直覺手術 (ISRG) 2019 Q2 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 Q2 2019 Earnings Release Call.

歡迎來到 Intuitive Surgical 2019 年第二季度收益發布電話會議。

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

（操作員說明）提醒一下，正在錄製此會議。

I would now like to turn the conference over to our host, Mr. Calvin Darling, Senior Director of Finance, Investor Relations.

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

Please go ahead.

請繼續。

Thank you.

謝謝。

Good afternoon, and welcome to Intuitive's second quarter earnings conference call.

下午好，歡迎來到 Intuitive 第二季度收益電話會議。

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, and 10-Q filed on April 19, 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 表格和 2019 年 4 月 19 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 second quarter results as described in our press release announced earlier today, followed by a question-and-answer session.

今天的形式將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二季度業績的亮點，然後是問答環節。

Gary will present the quarter's business and operational highlights, Marshall will provide a review of our second 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 將回顧我們第二季度的財務業績，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 will turn it over to Gary.

有了這個，我會把它交給加里。

Thank you for joining us today.

感謝您今天加入我們。

The second quarter of 2019 was a solid one for Intuitive with healthy customer interest and demand for our products.

2019 年第二季度對於 Intuitive 來說是一個堅實的季度，客戶對我們的產品有健康的興趣和需求。

Overall procedure growth met our expectations, while capital placements exceeded them.

整體程序增長符合我們的預期，而資本配置超出了他們的預期。

Global procedure growth was approximately 17% in the second quarter of 2019.

2019 年第二季度全球手術量增長約 17%。

Growth again centered on general surgery in the United States, with positive contributions to the global growth rate from Germany, France and Japan.

增長再次集中在美國的普通外科，德國、法國和日本對全球增長率做出了積極貢獻。

In China, we are pleased with procedure performance, given the recent release of systems under the new quota.

在中國，鑑於最近在新配額下發布的系統，我們對程序性能感到滿意。

Turning to the United States, year-over-year growth in the quarter was 16%.

轉向美國，本季度同比增長 16%。

General surgery growth again accounted for the largest increase year-over-year, accompanied by expected moderation of growth in U.S. urology and gynecology.

普外科增長再次成為同比增幅最大的，伴隨著美國泌尿科和婦科的預期增長放緩。

Underlying this performance, we saw a continued strength in bariatrics and cholecystectomy, with modest tempering of growth rate in hernia and colon resection.

在這種表現的基礎上，我們看到減肥和膽囊切除術的持續增長，疝氣和結腸切除術的增長率適度下降。

Given the different types of procedures being performed by general surgeons, we see additional demands on system access and accounts as well as increased demands on our representatives' time to support different procedure types.

鑑於普通外科醫生執行的手術類型不同，我們看到了對系統訪問和帳戶的額外需求，以及對我們代表支持不同手術類型的時間的需求增加。

We believe system placement strength in the U.S. is driven in part by the desire of general surgeons for increased access.

我們認為美國的系統放置強度部分是由於普通外科醫生希望增加訪問權限。

We have efforts ongoing to manage these issues.

我們正在努力解決這些問題。

Calvin will take you through global procedure dynamics in more detail later in the call.

Calvin 將在稍後的電話會議中更詳細地帶您了解全球程序動態。

With regard to our installed base, placement of new systems in the quarter was strong, with growth in total placements rising 24% from Q2 of 2018.

就我們的安裝基礎而言，本季度新系統的安裝量強勁，總安裝量比 2018 年第二季度增長了 24%。

Net of trade-ins and retirements, our da Vinci installed base again grew 13% over Q2 2018 to approximately 5,270.

扣除以舊換新和報廢後，我們的達芬奇安裝基數在 2018 年第二季度再次增長 13%，達到約 5,270 台。

The mix of system placements this quarter moved towards our flagship Xi System, while both sales of X Systems and trade-ins remained healthy.

本季度的系統佈局組合轉向了我們的旗艦 Xi 系統，而 X 系統和以舊換新的銷售都保持健康。

The proportions of systems placed under operating leases was 32% this quarter compared with 33% last quarter.

本季度經營租賃下的系統比例為 32%，而上一季度為 33%。

We do not anticipate this quarter-to-quarter variance is indicative of a larger trend in leasing.

我們預計這種季度間差異並不表示租賃有更大的趨勢。

With regard to capital average sales price, the mix of systems and geographies last quarter resulted in a lower ASP when compared to historical trends.

關於資本平均銷售價格，與歷史趨勢相比，上個季度系統和地域的組合導致平均售價較低。

The second quarter saw a reversal of mix dynamics, with more fully featured system sales and a greater proportion of system placements in direct markets, resulting in an ASP that is higher than recent quarterly averages.

第二季度出現了組合動態的逆轉，功能更齊全的系統銷售和直接市場中更大比例的系統安置，導致 ASP 高於最近的季度平均水平。

As we said last quarter, this variance in ASP quarter-to-quarter is the result of system and regional mix, not a fundamental change in our philosophy.

正如我們上個季度所說，ASP 的季度差異是系統和區域組合的結果，而不是我們理念的根本變化。

Turning to expenses, we continue to invest as we launch new platforms, strengthen our computational capabilities and execute projects that support future scale and provide leverage opportunities as we grow.

談到支出，我們在推出新平台時繼續投資，加強我們的計算能力並執行支持未來規模的項目，並隨著我們的成長提供槓桿機會。

Our spending met our expectations, falling within the range of projections we shared with you last quarter and supported by solid procedure growth and capital placements.

我們的支出符合我們的預期，在我們上個季度與您分享的預測範圍內，並得到穩健的程序增長和資本配置的支持。

Financial highlights of our second quarter results are as follows: Procedures grew approximately 17% over the second quarter of last year; we placed 273 da Vinci surgical systems, up from 220 in the second quarter of 2018; our installed base again grew 13% from a year ago; revenue for the quarter was approximately $1.1 billion, up 21%; pro forma gross profit margin was 71.3% compared to 71.1% in the second quarter last year; instrument and accessory revenue increased to $579 million, up 22%; total recurring revenue in the quarter was $780 million, growing 21% over Q2 of 2018 and representing 71% of total revenue.

我們第二季度業績的財務亮點如下： 程序比去年第二季度增長約 17%；我們放置了 273 個達芬奇手術系統，高於 2018 年第二季度的 220 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 11 億美元，增長 21%；預計毛利率為 71.3%，而去年第二季度為 71.1%；儀器和附件收入增加到 5.79 億美元，增長 22%；本季度經常性總收入為 7.8 億美元，比 2018 年第二季度增長 21%，佔總收入的 71%。

We generated a pro forma operating profit of $455 million in the quarter, up 17% from the second quarter of last year, and pro forma net income was $388 million, up 18%.

我們本季度的預估營業利潤為 4.55 億美元，比去年第二季度增長 17%，預估淨收入為 3.88 億美元，增長 18%。

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。

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。

For our customers, surgery has been digitized for the past 20 years.

對於我們的客戶來說，過去 20 年來手術已經數字化。

While we've made significant progress over our history, we believe continuous improvement is required and we have deployed our investment 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、高質量的手術，這些手術在總治療成本方面是高效且具有成本效益的。

Taking one example of our advanced instrument platforms, our second-generation SureForm staplers are now in the market at both 60-millimeter and 45-millimeter instrument lengths and represent product families.

以我們先進的儀器平台為例，我們的第二代 SureForm 訂書機現在以 60 毫米和 45 毫米的儀器長度上市，代表了產品系列。

Our 60-millimeter stapler has 4 staple lengths available and is sold in the U.S., Europe, Korea, Australia and now Japan.

我們的 60 毫米訂書機有 4 種訂書釘長度可供選擇，在美國、歐洲、韓國、澳大利亞和現在的日本銷售。

Our 45-millimeter SureForm stapler has 5 different staple-length cartridges as well as a straight-tip and curved-tip instrument and is available in initial launch in the United States and our direct EU markets.

我們的 45 毫米 SureForm 訂書機有 5 種不同的訂書釘長度的訂書釘盒以及直尖和彎尖儀器，並在美國和我們的直接歐盟市場首次推出。

Measured through Q2, surgeons have fired Intuitive staplers clinically over 1 million times cumulatively since our stapling launch.

從第 2 季度開始衡量，自我們的吻合器推出以來，外科醫生在臨床上累計發射了超過 100 萬次 Intuitive 吻合器。

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

談到系統，我們正處於達芬奇 SP 推出的第一階段。

We installed 13 systems in Q2 to bring our clinical installed base of SP to 34.

我們在第二季度安裝了 13 個系統，使我們的 SP 臨床安裝基數達到 34。

Our teams have done a nice job resolving the manufacturing variances that slowed our installs in Q1.

我們的團隊很好地解決了導致我們在第一季度安裝速度變慢的製造差異。

The highest per system utilization of SP is occurring in Korea, where regulatory clearances support the access to a large range of clinical applications.

SP 的每個系統利用率最高的發生在韓國，那裡的監管許可支持訪問大量的臨床應用。

The Korean experience with SP is encouraging with regard to the broad possibilities for our platform.

就我們平台的廣泛可能性而言，韓國在 SP 方面的經驗令人鼓舞。

In Korea, procedures in urology, gynecology, general surgery and head and neck surgery are being performed.

在韓國，正在開展泌尿科、婦科、普通外科和頭頸外科手術。

In the United States, we have 2 cleared indications for SP: urologic and transoral surgery.

在美國，我們有 2 個明確的 SP 適應症：泌尿外科和經口手術。

As you know, we're pursuing additional clinical indications for SP and have engaged regulatory agencies regarding their requirements.

如您所知，我們正在尋求 SP 的其他臨床適應症，並已就其要求與監管機構進行了接觸。

These requirements are in discussion, which implies projected timelines for additional indications are not yet available.

這些要求正在討論中，這意味著尚無其他適應症的預計時間表。

Our pipeline of interested SP customers is healthy, and the combination of additional indications for SP and our readiness for deployment at larger scale pace the speed of our SP commercial expansion.

我們感興趣的 SP 客戶的管道是健康的，並且 SP 的其他跡象和我們準備更大規模部署的結合加快了我們 SP 商業擴張的速度。

In flexible diagnostics, our Ion platform is focused on the need for accurate, timely biopsies to support definitive early diagnosis of suspicious lung cancers -- lesions for lung cancer.

在靈活的診斷中，我們的 Ion 平台專注於對準確、及時的活檢的需求，以支持對可疑肺癌（肺癌病變）進行明確的早期診斷。

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've initiated our next phase focused on clinical use, customer feedback and production optimization.

獲得 510(k) 許可後，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。

Placements to date are at hospital sites collecting data.

迄今為止的安置是在收集數據的醫院現場。

So far, 3 have been initiated and over 50 procedures have been performed so far.

到目前為止，已經啟動了 3 個程序，並且已經執行了 50 多個程序。

We're pleased with early clinical results and look forward to our customers' continued progress.

我們對早期的臨床結果感到滿意，並期待我們的客戶不斷取得進步。

We expect commercial placements to commence in the next few months along with the initiation of additional clinical collection sites.

我們預計在接下來的幾個月內將開始商業投放，同時還會啟動更多的臨床採集站點。

We do not anticipate material revenue from Ion in 2019.

我們預計 2019 年 Ion 不會帶來實質性收入。

Turning to imaging and analytics, this week, we announced the acquisition of the 3D robotic endoscope business from our long-time supplier, Schölly Fiberoptic.

談到成像和分析，本週，我們宣布從我們的長期供應商 Schölly Fiberoptic 手中收購 3D 機器人內窺鏡業務。

The transaction is subject to closing conditions and thereafter, we look forward to welcoming their employees to the Intuitive team.

該交易取決於成交條件，此後，我們期待著歡迎他們的員工加入 Intuitive 團隊。

Leading visualization has been a core pillar of our offerings and we believe it is essential to the future of intelligent surgery.

領先的可視化一直是我們產品的核心支柱，我們相信它對智能手術的未來至關重要。

This acquisition strengthens our design and supply chain capabilities and increases our manufacturing capacity for imaging products.

此次收購加強了我們的設計和供應鏈能力，並提高了我們的成像產品製造能力。

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 focus procedures and countries.

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程序中採用達芬奇；第二，啟動我們的 SP 和 Ion 平台；三是推動智能手術創新；最後，支持在我們的重點程序和國家/地區進行額外的臨床和經濟驗證。

Before I turn the call over to Marshall, I'd like to take a moment to acknowledge our Chief Operating Officer, Mr. Sal Brogna, who announced his intention to step back from day-to-day operations after 20 years at Intuitive.

在我將電話轉給 Marshall 之前，我想花點時間感謝我們的首席運營官 Sal Brogna 先生，他宣布他打算在 Intuitive 工作 20 年後退出日常運營。

Sal has made enormous contributions to building our product line, our capabilities and, in the past few years, our leadership team.

Sal 為建立我們的產品線、我們的能力以及過去幾年的領導團隊做出了巨大貢獻。

I extend my personal thanks and that of the company for his efforts over these past 2 decades.

我個人和公司感謝他在過去 2 年中所做的努力。

We anticipate working with Sal post-transition on projects of mutual interest.

我們預計在移交後與 Sal 就共同感興趣的項目進行合作。

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

我現在將電話轉給馬歇爾，他將審查財務亮點。

Good afternoon.

下午好。

I'll describe the highlights of our performance on a 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 prepared remarks.

我還將在稍後準備好的評論中總結我們的 GAAP 表現。

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

我們的備考結果與 GAAP 結果之間的對賬已發佈在我們的網站上。

Key business metrics for the second quarter were as follows: Second quarter 2019 procedures increased approximately 17% compared with the second quarter of 2018, and increased approximately 7% compared with last quarter; procedure growth continues to be driven by general surgery in the U.S. and urology worldwide.

第二季度主要業務指標如下： 2019年第二季度手續較2018年第二季度增長約17%，較上季度增長約7%；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。

Second quarter system placements of 273 systems increased 24% compared with 220 systems last year, and increased 16% compared with 235 systems last quarter.

273 個系統的第二季度系統佈局比去年的 220 個系統增加了 24%，比上個季度的 235 個系統增加了 16%。

We expanded our installed base of da Vinci systems by 17% to approximately 5,270 systems.

我們將達芬奇系統的安裝基礎擴大了 17%，達到約 5,270 個系統。

This growth is consistent with last quarter and slightly higher than the 12.5% increase last year.

這一增長與上一季度一致，略高於去年 12.5% 的增幅。

Utilization of clinical systems in the field, measured by procedures per system, grew approximately 3.5%, which is slightly lower than last quarter growth of approximately 4%, and below the 5% growth last year.

按每個系統的程序衡量，現場臨床系統的使用率增長了約 3.5%，略低於上一季度約 4% 的增長率，也低於去年 5% 的增長率。

Our revenue overview is as follows: Second quarter 2019 revenue was $1.1 billion, an increase of 21% compared with $909 million for the second quarter of 2018, and an increase of 13% compared with $974 million last quarter.

我們的收入概況如下： 2019 年第二季度收入為 11 億美元，比 2018 年第二季度的 9.09 億美元增長 21%，比上一季度的 9.74 億美元增長 13%。

Instrument and accessory revenue of $579 million increased 22% compared with last year, which is higher than procedure growth, primarily reflecting customer buying patterns and increased usage of our advanced instruments.

儀器和附件收入為 5.79 億美元，比去年增長 22%，高於程序增長，主要反映了客戶購買模式和我們先進儀器的使用增加。

Instrument and accessory revenue realized per procedure was approximately $1,920, an increase of 4% compared with the second quarter of 2018 and a decrease of 2% compared with last quarter.

每個程序實現的儀器和配件收入約為 1,920 美元，與 2018 年第二季度相比增長 4%，與上一季度相比下降 2%。

Systems revenue for the second quarter of 2019 was $344 million, an increase of 24% compared with the second quarter of 2018 and an increase of 39% compared with last quarter.

2019年第二季度系統營收為3.44億美元，較2018年第二季度增長24%，較上一季度增長39%。

Systems revenue in the quarter reflected higher system placements, higher ASPs and higher lease-related revenue.

本季度的系統收入反映了更高的系統佈局、更高的平均售價和更高的租賃相關收入。

We completed 88 operating lease transactions, representing 32% of total placements compared with 44 or 20% of total placements in the second quarter of 2018, and 78 or 33% of total placements last quarter.

我們完成了 88 筆經營租賃交易，佔總配售額的 32%，而 2018 年第二季度為 44 筆或占總配售額的 20%，上季度為 78 筆或占總配售額的 33%。

As of June 30, we have 486 operating leases outstanding and realized approximately $25 million of revenue related to these arrangements in the quarter compared with $12 million last year and $20 million last quarter.

截至 6 月 30 日，我們有 486 項未完成的經營租賃，本季度與這些安排相關的收入約為 2500 萬美元，而去年為 1200 萬美元，上季度為 2000 萬美元。

Operating leases create a future source of recurring revenue and reduce the volatility of system revenue, while the increased number of operating leases placed in the quarter dampens short-term revenue growth for the quarter in which they are placed.

經營租賃創造了未來的經常性收入來源並降低了系統收入的波動性，而本季度經營租賃數量的增加抑制了它們所在季度的短期收入增長。

Operating leases included usage-based financings 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 lease financing alternatives align with customer objectives and have enabled faster market adoption.

我們相信，我們的租賃融資方案符合客戶目標，並加快了市場採用速度。

Related 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 the anticipated usage levels.

與在租賃期內購買的系統相關，我們賺取少量溢價，反映貨幣的時間價值，並且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 vary quarter-to-quarter.

這些類型的安排的比例可能會長期增加，並且會因季度而異。

We recognized $27 million of lease buyout revenue in the quarter compared with $12 million last quarter and $13 million last year.

我們在本季度確認了 2700 萬美元的租賃買斷收入，而上一季度為 1200 萬美元，去年為 1300 萬美元。

Lease buyout revenue has varied significantly from quarter-to-quarter and will likely to do so.

租賃買斷收入在每個季度之間差異很大，而且很可能會如此。

We do not expect the second quarter buyout -- level of buyout revenue to repeat.

我們預計第二季度收購收入水平不會重複。

38% of the current quarter system placements involved trade-ins, reflecting customer desire to access or standardize on fourth-generation technology.

本季度 38% 的系統佈置涉及以舊換新，反映出客戶希望訪問第四代技術或對其進行標準化。

This is an increase in the proportion of trade-ins compared to 34% in the second quarter of 2018 and 36% last quarter.

與 2018 年第二季度的 34% 和上一季度的 36% 相比，以舊換新的比例有所增加。

74% of the systems placed in the quarter were da Vinci Xis and 20% were da Vinci X systems compared with 67% da Vinci Xis and 25% da Vinci Xs last quarter.

本季度放置的系統中有 74% 是 da Vinci Xis，20% 是 da Vinci X 系統，而上一季度為 67% da Vinci Xis 和 25% da Vinci Xs。

13% of the systems placed were SP systems.

放置的系統中有 13% 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。

Globally, our average selling price, which excludes the impact of operating leases and lease buyouts, was approximately $1.54 million compared with $1.42 million last year and $1.31 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收購的影響）約為 154 萬美元，而去年為 142 萬美元，上季度為 131 萬美元。

Our mix of systems and customers in the second quarter of 2019 was very favorable relative to prior periods.

與前期相比，我們在 2019 年第二季度的系統和客戶組合非常有利。

We had a high mix of Xi versus X and SI systems.

我們混合使用了 Xi 與 X 和 SI 系統。

We also had a low mix of distributor versus direct sales.

我們的分銷商與直接銷售的組合也很低。

In the second quarter of 2019, we also had fewer multisystem arrangements where we provided volume discounts.

在 2019 年第二季度，我們提供批量折扣的多系統安排也有所減少。

The mix of systems, customers and size of arrangements will vary over time.

系統的組合、客戶和安排的規模會隨著時間的推移而變化。

We expect system ASPs to be in the range of the midpoint of the first 2 quarters.

我們預計系統 ASP 將處於前兩個季度的中點範圍內。

Outside of the U.S., results were as follows: OUS procedures grew approximately 20% compared with the second quarter of 2018 and increased 4% compared with last quarter.

在美國以外，結果如下：與 2018 年第二季度相比，OUS 程序增長了約 20%，與上一季度相比增長了 4%。

Second quarter revenue outside of the U.S. of $314 million increased 19% compared with the second quarter of 2018 and increased 11% compared with last quarter.

第二季度美國以外的收入為 3.14 億美元，與 2018 年第二季度相比增長 19%，與上一季度相比增長 11%。

The increase compared with the prior year reflects increased instruments and accessory revenue of $34 million or 29% growth.

與上一年相比的增長反映了儀器和附件收入增加 3400 萬美元或增長 29%。

The increase in instrument accessory revenue was primarily driven by procedure growth and customer buying patterns.

儀器配件收入的增長主要是由程序增長和客戶購買模式推動的。

Outside of the U.S., we placed 80 systems in the second quarter compared with 82 in the second quarter of 2018 and 81 systems last quarter.

在美國以外，我們在第二季度放置了 80 個系統，而 2018 年第二季度為 82 個，上個季度為 81 個系統。

Current quarter system placements included 30 into Europe, 24 into Japan, and 8 into China.

當前季度的系統佈局包括 30 個進入歐洲、24 個進入日本和 8 個進入中國。

61% of the systems placed in the quarter were da Vinci Xis and 33% were da Vinci X systems compared with 38% da Vinci Xis and 44% da Vinci Xs last quarter.

本季度放置的系統中有 61% 是 da Vinci Xis，33% 是 da Vinci X 系統，而上一季度為 38% da Vinci Xis 和 44% da Vinci Xs。

12 of the system placements were operating leases compared with 6 last year and 11 last quarter.

12 個系統配售是經營租賃，而去年為 6 個，上季度為 11 個。

Placements outside of the U.S. will continue to vary as some of the OUS markets are in the early stages of adoption; some markets are highly seasonal, reflecting budget cycles or vacation patterns; and sales into some markets are constrained by government limitations.

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變化；一些市場具有很強的季節性，反映了預算週期或假期模式；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 second quarter of 2019 was 71.3% compared with 71.1% for the second quarter of 2018 and 71.2% last quarter.

2019 年第二季度的備考毛利率為 71.3%，而 2018 年第二季度為 71.1%，上一季度為 71.2%。

The increase compared with the second quarter of 2018 and last quarter primarily reflects higher system ASPs.

與 2018 年第二季度和上一季度相比的增長主要反映了更高的系統平均售價。

Future margins will fluctuate based on the mix of our new 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 second quarter of 2018 and decreased 1% compared with last quarter.

預計營業費用與 2018 年第二季度相比增長 27%，與上一季度相比下降 1%。

Spending is consistent with our plan and includes, in order of magnitude of increase, costs associated with expansion of our OUS markets, spending on our informatics capabilities, and investment in our infrastructure in order to scale the business.

支出與我們的計劃一致，包括（按增加幅度排序）與我們的 OUS 市場擴展相關的成本、信息學能力方面的支出，以及為擴大業務規模而對我們的基礎設施進行的投資。

Our pro forma tax rate for the second quarter was 20% and within our expectations of 19% to 20%.

我們第二季度的備考稅率為 20%，在我們 19% 至 20% 的預期範圍內。

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 2020 tax rate will increase with the return of the medical device tax.

我們2020年的稅率會隨著醫療器械稅的回歸而提高。

Our second quarter 2019 pro forma net income was $388 million or $3.25 per share compared with $327 million or $2.76 per share for the second quarter of 2018 and $312 million or $2.61 per share for the last -- for last quarter.

我們 2019 年第二季度的備考淨收入為 3.88 億美元或每股 3.25 美元，而 2018 年第二季度為 3.27 億美元或每股 2.76 美元，上一季度為 3.12 億美元或每股 2.61 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 $318 million or 200 -- or $2.67 per share for the second quarter of 2019 compared with GAAP net income of $255 million or $2.15 per share for the second quarter of 2018 and GAAP net income of $307 million or $2.56 per share for last quarter.

2019 年第二季度 GAAP 淨收入為 3.18 億美元或 200 美元或每股 2.67 美元，而 2018 年第二季度 GAAP 淨收入為 2.55 億美元或每股 2.15 美元，2018 年第二季度 GAAP 淨收入為 3.07 億美元或每股 2.56 美元上個季度。

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, amortization of intangibles and acquisition-related items 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 IP 費用、無形資產攤銷和收購相關項目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, approximately the same as March 31, 2019.

我們以 51 億美元的現金和投資結束了本季度，與 2019 年 3 月 31 日大致相同。

Cash generated from operations was offset by stock repurchases and investments in working capital and infrastructure during the quarter.

運營產生的現金被本季度的股票回購以及營運資金和基礎設施投資所抵消。

We repurchased approximately 400,000 shares for $200 million at an average purchase price of $477 per share.

我們以每股 477 美元的平均購買價格以 2 億美元的價格回購了大約 400,000 股股票。

In the quarter, we grew inventory by $45 million to $513 million, representing approximately 140 days of inventory.

本季度，我們的庫存增加了 4500 萬美元，達到 5.13 億美元，相當於大約 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, supply or other matters.

我們繼續建立庫存以應對業務增長，並減輕可能因貿易、供應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 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。

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 second quarter procedure growth was 17% compared to 18% during the second quarter of 2018 and last quarter.

我們第二季度的總體程序增長率為 17%，而 2018 年第二季度和上一季度為 18%。

Our Q2 procedure growth was driven by 16% growth in U.S. procedures and 20% growth in OUS markets.

我們第二季度的程序增長是由美國程序增長 16% 和 OUS 市場增長 20% 推動的。

In the U.S., Q2 procedure results were generally consistent with recent trends.

在美國，第二季度的程序結果與最近的趨勢基本一致。

Q2 growth was again driven by growth in U.S. general surgery, thoracic and benign gynecology procedures.

第二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。

Q2 2019 U.S. procedure growth was 16% compared to 17% last year and last quarter, reflecting anticipated slight moderation in mature urology and gynecology procedures and general surgery growth rates.

2019 年第二季度美國手術增長率為 16%，而去年和上一季度為 17%，這反映出成熟的泌尿外科和婦科手術以及普通外科手術增長率預期略有放緩。

In U.S. general surgery, second quarter hernia repair and colorectal procedure growth remained solid, although at slightly lower growth rates than last quarter and last year.

在美國普通外科，第二季度疝修補術和結直腸手術的增長保持穩健，儘管增長率略低於上一季度和去年。

Other general surgery procedures such as cholecystectomy, bariatric and liver and pancreatic cases made increasing contributions to growth in Q2, with higher growth rates than last quarter.

其他普通外科手術，如膽囊切除術、減肥和肝臟和胰腺病例對第二季度增長的貢獻越來越大，增長率高於上一季度。

As anticipated, U.S. procedure growth in mature urology and gynecology procedure categories moderated in Q2 compared to last year.

正如預期的那樣，與去年相比，第二季度美國成熟泌尿科和婦科手術類別的增長有所放緩。

U.S. gynecology growth and urology growth were in the mid-single digits.

美國婦科增長和泌尿科增長處於中等個位數。

dVP growth specifically was in the low single-digit range, in close alignment with the underlying incident rate for prostate cancer.

dVP 增長特別處於低個位數範圍內，與前列腺癌的潛在發病率密切相關。

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 during the second 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二季度再次穩定。

Second quarter OUS procedure volume grew approximately 20% compared with 22% for the second quarter 2018 and 21% last quarter.

第二季度 OUS 手術量增長了約 20%，而 2018 年第二季度和上季度分別增長了 22% 和 21%。

Second 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年第二季度 OUS 程序的增長是由 dVP 程序的持續增長和腎癌程序、普通外科和婦科的早期增長推動的。

Q2 OUS procedure growth faced modest working day headwinds due to the timing of the Easter holiday, mostly affecting Europe, and other national holidays, particularly in Japan.

由於復活節假期的時間，第二季度 OUS 程序增長面臨適度的工作日逆風，主要影響歐洲和其他國家假期，特別是在日本。

Japan procedure growth remains strong but moderated somewhat in Q2, reflecting lower growth rates in mature urology procedures as we reach higher levels of market penetration, the impact of holidays and the anniversary of the new procedure reimbursements.

日本的手術增長仍然強勁，但在第二季度有所放緩，這反映出隨著我們達到更高的市場滲透水平、假期的影響和新手術報銷週年紀念日，成熟泌尿外科手術的增長率較低。

In China, after several quarters of declining procedure growth, procedure growth accelerated slightly in Q2 driven by procedures performed on new systems installed under the latest system quota.

在中國，在經歷了幾個季度的下降程序增長之後，第二季度程序增長略有加速，這是由在最新系統配額下安裝的新系統上執行的程序驅動的。

In Europe, procedure growth was driven by strong results in Germany and France.

在歐洲，程序增長是由德國和法國的強勁業績推動的。

Overall, European procedure growth was largely consistent with prior periods, with variation by country.

總體而言，歐洲手術的增長與前期基本一致，但因國家/地區而異。

Now turning to the clinical side of our business.

現在轉向我們業務的臨床方面。

Each quarter on these calls, we highlight certainly recent published studies of note.

在每個季度的這些電話會議上，我們肯定會重點介紹最近發表的值得注意的研究。

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。

We are pleased to see the evidence landscape regarding our recently cleared Ion endoluminal system start to grow.

我們很高興看到關於我們最近清除的 Ion 腔內系統的證據景觀開始增長。

A manuscript describing the first [term and] use experience, led by Dr. David Fielding from the Royal Brisbane & Women's Hospital in Brisbane, Australia, has recently been accepted for publication in the peer-reviewed medical journal, Respiration.

由澳大利亞布里斯班皇家布里斯班婦女醫院的 David Fielding 博士領導的描述第一個 [術語和] 使用經驗的手稿最近已被同行評審的醫學期刊《呼吸》接受發表。

Previously presented at the annual CHEST Conference in 2017, this study was designed to evaluate the safety and feasibility of the Ion endoluminal platform and included 29 consecutive subjects with follow-up data through 6 months.

此前曾在 2017 年年度 CHEST 會議上發表過，該研究旨在評估 Ion 腔內平台的安全性和可行性，包括 29 名連續受試者，並提供 6 個月的隨訪數據。

Although each nodule was located in the peripheral part of the lung and the mean nodule size was approximately 15 millimeters, approximately 97% of the nodules were reached, with a tissue sample suitable for assessment obtained.

雖然每個結節都位於肺的外圍部分，平均結節大小約為 15 毫米，但達到了約 97% 的結節，並獲得了適合評估的組織樣本。

Importantly, across the entire study population, no instances of pneumothorax, bleeding or device-related adverse events were reported, suggesting a good safety profile.

重要的是，在整個研究人群中，沒有報告氣胸、出血或與設備相關的不良事件，表明安全性良好。

We believe that further scientific study and clinical evidence will be essential to build the market for Ion.

我們相信，進一步的科學研究和臨床證據對於建立 Ion 市場至關重要。

Soon after receiving FDA clearance for Ion in the U.S., we initiated a post-market clinical study called PRECISE, intending to enroll 360 subjects across 6 key centers in the United States.

Ion 在美國獲得 FDA 批准後不久，我們啟動了一項名為 PRECISE 的上市後臨床研究，打算在美國 6 個主要中心招募 360 名受試者。

Full details regarding the construct of the PRECISE study are available on the web at ClinicalTrials.gov.

有關 PRECISE 研究結構的完整詳細信息，請訪問 ClinicalTrials.gov 網站。

In May of this year, a large scale, real-world comparative study using the National Cancer Database was published in the journal, Colorectal Disease.

今年 5 月，一項使用國家癌症數據庫的大規模真實世界比較研究發表在《結直腸疾病》雜誌上。

The analysis, led by Dr. Ravi Kiran from NewYork-Presbyterian/Columbia University Medical Center, compared the results of over 41,000 patients from between 2010 and 2015 by surgical approach.

該分析由紐約長老會/哥倫比亞大學醫學中心的 Ravi Kiran 博士領導，比較了 2010 年至 2015 年間 41,000 多名手術患者的結果。

The National Cancer Database captures data from over 1,500 cancer-accredited facilities and represents approximately 70% of newly diagnosed cancer cases.

國家癌症數據庫從 1,500 多個癌症認證機構收集數據，約佔新診斷癌症病例的 70%。

The population for the study consisted of approximately 15% robotic-assisted, 33% laparoscopic and 52% open procedures.

該研究的人群包括大約 15% 的機器人輔助手術、33% 的腹腔鏡手術和 52% 的開放手術。

In propensity score-matched analysis, with over 4,000 subjects in each cohort, comparing the robotic LAR approach to the laparoscopic approach, the robotic LAR was associated with shorter length of stay, 6.3 days versus 6.8 days; and lower risk of conversion to open, 7.5% versus 14.95%; with multivariate analysis showing laparoscopic LAR patients being 2.2x more likely to be converted to open.

在傾向得分匹配分析中，每個隊列中有超過 4,000 名受試者，將機器人 LAR 方法與腹腔鏡方法進行比較，機器人 LAR 與較短的住院時間相關，分別為 6.3 天和 6.8 天；轉換為打開的風險較低，分別為 7.5% 和 14.95%；多變量分析顯示腹腔鏡 LAR 患者轉為開腹手術的可能性高出 2.2 倍。

Compared to open LAR, the robotic-assisted approach had shorter length of stay, 6.3 days versus 7.8 days; a higher rate of negative margins, 97.01% versus 95.96%; and higher nodal yield, 17 versus 16.4.

與開放式 LAR 相比，機器人輔助方法的住院時間更短，分別為 6.3 天和 7.8 天；更高的負利潤率，分別為 97.01% 和 95.96%；和更高的節點產量，17 對 16.4。

The authors concluded, and I quote, "For patients with rectal cancer, robotic LAR shows recovery benefits over both open and laparoscopic LAR, with reduced conversion to open compared with laparoscopic LAR and less prolonged length of stay compared with laparoscopic LAR and open LAR.

作者總結道，我引用，“對於直腸癌患者，機器人 LAR 比開腹 LAR 和腹腔鏡 LAR 都顯示出恢復優勢，與腹腔鏡 LAR 相比，轉換為開腹的情況更少，與腹腔鏡 LAR 和開腹 LAR 相比，住院時間延長更短。

Robotic LAR is associated with short-term oncological outcomes comparable to open LAR, supporting its use in minimally-invasive surgery for rectal cancer."

機器人 LAR 與短期腫瘤學結果相關，可與開放式 LAR 相媲美，支持其在直腸癌微創手術中的應用。”

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。

Last quarter, we forecast 2019 procedure growth of 15% to 17%.

上個季度，我們預測 2019 年的手術增長率為 15% 至 17%。

We are now refining our forecast to the upper half of this range and expect full year 2019 procedure growth of 16% to 17%.

我們現在將我們的預測細化到該範圍的上半部分，並預計 2019 年全年手術增長率為 16% 至 17%。

Turning to gross profit.

轉向毛利。

On our last call, we forecast our 2019 full year pro forma gross profit margin to be within 70% and 71% of net revenue.

在我們的最後一次電話會議上，我們預測我們 2019 年全年的備考毛利率將在淨收入的 70% 和 71% 之間。

We now expect to come in at the higher end of that range.

我們現在預計會進入該範圍的較高端。

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

我們的實際毛利率將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，每個季度都會有所不同。

Turning to operating expenses, we continue to expect to grow pro forma 2019 operating expenses between 24% and 28% above 2018 levels.

談到運營費用，我們繼續預計 2019 年備考運營費用將比 2018 年增長 24% 至 28%。

We continue to expect our noncash stock compensation expense to range between $320 million and $340 million in 2019.

我們繼續預計 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。

We expect other income, which is comprised mostly of interest income, to total between $130 million and $135 million in 2019, up from $120 million to $130 million forecast on our last call.

我們預計 2019 年主要包括利息收入的其他收入總額將在 1.3 億美元至 1.35 億美元之間，高於我們上次電話會議預測的 1.2 億美元至 1.3 億美元。

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 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 comes from the line of Bob Hopkins with Bank of America.

（操作員說明）我們的第一個問題來自美國銀行的 Bob Hopkins。

So first question, I wanted to ask about U.S. procedure growth.

所以第一個問題，我想問一下美國程序的增長。

By our math, the overall Q2 U.S. growth on the procedure side accelerated a little bit when you take into consideration the year ago comp, but you called out some slight moderation in hernia and colorectal.

根據我們的計算，考慮到去年同期，美國第二季度手術方面的整體增長略有加快，但你指出疝氣和結直腸癌的增長略有放緩。

So I was wondering if you could just talk about that a little bit.

所以我想知道你是否可以談談這個。

Like was that -- was the growth you experienced in hernia and colorectal this quarter different than you expected?

就像那樣 - 本季度您在疝氣和結直腸癌方面的增長是否與您預期的不同？

And how do you manage through this issue of kind of managing access?

您如何解決這種管理訪問的問題？

This is Gary.

這是加里。

We saw a tad of moderation.

我們看到了一點節制。

I think demand remains strong, and what we're really seeing is what we indicated to you.

我認為需求仍然強勁，我們真正看到的是我們向您表明的。

We have two things going on.

我們有兩件事正在進行。

One is there are a lot of different procedure types, and now, in busy centers, competition for system access.

一是有很多不同的程序類型，現在，在繁忙的中心，爭奪系統訪問權。

We can of course solve that with additional systems placed as well as work with folks on efficiency of use.

我們當然可以通過放置額外的系統來解決這個問題，並與人們一起提高使用效率。

And we're doing both.

我們正在做這兩件事。

And you've heard that from us over the last several quarters.

在過去的幾個季度裡，你已經從我們這裡聽到了這一點。

The next one is our commercial teams have been growing in the United States to support the growth of the company.

下一個是我們的商業團隊一直在美國發展，以支持公司的發展。

And it takes some time to have teams come up to full productivity and we're -- the percentage of new folks in new territories has been ticking up the last couple of quarters.

需要一些時間才能讓團隊充分發揮生產力，而且我們 - 過去幾個季度，新領域的新員工比例一直在上升。

And it's -- the new ratio is amongst the highest we've had in the last few.

而且它 - 新比率是我們在過去幾個中的最高比率之一。

Employee retention has been great.

員工保留率一直很高。

It's really around increased need to get increased case coverage, and so there, it's supporting our new folks in the field with tools and some of it is just time on task.

它確實圍繞著增加案例覆蓋率的需求增加，因此，它通過工具支持我們在該領域的新手，其中一些只是完成任務的時間。

Yes.

是的。

Bob, from just a pure mathematical standpoint, you know we track adoption curves pretty regularly around here.

鮑勃，從純數學的角度來看，你知道我們在這裡非常定期地跟踪採用曲線。

And it's a mathematical reality that really all points along the curve, the rate of growth actually declines.

這是一個數學現實，實際上所有點都沿著曲線，增長率實際上下降了。

So our results here in Q2 is aligned with what we would have expected.

因此，我們在第二季度的結果與我們的預期一致。

And clearly, there's a lot -- substantial remaining opportunity in both hernia and colorectal procedures, and our checks with surgeons generally indicate healthy demand.

很明顯，在疝氣和結直腸手術中還有很多——大量剩餘的機會，我們與外科醫生的檢查通常表明健康的需求。

That's great.

那太棒了。

And then just one on the system side because revenue growth from system sales this quarter was much higher than the first quarter due to mix, as you called out.

然後只是系統方面的一個，因為本季度系統銷售的收入增長遠高於第一季度，正如你所說的那樣。

But the placement numbers and the placement growth in both quarters suggest very strong underlying demand for your systems in both quarters.

但是兩個季度的安置數字和安置增長表明兩個季度對您的系統的潛在需求非常強勁。

I was just wondering if you could talk a little bit about the differences you saw from Q1 to Q2 in that mix dynamic and what that suggests about the outlook for the rest of the year on the system side.

我只是想知道您是否可以談談從第一季度到第二季度在混合動態中看到的差異，以及這對系統方面今年剩餘時間的前景有何暗示。

We're -- this is Marshall.

我們是——這是馬歇爾。

We have seen, as you suggested, reasonable strength in terms of system placements.

正如您所建議的，我們已經看到了系統佈局方面的合理實力。

I don't think there's anything really different quarter-to-quarter other than the mix.

我認為除了混合之外，季度與季度之間沒有什麼真正不同。

In other words, the buying behaviors of the customers hasn't changed.

換句話說，客戶的購買行為沒有改變。

We're seeing a nice cycle on trade-ups.

我們看到了一個不錯的換購週期。

And -- but we did see, again, more Xis this quarter.

而且 - 但我們確實在本季度再次看到了更多的 Xis。

And there's volatility or variability between quarter-to-quarter as it relates to particularly our distribution channel.

每個季度之間存在波動或變化，因為它特別與我們的分銷渠道有關。

And so we saw fewer distributor sales this quarter and more direct sales.

因此，本季度我們看到經銷商銷售減少，直接銷售增加。

And our direct sales are at a higher price than what we sell to our distributors as they incur the selling costs associated with those systems.

而且我們的直接銷售價格高於我們向分銷商銷售的價格，因為他們會產生與這些系統相關的銷售成本。

So that's really -- that's the color that we would provide on systems revenue.

所以這真的 - 這就是我們將在系統收入上提供的顏色。

Marshall, is it fair to look at it and say if you view the first half as a whole rather than in different quarters, you'd get a better picture?

Marshall，如果你將上半場作為一個整體而不是不同的部分來看待，你會得到一個更好的畫面，這是否公平？

That's true, Gary.

是的，加里。

You should -- when you look at ASPs, you should think about the combination of the 2 because 1.31 was a low point and 1.54 is a high point.

你應該——當你查看 ASP 時，你應該考慮 2 的組合，因為 1.31 是低點，1.54 是高點。

The next question comes from the line of Tycho Peterson with JPMorgan.

下一個問題來自第谷彼得森與摩根大通的對話。

Maybe I'll just follow-up on that last question.

也許我會跟進最後一個問題。

Why should ASPs take a little bit of a step back?

為什麼 ASP 應該退後一步？

You did -- you skew more toward fully featured system sales.

你做到了——你更傾向於功能齊全的系統銷售。

Obviously, your procedure mix is expanding.

顯然，您的程序組合正在擴展。

Why logically should ASPs step down a little bit going forward?

為什麼從邏輯上講，ASP 應該在未來有所下降？

You should expect that the -- again, distributor sales tend to be variable quarter-to-quarter.

您應該預料到——同樣，分銷商的銷售額往往會隨季度變化。

So I think you should blend the first quarter and the second quarter when you're looking at what level of the distributor sales you should expect.

因此，我認為當您查看您應該期望的分銷商銷售水平時，您應該將第一季度和第二季度混合在一起。

And I think same thing with the mix of Xi and X, just depending on the geography, X is targeting geographies where reimbursements are pressured.

我認為 Xi 和 X 的組合也是如此，只是取決於地理位置，X 的目標是報銷壓力很大的地區。

And so this quarter, just based on mix, we wound up selling fewer Xs and that should even out as well.

因此，本季度，僅基於組合，我們最終銷售的 X 數量減少了，這也應該持平。

And we've had a couple of quarters now of operating leases in kind of the low 30s, it was 29% at the end of last year.

我們現在有幾個季度的經營租賃都在 30 多歲左右，去年年底是 29%。

Is this kind of the new norm in your view?

在您看來，這是一種新常態嗎？

Or how should we think about operating leases in terms of mix going forward?

或者我們應該如何從未來的組合角度考慮經營租賃？

I don't think about it as a norm.

我不認為這是一種常態。

I think that there's going to be variability quarter-to-quarter.

我認為每個季度都會有變化。

And yes, Q2 is slightly lower, if not close to being the same as Q1.

是的，第二季度略低，即使不接近與第一季度相同。

But I think, over time, we will accommodate customers, and we think that on the other hand, leases are positive for the company in that they -- as I said in my prepared remarks, it increases the recurring revenue.

但我認為，隨著時間的推移，我們將容納客戶，而且我們認為，另一方面，租賃對公司來說是積極的，因為它們——正如我在準備好的發言中所說的那樣，它增加了經常性收入。

It eliminates volatility.

它消除了波動性。

It also enables an upgrade cycle when and if new systems come out.

它還可以在新系統出現時啟用升級週期。

So we think it's a positive and so we'll supply those to customers as they ask for them.

所以我們認為這是積極的，所以我們會在客戶要求時提供這些產品。

I would guess that over time -- or we're predicting over time that there's the possibility that the percentage actually will increase.

我猜想隨著時間的推移——或者我們預測隨著時間的推移，這個百分比實際上有可能會增加。

Okay.

好的。

And then on IRIS, I know it's early days, I didn't really hear you bring it up in the comments, but can you just talk a little bit about interest levels for kidney and liver and how we should think about the expanded use of that going forward?

然後在 IRIS 上，我知道現在還處於早期階段，我並沒有真正聽到你在評論中提到它，但是你能談談腎臟和肝臟的興趣水平以及我們應該如何考慮擴大使用那前進？

I think the interest from the forward-leaning surgeons is very high.

我認為前瞻性外科醫生的興趣非常高。

I think, in general, people are looking out seeing additional access to data.

我認為，總的來說，人們正在尋找對數據的額外訪問。

IRIS, just a reminder for everybody, is the integration of preoperative imaging, 3D imaging into a case in real-time.

IRIS，只是給大家一個提醒，是將術前成像，3D成像實時集成到一個病例中。

We're not in the clinic yet.

我們還沒到診所呢。

We do have our 510(k) clearance.

我們確實有 510(k) 許可。

We're working through agreements with first customers.

我們正在與第一批客戶達成協議。

We don't expect revenue this year.

我們預計今年不會有收入。

I think, directionally, there's quite a lot of support.

我認為，在方向上，有相當多的支持。

I think part of what we want to develop in the market as we go forward are use cases and really getting the value statement for them in terms of what it drives, either accuracy or efficiency or both.

我認為，隨著我們前進，我們希望在市場上開發的部分內容是用例，並根據其驅動的內容（準確性或效率或兩者兼而有之）真正為他們獲得價值聲明。

Early response is great, but these things take a little time to develop and to develop the evidence base that goes behind it.

早期反應很好，但這些事情需要一點時間來發展和發展背後的證據基礎。

Next question comes from the line of David Lewis with Morgan Stanley.

下一個問題來自 David Lewis 與摩根士丹利的對話。

A couple of questions here.

這裡有幾個問題。

I'll start with Gary.

我將從加里開始。

Gary, last year, procedures began to inflect from a [mentor] perspective and they still remain pretty strong.

加里，去年，從[導師]的角度來看，程序開始發生變化，而且它們仍然非常強大。

As you think about the next inflection for procedure growth, I mean, do you think it's more likely that it comes from new systems?

當您考慮程序增長的下一個拐點時，我的意思是，您認為它更有可能來自新系統嗎？

Obviously, SP, Ion creating this access, you've already talked about it on this call, or accessing new geographies, Japan and China.

顯然，SP，Ion 創建此訪問權限，您已經在本次電話會議上討論過，或者訪問新的地理區域，日本和中國。

I notice you already mentioned in a comment that just a few systems in Japan -- sorry, in China, was able to drive some demand.

我注意到你已經在評論中提到，日本的一些系統 - 抱歉，在中國，能夠推動一些需求。

So across those 3 buckets, Gary, systems, access, geographies, what is the most likely driver of the next wave of procedure inflection?

那麼在這 3 個桶中，Gary、系統、訪問、地理位置，下一波程序拐點最有可能的驅動因素是什麼？

I think in the near term, access in core markets is going to be important.

我認為在短期內，進入核心市場將很重要。

What's been nice here in the last few years is the procedure base has been building.

過去幾年這裡的好處是程序基礎一直在建設中。

So healthy double-digit growth rates in procedures, and absolute growth numbers are starting to become substantial and making sure that those surgeons who want access to the system have it has been important, and it's been one of the drivers for our increased flexibility and agility in capital acquisition models.

因此，手術中兩位數的健康增長率和絕對增長率開始變得可觀，確保那些想要使用該系統的外科醫生擁有它一直很重要，它一直是我們提高靈活性和敏捷性的驅動力之一在資本收購模型中。

As you look at SP and Ion, both of those are interesting platforms that I think, over time, will expand the total available market for robotic systems and diagnostics in single-port or single-access surgery.

當你看 SP 和 Ion 時，我認為這兩個都是有趣的平台，隨著時間的推移，它們將擴大單端口或單通道手術中機器人系統和診斷的總可用市場。

They take some time to develop.

他們需要一些時間來發展。

And the speed with which they develop is, as I said in the script, paced by additional indications and manufacturing scale.

正如我在劇本中所說，它們的發展速度取決於額外的適應症和製造規模。

Longer term, I think those things are exciting, but it will take some time to go through.

從長遠來看，我認為這些事情令人興奮，但需要一些時間才能完成。

Geography, we've seen real successes but they take time.

地理，我們已經看到了真正的成功，但它們需要時間。

Japan has been a great success.

日本取得了巨大的成功。

They're doing a really nice job.

他們做得很好。

But it is really heavy lifting to do all the things required to build market access, from partnering networks to training centers to the clinical evidence base to support additional adoption.

但要完成建立市場准入所需的所有工作，從合作網絡到培訓中心，再到支持更多采用的臨床證據基礎，確實是一項繁重的工作。

So I think those things are important.

所以我認為這些東西很重要。

We have invested in them and we'll continue to do so.

我們已經對它們進行了投資，並將繼續這樣做。

So short answer, maybe not a perfect modeling answer but I'll leave that to you.

如此簡短的回答，也許不是一個完美的建模答案，但我會把它留給你。

Okay.

好的。

And then just maybe a follow-up for you, Gary, just trying to get a sense of thinking about the SP rollout and the Ion rollout, your Ion commentary was fairly consistent with the first quarter.

然後可能只是你的後續行動，Gary，只是想了解一下 SP 推出和 Ion 推出，你的 Ion 評論與第一季度相當一致。

If I think about the first 4 quarters of SP, obviously ex-ing out the manufacturing issues last quarter, do you see Ion rolling out from a system placement perspective in a similar fashion to SP?

如果我考慮 SP 的前 4 個季度，顯然排除了上個季度的製造問題，您是否看到 Ion 以與 SP 類似的方式從系統佈局的角度推出？

Is there a reason why it would be faster in the first 4 quarters of commercialization?

在商業化的前4個季度它會更快的原因是什麼？

Or slower?

還是更慢？

Yes.

是的。

I'd anticipate measured in these first 4 quarters of launch as we optimize our systems on our side and also gathering our data.

我預計在發布的前 4 個季度會進行衡量，因為我們會優化我們的系統並收集我們的數據。

After that, we'll see.

在那之後，我們拭目以待。

I don't think I'd predict it one way or another for you.

我不認為我會以一種或另一種方式為你預測它。

The indications in Ion, we feel pretty good about to get started.

Ion 中的指示，我們感覺很好，可以開始了。

I think the size of that market is real, and so we'll see a year from now, I think, as to how fast we want to move.

我認為這個市場的規模是真實的，所以我認為我們將在一年後看到我們想要移動多快。

On SP, it has, I think, great long-term potential.

在 SP 上，我認為它具有很大的長期潛力。

It requires additional clearances, in the U.S. anyway, to keep moving and so we'll do that in sequence.

無論如何，它需要額外的許可才能繼續前進，因此我們將按順序進行。

Next, we'll go to the line of Amit Hazan with Citigroup.

接下來，我們將前往花旗集團的 Amit Hazan 行。

Let me start with one on the quarter and just follow after that.

讓我從一個季度開始，然後再跟進。

So on the quarter, the I&A versus procedures, I&A was up 22%, procedures up 17%.

因此，在本季度，I&A 與程序相比，I&A 增長了 22%，程序增長了 17%。

That's the widest gap I can recall in a little while.

這是我一會兒能記得的最大差距。

You touched on it a bit, but maybe just a little bit more color.

你觸及了一點，但也許只是多了一點顏色。

Is it that new and advanced instruments driving something that's sustainable?

是推動可持續發展的新的和先進的工具嗎？

Or are there onetime things in there that we should consider?

還是我們應該考慮其中的一次性事情？

Yes.

是的。

I think, in general, we have seen increasing revenue, instrument accessory revenue per procedure.

我認為，總的來說，我們已經看到每個程序的收入、儀器配件收入在增加。

Obviously, there's variability by quarter based mostly on the timing of customer orders.

顯然，主要基於客戶訂單的時間，季度存在差異。

But in general, we've been gradually increasing.

但總的來說，我們一直在逐漸增加。

And the biggest aspect of that has been increasing usage of the advanced instruments, from vessel sealing, the Vessel Sealer Extend we launched recently, now to stapling as well, and the 60-millimeter stapler we launched last year and are more fully available this year in the U.S.

其中最大的方面是增加了先進儀器的使用，從血管密封，我們最近推出的 Vessel Sealer Extend，現在到吻合器，以及我們去年推出的 60 毫米吻合器，今年將更全面地提供在美國。

So I think that's been the biggest factor that's probably been more than offsetting most everything else, whether it's more procedures in general surgery, hernia repair and others that may be lower tool usage.

所以我認為這是可能比抵消大多數其他一切的最大因素，無論是普通外科、疝氣修復和其他可能減少工具使用的更多程序。

So I think that's the biggest factor there.

所以我認為這是最大的因素。

And just a slightly longer-term question on flexible endoscopy with surgical instruments.

還有一個關於使用手術器械進行柔性內窺鏡檢查的稍微長期的問題。

One of your bigger future robotic competitors has been talking about this publicly now for the first time in just the past month or so.

就在過去一個月左右的時間裡，你未來更大的機器人競爭對手之一現在第一次公開談論這個問題。

Can you talk to how much of a priority this is for Intuitive?

你能談談這對 Intuitive 來說有多重要嗎？

What you can tell us about the opportunity from a robotic perspective?

您能從機器人的角度告訴我們關於這個機會的哪些信息？

Sure.

當然。

In general, as we've described before, we like to think in platforms.

一般來說，正如我們之前所描述的，我們喜歡在平台中思考。

And what I mean by that is if we can build some core technologies from advanced imaging to great precision to great software, then we can mix and match those core capabilities to pursue different endpoints clinically.

我的意思是，如果我們能夠構建從高級成像到高精度再到出色軟件的一些核心技術，那麼我們就可以混合和匹配這些核心功能，以在臨床上追求不同的終點。

And so you look at SP, SP is an exceptionally powerful system that brings together 4 instruments through a single access point.

所以你看看 SP，SP 是一個非常強大的系統，它通過一個接入點將 4 台儀器匯集在一起。

You look at Ion, and Ion has exquisite sensing and a flexible endoscopy or a flexible diagnostic platform.

你看 Ion，Ion 有精巧的感應和靈活的內窺鏡或靈活的診斷平台。

Over time, I think those 2 different sets of ingredients give us a lot of opportunity and optionality.

隨著時間的推移，我認為這兩種不同的成分給了我們很多機會和選擇。

And so I think those things are interesting and they could open for us additional clinical markets over the long term.

所以我認為這些事情很有趣，從長遠來看，它們可以為我們打開更多的臨床市場。

That said, product design is subtle, and architectural choices are really, really important.

也就是說，產品設計很微妙，架構選擇真的非常重要。

Doing it right, getting a great clinical outcome comes down to sub-millimeter precision and microsecond timings of these electronics.

如果操作得當，獲得出色的臨床結果取決於這些電子設備的亞毫米精度和微秒級計時。

And as a result, we want to make sure that we really deliver on the things we put in the market, from SP to Ion.

因此，我們希望確保我們真正交付我們投放市場的產品，從 SP 到 Ion。

So we're not sprinting to go as broad as possible.

所以我們不會衝刺盡可能廣泛。

We really want to make sure we deliver against the commitments we make and for the customers who purchase our products.

我們真的想確保我們兌現我們所做的承諾，並為購買我們產品的客戶做出承諾。

There's a fair amount of history out there of companies that have failed to attend to the details and start strong and peter out.

有相當多的公司未能關注細節並開始強大並逐漸消失的歷史。

And so we're careful and thoughtful about it.

所以我們對此非常謹慎和深思熟慮。

Next question comes from the line of Larry Biegelsen with Wells Fargo.

下一個問題來自 Larry Biegelsen 與 Wells Fargo 的對話。

First, could you talk about the strategic and financial implications of the Fiberoptics acquisition?

首先，您能否談談收購 Fiberoptics 的戰略和財務影響？

And I had one follow-up.

我有一個後續行動。

Sure.

當然。

I'll speak to why we did it.

我會談談我們為什麼這樣做。

This is a -- Schölly is a strong team and a supply chain partner that has been important for us over many years.

這是 - Schölly 是一支強大的團隊和供應鏈合作夥伴，多年來對我們來說一直很重要。

Clearly, great imaging manufacturing capability, design capability and processing is a core part of surgery of the future and interventions of the future.

顯然，強大的成像製造能力、設計能力和加工能力是未來手術和未來干預的核心部分。

As we've grown, we wanted to make sure that we can continue to invest in that space, both on the design side and on the manufacturing and production capability side.

隨著我們的成長，我們希望確保我們能夠繼續在該領域進行投資，無論是在設計方面，還是在製造和生產能力方面。

It's been a great partnership with that team.

與該團隊的合作非常愉快。

We respect them and have been very productive with them.

我們尊重他們，並且與他們合作非常有成效。

And so that gives us additional optionality and agility going forward in a core part of our business.

因此，這為我們業務的核心部分提供了額外的選擇權和靈活性。

On more of deal specifics and logistics, I'll turn it over to Marshall.

關於更多交易細節和物流，我會把它交給馬歇爾。

So we entered into an agreement to acquire certain assets and operations from Schölly for a cash consideration of approximately $100 million.

因此，我們簽訂了一項協議，以大約 1 億美元的現金對價從 Schölly 收購某些資產和業務。

The exact amount of the consideration and timing of the closing is subject to certain closing conditions.

對價的確切金額和交割時間取決於特定的交割條件。

And so that will occur over the next future periods.

因此，這將在接下來的未來時期發生。

And the employees will transfer after each of the closing events occurs.

員工將在每次關閉事件發生後轉移。

And then, on Ion, we haven't heard you talk about the opportunity or timing outside the U.S. What's the status, particularly in China and rest of the world?

然後，在 Ion 上，我們還沒有聽到您談論美國以外的機會或時機。情況如何，特別是在中國和世界其他地區？

Yes.

是的。

On the specifics on China, we are in discussions with China's regulatory agencies about how best to bring it to market and timing there.

關於中國的具體細節，我們正在與中國的監管機構討論如何最好地將其推向市場和時機。

I don't have a definitive answer for you yet, but it's an active discussion.

我還沒有給你一個明確的答案，但這是一個積極的討論。

Clearly, we believe there are end-user opportunities and value, health care value to bring in China and in Europe and in other markets.

顯然，我們相信最終用戶機會和價值，醫療保健價值可以為中國、歐洲和其他市場帶來。

And we'll take it in sequence.

我們將按順序進行。

We think this is a powerful set of technologies and a powerful platform.

我們認為這是一套強大的技術和強大的平台。

We are still in the early days.

我們仍處於早期階段。

Our greatest organizational focus right now is on really understanding the technology and the use of it carefully.

我們目前最大的組織重點是真正理解技術並仔細使用它。

The early clinical results are great and they are differentiated relative to other products in the market, so far, in these early days.

早期的臨床結果很好，並且相對於市場上的其他產品，到目前為止，在這些早期階段，它們是有區別的。

That's really important to us.

這對我們來說真的很重要。

We will focus there.

我們將專注於此。

And as we build strength and experience and scale, then it gives us a lot of opportunities to engage the rest of the world.

隨著我們建立實力、經驗和規模，它為我們提供了很多參與世界其他地區的機會。

Next, we go to the line of Lawrence Keusch with Raymond James.

接下來，我們將與 Raymond James 一同前往 Lawrence Keusch 的台詞。

This is John Hsu on for Larry.

這是 Larry 的 John Hsu。

Maybe if we could start, without providing guidance for 2020, can you give us some high-level guideposts for how we should generally think about investment spend next year going into 2019?

也許如果我們可以在不提供 2020 年指導的情況下開始，您能否給我們一些高層次的指導方針，說明我們應該如何總體考慮明年進入 2019 年的投資支出？

You obviously have a lot of products on your plate this year, but just any high-level color would be greatly appreciated.

今年你的盤子裡顯然有很多產品，但任何高級顏色都會受到極大的讚賞。

Well, we'll give you a better color when it comes to January about what's going to happen next year.

好吧，當談到明年一月份時，我們會給你一個更好的顏色來告訴你明年會發生什麼。

But the things that we're investing in are not short-term investments.

但我們投資的不是短期投資。

They take -- they occur over a long period.

他們需要——他們會在很長一段時間內發生。

And so you should expect that spending will continue to -- continue on those and on other matters going forward.

因此，您應該期望支出將繼續 - 繼續在這些和其他問題上繼續前進。

And as we grow the company, of course, there's an increased amount of support that's necessary to grow the company, particularly on the sales side in terms of personnel and commissions.

當然，隨著我們公司的發展，公司發展所需的支持也越來越多，特別是在銷售方面的人員和佣金方面。

And so I think spending will increase.

所以我認為支出會增加。

I won't give you anything more specific than that until we get later in the year.

在今年晚些時候，我不會給你任何比這更具體的信息。

Maybe I'll just speak for our philosophy a little bit.

也許我會稍微談談我們的理念。

We think the opportunity for improved performance and, therefore, opportunities for the business are substantial.

我們認為提高績效的機會，因此，業務機會是巨大的。

And what paces us as to how we decide how much we'll invest and when is that which we think we can do with excellence.

關於我們如何決定我們將投資多少以及何時投資，我們認為我們可以做得很好。

Generally speaking, we see more opportunity than we think we can pursue.

一般來說，我們看到的機會比我們認為可以追求的要多。

We wind up saying no to some things that are probably good ideas but we don't know that we can perform them well.

我們最終對一些可能是好主意但我們不知道我們能否很好地執行它們的事情說不。

And so that's what balances our investment portfolio.

這就是平衡我們投資組合的原因。

And we'll continue to use that philosophy as we plan out 2020 and go forward.

在我們計劃 2020 年並向前邁進時，我們將繼續使用這一理念。

Great.

偉大的。

And then just on the balance sheet, you obviously have $5 billion-plus in cash, you bought back some stock in the quarter, you also did a tuck-in acquisition for imaging capabilities.

然後在資產負債表上，你顯然有超過 50 億美元的現金，你在本季度回購了一些股票，你還進行了成像能力的收購。

Can you just remind us how you think about your capital deployment priorities at this point?

您能否提醒我們您目前如何看待您的資本部署優先事項？

Yes.

是的。

The philosophy and approach to capital deployment hasn't really changed.

資本配置的理念和方法並沒有真正改變。

But to remind you, we think about that cash obviously to operate the company.

但提醒您，我們考慮的現金顯然是為了經營公司。

We're making investments in our future.

我們正在為我們的未來進行投資。

We want cash.

我們要現金。

The market is volatile in terms of -- the environment is volatile in terms of tariffs and other things going on.

就關稅和其他正在發生的事情而言，市場是不穩定的——環境是不穩定的。

We want to make sure we've got proper investments to be able to deal with those.

我們希望確保我們有適當的投資來應對這些問題。

And then, ultimately, we look for opportunities to buy back stock and return cash to shareholders.

然後，最終，我們尋找機會回購股票並將現金返還給股東。

Okay.

好的。

Great.

偉大的。

And then just -- I could sneak one last one in on the tax rate.

然後只是 - 我可以偷偷最後一個關於稅率的信息。

I think you mentioned the medical device tax coming back in 2020.

我想你提到了 2020 年恢復的醫療器械稅。

By my estimate, I think we're coming up with an impact of roughly $30 million.

據我估計，我認為我們將產生大約 3000 萬美元的影響。

Is that a decent ballpark for how you're thinking about the impact of product gross margin in 2020?

對於您如何看待 2020 年產品毛利率的影響，這是一個不錯的大概嗎？

Yes.

是的。

When we're talking about medical device tax we were recognizing in the past, we charge that expense item to cost of sales.

當我們談論過去承認的醫療器械稅時，我們將該費用項目計入銷售成本。

So it impacts our gross margin there.

所以它影響了我們在那裡的毛利率。

We saw an impact around 70 to 100 basis points then.

那時我們看到了大約 70 到 100 個基點的影響。

And it's probably a similar kind of impact, should that be reenacted.

如果重演的話，這可能是一種類似的影響。

Next, we'll go to the line of JP McKim with Piper Jaffray.

接下來，我們將與 Piper Jaffray 一起探討 JP McKim 的產品線。

I wanted to ask one on just this push to -- on trade-ins and upgrading the installed base to Generation 4. I think, after the last quarter, I think, half the installed base was still older generation.

我想問一個關於這個推動——以舊換新和將已安裝的基礎升級到第 4 代的問題。我認為，在上個季度之後，我認為，一半的已安裝基礎仍然是老一代。

And so can you give us an update on where that is today?

那麼你能告訴我們今天的最新情況嗎？

And then just how -- strategically how important is that to you to get everyone on Gen 4 ahead of competition that, in theory, should come sometime next year or after that?

然後，從戰略上講，讓每個人在競爭中領先於第 4 代對您來說有多重要，理論上應該在明年或之後的某個時候出現？

I'll give you the numbers and let Gary talk to the strategy.

我會給你數字，讓加里談談戰略。

You heard on this call, it was another 38% of our system sales involved trade-ins this quarter.

你在這次電話會議上聽說，本季度我們系統銷售額的另外 38% 涉及以舊換新。

It's likely to continue to be a significant part of our capital sales in future periods.

在未來期間，它可能會繼續成為我們資本銷售的重要組成部分。

At this point in time, it is about 45% of our installed base of 5,270 systems that are Gen 3 and prior, mostly SIs.

目前，我們安裝的 5,270 個系統中約有 45% 是第 3 代及之前的系統，主要是 SI。

We think it helps.

我們認為這有幫助。

I mean, as to the strategy, we think our customers appreciate it.

我的意思是，至於策略，我們認為我們的客戶很欣賞它。

Many customers now are multisystem owners, or across their integrated delivery network, they have systems at different hospitals where surgeons visit.

許多客戶現在是多系統所有者，或者在他們的集成交付網絡中，他們在外科醫生訪問的不同醫院擁有系統。

So having consistency helps them.

因此，保持一致性對他們有幫助。

Gen 4 products have a greater access to advanced instruments and other technologies and are well appreciated.

第 4 代產品更容易獲得先進的儀器和其他技術，並受到高度讚賞。

So in that sense, we think we can lean in and help those organizations go do it.

所以從這個意義上說，我們認為我們可以依靠並幫助這些組織去做。

There's a different set of regulatory clearances.

有一套不同的監管許可。

In different countries around the world, there are different trade-in economics in each country.

在世界上不同的國家，每個國家都有不同的以舊換新經濟學。

So as you think about the analysis, you think a little bit about which region and which country can move most quickly, and we work through that as well.

所以當你考慮分析時，你會考慮一下哪個地區和哪個國家可以最快地移動，我們也在努力解決這個問題。

Okay.

好的。

And then, if I could ask one on just -- the comments you made on the general surgery dynamics with hernia and some of the others is tempering based on just law of large numbers.

然後，如果我能問一個問題——你對疝氣和其他一些人的普通手術動力學所做的評論是根據大數定律進行調和的。

But the shift to bariatrics and some more on chole, I mean, the shift [in turnaround] on general surgery, what does that do for your instrument ASPs?

但是轉向減肥和更多的膽汁，我的意思是，普通外科手術的轉變 [in turnaround]，這對你的儀器 ASPs 有什麼作用？

Are they more advanced instruments as you shift to different procedures in general surgery?

當您轉向普通外科手術的不同程序時，它們是否是更先進的儀器？

Highly variable.

高度可變。

You look at choles, those are lower revenue-per-procedure cases.

你看看 choles，那些是每次手術收入較低的案例。

If you look at bariatrics, it's the other side where a lot of staple pliers are used.

如果你看一下減肥藥，就會發現另一側使用了很多訂書釘鉗。

So it's a highly variable landscape.

所以這是一個高度可變的景觀。

Bariatrics is in early innings.

減肥是在早期局。

And as we start to optimize the instrument kit therein, we're seeing really pull from the market there.

當我們開始優化其中的儀器套件時，我們看到了真正從那裡的市場拉動。

We haven't changed our priorities in the U.S. sales force with regard to general surgery.

在普通外科方面，我們沒有改變美國銷售隊伍的優先事項。

We continue to believe there is opportunity and value in, of course, hernia and colorectal procedures.

我們仍然相信，當然，疝氣和結直腸手術存在機會和價值。

The bariatric side are really customers coming to us and starting to move that along.

減肥方面真的是客戶來找我們並開始推動它。

Next, we go to the line of Richard Newitter with SVB Leerink.

接下來，我們將與 SVB Leerink 一起訪問 Richard Newitter 的產品線。

I have 2 and housekeeping.

我有 2 和家政服務。

With the housekeeping, can you just quantify what the selling day headwind was, what your procedure growth would've been excluding the -- not the selling day, but some of the headwinds that you had described related to the holiday timing and whatnot?

通過內務管理，您能否量化銷售日的逆風是什麼，您的程序增長將被排除在外 - 不是銷售日，而是您描述的與假期時間相關的一些逆風等等？

And then, Gary, I was wondering, with respect to the capacity issues just getting robot time, are there certain types of procedure mix cases or certain types of institutions where you can proactively get in front of those capacity issues to get there before they occur?

然後，加里，我想知道，關於獲得機器人時間的能力問題，是否存在某些類型的程序組合案例或某些類型的機構，您可以在這些能力問題發生之前主動解決這些問題？

And is there any kind of characteristic of the institution's procedure mix that specifically is leading to capacity constraints?

該機構的程序組合是否有任何特別導致能力限制的特徵？

Yes.

是的。

First, on the working day, really minor in the quarter.

首先，在工作日，在季度中確實是次要的。

Not a big thing.

沒什麼大不了的。

We mentioned in the commentary, overall, maybe a 30-ish basis point impact on procedure volume, with a much larger portion attributable outside the U.S. due to the timing of Easter.

我們在評論中提到，總體而言，可能對程序量產生 30 個基點的影響，由於復活節的時間，其中更大一部分歸因於美國以外的地區。

On the capacity side, as we've said in the past, our customer base doesn't -- one size does not fit all.

在容量方面，正如我們過去所說的那樣，我們的客戶群並沒有——一種尺寸並不適合所有人。

Each institution runs with different operating cadences within their organization.

每個機構在其組織內以不同的運營節奏運行。

So in some places, we see extremely efficient capital utilization.

所以在一些地方，我們看到了極其高效的資本利用。

Really, a focused [actuary] approach where they have very high predictability and get a lot of procedures out of the system.

真的，一種專注的[精算]方法，他們具有非常高的可預測性，並從系統中獲取大量程序。

We're delighted to support that.

我們很高興支持這一點。

And we help to benchmark that and teach others as they need it.

我們幫助建立基準並在其他人需要時教導他們。

We see other institutions that, for various reasons, are operating at lower capital capacity for some reasons that are quite good.

我們看到其他機構出於各種原因以較低的資本能力運營，但出於某些非常好的原因。

Some may be teaching institutions, some may be institutions that take on the most complex comorbid patient sets where predictability of procedure duration is difficult.

有些可能是教學機構，有些可能是接受最複雜的合併症患者組的機構，在這些患者中很難預測手術持續時間。

So you can imagine, if you're sharing a system between a thoracic surgeon who's performing lung cancer procedures and a general surgeon who's doing hernia repairs, the cadences and rhythms in scheduling are quite different and you're going to get less optimal scheduling.

所以你可以想像，如果你在執行肺癌手術的胸外科醫生和進行疝氣修復的普通外科醫生之間共享一個系統，那麼調度的節奏和節奏就會大不相同，你將獲得不太理想的調度。

To the extent that we can have those conversations up front and help them optimize, we do.

在某種程度上，我們可以提前進行這些對話並幫助他們優化，我們做到了。

That's something we've been strengthening over time, so I think we can do better than we do today.

隨著時間的推移，我們一直在加強這一點，所以我認為我們可以做得比今天更好。

Great.

偉大的。

If I get one more, just the China utilization pickup on just 8 systems placed under the quota, did that surprise you that it was able to translate into a pickup in volumes so quickly?

如果我再得到一個，只是配額下僅 8 個系統的中國利用率回升，它能夠如此迅速地轉化為數量回升，這讓您感到驚訝嗎？

I was always of the impression that you needed -- there was going to be a lag time to train institutions.

我一直覺得你需要——培訓機構會有滯後時間。

If you could comment there.

如果你可以在那裡發表評論。

I don't know if we were surprised.

我不知道我們是否感到驚訝。

I'd say we were pleased.

我會說我們很高興。

That tells you the level of commitment and motivation of those customers to make their investment productive.

這告訴您這些客戶使他們的投資富有成效的承諾和動機水平。

Last questioner, please.

請最後一位提問者。

Yes.

是的。

The last question comes from the line of Imron Zafar with Deutsche Bank.

最後一個問題來自德意志銀行的 Imron Zafar。

First question is on Japan.

第一個問題是關於日本的。

I believe you noted some moderation in procedure growth there, but at the same time, we're still seeing some very strong capital equipment placement numbers this quarter.

我相信你注意到那裡的程序增長有所放緩，但與此同時，本季度我們仍然看到一些非常強勁的資本設備安置數字。

Can you just sort of give us some color on what's driving these placements?

你能給我們一些關於推動這些展示位置的顏色嗎？

Is it more sort of greenfield robotics programs that are looking to get into presumably urology?

是否更多的是希望進入泌尿外科的全新機器人項目？

Or is it the established customers wanting to get more into general surgery?

還是老牌客戶希望更多地涉足普通外科？

In light of the sort of the less financial incentive that they have, I'm just wondering if there's any -- if the growth should continue to slow going forward in general surgery.

鑑於他們擁有的那種較少的經濟激勵，我只是想知道是否有任何——普通外科的增長是否應該繼續放緩。

It's a combination of greenfields, where you have hospitals that are positioning themselves to do the newer procedures that were approved for reimbursement last year.

它是一片綠地的組合，那裡有醫院將自己定位為執行去年批准報銷的較新程序。

And there's still a trade-in cycle going on in Japan.

日本仍然存在以舊換新的周期。

Our distributor had sold SIs on leases, and as those leases are coming up -- are coming due, then we see customers wanting to upgrade to the newer technology.

我們的分銷商以租約出售 SI，隨著這些租約即將到期——我們看到客戶希望升級到更新的技術。

Okay.

好的。

And then we've heard some mention from some surgeons on some third parties that hospitals can ship instruments to their -- that are approaching the end of their useful life and that this limited useful life can be extended presumably via some sort of a software intervention or something.

然後我們聽到一些外科醫生提到一些第三方，醫院可以將儀器運送到他們的——這些儀器的使用壽命即將結束，而且這種有限的使用壽命可能可以通過某種軟件干預來延長或者其他的東西。

Is this something that you're seeing any impact from?

這是你看到的任何影響嗎？

Or is there any regulatory preclusion that would limit the ability for companies to do this kind of stuff?

或者是否有任何監管排除措施會限制公司做這類事情的能力？

On the -- on how good an idea is it, the people in reprocess like that are bound by the same regulatory framework that we are in terms of assuring the quality of that product and making sure it's not sold as an adulterated product, and they have to take on that burden and it is a sophisticated one.

關於——關於這個想法有多好，像這樣進行再加工的人在確保產品質量和確保它不作為摻假產品出售方面受到與我們相同的監管框架的約束，他們必須承擔這個負擔，這是一個複雜的負擔。

Calvin, I'll let you respond.

卡爾文，我會讓你回應。

No.

不。

Yes.

是的。

I think that's essentially it.

我認為基本上就是這樣。

In terms of materiality of it.

就其物質性而言。

Yes.

是的。

And you look at our revenue per procedure, I mean, it's -- we've talked about that a little bit and I don't think we've seen any impact on that.

你看看我們每個程序的收入，我的意思是，我們已經討論了一點，我認為我們沒有看到任何影響。

That was our last question.

這是我們的最後一個問題。

In closing, we believe there is a substantial and durable opportunity to fundamentally improve surgery and acute intervention.

最後，我們認為有大量和持久的機會從根本上改善手術和急性干預。

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

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：更好和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，以及最終更低的總體治療費用。

We believe that accomplishing this aim takes the integration of 3 elements: first, a deep understanding of the 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 analytic insights and translation of these insights into action driving positive change.

我們認為，實現這一目標需要整合 3 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互聯繫統、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。

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。

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

女士們，先生們，今天的會議到此結束。

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

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

You may now disconnect.

您現在可以斷開連接。