercial airline, you want the lowest total cost per passenger mile but you can get that a lot of different ways, and cheapening the capital, maybe not the best way.

可以肯定的是，如果您乘坐的是商業航空公司，您希望每乘客英里的總成本最低，但您可以通過很多不同的方式實現這一點，並且降低資本成本，也許不是最好的方式。

We evaluate all of those elements, we've thought about them deeply and we've made investments to pursue what we think is the right leadership position here.

我們評估了所有這些要素，我們對它們進行了深入思考，並進行了投資以追求我們認為在這裡的正確領導地位。

Our next question is from the line of Tycho Peterson, JPMorgan.

我們的下一個問題來自摩根大通的第谷彼得森。

I want to maybe just pick up where you left off on some of these new initiatives.

我想也許只是繼續你在這些新計劃中停下來的地方。

You talked about the first clinical use case for augmented reality this year.

你談到了今年增強現實的第一個臨床用例。

Can you talk a little bit about how you think about commercializing that, where you see the key application areas?

您能談談您如何考慮將其商業化，以及您看到的關鍵應用領域嗎？

And then similarly, on the informatics investments, can you talk a little bit about what you're hoping to accomplish there?

然後類似地，在信息學投資方面，你能談談你希望在那裡實現的目標嗎？

Sure, those two are related but we'll start with augmented reality or mixed reality, and that's something we have been working on for some time and the world has been interested in.

當然，這兩者是相關的，但我們將從增強現實或混合現實開始，這是我們已經研究了一段時間並且全世界都感興趣的東西。

The idea here is to use multiple sources of information.

這裡的想法是使用多個信息源。

Preoperative: CT scans or MRI scans; intraoperative: other imaging like ultrasound or fluorescence imaging, molecular imaging, and combine them in ways that allow the surgeon or physician to see things differently.

術前：CT掃描或MRI掃描；術中：其他成像，如超聲或熒光成像、分子成像，並以允許外科醫生或醫生以不同方式看待事物的方式將它們結合起來。

It is embedded and inherent in Ion already, that some of that core capability is required.

Ion 已經嵌入和固有，需要一些核心功能。

We're also bringing some of that core capability to our da Vinci systems.

我們還將一些核心功能引入我們的達芬奇系統。

In the beginning, it will be around preoperative imaging and some intraoperative imaging mixed together for the surgeon in real-time.

一開始，它將圍繞術前成像和一些術中成像實時混合在一起，供外科醫生使用。

First, I'd expect first clinical uses this year and the beginnings of the study that go around that.

首先，我預計今年將首次用於臨床，並開始圍繞該研究展開研究。

I don't think it will be a meaningful revenue contributor in the near term, but I think it's one of the things that can really change outcomes.

我不認為它在短期內會成為有意義的收入貢獻者，但我認為這是真正可以改變結果的事情之一。

Efficiency in the procedure and outcomes, now that remains to be proven, but we're excited about it.

程序和結果的效率，現在仍有待證明，但我們對此感到興奮。

That's one leg of our thoughts around informatics and you've heard us talk about this over the years from strengthening our cloud computing capabilities.

這是我們圍繞信息學思考的一個方面，多年來您已經聽到我們通過加強我們的雲計算能力來談論這個問題。

We Internet-connected our systems a decade ago to a partnership and then an increased and closer investment with InTouch Health around routing of data quickly in low latency and real-time, to internal capabilities around managing data lakes and providing for customers, off-line processing that allows them to compare their programs and take advantage of some advances in machine learning.

十年前，我們將我們的系統連接到互聯網以建立合作夥伴關係，然後與 InTouch Health 進行更多和更密切的投資，圍繞低延遲和實時快速路由數據，以及管理數據湖和為客戶提供離線服務的內部功能處理，使他們能夠比較他們的程序並利用機器學習的一些進步。

Those are the types of elements that we're bringing to bear.

這些是我們要承受的元素類型。

It's nice, we have a foothold, we have some brilliant scientists who are advancing and leading that cause and we think we have discrete, deliverable steps that we can do and then validate, that will start bringing real value to the market.

這很好，我們有一個立足點，我們有一些傑出的科學家正在推進和領導這一事業，我們認為我們有離散的、可交付的步驟，我們可以執行這些步驟然後進行驗證，這將開始為市場帶來真正的價值。

And then I guess, a follow-up on Ion, a couple of questions here.

然後我想，Ion 的後續行動，這裡有幾個問題。

Any risk of timelines slipping with the government shutdown, I mean, now that you've submitted the 510(k)?

我的意思是，既然您已經提交了 510(k)，政府關門是否會導致時間表下滑？

And then should we expect additional clinical data to come out this year?

那麼我們是否應該期待今年會出現更多的臨床數據？

And it sounds like, for the gross margin commentary, you're not expecting any real impacts on -- negative impact on gross margins with the roll out, can you confirm that?

聽起來，對於毛利率評論，您預計不會對毛利率產生任何實際影響 - 推出後對毛利率產生負面影響，您能證實嗎？

Let me speak to the first 2 and I'll let Marshall speak to the last one on margin.

讓我對前 2 位發言，我將讓 Marshall 對最後一位發言。

There's always a risk that things slow down.

事情總是有放緩的風險。

We are in engaged contact with FDA.

我們正與 FDA 保持聯繫。

And so far, we're feeling pretty good about it but I can't speak to what the long-term implications will be in terms of shutdown dynamics.

到目前為止，我們對此感覺非常好，但我不能說關閉動態方面的長期影響是什麼。

In terms of clinical data, there'll be, if things proceed the way we hope, we'll start collecting additional data as they comes out.

在臨床數據方面，如果事情按照我們希望的方式進行，我們將開始收集額外的數據。

In terms of when that gets published, I think it will depend on the timing of the clearance and the speed with which some of the installs happen.

就何時發布而言，我認為這將取決於許可的時間和某些安裝發生的速度。

We think that the demand pipeline for Ion looks really good.

我們認為 Ion 的需求管道看起來非常好。

The scientific response to FDA's questions, we feel good about.

對FDA問題的科學回應，讓我們感到欣慰。

And the engineering team and supply chain team bringing those early systems up looks really good, too.

啟用這些早期系統的工程團隊和供應鏈團隊看起來也非常好。

So I'm really pleased with the internal team's performance and the set up of the activities.

所以我對內部團隊的表現和活動的安排非常滿意。

With regard to margin impact, Marshall?

關於利潤率影響，馬歇爾？

Yes, Ion will be rolled out in a measured fashion to create a good foundation.

是的，Ion 將以審慎的方式推出，以打下良好的基礎。

And so the consequences of -- both on the revenue and the gross margin line will be very small.

因此，對收入和毛利率的影響將非常小。

Okay, and if I could just ask one last one.

好的，如果我可以問最後一個。

On the cadence of placements in China you're expecting, now that you've had a little bit of time to digest the quota, anything to think about in the first half of the year here?

關於您期望的中國安置節奏，既然您已經有一點時間來消化配額，那麼今年上半年這裡有什麼要考慮的嗎？

Yes.

是的。

So the quota, just to recap for everybody, 154 systems.

所以配額，只是給大家總結一下，154 個系統。

Keep in mind that 154 systems is for surgical robots.

請記住，154 系統適用於手術機器人。

If there were to be competitors that got their product approved in China, they would share in that quota.

如果有競爭對手的產品在中國獲得批准，他們將分享該配額。

So it's not just a quota for us.

所以這不僅僅是我們的配額。

The quota has been released.

配額已經釋放。

However, there are tendering processes that the hospitals have to go through, just to remind you the last time we got a quota in 2013, most of the systems were shipped near the end of 2015, so it took a while.

然而，醫院必須經過招標程序，提醒您我們上次在 2013 年獲得配額時，大部分系統是在 2015 年底附近發貨的，所以需要一段時間。

The -- what I would say -- and then finally, the other implication is that there was a 25% tariff on the robots that the Chinese have imposed.

我要說的是——最後，另一個含義是中國對機器人徵收 25% 的關稅。

We think that there's high interest in robotics in China.

我們認為中國對機器人技術很感興趣。

So I don't know what that 25% -- how that 25% will affect their desire to buy.

所以我不知道那 25% 是什麼——這 25% 將如何影響他們的購買慾望。

What I would say is that the pattern of placements will be few in the first half and more near the end of the quota period, which is 2020.

我要說的是，上半年的配額模式會很少，而在配額期末尾，即 2020 年，配額會更多。

Our next question is from the line of Larry Biegelsen, Wells Fargo.

我們的下一個問題來自富國銀行的 Larry Biegelsen。

One on SP and one strategic question for you, Gary.

一個關於 SP 和一個戰略問題給你，加里。

So on SP, I heard the commentary upfront, about a few hundred procedures.

所以在 SP 上，我提前聽到了評論，大約有幾百個程序。

Any themes you would highlight?

你會強調什麼主題？

And remind us again of when we can expect the full launch.

並再次提醒我們何時可以期待全面發布。

With regard to early themes, the feedback has been that usability on the new platform, it's got a little slightly different set of operating principles, has been a positive surprise.

關於早期主題，反饋是新平台的可用性，它的操作原則略有不同，令人驚喜。

The -- also, the physician excitement about its ability to reach into small places and some of the flexibility it exhibits relative to setup and access has been a really positive surprise for us, which has been great.

同樣，醫生對其能夠進入小地方的能力以及它在設置和訪問方面表現出的一些靈活性感到興奮，這對我們來說是一個非常積極的驚喜，這非常棒。

So that's been good, I think pacing, demand looks really good.

所以這很好，我認為節奏，需求看起來非常好。

We're, for sure, supply constrained, relative to demand.

可以肯定的是，相對於需求，我們的供應受到限制。

And the pacing there will really be around a couple of things: one, is we want to get our supply chain partners ready for real volumes so we've knocked down some of the issues that make it -- take them a while to produce things, we want to solve some of the manufacturing bottlenecks.

那裡的節奏真的圍繞著幾件事：第一，我們想讓我們的供應鏈合作夥伴為真正的數量做好準備，所以我們已經解決了一些導致它的問題——讓他們花點時間來生產東西，我們要解決一些製造瓶頸。

The second thing is we want some of the additional indications that give our customers a little more flexibility with how they can use the product.

第二件事是我們想要一些額外的指示，讓我們的客戶在如何使用產品方面有更多的靈活性。

So that will pace it, we don't have a timeline yet for you on those 2 things.

因此，這將加快步伐，我們還沒有關於這兩件事的時間表。

Both of them have a little bit of uncertainty in them, with the FDA review of submissions being one and working down some of the technical bottlenecks is the other.

兩者都有一點不確定性，FDA 對提交的審查是一個，解決一些技術瓶頸是另一個。

I don't see any insurmountable technical challenges, I think it's just work.

我沒有看到任何無法克服的技術挑戰，我認為這只是工作。

But so far, so good, and we're feeling like they're meeting the plan we set.

但到目前為止，一切都很好，我們感覺他們正在實現我們設定的計劃。

And Gary, as you know, we're seeing procedures in the U.S. moving to the outpatient and ASC settings.

加里，正如你所知，我們看到美國的程序正在轉向門診和 ASC 設置。

Do you believe your current Gen 4 offering and leasing option provide adequate terms for expansion into this environment?

您認為您當前的第 4 代產品和租賃選項是否為擴展到該環境提供了足夠的條件？

When you think about freestanding centers, there's kind of 2 dimensions on which you think about freestanding surgery centers.

當您考慮獨立式手術中心時，您會從兩個方面考慮獨立式手術中心。

One of them are hospital-owned outpatient departments.

其中之一是醫院擁有的門診部。

We are already well used and appreciated in those settings.

我們已經在這些環境中得到很好的使用和讚賞。

So that's the physical structure is kind of the same.

所以這就是物理結構是一樣的。

It's just how the ownership and operations are organized.

這就是所有權和運營的組織方式。

Freestanding centers that are owned by group practices, not hospital owned, have a little bit different reimbursement and economics.

由團體執業而非醫院擁有的獨立中心的報銷和經濟狀況略有不同。

We actually do see some of them starting to express interest and adopt robotics.

我們確實看到他們中的一些人開始表達興趣並採用機器人技術。

I think that -- as we were saying earlier in the call, which procedures go there depends both on the reimbursement of the procedure and the efficiencies with which products get used.

我認為——正如我們早些時候在電話會議中所說的那樣，去那裡執行哪些程序取決於程序的報銷和產品使用的效率。

And I think that for the right settings, Gen 4 can be quite strong.

而且我認為對於正確的設置，第 4 代可以非常強大。

Our next question is from the line of Amit Hazan, Citigroup.

我們的下一個問題來自花旗集團的 Amit Hazan。

Let me just start with system or a unit growth question first.

讓我先從系統或單位增長問題開始。

Totally understanding the macro comments you made about that, but if I look at the data, look at the numbers, second year of accelerating growth, lots of drivers kind of seeming to be accelerating at the same time, trade-ins, operating leases, new products, procedure growth accelerating.

完全理解你對此的宏觀評論，但如果我看一下數據，看看數字，加速增長的第二年，許多驅動因素似乎同時在加速，以舊換新，經營租賃，新產品、流程增速加快。

So a lot's happening that's accelerating.

所以很多事情正在加速發生。

And after that, very little, really nothing to tell me that growth trends are going to change that much.

在那之後，幾乎沒有任何跡象表明增長趨勢會發生如此大的變化。

So help me out and tell me, outside of the macro issues, why would unit growth trends change much in 2019?

那麼請幫我告訴我，除了宏觀問題之外，為什麼 2019 年的單位增長趨勢會發生很大變化？

Yes, I mean regarding procedures, like we said in the prepared comments, it's really the procedure growth that drives demand for capital placements.

是的，我的意思是關於程序，就像我們在準備好的評論中所說的那樣，實際上是程序的增長推動了對資本配售的需求。

You mentioned a number of other factors, things like trade-ins, leasing programs, new product introductions.

您提到了許多其他因素，例如以舊換新、租賃計劃、新產品介紹等。

Things like that can have an effect on the results either but we talk about these things possibly fluctuating quarter-to-quarter and it comes down to just laying out your model and your frame of thought and working backwards from the installed base and working at the installations.

諸如此類的事情也會對結果產生影響，但我們談論的這些事情可能會隨季度波動，歸根結底就是佈置你的模型和你的思維框架，並從已安裝的基礎向後工作，並在安裝。

But there's a lot of -- the factors you described, are what's in the world.

但是有很多 - 你描述的因素是世界上的。

And mature procedures will moderate growth for sure.

成熟的程序肯定會適度增長。

And we also know that in some cases, for example, there was a publication of a couple of articles about cervical cancer in New England Journal and that can change procedure growth rates too.

我們也知道，在某些情況下，例如，在新英格蘭雜誌上發表了幾篇關於宮頸癌的文章，這也可以改變手術的增長率。

So -- and create a headwind.

所以 - 並製造逆風。

So there's a little bit of puts and takes here.

所以這裡有一些 puts 和 takes。

In general, we are feeling like the business is strong and there's strong momentum but there are some things that will moderate as well.

總的來說，我們感覺業務很強勁，勢頭強勁，但有些事情也會有所緩和。

And I thought I'd follow-up on the operating lease side.

我想我會在經營租賃方面跟進。

In the U.S. in particular, where, obviously, I think it's up above 30% of units sold in '18.

特別是在美國，很明顯，我認為它在 18 年銷量中所佔比例超過 30%。

I think it was 20% of units sold in '17.

我認為這是 17 年售出單位的 20%。

So we're starting to see kind of a trend line.

所以我們開始看到某種趨勢線。

And I do get what you're saying with volatility.

我確實明白你所說的波動性。

But the question, I think, for us, especially as we start to model or try to model your system revenue number accurately for the year, is how to think about that trend for '19 and even '20.

但我認為，對我們來說，問題是如何考慮 19 年甚至 20 年的趨勢，尤其是當我們開始建模或嘗試準確建模您的系統收入數字時。

It seems like you're focusing more on it, you're offering more programs and that trend line could continue so we could kind of be towards the mid-30% to 40% range in the U.S. in '19.

看起來你更關注它，你提供了更多的項目，而且這條趨勢線可能會繼續下去，所以我們在 19 年可能會在美國達到 30% 到 40% 的中間範圍。

Are there other things that I should be considering for why that wouldn't happen?

是否還有其他事情我應該考慮為什麼不會發生？

Well, it's been a successful program.

嗯，這是一個成功的計劃。

I mean, it's been a way for us to offer hospitals an opportunity to expand their capacities without the initial capital investment.

我的意思是，這是我們為醫院提供機會來擴大其能力而無需初始資本投資的一種方式。

So it's been very successful.

所以它非常成功。

I'm not sure the numbers completely jive with what you said.

我不確定這些數字是否與您所說的完全吻合。

We were 25% of placements in Q3 and 29% in Q4 were under operating leases.

我們在第三季度和第四季度分別有 25% 和 29% 的配售屬於經營租賃。

So you saw that step up quite a bit in the last couple of quarters.

所以你在過去幾個季度看到了相當大的進步。

And so our comments are like, okay, we're here now, it's likely to fluctuate quarter-to-quarter from where we ended the year.

所以我們的評論就像，好吧，我們現在就在這裡，它可能會從我們年底的季度到季度波動。

And then over the long term, it could increase.

然後從長遠來看，它可能會增加。

We believe that operating leases are a good thing.

我們認為經營租賃是一件好事。

We would, if having the choice, place a system under an operating lease rather than sell the system.

如果有選擇的話，我們會以經營租賃的方式放置一個系統，而不是出售該系統。

It reduces its fluctuation, like you said, it stabilizes sort of the revenue stream, if you will.

它減少了它的波動，就像你說的，它穩定了某種收入流，如果你願意的話。

It also -- and in terms of if there were an upgrade cycle, what we've seen in studies is that the upgrade cycle is quicker when there's leases versus purchased product.

它還 - 就是否存在升級週期而言，我們在研究中看到的是，當有租賃產品而不是購買產品時，升級週期更快。

So we think it's positive in a number of ways.

所以我們認為它在很多方面都是積極的。

However, it's up to customers.

但是，這取決於客戶。

We really leave it to customers to decide what is best for them and we will fulfill that.

我們真的讓客戶來決定什麼對他們最好，我們會實現這一點。

And so it's hard for this to predict exactly where the customer will go and to what level we'll wind up with leases versus purchase.

因此，很難準確預測客戶的去向以及租賃與購買的最終結果。

Our next questions from the line of Rick Wise, Stifel.

我們的下一個問題來自 Stifel 的 Rick Wise。

Gary, maybe turning back to the acquisition of your da Vinci business in India and Taiwan again.

加里，也許會再次回到收購你在印度和台灣的達芬奇業務。

I heard you clearly, these are long-term investments that will take a long time to play out.

我聽你說得很清楚，這些是長期投資，需要很長時間才能發揮作用。

I'd be curious to hear more about your thoughts about the relative size of the opportunities in India and Taiwan.

我很想知道更多關於您對印度和台灣機會的相對規模的看法。

Is this sort of -- you mentioned Japan as a proxy a little bit, but do India and Taiwan match up with China and Japan in terms of magnitude?

這是不是——你提到日本作為代理，但印度和台灣在規模上是否與中國和日本相匹配？

I mean, I assume you must think the opportunity there is significant.

我的意思是，我假設你一定認為那裡的機會很大。

Just maybe help us think about that and frame it for us.

也許可以幫助我們考慮一下並為我們制定框架。

Clearly, the strategic motivation behind India and Taiwan are a little bit different.

顯然，印度和台灣背後的戰略動機略有不同。

With regard to Taiwan, in terms of [absolute size], it's not going to be a huge part of the business.

關於台灣，就[絕對規模]而言，它不會成為業務的很大一部分。

However, it's an influential market.

然而，這是一個有影響力的市場。

We -- the distributor there that we were working with was well-built and we think that it's a group that does good surgery and has good influence in the region.

我們 - 與我們合作的那裡的經銷商建立良好，我們認為這是一個做得很好的團隊，並且在該地區具有良好的影響力。

I think it's important to serve that customer base well.

我認為為該客戶群提供良好的服務很重要。

But it's not a massive financial impact by any means nor do we expect it to be.

但這無論如何都不會產生巨大的財務影響，我們也不希望如此。

India has, I think, a fair amount of runway.

我認為，印度有相當多的跑道。

Where it is today and where it might be in a decade can be quite different.

今天的位置和十年後可能的位置可能會大不相同。

And so here, the idea is it will take some time to build our capabilities in India but we also think it's an economy that's been growing, there's a strength in the surgical community in India, both there and globally.

所以在這裡，我們的想法是需要一些時間來建立我們在印度的能力，但我們也認為這是一個一直在增長的經濟體，印度的外科界在印度和全球都有實力。

And so it's an important long-term market for us.

因此，這對我們來說是一個重要的長期市場。

We think that financially, of course, it can become a significant part of Intuitive's business over the years.

我們認為，在財務上，當然，多年來它可以成為 Intuitive 業務的重要組成部分。

And the point of the -- of illustrating some of the Japanese example is that building a real presence and building the organization and the trust within the health care community in those markets takes time.

舉例說明日本的一些例子的要點是，在這些市場的醫療保健社區中建立真正的存在並建立組織和信任需要時間。

So if you want to get there in a decade, then you better start.

所以如果你想在十年內到達那裡，那麼你最好開始。

And that's really what's driven us in those 2 markets.

這才是真正推動我們進入這兩個市場的原因。

Just as a follow-up on a different topic.

就像對不同主題的跟進一樣。

You highlighted, obviously, some puts and takes in terms of growth, procedure growth, and you mentioned specifically slowing mature procedure growth in some countries.

顯然，您強調了增長、程序增長方面的一些看跌期權，並且您特別提到了一些國家/地區成熟程序增長的放緩。

Maybe just expand on that?

也許只是對此進行擴展？

Is this just you've penetrated the market and it's slowing?

這只是您已經進入市場並且正在放緩嗎？

Or is there something else going on?

還是有其他事情發生？

Maybe just give us a little more color there.

也許只是給我們多一點顏色。

In several countries, we are a substantial share of the surgical market, think of United States prostatectomy or partial nephrectomy in the United States or hysterectomies for certain conditions.

在一些國家，我們在手術市場佔有很大份額，想想美國的前列腺切除術或美國的部分腎切除術或某些情況下的子宮切除術。

And as a result, we see that part really growing at the demographic trends rather than a changing share of approach trends.

結果，我們看到這部分確實隨著人口趨勢而增長，而不是方法趨勢的變化份額。

And that's true in the U.S. It's true in some countries in Europe, with regard to prostatectomy and some of the urologic procedures.

這在美國是真的。在歐洲的一些國家也是如此，關於前列腺切除術和一些泌尿外科手術。

In Japan, we're already quite highly penetrated in prostatectomy and increasingly so in nephrectomy.

在日本，我們在前列腺切除術和腎切除術方面的滲透率已經很高。

So that's was the -- what's some of the detail or examples of what underlies the more general comment.

這就是——更一般性評論的一些細節或示例是什麼。

Just one more questioner, please.

請再問一位提問者。

And that question is from the line of Richard Newitter.

這個問題來自 Richard Newitter。

I wanted to start off on the percentage of operating leases and flexible financing arrangements.

我想從經營租賃和靈活融資安排的百分比開始。

That's clearly increasing as a percent of the total placements.

這明顯增加了總展示位置的百分比。

Could you characterize for us what the -- what the utilization rate differences are on the systems that are getting placed under those types of contracts versus the rest of the installed base?

您能否為我們描述一下 - 根據這些類型的合同放置的系統與其他已安裝基礎的系統的利用率差異是什麼？

I would imagine it's higher, but can you quantify it at all?

我想它會更高，但你能量化它嗎？

We do quantify it.

我們確實量化了它。

We monitor it closely and there is not a marked difference between what the utilization rates are on leases versus purchase product.

我們密切監控它，租賃產品的利用率與購買產品的利用率之間沒有明顯差異。

Okay.

好的。

And then just on the follow-up to the last question, Rick's question.

然後是最後一個問題的後續問題，Rick 的問題。

As you think about the low end and the high end of your 2019 procedure growth range, is there -- is the slowing mature procedure growth commentary kind of meant to be throughout the entire range?

當您考慮 2019 年程序增長范圍的低端和高端時，成熟程序增長放緩的評論是否意味著貫穿整個範圍？

Or is that contemplated at the low end instead of the high end?

或者是在低端而不是高端考慮的？

Yes, some level of moderation, particularly, in the U.S. is part of the trend and obviously, more moderation at the lower end and less moderation at the higher end.

是的，某種程度的節制，特別是在美國，是趨勢的一部分，顯然，低端的節制更多，高端的節制更少。

But the range will be largely -- the range itself is largely reflective -- the biggest factor's going to be the breadth and pace of growth in U.S. general surgery, our largest category now, then the mature procedures and some other factors regarding growth in China, the timing of placements of new systems and the pace of adoption of reimbursed procedures in Japan.

但這個範圍在很大程度上——這個範圍本身在很大程度上是反映性的——最大的因素將是美國普通外科的增長廣度和速度，我們現在最大的類別，然後是成熟的程序和一些與中國增長有關的其他因素、新系統的部署時間以及日本採用報銷程序的速度。

Well, thank you.

嗯，謝謝。

Thank you for the questions.

謝謝你的問題。

That was our last one.

那是我們的最後一個。

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

我們已經建立了我們的公司，以超越人手的極限進行手術，我向您保證，我們將繼續致力於推動真正有所作為的重要少數事情。

This concludes today's call.

今天的電話會議到此結束。

We thank you for your participation and support on this extraordinary journey to improve surgery and we look forward to talking to you again in 3 months.

我們感謝您參與和支持這一改善手術的非凡旅程，我們期待在 3 個月後再次與您交談。

Thank you.

謝謝。

Ladies and gentlemen, that does conclude your conference.

女士們，先生們，你們的會議到此結束。

We do thank you for joining.

我們非常感謝您的加入。

You may now disconnect.

您現在可以斷開連接。

Have a good day.

祝你有美好的一天。