直覺手術 (ISRG) 2019 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Surgical Q3 2019 Earnings Release Call.

女士們，先生們，感謝您的支持，歡迎參加 Intuitive Surgical 2019 年第三季度收益發布電話會議。

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

（操作員說明）作為提醒，本次會議正在錄製中。

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

我現在想將會議轉交給我們的主持人，投資者關係財務高級總監 Calvin Darling 先生。

Please go ahead, sir.

請繼續，先生。

Thank you.

謝謝你。

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

下午好，歡迎參加 Intuitive 第三季度財報電話會議。

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

今天和我在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大不相同。

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 July 22, 2019.

這些風險和不確定性在公司提交給證券交易委員會的文件中進行了詳細描述，包括我們最近於 2019 年 2 月 4 日提交的 10-K 表格和 2019 年 7 月 22 日提交的 10-Q 表格。

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

我們的 SEC 文件可以通過我們的網站或 SEC 的網站找到。

Investors are cautioned not to place undue reliance on such forward-looking statements.

告誡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，本次電話會議將在我們的網站上進行音頻重播，網址為：intuitive.com，位於我們投資者關係頁面下的“最新活動”部分。

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。

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

今天的形式將包括為您提供我們今天早些時候宣布的新聞稿中所述的第三季度業績的亮點，然後是問答環節。

Gary will present the quarter's business and operational highlights.

Gary 將介紹本季度的業務和運營亮點。

Marshall will provide a review of our third quarter financial results.

Marshall 將對我們第三季度的財務業績進行審查。

Then I will discuss procedures and clinical highlights and provide our updated financial outlook for 2019.

然後我將討論程序和臨床亮點，並提供我們對 2019 年的最新財務展望。

And finally, we will host a question-and-answer session.

最後，我們將舉辦問答環節。

With that, I'll turn it over to Gary.

有了這個，我會把它交給加里。

Thank you for joining us today.

感謝您今天加入我們。

Intuitive has been enabling customers in their delivery of high-quality minimally invasive surgery for 20 years.

20 年來，Intuitive 一直在幫助客戶提供高質量的微創手術。

And we believe the adoption of robotics and computer-aided interventions is early relative to its long-term potential.

我們相信，機器人技術和計算機輔助干預的採用相對於其長期潛力而言還處於早期階段。

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.

我們通過他們對四重目標產生積極影響的能力來衡量我們的努力：更好的結果、更好的患者體驗、更好的護理團隊體驗和更低的每次患者治療總成本。

This third quarter of 2019 was another solid one for Intuitive in pursuit of these aims.

2019 年第三季度是 Intuitive 追求這些目標的又一個堅實的一年。

Our performance in the quarter is a reflection of our progress with procedures and system placements showing continued strength.

我們在本季度的表現反映了我們在程序和系統安置方面取得的進展，顯示出持續的實力。

For the quarter, global procedure growth was nearly 20%, aided by an increase of approximately a surgery day relative to Q3 of 2018.

本季度，全球手術增長近 20%，這得益於相對於 2018 年第三季度增加了約一個手術日。

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

增長再次集中在美國的普外科，德國、韓國和日本對全球增長率的貢獻是積極的。

China procedure growth continues to be limited by installed base growth.

中國程序的增長繼續受到安裝基數增長的限制。

Total procedure growth in China is responding positively considering the release of system quota and subsequent placements.

考慮到系統配額的釋放和後續的安置，中國的總程序增長正在積極響應。

In the United States, year-over-year procedure growth for the quarter was 18%.

在美國，該季度的程序同比增長為 18%。

General surgery again accounted for the largest increase year-over-year, accompanied by solid growth in urology and stable growth in gynecology.

普外科再次成為同比增幅最大的手術，伴隨泌尿科的穩健增長和婦科的穩定增長。

We also saw strength in bariatrics and cholecystectomy.

我們還看到了減肥和膽囊切除術的優勢。

Hernia repair and cholecystectomy growth rates were solid in the quarter.

本季度疝氣修復和膽囊切除術的增長率穩定。

Improvements in system utilization by customers and alternative capital placement models are having a positive impact on our business.

客戶系統利用率的提高和替代資本配置模式對我們的業務產生了積極影響。

Our U.S. sales force productivity improved in the quarter as our new team members gained experience.

由於我們的新團隊成員獲得了經驗，我們的美國銷售團隊的生產力在本季度有所提高。

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局過程動態。

With regard to our installed base, placement of new systems in the quarter was solid with growth in total placements rising 19% from Q3 of 2018.

就我們的安裝基礎而言，本季度新系統的安裝量穩定，總安裝量比 2018 年第三季度增長了 19%。

Net of trade-ins and retirements, our da Vinci installed base grew 12% over Q3 2018 to approximately 5,406.

扣除以舊換新和退役後，我們的達芬奇安裝基數比 2018 年第三季度增長 12%，達到約 5,406。

The mix of system placements this quarter moved towards our flagship Xi Systems, and trade-ins were healthy.

本季度的系統佈局組合轉向了我們的旗艦 Xi Systems，並且以舊換新是健康的。

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

本季度經營租賃的系統比例為 33%，上一季度為 32%。

As a reminder, total placements and the percentage of systems placed under lease or usage-based arrangements can vary substantially quarter-to-quarter.

提醒一下，根據租賃或基於使用的安排放置的系統總數和百分比可能每季度都有很大差異。

Turning to expenses.

轉向開支。

We are investing in building our capability in international regions, launching new platforms, strengthening our computational capabilities and executing projects that support future sale and provide leverage opportunities as we grow.

我們正在投資建設我們在國際地區的能力，推出新平台，加強我們的計算能力，並執行支持未來銷售的項目，並在我們成長的過程中提供槓桿機會。

Our spending is on track with our expectations.

我們的支出符合我們的預期。

It is supported by solid procedure growth, capital placements and product cost reductions.

它得到了穩健的程序增長、資本配置和產品成本降低的支持。

Financial highlights for our third quarter results were as follows: Procedures grew nearly 20% over the third quarter of last year.

我們第三季度業績的財務亮點如下： 程序比去年第三季度增長了近 20%。

We placed 275 da Vinci Surgical Systems, up from 231 in the third quarter of 2018.

我們放置了 275 台達芬奇手術系統，高於 2018 年第三季度的 231 台。

Our installed base grew 12% from a year ago.

我們的安裝基數比一年前增長了 12%。

Revenue for the quarter was approximately $1.1 billion, up 23%.

本季度收入約為 11 億美元，增長 23%。

Pro forma gross profit margin was 72% compared to 71.5% in the third quarter last year.

備考毛利率為 72%，而去年第三季度為 71.5%。

Instrument and accessory revenue increased to $606 million, up 25%.

儀器和配件收入增至 6.06 億美元，增長 25%。

Total recurring revenue in the quarter was $817 million, growing 24% over Q3 of 2018 and representing 72% of total revenue.

本季度的總經常性收入為 8.17 億美元，比 2018 年第三季度增長 24%，佔總收入的 72%。

We generated a pro forma operating profit of $462 million in the quarter, up 18% from the third quarter of last year.

我們在本季度產生了 4.62 億美元的備考營業利潤，比去年第三季度增長了 18%。

Pro forma net income was $409 million, up 21%.

備考淨收入為 4.09 億美元，增長 21%。

And we repurchased 70 million in shares at an average price of $493 per share.

我們以每股 493 美元的平均價格回購了 7000 萬股股票。

Turning to our investments in products.

轉向我們對產品的投資。

I'll start first with systems.

我將首先從系統開始。

We are in our Phase 1 launch of da Vinci SP as we work to expand clinical clearances and build SP products at scale.

我們正處於 da Vinci SP 的第一階段推出，因為我們正在努力擴大臨床許可並大規模生產 SP 產品。

In the quarter, we proactively held shipments on SP endoscopes and limited new system installations for a limited time as we investigated a robustness concern on the SP endoscope.

在本季度，由於我們調查了 SP 內窺鏡的穩健性問題，我們在有限的時間內主動保留了 SP 內窺鏡的出貨量並限制了新系統的安裝。

We resumed shipping endoscopes and systems in the quarter.

我們在本季度恢復了內窺鏡和系統的運輸。

Given the slowdown on endoscopes, we installed 4 systems to bring our installed base with SP to 38.

鑑於內窺鏡速度放緩，我們安裝了 4 個系統，使我們的 SP 安裝基數達到 38 個。

Customer response and early clinical results using SP remain encouraging.

使用 SP 的客戶反應和早期臨床結果仍然令人鼓舞。

In addition, utilization rates for SP in Korea, where clinical indications are the broadest, are at Xi levels already, a testament to surgeons' engagement and our teams' skill and design for usability.

此外，在臨床適應症最廣泛的韓國，SP 的使用率已經達到 Xi 水平，這證明了外科醫生的參與以及我們團隊的技能和可用性設計。

With regard to additional indications for SP, we have been in discussion with FDA regarding data requirements for a colorectal indication.

關於 SP 的其他適應症，我們一直在與 FDA 討論結直腸適應症的數據要求。

We expect this to require an IDE trial that includes follow-up analysis.

我們預計這需要包含後續分析的 IDE 試用版。

This implies we do not expect a third indication of SP in the U.S. in 2020.

這意味著我們預計 2020 年美國不會出現第三個 SP 跡象。

While we had planned for a smoother launch of SP and product availability and new indication time lines, our teams are focused on building at scale and satisfying regulatory requirements for additional indications.

雖然我們計劃更順利地推出 SP 和產品可用性以及新的適應症時間表，但我們的團隊專注於大規模建設並滿足對其他適應症的監管要求。

Interest in SP is healthy and clinical outcomes are encouraging, forming the basis of our belief in the long-term potential of the platform to improve care.

對 SP 的興趣是健康的，臨床結果令人鼓舞，這是我們相信該平台改善護理的長期潛力的基礎。

The combination of additional indications for SP and our readiness for deployment at larger scale pace the speed of our SP commercial expansion.

SP 的其他跡象和我們準備進行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 and timely biopsies to support definitive early diagnosis of suspicious lesions.

在靈活的診斷中，我們的 Ion 平台專注於對準確和及時的活檢的需求，以支持對可疑病變的明確早期診斷。

Since our 510(k) clearance in Q1 of this year, we initiated our first phase launch focused on clinical use, customer feedback and production optimization.

自今年第一季度獲得 510(k) 批准以來，我們啟動了第一階段的啟動，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.

已清除系統上的第一個案例是在第一季度末執行的。

There are now 9 systems in the field performing cases with the total case experience in the hundreds.

目前有9個系統在現場執行案例，總案例經驗達數百個。

To date, the rollout is meeting our expectations with a mix of clinical trial sites and commercial sites.

迄今為止，推出的臨床試驗場所和商業場所都滿足了我們的期望。

User feedback during this initial launch period has been strong.

在此初始發布期間，用戶反饋非常強烈。

For instruments and accessories, our team moved to full United States launch of our 45-millimeter SureForm stapler and obtained clearance for it in Japan and Korea in the quarter.

對於儀器和配件，我們的團隊開始在美國全面推出 45 毫米 SureForm 訂書機，並於本季度在日本和韓國獲得許可。

We also obtained 510(k) clearance for new a Curved-Tip SureForm 45-millimeter stapler and a new Gray reload designed to staple thin structures.

我們還為新的 Curved-Tip SureForm 45 毫米訂書機和新的 Grey reload 獲得了 510(k) 間隙，該訂書機設計用於縫合薄結構。

Recall that surgical stapling is a family of products that help surgeons in a range of procedures covering parts of the body from the rectum to the thoracic cavity.

回想一下，外科吻合器是一系列產品，可幫助外科醫生進行一系列手術，涵蓋從直腸到胸腔的身體部位。

Robotically held staplers are a sophisticated technology, and our team is doing an excellent job filling out the product portfolio.

機器人手持訂書機是一項複雜的技術，我們的團隊在完善產品組合方面做得非常出色。

Our experience has shown that procedure adoption occurs when the holistic needs of the care team are met, when the right system and imaging products come together with the right instruments and accessories.

我們的經驗表明，當護理團隊的整體需求得到滿足、正確的系統和成像產品與正確的儀器和附件相結合時，就會採用程序。

Stapling is another example of this synergy with surgeon adoption of generation 4 da Vinci Systems with SureForm staplers gaining momentum.

縫合是這種協同作用的另一個例子，外科醫生採用第 4 代達芬奇系統和 SureForm 縫合器獲得動力。

Turning to imaging and analytics.

轉向成像和分析。

We are working on computing and real-time cloud technologies to allow for tests from telementoring to augmented reality.

我們正在研究計算和實時雲技術，以允許從遠程指導到增強現實的測試。

We now have over 20 active telementoring sites that together have supported hundreds of cloud-enabled, real-time surgery sessions as we progress in building our real-time cloud capabilities.

隨著我們在構建實時雲功能方面取得進展，我們現在擁有 20 多個活躍的遠程指導站點，它們共同支持了數百個支持雲的實時手術會話。

Feedback on the utility of these sites for case observations and mentoring has been supported.

對這些網站在案例觀察和指導方面的效用的反饋得到了支持。

In augmented reality, we are working through logistics and installation of our first IRIS accounts to gather customer and clinical feedback.

在增強現實中，我們正在通過物流和安裝我們的第一個 IRIS 帳戶來收集客戶和臨床反饋。

We expect first clinical cases on the IRIS System in the next few months.

我們預計未來幾個月將在 IRIS 系統上出現第一批臨床病例。

Lastly, our surgical simulation products have become widely adopted in the installed base with more than 3,200 da Vinci simulators in the field.

最後，我們的手術模擬產品已被安裝基地廣泛採用，現場有超過 3,200 台達芬奇模擬器。

Before turning the time over to Marshall, let's step back and consider Intuitive's evolution over the past few years.

在將時間交給 Marshall 之前，讓我們退一步思考一下 Intuitive 在過去幾年中的發展。

Over this period, general surgeons have increased their adoption of our offerings, underpinned by improvements in the quadruple aim and procedures they perform, from colon and rectal procedures to hernia repair, cholecystectomy and bariatric surgery.

在此期間，普通外科醫生增加了他們對我們產品的採用，這得益於他們執行的四重目標和程序的改進，從結腸和直腸手術到疝氣修復、膽囊切除術和減肥手術。

General surgery procedures span a broad range of complexity and economics.

普通外科手術涉及廣泛的複雜性和經濟性。

At the same time, we've extended our reach into key countries to support the adoption of robotic-assisted surgery into their health care environments.

同時，我們已將我們的影響力擴展到主要國家，以支持將機器人輔助手術應用到他們的醫療保健環境中。

We have flexed our company to better serve these customers with the launch of new systems, new instruments and updates to our software, along with changes to our sales and support models and pricing structures.

我們通過推出新系統、新儀器和更新我們的軟件，以及改變我們的銷售和支持模式以及定價結構，讓我們的公司更好地為這些客戶服務。

Given the large global opportunity to pursue the quadruple aim, we believe the next few years for the company will be dynamic.

鑑於追求四重目標的巨大全球機遇，我們相信公司未來幾年將充滿活力。

We will guide the company to meet our customers' clinical and economic needs across this wide range of procedures and geographies.

我們將指導公司在廣泛的程序和地域範圍內滿足客戶的臨床和經濟需求。

Doing so will involve continued investment in innovation for both technology and economic models, and we see a path to do both.

這樣做將涉及對技術和經濟模式創新的持續投資，我們看到了兩者兼顧的道路。

For the balance of the year, our focus remains in completing the task we set for ourselves.

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。

First, supporting adoption of da Vinci in general surgery and in key procedures in global markets; second, launching our da Vinci -- I'm sorry, our SP and Ion platforms; third, driving intelligent surgery innovation; and finally, supporting additional clinical and economic validation and our focused procedures in countries.

第一，支持達芬奇在普外科和全球市場關鍵手術中的應用；第二，推出我們的達芬奇——對不起，我們的 SP 和 Ion 平台；三是推動智能手術創新；最後，支持額外的臨床和經濟驗證以及我們在國家/地區的重點程序。

I'll now turn the call over to Marshall, who'll 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 will describe the highlights of our performance on a non-GAAP or pro forma basis.

我將在非公認會計原則或備考基礎上描述我們表現的亮點。

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

稍後我還將在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.

我們的備考結果和公認會計原則結果之間的對賬發佈在我們的網站上。

Key business metrics for the third quarter are as follows: Third quarter 2019 procedures increased nearly 20% compared with the third quarter of 2018 and increased approximately 2% compared with last quarter.

第三季度的主要業務指標如下： 2019 年第三季度程序較 2018 年第三季度增加近 20%，與上一季度相比增加約 2%。

There was one more operating day in the third quarter of 2019 compared with the third quarter of 2018.

與 2018 年第三季度相比，2019 年第三季度的營業日增加了一天。

Excluding the impact of the extra operating day, we would have been in line with our full year average growth.

排除額外營業日的影響，我們將與全年平均增長保持一致。

Procedure growth continues to be driven by general surgery in the U.S. and urology worldwide.

手術增長繼續受到美國普外科和全球泌尿外科的推動。

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

Calvin 將在本次電話會議稍後審查程序增長的詳細信息。

Third quarter system placements of 275 systems increased 19% compared with 231 systems last year and increased 1% compared with 273 systems last quarter.

與去年的 231 個系統相比，第三季度 275 個系統的系統佈局增加了 19%，與上一季度的 273 個系統相比增加了 1%。

We expanded our installed base of da Vinci systems by 12% to approximately 5,406 systems.

我們將達芬奇系統的安裝基礎擴大了 12%，達到約 5,406 個系統。

The growth rate compares with 13% in both the last quarter and last year.

與上一季度和去年同期相比，增長率均為 13%。

Utilization of clinical systems in the field, measured by procedures per system, grew approximately 6%, which is higher than the 4% growth last quarter and below the 7% growth last year.

以每個系統的程序衡量，該領域臨床系統的利用率增長了約 6%，高於上一季度的 4%，低於去年的 7%。

Our revenue overview is as follows: Third quarter 2019 revenue was $1.1 billion, an increase of 23% compared with $921 million for the third quarter of 2018 and an increase of 3% compared with $1.1 billion last quarter.

我們的收入概覽如下： 2019 年第三季度收入為 11 億美元，與 2018 年第三季度的 9.21 億美元相比增長 23%，與上一季度的 11 億美元相比增長 3%。

Instrument and accessory revenue of $606 million increased 25% compared with last year, which is higher than procedure growth primarily reflecting customer buying patterns and increased usage of our advanced instruments.

儀器和配件收入為 6.06 億美元，與去年相比增長了 25%，高於主要反映客戶購買模式和我們先進儀器使用量增加的程序增長。

Instrument and accessory revenue realized per procedure was approximately $1,980, an increase of 4% compared with the third quarter of 2018 and an increase of 3% compared with last quarter.

每個程序實現的儀器和附件收入約為 1,980 美元，與 2018 年第三季度相比增長 4%，與上一季度相比增長 3%。

Systems revenue for the third quarter of 2019 was $339 million, an increase of 23% compared with the third quarter of 2018 and a decrease of 2% compared with last quarter.

2019年第三季度系統收入為3.39億美元，比2018年第三季度增長23%，比上一季度下降2%。

Relative to the third quarter of 2018, systems revenue reflected higher system placements, higher ASPs and higher lease-related revenues.

相對於 2018 年第三季度，系統收入反映了更高的系統佈局、更高的 ASP 和更高的租賃相關收入。

We completed 92 operating lease transactions, representing 33% of total placements compared with 58 or 25% of total placements in the third quarter of 2018, and 88 or 32% of total placements last quarter.

我們完成了 92 筆經營租賃交易，佔總配售的 33%，而 2018 年第三季度為 58 筆或占總配售的 25%，上一季度為 88 筆或總配售的 32%。

As of September 30, we have 560 operating leases outstanding and realized approximately $27 million of revenue related to these arrangements in the quarter compared with $14 million last year and $25 million last quarter.

截至 9 月 30 日，我們有 560 份未完成的經營租賃，本季度與這些安排相關的收入約為 2700 萬美元，而去年同期為 1400 萬美元，上一季度為 2500 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 systems placed in the quarter dampen 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，而本季度放置的操作系統數量的增加抑制了它們所在季度的短期收入增長。

Operating leases include usage-based financings that we provide to certain hospitals with advanced robotics experience.

經營租賃包括我們向某些具有先進機器人技術經驗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，我們的租賃融資替代方案符合客戶目標，並促進了更快的市場採用。

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

相對於在租賃期內購買的系統，我們賺取了反映金錢時間價值的少量溢價，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的使用水平的風險。

The proportion of operating lease and usage-based arrangements will likely increase long term and will vary quarter-to-quarter.

經營租賃和基於使用的安排的比例可能會長期增加，並且會因季度而異。

We recognized $20 million of lease buyout revenue in the third quarter compared with $27 million last quarter and $8 million last year.

我們在第三季度確認了 2000 萬美元的租賃收購收入，而上一季度為 2700 萬美元，去年為 800 萬美元。

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

每個季度的租賃收購收入差異很大，而且很可能會繼續如此。

116 or 42% of current quarter system placements involve trade-ins, reflecting customer desire to access or standardize in our fourth generation technology and contributing to an Xi installed base growth of 41% year-over-year.

本季度 116 或 42% 的系統佈局涉及以舊換新，這反映了客戶希望訪問或標準化我們的第四代技術，並促成 Xi 安裝基數同比增長 41%。

This is an increase compared with 65 or 28% of system placements in the third quarter 2018 and 103 or 38% last quarter.

與 2018 年第三季度 65 或 28% 的系統佈局和上一季度的 103 或 38% 相比，這一數字有所增加。

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

以舊換新活動可能會波動且難以預測。

However, prior product trade-in -- however, given prior product trade-in cycles, we expect the proportion of installed base traded in, in future quarters to decrease over time.

然而，之前的產品以舊換新——然而，鑑於之前的產品以舊換新周期，我們預計未來幾個季度以舊換新的安裝基數比例將隨著時間的推移而減少。

79% of the systems placed in the quarter were da Vinci Xis and 17% were da Vinci X Systems compared with 74% da Vinci Xis and 20% da Vinci Xs last quarter.

本季度放置的系統中有 79% 是 da Vinci Xis，17% 是 da Vinci X Systems，而上一季度為 74% da Vinci Xis 和 20% da Vinci Xs。

We sold 3 Ion systems in the quarter.

我們在本季度售出了 3 個 Ion 系統。

Ion system placements are excluded from our overall systems count and will be reported separately.

離子系統佈置不包括在我們的整體系統計數中，將單獨報告。

Procedures and other information associated with Ion are excluded from our prepared remarks and will be reported separately when they become more substantive.

與 Ion 相關的程序和其他信息不包括在我們準備好的評論中，當它們變得更加實質性時將單獨報告。

4 of the systems placed in the third quarter were SP systems.

第三季度放置的系統中有 4 個是 SP 系統。

Third quarter SP placements were impacted by our decision to hold shipments of endoscopes as Gary outlined.

正如 Gary 所述，我們決定保留內窺鏡的出貨量，影響了第三季度的 SP 安置。

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

我們將繼續衡量我們推出的 SP 手術系統，將系統交到經驗豐富的達芬奇用戶手中，同時我們優化供應鏈中的培訓途徑。

Globally, our average selling price, which excludes the impact of operating lease revenue and lease buyouts, was approximately $1.57 million compared with $1.45 million last quarter and $1.54 million last quarter.

在全球範圍內，我們的平均售價（不包括經營租賃收入和租賃收購的影響）約為 157 萬美元，上一季度為 145 萬美元，上一季度為 154 萬美元。

Similar to the second quarter, our mix of systems and customers in the third quarter was very favorable relative to prior periods.

與第二季度類似，我們在第三季度的系統和客戶組合相對於前期非常有利。

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

我們對 Xi 與 X 和 Si 系統進行了高度混合。

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

我們的分銷商與直銷的比例也很低。

Finally, in the third quarter of 2019, we had fewer multisystem arrangements where we provided volume discounts.

最後，在 2019 年第三季度，我們提供批量折扣的多系統安排減少了。

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

系統、客戶的組合和安排的規模將隨時間而變化。

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

我們預計系統平均售價將在今年前兩個季度的中點範圍內。

Outside of U.S., results were as follows: OUS procedures grew approximately 23% compared with the third quarter of 2018 and increased 1% compared with last quarter.

在美國以外的地區，結果如下：與 2018 年第三季度相比，OUS 程序增長了約 23%，與上一季度相比增長了 1%。

Third quarter revenue outside of the U.S. of $332 million increased 36% compared with the third quarter of 2018 and increased 6% compared with last quarter.

第三季度美國以外的收入為 3.32 億美元，與 2018 年第三季度相比增長了 36%，與上一季度相比增長了 6%。

The increase compared with the prior year reflects increased system instruments and accessories revenue of $37 million or a 32% growth and increased system revenue of $40 million or 50% growth.

與上一年相比的增長反映了系統儀器和配件收入增加了 3700 萬美元或增長了 32%，以及系統收入增加了 4000 萬美元或增長了 50%。

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

儀器和配件收入的增長主要受程序增長和客戶購買模式的推動。

The increase in systems revenue primarily is a result of the increased ASPs reflecting favorable geographic and product mix.

系統收入的增加主要是由於 ASP 的增加反映了有利的地理和產品組合。

Outside of the U.S., we placed 90 systems in the third quarter compared with 75 in the third quarter of 2018 and 80 systems last quarter.

在美國以外，我們在第三季度放置了 90 個系統，而 2018 年第三季度為 75 個，上一季度為 80 個。

Current quarter system placements included 36 into Europe, 27 into Japan and 10 into China.

目前的季度系統安置包括歐洲 36 個、日本 27 個和中國 10 個。

59% of the systems placed in the quarter were da Vinci Xis and 33% were da Vinci X Systems compared with 43% da Vinci Xis and 48% da Vinci Xs last year.

本季度放置的系統中有 59% 是 da Vinci Xis，33% 是 da Vinci X Systems，而去年這一比例為 43% da Vinci Xis 和 48% da Vinci Xs。

21 of the system placements in the quarter were operating leases compared with 9 last year and 12 last quarter.

本季度的系統安置中有 21 次是經營租賃，而去年為 9 次，上季度為 12 次。

Placements outside of the U.S. will continue to vary as some of the OUS markets are in early stages of adoption, some markets are highly seasonal, reflecting budget cycles or vacation patterns.

由於一些 OUS 市場處於採用的早期階段，一些市場具有高度季節性，反映了預算週期或假期模式，因此美國以外的安置將繼續變化。

And some -- and sales into some markets are constrained by government limitations.

還有一些——以及一些市場的銷售受到政府限制的限制。

Moving on to gross margin and operating expenses.

繼續討論毛利率和運營費用。

Pro forma gross margin for the third quarter was 72% compared with 71.5% for the third quarter of 2018 and 71.3% last quarter.

第三季度的備考毛利率為 72%，而 2018 年第三季度為 71.5%，上一季度為 71.3%。

The increase compared with the third quarter of 2018 and last quarter primarily reflects higher system ASPs and product cost reductions.

與 2018 年第三季度和上一季度相比的增長主要反映了更高的系統 ASP 和產品成本的降低。

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

未來利潤率將根據我們的新產品組合、系統和儀器及配件收入組合、系統平均售價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。

We expect the return of the medical device tax in 2020, which will reduce our gross margin by approximately 70 to 100 basis points.

我們預計醫療器械稅將在 2020 年回歸，這將使我們的毛利率降低約 70 至 100 個基點。

Pro forma operating expenses increased 31% compared with the third quarter of 2018 and increased 7% compared with last quarter.

與 2018 年第三季度相比，備考運營費用增加了 31%，與上一季度相比增加了 7%。

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，包括按增加的數量級增加與我們的 OUS 市場擴展相關的成本、信息學能力支出和基礎設施投資以擴大業務規模。

We believe we have a unique opportunity to expand the benefits of minimally invasive surgery around the world and have been -- and will continue to invest in the business accordingly.

我們相信我們有一個獨特的機會來擴大全球微創手術的好處，並且已經 - 並將繼續相應地投資於該業務。

Our pro forma effective tax rate for the third quarter was 16.8%, reflecting $8 million of reserves -- of reserve releases primarily associated with the expiration of statutes of limitation in certain jurisdictions.

我們第三季度的備考有效稅率為 16.8%，反映了 800 萬美元的準備金——主要與某些司法管轄區的訴訟時效到期相關的準備金釋放。

While we expect our tax rate to be between 19% and 20% in the fourth quarter, our actual tax rate 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.

雖然我們預計第四季度的稅率將在 19% 至 20% 之間，但我們的實際稅率將隨著美國和美國收入組合的變化、地方當局的稅收變化以及一次性項目的影響而波動.

Our third quarter 2019 pro forma net income was $409 million or $3.43 per share compared with $337 million or $2.83 per share for the third quarter of 2018 and $388 million or $3.25 per share for last quarter.

我們 2019 年第三季度的備考淨收入為 4.09 億美元或每股 3.43 美元，而 2018 年第三季度為 3.37 億美元或每股 2.83 美元，上一季度為 3.88 億美元或每股 3.25 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 $397 million or $3.33 per share for the third quarter of 2019 compared with GAAP net income of $293 million or $2.45 per share for the third quarter of 2018 and GAAP net income of $318 million or $2.67 per share for last quarter.

2019 年第三季度 GAAP 淨收入為 3.97 億美元或每股 3.33 美元，而 2018 年第三季度 GAAP 淨收入為 2.93 億美元或每股 2.45 美元，上一季度 GAAP 淨收入為 3.18 億美元或每股 2.67 美元。

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、員工股權和知識產權費用、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 $5.4 billion compared with $5.1 billion at June 30, 2019.

截至本季度末，我們的現金和投資為 54 億美元，而 2019 年 6 月 30 日為 51 億美元。

The cash generated from operations was offset by stock repurchases, acquisition of Schölly Fiberoptic's 3D robotic endoscope business and investments in working capital and infrastructure during the quarter.

運營產生的現金被股票回購、收購 Schölly Fiberoptic 的 3D 機器人內窺鏡業務以及本季度對營運資金和基礎設施的投資所抵消。

We repurchased approximately 141,000 shares for $70 million at an average price of $493 per share.

我們以每股 493 美元的平均價格以 7000 萬美元的價格回購了大約 141,000 股股票。

In the quarter, we grew inventory by approximately 67 million to 580 million, representing approximately 150 days of inventory.

本季度，我們的庫存增加了大約 6700 萬至 5.8 億，相當於大約 150 天的庫存。

We continue to build inventory to address the growth of the business as well as mitigate risks of disruption that could arise from trade supply or other matters.

我們將繼續建立庫存以應對業務增長並降低貿易供應或其他問題可能引起的中斷風險。

In summary, our results for the quarter were solid.

總而言之，我們本季度的業績是穩健的。

While we will provide you with detailed 2020 guidance in January, I want to highlight certain business dynamics that may impact your models.

雖然我們將在 1 月份為您提供詳細的 2020 年指導，但我想強調某些可能影響您的模型的業務動態。

As I noted earlier, we will continue to invest in the business, growing operating expenses as we see it, the substantial opportunity to expand the benefits of minimally invasive surgery.

正如我之前提到的，我們將繼續投資該業務，增加我們所看到的運營費用，這是擴大微創手術收益的重大機會。

We also believe the percentage of leasing and alternative financing arrangements will increase over time.

我們還認為，租賃和替代融資安排的百分比將隨著時間的推移而增加。

In addition, we believe the number of trade-in transactions will level off in the short term and then decline over time.

此外，我們認為以舊換新交易的數量將在短期內趨於平穩，然後隨著時間的推移而下降。

It is also likely we will see increased price negotiations and elongated negotiation time lines as competition get closer to launching new products.

隨著競爭越來越接近推出新產品，我們也可能會看到更多的價格談判和延長的談判時間線。

These dynamics could result in profit fluctuation.

這些動態可能導致利潤波動。

However, we will continue to manage the business for the long term as we believe that the fundamentals of the business are strong.

然而，我們將繼續長期管理業務，因為我們相信業務的基本面強勁。

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 Calvin，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 third quarter procedure growth was nearly 20% compared to 20% during the third quarter of 2018 and 17% last quarter.

與 2018 年第三季度的 20% 和上一季度的 17% 相比，我們第三季度的整體程序增長接近 20%。

Our Q3 procedure growth was driven by 18% growth in U.S. procedures and 23% growth in OUS markets.

我們的第三季度程序增長受到美國程序增長 18% 和 OUS 市場增長 23% 的推動。

Third quarter 2019 procedure growth benefited from 1 additional working day compared to last year.

與去年相比，2019 年第三季度的程序增長受益於增加了 1 個工作日。

Through 3 quarters, working days are now roughly consistent between this year and last.

通過 3 個季度，今年和去年的工作日大致保持一致。

Our Q3 2019 year-to-date procedure growth was 18%, equal to 18% growth through 3 quarters of last year.

我們 2019 年第三季度迄今的程序增長率為 18%，相當於去年三個季度的 18%。

In the U.S., Q3 procedure growth was largely driven by continued strength in general surgery, with substantive contributions from gynecologic and urologic procedures.

在美國，第三季度手術增長主要是由普通手術的持續強勁推動的，婦科和泌尿科手術也有實質性貢獻。

In U.S. general surgery, third quarter growth in leading procedures, hernia repair and colorectal, remains solid at days adjusted growth rates consistent with last quarter.

在美國普外科，第三季度主要手術、疝修補和結直腸手術的增長保持穩定，調整後的天數增長率與上一季度一致。

Cholecystectomy growth continued to accelerate in the third quarter and now represents a significant driver of incremental procedures.

膽囊切除術的增長在第三季度繼續加速，現在是增量手術的重要推動力。

While we remain cautious regarding the size of the addressable chole market for robotics, our recent data is encouraging.

雖然我們對機器人的潛在市場規模保持謹慎，但我們最近的數據令人鼓舞。

Growth in cholecystectomy represents a healthy mix of new and continuing surgeons, shows very little churn and sees increasing Firefly utilization.

膽囊切除術的增長代表了新外科醫生和繼續外科醫生的健康組合，顯示出很少的流失並且看到螢火蟲的利用率增加。

Bariatric procedures, while still not an area of broad emphasis, again accelerated modestly in Q3.

減肥手術雖然仍然不是一個廣泛強調的領域，但在第三季度再次小幅加速。

Q3 U.S. gynecology procedure growth was largely consistent with the first half of 2019 and last year in the mid-single-digit range, with hysterectomy for cancer volumes accelerating modestly in the quarter.

第三季度美國婦科手術的增長與 2019 年上半年和去年的中個位數範圍基本一致，該季度因癌症而進行的子宮切除術數量適度增加。

We had surprisingly strong growth in U.S. urology and dVP procedures in the third quarter.

第三季度，我們在美國泌尿外科和 dVP 程序方面出現了驚人的強勁增長。

dVP growth was just over 10% for the quarter after having moderated to low single digits in Q2.

在第二季度放緩至低個位數之後，該季度的 dVP 增長率剛剛超過 10%。

As a highly penetrated mature procedure category, we believe that our U.S. prostatectomy volume should track to the broader prostate surgery market.

作為一個滲透率很高的成熟手術類別，我們認為我們的美國前列腺切除術數量應該跟上更廣泛的前列腺手術市場。

Third quarter OUS procedure volume grew approximately 23% compared with 23% for the third quarter of 2018 and 20% last quarter.

第三季度 OUS 手術量增長了約 23%，而 2018 年第三季度和上一季度分別增長了 23% 和 20%。

Third 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 年第三季度 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。

In China, as in Q2, procedure growth accelerated modestly as new systems installed under the latest system quota began to provide additional capacity for incremental growth.

在中國，與第二季度一樣，隨著在最新系統配額下安裝的新系統開始為增量增長提供額外容量，程序增長溫和加速。

The Q3 China procedure growth rate remained below the overall OUS metric.

第三季度中國程序增長率仍低於整體 OUS 指標。

In Japan, procedure growth was again strong at roughly 40%, reflecting growth in procedures granted reimbursement status in April 2018 and continued later-stage growth in urology procedures.

在日本，手術增長再次強勁，約為 40%，這反映了 2018 年 4 月獲得報銷資格的手術的增長以及泌尿外科手術的後期持續增長。

Our emphasis in Japan remains on surgeon and team training and building proctoring networks.

我們在日本的重點仍然是外科醫生和團隊培訓以及建立監考網絡。

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

歐洲的整體程序增長與之前的時期基本一致，但因國家/地區而異。

German results were particularly strong, while results in the U.K. were below our plans.

德國的業績特別強勁，而英國的業績則低於我們的計劃。

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 certain recently published studies that we deem to be notable.

在這些電話會議的每個季度，我們都會重點介紹我們認為值得注意的某些最近發表的研究。

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

但是，為了更全面地了解證據主體，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。

Adoption of Intuitive systems for surgery is fundamentally based upon the clinical utility they provide for surgeons and positive procedure outcomes they enable for patients.

採用 Intuitive 手術系統基本上是基於它們為外科醫生提供的臨床效用以及它們為患者帶來的積極手術結果。

We are now in the early stages of introducing the da Vinci SP to the market, and over 50 clinical articles have been published involving the SP thus far.

我們現在正處於將達芬奇 SP 推向市場的早期階段，到目前為止，已經發表了 50 多篇涉及該 SP 的臨床文章。

Last month, some of the first clinical research related to da Vinci SP usage in transoral surgery was published by JAMA Otolaryngology - Head & Neck Surgery section.

上個月，JAMA 耳鼻喉科 - 頭頸外科部門發表了一些與 da Vinci SP 在經口手術中使用相關的首批臨床研究。

The research titled A Next-Generation Single-Port Robotic Surgical System for Transoral Robotic Surgery results from prospective nonrandomized clinical trials was authored by Dr. F. Christopher Holsinger from Stanford, et al.

這項名為 A Next-Generation Single-Port Robotic Surgical System for Transoral Robotic Surgery 的研究來自前瞻性非隨機臨床試驗，由斯坦福大學的 F. Christopher Holsinger 博士等人撰寫。

The objective of the study was to evaluate the da Vinci SP in head and neck surgery prospectively through concurrent nonrandomized clinical trials.

該研究的目的是通過同時進行的非隨機臨床試驗，前瞻性地評估 da Vinci SP 在頭頸部手術中的應用。

The study included a total of 47 patients across 4 institutions: 3 in the U.S. and 1 in Hong Kong.

該研究包括來自 4 個機構的 47 名患者：3 名在美國，1 名在香港。

All 47 patients had tumors of the oral pharynx and underwent surgery with the da Vinci SP.

所有 47 名患者均患有口咽腫瘤，並接受了達芬奇 SP 手術。

40 patients had malignant tumors while 7 were benign.

惡性腫瘤40例，良性7例。

All 47 patients, 8 women and 39 men with a mean age of 61, safely underwent transoral resection with the da Vinci SP without conversion to open surgery, laser surgery or multi-port robotic surgery.

所有 47 名患者（8 名女性和 39 名男性，平均年齡為 61 歲）均安全地接受了 da Vinci SP 經口切除術，而無需轉換為開放手術、激光手術或多端口機器人手術。

There were no intraoperative complications or device-related serious adverse events.

沒有術中並發症或與器械相關的嚴重不良事件。

Mean estimated intraoperative blood loss per procedure was 15.4 milliliters, with no patients received a transfusion.

每次手術的平均估計術中失血量為 15.4 毫升，沒有患者接受輸血。

Within 30 days, 45 of the 47 patients were eating by mouth and without the need for percutaneous endoscopic gastrostomy tube.

在 30 天內，47 名患者中有 45 名通過口進食且無需經皮內窺鏡胃造口管。

The authors concluded, "The use of the device appears to be feasible, safe and effective for transoral robotic surgery of oropharyngeal tumors."

作者總結說：“該設備的使用對於口咽腫瘤的經口機器人手術似乎是可行、安全和有效的。”

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

我現在將轉向我們 2019 年的財務展望，從程序開始。

Last quarter, we forecast 2019 procedure growth of 16% to 17%.

上個季度，我們預測 2019 年程序增長 16% 至 17%。

We are now increasing our forecast and expect full year 2019 procedure growth of 17% to 18%.

我們現在正在提高我們的預測，並預計 2019 年全年程序增長 17% 至 18%。

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.

在我們上次的電話會議上，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% 以內。

We are now slightly increasing our forecast and expect full year gross profit margin to be between 71% and 71.5% of net revenue.

我們現在略微上調我們的預測，預計全年毛利率將在淨收入的 71% 至 71.5% 之間。

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隨季度變化，主要取決於產品、區域和以舊換新組合以及新產品推出的影響。

Turning to operating expenses.

轉向運營費用。

On our last call, we forecast to grow full year pro forma 2019 operating expenses between 24% and 28% above 2018 levels.

在我們上次的電話會議上，我們預計 2019 年全年備考運營費用將比 2018 年水平增長 24% 至 28%。

We are now retiring the top end of the range and expect our full year pro forma operating expense growth to be between 24% and 27%.

我們現在正在淘汰該範圍的高端，並預計我們全年的備考運營費用增長將在 24% 至 27% 之間。

On our last call, we forecast our noncash stock compensation expense to range between $320 million and $340 million in 2019.

在我們上次的電話會議上，我們預測 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 are now refining this estimate to the top half of the range between $330 million and $340 million.

我們現在正在將此估計值細化到 3.3 億美元至 3.4 億美元之間的上半部分。

We expect other income, which is comprised mostly of interest income, to total between $125 million and $130 million in 2019 compared to $130 million to $135 million forecast on our last call.

我們預計 2019 年主要由利息收入組成的其他收入總額將在 1.25 億美元至 1.3 億美元之間，而我們上次電話會議的預測為 1.3 億美元至 1.35 億美元。

With regard to income tax, apart from certain nondiscrete items impacting Q3, we have a consistent view of our tax rate.

關於所得稅，除了影響第三季度的某些非離散項目外，我們對稅率的看法是一致的。

We estimate our Q4 pro forma tax rate to be between 19% and 20% of pretax income.

我們估計第四季度的備考稅率在稅前收入的 19% 到 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 David Lewis with Morgan Stanley.

（操作員說明）我們的第一個問題來自摩根士丹利的 David Lewis。

Just a couple of questions for me.

對我來說只是幾個問題。

Gary, just starting off on procedure acceleration.

加里，剛剛開始程序加速。

Even adjusting for [telling] that there's still couple hundred basis points, maybe 200 to 300 basis points of momentum acceleration to the third quarter, I wonder if you could talk about some of the drivers there.

即使調整 [告訴] 仍有幾百個基點，也許 200 到 300 個基點的勢頭加速到第三季度，我想知道你是否可以談談那裡的一些驅動因素。

You talked about the gen surg capacity issues last quarter.

你談到了上個季度的發電量激增問題。

It sounds that they've been resolved.

聽起來他們已經解決了。

But was that the principal driver of the momentum improvement?

但這是推動勢頭改善的主要動力嗎？

Or could you just kind of point out other factors that drove this relative momentum acceleration to the third quarter?

或者您能否指出其他推動這種相對勢頭加速到第三季度的因素？

And then I had a quick follow-up.

然後我進行了快速跟進。

General surgery was positive for us.

普通手術對我們來說是積極的。

I would not say that we have resolved all of the constrained issues that we have been -- we had talked about last quarter.

我不會說我們已經解決了我們上個季度討論過的所有受限問題。

We moved in the right direction.

我們朝著正確的方向前進。

So I think productivity for the U.S. sales force was something we talked about last quarter.

所以我認為美國銷售隊伍的生產力是我們上個季度討論的話題。

I think we took a modest step in the right way.

我認為我們以正確的方式邁出了適度的一步。

We'll keep working on that, likewise, convenient access to systems.

我們將繼續努力，同樣，方便地訪問系統。

So general surgery was strong for us, but I think there's more opportunity there over the long term.

所以普通外科手術對我們來說很強大，但我認為從長遠來看那裡有更多的機會。

We had -- and Calvin touched on it, we're positively surprised in the urology part of the business.

我們有 - Calvin 談到了它，我們對業務的泌尿科部分感到非常驚訝。

And we're digging in a little bit to figure out where that positive surprises come from.

我們正在挖掘一些積極的驚喜來自哪裡。

Calvin, I don't know if you want to add to that.

卡爾文，我不知道你是否想補充。

No.

不。

I'd say -- I mean you saw us kind of settle in the low single digits last quarter and just over 10% this quarter, and we are working with our field team and customers to better understand the dynamics behind that.

我想說 - 我的意思是你看到我們在上個季度穩定在低個位數，本季度剛剛超過 10%，我們正在與我們的現場團隊和客戶合作，以更好地了解這背後的動態。

Okay.

好的。

Very helpful.

很有幫助。

Then maybe just a quick 2-part question on broader CapEx.

然後可能只是一個關於更廣泛資本支出的快速兩部分問題。

And Gary, the gross system placements this quarter, I know trade-ins and retirements looked heavier, but gross system placements in the U.S. looked a little lighter.

加里，我知道本季度的總系統安置，以舊換新和退休看起來更重，但美國的總系統安置看起來更輕一些。

Is there anything you've seen from a change in the capital environment in the U.S. that you're willing to call out?

您從美國資本環境的變化中看到了什麼，您願意大聲疾呼嗎？

And then related to that, Marshall, your commentary on next year competitive dynamics, maybe could you share with us what you've seen from some of these new systems that have now been displayed in the U.S. and Europe, any comments you're willing to provide there and how your commercial strategy may change next year as you learn more about these systems?

然後與此相關，Marshall，您對明年競爭動態的評論，也許您能與我們分享您從現在已在美國和歐洲展示的一些新系統中看到的內容，您願意發表任何評論提供那里以及隨著您對這些系統的了解更多，您的商業策略明年可能會如何變化？

On the first front, I don't know that we're a perfect read on the CapEx environment more broadly.

在第一方面，我不知道我們是更廣泛地了解資本支出環境的完美讀物。

We do think that procedure growth is in the U.S., the dominant driver of additional systems over time, system capability but also clinical installed base access.

我們確實認為，程序增長是在美國，隨著時間的推移，額外系統、系統能力以及臨床安裝基礎訪問的主要驅動力。

So I think we saw in this quarter, met our expectations.

所以我認為我們在本季度看到的，符合我們的預期。

I think the second question around spending looking into next year, I'll let Marshall take.

我認為關於明年支出的第二個問題，我會讓馬歇爾回答。

Yes.

是的。

So U.S. and specifically about dynamics around potential competitors and my comment about the impacts that might have in terms of elongated negotiations or negotiations with customers, we know that when the competitors' products comes out, that will be an impact.

因此，美國，特別是關於潛在競爭對手的動態以及我對延長談判或與客戶談判可能產生的影響的評論，我們知道當競爭對手的產品問世時，這將產生影響。

When it comes out or when it will have an impact is less certain.

它何時出現或何時會產生影響則不太確定。

And so we're just trying to make sure that you understand that as those dynamics occur, that you're not surprised.

因此，我們只是想確保您了解當這些動態發生時，您不會感到驚訝。

And next, we turn to the line of Larry Biegelsen with Wells Fargo.

接下來，我們轉向富國銀行的拉里·比格爾森（Larry Biegelsen）的路線。

Just maybe 1 follow-up for you, Marshall, on the operating margin and the OpEx spending that you talked about for next year.

馬歇爾，您可能只需要跟進您明年談到的營業利潤率和運營支出支出。

I mean in the past, you've talked about not expecting constant deleveraging over time, but how should we think about margins, margin pressure in 2020 relative to 2019 as you invest for top line growth and you potentially have new competition coming in?

我的意思是，在過去，您曾談到預計不會隨著時間的推移持續去槓桿化，但我們應該如何考慮利潤率，相對於 2019 年，2020 年的利潤率壓力，因為您投資於頂線增長並且您可能有新的競爭進入？

I have one follow-up.

我有一個跟進。

Yes.

是的。

I think you -- what you've heard from us and you've heard from others is that there's a substantial opportunity in front of us in terms of the minimally invasive market.

我認為您 - 您從我們那裡聽到的以及從其他人那裡聽到的是，在微創市場方面，我們面前存在著巨大的機會。

And so we think about those opportunities, we think about the technology, that they're necessary to take advantage of those to improve patient outcomes and we think about global expansion.

因此，我們考慮了這些機會，我們考慮了技術，它們對於利用這些機會來改善患者結果是必要的，我們考慮全球擴張。

And so that's where we're spending our money.

這就是我們花錢的地方。

We'll give you more precise guidance on what spending will do when we get to the January call.

當我們到達 1 月份電話會議時，我們將為您提供更準確的支出指導。

So I'm not going to really comment at this point about magnitude of leverage or deleverage or whatever.

因此，在這一點上，我不會真正評論槓桿或去槓桿的幅度或其他什麼。

But we will continue to spend on expansion.

但我們將繼續在擴張上花錢。

That's helpful.

這很有幫助。

And then (inaudible) 2020 theme, Calvin, on the guidance, the implied Q4 is about -- that's somewhere about 15% at the midpoint for procedure growth.

然後（聽不清）2020 年主題，卡爾文，在指導上，隱含的第四季度大約是——在程序增長的中點大約 15%。

Should we be thinking about more of the high end here, Calvin?

卡爾文，我們應該考慮更多的高端產品嗎？

And maybe if you could talk about the puts and takes for next year.

也許你可以談談明年的看跌期權。

You have some good growth drivers from general surgery and international.

你有一些來自普通外科和國際的良好增長動力。

Should we be thinking about kind of stability in procedure growth?

我們應該考慮程序增長的穩定性嗎？

Yes.

是的。

I think as you look at Q4, then further out into 2020, the growth drivers, as you say, are general surgery in the United States as well as growth outside the United States, and I think that's likely to continue to be the drivers.

我認為當你看第四季度，然後再到 2020 年，增長驅動力，正如你所說，是美國的普通外科手術以及美國以外的增長，我認為這可能會繼續成為驅動力。

At the high end of the guidance range, I think we're seeing consistency with where we are in a year-to-date basis.

在指導範圍的高端，我認為我們看到與年初至今的情況保持一致。

But again, in the third quarter, we saw benefit from some of the mature categories.

但同樣，在第三季度，我們看到了一些成熟品類的好處。

So I think at the lower end, you can contemplate some moderation there.

所以我認為在低端，你可以考慮適度。

And next, we turn to the line of Bob Hopkins with Bank of America.

接下來，我們轉向美國銀行的鮑勃·霍普金斯 (Bob Hopkins) 的路線。

I just want to ask a couple of quick questions on the comments you guys made on SP in prepared remarks.

我只想問幾個關於你們在準備好的評論中對 SP 的評論的快速問題。

It sounds like the regulatory pathway is moving around a little bit.

聽起來監管途徑正在發生一些變化。

Gary, is that a function of something specific with your process?

加里，這是您流程中特定功能的功能嗎？

Or is it just a tougher regulatory environment generally with the FDA with these newer product platforms?

或者這只是 FDA 對這些新產品平台的更嚴格的監管環境？

Yes.

是的。

I think it's probably the latter.

我想大概是後者。

As you look at both our products that are moving into new clinical domains and also a little more broadly across the med device industry, it looks like the environment is becoming a more data-centric or the data requirements are increasing.

當您看到我們正在進入新臨床領域的產品以及更廣泛的醫療設備行業時，看起來環境正在變得更加以數據為中心，或者數據需求正在增加。

And just -- also just wondering if you could characterize kind of the demand for SP generally and what your comments imply about kind of next year's growth opportunity in SP.

而且只是 - 也只是想知道您是否可以概括地描述對 SP 的需求，以及您的評論對 SP 明年的增長機會有何暗示。

Should we be thinking it's fairly limited until you get colorectal?

在您患上結腸直腸癌之前，我們是否應該認為它相當有限？

Or do you see enough underlying demand that 2020 could be some nice sales of that product?

或者你是否看到了足夠的潛在需求，以至於 2020 年該產品可能會有一些不錯的銷售？

We won't forecast it for you on this call.

我們不會在本次電話會議上為您預測。

I think in general, there's an opportunity for the indications that we have, and more indications are better.

我認為總的來說，我們擁有的跡像是有機會的，而且更多的跡象會更好。

The clinical data that we're seeing, and that's building in the database, reinforces my support for the product line long term.

我們看到的臨床數據，以及正在建立在數據庫中的數據，加強了我對產品線的長期支持。

And I think there's also a set of indications beyond the colorectal that will be interesting to us.

而且我認為除了結直腸之外還有一系列對我們來說很有趣的跡象。

That said, we'll work with regulatory bodies to meet the requirements, and that may take some time.

也就是說，我們將與監管機構合作以滿足要求，這可能需要一些時間。

That will pace us.

這將使我們步調一致。

So near term, as we get closer to 2020 and get into it, we'll talk a little more about it.

所以在短期內，隨著我們接近 2020 年並進入它，我們將多談一點。

And we have a question from the line of Tycho Peterson with JPMorgan.

我們有一個來自摩根大通的 Tycho Peterson 的問題。

I want to go back to some of the procedure commentary.

我想回到一些程序評論。

The cholecystectomy recovery, can you comment on what you think might be driving that?

膽囊切除術的恢復，你能評論一下你認為可能是什麼原因嗎？

And then to your comments on the dVP step-up, any early view on what might be behind that?

然後對於您對 dVP 升級的評論，您對這背後的原因有什麼早期看法嗎？

Is that patients dropping out of watchful waiting?

那是病人退出觀察等待嗎？

Or is there another dynamic there?

還是那裡有另一種動態？

Yes.

是的。

On the chole side, Tycho, talked about acceleration being driven by a healthy mix of the new surgeons and existing surgeons, there's not a lot of churn and increasing FireFly utilization.

在膽汁方面，第谷談到加速是由新外科醫生和現有外科醫生的健康組合推動的，沒有太多的流失和增加 FireFly 的利用率。

So that feels a lot different than, say, our earlier experience with Single-Site set of tools or was more of a cosmesis-oriented value proposition.

因此，這與我們之前使用單站點工具集的經驗大不相同，或者更多的是面向外觀的價值主張。

And what's interesting is while in the past, chole may have been a popular training procedure, and it still can be that, now it's not necessarily the first procedure.

有趣的是，在過去，chole 可能是一種流行的訓練程序，現在仍然可能是這樣，現在它不一定是第一個程序。

It's a lot more often that it's, say, a hernia repair that's the first procedure.

比方說，疝修補術是第一個手術。

And as general surgeons are applying robotics across their practices, chole is obviously a big part of what they do.

隨著普通外科醫生在他們的實踐中應用機器人技術，膽汁顯然是他們工作的重要組成部分。

So the reasons for optimism, given what we see in the data, but we continue to monitor and analyze the growth trends closely and remain conservative about the overall opportunity.

因此，鑑於我們在數據中看到的情況，我們保持樂觀的原因是，但我們將繼續密切監測和分析增長趨勢，並對整體機會保持保守。

Prostatectomy.

前列腺切除術。

Yes.

是的。

Prostatectomy, I think we pretty much stated on that, we were surprised and were kind of digging into what the (inaudible) may be.

前列腺切除術，我想我們幾乎已經說過了，我們很驚訝，並且有點深入研究（聽不清）可能是什麼。

Okay.

好的。

And then on SP, it sounds like you worked through the endoscope issues in relatively short order.

然後在 SP 上，聽起來您在相對較短的時間內解決了內窺鏡問題。

Should we think about any sort of catch-up effect in the fourth quarter in terms of installations?

我們是否應該考慮第四季度安裝量的任何形式的追趕效應？

And then any comment you're willing to make on the IDE trial, how big you think that might have to be?

然後您願意對 IDE 試用發表任何評論，您認為這可能需要多大？

Well, on the SP endoscope, we have released supply and -- but we still have some work to do, and we will work through it really for SP endoscopy at scale.

好吧，在 SP 內窺鏡上，我們已經發布了供應，但我們還有一些工作要做，我們將真正完成大規模的 SP 內窺鏡檢查。

So we can support the scale we're at today.

所以我們可以支持我們今天的規模。

But as we get bigger and what our long-term plans are, I want to see improvements in that product line.

但隨著我們變得更大以及我們的長期計劃是什麼，我希望看到該產品線的改進。

So we will see.

所以我們會看到的。

We're not ready to describe what the outline for the trial yet are.

我們還沒有準備好描述試驗的大綱是什麼。

Indeed, it finalizes an IDE that will get published in a public database, and you'll be able to look it up and we'll point you to it.

事實上，它最終確定了一個將在公共數據庫中發布的 IDE，您將能夠查找它，我們會為您指出它。

Right.

對。

And then lastly, any comments you can make on ASPs?

最後，您可以對 ASP 發表任何評論嗎？

I think last quarter, there was a view that they would maybe step down, but obviously, they didn't.

我認為上個季度，有人認為他們可能會下台，但顯然他們沒有下台。

So just curious how we should be thinking about system ASPs going forward.

所以只是好奇我們應該如何考慮未來的系統 ASP。

Yes.

是的。

I think specific in my remarks actually, for ASPs this quarter, we just saw a really favorable mix just like last quarter in terms of Xis versus Xs and Sis.

實際上，我認為在我的評論中具體，對於本季度的 ASP，我們剛剛看到了一個非常有利的組合，就像上個季度一樣，在 Xis 與 Xs 和 Sis 方面。

We also saw a really favorable mix in terms of distributor -- lower distributor and higher direct sales.

在分銷商方面，我們還看到了非常有利的組合——較低的分銷商和較高的直銷。

As far as what you should expect going forward, I think what I said was for the remainder of this year, you should look at ASPs more similar to the mix between Q1 and Q2, and that's where we see it coming out.

至於你對未來的預期，我認為我所說的是今年剩餘時間，你應該看看 ASP 更類似於第一季度和第二季度之間的混合，這就是我們看到它出現的地方。

And that will reflect higher mix of distribution sales in Q4, which is typical if you go back and look at our history.

這將反映第四季度更高的分銷銷售組合，如果你回顧我們的歷史，這是典型的。

And next, we turn to the line of JP McKim with Piper Jaffray.

接下來，我們轉向 JP McKim 和 Piper Jaffray 的路線。

I just wanted to touch on just the uplift in instrument ASPs.

我只是想談談儀器 ASP 的提升。

Can you talk about, a, the sustainability there and just what's really driving it?

你能談談那裡的可持續性以及真正推動它的因素嗎？

Is it more advanced procedures or just more advanced instruments with the staplers and vessel sealers?

是更先進的程序還是只是更先進的帶有訂書機和血管密封器的儀器？

Yes.

是的。

JP, it's Calvin.

JP，是卡爾文。

Yes, we saw this.

是的，我們看到了這一點。

In this quarter, revenue per procedure was approximately $1,980, and that's the highest we've seen in quite some time.

在本季度，每個程序的收入約為 1,980 美元，這是我們在相當長一段時間內看到的最高水平。

Marshall mentioned in his comments that we did see a benefit relative to the last quarter just due to timing of orders, but obviously, a higher usage of the advanced stapling and vessel sealing has also contributed to the growth.

Marshall 在他的評論中提到，與上一季度相比，我們確實看到了訂單時間帶來的好處，但顯然，高級裝訂和容器密封的更多使用也促進了增長。

Going forward, clearly, the favorable timing of the orders should offset, but there's a number of factors that are going to kind of impact the trend going in different directions, including the anticipated continued growth in the advanced instrument usage, offset by an increasing proportion of lower complexity cases like cholecystectomy that we've talked about.

展望未來，很明顯，訂單的有利時機應該會抵消，但有許多因素會影響不同方向的趨勢，包括預期的先進儀器使用的持續增長，被越來越多的比例抵消我們已經討論過的複雜程度較低的病例，例如膽囊切除術。

So I&A revenue per procedure is going to have variability quarter-to-quarter, and I don't have a long-term direction to give you.

因此，每個程序的 I&A 收入會隨著季度的變化而變化，我沒有一個長期的方向可以給你。

Okay.

好的。

That's helpful.

這很有幫助。

And then maybe just on -- you've got the CHEST conference coming up this weekend.

然後也許就在——這個週末你有 CHEST 會議。

Maybe what can we or should we expect from you guys in terms of Ion, any Single-Site data and then maybe what investors should be looking for in terms of the right way to sort of compare systems or what really is going to drive adoption if there's an interest?

也許我們可以或應該從 Ion、任何單站點數據方面對你們期待什麼，然後也許投資者應該在比較系統的正確方法方面尋找什麼，或者如果真的會推動採用什麼有興趣嗎？

Yes.

是的。

So the conference, I think what you're going to see is a lot of what we've talked on this call.

所以這次會議，我想你會看到很多我們在這次電話會議上討論的內容。

We're going to talk about just qualitatively, I think, some of the early experiences in the field.

我認為，我們將定性地討論該領域的一些早期經驗。

We'll be doing a lot of test drives and talking about the system and its capabilities.

我們將進行大量試駕並討論系統及其功能。

I don't think -- there's no new data that I think is going to be groundbreaking at the event.

我不認為 - 我認為沒有新數據會在此次活動中具有開創性。

In general, I think you'll see from both sides relatively early data.

總的來說，我想你會從雙方比較早的數據中看到。

I think the larger market in Ion and in the robotic-assisted bronchoscopy will be data-oriented, in broader settings, looking at safety and efficacy.

我認為 Ion 和機器人輔助支氣管鏡檢查的更大市場將以數據為導向，在更廣泛的環境中著眼於安全性和有效性。

And as that develops, I think we're feeling pretty good.

隨著情況的發展，我認為我們感覺很好。

There have been systems in the market in the past, as you know, and I think a fair number of accounts will wait to see what the data says.

如你所知，過去市場上有過系統，我認為相當多的賬戶會等著看數據說什麼。

So there's the feature-benefit kind of conversations that happened in the early market.

因此，在早期市場中發生了具有功能優勢的對話。

I think a lot of the market will wait to see what that expresses like in clinical use.

我認為很多市場都會等著看它在臨床使用中的表現。

And our next question comes from the line of Richard Newitter with SVB Leerink.

我們的下一個問題來自 SVB Leerink 的 Richard Newitter。

Wanted to just follow up on chole.

只想跟進chole。

So I know that I believe chole is a faster procedure relative to some of the more complex areas where the robot gets used.

所以我知道，相對於機器人使用的一些更複雜的區域，我相信膽汁是一個更快的過程。

So I'm just curious the extent to which you think acceleration (inaudible) staying power could that help alleviate some of the capacity and training issues that you've outlined in the past with respect to the mix or the types of procedures getting done.

所以我只是好奇你認為加速（聽不清）的持久力在多大程度上有助於緩解你過去概述的關於混合或完成的程序類型的一些能力和培訓問題。

I think it can change the -- certainly, utilization rate for systems in the field, it's still -- it can still create access challenges as different people buy for time, but as you just described, if they're faster through it.

我認為它可以改變——當然，該領域系統的利用率，它仍然——它仍然可以創造訪問挑戰，因為不同的人購買時間，但正如你剛才所描述的，如果他們通過它更快。

With regard to training, I think that high-volume procedures allow surgeons to move through their early experiences more quickly, and that has a generally positive note effect.

關於培訓，我認為大批量的手術可以讓外科醫生更快地完成他們的早期經驗，這通常會產生積極的影響。

Great.

偉大的。

And I was hoping -- thanks for the color on the China procedure growth metrics relative to the overall U.S. Just curious, as you have more systems getting placed each quarter, how many quarters you think it might take to get approaching the international average?

我希望 - 感謝中國程序增長指標相對於整個美國的顏色。只是好奇，因為每個季度都有更多的系統安裝，你認為可能需要多少個季度才能接近國際平均水平？

And I think it would be helpful just to know, where was the growth rate trending in the last 2 quarters relative to this quarter?

而且我認為知道過去兩個季度相對於本季度的增長率趨勢在哪裡會很有幫助？

Right.

對。

So the overall OUS growth rate is roughly 23%.

所以總體 OUS 增長率約為 23%。

And in the last 2 quarters, we've seen some modest acceleration.

在過去的兩個季度中，我們看到了一些適度的加速。

We're probably approaching that right now, so successful scenario, in the next quarter or 2, we may cross over.

我們現在可能正在接近這一點，如此成功的情景，在下一季度或第二季度，我們可能會跨越。

And next, we turn to the line of Imron Zafar with Deutsche Bank.

接下來，我們轉向德意志銀行的 Imron Zafar 路線。

Gary, you highlighted in your prepared remarks the stapling franchise.

加里，你在準備好的評論中強調了主要的特許經營權。

Can you talk a little bit more about, I guess, the 60-millimeter in particular and the impact you're seeing in terms of specific procedures, where you're just seeing the uptake?

我猜你能多談談，特別是 60 毫米，以及你在具體程序方面看到的影響，你只是看到了吸收嗎？

Is it colorectal versus gastric sleeve?

是結直腸還是胃套？

And then also, how much cannibalization are you seeing in the 45-millimeter in cases like bowel resection, et cetera?

此外，在腸切除等情況下，您在 45 毫米內看到多少同類相食？

60 is mostly used in the lower abdomen, so you definitely have stomach and in colorectal.

60多用在小腹，所以你肯定有胃和大腸。

There's modest exchange for the 45s where a 60 will do.

45s 可以進行適度的交換，而 60 可以。

[It's fewer fires].

[火災更少]。

But in general, I think that mix and surgeon selection in that space is pretty well understood from prior experience with laparoscopy, and we're not overly stressed about it.

但總的來說，我認為從以前的腹腔鏡檢查經驗中可以很好地理解該領域的混合和外科醫生選擇，我們對此並沒有過分強調。

Okay.

好的。

And then in Japan, I know last quarter, you've talked about some sequential slowdown.

然後在日本，我知道上個季度，你談到了一些連續放緩。

But the metrics you gave today, the 40%-plus procedure growth and healthy placements, I think 27, can you just talk about the contributors to procedure growth there?

但是你今天給出的指標，超過 40% 的程序增長和健康的安置，我想 27，你能談談那里程序增長的貢獻者嗎？

Is it still urology, non-dVP urology or general surgery mostly?

主要還是泌尿科、非dVP泌尿科還是普通外科？

And then are we expecting more procedure reimbursement approvals in April 2020?

然後我們是否期望在 2020 年 4 月獲得更多的程序報銷批准？

Yes.

是的。

So as we mentioned on the call, the growth -- it moved back to 40% where we had been prior to last quarter.

因此，正如我們在電話會議上提到的那樣，增長——它回到了上一季度之前的 40%。

Last quarter, I think we largely felt the effect of a number of holidays or fewer workdays in the quarter than this quarter where that recovered.

上個季度，我認為我們在很大程度上感受到了本季度假期數量或工作日少於本季度恢復的影響。

So that was the main thing.

所以這是主要的。

We're seeing increasing numbers of the 12 procedures that were granted reimbursement status in April of 2018 as well as continuing to see adoption of the urology procedures.

我們看到在 2018 年 4 月獲得報銷資格的 12 項程序中越來越多，並且繼續看到採用泌尿外科程序。

We don't think that the -- of the 12, that they'll adopt it equal rate, and we'll see some start to break out from the pack, whether it's in colorectal or thoracic relative to some of the others.

我們認為這 12 人中的 - 他們會採用相同的比率，我們會看到一些人開始從包裝中脫穎而出，無論是在結直腸或胸部相對於其他一些。

With regard to reimbursement opportunities going forward, it's something we track and we discuss with surgical societies for their support as needed.

關於未來的報銷機會，這是我們跟踪的事情，我們會根據需要與外科學會討論以獲得他們的支持。

We'll see.

我們拭目以待。

Nothing to communicate with you at this time.

暫時沒有什麼可以和你交流的。

Next, we turn to the line of Craig Bijou with Cantor Fitzgerald.

接下來，我們轉向 Craig Bijou 和 Cantor Fitzgerald 的路線。

Just a couple of quick follow-ups.

只是幾個快速跟進。

Gary, on SP, I think you mentioned that you might be looking at other indications.

加里，關於 SP，我想你提到你可能正在研究其他跡象。

So I guess I just wanted to get a sense for given the IDE that will be required for colorectal, could we see another indication come in before seeing colorectal?

所以我想我只是想了解一下結腸直腸癌所需的 IDE，我們是否可以在看到結腸直腸癌之前看到另一個跡象？

I can give you no reason to be optimistic for that.

我不能給你任何理由對此感到樂觀。

Okay.

好的。

Fair enough.

很公平。

And then, Marshall, just your comments on the med device tax, I just wanted to -- you said that you expect it to come in, and I just wanted to get -- is that just you being conservative or assuming that it'll come in, in 2020?

然後，馬歇爾，只是你對醫療器械稅的評論，我只是想 - 你說你希望它進來，我只是想得到 - 只是你保守還是假設它會來吧，2020年？

Or is there anything else behind that comment?

或者該評論背後還有其他什麼？

At this point, that is what is supposed to happen.

在這一點上，這就是應該發生的事情。

I know there's lobbying efforts to try to change that, but we're just telling you the way it is.

我知道有遊說努力試圖改變這種情況，但我們只是告訴你它的方式。

Also fair enough.

也足夠公平。

And we have a question from the line of Jason Mills with Canaccord Genuity.

我們有一個來自 Canaccord Genuity 的 Jason Mills 的問題。

I wanted to follow up, Calvin, on the revenue per procedure.

卡爾文，我想跟進每個程序的收入。

You've given us that data fairly consistently.

您已經相當一致地向我們提供了這些數據。

So (inaudible) things would have to change quite significantly across several different procedures for that trend line to change over, let's say, the next 3 years.

所以（聽不清）事情必須在幾個不同的過程中發生相當大的變化，這樣趨勢線才能改變，比如說，接下來的 3 年。

So it's been on a nice, fairly decent upward slope.

所以它一直在一個不錯的，相當不錯的上升斜坡上。

What would you say, I guess, over the longer term with respect to that trend line, given you have so much data, but it is a dynamic business, it would seem like it could continue to trend upward with some volatility quarter-to-quarter but upward over a longer period of time.

我想，從長遠來看，關於該趨勢線，您會怎麼說，鑑於您擁有如此多的數據，但這是一項動態業務，看起來它可能會繼續呈上升趨勢，且季度間存在一定的波動性。季度，但在較長時間內向上。

Can you tell me what I'm missing if that's incorrect?

如果不正確，你能告訴我我錯過了什麼嗎？

No, it has been increasing in low single digits the last couple of years anyway.

不，無論如何，過去幾年它一直在以低個位數增長。

And I tried to mention that we do expect to see a contribute -- continued contribution from the advanced instruments as a tailwind to the metric, but that's being offset by a number of factors.

我試圖提到，我們確實希望看到一個貢獻——先進儀器的持續貢獻作為對指標的順風，但這被許多因素所抵消。

I mentioned increasing proportion of lower complexity cases.

我提到了越來越多的低複雜度案例。

And fact is, people are just becoming all the more efficient as time goes on as well, wasting less, doing less with more.

事實上，隨著時間的推移，人們變得越來越有效率，浪費更少，事半功倍。

And we help them to do that with some of the analytics we provide.

我們通過我們提供的一些分析幫助他們做到這一點。

So those are the offsets.

所以這些是偏移量。

And so you have the gives and the takes.

所以你有付出也有收穫。

So at this point, I'm not ready to say whether the trend is going to continue up or be flat or trend down.

所以在這一點上，我還沒有準備好說趨勢是繼續上漲還是持平還是下跌。

Okay.

好的。

It's fair enough.

這很公平。

And obviously, the bigger view of one of the competitors, we saw -- well, the number that they continue to harp on was 2% robotic surgery relative to procedures done, whether it be general endoscopic.

顯然，我們看到了其中一個競爭對手的更大觀點——好吧，他們繼續強調的數字是機器人手術相對於已完成的手術的 2%，無論是普通內窺鏡檢查。

I was wondering if you could perhaps, Gary, comment on that number from your perspective, obviously, it being much more broad.

我想知道你是否可以，加里，從你的角度評論這個數字，顯然，它更廣泛。

If you could comment on that number or just give any general commentary as it relates to robotic surgery penetration.

如果你能評論這個數字，或者只是給出任何與機器人手術滲透有關的一般性評論。

I know you talked qualitatively about it being early innings, but just specifics of that quantitative figure, I'd like your thoughts.

我知道你定性地談論它是早期的一局，但只是那個定量數字的細節，我想听聽你的想法。

And then specifically to Japan, as it relates to the penetration of robotic surgery, it would seem to be lower than that.

然後特別是日本，因為它涉及機器人手術的滲透，它似乎比這要低。

I'd like your commentary with respect to that geography specifically if you don't mind.

如果你不介意的話，我想听聽你關於那個地理的評論。

Well, let's zoom out for a second and then we can zoom back in.

好吧，讓我們縮小一秒鐘，然後我們可以重新放大。

I think the opportunity for computer-aided and robotically assisted surgery and acute intervention more broadly is clearly substantial and clearly durable.

我認為計算機輔助和機器人輔助手術以及更廣泛的急性干預的機會顯然是巨大的並且顯然是持久的。

And that's going to draw new entrants, which is (inaudible).

這將吸引新的進入者，這是（聽不清）。

I think those new entrants will help accelerate broader adoption more generally.

我認為這些新進入者將有助於更廣泛地加速更廣泛的採用。

And customers will appreciate that choice, and I think they'll look at that.

客戶會欣賞這種選擇，我認為他們會考慮這一點。

Our strategy over this period has really been to understand our customers deeply and understand the quadruple aim.

我們在此期間的策略實際上是深入了解我們的客戶並了解四重目標。

It's really hard to do the total accounting of what the total available market will be.

很難對可用市場總量進行全面核算。

And what I'd ask you to look at is, over time, what does it look like in the next couple of years?

我想讓你看看，隨著時間的推移，未來幾年它會是什麼樣子？

What does it look like in the next 4?

在接下來的 4 中會是什麼樣子？

Or what does it look like in the next 10?

或者在接下來的 10 年中會是什麼樣子？

I think some of our competitors, as they speak about these opportunities, are looking out pretty far.

我認為我們的一些競爭對手，在談到這些機會時，已經把目光投向了很遠的地方。

And okay, that's a forecast, hard to have an exact crystal ball.

好吧，這是一個預測，很難有一個準確的水晶球。

But clearly, even speaking with our most candid critics, the idea that computer aids and robotics are going to make an impact more broadly in surgery is pretty well accepted.

但很明顯，即使與我們最坦率的批評者交談，計算機輔助和機器人技術將在外科手術中產生更廣泛影響的想法也得到了很好的接受。

So I think we're early innings.

所以我認為我們處於早期階段。

Japan, I think likewise.

日本，我也這麼認為。

We're a little bit different health care system.

我們的醫療保健系統有點不同。

The single payer system that runs through MHLW or the predominantly single-payer system means that their requirements and negotiations using data with the government early are much more important and getting those right open to market over time, and that's what we've been working on.

通過 MHLW 運行的單一付款人系統或主要是單一付款人系統意味著他們的要求和早期與政府使用數據的談判更為重要，並且隨著時間的推移將這些數據正確地推向市場，這就是我們一直在努力的方向.

So clearly, that's an early set of opportunities for us as well.

很明顯，這對我們來說也是早期的機會。

Our methodology when we think about total available market is to be conservative in the early days, show that we can bring real value and then revise as we see greater depth.

當我們考慮總可用市場時，我們的方法是在早期保持保守，表明我們可以帶來真正的價值，然後隨著我們看到更大的深度進行修改。

Other companies take a different statistical approach to that.

其他公司對此採取不同的統計方法。

And next, we turn to the line of Vijay Kumar with Evercore ISI.

接下來，我們轉向 Vijay Kumar 與 Evercore ISI 的產品線。

Maybe just tacking on the last question, Gary, if you just look at the medium-term outlook, right, just given where we are in the CapEx cycle, given the amount of product cycles that you guys have on a number of different platforms, where -- I know historically, you looked at utilization rates as being -- on the system utilization rates -- the growth in system utilization as being a leading indicator for systems.

也許只是回答最後一個問題，加里，如果你只看中期前景，對，考慮到我們在資本支出週期中的位置，考慮到你們在許多不同平台上擁有的產品週期數量，在哪裡 - 我從歷史上知道，您將利用率視為 - 在系統利用率上 - 系統利用率的增長作為系統的領先指標。

Is this now -- given the acceleration we're seeing in procedures, is that a leading indicator for our systems?

現在是這樣 - 鑑於我們在程序中看到的加速，這是我們系統的領先指標嗎？

Like can you just give us a sense for what drives that systems next year?

就像您能否讓我們了解明年驅動該系統的原因是什麼？

Because, obviously, you have competition.

因為，顯然，你有競爭。

I'm just curious given -- why we're seeing base procedures accelerating.

我只是好奇——為什麼我們看到基礎程序在加速。

Is that an indicator for how we should be modeling systems?

這是我們應該如何建模系統的指標嗎？

Well, I'll just draw a broader picture and let Calvin speak to a little bit of the modeling.

好吧，我將畫一個更廣泛的畫面，讓 Calvin 談談建模。

In the broader sense, we know that in a mature market that has experience with robotic surgery, that procedure demand will drive the underlying system demand.

在更廣泛的意義上，我們知道在一個擁有機器人手術經驗的成熟市場中，這種手術需求將推動底層系統需求。

And there's 2 ways that they go about it.

他們有兩種方法。

One is capacity, and they can get additional capacity by more efficient utilization of their systems.

一是容量，他們可以通過更有效地利用他們的系統來獲得額外的容量。

We have designed our systems with that in mind.

我們在設計系統時就考慮到了這一點。

We work closely with them in various arrangements to help them get improved efficiency.

我們在各種安排中與他們密切合作，以幫助他們提高效率。

They don't have to buy an x system if they don't want to.

如果他們不想，他們不必購買 x 系統。

The other thing is feature content.

另一件事是特色內容。

Does the product have the feature content that's required to do the procedures they want to do?

產品是否具有執行他們想要執行的程序所需的功能內容？

And so we work with them on those things.

所以我們在這些事情上與他們合作。

Clearly, competitors will enter the market and make claims.

顯然，競爭對手將進入市場並提出索賠。

And I guess what I would say for both customers and for shareholders, due diligence is really important.

我想我會對客戶和股東說什麼，盡職調查真的很重要。

It's really easy to make claims on trade show floors, and it's pretty hard to back them up in real life.

在展會現場提出要求真的很容易，而在現實生活中很難支持它們。

And our experience in the world has been that there's a lot of noise in the beginning as those claims are made.

我們在世界上的經驗是，在提出這些聲明時，一開始就有很多噪音。

And then it takes a couple or 3 years in the actual clinical market and clinical use to see what the broad market thinks about that.

然後在實際的臨床市場和臨床使用中需要幾年或三年的時間才能看到廣大市場對此的看法。

That will have an impact for us in the next few years.

這將在未來幾年對我們產生影響。

I don't know if it's next year or the year after.

不知道是明年還是後年。

And I think that's what Marshall's commentary was signaling is that customers will evaluate and will take their time, and that may change capital acquisition cycle time lines or otherwise and may change the nature of negotiations for us.

我認為這就是馬歇爾的評論所暗示的，客戶將評估並花時間，這可能會改變資本收購週期時間線或其他方式，並可能改變我們談判的性質。

But we're planning and thinking for the long term and we're focused on enablement of the quadruple aim and we'll be here for our customers as we go through that.

但我們正在進行長期規劃和思考，我們專注於實現四重目標，我們將在這里為我們的客戶服務。

Calvin, anything you want to help with modeling?

卡爾文，你想幫助建模嗎？

No.

不。

I mean clearly, procedures are the catalyst for driving the demand for systems.

我的意思很清楚，程序是推動系統需求的催化劑。

When we look at our models, we would expect to see a continuation of the trend of increasing utilization over time.

當我們查看我們的模型時，我們預計會看到隨著時間的推移利用率增加的趨勢的延續。

Vijay, if you have a short follow-up, this is your chance.

維杰，如果你有一個簡短的跟進，這是你的機會。

One last one.

最後一張。

Just 1 quick follow-up, Gary.

只需 1 次快速跟進，加里。

I mean headcount is up 30%, up from 5,000.

我的意思是員工人數從 5,000 人增加了 30%。

We've crossed 7,000.

我們已經超過了7,000。

I mean that's an impressive phenomenal number.

我的意思是這是一個令人印象深刻的驚人數字。

I'm just curious where that is going.

我只是好奇這是怎麼回事。

Yes.

是的。

We try to balance our growth in our investments by both the opportunity, and we think the opportunity is enormous and durable.

我們試圖通過機會來平衡我們的投資增長，我們認為機會是巨大而持久的。

And then we balance it by what we think we can achieve and do well, and that really is what caps our growth and our spend.

然後我們通過我們認為可以實現和做得好的來平衡它，這確實是限制我們的增長和支出的原因。

Absorbing, training, selecting, developing staff, doing rapid growth is really a challenge, and that's what we are focused on.

吸納、培訓、選拔、發展員工，實現快速增長確實是一項挑戰，這也是我們關注的重點。

As we get into 2020, 2021, and we'll share with you in future quarters what our plans are, but we try to balance those 2 things: being agile on pursuing the opportunity; at the same time, making sure we're not overextended and losing our ability to execute and be efficient.

隨著我們進入 2020 年和 2021 年，我們將在未來幾個季度與您分享我們的計劃，但我們試圖平衡這兩件事：敏捷地抓住機會；同時，確保我們不會過度擴張並失去執行和高效的能力。

So thank you.

所以謝謝。

That was our last question.

那是我們的最後一個問題。

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

最後，我們認為從根本上改善手術和急性干預是一個巨大而持久的機會。

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

我們的團隊繼續與醫院、醫生和護理團隊密切合作，以追求我們的客戶稱之為他們的四重目標：更好、更可預測的患者結果、更好的患者體驗、更好的護理團隊體驗，並最終降低總體治療費用。

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

我們相信，手術和急症護理的價值創造從根本上說是人性化的。

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

它源於對患者和護理團隊、他們的需求和環境的尊重和理解。

Thank you for your support on this extraordinary journey to improve surgery.

感謝您在這次改善手術的非凡旅程中的支持。

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 our 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 行政電話會議服務。

You may now disconnect.

您現在可以斷開連接。