直覺手術 (ISRG) 2019 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by. Welcome to the Intuitive Surgical Q2 2019 Earnings Release Call. (Operator Instructions) As a reminder, this conference is being recorded.

女士們、先生們，感謝你們的耐心等待。歡迎參加直覺外科公司2019年第二季財報發布電話會議。（操作說明）提醒各位，本次會議正在錄音。

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

現在我謹將會議交給我們的主持人，財務高級總監兼投資者關係主管卡爾文·達林先生。請繼續。

Thank you. Good afternoon, and welcome to Intuitive's second quarter earnings conference call. With me today, we have Gary Guthart, our CEO; and Marshall Mohr, our Chief Financial Officer.

謝謝。下午好，歡迎參加 Intuitive 第二季財報電話會議。今天和我在一起的有我們的執行長 Gary Guthart；以及我們的財務長 Marshall Mohr。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are described in detail in the company's Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 4, 2019, and 10-Q filed on April 19, 2019. Our SEC filings can be found through our website or at the SEC's website. Investors are cautioned not to place undue reliance on such forward-looking statements.

在開始之前，我想告知各位，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於存在某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定性在公司向美國證券交易委員會提交的文件中均有詳細描述，包括我們最近於 2019 年 2 月 4 日提交的 10-K 表格和於 2019 年 4 月 19 日提交的 10-Q 表格。您可以透過我們的網站或美國證券交易委員會的網站找到我們向該委員會提交的文件。投資者應注意，不要過度依賴此類前瞻性陳述。

Please note that this conference call will be available for audio replay on our website at intuitive.com on the Latest Events section under our Investor Relations page. In addition, today's press release and supplementary financial data tables have been posted to our website.

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

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

今天的會議形式將包括：首先向您介紹我們今天早些時候發布的新聞稿中所述的第二季度業績亮點，然後進行問答環節。

Gary will present the quarter's business and operational highlights, Marshall will provide a review of our second quarter financial results, then I will discuss procedures and clinical highlights and provide our updated financial outlook for 2019. And finally, we will host a question-and-answer session.

Gary 將介紹本季的業務和營運亮點，Marshall 將回顧我們第二季的財務業績，然後我將討論流程和臨床亮點，並提供我們 2019 年的最新財務展望。最後，我們將舉行問答環節。

With that, I will turn it over to Gary.

接下來，我將把麥克風交給蓋瑞。

Thank you for joining us today. The second quarter of 2019 was a solid one for Intuitive with healthy customer interest and demand for our products. Overall procedure growth met our expectations, while capital placements exceeded them.

感謝您今天蒞臨。2019 年第二季對 Intuitive 來說是穩健的一年，顧客對我們的產品展現了濃厚的興趣和需求。整體手術量成長符合預期，而資金投入超出預期。

Global procedure growth was approximately 17% in the second quarter of 2019. Growth again centered on general surgery in the United States, with positive contributions to the global growth rate from Germany, France and Japan. In China, we are pleased with procedure performance, given the recent release of systems under the new quota.

2019年第二季全球手術量成長約17%。美國的普通外科手術再次成為成長的焦點，德國、法國和日本也對全球成長率做出了積極貢獻。在中國，鑑於最近在新配額下推出的系統，我們對流程執行感到滿意。

Turning to the United States, year-over-year growth in the quarter was 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. Underlying this performance, we saw a continued strength in bariatrics and cholecystectomy, with modest tempering of growth rate in hernia and colon resection. 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.

再來看美國，該季度年增 16%。普通外科手術的成長再次成為年增幅最大的領域，同時，美國泌尿科和婦科的成長預計會放緩。在這一業績的背後，我們看到減肥手術和膽囊切除術繼續保持強勁勢頭，而疝氣和結腸切除術的增長速度略有放緩。鑑於普通外科醫生執行的手術類型各不相同，我們看到對系統訪問和帳戶的需求增加，同時也對我們的代表的時間提出了更高的要求，以支持不同類型的手術。

We believe system placement strength in the U.S. is driven in part by the desire of general surgeons for increased access. We have efforts ongoing to manage these issues. Calvin will take you through global procedure dynamics in more detail later in the call.

我們認為，美國醫療系統佈局的優勢部分源於一般外科醫生希望獲得更多醫療服務。我們正在努力解決這些問題。Calvin 將在稍後的通話中更詳細地向您介紹全域流程動態。

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. Net of trade-ins and retirements, our da Vinci installed base again grew 13% over Q2 2018 to approximately 5,270. The mix of system placements this quarter moved towards our flagship Xi System, while both sales of X Systems and trade-ins remained healthy. The proportions of systems placed under operating leases was 32% this quarter compared with 33% last quarter. We do not anticipate this quarter-to-quarter variance is indicative of a larger trend in leasing.

就我們的已安裝基礎而言，本季新系統的安裝情況強勁，總安裝量比 2018 年第二季成長了 24%。扣除以舊換新和退役設備後，我們的達文西手術系統安裝基礎比 2018 年第二季再次成長了 13%，達到約 5,270 台。本季系統配置組合向我們的旗艦產品 Xi 系統傾斜，同時 X 系統的銷售和以舊換新均保持良好勢頭。本季以經營租賃方式部署的系統比例為 32%，而上季為 33%。我們認為這種季度間的差異並不預示著租賃業的更大趨勢。

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. 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. 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.

就資本平均銷售價格而言，上個季度的系統和地理組合導致平均銷售價格低於歷史趨勢。第二季產品組合動態發生了逆轉，功能齊全的系統銷售量增加，直接市場中的系統安裝比例也更高，導致平均售價高於近幾季的平均水準。正如我們上個季度所說，ASP 的季度間差異是系統和區域組合變化的結果，而不是我們理念的根本改變。

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. 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.

談到支出，我們將繼續投資，推出新平台，增強運算能力，並執行支援未來規模化發展的項目，並在我們發展的過程中提供槓桿效應的機會。我們的支出符合預期，在我們上個季度與您分享的預測範圍內，並得到了穩健的業務成長和資本投入的支持。

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.

我們第二季業績的財務亮點如下：手術量較去年同期成長約 17%；我們安裝了 273 台達文西手術系統，高於 2018 年第二季的 220 台；我們的裝置量較去年同期再次成長 13%；本季營收約 11 億美元，成長 21%較去年同期再次成長 13%；本季營收約 11 億美元，成長 21%； 5.79 億美元，成長 22%；本季經常性收入總額為 7.8 億美元，較 2018 年第二季成長 21%，佔總營收的 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%. 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.

本季我們實現了 4.55 億美元的備考營業利潤，比去年第二季度增長了 17%；備考淨利潤為 3.88 億美元，增長了 18%。如您所知，我們衡量自身努力的標準是：能否對四重目標產生正面影響：更好的治療效果、更好的患者體驗、更好的護理團隊體驗以及更低的每次患者治療總成本。

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. For our customers, surgery has been digitized for the past 20 years. While we've made significant progress over our history, we believe continuous improvement is required and we have deployed our investment toward these aims.

我們認為智慧手術需要整合三個要素：首先，深入了解人類互動，從而指導整體系統設計；其次，開發高品質、智慧且與雲端連接的機器人成像和儀器系統；最後，利用資訊學和人工智慧提供相關的、經過驗證的見解。對於我們的客戶而言，手術已經實現了數位化20年。雖然我們在過去的發展歷程中取得了顯著進步，但我們相信需要不斷改進，並且我們已經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. 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. Our 60-millimeter stapler has 4 staple lengths available and is sold in the U.S., Europe, Korea, Australia and now Japan. 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. Measured through Q2, surgeons have fired Intuitive staplers clinically over 1 million times cumulatively since our stapling launch.

我們設計的儀器和配件能夠實現可重複的高品質手術，從而提高手術效率並降低治療總成本。以我們先進的儀器平台為例，我們的第二代 SureForm 縫合器目前有 60 毫米和 45 毫米兩種儀器長度，並代表了多個產品系列。我們的 60 毫米訂書機有 4 種訂書針長度可供選擇，在美國、歐洲、韓國、澳洲以及現在的日本都有販售。我們的 45 毫米 SureForm 訂書機有 5 種不同長度的訂書針盒，以及直頭和彎頭兩種型號，目前已在美國和我們的歐盟直銷市場推出。截至第二季度，自我們推出縫合器以來，外科醫生已累積使用 Intuitive 縫合器進行臨床手術超過 100 萬次。

Turning to systems, we are in the first phase of launch of da Vinci SP. We installed 13 systems in Q2 to bring our clinical installed base of SP to 34. Our teams have done a nice job resolving the manufacturing variances that slowed our installs in Q1. The highest per system utilization of SP is occurring in Korea, where regulatory clearances support the access to a large range of clinical applications. The Korean experience with SP is encouraging with regard to the broad possibilities for our platform. In Korea, procedures in urology, gynecology, general surgery and head and neck surgery are being performed.

就係統而言，我們目前正處於達文西SP系統發布的第一階段。我們在第二季安裝了 13 套系統，使我們的 SP 臨床安裝基礎達到 34 套。我們的團隊出色地解決了第一季導致安裝進度放緩的製造差異問題。SP 系統利用率最高的國家是韓國，該國的監管許可支持 SP 應用於廣泛的臨床應用。韓國在SP方面的經驗令人鼓舞，也展現了我們平台的廣闊前景。在韓國，泌尿科、婦科、一般外科和頭頸外科等手術都在進行中。

In the United States, we have 2 cleared indications for SP: urologic and transoral surgery. As you know, we're pursuing additional clinical indications for SP and have engaged regulatory agencies regarding their requirements. These requirements are in discussion, which implies projected timelines for additional indications are not yet available. 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.

在美國，SP 有 2 個已獲批准的適應症：泌尿外科手術和經口手術。如您所知，我們正在尋求 SP 的其他臨床適應症，並已就​​監管機構的要求與其進行了溝通。這些要求仍在討論中，這意味著其他指標的預期時間表尚未確定。我們擁有大量感興趣的 SP 客戶，SP 的更多適應症以及我們大規模部署的準備工作，都加快了 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. Ion received FDA clearance in the first quarter. With 510(k) clearance, we've initiated our next phase focused on clinical use, customer feedback and production optimization. First cases on the cleared system were performed at the end of Q1, and we plan a measured rollout this year. Placements to date are at hospital sites collecting data. So far, 3 have been initiated and over 50 procedures have been performed so far. We're pleased with early clinical results and look forward to our customers' continued progress. We expect commercial placements to commence in the next few months along with the initiation of additional clinical collection sites. We do not anticipate material revenue from Ion in 2019.

在靈活診斷方面，我們的 Ion 平台專注於準確、及時的活檢，以支持對可疑肺癌（肺癌病灶）進行明確的早期診斷。Ion在第一季獲得了FDA的批准。在獲得 510(k) 許可後，我們啟動了下一階段，重點是臨床應用、客戶回饋和生產優化。首批在已獲批准的系統上進行的案例於第一季末完成，我們計劃今年逐步推廣。目前為止，所有受試者均在醫院收集數據。目前已啟動 3 項手術，並已完成 50 多次手術。我們對初步臨床結果感到滿意，並期待客戶的持續進展。我們預計商業化安置工作將在未來幾個月內開始，同時也將啟動額外的臨床採集點。我們預期 2019 年 Ion 不會帶來實質收入。

Turning to imaging and analytics, this week, we announced the acquisition of the 3D robotic endoscope business from our long-time supplier, Schölly Fiberoptic. The transaction is subject to closing conditions and thereafter, we look forward to welcoming their employees to the Intuitive team. Leading visualization has been a core pillar of our offerings and we believe it is essential to the future of intelligent surgery. This acquisition strengthens our design and supply chain capabilities and increases our manufacturing capacity for imaging products.

本週，在成像和分析方面，我們宣布從長期供應商 Schölly Fiberoptic 收購 3D 機器人內視鏡業務。這筆交易尚需滿足成交條件，之後，我們期待他們的員工加入 Intuitive 團隊。領先的視覺化技術一直是我們產品的核心支柱，我們相信它對智慧手術的未來至關重要。此次收購增強了我們的設計和供應鏈能力，並提高了我們成像產品的製造能力。

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.

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，支持達文西手術系統在全球市場的普通外科手術和關鍵手術中得到應用；其次，推出我們的 SP 和 Ion 平台；第三，推動智能手術創新；最後，支持在我們重點關注的手術和國家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. Sal has made enormous contributions to building our product line, our capabilities and, in the past few years, our leadership team. I extend my personal thanks and that of the company for his efforts over these past 2 decades. We anticipate working with Sal post-transition on projects of mutual interest.

在將電話交給馬歇爾之前，我想花一點時間感謝我們的營運長薩爾·布羅尼亞先生，他宣佈在 Intuitive 工作 20 年後，他打算退出日常營運。Sal 為我們的產品線建立、能力提升以及近年來的領導團隊建立做出了巨大貢獻。我謹代表我個人和公司，感謝他在過去二十年所做的貢獻。我們期待在過渡期後與 Sal 在共同感興趣的項目上合作。

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

現在我將把電話交給馬歇爾，他將回顧財務要點。

Good afternoon. I'll describe the highlights of our performance on a non-GAAP pro forma basis. I will also summarize our GAAP performance later in my prepared remarks. A reconciliation between our pro forma and GAAP results is posted on our website.

午安.我將以非GAAP備考財務報表的形式，介紹我們業績的亮點。我稍後將在準備好的發言稿中總結我們的GAAP表現。我們已在網站上公佈了模擬財務報表與GAAP財務報表之間的調節表。

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. Calvin will review details of procedure growth later in this call. Second quarter system placements of 273 systems increased 24% compared with 220 systems last year, and increased 16% compared with 235 systems last quarter.

第二季的關鍵業務指標如下：2019 年第二季手術量比 2018 年第二季成長約 17%，比上一季成長約 7%；手術量的成長繼續由美國的普通外科手術和全球的泌尿外科手術推動。Calvin將在本次通話中稍後詳細介紹手術進展。第二季系統安裝量為 273 套，比去年同期的 220 套成長了 24%，比上一季的 235 套成長了 16%。

We expanded our installed base of da Vinci systems by 17% to approximately 5,270 systems. This growth is consistent with last quarter and slightly higher than the 12.5% increase last year. 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.

我們將達文西手術系統的安裝量擴大了 17%，達到約 5,270 套系統。這一成長與上一季持平，略高於去年同期的12.5%的增幅。現場臨床系統的使用率（以每個系統的手術量衡量）成長了約 3.5%，略低於上一季約 4% 的成長率，也低於去年 5% 的成長率。

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. 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. 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.

我們的營收概況如下：2019 年第二季營收為 11 億美元，比 2018 年第二季的 9.09 億美元成長了 21%，比上一季的 9.74 億美元成長了 13%。儀器及配件收入為 5.79 億美元，比去年增長 22%，高於手術量增長，這主要反映了客戶的購買模式和我們先進儀器的使用量增加。每台手術的器械和配件收入約為 1,920 美元，與 2018 年第二季度相比增長了 4%，與上一季相比下降了 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. Systems revenue in the quarter reflected higher system placements, higher ASPs and higher lease-related revenue. 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.

2019 年第二季系統營收為 3.44 億美元，比 2018 年第二季成長 24%，比上一季成長 39%。本季系統收入反映了更高的系統安裝量、更高的平均售價和更高的租賃相關收入。我們完成了 88 筆經營租賃交易，佔總交易量的 32%，而 2018 年第二季完成了 44 筆，佔總交易量的 20%，上一季完成了 78 筆，佔總交易量的 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. 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.

截至 6 月 30 日，我們有 486 份未結清的經營租賃合同，本季度與這些安排相關的收入約為 2500 萬美元，而去年同期為 1200 萬美元，上一季為 2000 萬美元。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，但本季增加的經營租賃數量會抑制該季度短期收入的成長。

Operating leases included usage-based financings that we provide to certain experienced hospitals. We believe that our lease financing alternatives align with customer objectives and have enabled faster market adoption. 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. The proportion of these types of arrangements could increase long term and will vary quarter-to-quarter.

營業租賃包括我們向某些經驗豐富的醫院提供的基於使用量的融資。我們相信，我們的租賃融資方案符合客戶的目標，並促進了市場更快接受我們的方案。對於在租賃期間內購買的系統，我們會獲得少量溢價，這反映了貨幣的時間價值；而對於按使用量計費的安排，則反映了這些系統可能無法達到預期使用水準的風險。從長遠來看，這類安排的比例可能會增加，並且每季都會有所不同。

We recognized $27 million of lease buyout revenue in the quarter compared with $12 million last quarter and $13 million last year. Lease buyout revenue has varied significantly from quarter-to-quarter and will likely to do so. We do not expect the second quarter buyout -- level of buyout revenue to repeat. 38% of the current quarter system placements involved trade-ins, reflecting customer desire to access or standardize on fourth-generation technology. This is an increase in the proportion of trade-ins compared to 34% in the second quarter of 2018 and 36% last quarter.

本季我們確認了 2,700 萬美元的租賃買斷收入，而上一季為 1,200 萬美元，去年同期為 1,300 萬美元。租賃買斷收入每季波動較大，未來可能還會持續波動。我們預計第二季的收購收入水準不會重現。本季系統安裝中有 38% 涉及以舊換新，反映出客戶希望獲得或採用第四代技術。與 2018 年第二季的 34% 和上一季的 36% 相比，以舊換新的比例增加。

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. 13% of the systems placed were SP systems. 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. 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.

在本季安裝的系統中，74% 為達文西 Xi 系統，20% 為達文西 X 系統，而上一季達文西 Xi 系統佔比為 67%，達文西 X 系統佔比為 25%。已安裝的系統中，13%為SP系統。我們對 SP 手術系統的推廣採取循序漸進的方式，將系統交給經驗豐富的達文西用戶，同時優化供應鏈中的訓練途徑。在全球範圍內，我們的平均售價（不包括營業租賃和租賃買斷的影響）約為 154 萬美元，而去年同期為 142 萬美元，上一季為 131 萬美元。

Our mix of systems and customers in the second quarter of 2019 was very favorable relative to prior periods. We had a high mix of Xi versus X and SI systems. We also had a low mix of distributor versus direct sales. In the second quarter of 2019, we also had fewer multisystem arrangements where we provided volume discounts. The mix of systems, customers and size of arrangements will vary over time. We expect system ASPs to be in the range of the midpoint of the first 2 quarters.

與以往時期相比，我們 2019 年第二季的系統和客戶組合非常有利。我們混合使用了 Xi 與 X 以及 SI 系統。此外，我們的經銷商銷售比例也較低，直接銷售的比例較低。2019 年第二季度，我們提供批量折扣的多系統合作安排也減少了。系統、客戶和合作規模的組合會隨著時間而改變。我們預計系統平均售價將處於前兩季的中點水準。

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. 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. The increase compared with the prior year reflects increased instruments and accessory revenue of $34 million or 29% growth. The increase in instrument accessory revenue was primarily driven by procedure growth and customer buying patterns.

在美國以外，結果如下：與 2018 年第二季度相比，美國境外手術量增長了約 20%，與上一季相比增長了 4%。第二季美國以外的營收為 3.14 億美元，比 2018 年第二季成長 19%，比上一季成長 11%。與前一年相比，成長反映了儀器和配件收入增加 3,400 萬美元，增幅達 29%。儀器配件收入的成長主要受手術量成長和客戶購買習慣改變的推動。

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. Current quarter system placements included 30 into Europe, 24 into Japan, and 8 into China. 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. 12 of the system placements were operating leases compared with 6 last year and 11 last quarter. 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.

在美國以外，我們第二季安裝了 80 套系統，而 2018 年第二季安裝了 82 套，上一季安裝了 81 套。在當前季度製度下的就業分配包括：30人進入歐洲，24人進入日本，8人進入中國。在本季安裝的系統中，61% 為達文西 Xi 系統，33% 為達文西 X 系統，而上一季達文西 Xi 系統佔比為 38%，達文西 X 系統佔比為 44%。12 個系統部署方案為經營租賃，去年同期為 6 個，上季為 11 個。美國以外地區的市場佈局將繼續變化，因為一些美國以外市場仍處於早期採用階段；一些市場具有很強的季節性，反映了預算週期或度假模式；而且一些市場的銷售受到政府限制。

Moving on to gross margin and operating expenses. 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. The increase compared with the second quarter of 2018 and last quarter primarily reflects higher system ASPs. 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.

接下來分析毛利率和營運費用。2019 年第二季的備考毛利率為 71.3%，而 2018 年第二季為 71.1%，上一季為 71.2%。與 2018 年第二季和上一季相比，成長主要反映了系統平均售價的提高。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、系統平均售價以及我們進一步降低產品成本和提高生產效率的能力而波動。

Pro forma operating expenses increased 27% compared with the second quarter of 2018 and decreased 1% compared with last quarter. 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.

與 2018 年第二季相比，以備考計算的營運費用增加了 27%，與上一季相比下降了 1%。支出與我們的計劃一致，按成長幅度排序，包括與拓展海外市場相關的成本、資訊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 tax rate for the second quarter was 20% and within our expectations of 19% to 20%. Our tax rates will fluctuate with changes in the mix of U.S. and OUS income, changes in taxation made by local authorities, and with the impact of onetime items. Our 2020 tax rate will increase with the return of the medical device tax. 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.

我們第二季的預計稅率為 20%，符合我們 19% 至 20% 的預期。我們的稅率會隨著美國境內外收入組成的變化、地方政府稅收政策的變化以及一次性項目的影響而波動。隨著醫療器材稅的恢復，我們2020年的稅率將會提高。2019 年第二季度，我們的備考淨收入為 3.88 億美元，即每股 3.25 美元，而 2018 年第二季度為 3.27 億美元，即每股 2.76 美元，上一季為 3.12 億美元，即每股 2.61 美元。

I will now summarize our GAAP results. 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. 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.

現在我將總結一下我們的GAAP業績。2019 年第二季 GAAP 淨利為 3.18 億美元，即每股 2.67 美元；而 2018 年第二季 GAAP 淨利為 2.55 億美元，即每股 2.15 美元；上一季 GAAP 淨利為 3.07 億美元，即每股 2.56 美元。我們的網站上列出了備考淨收入與 GAAP 淨收入之間的調整，並進行了量化，其中包括與員工股票獎勵、員工股權和知識產權費用相關的超額稅收優惠、無形資產攤銷、收購相關項目和法律和解。

We ended the quarter with cash and investments of $5.1 billion, approximately the same as March 31, 2019. Cash generated from operations was offset by stock repurchases and investments in working capital and infrastructure during the quarter. We repurchased approximately 400,000 shares for $200 million at an average purchase price of $477 per share. In the quarter, we grew inventory by $45 million to $513 million, representing approximately 140 days of inventory. 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. 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.

本季末，我們的現金和投資總額為 51 億美元，與 2019 年 3 月 31 日基本持平。本季經營活動產生的現金流量被股票回購以及對營運資金和基礎設施的投資所抵銷。我們以每股 477 美元的平均購買價格，回購了約 40 萬股股票，總額達 2 億美元。本季度，我們的庫存增加了 4,500 萬美元，達到 5.13 億美元，相當於約 140 天的庫存。我們持續增加庫存，以因應業務成長，並降低因貿易、供應或其他事項可能造成的中斷風險​​。隨著業務的成長以及我們對效率和規模的重視，我們預計 2019 年的資本支出將增加到 2.5 億美元以上。

And with that, I'd like to turn it over to Calvin, who will go over procedure performance and our outlook for 2019.

接下來，我將把發言權交給卡爾文，他將介紹手術流程的執行情況以及我們對 2019 年的展望。

Thank you, Marshall. Our overall second quarter procedure growth was 17% compared to 18% during the second quarter of 2018 and last quarter. Our Q2 procedure growth was driven by 16% growth in U.S. procedures and 20% growth in OUS markets. In the U.S., Q2 procedure results were generally consistent with recent trends. Q2 growth was again driven by growth in U.S. general surgery, thoracic and benign gynecology procedures. 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. 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. 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.

謝謝你，馬歇爾。我們第二季的整體手術量成長了 17%，而 2018 年第二季和上一季均為 18%。第二季度手術量成長主要得益於美國手術量成長 16% 和美國境外市場手術量成長 20%。在美國，第二季手術結果大致與近期趨勢一致。第二季的成長再次得益於美國一般外科、胸腔外科和良性婦科手術的成長。2019 年第二季度美國手術量增長 16%，而去年同期和上一季度均為 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的增長率預計會略有放緩。在美國一般外科領域，第二季疝氣修補術和大腸直腸手術的成長依然穩健，儘管成長速度略低於上一季和去年同期。其他普通外科手術，如膽囊切除術、減肥手術以及肝臟和胰臟手術，在第二季度對成長的貢獻越來越大，成長率高於上一季。

As anticipated, U.S. procedure growth in mature urology and gynecology procedure categories moderated in Q2 compared to last year. U.S. gynecology growth and urology growth were in the mid-single digits. dVP growth specifically was in the low single-digit range, in close alignment with the underlying incident rate for prostate cancer. As a mature procedure category, we believe that our U.S. prostatectomy volumes have been tracking to the broader prostate surgery market. In other U.S. procedures, adoption of lobectomies and other thoracic procedures was again solid during the second quarter.

正如預期的那樣，與去年同期相比，美國成熟泌尿外科和婦科手術類別的手術量增長在第二季度有所放緩。美國婦科和泌尿科的成長率為個位數中段。dVP 的成長幅度具體處於個位數低水平，與攝護腺癌的潛在發生率密切相關。作為一個成熟的手術類別，我們認為我們在美國的前列腺切除手術量與更廣泛的前列腺手術市場趨勢一致。在美國其他手術方面，肺葉切除術和其他胸腔外科手術在第二季度再次保持穩定。

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

第二季 OUS 手術量成長約 20%，而 2018 年第二季成長 22%，上一季成長 21%。2019 年第二季 OUS 手術量的成長主要得益於 dVP 手術量的持續成長以及腎癌手術、一般外科手術和婦科手術早期階段的成長。第二季 OUS 手術量成長受到復活節假期（主要影響歐洲）和其他國家假期（尤其是日本）的影響，導致工作日略有不利。日本手術量成長依然強勁，但在第二季度有所放緩，這反映出隨著市場滲透率的提高，成熟的泌尿外科手術的增長率有所下降，以及假日和新手術報銷政策週年紀念的影響。

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. In Europe, procedure growth was driven by strong results in Germany and France. Overall, European procedure growth was largely consistent with prior periods, with variation by country.

在中國，在經歷了幾個季度的手術量增長下滑之後，第二季度手術量增長略有加快，這主要得益於根據最新系統配額安裝的新系統所進行的手術量。在歐洲，手術量的成長主要得益於德國和法國的強勁業績。整體而言，歐洲手術量的成長與以往時期基本一致，但各國之間存在差異。

Now turning to the clinical side of our business. Each quarter on these calls, we highlight certainly recent published studies of note. 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. We are pleased to see the evidence landscape regarding our recently cleared Ion endoluminal system start to grow. 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.

現在我們來談談我們業務的臨床方面。每季的電話會議上，我們都會重點介紹一些近期發表的值得關注的研究。然而，為了更全面地了解證據體系，我們鼓勵所有利害關係人徹底審查多年來發表的大量科學研究的細節。我們很高興看到有關我們最近核准的 Ion 腔內系統的證據越來越多。由澳洲布里斯班皇家布里斯班婦女醫院的 David Fielding 博士領導的關於首次[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. 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. Importantly, across the entire study population, no instances of pneumothorax, bleeding or device-related adverse events were reported, suggesting a good safety profile.

該研究曾在 2017 年的 CHEST 年度會議上發表，旨在評估 Ion 腔內平台的安全性和可行性，並納入了 29 名連續受試者，追蹤數據長達 6 個月。雖然每個結節都位於肺的周邊部分，平均結節大小約為 15 毫米，但約 97% 的結節都獲得了適合評估的組織樣本。重要的是，在整個研究族群中，沒有報告任何氣胸、出血或與設備相關的不良事件，顯示其安全性良好。

We believe that further scientific study and clinical evidence will be essential to build the market for Ion. 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. Full details regarding the construct of the PRECISE study are available on the web at ClinicalTrials.gov.

我們認為，進一步的科學研究和臨床證據對於建立 Ion 的市場至關重要。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，計劃在美國 6 個主要中心招募 360 名受試者。有關 PRECISE 研究的完整詳細資訊可在 ClinicalTrials.gov 網站上查閱。

In May of this year, a large scale, real-world comparative study using the National Cancer Database was published in the journal, Colorectal Disease. 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. The National Cancer Database captures data from over 1,500 cancer-accredited facilities and represents approximately 70% of newly diagnosed cancer cases. The population for the study consisted of approximately 15% robotic-assisted, 33% laparoscopic and 52% open procedures. 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. 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.

今年 5 月，《結直腸疾病》雜誌發表了一項利用國家癌症資料庫進行的大規模真實世界對比研究。這項由紐約長老會/哥倫比亞大學醫學中心的 Ravi Kiran 博士領導的分析，按手術方法比較了 2010 年至 2015 年間 41,000 多名患者的治療結果。國家癌症資料庫收集了來自 1500 多家癌症認證機構的數據，約佔新診斷癌症病例的 70%。研究族群中，約 15% 為機器人輔助手術，33% 為腹腔鏡手術，52% 為開放性手術。在評分配對分析中，每個隊列超過 4,000 名受試者，比較機器人輔助低位前切除術 (LAR) 和腹腔鏡手術，機器人輔助低位前切除術與較短的住院時間（6.3 天對 6.8 天）和較低的轉為開放手術的風險（7.5% 對 14.95%）相關手術患者的低位數字，患者為腹腔鏡手術患者的低位輔助手術，患者為低位輔助手術，是低位機器人測量患者的低位輔助手術，患者的低位數字，患者則為低位機械性患者的傾向分析2.2 倍。與開放式 LAR 相比，機器人輔助手術的住院時間更短，為 6.3 天，而開放式手術為 7.8 天；陰性切緣率更高，為 97.01%，而開放式手術為 95.96%；淋巴結清掃數量更多，為 17 個，而開放式手術為 16.4 個。

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

作者總結（我引用如下）：「對於直腸癌患者，機器人輔助低位前切除術 (LAR) 比開放式和腹腔鏡 LAR 均顯示出復健優勢，與腹腔鏡 LAR 相比，轉為開放式手術的比例更低，與腹腔鏡 LAR 和開放式 LAR 相比，住院時間更短。機器人輔助低位直腸切除術（LAR）的短期腫瘤學療效與開放式低位直腸切除術相當，支持將其用於直腸癌的微創手術。

I will now turn to our financial outlook for 2019. Starting with procedures. Last quarter, we forecast 2019 procedure growth of 15% to 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%.

接下來，我將談談我們對2019年的財務展望。首先從流程入手。上個季度，我們預測 2019 年手術量將增加 15% 至 17%。我們現在將預測值調整到該範圍的上半部分，預計 2019 年全年手術量將增加 16% 至 17%。

Turning to gross profit. On our last call, we forecast our 2019 full year pro forma gross profit margin to be within 70% and 71% of net revenue. We now expect to come in at the higher end of that range. 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.

接下來討論毛利。在上一次電話會議上，我們預測 2019 年全年預計毛利率將達到淨收入的 70% 至 71%。我們現在預計最終結果會處於該範圍的較高水平。我們的實際毛利率會因產品、地區和以舊換新組合以及新產品推出的影響而逐季度變化。

Turning to operating expenses, we continue to expect to grow pro forma 2019 operating expenses between 24% and 28% above 2018 levels. We continue to expect our noncash stock compensation expense to range between $320 million and $340 million in 2019. 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. 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.

就營運費用而言，我們仍預期 2019 年的備考營運費用將比 2018 年的水準成長 24% 至 28%。我們預計 2019 年的非現金股票補償支出將在 3.2 億至 3.4 億美元之間。我們預計 2019 年其他收入（主要包括利息收入）總額將在 1.3 億美元至 1.35 億美元之間，高於上次電話會議預測的 1.2 億美元至 1.3 億美元。關於所得稅，我們繼續預期 2019 年的預計所得稅稅率為稅前收入的 19% 至 20%。

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

我們的發言到此結束。現在開始回答各位的問題。

(Operator Instructions) 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鮑伯霍普金斯。

So first question, I wanted to ask about U.S. procedure growth. 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. So I was wondering if you could just talk about that a little bit. Like was that -- was the growth you experienced in hernia and colorectal this quarter different than you expected? And how do you manage through this issue of kind of managing access?

首先，我想問美國手術量的成長情況。根據我們的計算，考慮到去年同期的情況，第二季度美國整體手術業務的成長略有加速，但您指出疝氣和大腸直腸手術的成長略有放緩。所以我想問您能否稍微談談這方面的情況。比如說—本季度您在疝氣和大腸癌方面的成長是否與您的預期有所不同？那麼，您是如何解決這種存取權限管理問題的呢？

This is Gary. We saw a tad of moderation. I think demand remains strong, and what we're really seeing is what we indicated to you. We have two things going on. One is there are a lot of different procedure types, and now, in busy centers, competition for system access. We can of course solve that with additional systems placed as well as work with folks on efficiency of use. And we're doing both. And you've heard that from us over the last several quarters. The next one is our commercial teams have been growing in the United States to support the growth of the company. 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. And it's -- the new ratio is amongst the highest we've had in the last few. Employee retention has been great. 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.

這是加里。我們看到了一些緩和的跡象。我認為需求依然強勁，我們實際看到的情況也和我們之前向你們展示的一樣。我們有兩件事正在進行。一是手術類型很多，二是現在繁忙的醫療中心，對系統存取權限的競爭也很激烈。我們當然可以透過增設系統以及與大家合作提高使用效率來解決這個問題。我們兩者都在做。過去幾個季度，我們已經多次強調這一點。其次，為了支持公司的發展，我們在美國的商業團隊一直在壯大。團隊需要一些時間才能達到完全生產力，而且在過去的幾個季度裡，新地區新員工的比例一直在上升。而且──這個新比例是近幾個月來最高的比例之一。員工留任率一直很高。實際上，這主要是因為需要增加案件覆蓋範圍，因此，我們需要為第一線新員工提供工具，其中一些工作也需要投入時間。

Yes. Bob, from just a pure mathematical standpoint, you know we track adoption curves pretty regularly around here. And it's a mathematical reality that really all points along the curve, the rate of growth actually declines. So our results here in Q2 is aligned with what we would have expected. And clearly, there's a lot -- substantial remaining opportunity in both hernia and colorectal procedures, and our checks with surgeons generally indicate healthy demand.

是的。鮑勃，從純粹的數學角度來看，你知道我們這裡經常追蹤採用率曲線。從數學角度來看，沿著這條曲線，成長率其實是下降的。因此，我們第二季的業績與預期相符。顯然，疝氣和結直腸手術領域仍有許多機會，我們與外科醫生的交流也表明，市場需求普遍旺盛。

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

那太棒了。然後，系統方面只有一項，因為正如您所指出的，由於產品組合的變化，本季系統銷售的收入成長遠高於第一季。但兩個季度的安裝量和安裝量成長都表明，這兩個季度對貴公司係統的潛在需求非常強勁。我只是想請您談談您在第一季和第二季觀察到的組合動態方面有哪些不同，以及這對於今年剩餘時間的系統前景有何啟示。

We're -- this is Marshall. We have seen, as you suggested, reasonable strength in terms of system placements. I don't think there's anything really different quarter-to-quarter other than the mix. In other words, the buying behaviors of the customers hasn't changed. We're seeing a nice cycle on trade-ups. And -- but we did see, again, more Xis this quarter. And there's volatility or variability between quarter-to-quarter as it relates to particularly our distribution channel. And so we saw fewer distributor sales this quarter and more direct sales. 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. So that's really -- that's the color that we would provide on systems revenue.

我們是－－這裡是馬歇爾。正如您所說，我們已經看到系統部署方面具備相當的優勢。除了產品組合之外，我認為每季之間並沒有什麼真正的不同。換句話說，顧客的購買行為並沒有改變。我們看到一波不錯的以舊換新行情。但是——我們本季又看到了更多習近平成員。而且，就我們的分銷管道而言，季度之間也存在波動或變化。因此，本季我們看到分銷商銷售額減少，而直接銷售額增加。而且，我們的直銷價格比我們賣給經銷商的價格要高，因為經銷商需要承擔與這些系統相關的銷售成本。所以，這其實就是──這就是我們對系統收入的描述。

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?

馬歇爾，如果把前半部看成一個整體，而不是分成不同的部分來看，這樣是否能更好地理解它呢？

That's true, Gary. 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.

沒錯，加里。你應該－在查看平均售價時，你應該考慮這兩個因素的組合，因為 1.31 是低點，1.54 是高點。

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

下一個問題來自摩根大通的泰科彼得森。

Maybe I'll just follow-up on that last question. Why should ASPs take a little bit of a step back? You did -- you skew more toward fully featured system sales. Obviously, your procedure mix is expanding. Why logically should ASPs step down a little bit going forward?

或許我應該就最後一個問題再追問一下。為什麼應用程式服務提供者應該稍微退後一步？確實如此——你們更傾向於銷售功能齊全的系統。顯然，您的手術組合正在不斷擴展。從邏輯上講，ASP（應用服務提供者）為何未來應該有所減少？

You should expect that the -- again, distributor sales tend to be variable quarter-to-quarter. 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. 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. And so this quarter, just based on mix, we wound up selling fewer Xs and that should even out as well.

你應該預料到——再次強調，分銷商的銷售額往往會因季度而異。所以我認為，在預測經銷商的銷售預期水準時，應該將第一季和第二季的數據結合起來考慮。我認為 Xi 和 X 的組合也是如此，只是取決於地理位置，X 的目標是那些報銷面臨壓力的地區。因此，本季僅從產品組合來看，我們最終售出的 X 型號產品較少，這種情況應該也會得到改善。

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. Is this kind of the new norm in your view? Or how should we think about operating leases in terms of mix going forward?

我們已經連續幾季經營租賃率徘徊在 30% 左右，而去年年底這一比例為 29%。你認為這是一種新的常態嗎？或者，我們應該如何看待未來租賃組合中的營業租賃問題？

I don't think about it as a norm. I think that there's going to be variability quarter-to-quarter. And yes, Q2 is slightly lower, if not close to being the same as Q1. 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. It eliminates volatility. It also enables an upgrade cycle when and if new systems come out. So we think it's a positive and so we'll supply those to customers as they ask for them.

我不認為這是常態。我認為每個季度之間都會有波動。是的，第二季度略低於第一季，即便不是與第一季持平，也相差無幾。但我認為，隨著時間的推移，我們會滿足客戶的需求，另一方面，我們認為租賃對公司來說是正面的，因為正如我在準備好的發言稿中所說，它可以增加經常性收入。它消除了波動性。它還可以在新系統推出時實現升級循環。所以我們認為這是一個積極的信號，因此我們會根據客戶的需求提供這些產品。

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

我猜測隨著時間的推移——或者我們預測隨著時間的推移——這個百分比實際上可能會增加。

Okay. 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?

好的。關於 IRIS，我知道現在還處於早期階段，我也沒有聽到您在評論中提到它，但您能否談談人們對腎臟和肝臟的興趣程度，以及我們應該如何看待未來擴大其應用範圍？

I think the interest from the forward-leaning surgeons is very high. I think, in general, people are looking out seeing additional access to data. IRIS, just a reminder for everybody, is the integration of preoperative imaging, 3D imaging into a case in real-time. We're not in the clinic yet. We do have our 510(k) clearance. We're working through agreements with first customers. We don't expect revenue this year.

我認為，具有前瞻性思維的外科醫生對此非常感興趣。我認為，總的來說，人們都在期待獲得更多的數據存取權限。提醒大家一下，IRIS 是將術前影像、3D 影像即時整合到病例中的技術。我們還沒到診所。我們確實擁有 510(k) 許可。我們正在與首批客戶洽談協議。我們預計今年不會有收入。

I think, directionally, there's quite a lot of support. 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，從方向上看，這個方向得到了相當多的支持。我認為，隨著我們不斷拓展市場，我們希望發展的部分內容是用例，並真正從其驅動力（準確性、效率或兩者兼具）的角度來闡述它們的價值。

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

早期反應固然很好，但這些事情需要一些時間來發展，也需要時間來累積支持背後的證據基礎。

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

下一個問題來自摩根士丹利的戴維·劉易斯。

A couple of questions here. I'll start with Gary. Gary, last year, procedures began to inflect from a [mentor] perspective and they still remain pretty strong. 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? Obviously, SP, Ion creating this access, you've already talked about it on this call, or accessing new geographies, Japan and China. I notice you already mentioned in a comment that just a few systems in Japan -- sorry, in China, was able to drive some demand. So across those 3 buckets, Gary, systems, access, geographies, what is the most likely driver of the next wave of procedure inflection?

這裡有幾個問題。我先從加里說起。Gary，去年，流程開始從（導師）的角度進行調整，而這些調整仍然非常有效。當你思考手術量成長的下一個轉折點時，你認為它更有可能來自新的系統嗎？顯然，SP 和 Ion 正在創造這種訪問權限，你們已經在這次通話中談到了這一點，或者說是進入新的地區，例如日本和中國。我注意到你已經在評論中提到，日本（抱歉，是中國）的少數系統能夠帶動一些需求。那麼，Gary，從這三個面向來看，系統、存取、地理位置，下一波流程變革最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. What's been nice here in the last few years is the procedure base has been building. 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.

我認為在短期內，進入核心市場至關重要。近幾年來，這裡令人欣慰的是，手術流程基礎一直在不斷改進。因此，手術量和絕對成長數量都開始呈現健康的兩位數成長率，成長幅度也開始變得相當可觀。確保那些想要使用該系統的外科醫生能夠獲得該系統一直非常重要，這也是我們提高資本獲取模式的靈活性和敏捷性的驅動因素之一。

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. They take some time to develop. And the speed with which they develop is, as I said in the script, paced by additional indications and manufacturing scale. Longer term, I think those things are exciting, but it will take some time to go through.

SP 和 Ion 都是很有趣的平台，我認為隨著時間的推移，它們將擴大單孔或單通道手術中機器人系統和診斷的總可用市場。它們需要一些時間才能發育成熟。正如我在劇本中所說，它們的發展速度取決於更多適應症的出現和生產規模的擴大。從長遠來看，我認為這些事情令人興奮，但這需要一些時間才能實現。

Geography, we've seen real successes but they take time. Japan has been a great success. They're doing a really nice job. 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. So I think those things are important. We have invested in them and we'll continue to do so.

地理學領域，我們已經看到了一些真正的成功，但這需要時間。日本取得了巨大的成功。他們做得非常出色。但要建立市場准入，從合作夥伴網絡到培訓中心，再到支持進一步推廣的臨床證據基礎，所有需要做的事情都是一項艱鉅的任務。所以我認為這些事情很重要。我們已經對他們進行了投資，並將繼續進行投資。

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

簡而言之，這可能不是一個完美的建模答案，但我把這個問題留給你來解決。

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

好的。Gary，或許我還有一個後續問題想問你，我只是想了解一下你對 SP 和 Ion 的推出有何看法，你對 Ion 的評論與第一季相當一致。如果我回顧SP的前四個季度，當然要排除上個季度的製造問題，你認為從系統佈局的角度來看，Ion的推出方式會與SP類似嗎？為什麼在商業化的前四個季度速度會更快？或者更慢？

Yes. I'd anticipate measured in these first 4 quarters of launch as we optimize our systems on our side and also gathering our data. After that, we'll see. I don't think I'd predict it one way or another for you. The indications in Ion, we feel pretty good about to get started. 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.

是的。我預計在產品發布的前四個季度，我們會採取穩健的策略，因為我們需要優化我們自身的系統並收集數據。之後的事，我們再看。我覺得我無法替你預測結果。根據 Ion 的跡象來看，我們感覺一切進展順利，可以開始啟動了。我認為這個市場的規模是真實存在的，所以我覺得一年後我們就能知道我們想以多快的速度推進這件事了。

On SP, it has, I think, great long-term potential. It requires additional clearances, in the U.S. anyway, to keep moving and so we'll do that in sequence.

我認為，SP 具有巨大的長期潛力。至少在美國，要繼續前進還需要額外的許可，所以我們會按順序進行。

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

接下來，我們將連線花旗集團的 Amit Hazan。

Let me start with one on the quarter and just follow after that. So on the quarter, the I&A versus procedures, I&A was up 22%, procedures up 17%. That's the widest gap I can recall in a little while. You touched on it a bit, but maybe just a little bit more color. Is it that new and advanced instruments driving something that's sustainable? Or are there onetime things in there that we should consider?

讓我先從四分之一英里開始，然後接著講下去。因此，本季 I&A 與手術相比，I&A 成長了 22%，手術成長了 17%。這是我最近一段時間印像中最大的差距。你稍微提到了這一點，但或許可以再詳細一些。是這些新型先進儀器推動了永續發展嗎？或者，其中是否有我們應該考慮的一次性事項？

Yes. I think, in general, we have seen increasing revenue, instrument accessory revenue per procedure. Obviously, there's variability by quarter based mostly on the timing of customer orders. But in general, we've been gradually increasing. 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.

是的。我認為，總體而言，我們看到收入，尤其是每次手術的器械配件收入都在增加。顯然，每季的情況都會有所不同，這主要取決於客戶訂單的時間。但總的來說，我們一直在逐步增加。其中最顯著的一點是，先進儀器的使用量不斷增加，從血管密封（我們最近推出的血管密封器 Extend），到縫合（我們去年推出的 60 毫米縫合器，今年在美國將得到更全面的應用）。

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. So I think that's the biggest factor there.

所以我認為這可能是最大的因素，它抵消了其他大部分因素的影響，無論是普通外科手術的增加、疝氣修補術以及其他可能減少器械使用量的手術。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. 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. Can you talk to how much of a priority this is for Intuitive? What you can tell us about the opportunity from a robotic perspective?

還有一個關於使用手術器械進行柔性內視鏡檢查的稍長遠問題。你們未來在機器人領域的主要競爭對手之一，在過去一個月左右的時間裡首次公開談論了這個問題。能談談Intuitive公司對此事的重視程度嗎？從機器人技術的角度來看，您能跟我們談談這個機會嗎？

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

當然。總的來說，正如我們之前所描述的那樣，我們喜歡以平台的方式思考。我的意思是，如果我們能夠建立一些核心技術，從先進的成像技術到高精度技術再到優秀的軟體，那麼我們就可以將這些核心能力進行組合搭配，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. You look at Ion, and Ion has exquisite sensing and a flexible endoscopy or a flexible diagnostic platform. Over time, I think those 2 different sets of ingredients give us a lot of opportunity and optionality. And so I think those things are interesting and they could open for us additional clinical markets over the long term.

所以你看 SP，SP 是一個功能極其強大的系統，它透過一個接入點將 4 個儀器連接在一起。你看看 Ion，Ion 擁有精湛的感測技術和靈活的內視鏡或靈活的診斷平台。隨著時間的推移，我認為這兩組不同的配料給我們提供了許多機會和選擇。所以我認為這些事情很有趣，從長遠來看，它們可能會為我們開闢更多的臨床市場。

That said, product design is subtle, and architectural choices are really, really important. Doing it right, getting a great clinical outcome comes down to sub-millimeter precision and microsecond timings of these electronics.

也就是說，產品設計是微妙的，架構選擇真的非常非常重要。要獲得良好的臨床效果，關鍵在於這些電子元件的亞毫米級精度和微秒計時。

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. So we're not sprinting to go as broad as possible. We really want to make sure we deliver against the commitments we make and for the customers who purchase our products. 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. And so we're careful and thoughtful about it.

因此，我們希望確保我們真正兌現投放市場的產品，從 SP 到 Ion。所以我們並沒有全力以赴地擴大覆蓋面。我們真心希望確保履行我們對客戶所做的承諾，並為購買我們產品的客戶帶來滿意的服務。歷史上有很多公司因為忽視細節而導致開局強勁但最終走向衰落。所以我們對此非常謹慎和周全。

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

下一個問題來自富國銀行的 Larry Biegelsen。

First, could you talk about the strategic and financial implications of the Fiberoptics acquisition? And I had one follow-up.

首先，您能否談談此次光纖收購的策略和財務影響？我還有一個後續問題。

Sure. I'll speak to why we did it. This is a -- Schölly is a strong team and a supply chain partner that has been important for us over many years. Clearly, great imaging manufacturing capability, design capability and processing is a core part of surgery of the future and interventions of the future.

當然。我將解釋我們這樣做的原因。這是——Schölly 是一家實力雄厚的團隊，也是我們多年來重要的供應鏈合作夥伴。顯然，強大的影像製造能力、設計能力和處理能力是未來外科手術和未來介入治療的核心組成部分。

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. It's been a great partnership with that team. We respect them and have been very productive with them. And so that gives us additional optionality and agility going forward in a core part of our business.

隨著我們的發展壯大，我們希望確保能夠繼續投資於該領域，包括設計方面以及製造和生產能力方面。與該團隊的合作一直非常愉快。我們尊重他們，並且與他們合作非常有效率。因此，這為我們在業務核心部分的未來發展提供了更多的選擇和靈活性。

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

關於交易的具體細節和後勤安排，我將交給馬歇爾來解答。

So we entered into an agreement to acquire certain assets and operations from Schölly for a cash consideration of approximately $100 million. The exact amount of the consideration and timing of the closing is subject to certain closing conditions. And so that will occur over the next future periods. And the employees will transfer after each of the closing events occurs.

因此，我們與 Schölly 達成協議，以約 1 億美元的現金對價收購其某些資產和業務。具體的交易金額和交割時間取決於某些交割條件。因此，這種情況將在未來一段時間內發生。員工將在每次交易完成後進行調動。

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?

此外，關於 Ion，我們還沒有聽到您談到美國以外地區的機會或時機。目前的情況如何，尤其是在中國和世界其他地區？

Yes. 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. I don't have a definitive answer for you yet, but it's an active discussion. Clearly, we believe there are end-user opportunities and value, health care value to bring in China and in Europe and in other markets. And we'll take it in sequence. We think this is a powerful set of technologies and a powerful platform. We are still in the early days.

是的。關於中國的具體情況，我們正在與中國監管機構討論如何以最佳方式將產品推向市場以及何時上市。我目前還沒有確切的答案，但我們正在積極討論這個問題。顯然，我們相信在中國、歐洲和其他市場，存在著終端用戶機會和價值，以及醫療保健價值。我們將按順序進行。我們認為這是一套強大的技術組合和一個強大的平台。我們仍處於起步階段。

Our greatest organizational focus right now is on really understanding the technology and the use of it carefully. The early clinical results are great and they are differentiated relative to other products in the market, so far, in these early days. That's really important to us. We will focus there. And as we build strength and experience and scale, then it gives us a lot of opportunities to engage the rest of the world.

我們目前組織工作的重點是真正了解這項技術及其謹慎的使用方法。目前的早期臨床結果非常理想，與市場上其他產品相比，它們具有顯著優勢。這對我們來說非常重要。我們將重點放在那裡。隨著我們實力、經驗和規模的積累，我們將有很多機會與世界其他地區互動。

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

接下來，我們來看看勞倫斯·科伊什和雷蒙德·詹姆斯的合作系列。

This is John Hsu on for Larry. 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? You obviously have a lot of products on your plate this year, but just any high-level color would be greatly appreciated.

這裡是約翰許，替拉里報道。或許我們可以先拋開 2020 年的指導意見，您能否為我們提供一些關於 2019 年投資支出規劃的整體指導原則？今年您顯然有很多產品要推出，但任何一款高品質的色彩都會受到您的熱烈歡迎。

Well, we'll give you a better color when it comes to January about what's going to happen next year. But the things that we're investing in are not short-term investments. They take -- they occur over a long period. And so you should expect that spending will continue to -- continue on those and on other matters going forward. 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. And so I think spending will increase. I won't give you anything more specific than that until we get later in the year.

嗯，到了明年一月，我們會更清楚地告訴大家明年會發生什麼事。但我們投資的並非短期投資。它們需要很長時間才能發生。因此，你應該預料到，未來在這些方面以及其他方面，支出將會繼續增加。隨著公司的發展壯大，當然也需要更多的支援來促進公司的發展，尤其是在銷售方面的人員配備和佣金方面。所以我認為支出將會增加。在今年晚些時候之前，我不會透露更多細節。

Maybe I'll just speak for our philosophy a little bit. We think the opportunity for improved performance and, therefore, opportunities for the business are substantial. 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. Generally speaking, we see more opportunity than we think we can pursue. We wind up saying no to some things that are probably good ideas but we don't know that we can perform them well. And so that's what balances our investment portfolio. And we'll continue to use that philosophy as we plan out 2020 and go forward.

或許我可以稍微談談我們的理念。我們認為，提高業績的機會以及由此帶來的業務發展機會是巨大的。而決定我們投資多少以及何時投資的，是我們認為自己能夠做到卓越的那件事。總的來說，我們看到的機會比我們認為自己能夠抓住的機會還要多。我們最終會拒絕一些可能很好的想法，但我們不知道自己能否把它們做好。這就是我們平衡投資組合的方法。我們將繼續秉持這一理念，制定 2020 年的計劃並展望未來。

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

偉大的。然後，僅從資產負債表來看，你們顯然擁有超過 50 億美元的現金，你們在本季度回購了一些股票，你們還進行了一項收購，以增強成像能力。您能否簡要說明一下您目前是如何考慮資金部署優先事項的？

Yes. The philosophy and approach to capital deployment hasn't really changed. But to remind you, we think about that cash obviously to operate the company. We're making investments in our future. We want cash. The market is volatile in terms of -- the environment is volatile in terms of tariffs and other things going on. We want to make sure we've got proper investments to be able to deal with those. And then, ultimately, we look for opportunities to buy back stock and return cash to shareholders.

是的。資本部署的理念和方法並沒有真正改變。但需要提醒您的是，我們顯然會考慮用這筆現金來維持公司的營運。我們正在為未來進行投資。我們要現金。市場波動性很大，環境也因關稅和其他因素而變得不穩定。我們希望確保有足夠的投資來應對這些問題。最後，我們會尋找機會回購股票，並將現金回饋給股東。

Okay. Great. And then just -- I could sneak one last one in on the tax rate. I think you mentioned the medical device tax coming back in 2020. By my estimate, I think we're coming up with an impact of roughly $30 million. Is that a decent ballpark for how you're thinking about the impact of product gross margin in 2020?

好的。偉大的。然後——我還可以偷偷地在稅率上再加一點。我想你提到過醫療器材稅將於 2020 年恢復徵收。據我估計，我們得出的影響約為 3000 萬美元。你認為這個估算值大致反映了2020年產品毛利率的影響嗎？

Yes. When we're talking about medical device tax we were recognizing in the past, we charge that expense item to cost of sales. So it impacts our gross margin there. We saw an impact around 70 to 100 basis points then. And it's probably a similar kind of impact, should that be reenacted.

是的。當我們談到醫療器材稅時，過去我們通常會將該項費用計入銷售成本。所以這會影響我們那裡的毛利率。當時我們看到受到的影響大約在 70 到 100 個基點之間。如果類似事件重演，可能會產生類似的後果。

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

接下來，我們將介紹 JP McKim 和 Piper Jaffray 的比賽。

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

我想問一個關於此次推廣活動的問題——關於以舊換新和將已安裝的設備升級到第四代。我認為，在上個季度結束後，大約有一半的已安裝設備仍然是老一代產品。那麼，您能否向我們介紹目前的最新進展？那麼，從策略角度來看，讓所有人都先於競爭對手（理論上，第四代產品應該會在明年或之後推出）使用第四代產品對你來說有多重要？

I'll give you the numbers and let Gary talk to the strategy. You heard on this call, it was another 38% of our system sales involved trade-ins this quarter. It's likely to continue to be a significant part of our capital sales in future periods. 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.

我會把數據給你，讓加里來談談策略。你們在這次電話會議上也聽到了，本季我們系統銷售額中又有 38% 是來自以舊換新。未來一段時間內，這很可能仍將是我們資本銷售的重要組成部分。目前，在我們已安裝的 5,270 個系統中，約有 45% 是第三代及以前的系統，其中大部分是系統整合商。

We think it helps. I mean, as to the strategy, we think our customers appreciate it. Many customers now are multisystem owners, or across their integrated delivery network, they have systems at different hospitals where surgeons visit. So having consistency helps them. Gen 4 products have a greater access to advanced instruments and other technologies and are well appreciated.

我們認為這很有幫助。我的意思是，就策略而言，我們認為我們的客戶會欣賞它。現在許多客戶都是多系統所有者，或者在其綜合醫療服務網絡中，他們在外科醫生經常出入的不同醫院都擁有系統。所以保持一致性對他們有幫助。第四代產品更容易獲得先進的儀器和其他技術，因此備受好評。

So in that sense, we think we can lean in and help those organizations go do it. There's a different set of regulatory clearances. In different countries around the world, there are different trade-in economics in each country. 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.

所以從這個意義上講，我們認為我們可以積極參與並幫助這些組織實現目標。還有一套不同的監管審批流程。世界各國的貿易經濟體系各不相同。所以，在進行分析時，你會稍微思考哪個地區、哪個國家可以發展得最快，我們也會考慮這個問題。

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

好的。然後，如果我可以問一個問題——您對疝氣和其他一些疾病的一般外科手術動態的評論是基於大數定律的緩和。但是，轉向減肥手術和一些膽囊切除手術，我的意思是，轉向普通外科手術，這對你們的器械應用服務項目（ASP）有什麼影響？隨著一般外科手術操作的深入，使用的儀器是否也更加先進？

Highly variable. You look at choles, those are lower revenue-per-procedure cases. If you look at bariatrics, it's the other side where a lot of staple pliers are used. So it's a highly variable landscape.

差異很大。你看膽囊炎，這些病例的單次手術收入較低。如果你看看減重手術，你會發現釘鉗的使用頻率很高。所以，這裡的地形變化很大。

Bariatrics is in early innings. And as we start to optimize the instrument kit therein, we're seeing really pull from the market there. We haven't changed our priorities in the U.S. sales force with regard to general surgery. We continue to believe there is opportunity and value in, of course, hernia and colorectal procedures. The bariatric side are really customers coming to us and starting to move that along.

減重手術尚處於起步階段。隨著我們開始優化其中的儀器套件，我們看到了來自市場的真正需求。對於美國銷售團隊而言，我們在一般外科方面的優先事項並沒有改變。我們仍然相信，疝氣和結直腸手術等領域蘊藏著機會和價值。減重手術方面的客戶都是主動來找我們，開始推進手術流程的。

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

接下來，讓我們來看看 Richard Newitter 與 SVB Leerink 的合作。

I have 2 and housekeeping. 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?

我有2個家事服務人員。關於內部事務，您能否量化一下銷售日的不利因素，以及在排除——不是銷售日，而是您之前描述的與假期時間安排等相關的某些不利因素之後，您的業務增長會是多少？

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

然後，Gary，我想知道，關於獲取機器人時間的容量問題，是否存在某些類型的手術組合案例或某些類型的機構，可以主動解決這些容量問題，防患於未然？該機構的程序組合是否存在某種特定特徵，導致容量限制？

Yes. First, on the working day, really minor in the quarter. Not a big thing. 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.

是的。首先，在工作日，這在季度中真的微不足道。沒什麼大不了的。我們在評論中提到，總體而言，手術量可能會受到大約 30 個基點的影響，其中很大一部分是由於復活節的時間安排，美國以外的地區受到的影響更大。

On the capacity side, as we've said in the past, our customer base doesn't -- one size does not fit all. Each institution runs with different operating cadences within their organization. So in some places, we see extremely efficient capital utilization. Really, a focused [actuary] approach where they have very high predictability and get a lot of procedures out of the system. We're delighted to support that. And we help to benchmark that and teach others as they need it.

就產能而言，正如我們過去所說，我們的客戶群並不需要——一種模式並不適合所有人。每個機構的運作節奏都不一樣。因此，在某些地方，我們看到了非常有效率的資本利用。實際上，這是一種專注的[精算師]方法，它具有很高的可預測性，並且可以從系統中省去很多程式。我們很樂意支持這項提議。我們幫助制定基準，並根據其他人的需求進行培訓。

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

我們看到其他一些機構由於各種原因，以較低的資本能力運營，其中一些原因相當合理。有些可能是教學機構，有些可能是接收病情最複雜的合併症患者的機構，這類機構的手術時間難以預測。所以你可以想像，如果一個胸腔外科醫生（負責肺癌手術）和一個普通外科醫生（負責疝氣修補手術）共用一個系統，那麼他們的排班節奏和頻率就大不相同，排班效果自然也就不那麼理想了。

To the extent that we can have those conversations up front and help them optimize, we do. That's something we've been strengthening over time, so I think we can do better than we do today.

只要我們能夠事先與他們進行這些對話並幫助他們進行優化，我們就會這樣做。這是我們一直在努力加強的方面，所以我認為我們還能做得比現在更好。

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

偉大的。如果我再得到一個數據，僅僅是中國在配額範圍內部署的 8 個系統的利用率提升，你是否會驚訝於它能夠如此迅速地轉化為銷量的增長？我一直覺得你需要──培訓機構需要一段時間。如果您能在那裡發表評論就太好了。

I don't know if we were surprised. I'd say we were pleased. That tells you the level of commitment and motivation of those customers to make their investment productive. Last questioner, please.

我不知道我們當時是否感到驚訝。我想說我們很滿意。這說明這些客戶對投資的投入程度和積極性，以及他們希望投資獲得回報的動力。最後一位提問者，請繼續。

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

是的。最後一個問題來自德意志銀行的伊姆龍·紮法爾。

First question is on Japan. 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. Can you just sort of give us some color on what's driving these placements? Is it more sort of greenfield robotics programs that are looking to get into presumably urology? Or is it the established customers wanting to get more into general surgery? 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.

第一個問題是關於日本的。我相信您已經注意到手術量成長有所放緩，但與此同時，我們本季仍然看到一些非常強勁的資本設備購置量。能否簡單介紹一下這些排名背後的驅動因素？是不是更多一些全新的機器人項目，目標是進入泌尿外科領域？或者，是現有客戶希望更多參與一般外科手術？鑑於他們所面臨的經濟誘因較小，我只是想知道——普通外科的成長是否會在未來繼續放緩。

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

它既包括新建的醫療機構，也包括正在為開展去年獲準報銷的新手術而進行準備的醫院。日本目前仍在進行以舊換新的交易。我們的經銷商之前一直以租賃的方式銷售系統整合商，隨著這些租賃合約即將到期，我們看到客戶想要升級到更新的技術。

Okay. 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. Is this something that you're seeing any impact from? Or is there any regulatory preclusion that would limit the ability for companies to do this kind of stuff?

好的。然後，我們從一些第三方的外科醫生那裡聽到一些說法，說醫院可以將即將達到使用壽命終點的器械運送給他們，而這種有限的使用壽命可以透過某種軟體幹預或其他方式來延長。你覺得這件事對你有什麼影響嗎？或是否有任何監管限制，會阻止公司從事這類活動？

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. Calvin, I'll let you respond.

至於——關於這個想法有多好，從事再加工的人員和我們一樣，都受到同樣的監管框架約束，以確保產品質量，並確保產品不會作為摻假產品出售，他們必須承擔起這個責任，而且這是一個複雜的責任。卡爾文，我讓你來回答。

No. Yes. I think that's essentially it.

不。是的。我想基本上就是這樣了。

In terms of materiality of it.

就其物質性而言。

Yes. 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.

是的。看看我們每項手術的收入，我的意思是——我們已經稍微討論過這個問題，我認為我們還沒有看到這方面受到任何影響。

That was our last question. In closing, we believe there is a substantial and durable opportunity to fundamentally improve surgery and acute intervention. 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.

這是我們最後一個問題。最後，我們認為，從根本上改善外科手術和急診幹預存在著巨大而持久的機會。我們的團隊繼續與醫院、醫生和護理團隊密切合作，追求客戶所稱的四重目標：更好、更可預測的患者治療結果，更好的患者體驗，更好的護理團隊體驗，以及最終更低的治療總成本。

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三個要素：首先，深入了解整個護理過程中的人際互動；其次，利用智慧互聯的系統、影像和儀器來增強護理團隊的能力；第三，透過分析洞察來衡量影響，並將這些洞察轉化為行動，從而推動積極的改變。

Thank you for your support on this extraordinary journey. We look forward to talking with you again in 3 months.

感謝您在這段非凡旅程中給予的支持。我們期待三個月後再次與您交談。

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

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