直覺手術 (ISRG) 2019 Q1 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 Q1 2019 Earnings Release Call.

歡迎來到 Intuitive Surgical 2019 年第一季度收益發布電話會議。

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

（操作員說明）作為提醒，正在錄製此會議。

I'd now like to turn the conference over to Calvin Darling, Senior Director of Finance, Investor Relations.

我現在想將會議轉交給投資者關係財務高級總監 Calvin Darling。

Please go ahead.

請繼續。

Thank you.

謝謝。

Good afternoon, and welcome to Intuitive Surgical first quarter earnings conference call.

下午好，歡迎來到 Intuitive Surgical 第一季度收益電話會議。

With me today, we have Gary Guthart, our CEO; and Marshall Mohr, our Chief Financial Officer.

今天和我一起的是我們的首席執行官 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 4, 2019.

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 2019 年 2 月 4 日提交的最新 10-K 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活動部分提供。

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 first 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一季度業績的亮點，然後是問答環節。

Gary will present the quarter's business and operational highlights; Marshall will provide a review of our first quarter financial results; then I will discuss procedures and clinical highlights and provide our updated financial outlook for 2019.

Gary 將介紹本季度的業務和運營亮點； Marshall 將對我們的第一季度財務業績進行審查；然後我將討論程序和臨床亮點，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'll turn it over to Gary.

有了這個，我會把它交給加里。

Let's first start -- this first quarter was a solid start to 2019 for Intuitive.

讓我們首先開始——第一季度對 Intuitive 來說是 2019 年的良好開端。

Customer response to our products and services is healthy with continued growth in their use of da Vinci to deliver high-quality, minimally-invasive surgery to our broad base of patients.

客戶對我們的產品和服務的反應是健康的，他們使用達芬奇為我們廣泛的患者群提供高質量、微創手術的人數持續增加。

As I've said in the past, 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.

正如我過去所說，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。

We have a substantial opportunity and there is significant work to be done.

我們有大量的機會，還有大量的工作要做。

Global procedure growth was strong at approximately 18% in the first quarter of 2019, progress of growth remained consistent with our trailing several quarters, with growth in general surgery accounting for strength in the United States.

2019 年第一季度，全球手術增長強勁，約為 18%，增長的進展與我們過去幾個季度保持一致，普通外科的增長在美國占優勢。

Growth in Japan continues to be healthy with strength in urology, gastrectomy and colorectal procedures.

日本在泌尿外科、胃切除術和結直腸手術方面的實力繼續保持健康增長。

Growth in China met our expectations given constraints on capital placements.

考慮到資本配置的限制，中國的增長符合我們的預期。

Placements of new systems in the quarter was strong with growth in total placements rising 27% from Q1 of 2018.

本季度新系統的佈局強勁，總佈局比 2018 年第一季度增長了 27%。

Net of trade-ins and retirements, our da Vinci installed base again grew 13% over Q1 2018 to approximately 5,110.

扣除以舊換新和報廢後，我們的達芬奇安裝基數在 2018 年第一季度再次增長 13%，達到約 5,110 台。

The mix of systems 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。

Trade-ins of earlier generation systems increased this quarter as customers pursued the features of our generation 4 systems and some hospitals seek to standardize.

隨著客戶追求我們第 4 代系統的功能以及一些醫院尋求標準化，本季度較早一代系統的折價交易有所增加。

As we discussed on our previous earnings calls, customers are interested in leasing, including usage-based models.

正如我們在之前的財報電話會議上討論的那樣，客戶對租賃感興趣，包括基於使用的模型。

The proportion of systems placed under operating leases increased again from 29% in Q4 2018 to 33% in Q1 of this year.

根據經營租賃放置的系統比例再次從 2018 年第四季度的 29% 增加到今年第一季度的 33%。

The increase in trade-ins, leasing and usage-based models aligns with our strategy in supporting customers.

以舊換新、租賃和基於使用的模型的增加符合我們支持客戶的戰略。

It allows them greater flexibility to have the right systems in the right care delivery environments.

它使他們能夠更靈活地在正確的護理提供環境中擁有正確的系統。

For the investor, it can make revenue modeling for systems harder to evaluate relative to prior quarters as trade-ins impact our reported ASP and leasing defers revenue to future quarters.

對於投資者而言，由於以舊換新會影響我們報告的平均售價，而租賃會將收入推遲到未來幾個季度，因此與前幾個季度相比，它可能會使系統的收入建模更難評估。

Marshall will take you through greater detail later in the call.

Marshall 將在稍後的通話中向您介紹更多細節。

Turning to expenses, we described our plans for increased investment in 2019 as we launch new platforms, strengthen our computational capabilities and invest in projects that support future scale and provide leverage opportunities as we grow.

談到支出，我們描述了我們在 2019 年增加投資的計劃，因為我們推出了新平台，加強了我們的計算能力，並投資於支持未來規模並在我們成長過程中提供槓桿機會的項目。

Over the past year, we've seen our increased flexibility with customers catalyze growth, which in turn enables us to invest in manufacturing efficiencies that lower our costs.

在過去的一年裡，我們已經看到我們與客戶的靈活性增加促進了增長，這反過來又使我們能夠投資於降低成本的製造效率。

Our spending fell near the top end of the range of projections we shared with you last quarter, supported by procedure growth above the top end of our procedure guidance range.

我們的支出接近我們上個季度與您分享的預測範圍的上限，這得益於程序增長高於我們的程序指導範圍的上限。

Financial highlights of our first quarter are as follows: procedures grew approximately 18% for the first quarter of last year; we placed 235 da Vinci surgical systems, up from 185 in the first quarter of 2018; our installed base again grew 13% from a year ago; revenue for the quarter was approximately $974 million, up 15%; pro forma gross profit margin was 71.2% compared to 71.6% in the first quarter last year; instrument and accessory revenue increased to $552 million, up 20%; total recurring revenue in the quarter was $747 million, growing 20% over Q1 of 2018 and representing 77% of total revenue.

我們第一季度的財務亮點如下：去年第一季度手術增長約 18%；我們放置了 235 個達芬奇手術系統，高於 2018 年第一季度的 185 個；我們的安裝基數再次比一年前增長了 13%；本季度收入約為 9.74 億美元，增長 15%；預計毛利率為 71.2%，而去年第一季度為 71.6%；儀器和附件收入增加到 5.52 億美元，增長 20%；本季度經常性總收入為 7.47 億美元，比 2018 年第一季度增長 20%，佔總收入的 77%。

We generated a pro forma operating profit of $362 million in the quarter, up 4% from the first quarter last year and pro forma net income was $312 million, up 9%.

本季度我們的預估營業利潤為 3.62 億美元，比去年第一季度增長 4%，預估淨收入為 3.12 億美元，增長 9%。

As you know, we measure our efforts by their ability to positively impact the quadruple aim: better outcomes, better patient experience, better care team experience, and lower total cost to treat per patient episode.

如您所知，我們根據他們對四重目標產生積極影響的能力來衡量我們的努力：更好的結果、更好的患者體驗、更好的護理團隊體驗以及更低的每例患者治療總成本。

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；二是開發高質量、智能化、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 have deployed our investments toward these aims.

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

We design instruments and accessories to enable repeatable high-quality surgeries that are efficient and cost-effective relating to total cost to treat.

我們設計儀器和配件，以實現可重複的高質量手術，這些手術在總治療成本方面是高效且具有成本效益的。

Our team is in the process of launching several sophisticated products in pursuit of the same, and customers are now adopting them broadly.

我們的團隊正在推出幾款複雜的產品以實現同樣的目標，客戶現在正在廣泛採用它們。

Our 60-millimeter stapler is now in full launch and is used primarily in abdominal surgeries.

我們的 60 毫米吻合器現已全面推出，主要用於腹部手術。

Our second generation 45-millimeter stapler has recently received 510(k) clearance, incorporating several of the learnings from our 80-millimeter line.

我們的第二代 45 毫米訂書機最近獲得了 510(k) 許可，其中包含我們 80 毫米系列的一些經驗教訓。

Surgeon response has been strong and adoption of our stapling line is encouraging.

外科醫生反應強烈，採用我們的吻合線令人鼓舞。

We also launched our third generation vessel sealer.

我們還推出了第三代容器封口機。

Its adoption has likewise been strong.

它的採用同樣很強勁。

Turning to the systems, we are in our first phase launch of da Vinci SP.

談到系統，我們正處於達芬奇 SP 的第一階段發布。

We installed 6 systems in Q1, constrained in the quarter by manufacturing availability and bringing our clinical installed base of SP to 21.

我們在第一季度安裝了 6 個系統，該季度受到製造可用性的限制，使我們的 SP 臨床安裝基數達到 21。

Roughly 800 procedures had been performed to date (07.36).

迄今為止 (07.36) 已經執行了大約 800 個程序。

Recall, we have 2 cleared indications for SP: urologic and transoral surgery.

回想一下，我們有 2 個明確的 SP 適應症：泌尿外科和經口手術。

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。

Going forward, we expect continued progress in strengthening our production performance to support SP launch at scale.

展望未來，我們預計在加強我們的生產性能以支持 SP 大規模推出方面繼續取得進展。

As we've described in the past, we are also pursuing additional clinical indications for SP and have engaged regulatory agencies regarding their requirements.

正如我們過去所描述的那樣，我們還在尋求 SP 的其他臨床適應症，並就其要求與監管機構進行了接觸。

The combination of additional indications for SP and production readiness at scale will pace the speed of SP commercial deployment.

SP 的額外指示和大規模生產準備的結合將加快 SP 商業部署的速度。

In flexible diagnostics, our Ion platform is focused on the need for definitive early diagnosis of suspicious lesions for lung cancer.

在靈活的診斷中，我們的 Ion 平台專注於對肺癌可疑病變進行明確早期診斷的需求。

Ion received FDA clearance in the first quarter.

Ion 在第一季度獲得了 FDA 的批准。

With 510(k) clearance, we have initiated our next phase focused on clinical use, customer feedback and production optimization.

獲得 510(k) 批准後，我們開始了下一階段，重點是臨床使用、客戶反饋和生產優化。

First cases on the cleared system were performed at the end of Q1, and we plan a measured rollout this year.

已清除系統的第一批案例在第一季度末進行，我們計劃在今年進行有計劃的推出。

We do not anticipate material revenues from Ion in 2019.

我們預計 2019 年不會從 Ion 獲得實質性收入。

In our cloud computing and informatics efforts, we routinely deliver programmatic insights to customers using our systems, which have been smart and connected for the past decade.

在我們的雲計算和信息學工作中，我們經常向使用我們的系統的客戶提供程序化的見解，這些系統在過去十年中一直是智能和互聯的。

We received FDA clearance for our Auris augmented reality product in first quarter and anticipate first clinical use in 2019, focused on several high-volume da Vinci institutions that will lead clinical evaluation and analysis.

我們的 Auris 增強現實產品在第一季度獲得了 FDA 的批准，預計將在 2019 年首次用於臨床，重點是幾個將領導臨床評估和分析的大批量達芬奇機構。

We do not anticipate any revenue from Auris in 2019.

我們預計 2019 年 Auris 不會有任何收入。

In closing, our business fundamentals are strong and for the balance of the year, our focus remains in completing the tasks we set for ourselves: first, supporting adoption of da Vinci in general surgery and in key procedures in global markets; second, launching our SP and Ion platforms; third, driving intelligent surgery innovation; and finally, supporting additional clinical and economic validation in our focused procedures and countries.

最後，我們的業務基礎穩健，在今年餘下的時間裡，我們的重點仍然是完成我們為自己設定的任務：首先，支持在全球市場的普外科和關鍵手術中採用達芬奇；第二，啟動我們的 SP 和 Ion 平台；三是推動智能手術創新；最後，支持在我們重點程序和國家/地區進行額外的臨床和經濟驗證。

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

我現在將電話轉給 Marshall，他將審查財務亮點。

Good afternoon.

下午好。

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

我將在非 GAAP 備考基礎上描述我們的業績亮點。

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

我還將在稍後的發言中總結我們的 GAAP 表現。

Our reconciliation between our pro forma and GAAP results is posted on our website.

我們的備考結果和公認會計原則結果之間的對賬已發佈在我們的網站上。

Key business metrics for the first quarter were as follows: first quarter 2019 procedures increased approximately 18% compared with the first quarter 2018 and decreased approximately 1% compared with last quarter; procedure growth continues to be driven by general surgery in the U.S. and urology worldwide.

第一季度主要業務指標如下： 2019年第一季度手術量較2018年第一季度增長約18%，較上季度下降約1%；手術的增長繼續受到美國普通外科和全球泌尿外科的推動。

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

卡爾文將在本次電話會議的稍後部分審查程序增長的細節。

First quarter system placements of 235 systems increased 27% compared with 185 systems last year and decreased from the 290 system placements in our seasonally stronger fourth quarter.

與去年的 185 個系統相比，第一季度 235 個系統的系統佈置增加了 27%，低於我們季節性強勁的第四季度的 290 個系統佈置。

We expanded our installed base of da Vinci systems by 13% to approximately 5,110 systems, which is consistent with the fourth quarter and slightly higher than the 12.6% increase last year.

我們將達芬奇系統的安裝基數擴大了 13%，達到約 5,110 個系統，這與第四季度一致，略高於去年 12.6% 的增幅。

Utilization of current clinical systems in the field, measured by procedures per system, grew in the mid-single digits.

按每個系統的程序衡量，該領域當前臨床系統的利用率以中等個位數增長。

Our revenue overview is as follows.

我們的收入概覽如下。

First quarter 2019 revenue was $974 million, an increase of 15% compared with $848 million for the first quarter of 2018, and a decrease of 7% compared with the seasonally stronger fourth quarter revenue of $1.047 billion.

2019 年第一季度收入為 9.74 億美元，與 2018 年第一季度的 8.48 億美元相比增長 15%，與季節性強勁的第四季度收入 10.47 億美元相比下降 7%。

Instrument and accessory revenue of $552 million increased 20% compared with last year, which is higher than procedure growth, primarily reflecting increased use of our advanced instruments and customer buying patterns.

儀器和附件收入為 5.52 億美元，比去年增長 20%，高於程序增長，主要反映了我們先進儀器的使用增加和客戶購買模式。

Instrument and accessory revenue realized per procedure was approximately $1,960, an increase of 2% compared with the first quarter of 2018 and an increase of 4% compared with last quarter.

每個程序實現的儀器和配件收入約為 1,960 美元，與 2018 年第一季度相比增長 2%，與上一季度相比增長 4%。

Systems revenue for the first quarter 2019 was $248 million, an increase of 6% compared with the first quarter of 2018 and a decrease of 27% compared with last quarter.

2019年第一季度系統收入為2.48億美元，較2018年第一季度增長6%，較上季度下降27%。

The variation between 6% systems revenue growth and the 27% system placements growth reflects greater proportion of operating leases, a greater proportion of system trade-ins, a greater proportion of X systems, a higher mix of distributor placements and volume-based discounts provided to customers purchasing multiple systems.

6% 的系統收入增長和 27% 的系統安置增長之間的差異反映了更大比例的經營租賃、更大比例的系統以舊換新、更大比例的 X 系統、更高的分銷商安置組合和提供的基於數量的折扣給購買多個系統的客戶。

We completed 78 operating lease transactions, representing 33% of total placements compared with 43 or 23% of total placements in the first quarter of 2018, and 84 or 29% of total placements last quarter.

我們完成了 78 筆經營租賃交易，佔總配售額的 33%，而 2018 年第一季度為 43 筆或占總配售額的 23%，上季度為 84 筆或占總配售額的 29%。

As of March 31, we have 423 operating leases outstanding and realized approximately $20 million of revenue related to these arrangements in the quarter compared with $10 million last year and $16 million last quarter.

截至 3 月 31 日，我們有 423 項未完成的經營租賃，本季度與這些安排相關的收入約為 2000 萬美元，而去年為 1000 萬美元，上季度為 1600 萬美元。

Operating leases create a future source of recurring revenue and reduce the volatility of system revenue.

經營租賃創造了未來的經常性收入來源，並減少了系統收入的波動性。

While the increased number of operating systems placed in the quarter dampen short-term revenue growth for the quarter in which they are placed.

雖然本季度放置的操作系統數量增加抑制了放置它們的季度的短期收入增長。

Operating leases include usage-based financing that we provide to certain experienced hospitals.

經營租賃包括我們向某些經驗豐富的醫院提供的基於使用的融資。

We believe that our leasing alternatives align with customer objectives and have enabled faster market adoption.

我們相信，我們的租賃替代方案符合客戶目標，並加快了市場採用速度。

Relative to systems purchased over the lease period, we earn a small premium, reflecting the time value of money and in the case of usage-based arrangements, the risk that those systems may not achieve anticipated usage levels.

相對於在租賃期內購買的系統，我們賺取少量溢價，反映貨幣的時間價值以及在基於使用的安排的情況下，這些系統可能無法達到預期使用水平的風險。

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

這些類型的安排的比例可能會長期增加，並且每個季度都會出現波動。

36% of the current quarter system placements involved trade-ins, reflecting customer desire to access or standardize on our fourth-generation technology.

本季度 36% 的系統佈置涉及以舊換新，反映出客戶希望訪問或標準化我們的第四代技術。

This is an increase in the proportion of trade-ins compared to 31% in the first quarter of 2018 and 28% last quarter.

與 2018 年第一季度的 31% 和上一季度的 28% 相比，以舊換新的比例有所增加。

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

以舊換新活動可能起伏不定且難以預測。

67% of the systems placed in the quarter were da Vinci Xis.

本季度放置的系統中有 67% 是 da Vinci Xis。

25% were da Vinci X systems compared with 73% da Vinci Xis and 18% da Vinci Xs last quarter.

25% 是 da Vinci X 系統，而上個季度 da Vinci Xis 和 da Vinci Xs 分別為 73% 和 18%。

Six of the systems placed were SP systems.

放置的系統中有六個是 SP 系統。

Our rollout of the SP surgical system is measured, putting systems in the hands of experienced da Vinci users, while we optimize training pathways in our supply chain.

我們對 SP 手術系統的推出進行了衡量，將系統交到經驗豐富的達芬奇用戶手中，同時我們優化了供應鏈中的培訓途徑。

As mentioned by Gary, SP production was constrained in the first quarter.

正如 Gary 所提到的，SP 生產在第一季度受到限制。

Globally, our average selling price, which excludes the impact of operating leases and lease buyouts was approximately $1.31 million compared with $1.49 million last year and $1.46 million last quarter.

在全球範圍內，我們的平均售價（不包括經營租賃和租賃買斷的影響）約為 131 萬美元，而去年為 149 萬美元，上季度為 146 萬美元。

The changes compared with prior periods primarily reflect a greater portion of trade-in transactions, volume-based incentives providing customers purchasing multiple systems, a greater proportion of X Systems and higher proportion of distributor sales.

與前期相比的變化主要反映了更大比例的以舊換新交易、為客戶提供購買多個系統的基於數量的激勵、更大比例的 X Systems 和更高比例的分銷商銷售。

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

在美國以外，結果如下。

OUS procedures grew approximately 21% compared with the first quarter of 2018 and increased 6% compared with last quarter.

OUS 程序與 2018 年第一季度相比增長了約 21%，與上一季度相比增長了 6%。

First quarter revenue outside of the U.S. of $282 million increased 3% compared with the first quarter of 2018 and decreased 8% compared with last quarter.

美國以外的第一季度收入為 2.82 億美元，與 2018 年第一季度相比增長 3%，與上一季度相比下降 8%。

The 3% year-over-year revenue growth primarily reflects a greater proportion of X systems, a higher mix of distributor arrangements, and a greater proportion of operating leases.

3% 的同比收入增長主要反映了更大比例的 X 系統、更高的分銷商安排組合以及更大比例的經營租賃。

Outside the U.S., we placed 81 systems in the first quarter compared with 73 in the first quarter of 2018 and 115 systems last quarter.

在美國以外，我們在第一季度部署了 81 個系統，而 2018 年第一季度為 73 個，上季度為 115 個系統。

Current quarter system placements included 49 into Europe, 13 into Japan, 8 into Brazil and 3 into China.

當前季度的系統佈局包括 49 個進入歐洲、13 個進入日本、8 個進入巴西和 3 個進入中國。

36 or 44% of the systems placed in the first quarter were X systems compared with 19% last year and 30% last quarter.

第一季度放置的系統中有 36 個或 44% 是 X 系統，而去年和上個季度分別為 19% 和 30%。

11 of the system placements were operating leases compared with one last year and 15 last quarter.

與去年和上季度的 15 個相比，11 個系統配售是經營租賃。

Placements outside 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 limitation.

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限制的限制。

Moving on to gross margin and operating expenses.

轉向毛利率和運營費用。

Pro forma gross margin for the first quarter of 2019 was 71.2% compared with 71.6% for the first quarter of 2018 and 71.8% last quarter.

2019 年第一季度的備考毛利率為 71.2%，而 2018 年第一季度為 71.6%，上一季度為 71.8%。

The decrease compared with the first quarter of 2018 and last quarter primarily reflects lower system ASPs and a higher mix of advanced instruments, partially offset by improvements in manufacturing efficiency.

與 2018 年第一季度和上一季度相比的下降主要反映了較低的系統平均售價和較高的先進儀器組合，部分被製造效率的提高所抵消。

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

未來的利潤率將根據我們新產品的組合、系統和儀器及配件收入的組合、系統平均銷售價格以及我們進一步降低產品成本和提高製造效率的能力而波動。

Pro forma operating expenses increased 27% compared with the first quarter of 2018 and decreased 2% compared with last quarter.

預計營業費用與 2018 年第一季度相比增長 27%，與上一季度相比下降 2%。

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。

Excluding the contribution to the foundation, pro forma operating expenses increased 5% compared with last quarter.

不包括對基金會的貢獻，預計運營費用較上一季度增長 5%。

In order of magnitude of increase, first quarter expenses reflect costs associated with expansion of our OUS markets, spending on our informatics capabilities and investment in our infrastructure in order to scale the business.

按增長幅度排序，第一季度支出反映了與我們的 OUS 市場擴張相關的成本、信息能力方面的支出以及為擴大業務規模而對基礎設施的投資。

Our pro forma effective tax rate for the first quarter was 19.8% compared with our expectations of 19% to 20%.

我們第一季度的備考有效稅率為 19.8%，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 and 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 first quarter 2019 pro forma net income was $312 million or $2.61 per share compared with $288 million or $2.44 per share for the first quarter of 2018 and $353 million or $2.96 per share for the fourth quarter 2018.

我們 2019 年第一季度的備考淨收入為 3.12 億美元或每股 2.61 美元，而 2018 年第一季度為 2.88 億美元或每股 2.44 美元，2018 年第四季度為 3.53 億美元或每股 2.96 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 $307 million or $2.56 per share for the first quarter of 2019, compared with GAAP net income of $288 million or $2.44 per share for the first quarter of 2018, and GAAP net income of $293 million or $2.45 per share for the fourth quarter of 2018.

2019 年第一季度 GAAP 淨收入為 3.07 億美元或每股 2.56 美元，而 2018 年第一季度 GAAP 淨收入為 2.88 億美元或每股 2.44 美元，第四季度 GAAP 淨收入為 2.93 億美元或每股 2.45 美元2018 年四分之一。

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

我們的網站上概述並量化了備考和 GAAP 淨收入之間的調整。

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

它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 $5.1 billion compared with $4.8 billion at December 31, 2018.

本季度末，我們的現金和投資為 51 億美元，而 2018 年 12 月 31 日為 48 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 $60 million to $468 million, representing approximately 140 days of inventory.

本季度，我們的庫存增加了約 6000 萬美元至 4.68 億美元，相當於約 140 天的庫存。

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 or other matters.

我們繼續建立庫存以應對業務增長，並降低可能因貿易、供應商或其他問題而產生的中斷風險。

With the growth in the business and our focus on efficiency and scale, we expect 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 2019 年的資本支出將增加到 2.5 億美元以上。

In January, our Board of Directors increased our stock buyback authorization to $2 billion.

一月份，我們的董事會將我們的股票回購授權增加到 20 億美元。

We did not repurchase any shares in the quarter.

本季度我們沒有回購任何股票。

And with that, I'd like to turn it over to Calvin who will go over procedure performance, and will update 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，並將更新我們對 2019 年的展望。

Thank you, Marshall.

謝謝你，馬歇爾。

Our overall first quarter procedure growth was 18% compared to 15% during the first quarter of 2018 and 19% last quarter.

我們第一季度的總體程序增長率為 18%，而 2018 年第一季度為 15%，上季度為 19%。

Our Q1 procedure growth was driven by 17% growth in U.S. procedures and 21% growth in OUS markets.

我們第一季度的程序增長是由美國程序增長 17% 和 OUS 市場增長 21% 推動的。

In the U.S., Q1 procedure results were generally consistent with recent trends.

在美國，Q1 程序結果與近期趨勢大體一致。

Q1 growth was again driven by growth in U.S. general surgery, thoracic and benign gynecology procedures.

第一季度的增長再次受到美國普通外科、胸科和良性婦科手術增長的推動。

In general surgery, first quarter hernia repair and colorectal procedure growth remained strong, while growth in other general surgery procedures such as cholecystectomy, bariatric, and liver and pancreatic cases also contributed to growth.

在普通外科手術中，第一季度疝修補術和結直腸手術的增長依然強勁，而膽囊切除術、減肥手術、肝臟和胰腺手術等其他普通外科手術的增長也對增長做出了貢獻。

First quarter U.S. gynecology continued to grow in the mid-single digits, driven by benign hysterectomy procedures.

在良性子宮切除手術的推動下，第一季度美國婦科繼續以中個位數增長。

Our data continues to indicate an increasing proportion of overall gynecology procedures are being performed by gynecologic oncologist.

我們的數據繼續表明，越來越多的婦科手術由婦科腫瘤科醫生執行。

In addition, our recently launched Vessel Sealer Extend instrument is increasingly being adopted by gynecologists.

此外，我們最近推出的 Vessel Sealer Extend 儀器越來越多地被婦科醫生採用。

U.S. urology first quarter growth moderated a bit in Q1, driven by prostatectomy, which moved closer to the underlying incident rate for prostate cancer.

在前列腺切除術的推動下，美國泌尿外科第一季度的增長有所放緩，前列腺切除術更接近前列腺癌的潛在發病率。

As a mature procedure category, we believe that our U.S. prostatectomy volumes have been tracking to the broader prostate surgery market.

作為一個成熟的手術類別，我們相信我們在美國的前列腺切除術量一直在追踪更廣泛的前列腺手術市場。

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

在美國的其他手術中，肺葉切除術和其他胸腔手術的採用在第一季度再次表現穩定。

First quarter OUS procedure volume grew approximately 21% compared with 18% for the first quarter 2018 and 24% last quarter.

第一季度 OUS 手術量增長了約 21%，而 2018 年第一季度和上季度分別增長了 18% 和 24%。

First quarter 2019 OUS procedure growth was driven by continued growth in dVP procedures and earlier stage growth in kidney cancer procedures, general surgery and gynecology.

2019 年第一季度 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。

Two weeks ago, we attended the Society of American Gastrointestinal and Endoscopic Surgeons or SAGES conference in Baltimore.

兩週前，我們參加了在巴爾的摩舉行的美國胃腸和內窺鏡外科醫生協會或 SAGES 會議。

SAGES is one of the largest general surgery meetings each year, attended by many of the world's leading general surgeons.

SAGES 是每年最大的普通外科會議之一，有許多世界領先的普通外科醫生參加。

We were encouraged by the emerging consensus view regarding the value of robotic-assisted approaches in general surgery procedures.

關於機器人輔助方法在普通外科手術中的價值的新興共識觀點令我們感到鼓舞。

Our booth was highly visited by surgeons interested in hands-on access to the full breadth of our generation 4 platform, including the da Vinci Xi, X and SP systems on the floor.

我們的展位受到外科醫生的高度訪問，他們有興趣親身體驗我們第 4 代平台的全部範圍，包括地板上的達芬奇 Xi、X 和 SP 系統。

And our advanced instrumentation, including the SureForm surgical stapler.

以及我們先進的器械，包括 SureForm 手術吻合器。

The SAGES conference emphasizes clinical evidence, and I will share with you one of the e-posters presented at the event, analyzing real-world evidence.

SAGES 會議強調臨床證據，我將與您分享在活動中展示的一張電子海報，分析真實世界的證據。

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

在這些電話會議的每個季度，我們都會重點介紹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。

At this year's SAGES, Dr. Elizabeth Raskin from Loma Linda University, presented research titled: Reducing Variability and Outcomes, Conversion Rate Analysis of Minimally Invasive Sigmoidectomy.

在今年的 SAGES 上，Loma Linda 大學的 Elizabeth Raskin 博士介紹了題為“減少變異性和結果，微創乙狀結腸切除術的轉化率分析”的研究。

The study used the premier healthcare database, selecting data from institutions performing at least 100 laparoscopic-assisted or robotic-assisted sigmoidectomy cases between 2013 and 2015.

該研究使用了主要的醫療保健數據庫，從 2013 年至 2015 年期間執行至少 100 例腹腔鏡輔助或機器人輔助乙狀結腸切除術的機構中選擇數據。

Data for 8,821 patients from 75 hospitals were analyzed.

分析了來自 75 家醫院的 8,821 名患者的數據。

The median conversion rate for minimally-invasive surgery to open surgery across the entire sample was 10.85%.

整個樣本中從微創手術到開放手術的中位轉化率為 10.85%。

The data was split between higher conversion rate hospitals above the median and lower conversion rate hospitals below the median.

數據分為高於中位數的較高轉化率醫院和低於中位數的較低轉化率醫院。

Among patients from the higher conversion rate hospitals, the conversion rate for lab procedures was 18.41% compared to 11.33% robotic assisted.

在轉化率較高的醫院的患者中，實驗室程序的轉化率為 18.41%，而機器人輔助的轉化率為 11.33%。

Among patients from lower conversion rate hospitals, the conversion rate for lab-assisted cases was 7.33% compared to 2.89% for the robotic cases.

在轉化率較低的醫院的患者中，實驗室輔助病例的轉化率為 7.33%，而機器人病例的轉化率為 2.89%。

After adjusting for variables, the lap patients in the higher conversion rate hospitals had 75% more risk of converting to open approach.

調整變量後，轉換率較高的醫院的膝關節患者轉換為開放式方法的風險增加 75%。

In the lower conversion group, laparoscopic approach was found to be 2.5x more likely to be converted to open compared to the robotic-assisted approach.

在轉化率較低的組中，發現腹腔鏡手術轉為開腹手術的可能性是機器人輔助手術的 2.5 倍。

While we are encouraged by the lower da Vinci conversion rates relative to laparoscopy, this study highlights that there is still significant remaining opportunity for surgeons to drive conversion rates meaningfully lower, which has the potential to improve outcomes and patient experience.

雖然我們對相對於腹腔鏡檢查較低的達芬奇轉化率感到鼓舞，但這項研究強調，外科醫生仍有很大的剩餘機會顯著降低轉化率，這有可能改善結果和患者體驗。

Furthermore, as evidenced by the large gap between the higher and lower conversion rate hospitals, there remains significant opportunity to reduce the variability of outcomes across care teams.

此外，正如轉換率較高和較低的醫院之間的巨大差距所證明的那樣，仍然有很大的機會來減少護理團隊之間結果的可變性。

I will now turn to our financial outlook for 2019, starting with procedures.

我現在將從程序開始談談我們對 2019 年的財務展望。

On our last call, we forecast full year 2019 procedure growth within a range of 13% to 17%.

在我們的最後一次電話會議上，我們預測 2019 年全年的程序增長將在 13% 至 17% 的範圍內。

We are now refining our estimate to the upper half of that range and estimate full year 2019 procedure growth of 15% to 17%.

我們現在正在將我們的估計細化到該範圍的上半部分，並估計 2019 年全年的手術增長率為 15% 至 17%。

With respect to revenue, as we have mentioned previously, in mature markets, 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，在成熟市場中，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 revenue 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，資本銷售收入在不同時期可能會有很大差異。

Indeed, the impact of leasing, trade-in and product mix are reflected in our systems revenue results for Q1.

事實上，租賃、以舊換新和產品組合的影響反映在我們第一季度的系統收入結果中。

While these factors are aligned with our strategy and positive business levers, the revenue result was lower than historical norms relative to the number of systems placed.

雖然這些因素與我們的戰略和積極的業務槓桿相一致，但相對於所放置系統的數量，收入結果低於歷史標準。

Looking forward, we expect continued variation by quarter and we expect to continue to see meaningful proportions of capital placements involving trade-ins and/or these structured as operating leases.

展望未來，我們預計季度將繼續變化，我們預計將繼續看到涉及以舊換新和/或這些結構化為經營租賃的資本配售的有意義比例。

Turning to gross profit.

轉向毛利。

We continue to expect our pro forma gross profit margin to be within a range of between 70% and 71% of net revenue.

我們繼續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 are expanding our investments in 2019.

正如 Gary 和 Marshall 所述，我們將在 2019 年擴大投資。

Given our results in the first quarter, we expect to grow pro forma 2019 operating expenses between 24% and 28% above 2018 levels compared to the 20% to 28% range forecast on our last call.

鑑於我們在第一季度的業績，我們預計 2019 年的備考運營費用將比 2018 年的水平增長 24% 至 28%，而我們上次電話會議預測的範圍為 20% 至 28%。

We expect our noncash stock compensation expense to range between $320 million and $340 million in 2019 compared with $310 million to $340 million forecast on our last call.

我們預計 2019 年我們的非現金股票補償費用將在 3.2 億美元至 3.4 億美元之間，而我們上次電話會議預測的為 3.1 億美元至 3.4 億美元。

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

我們繼續預計 2019 年其他收入（主要包括利息收入）總額將在 1.2 億美元至 1.3 億美元之間。

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

關於所得稅，我們繼續估計我們 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 remarks.

我們準備好的發言到此結束。

We will now open the call to your questions.

我們現在將打開您的問題的電話。

(Operator Instructions) Our first question will come from Tycho Peterson at JPMorgan.

（操作員說明）我們的第一個問題將來自摩根大通的第谷彼得森。

Maybe I will start with bariatric.

也許我會從減肥開始。

Obviously, a lot of excitement coming out of SAGES on the opportunity around bariatric.

顯然，SAGES 對圍繞減肥的機會感到非常興奮。

Gary, can you maybe just talk about the ramp and any infraction you're seeing between gastric bypass leads reviews?

加里，你能不能談談斜坡和你在胃旁路術引導審查之間看到的任何違規行為？

And if we think about the 180,000 niche procedures in the U.S., what do you think the adoption curve looks like over the next couple of years?

如果我們考慮美國的 180,000 個利基程序，您認為未來幾年的採用曲線會是什麼樣子？

Well, thank you.

嗯，謝謝。

For starters on bariatrics, we're excited about the long-term opportunity.

對於減肥的初學者，我們對長期的機會感到興奮。

And as you described, there's interest in all of the procedures' subcategories you've laid out.

正如您所描述的，人們對您列出的所有程序子類別都感興趣。

I'll, in a minute, turn it over to Calvin and speak a little bit about sizing.

我會在一分鐘內將其轉交給 Calvin 並談一談尺寸。

Where we are in terms of commercial focus, the commercial team is largely focused now on hernia and colorectal procedures.

我們在商業重點方面的位置，商業團隊現在主要關注疝氣和結直腸手術。

We see some early interest in bariatrics and we'll support that early interest, but we'll -- we'd like to make sure we satisfy the hernia markets and the colorectal markets we're in today, and then we'll pivot over time to support bariatrics more broadly.

我們看到一些早期對減肥的興趣，我們會支持這種早期興趣，但我們會 - 我們想確保我們滿足今天所處的疝氣市場和結直腸市場，然後我們將轉向隨著時間的推移，更廣泛地支持減肥。

Calvin, you might speak to...

卡爾文，你可以和...

Yes.

是的。

Tycho, you're right.

第谷，你是對的。

I mean, the 180,000 is about right in aggregate, but there's a lot of different types of procedures within that category from sleeve gastrectomies, to the full bypasses, to the redo procedures you mentioned where I think there's some clear benefits to robotic approach for those complex surgeries.

我的意思是，180,000 總體來說是正確的，但該類別中有很多不同類型的手術，從袖狀胃切除術到完全旁路手術，再到你提到的重做手術，我認為機器人方法對這些手術有一些明顯的好處複雜的手術。

At this point in time, we've seen some very nice early-stage adoption.

在這個時間點，我們已經看到了一些非常好的早期採用。

Obviously, based upon the patient benefits, but also, there's some pretty significant surgeon benefit as well from an ergonomic standpoint.

顯然，基於患者的利益，而且從人體工程學的角度來看，外科醫生也有一些非常重要的利益。

So it's a nice foundation that's building and at this point, as Gary mentioned, we haven't focused the team entirely there.

所以這是一個很好的基礎，正如加里提到的那樣，在這一點上，我們還沒有把團隊的注意力完全集中在那裡。

And then on China, Gary, you characterized the market as still being constrained.

然後在中國，加里，你將市場描述為仍然受到限制。

You only had kind of 3 systems this quarter.

本季度您只有 3 個系統。

Can you talk about your latest thinking on the quota impact?

能否談談您對配額影響的最新思考？

And when do you think things start to free up there a little bit?

你認為事情什麼時候開始有所緩解？

Marshall, why don't you take us through that?

馬歇爾，你為什麼不帶我們通過那個？

Sure.

當然。

So just to replay, the quota is 154 systems for robotic systems.

所以只是為了重播，配額是 154 個機器人系統。

That is a quota that is available to anybody that has approval to sell robotic systems.

這是任何獲准銷售機器人系統的人都可以使用的配額。

So if there were to be another company that came along that got approval through CFDA, they would also be able to share in that quota.

因此，如果有另一家公司通過 CFDA 獲得批准，他們也將能夠分享該配額。

The quota has been distributed to provinces.

配額已分配到各省。

The provinces are responsible for identifying the specific hospitals.

各省負責確定具體的醫院。

And then to the hospitals that have to launch a tendering process.

然後是必須啟動招標程序的醫院。

All of that takes time and the tendering processes can take quite a bit of time.

所有這些都需要時間，而招標過程可能需要相當長的時間。

And in fact, if you replay back to when we got to 2015 -- or the 2013 quota, it took till near the end of 2015 when we saw majority of those systems get done.

事實上，如果你回放我們到 2015 年或 2013 年配額的時間，直到 2015 年底我們才看到大部分系統已經完成。

So what we had told you before was that you should plan on fewer systems early and more systems later.

因此，我們之前告訴您的是，您應該儘早規劃較少的系統，稍後規劃更多的系統。

And in fact, the 3 systems that were done this quarter were not done within that quota.

事實上，本季度完成的 3 個系統並未在該配額內完成。

So we have not seen any systems from the quota yet.

所以我們還沒有看到配額中的任何系統。

Okay.

好的。

And then just last one on Ion.

然後是關於 Ion 的最後一個。

Now that you're out on the market, how do we think about the kind of data collection window here?

現在你已經上市了，我們如何看待這裡的數據收集窗口？

And what time frame would we start to see some publications?

我們什麼時候會開始看到一些出版物？

Could we see some by the back half of the year?

我們能在今年下半年看到一些嗎？

And then, can you maybe talk to your supply chain optimization efforts and then where you are on that?

然後，您能否談談您的供應鏈優化工作以及您在這方面的進展？

Sure.

當然。

I think we'll be gathering 2 sets of data.

我認為我們將收集兩組數據。

Some are position preference and workflow data and the other is outcomes over time.

一些是位置偏好和工作流程數據，另一個是隨時間變化的結果。

I imagine you'll see various interim publications toward the end of the year.

我想您會在年底看到各種臨時出版物。

It will take some time to get the full set written and reviewed that may come after '19, but I think you'll see updates from key customers as we go through the year.

19 年後可能會完成整套的編寫和審核，這需要一些時間，但我認為隨著我們度過這一年，您會看到來自主要客戶的更新。

In terms of manufacturing optimization, so far so good.

在製造優化方面，到目前為止一切順利。

A lot of this is really just starting to create the manufacturing process and lines to build things at a little bit bigger scale and incorporate learnings and update tolerances and other kinds of validation work.

其中很多實際上只是開始創建製造流程和生產線，以構建更大規模的東西，並結合學習和更新公差以及其他類型的驗證工作。

So far, so good.

到目前為止，一切都很好。

I think the team is doing a nice job there.

我認為團隊在那裡做得很好。

And next, we go to Bob Hopkins with Bank of America.

接下來，我們和美國銀行一起去鮑勃霍普金斯。

Just 2 for me.

對我來說只有2個。

First, Marshall, to start out, I just want to get your latest thinking on operating leases.

首先，馬歇爾，首先，我只想了解您對經營租賃的最新想法。

Obviously, it's accelerated up to 33% replacements.

顯然，它加速了高達 33% 的替換。

I guess the way I'd ask the question is would you be surprised if that moved up to 50%?

我想我問這個問題的方式是，如果上升到 50%，你會感到驚訝嗎？

Or do you think we're kind of getting close to a top here with 1/3 of the placements?

還是您認為我們在 1/3 的位置上接近頂峰？

Yes.

是的。

We introduced leasing and other alternatives, financing alternatives, a few years ago.

幾年前，我們引入了租賃和其他替代方案、融資方案。

And we did that in the face of what we thought would be customer demand.

面對我們認為的客戶需求，我們這樣做了。

And in fact, we think it's played out quite well.

事實上，我們認為它發揮得很好。

And that we have been able to allow customers to expand more quickly their install base.

而且我們已經能夠讓客戶更快地擴大他們的安裝基礎。

I think -- so it's really customer driven, the demand.

我認為 - 所以這真的是客戶驅動的需求。

And having said that, if it were my choice, I'd find that leases and the alternatives that we're providing customers are favorable to us and that it creates a recurring revenue stream, eliminate some of the volatility of system placement revenue.

話雖如此，如果這是我的選擇，我會發現我們為客戶提供的租賃和替代方案對我們有利，並且它創造了經常性收入流，消除了系統安置收入的一些波動性。

And I think, in the long term, it will enhance any type of upgrade cycle that might come along.

而且我認為，從長遠來看，它將增強可能出現的任何類型的升級週期。

So it's hard for me to predict exactly how far it will go, but again, if it were my choice, I'd like to see it go further.

所以我很難準確預測它會走多遠，但同樣，如果這是我的選擇，我希望看到它走得更遠。

But it doesn't -- it seems like it's going to go higher from here.

但事實並非如此——它似乎會從這裡走高。

I mean, it clearly seems like there's no momentum in that, and I don't think it's that big of a deal.

我的意思是，這顯然似乎沒有動力，而且我認為這沒什麼大不了的。

I'm just curious to hear your thoughts as to where we might be headed.

我只是想听聽您對我們可能走向何方的想法。

Yes.

是的。

I've given you my thoughts.

我已經給了你我的想法。

Well, it's hard to predict what the anchor point is.

好吧，很難預測錨點是什麼。

Likely, a little more from here.

可能，從這裡多一點。

Okay.

好的。

And then, one last question, Gary.

然後，最後一個問題，加里。

You guys -- or for Marshall, you spend at the high end of the guidance this quarter.

你們 - 或者對於馬歇爾來說，你們本季度的支出處於指導的高端。

And it was particularly, the R&D spend I think, was up 38%, now annualizing at roughly $400 million.

特別是，我認為研發支出增長了 38%，現在年化約為 4 億美元。

I was just wondering if you could just go into a little more detail on where that incremental R&D spending is going?

我只是想知道您是否可以更詳細地說明增量研發支出的去向？

And I know we talked about it last quarter but any incremental details on where that big uptick in R&D spending is going would be helpful.

我知道我們在上個季度討論過這個問題，但任何關於研發支出大幅增加的進展細節都會有所幫助。

Yes.

是的。

It's a fair question.

這是一個公平的問題。

So first, just total spending in context.

所以首先，只是上下文中的總支出。

The bigger component of the increase was actually expanding our field teams outside the U.S. So on a percentage basis, R&D grew.

增長的更大組成部分實際上是在美國以外擴展我們的現場團隊。因此，在百分比基礎上，研發增長了。

On an absolute basis, it was actually investments in commercial teams and field teams in Asia that drove the biggest side.

在絕對基礎上，實際上是對亞洲商業團隊和現場團隊的投資推動了最大的一面。

With breaking down the R&D, to answer your question, in kind of priority order, computational capability and informatics, both in the product and back in the office is the largest uptick, followed by ION, followed by Advanced Instrument investments, followed by Imaging investments.

通過分解研發，回答你的問題，按照優先順序，計算能力和信息學，在產品和辦公室後方都是最大的增長，其次是 ION，其次是 Advanced Instrument 投資，其次是 Imaging 投資.

Those are the ones that are responsible for growth down that pathway.

那些是負責沿著這條道路發展的人。

And we think we're on a front foot there and making progress where we are, and we're putting those investments out to support our future growth.

我們認為我們在這方面處於領先地位並在我們所處的位置取得進展，我們正在投入這些投資以支持我們未來的增長。

But that's the rough priority order.

但這是粗略的優先順序。

And next, we have David Lewis with Morgan Stanley.

接下來，我們有摩根士丹利的大衛劉易斯。

Just a couple of questions for me.

只問我幾個問題。

And Marshall, I wanted to come back to this dynamic of systems mix more broadly.

Marshall，我想更廣泛地回到這種動態的系統組合。

I mean you gave a lot more detail on systems mix this quarter than we've heard in the last several quarters, Calvin highlighted this in guidance.

我的意思是，您本季度提供的系統組合細節比我們在過去幾個季度聽到的要多得多，卡爾文在指導中強調了這一點。

So I think it's going to create this notion of something (inaudible) cyclically, this is just a weird quarter or structurally, there is different dynamics we should be considering for 2019 and beyond.

所以我認為這將周期性地創造出某種東西（聽不清）的概念，這只是一個奇怪的季度或結構性的，我們應該在 2019 年及以後考慮不同的動態。

So can you just talk in more detail, you talked about trade-ins x distributors, volume-based discounting.

那麼你能不能更詳細地談談，你談到了以舊換新 x 分銷商，基於數量的折扣。

So it does seem like mix dynamics shifted more maturely this quarter than, perhaps, in the last 2 to 3 quarters.

因此，與過去 2 到 3 個季度相比，本季度混合動力的轉變似乎更為成熟。

I wonder if you could just highlight what changed and what's driving some of those changes?

我想知道您是否可以強調發生了什麼變化以及是什麼推動了其中的一些變化？

Sure.

當然。

So to be clear, there was a shift.

所以要明確的是，有一個轉變。

You're right, that we've seen an increase in the trade-ins, the percentage of trade-ins.

你是對的，我們已經看到以舊換新的增加，以舊換新的百分比。

And as I said earlier, it was 36% compared to 28% a year ago.

正如我之前所說，這一比例為 36%，而一年前為 28%。

And what we're seeing is just customers wanting to avail themselves to the fourth-generation technology...

而我們所看到的只是希望利用第四代技術的客戶......

And standardize to have multiple systems.

並標準化為擁有多個系統。

And standardize their portfolio.

並標準化他們的投資組合。

And then we've seen more multisystem deals, and some of that has to do with what Gary was just talking about, their desire to expand their base.

然後我們看到了更多的多系統交易，其中一些與加里剛才所說的有關，他們希望擴大他們的基礎。

And as they are doing that, they would rather deal with one set of I&A, one set of training protocol and so forth and so they standardize on the platform.

當他們這樣做時，他們寧願處理一套 I&A、一套培訓協議等等，因此他們在平台上進行標準化。

So the 2 are somewhat intertwined.

所以兩者有點交織在一起。

We also saw a greater proportion of X systems, and that's been kind of a volatile statistic, actually.

我們還看到了更大比例的 X 系統，實際上這是一個不穩定的統計數據。

If you go back in time since we introduced X, and it's jumped around a little bit.

如果你回到我們推出 X 後的時間，它會跳躍一點點。

But indeed, we introduced X with the intention of being able to deliver a lower cost product to geographies where reimbursements are lower.

但事實上，我們引入 X 的目的是為了能夠向報銷較低的地區提供成本較低的產品。

And in fact, in Europe, we saw 45% of the systems sold were Xs, which is exactly the market we targeted for.

事實上，在歐洲，我們看到 45% 的售出系統是 Xs，這正是我們的目標市場。

So these are all things that we think are positive trends, and leasing as well as I spoke to earlier.

所以這些都是我們認為是積極趨勢的事情，租賃以及我之前談到的。

But the confluence of them all this quarter did drive systems revenue to only grow 6% and also ASPs be a little lower.

但本季度所有這些因素的共同作用確實推動系統收入僅增長 6%，平均售價也略有下降。

If you were looking out into the future for the rest of this year, it's more likely, given the trend in trade-ins and the trend in the multisystem arrangements that will be closer to, let's say, the ASPs we saw this quarter than we saw for the whole of last year.

如果您展望今年剩餘時間的未來，考慮到以舊換新的趨勢和多系統安排的趨勢，這更有可能比我們本季度看到的 ASP 更接近看到了整個去年。

If you go back to last year, we were pretty much around $1.45 million on a consistent basis last year.

如果你回到去年，我們去年的收入幾乎穩定在 145 萬美元左右。

And so that's where I think we are and where we're going.

這就是我認為我們所處的位置和我們要去的地方。

I don't want to put words in your mouth, Marshall, but it sounds like this trade-in dynamics has been going for 6 to 8 quarters.

馬歇爾，我不想把話說到你嘴裡，但聽起來這種以舊換新的動態已經持續了 6 到 8 個季度。

That's sort of been there.

那有點像在那裡。

The x mix number can move around quarter-by-quarter.

x 混合數可以按季度移動。

So it sounds like the only incremental new piece of information is some of these larger system orders.

所以聽起來唯一增量的新信息是這些更大的系統訂單中的一些。

Is that a fair characterization of what's probably the incremental new piece of information?

這是對可能是增量新信息的公平描述嗎？

True.

真的。

Yes.

是的。

Okay.

好的。

Very helpful.

很有幫助。

Just 2 more for me, and I'll jump back in queue.

對我來說只有 2 個，我會跳回到隊列中。

One, Gary, you mentioned some SP manufacturing constraints here in the first quarter?

一，加里，你在第一季度在這裡提到了一些 SP 製造限制？

Are those resolved?

那些解決了嗎？

And sort of what's the pace to resolve them?

解決這些問題的速度如何？

And then, maybe for Calvin, just -- there's been a lot of -- your channel dynamics around women's health, more broadly women's health, general surgery breast in your gynecological FDA letters.

然後，也許對於卡爾文來說，只是 - 有很多 - 你在你的婦科 FDA 信件中圍繞女性健康的渠道動態，更廣泛的女性健康，普通外科乳房。

Any impact on the impacting underlying base targeted on either those 2 letters or channel disruption?

對針對這兩個字母或渠道中斷的影響基礎有任何影響嗎？

Those 2 questions.

那2個問題。

Okay.

好的。

On the SP side, the manufacturing constraint was a mechanical thing, having to do with frictions and rails and the way these things pull together.

在 SP 方面，製造限制是一個機械問題，與摩擦和導軌以及這些東西組合在一起的方式有關。

I think the team has got it.

我認為團隊已經做到了。

I think we'll meet our SP shipment client for the year.

我想我們今年會見我們的 SP 發貨客戶。

So I think they're knocking it down.

所以我認為他們正在打倒它。

It's just a timing issue there.

這只是一個時間問題。

With regard, I'll start on the broader one.

關於這一點，我將從更廣泛的方面開始。

With regard to FDA environment as it relates to medical devices and on women's health, clearly, they're signaling a more conservative approach and are speaking about it broadly across the industry.

關於與醫療器械和女性健康相關的 FDA 環境，很明顯，他們正在發出一種更保守的方法，並在整個行業廣泛談論它。

With regard to Intuitive, that may change some future data requirements and it may introduce some uncertainty and timelines for indications of kind of the things we're interested in over time.

關於 Intuitive，這可能會改變一些未來的數據要求，並且可能會引入一些不確定性和時間表，以指示我們隨著時間的推移感興趣的事物類型。

With regard to what it looks like in the installed base and things like cyclical perplexity, Calvin, I'll turn that back to you.

關於它在已安裝基礎中的樣子以及週期性困惑之類的東西，卡爾文，我會把它轉回給你。

Yes.

是的。

And as it relates to the -- there actually -- the FDA action relates to the use of mesh intended for transvaginal or pelvic organ prolapse.

因為它涉及 - 實際上 - FDA 的行動涉及使用用於經陰道或盆腔器官脫垂的網狀物。

There are actually various methods of medical management for pelvic organ prolapse including observation, history management and surgery.

盆腔器官脫垂的內科治療方法其實有多種，包括觀察、病史管理和手術治療。

da Vinci sacrocolpopexy is a minimally invasive method of abdominal surgery, so not transvaginal.

達芬奇骶骨陰道固定術是一種微創的腹部手術方法，因此不能經陰道。

And so since our procedure is abdominal, we don't think that this action is going to negatively impact our sacrocolpopexy volumes.

因此，由於我們的手術是腹部手術，我們認為此操作不會對我們的骶骨陰道固定術體積產生負面影響。

Last year, we did something like 15,000 to 20,000 cases in that category, and we were about 40% of the market.

去年，我們在該類別中做了大約 15,000 到 20,000 個案例，我們約佔市場的 40%。

And our next question is from Larry Biegelsen with Wells Fargo.

我們的下一個問題來自富國銀行的 Larry Biegelsen。

One for Gary, one for Marshall.

一份給加里，一份給馬歇爾。

I'll start with the one for Gary.

我將從 Gary 的那個開始。

Intuitive has launched a new system every, call it, 6 to 7 years.

Intuitive 每隔 6 到 7 年就會推出一個新系統。

Do you expect to maintain that cadence?

你希望保持這種節奏嗎？

I think it's been about 5 years since you launched Xi.

我認為自您啟動習近平以來已經過去了大約 5 年。

And what can you tell us about how you're thinking about enhancing Xi?

你能告訴我們你是如何考慮加強習近平的嗎？

And should we expect a low-cost system, perhaps for the ASE setting?

我們是否應該期待一個低成本的系統，也許是針對 ASE 設置？

And I have one follow-up.

我有一個後續行動。

With regard to innovation cadence, we continue to be committed to innovation.

關於創新節奏，我們繼續致力於創新。

On exact cadences, we won't predict timelines because it's uncertain based on what kind of technologies we're developing and based on the regulatory environment.

在確切的節奏上，我們不會預測時間表，因為根據我們正在開發的技術類型和監管環境，它是不確定的。

But you can be assured that we are committed to bringing the market, things that help our customers solve their problems.

但您可以放心，我們致力於為市場帶來幫助客戶解決問題的產品。

With regard to the specific question of economics and price points, you can see our history -- historically, X and Xi, and what we've done there, but just frankly, we routinely assess and balance customer needs, the features that they're interested in to achieve their aims and the price points, and we explore and invent broadly.

關於經濟和價格點的具體問題，你可以看到我們的歷史——歷史上，X 和 Xi，以及我們在那裡所做的，但坦率地說，我們經常評估和平衡客戶需求，他們的功能如果您對實現他們的目標和價格點感興趣，我們會進行廣泛的探索和發明。

We don't dispose what our specific plans are or timing for competitive reasons.

我們不會出於競爭原因處理我們的具體計劃或時間安排。

Understood.

明白了。

And Marshall, based on your guidance for procedure growth and OpEx growth in 2019, you're operating margin will likely decline.

馬歇爾，根據你對 2019 年程序增長和運營支出增長的指導，你的營業利潤率可能會下降。

So how do you want investors to think about your operating margin beyond 2019, especially in 2020, when we could start to see new competition?

那麼，您希望投資者如何考慮您在 2019 年之後的營業利潤率，尤其是在 2020 年，屆時我們可能會開始看到新的競爭？

Sure.

當然。

We haven't provided guidance beyond this year.

我們沒有提供今年以後的指導。

And I think what we said at the beginning of this year was you would see a decline in our operating margins, given the level of increased spending that we were going to embark on.

而且我認為我們在今年年初所說的是，鑑於我們將要開始的支出增加水平，你會看到我們的營業利潤率下降。

Calvin gave you the guidance for increased operating spending.

Calvin 為您提供了增加運營支出的指導。

As you know, it did not change from our previous guidance.

如您所知，它與我們之前的指南沒有變化。

So I think that's all I really have to say about that.

所以我認為這就是我真正要說的。

Yes.

是的。

I'd add something.

我會添加一些東西。

I think as we look out, the opportunity for improvement in acute interventions in surgery with the kinds of things we do, robotics, informatics, imaging, advanced imaging, we think it's substantial.

我認為，正如我們所看到的那樣，通過我們所做的各種事情、機器人技術、信息學、成像、高級成像來改進外科手術的急性干預的機會，我們認為這是巨大的。

And as a result, we take a long-term view.

因此，我們採取長遠眼光。

We think these are multiyear developments, multiyear investments, but ultimately, the size of that opportunity is quite large.

我們認為這些是多年的發展，多年的投資，但最終，這個機會的規模相當大。

And as a result, we try not to tune it perfectly quarter by quarter or year by year, but really, look over the very long term.

因此，我們盡量不逐季或逐年完美地調整它，而是從長遠來看。

Next, we will go to Amit Hazan with Citigroup.

接下來，我們將與花旗集團一起前往Amit Hazan。

Let me start with procedures for the quarter.

讓我從本季度的程序開始。

Just big picture, it looked to us like a state of comp-adjusted slowdown in growth in the U.S. and OUS.

從大局來看，在我們看來，美國和美國的經濟增長處於經過調整後的放緩狀態。

And I'm just wondering, I want to make sure we're not missing anything, but is there anything to call out that was off trend?

我只是想知道，我想確保我們沒有遺漏任何東西，但是有什麼東西要指出的是不合時宜的嗎？

I heard you say prostate, we got that one, but if there's any other headwinds that you saw in the quarter on a year-over-year basis, that would have kind of driven a slight slowdown.

我聽說你說前列腺，我們得到了那個，但如果你在本季度看到與去年同期相比有任何其他不利因素，那將導致略有放緩。

Is there anything there at all?

那裡有什麼嗎？

No.

不。

I think the comment is pretty much reflective that we were on trend in most of the major growth drivers in general surgery and continuation of what we've seen before.

我認為這一評論在很大程度上反映了我們在普通外科領域的大多數主要增長驅動因素中處於趨勢，並且延續了我們之前看到的情況。

And you can look at the Q1 comp, but then another thing to look at is workplace.

您可以查看 Q1 comp，但要查看的另一件事是工作場所。

So we had one fewer operating day in the first quarter, just due to timing of weekends is partially offset by Easter.

所以我們在第一季度的營業日減少了，只是因為周末的時間被復活節部分抵消了。

So I think you overcame that a little bit too.

所以我認為你也克服了一點。

So I don't think there's anything more to add to that.

所以我認為沒有什麼可以補充的了。

Okay.

好的。

Good.

好的。

And then, secondly, I want to ask about the da Vinci Sis.

然後，其次，我想問一下達芬奇姐姐。

So we spent some time with a few of your customers this quarter.

因此，本季度我們花了一些時間與您的一些客戶交流。

And they basically told us that you guys are -- sent them a letter that you're sunsetting the da Vinci Si, and its instruments by 2024.

他們基本上告訴我們，你們是——給他們發了一封信，說你們要在 2024 年之前讓達芬奇 Si 及其儀器落伍。

And so I just want to see if we could, first of all, get a confirmation of that.

所以我只想看看我們是否可以首先確認這一點。

And also, some context for how many Sis are still out there and how you'd expect it to play out in terms of the replacement cycle?

而且，關於還有多少 Sis 仍然存在的一些背景信息，以及您希望它在更換週期方面如何發揮作用？

Yes.

是的。

I'll let Calvin speak to the number of Sis that are out there.

我會讓 Calvin 談談那裡的 Sis 人數。

Indeed, we did put a letter out.

事實上，我們確實發出了一封信。

The letter really talked about discontinuation of stapling in certain energy instruments, specifically.

這封信具體談到了停止在某些能量儀器中裝訂。

And that those would be coming to an end in 2020.

那些將在 2020 年結束。

We also indicated that we would discontinue annual service pricing in 2025.

我們還表示，我們將在 2025 年停止年度服務定價。

The -- having said that, we're committed to supporting Si.

話雖如此，我們致力於支持 Si。

We'll continue to deliver instruments and accessories even beyond the end date of 2024.

即使在 2024 年結束日期之後，我們仍將繼續提供儀器和配件。

And we will even provide services beyond 2024, just not in the form of annual service, but rather, in the form of time and materials.

我們甚至會提供 2024 年以後的服務，只是不是以年度服務的形式，而是以時間和材料的形式。

Yes.

是的。

In terms of the installed base, we just turned the -- crossed the line here this quarter.

就已安裝基礎而言，我們剛剛在本季度越過了這條線。

The slight majority are now da Vinci Xi systems.

微弱的大多數現在是達芬奇 Xi 系統。

But still, nearly half are Si and previous models.

但是，仍然有將近一半是 Si 和以前的型號。

And we talked a lot about trade-in cycle and the impact in a number of trade-ins so there's still a significant number of Si and previous out there.

我們談了很多關於以舊換新周期和一些以舊換新的影響，所以那裡仍然有大量的 Si 和以前的產品。

Next, we have JP McKim with Piper Jaffray.

接下來，我們有 JP McKim 和 Piper Jaffray。

I wanted to ask one on SP.

我想在SP上問一個。

I think you said there was around 800 procedures performed in that platform to date.

我想你說過迄今為止在該平台上執行了大約 800 個程序。

Maybe if you could just talk about whether those were procedures that would've been done robotically previously?

也許你可以談談這些程序是否是以前由機器人完成的？

Or if it is expanding the market a little bit?

或者它是否在一點點擴大市場？

And then maybe your thought on other indications this year, and some rough timing around when those could happen.

然後也許你對今年其他跡象的想法，以及這些可能發生的粗略時間。

Thanks for the question.

謝謝你的問題。

The bulk of the procedures so far were in urology would likely have been done robotically anyway.

到目前為止，大部分手術都是在泌尿科進行的，無論如何都可能由機器人完成。

Indication -- the additional indication we got in transoral robotic surgery was relatively recent.

適應症——我們在經口機器人手術中獲得的額外適應症是相對較新的。

That will grow in time.

那會隨著時間的推移而增長。

That will likely be a small expansion relative to what's being done robotically.

相對於機器人所做的事情，這可能是一個小的擴展。

The next likely procedure for us to pursue is a colorectal indication.

我們接下來可能要進行的手術是結直腸適應症。

That will not occur in 2019.

這不會發生在 2019 年。

We will do a lot of the work, but I do not anticipate an additional clearance in '19 for colorectal, but it's likely next on deck that we expect to be more expansive than substituting.

我們將做很多工作，但我預計在 19 年不會對結直腸癌進行額外的許可，但我們預計下一步可能會比替代更廣泛。

That's helpful.

這很有幫助。

And there's clearly a push to get everything under the fourth generation, just in terms of the program you talked about earlier.

就您之前談到的程序而言，顯然有推動一切都在第四代之下的努力。

But maybe, if you could talk about strategically, how important that is for you as a company either just to standardize manufacturing more?

但也許，如果你能從戰略上談談，這對你作為一家公司來說有多重要，要么只是為了使製造更加標準化？

Or ahead of competition to get more and more customers standardized on this fourth-generation platform.

或者領先於競爭，讓越來越多的客戶在這個第四代平台上標準化。

Our primary motivation is that the fourth gen is well optimized to the kinds of things our customers do.

我們的主要動機是第四代針對我們客戶所做的事情進行了很好的優化。

So our first motivation is we think it's beneficial for them, particularly things like advanced instruments and stapling and so on.

所以我們的第一個動機是我們認為這對他們有益，特別是像先進儀器和吻合器等。

We're at more mature products and those kind of advanced instruments.

我們擁有更成熟的產品和那些先進的儀器。

And in that sense, you see the trading numbers go up and some of the ASP conversations, we think we want to be aligned with our customers to both standardize and get the right access to the right technologies in the right place.

從這個意義上說，你看到交易數字上升，一些 ASP 對話，我們認為我們希望與我們的客戶保持一致，以實現標準化並在正確的地方正確訪問正確的技術。

We think that helps them.

我們認為這對他們有幫助。

We think that helps us, and if we're helping both sides, we think that's good for our competitive position over time.

我們認為這對我們有幫助，如果我們幫助雙方，我們認為隨著時間的推移這對我們的競爭地位有利。

We go now to Larry Keusch with Raymond James.

我們現在和 Raymond James 一起去 Larry Keusch。

Gary, just one relative to hernia.

加里，只是疝氣的一個親戚。

You obviously indicated that you still have the sales organization very much focused in the general surgical area on hernia and colorectal, and you're not ready yet to quite get going on bariatric yet with meaningful field support.

你顯然表示你的銷售組織仍然非常關注疝氣和結直腸癌的普通外科領域，你還沒有準備好在有意義的現場支持下開始減肥。

So just on hernia itself since that remains a focal point, can you help us think a little bit sort of what inning we're in at this point as you look U.S.?

所以就疝氣本身而言，因為它仍然是一個焦點，你能幫助我們思考一下你看美國時我們在這一點上的局嗎？

And I guess the follow-on question is, what will it take to really start to drive general surgical procedures in Europe because again, still being dominated by urology?

我想接下來的問題是，要真正開始在歐洲推動普通外科手術需要做些什麼，因為仍然由泌尿外科主導？

Yes.

是的。

I think in the hernia markets, I think we're in the end of the early innings is kind of where I'd put it.

我認為在疝氣市場，我認為我們在早期局的末尾就是我所說的那樣。

I think starting to enter more mainstream use.

我認為開始進入更主流的使用。

How far it goes, depends a little bit on clinical condition.

它能走多遠，在一定程度上取決於臨床情況。

As you know, not every hernia is the same, not every patient is the same in terms of comorbidities.

如您所知，並非每個疝氣都是相同的，並非每個患者的合併症都是相同的。

So assessing total size of the market and applicability is always a bit of an estimate.

因此，評估市場的總規模和適用性總是有點估計。

But I don't think we're half-way done yet, and that's why we have our sales force focused the way it is.

但我認為我們還沒有完成一半，這就是為什麼我們讓銷售人員如此專注的原因。

Second half of the question, I'm sorry?

問題的後半部分，對不起？

Europe and urology.

歐洲和泌尿外科。

So on European side, we're starting to see some early interest in general surgery and visceral surgery.

因此，在歐洲方面，我們開始看到對普通外科和內臟外科的一些早期興趣。

Certainly, on the more complex procedure side, we see interest in procedures that are done where the underlying causes cancer also has interest.

當然，在更複雜的程序方面，我們看到人們對在潛在致癌原因也有興趣的地方進行的程序感興趣。

There may be an opportunity in benign general surgery as well.

良性普通外科手術也可能有機會。

The economics may be slightly different and that may require a slightly different adjustment from the company that made sure we satisfy that market.

經濟學可能略有不同，這可能需要與確保我們滿足該市場的公司進行略微不同的調整。

Early on, we have work to do to finish urology.

在早期，我們需要完成泌尿外科的工作。

We're not done yet.

我們還沒有完成。

And then, we're looking at the next indications in the more complex side as the next step.

然後，我們正在研究更複雜方面的下一個跡像作為下一步。

Okay.

好的。

Perfect.

完美的。

And then, one quick one for Marshall, just on the operating leases.

然後，馬歇爾的一個快速的，只是關於經營租賃。

I know it's still early in the experience in terms of ramping those up.

我知道在提升這些方面的經驗還處於早期階段。

They did ramp relatively consistently through to last year, I guess, the 2Q was down a little bit, but should we think about any seasonality just in the operating lease percentages given what you know today?

他們確實相對穩定地持續到去年，我猜，第二季度有所下降，但我們是否應該考慮根據你今天所知道的經營租賃百分比中的任何季節性因素？

No.

不。

I don't think we've seen enough of a pattern to know whether there's any kind of seasonality to it.

我認為我們還沒有看到足夠多的模式來了解它是否存在任何季節性。

I suppose that there's the possibility that there's some seasonality associated with hospital budgeting cycles and so forth.

我想有可能存在與醫院預算週期等相關的季節性。

But again, we haven't seen any particular patterns we'd point out at this point.

但同樣，我們目前還沒有看到我們要指出的任何特定模式。

And next in queue, we have Richard Newitter at SVB Leerink.

接下來是 SVB Leerink 的 Richard Newitter。

I have two.

我有兩個。

First one for you, Gary.

第一個給你，加里。

Just on -- I appreciate that maybe you're not as focused with the commercial focus to move into bariatrics with hernia and colorectal priorities now.

只是——我很欣賞你現在可能沒有像商業重點那樣專注於疝氣和結直腸優先事項的減肥。

But with the introduction of the 60-millimeter stapler, have you noticed any kind of inflection in the demand curve, at least, with respect to interest in bariatrics?

但是隨著 60 毫米訂書機的推出，您是否注意到需求曲線有任何變化，至少在對減肥的興趣方面？

And are we nearing that point where you would start to allocate the resources there?

我們是否接近您開始在那里分配資源的那個點？

And then I have a follow-up.

然後我有一個後續行動。

Remember, in terms of sequencing to activate a market, there is optimizing the product set to get them there, there's helping build the partnering networks and the capacity for training and team training.

請記住，就激活市場的順序而言，需要優化產品集以使其到達那裡，需要幫助建立合作網絡以及培訓和團隊培訓的能力。

So there's some pre-work, and then there's the building of the sales force competencies and support, customer base.

所以有一些前期工作，然後是銷售隊伍能力和支持、客戶群的建設。

So we're engaged in the pre-work.

所以我們正在進行前期工作。

First, from the products and now into building the pathways and engaging those who will lead.

首先，從產品到現在建立路徑並吸引那些將要領導的人。

So we're excited about it.

所以我們對此感到興奮。

I think there's real interest and there's real long-term opportunity and it's really just a question of timing.

我認為有真正的興趣和真正的長期機會，這真的只是一個時間問題。

In terms of results, I wouldn't call anything out.

就結果而言，我不會說出任何東西。

One way or another, showing strength or weakness.

一種或另一種方式，顯示力量或弱點。

I think we're really in a building capacity phase before we expect more out of the commercial team.

我認為在我們期望商業團隊提供更多服務之前，我們確實處於建設能力階段。

Okay.

好的。

And just as we think about a higher proportion of systems getting placed under these flexible financing arrangements, minimum volume committed -- commit arrangements, I'm just curious, a straight operating lease model, one would've thought, hey, some of these systems maybe are more susceptible or the customers are more susceptible to a trialing phenomenon as competitors come into the market.

正如我們考慮在這些靈活的融資安排下放置更高比例的系統一樣，最小承諾量 - 承諾安排，我很好奇，一種直接的經營租賃模式，人們會想，嘿，其中一些當競爭對手進入市場時，系統可能更容易受到影響，或者客戶更容易受到試用現象的影響。

But the more I hear you talk about these and the multisystem sales in these volume commitments, I'm wondering, does that just raise the switching costs as we think of a higher percentage of systems getting placed in there?

但我越是聽到你談論這些以及這些批量承諾中的多系統銷售，我想知道，這是否會增加轉換成本，因為我們認為有更高比例的系統被放置在那裡？

Well, first of all, when you say volume commitments, they are not volume commitments.

嗯，首先，當你說數量承諾時，它們不是數量承諾。

They are targets that we establish, but we don't have a volume commitment per se.

它們是我們制定的目標，但我們本身沒有數量承諾。

Second, I think there are costs to switch, of course, that go beyond the system itself, training surgeons and staff as well as protocols on how you set up the -- how you set up the OR, how you manage the product and how use the product and so I think those are barriers as well.

其次，我認為轉換成本當然會超出系統本身，培訓外科醫生和工作人員以及關於如何設置的協議——如何設置 OR，如何管理產品以及如何使用該產品，所以我認為這些也是障礙。

As far switching costs associated with the system itself, you do run a risk with the some of the variations we're putting out there in financing that it may be easier for our customer to switch out.

就與系統本身相關的轉換成本而言，我們在融資中推出的一些變體確實存在風險，我們的客戶可能更容易轉換。

But we think that broadening the base now and getting the commitment of the surgeons and getting them trained so that we increase the barrier on that front is a better route to go.

但我們認為，現在擴大基礎並獲得外科醫生的承諾並讓他們接受培訓，以便我們在這方面增加障礙是一個更好的途徑。

And next, we have Craig Bijou with Cantor Fitzgerald.

接下來，我們有克雷格·比茹和坎托·菲茨杰拉德。

I wanted to ask on Japan.

我想問問日本。

I appreciate the comment that procedural growth was still strong.

我很欣賞關於程序增長仍然強勁的評論。

But I wanted to see, is it -- are you still seeing some of the growth that you saw in the last couple of quarters?

但我想看看，你是否仍然看到過去幾個季度的一些增長？

Just -- how should we think about where exactly or I guess, how strong that growth is with the new procedures?

只是 - 我們應該如何考慮新程序的確切增長或我猜的增長有多強勁？

Yes.

是的。

We're full year now, right?

我們現在已經整整一年了，對吧？

We got clearance for those 12 new procedures April 1, 2018.

我們在 2018 年 4 月 1 日獲得了這 12 項新程序的許可。

And even after full year, it's still fairly early.

即使在全年之後，它仍然相當早。

And so we're focused on things like we were talking about, the training support, proctoring network, building a solid foundation of surgeons, the OR teams and really emphasizing the clinical outcomes.

因此，我們專注於我們正在談論的事情，培訓支持、監考網絡、為外科醫生、手術室團隊打下堅實的基礎，並真正強調臨床結果。

We talked about, back in Q3 of '18, procedure growth moving above the 40% line in Japan, that continued in Q4.

早在 18 年的第三季度，我們就談到了日本的程序增長超過 40%，並在第四季度繼續。

And in fact, here in Q1 of 2019, it kind of held onto that kind of rate of growth.

事實上，在 2019 年第一季度，它保持了這種增長率。

And maybe just a follow-up on Japan, I know you added 13 systems in the quarter, but maybe just help us get a sense for what the demand -- or I guess, system demand is.

也許只是對日本的跟進，我知道你在本季度增加了 13 個系統，但也許只是幫助我們了解需求——或者我猜，系統需求是什麼。

I know that -- I believe that utilization of the Japan systems was one of your lower geographic regions.

我知道——我相信日本系統的使用是你們較低的地理區域之一。

So just maybe a little color there.

所以那裡可能只有一點顏色。

Yes.

是的。

I think what we've said before and we're still on that same page is that, the systems are utilized poorly at this point and there is the opportunity to increase the number of procedures that can be done on them.

我認為我們之前說過並且我們仍然在同一頁面上的是，目前系統的利用率很低，並且有機會增加可以在它們上完成的程序的數量。

However, the 12 procedures that were improved last year are not necessarily all done at the same hospitals so you've seen us sell systems because there are hospitals that do those procedures that were not doing prostatectomies or nephrectomies and now want to do robotic surgery.

然而，去年改進的 12 項手術不一定都在同一家醫院完成，所以你看到我們出售系統，因為有些醫院做那些不做前列腺切除術或腎切除術的手術，現在想做機器人手術。

So it's hard for us to gauge exactly how much more -- how many more systems we can sell given the opportunity in front of us.

因此，我們很難準確衡量我們還能賣出多少——鑑於我們面前的機會，我們還能賣出多少系統。

The number of procedures being performed that had previously been approved, which was prostatectomy and nephrectomy was around 25,000 to 30,000 and these additional 12 procedures was 200,000, although they were highly laparoscopically penetrated, and so it's also difficult to know how many of those will actually adopt or switch.

之前已經批准的正在執行的手術數量，即前列腺切除術和腎切除術，大約有 25,000 到 30,000，而這額外的 12 個手術是 200,000，儘管它們是高度腹腔鏡穿透的，因此也很難知道其中有多少實際上會採用或轉換。

Our final question will come from Imron Zafar with Deutsche Bank.

我們的最後一個問題將來自德意志銀行的 Imron Zafar。

First, on U.S. general surgery, I'm curious if you could give us some insight on how much of the growth you're seeing is coming from higher penetration within your existing users versus new general surgeons embracing robotics?

首先，關於美國普外科，我很好奇你是否能給我們一些見解，說明你所看到的增長有多少來自現有用戶的更高滲透率，而不是新的普通外科醫生接受機器人技術？

Yes.

是的。

You just look at what we're selling.

你只要看看我們賣的是什麼。

The large majority of capital is -- are going into existing customers.

大部分資金是 - 正在進入現有客戶。

They were expanding their programs and we're working with them as thoughtfully as we can with analytics and insights and expanding programs to build them out in the hospitals.

他們正在擴展他們的項目，我們正在通過分析和洞察力盡可能深思熟慮地與他們合作，並擴展項目以在醫院中建立它們。

So a large part of the remaining opportunity and procedures that are currently adopting are in the hospitals or hospital networks that we have established relationships.

因此，目前正在採用的大部分剩餘機會和程序都在我們建立關係的醫院或醫院網絡中。

Yes.

是的。

We still have some greenfield opportunities to be sure, but in terms of proportion, it's heavy on existing.

我們仍然有一些綠地機會可以肯定，但就比例而言，它對現有機會很重要。

Question may have been asked from the point of surgeon themselves, more from a surgeon or newly trained surgeons and it's clearly a balanced mix of both.

問題可能是從外科醫生本身的角度提出的，更多的是來自外科醫生或新培訓的外科醫生，這顯然是兩者的平衡組合。

Okay.

好的。

And then, can you just talk about the long-term opportunity for a mastectomy?

然後，你能談談乳房切除術的長期機會嗎？

I know you have a clinical study ongoing -- or is getting underway.

我知道您正在進行一項臨床研究——或者正在進行中。

And is it fair to assume that that's more of an SP opportunity rather than the multiport?

假設這更像是一個 SP 機會而不是多端口是否公平？

Not ready to characterize anything yet.

還沒有準備好描述任何東西。

And we know that there are some folks who are interested in it who are starting to work through what studies might look like, but we are not yet prepared to talk about what the long-term looks like there.

我們知道有些人對此很感興趣，他們開始著手研究可能是什麼樣子，但我們還沒有準備好談論那裡的長期情況。

Okay.

好的。

And then one just -- one last quick one for Marshall.

然後是 Marshall 的最後一個快速發言。

There's been a pretty sizable increase in your headcount since the third quarter.

自第三季度以來，你們的員工人數有了相當大的增加。

I think it's up like 800 something.

我認為它漲了800左右。

I assume some of that is just headcount accretion from some of your distributor acquisitions late last year, but can you just talk about what geographies those hires are targeting?

我假設其中一些只是去年年底你的一些分銷商收購的員工人數增加，但你能談談這些員工的目標地區嗎？

The two greatest increases, one is what you characterize, which is that we took on distributor headcounts.

兩個最大的增長，一個是你所描述的，那就是我們增加了經銷商人數。

So specifically, over the last year, we've added over 300 heads associated with our growth in Asia-Pacific.

具體來說，在過去的一年裡，我們增加了 300 多名與我們在亞太地區的增長相關的負責人。

And the second area is really manufacturing headcount, and we bring manufacturing headcount in to -- on a temporary basis at first, and then we hire them in boluses.

第二個領域是真正的製造業員工人數，我們將製造業員工人數帶入——一開始是臨時的，然後我們以大劑量的方式僱傭他們。

And in fact, we hired a bolus of them in the last 6 months.

事實上，我們在過去 6 個月裡聘請了他們中的一大批。

Well, thank you.

嗯，謝謝。

That was our last question.

這是我們的最後一個問題。

In closing, we believe there's a substantial and durable opportunity to fundamentally improve surgery and acute interventions.

最後，我們相信有大量和持久的機會從根本上改善手術和急性干預措施。

Our teams continue to work closely with hospitals, physicians and care teams in pursuit of what our customers have termed the quadruple aim: better more predictable patient outcomes, better experiences for patients, better experiences for care teams, and ultimately, a lower total cost of care.

我們的團隊繼續與醫院、醫生和護理團隊密切合作，以實現我們的客戶所說的四重目標：更好、更可預測的患者結果、更好的患者體驗、更好的護理團隊體驗，以及最終更低的總成本關心。

We believe that accomplishing the same takes the integration of 3 elements: first, a deep understanding of human interactions across the continuum of care; second, smart and connected systems imaging and instruments that augment care teams; and third, the ability to measure impact through analytical insights and translation of these insights into action that drives positive change.

我們認為，要實現這一目標需要整合三個要素：首先，深入了解整個護理過程中的人際互動；第二，增強護理團隊的智能和連接系統成像和儀器；第三，通過分析洞察力並將這些洞察力轉化為推動積極變革的行動來衡量影響的能力。

We believe value creation in surgery and acute care is foundationally human.

我們相信手術和急症護理的價值創造從根本上講是人性化的。

It flows from respect for and understanding of patients and care teams, their needs and their environment.

它源於對患者和護理團隊、他們的需求和環境的尊重和理解。

Thank you for your support on this extraordinary journey.

感謝您對這段非凡旅程的支持。

We look forward to talking with you again in 3 months.

我們期待在 3 個月後再次與您交談。

That does conclude our conference for today.

我們今天的會議到此結束。

Thank you for your participation, and for using AT&T Teleconference.

感謝您的參與和使用 AT&T 電話會議。

You may now disconnect.

您現在可以斷開連接。