直覺手術 (ISRG) 2022 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by. Welcome to the Intuitive Third Quarter Earnings Release Call. (Operator Instructions)

女士們、先生們，感謝您的耐心等待。歡迎參加 Intuitive 第三季財報發布電話會議。 （操作說明）

As a reminder, this conference is being recorded. I would now like to turn the conference over to our host, Head of Investor Relations, Mr. Brian King. Please go ahead.

再次提醒各位，本次會議正在錄製。現在我將會議交給主持人、投資人關係主管布萊恩金先生。請開始吧。

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

下午好，歡迎參加 Intuitive 第三季財報電話會議。

With me today we have Gary Guthart, our CEO; and Jamie Samath, our CFO. 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 our Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 3, 2022, and Form 10-Q filed on July 22, 2022. 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.

今天與我一同出席會議的有我們的執行長 Gary Guthart 和財務長 Jamie Samath。在會議開始之前，我想告知各位，今天電話會議中提及的評論可能包含前瞻性陳述。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有重大差異。這些風險和不確定性已在我們的美國證券交易委員會（SEC）文件中詳細描述，包括我們於 2022 年 2 月 3 日提交的最新 10-K 表格和於 2022 年 7 月 22 日提交的 10-Q 表格。您可以透過我們的網站或 SEC 網站查閱我們的 SEC 文件。投資者請勿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 Events section under our Investor Relations page. 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可在我們網站intuitive.com的「投資者關係」頁面下的「活動」欄位中找到。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 third quarter results as described in our press release announced earlier today, followed by a question-and-answer session. Gary will present the quarter's business and operational highlights, Jamie will provide a review of our financial results, then I will discuss procedure and clinical highlights and provide our updated financial outlook for 2022. And finally, we will host a question-and-answer session.

今天的會議形式如下：首先，我們將重點介紹今天早些時候發布的新聞稿中概述的第三季度業績；隨後進行問答環節。 Gary 將介紹本季的業務和營運亮點；Jamie 將回顧我們的財務表現；之後，我將討論流程和臨床方面的亮點，並提供我們最新的 2022 年財務展望；最後，我們將進行問答環節。

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.

感謝您今天蒞臨。

Our business fundamentals strengthened in Q3 with 20% procedure growth in da Vinci procedures compared with Q3 of last year and solid performance in each of our global regions. Our capital placements reflected 13% growth in our installed base to meet procedure demand accompanied by continued increases in utilization per system per year, healthy indicators for our customers and for us. Ion also experienced increases in installs, procedures performed and annualized system utilization. Supply chain challenges while still present, are abating from their pandemic peaks.

第三季度，我們的業務基本面加強，達文西手術量較去年同期成長20%，全球各區域業績均表現穩健。為滿足手術需求，我們的資本投入反映了裝機量成長13%，同時單系統年利用率持續提升，這對我們的客戶和我們本身而言都是利好消息。 Ion的安裝量、手術量和系統年利用率也均有所成長。供應鏈挑戰雖然依然存在，但已從疫情高峰期逐漸緩解。

Looking more closely at procedures, 20% growth is up from 14% last quarter and above our 3-year compound annual growth rate of 16% during the pandemic. General surgery, our largest procedure category is growing at the fastest rate of any category fueled by bariatric surgery, cholecystectomy, hernia repair and other foregut procedures in the United States.

進一步分析手術量，20%的成長率高於上季的14%，也高於疫情期間三年16%的複合年增長率。一般外科手術是我們最大的手術類別，也是所有類別中成長最快的，這主要得益於美國減肥手術、膽囊切除術、疝氣修補術和其他上消化道手術的進行。

In Europe, several countries are growing nicely with diversified use beyond urology. Germany, the U.K. and Ireland, Italy and Spain stood out in the quarter.

在歐洲，一些國家泌尿科以外的多元化應用發展良好。德國、英國、愛爾蘭、義大利和西班牙在本季表現突出。

In Asia, Japanese procedure growth accelerated relative to Q2 and Korean growth remained solid. Procedures in both countries are also diversifying beyond urology. In China, procedure growth was just above our global average, hampered in part by regional rolling lockdowns that continue to impact procedures and utilization.

在亞洲，日本的手術量成長較第二季度加快，韓國的成長也保持穩健。兩國的手術類型也正從泌尿科擴展到其他領域。在中國，手術量成長略高於全球平均水平，部分原因是區域性輪流封鎖措施持續影響手術量和醫療資源利用率。

Turning to capital. We placed 305 systems in the quarter compared with 336 in Q3 a year ago and 279 last quarter. Strong procedure demand is supporting da Vinci installed base growth of 13% in the quarter. Per system utilization grew 7% in the quarter, up from our 3-year compound annual growth of 5% over the pandemic. Utilization was aided by recovery from a softer U.S. procedure quarter last year as well as customer performance of more types of procedures and higher volume categories and increases in customer efficiency.

再來看資金方面。本季我們安裝了305套系統，而去年同期為336套，上季為279套。強勁的手術需求支撐了達文西手術系統本季13%的裝機量成長。本季單一系統利用率成長了7%，高於疫情期間三年5%的複合年增長率。利用率的成長得益於去年美國手術量疲軟後本季的復甦，以及客戶進行更多類型手術和更高數量手術的積極性，以及客戶效率的提高。

Si trade-ins continued to slow given the decline in remaining trade-in opportunity. Ion placements grew to 50 this quarter, up from 28 last year and 41 last quarter, reflecting continued growth in an early market. Overall, our customers are acquiring systems where there is opportunity for procedure growth.

鑑於剩餘的以舊換新機會減少，矽基（Si）系統的以舊換新速度持續放緩。本季離子植入量增加至 50 例，高於去年同期的 28 例和上季的 41 例，反映出早期市場持續成長。整體而言，我們的客戶正在購買那些有手術量成長機會的系統。

On the investment front, we continue to focus on our platforms in multiport endoluminal, single port and digital through indication and regional regulatory expansions, innovation in products and services that meet customer needs and product quality and cost refinements. We expect our new platforms to approach our historical levels of contribution margin over time. Progress year-to-date has met our expectations.

在投資方面，我們將繼續專注於多端口腔內、單端口和數位化平台，透過拓展適應症和區域監管，創新產品和服務以滿足客戶需求，並不斷提升產品品質和降低成本。我們預計，隨著時間的推移，這些新平台的貢獻利潤率將逐漸接近歷史水準。今年迄今的進展符合預期。

With regard to our expenses this quarter, we moderated headcount growth to focus on deeply integrating those employees who joined us in the past several quarters. Going into 2023, we expect the rate of growth in fixed expenses to slow as we pursue leverage in our enabling functions and sequence some of our forward investments.

本季度，我們放緩了員工人數成長，以便更好地整合過去幾季加入公司的新員工。展望2023年，隨著我們提升職能部門的槓桿作用並調整部分前瞻性投資的順序，我們預期固定支出成長將放緩。

We've had a solid quarter achieving product and services milestones. We continue to expand access to our multiport products, training and services globally. Standouts in the quarter include record global quarterly new surgeon training completions to first case and accreditation of our technology training pathway by the Royal College of Surgeons in the U.K.

本季我們取得了穩健的業績，在產品和服務方面均實現了里程碑式的成就。我們將繼續在全球範圍內擴大多端口產品、培訓和服務的覆蓋範圍。本季度亮點包括：全球新外科醫生培訓完成首例手術人數創下季度新高，以及我們的技術培訓路徑獲得英國皇家外科醫學院的認證。

For Ion, we submitted our registration application in China, and we obtained German regulatory clinical study approval for ion ablation technology, which starts our clinical journey towards enabling interventions beyond biopsy. Ion procedures grew 211% in the quarter.

對於 Ion 技術，我們已在中國提交註冊申請，並獲得了德國監管機構對離子消融技術的臨床研究批准，這標誌著我們邁向超越活檢的臨床介入治療征程。本季 Ion 手術量增加了 211%。

Turning to our single-port platform, da Vinci SP. Procedures grew 46% year-over-year, with particular strength in Korea, where our SP team launched next-generation SP instruments and our Firefly-enabled endoscope. We also received PMDA clearance in the quarter, market SP in Japan across a broad set of clinical indications similar to the indications SP has in Korea.

再來看看我們的單孔手術平台達文西SP。手術量較去年同期成長46%，尤其在韓國表現強勁。我們的SP團隊在韓國推出了新一代SP手術器械和搭載Firefly技術的內視鏡。此外，本季度我們也獲得了日本藥品和醫療器材管理局（PMDA）的批准，將SP產品推向日本市場，其適應症與SP在韓國的適應症類似，涵蓋了廣泛的臨床領域。

In our digital portfolio, our My Intuitive app and PORTaL are being adopted broadly in regions in which they are released as the go-to digital portal for da Vinci customers. Installs of our in-room computing platform, Intuitive Hub grew 21% over the third quarter last year and software updates to our hub installed base improved usability and enabled telepresence.

在我們的數位化產品組合中，My Intuitive 應用程式和 PORTaL 平台在已發布地區被廣泛採用，成為達文西手術系統用戶的首選數位化入口網站。我們的室內運算平台 Intuitive Hub 的安裝量較去年第三季成長了 21%，並且針對已安裝平台的軟體更新提升了易用性並實現了遠端呈現功能。

In summary, our core business strengthened in the quarter as acute pandemic impact softened. We are managing spend growth while investing in core growth opportunities for the future.

總而言之，隨著疫情衝擊的減弱，我們的核心業務在本季有所增強。我們正在控制支出成長，同時投資未來的核心成長機會。

I'll now pass the time over to Jamie to take us through our finances and some persistent macroeconomic issues in greater detail.

現在我將把時間交給傑米，讓他更詳細地為我們介紹我們的財務狀況和一些持續存在的宏觀經濟問題。

Good afternoon.

午安.

I will describe the highlights of our performance on a non-GAAP or 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.

我會先介紹我們以非公認會計準則（非GAAP）或備考財務報表計算的績效重點。稍後，我將在準備好的演講稿中概述我們按公認會計準則（GAAP）計算的績效。我們網站上已公佈備考財務報表與GAAP財務報表的調節表。

In Q3, growth in procedures, the installed base of da Vinci systems and average system utilization was healthy. The strength of these key business drivers resulted in a pro forma operating margin of 36% and pro forma EPS of $1.19.

第三季度，手術量、達文西手術系統裝機量和平均係統利用率均呈現健康成長態勢。這些關鍵業務驅動因素的強勁表現，使得公司達到36%的備考營業利潤率和1.19美元的備考每股收益。

Simultaneously, we saw headwinds from the strong U.S. dollar, lingering supply chain issues and inflation, which together negatively impacted pro forma operating margin by approximately 2 percentage points compared to the third quarter of last year. I will take you through these details.

同時，強勢美元、持續的供應鏈問題和通貨膨脹等不利因素也對公司業績造成了影響，這些因素共同導致備考營業利潤率較去年第三季下降了約2個百分點。接下來我將詳細介紹這些情況。

Q3 procedure growth of 20% reflected an increase in U.S. procedures of 18% and OUS procedure growth of 24%. U.S. procedure growth reflected a favorable comparison to the year ago quarter given the impact of the Delta variant last year. On a 3-year compound annual growth rate basis, U.S. procedures grew approximately 13%.

第三季手術量成長20%，其中美國手術量成長18%，美國境外手術量成長24%。考慮到去年Delta變體的影響，美國手術量的成長較去年同期有所改善。以三年複合年增長率計算，美國手術量成長約13%。

In China, our second largest market during the quarter, procedures continued to recover from the impact of COVID-related lockdowns that we described on last quarter's earnings call. However, we continue to see regional lockdowns occur as COVID cases rise.

在中國，作為我們本季第二大市場，手術量持續從上季財報電話會議上提到的與新冠疫情相關的封鎖措施的影響中恢復。然而，隨著新冠病例的增加，我們仍然看到一些地區出現封鎖措施。

Turning to capital. We placed 305 systems in the third quarter, 9% lower than the 336 systems we placed last year. Third quarter system placements included approximately 15 systems that were delayed at the end of last quarter due to component supply delays.

再來看資金方面。第三季我們共安裝了305套系統，比去年同期的336套減少了9%。第三季安裝的系統中，約有15套是由於上季末零件供應延遲而延後的。

There were 71 trading transactions in the quarter as compared to 136 in Q3 of 2021, reflecting the decline in the number of Si remaining in the installed base. As of the end of Q3, there were approximately 739 Sis remaining in the installed base, of which 191 are in the U.S.

本季共有 71 筆交易，而 2021 年第三季為 136 筆，這反映出已安裝設備中剩餘 Si 數量的下降。截至第三季末，已安裝設備中約有 739 台 Si，其中 191 台位於美國。

Excluding trading transactions, global system placements grew 17% from last year. The installed base of da Vinci systems grew approximately 13% year-over-year, consistent with recent trends. The utilization of clinical systems in the field, measured by procedures per system, increased almost 7% compared to last year. Using a 3-year compound annual growth rate, third quarter utilization was consistent with historical averages, increasing almost 5%.

剔除交易數據後，全球系統安裝量較去年成長17%。達文西手術系統的裝機量年增約13%，與近期趨勢一致。以每台系統完成的手術量衡量，臨床系統的現場使用率較去年增加近7%。以三年複合年增長率計算，第三季使用率與歷史平均持平，成長近5%。

Average system utilization in the U.S. grew 6% year-over-year, an improvement from the 1% decline in utilization in Q2. As a result of our procedure and capital performance, Q3 revenue was $1.56 billion, an increase of 11% from the third quarter of 2021. On a constant currency basis, third quarter revenue grew approximately 15%.

美國平均係統利用率年增6%，較第二季1%的下降幅度有所改善。由於我們的流程和資本營運表現，第三季營收達15.6億美元，較2021年第三季成長11%。以固定匯率計算，第三季營收成長約15%。

In the third quarter, revenue denominated in non-USD currencies represented 22% of total revenue. On a revenue-weighted basis, using current exchange rates, net of hedges in place for Q4, the U.S. dollar is approximately 3% stronger than the rates realized in Q3. Additional revenue statistics and trends are as follows: In the U.S., we placed 175 systems in the third quarter, lower than the 227 in Q3 of 2021, reflecting a decline of 66 systems associated with trade-in transactions and a challenging macroeconomic environment. Outside the U.S., we placed 130 systems in the third quarter compared with 109 last year. Current quarter system placements included 54 into Europe, 32 into Japan and 14 into China compared with 47 into Europe, 20 into Japan and 17 into China in the third quarter of 2021.

第三季度，以非美元貨幣計價的收入佔總收入的22%。以收入加權計算，採用當前匯率（已扣除第四季對沖交易的影響），美元匯率較第三季實際匯率高出約3%。其他營收統計數據和趨勢如下：在美國，第三季我們部署了175套系統，低於2021年第三季的227套，這反映出與以舊換新交易相關的系統數量減少了66套，以及宏觀經濟環境充滿挑戰。在美國以外，第三季我們部署了130套系統，去年同期為109套。本季部署的系統包括歐洲54套、日本32套和中國14套，而2021年第三季分別為歐洲47套、日本20套和中國17套。

As of the end of Q3 2022, there were 40 systems remaining under the current quota in China, which is also available to the 3 domestic competitors that have completed local registration with NMPA. Markets that are served through distributors have represented approximately 10% of system placements so far this year. Our distribution partners purchased product from us in U.S. dollars and sell in their local currencies. While we have not experienced a significant impact so far, the strengthening of the U.S. dollar reduces distributor margins and may cause delays in capital purchases.

截至2022年第三季末，中國市場現有配額下剩下40套系統，此分配金額也提供給已完成國家藥品監督管理局（NMPA）本地註冊的3家國內競爭對手。今年迄今，透過經銷商銷售的市場約佔系統總裝機量的10%。我們的分銷合作夥伴以美元向我們採購產品，並以當地貨幣銷售。雖然目前我們尚未受到顯著影響，但美元走強會降低經銷商的利潤率，並可能導致資金採購延遲。

Leasing represented 37% of Q3 placements compared with 42% last quarter and 41% in the third quarter of 2021. The lower lease mix is a function of customer and regional mix. And while leasing will fluctuate from quarter-to-quarter, we continue to expect that the proportion of placements under operating leases will increase over time.

第三季租賃佔總部署量的37%，低於上季的42%和2021年第三季的41%。租賃佔比下降與客戶和區域組成有關。儘管租賃佔比會隨季度波動，但我們仍預期經營租賃的部署比例會隨著時間的推移而增加。

Third quarter system average selling prices were $1.5 million, consistent with last quarter. System ASPs were negatively impacted by a higher trade-in mix and the impact of FX, offset by a higher mix of Xi dual console placements. We recognized $17 million of lease buyout revenue in the third quarter compared with $22 million last quarter and $25 million last year. Lease buyout revenue has varied significantly quarter-to-quarter and will likely continue to do so.

第三季系統平均售價為150萬美元，與上季持平。系統平均售價受到以舊換新比例上升和匯率波動的影響，但被Xi雙主機配置比例上升所抵銷。第三季我們確認了1,700萬美元的租賃買斷收入，而上季為2,200萬美元，去年同期為2,500萬美元。租賃買斷收入季度間波動較大，預計未來仍將如此。

Instrument and accessory revenue per procedure was approximately $1,800 compared with approximately $1,900 for both last quarter and last year. On a year-over-year basis, FX negatively impacted I&A per procedure by approximately $50. The remainder of the year-over-year reduction was primarily a result of customer ordering patterns. During the quarter, our distributors and customers in certain OUS markets reduced their inventory as supply chain predictability moderately improved.

每台手術的器械及配件收入約為 1,800 美元，而上一季和去年同期均為約 1,900 美元。年比來看，匯率波動使每台手術的器械及配件收入減少了約 50 美元。其餘同比下降主要歸因於客戶訂購模式的變化。本季度，隨著供應鏈可預測性的略微改善，我們在部分海外市場的經銷商和客戶減少了庫存。

We placed 50 Ion systems in the quarter as compared to 28 in the third quarter of last year. The installed base of Ion systems is now 254 systems, of which 112 are under operating lease arrangements. Third quarter Ion procedures of approximately 6,400 increased 211% on a year-over-year basis. Ion is in the new MDR regulatory review process in Europe, and during the quarter, we submitted Ion into the regulatory process in China. As a reminder, regulatory review timelines in China are lengthy.

本季我們安裝了50套Ion系統，而去年同期為28套。目前Ion系統的裝機量為254套，其中112套為租賃經營。第三季Ion系統手術量約6,400例，較去年同期成長211%。 Ion系統目前正在歐洲接受新的醫療器材法規（MDR）審查，本季我們也已將Ion系統提交至中國監管機構進行審查。需要提醒的是，中國的監管審查週期較長。

Moving on to the rest of the P&L. Pro forma gross margin for the third quarter of 2022 was 69.8% compared with 71.3% for the third quarter of 2021 and 69.2% last quarter. Q3 pro forma gross margin included a onetime benefit of approximately 50 basis points relating to the favorable conclusion of certain indirect tax matters. Pro forma gross margin was lower than last year, primarily due to the stronger U.S. dollar, manufacturing and logistics inefficiencies as a result of the supply chain environment, higher component pricing and increased fixed costs relative to revenue. Indicators of supply and inventory held modestly improved in the quarter but remained well below pre-pandemic levels. Pro forma operating expenses increased 24% compared with third quarter of 2021, driven by increased headcount, higher R&D-related project costs and higher travel costs.

接下來來看損益表的其他部分。 2022年第三季的備考毛利率為69.8%，而2021年第三季為71.3%，上一季為69.2%。第三季備考毛利率包含約50個基點的一次性收益，該收益與某些間接稅事項的有利結果有關。備考毛利率低於去年同期，主要原因是美元走強、供應鏈環境導致生產和物流效率低下、零件價格上漲以及固定成本佔收入的比例增加。本季供應和庫存指標略有改善，但仍遠低於疫情前水準。備考營運費用較2021年第三季成長24%，主要原因是員工人數增加、研發相關專案成本上升以及差旅費用增加。

Growth in operating expenses has been primarily in support of our Ion platform, next-generation robotics capabilities, our digital capabilities and expansion of our infrastructure to allow us to effectively scale. We are also seeing higher regulatory costs as a result of increased regulatory requirements globally and expansion of our new platforms into OUS markets.

營運支出成長主要用於支援我們的Io平台、下一代機器人技術、數位化能力以及基礎設施的擴展，從而實現有效規模化發展。此外，由於全球監管要求的提高以及新平台拓展至美國境外市場，我們也面臨更高的監管成本。

As Gary mentioned earlier, during the quarter, we slowed our hiring pace, adding approximately 530 employees lower than the 700-plus employees we have added per quarter in the last 3 quarters. As we look forward to 2023, we expect our operating expense growth will be lower than the growth for this year. The slowing growth rate of operating expenses reflects the completion of some of our infrastructure and business process improvement investments and planned leverage in our enabling functions.

正如Gary先前所提到的，本季我們放緩了招募速度，新增員工約530人，低於過去三個季度每季新增700多人的平均值。展望2023年，我們預期營運費用成長將低於今年的水準。營運費用成長放緩反映了我們部分基礎設施和業務流程改善投資的完成，以及我們在各項職能部門中規劃的槓桿作用。

As part of our planning process, we are also conducting a review of our capital expenditure priorities and we'll provide an update as to the outcome of this review on the next call. Within this framework, we will continue to invest in our new platforms, in NSP, next-generation capabilities and our digital ecosystem given the return profiles we see for those investments.

作為規劃流程的一部分，我們正在對資本支出優先事項進行審查，並將在下次電話會議上報告審查結果。在此框架下，鑑於我們對這些投資回報的預期，我們將繼續投資於新平台、網路服務供應商 (NSP)、下一代功能以及數位生態系統。

Pro forma other income was $7.2 million for Q3, lower than $10.4 million in the prior quarter, primarily due to the impact of foreign exchange losses from remeasurement of the balance sheet resulting from the continued strengthening of the U.S. dollar. Our pro forma effective tax rate for the third quarter was 23.4%, in line with our expectations.

第三季其他收入（以備考基準計算）為720萬美元，低於上一季的1,040萬美元，主要原因是美元持續走強導致資產負債表重新計量，進而產生外匯損失。第三季實際稅率（以備考基準計算）為23.4%，符合預期。

Third quarter 2022 pro forma net income was $429 million or $1.19 per share compared with $435 million and also $1.19 per share for the third quarter of last year.

2022 年第三季以備考計算的淨收入為 4.29 億美元，即每股 1.19 美元，而去年同期為 4.35 億美元，每股收入也為 1.19 美元。

Capital expenditures in Q3 were $153 million primarily comprised of infrastructure investments to expand our facilities footprint and increase manufacturing capacity.

第三季資本支出為 1.53 億美元，主要包括基礎設施投資，以擴大我們的設施規模和提高生產能力。

I will now summarize our GAAP results. GAAP net income was $324 million or $0.90 per share for the third quarter of 2022 compared with GAAP net income of $381 million or $1.04 per share for the third quarter of 2021. 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 stock-based compensation, amortization of intangibles, litigation charges and gains and losses on strategic investments.

現在我將總結我們的GAAP業績。 2022年第三季GAAP淨利為3.24億美元，即每股0.90美元，而2021年第三季GAAP淨利為3.81億美元，即每股1.04美元。備考淨利潤與GAAP淨利潤之間的調整項已在我們的網站上列出並量化，其中包括與員工股票獎勵、員工股票期權激勵、無形資產攤銷、訴訟費用以及戰略投資損益相關的超額稅收優惠。

We ended the quarter with cash and investments of $7.4 billion compared with $8.2 billion at the end of Q2. The sequential reduction in cash and investments reflected share repurchases and capital expenditures, partially offset by cash from operating activities. During the quarter, we completed a $1 billion ASR in addition to the $607 million of shares repurchased in the first half.

本季末，我們的現金及投資總額為74億美元，而第二季末為82億美元。現金及投資的環比減少反映了股票回購和資本支出，部分被經營活動產生的現金流量所抵銷。本季度，我們完成了10億美元的增發股份回購（ASR），此外，上半年我們也回購了6.07億美元的股票。

Since the end of 2021, our diluted share count has decreased by approximately 7 million shares or 2% and we have a remaining authorization to repurchase our shares of $2.5 billion.

自 2021 年底以來，我們的稀釋股份數量減少了約 700 萬股，即 2%，我們還有 25 億美元的股份回購授權。

And with that, I would like to turn it over to Brian, who will discuss clinical highlights and provide our updated outlook for 2022.

接下來，我將把發言權交給布萊恩，他將討論臨床亮點並提供我們最新的 2022 年展望。

Thank you, Jamie.

謝謝你，傑米。

Our overall third quarter 2022 procedure growth was 20% compared to 20% for the third quarter of 2021 and 14% last quarter. The 3-year compound annual growth rate between the third quarter of 2019 and third quarter of 2022 was 16%. In the U.S., third quarter 2022 procedures exceeded our expectations with growth at 18% year-over-year compared to 16% for the third quarter of 2021 and 11% last quarter.

2022年第三季度，我們的整體手術量成長了20%，與2021年第三季度的20%和上一季的14%持平。 2019年第三季至2022年第三季的三年複合年增長率為16%。在美國，2022年第三季的手術量超出預期，年增18%，高於2021年第三季的16%和上一季的11%。

Procedure growth reflects a positive impact relative to Q3 last year, which was impacted by the Delta variant. On a 3-year compound annual growth basis, U.S. procedure growth was 13%. Third quarter procedure growth continued to be driven by general surgery with strength in bariatrics, cholecystectomy and hernia repair. Trends in malignant procedures, namely colorectal and lobectomy procedures were also strong. Growth in gynecology, our second largest procedure category in the U.S., also experienced double-digit growth while more mature urologic procedures grew in the high single digits.

與去年第三季受Delta波動影響相比，手術量成長呈現正向態勢。以三年複合年增長率計算，美國手術量成長率為13%。第三季手術量成長持續由一般外科手術推動，其中減重手術、膽囊切除術和疝氣修補術表現強勁。惡性腫瘤手術，特別是結直腸手術和肺葉切除術，也呈現強勁成長趨勢。婦科手術（美國第二大手術類別）也實現了兩位數增長，而較成熟的泌尿外科手術則實現了接近兩位數的增長。

Outside of the U.S., third quarter procedure volume grew approximately 24% year-over-year compared to 30% for the third quarter of 2021 and 22% last quarter. On a 3-year compound annual growth basis, procedure growth was 21%.

除美國以外，第三季手術量年增約24%，而2021年第三季為30%，上一季為22%。以三年複合年增長率計算，手術量成長率為21%。

Turning to Europe. Procedure growth was led by strong growth in Germany, U.K., Italy and Spain. In all of the regions noted, procedure growth outside of urology was strong in general surgery and gynecology categories. Specifically in Germany, we experienced early stage growth in benign hysterectomy and colorectal surgery. In the U.K., growth was led by benign hysterectomy, colorectal and cholecystectomy procedures. While still early stage, year-over-year procedure growth in these non-urology procedures was almost 4x higher than urology.

再來看歐洲。手術量的成長主要得益於德國、英國、義大利和西班牙的強勁成長。在上述所有地區，泌尿外科以外的手術量成長也十分強勁，尤其是在一般外科和婦科領域。具體而言，在德國，良性子宮切除術和結直腸手術的成長尚處於早期階段。在英國，良性子宮切除術、大腸直腸手術和膽囊切除術的成長尤其顯著。儘管仍處於早期階段，但這些非泌尿外科手術的年增長率幾乎是泌尿外科手術的四倍。

Turning to Asia. In Japan, growth in general surgery and gynecology continued to be strong. We experienced robust growth in these categories led by gastrectomy, rectal resection and benign hysterectomy. Further contributing to strong procedure performance was continued early-stage growth in newly reimbursed procedures, namely colon resection and nephrectomy procedures.

再來看亞洲市場。在日本，一般外科和婦科手術的成長動能依然強勁。在胃切除術、直腸切除術和良性子宮切除術的帶動下，這些領域的成長尤其顯著。此外，新納入健保報銷範圍的手術，如結腸切除術和腎切除術，也持續保持早期成長，進一步推動了手術業務的強勁表現。

In China, we continue to see a recovery in the first couple of months of the third quarter as COVID cases began to decline and lockdown restrictions were lifted. Procedure growth was driven by urologic procedures, specifically prostatectomy and partial nephrectomy, along with strong growth in colon resection within general surgery. Later in the quarter, we began to see procedures start to moderate as COVID began to reemerge in various regions and rolling lockdowns were implemented.

在中國，隨著新冠病例開始下降和封鎖限制的解除，第三季前幾個月我們持續看到復甦跡象。手術量的成長主要由泌尿外科手術推動，特別是前列腺切除術和部分腎切除術，同時普通外科的結腸切除術也實現了強勁增長。但到了第三季後期，隨著新冠疫情在各地再次出現，以及各地實施輪流封鎖措施，手術量開始趨於平穩。

Korea procedure growth was also solid in the third quarter. Growth in procedures continued to be broad-based with strong growth in SP procedures.

韓國第三季手術量成長依然穩健。手術量成長持續全面，其中SP手術量成長強勁。

Now turning to the clinical side of our business. Each quarter on these calls, we highlight certain recently published studies that we deem to be notable. 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.

現在我們來談談業務的臨床方面。每個季度，我們都會在這些電話會議上重點介紹一些我們認為值得關注的近期發表的研究。然而，為了更全面地了解現有證據，我們鼓勵所有利害關係人仔細審查多年來發表的大量科學研究的詳細資訊。

Earlier today at the Annual CHEST conference in Nashville, Tennessee, Dr. Eric Folk from Massachusetts General Hospital presented preliminary performance updates from the PRECIsE study. Results were consistent with data released last year and demonstrated encouraging results for diagnostic yield and sensitivity of malignancy for samples obtained through an Ion procedure with a strong safety profile. We anticipate the final data from PRECIsE to be published in the first part of next year.

今天早些時候，在田納西州納許維爾舉行的年度胸腔科（CHEST）會議上，麻省總醫院的埃里克·福克博士介紹了PRECIsSE研究的初步表現更新。結果與去年發表的數據一致，顯示透過離子束技術取得的樣本在診斷率和惡性腫瘤敏感性方面均取得了令人鼓舞的結果，且安全性良好。我們預計PRECIsSE的最終數據將於明年上半年公佈。

Continuing with Ion, a group from the Mayo Clinic in both Rochester, Minnesota and Jacksonville, Florida, led by doctors Alejandra Yu Lee-Mateus, Janani Reisenauer and Sebastian Fernandez-Bussy published a retrospective case series in respirology, comparing the performance of the Ion endoluminal system with the CT guided transthoracic approach for pulmonary lesion biopsy.

繼續介紹 Ion，來自明尼蘇達州羅徹斯特和佛羅裡達州傑克遜維爾的梅奧診所的一個小組，由 Alejandra Yu Lee-Mateus、Janani Reisenauer 和 Sebastian Fernandez-Bussy 醫生領導，在呼吸病學中發表了一系列回顧性病例，比較了 Ion 腔內系統與 CT 引導經胸路進行肺活檢的表現。

A total of 225 patients were included in this study. 113 who underwent an Ion procedure with a median nodule size of 18 millimeters and 112 who underwent a transthoracic biopsy with a median nodule size of 16 millimeters. Within the Ion group, the overall diagnostic yield and sensitivity for malignancy reported was 87.6% and 82.1%, respectively, which were comparable to the same outcomes from the transthoracic approach.

本研究共納入225例患者。其中113例接受了Ion手術，結節中位數為18毫米；112例接受了經胸穿刺活檢，結節中位數大小為16毫米。 Ion組的整體診斷率和惡性腫瘤敏感性分別為87.6%和82.1%，與經胸穿刺切片的結果相當。

Importantly, the rate of complications was significantly lower for the Ion approach with a 13% difference relative to the transthoracic approach. Further analysis demonstrated an approximately 80% reduced chance of pneumothorax associated with the Ion procedure. The authors concluded in part that robotic-assisted approach with Ion can be as accurate as the transthoracic approach for sampling pulmonary nodules with similar or reduced complications and should be considered as a means for nodule biopsy.

值得注意的是，與經胸入路相比，Ion 手術的併發症發生率顯著降低，差異達 13%。進一步分析表明，Ion 手術可使氣胸發生率降低約 80%。作者得出結論，機器人輔助 Ion 手術在肺結節取樣方面與經胸入路一樣精準，且並發症相似或更少，應被視為一種可行的結節活檢方法。

Turning to the surgical side. Dr. Leonardo (inaudible) from the University of Bologna and colleagues published a systematic review and meta-analysis comparing the robotic-assisted and laparoscopic approaches for left colectomy procedures in the International Journal of Colorectal Disease. Data from 11 different articles, including over 52,000 patients were included in this analysis, with over 13,500 in the robotic arm and over 39,000 in the laparoscopic arm and with no difference in preoperative characteristics reported. With regard to perioperative outcomes, a 4% lower conversion to open rate was reported for the robotic-assisted approach compared to the laparoscopic approach.

轉向外科手術方面。博洛尼亞大學的萊昂納多博士（聽不清楚）及其同事在《國際結直腸疾病雜誌》上發表了一篇系統性回顧和統合分析，比較了機器人輔助和腹腔鏡左半結腸切除術。分析納入了11篇不同文章的數據，共涉及超過52,000名患者，其中機器人輔助組超過13,500名，腹腔鏡組超過39,000名，兩組患者的術前特徵無差異。關於圍手術期結果，機器人輔助組的開腹手術率比腹腔鏡組低4%。

Further analysis demonstrated the risk of conversion to open for the robotic-assisted approach was approximately half the rest of the laparoscopic approach. In addition, the analysis showed a higher risk of postoperative complications after a laparoscopic left colectomy, as well as a lower rate of superficial wound infections for the robotic-assisted approach.

進一步分析表明，機器人輔助手術轉為開腹手術的風險約為其他腹腔鏡手術的一半。此外，分析也顯示，腹腔鏡左半結腸切除術後併發症的風險較高，而機器人輔助手術的淺層傷口感染率較低。

The analysis also showed anastomotic leak was 30% less likely with the robotic-assisted approach compared to the lap group. The authors concluded in part that robotic left colectomy requires less conversion to open surgery than the standard laparoscopic approach and more studies are warranted to highlight possible advantages in using the robotic platform for left colectomy.

分析也顯示，與腹腔鏡手術組相比，機器人輔助手術組的吻合口滲漏發生率降低了30%。作者的部分結論是，機器人輔助左半結腸切除術較標準腹腔鏡手術需要轉為開腹手術的比例更低，但仍需進行更多研究來凸顯機器人輔助左半結腸切除術的潛在優勢。

I will now turn to our financial outlook for 2022. Starting with procedures. On our last call, we forecast full year 2022 procedure growth within a range of 14% to 16.5%. We are now increasing our forecast and expect full year 2022 procedure growth of 17% to 18%. This range continues to reflect the uncertainty associated with the course of the pandemic. The low end of the range still assumes increasing COVID hospitalizations, regional lockdowns and staffing pressure at hospitals for the remainder of the year.

接下來，我將談談我們對2022年的財務展望。首先是手術量。在上一次電話會議上，我們預測2022年全年手術量成長率介於14%至16.5%之間。現在，我們上調了預測，預計2022年全年手術量成長率將達到17%至18%。這項預測區間仍反映了疫情發展帶來的不確定性。即使將預測值設定在較低水平，也仍假設今年剩餘時間內新冠肺炎住院人數將持續增加，部分地區將實施封鎖措施，並且醫院將面臨人員短缺的壓力。

At the high end of the range, we assume COVID-19-related hospitalizations around the world continue to decline throughout the remainder of 2022, and there are no additional significant impacts from further resurgences. The range does not reflect significant material supply chain disruptions or hospital capacity constraints similar to what we have experienced at the start of the pandemic.

在預測範圍的高端，我們假設2022年剩餘時間內全球新冠肺炎相關住院人數將持續下降，且不會出現疫情反彈帶來的其他重大影響。此預測範圍並未考慮類似疫情初期那樣嚴重的物資供應鏈中斷或醫院容量限制。

Turning to gross profit. On our last call, we forecast our 2022 full year pro forma gross profit margin to be within 69% and 70.5%, expected to be towards the lower end of that range. We are now refining our estimate of pro forma gross profit margin to be within 69% and 69.5% of net revenue, given the ongoing impact of higher input costs related to supply chain and the impact from a stronger U.S. dollar. Our actual gross profit margin will vary quarter-to-quarter depending largely on products, regional and trade-in mix, fluctuations in foreign currency rates and the impact of new product introductions.

接下來談談毛利。在上一次電話會議上，我們預測2022年全年備考毛利率將在69%至70.5%之間，預計會更接近該區間的下限。鑑於供應鏈相關投入成本持續上漲以及美元走強的影響，我們現在將備考毛利率佔淨收入的預估值調整為69%至69.5%。實質毛利率將因產品、地區和以舊換新組合、外匯匯率波動以及新產品上市的影響而逐季波動。

With respect to operating expenses, on our last call, we forecast pro forma operating expense growth to be between 23% and 25%. We are adjusting our estimate and now expect our full year pro forma operating expense growth to be between 21% and 23%. We are narrowing our estimate for noncash stock compensation expense to range between $520 million to $530 million in 2022. We are also updating our estimate for other income which is comprised mostly of interest income to total between $40 million and $50 million in 2022, a decrease from our previous estimate of $60 million and $70 million. The decrease primarily reflects lower interest income on cash that was used to repurchase shares and also the net impact of certain foreign exchange gains and losses.

關於營運費用，在上一次電話會議上，我們預測備考營運費用成長率將在23%至25%之間。我們正在調整這項預測，目前預計全年備考營運費用成長率將在21%至23%之間。我們將2022年非現金股權激勵費用的預測範圍縮小至5.2億美元至5.3億美元之間。同時，我們也更新了其他收入的預測，該收入主要包括利息收入，預計2022年總額將在4000萬美元至5000萬美元之間，低於我們先前預測的6000萬美元至7000萬美元。此次下調主要反映了用於回購股票的現金利息收入減少，以及某些外匯損益的淨影響。

On last quarter's call, we forecast 2022 capital expenditures within a range of $700 million to $800 million. We are now lowering our estimate for capital expenditures for 2022 to be in the range of $600 million to $700 million. With regard to income tax, we continue to estimate our 2022 pro forma tax rate to be between 22% and 24% of pretax income.

在上季財報電話會議上，我們預測2022年資本支出將在7億至8億美元之間。現在，我們將2022年資本支出預期下調至6億至7億美元。關於所得稅，我們仍預期2022年備考稅率為稅前利潤的22%至24%。

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

我們的發言到此結束。現在開始接受各位提問。

Maggie, I think we'd like to go ahead and lead the Q&A to the...

瑪吉，我想我們應該繼續進行問答環節…

(Operator Instructions)

（操作說明）

And first, we have a question from the line of Travis Steed with Bank of America.

首先，我們來聽聽美國銀行的崔維斯‧史蒂德提出的問題。

Congrats on the good quarter. Maybe, Gary, on the capital selling funnel, just maybe you could comment how the funnel has changed since the beginning of the year when you initially highlighted a slower funnel. And just trying to square away the 13% installed base growth with the slower funnel. And if that's being offset by the 7% higher utilization and how to think about capital in the double placements moving forward?

恭喜本季業績出色。 Gary，關於資本銷售管道，您能否談談自年初以來通路變化情況？年初時您曾指出通路成長放緩。另外，能否解釋一下13%的裝置成長與通路成長放緩之間的關係？ 7%的利用率提升是否抵銷了這一成長？未來在雙倍裝置容量的情況下，您又該如何看待資本投入問題？

What we're seeing on that side, on the capital side, is that where we see healthy procedure growth, the installed base growth is keeping pace. And you're absolutely right in your question to kind of link utilization growth with installed base growth.

從資本方面來看，我們看到，在手術量健康成長的地方，設備安裝量也同步成長。您提出的將利用率成長與設備安裝量成長連結起來的問題完全正確。

On the utilization side, the 7% is higher than the norm. It's got a little artifact in it, we think, which is a year ago, third quarter was a little bit suppressed because of the Delta variant. So I think it's hard to keep doing 7% quarterly. If the customers could do that, we'd be delighted. It's -- utilization is good for them, it's good for us and it's fine. It's just hard to move in a durable way because of all the workflow issues in the hospital at large, not just robotics, but just across the system. So we're seeing both.

從利用率方面來看，7%高於正常水準。我們認為這其中存在一些偏差，因為年前的第三季由於Delta變體的影響，數據略有下降。所以我認為很難每季都維持7%的利用率。如果客戶能夠做到這一點，我們會非常高興。利用率對他們有利，對我們有利，這很好。只是由於醫院整體工作流程中存在諸多問題，不僅是機器人方面的問題，而是整個系統的問題，因此很難持續維持這種水準。所以我們目前兩種情況都存在。

I think the capital side, what we've seen here is that capital is available to be competed for if you can become a high priority within the hospital to get it. So it's not so much that the capital environment is easy as it is competitive. And if you can rise on the party list, then we'll find that the loop, and we're seeing that in installed base growth in greenfields and in Ion.

我認為，就資金方面而言，我們已經看到，如果你能在醫院內部獲得優先權，就能競爭到資金。所以，與其說資金環境容易取得，不如說競爭非常激烈。如果你能在醫院的名單上排名靠前，我們會發現，這形成了一個良性循環，我們在新建項目和Ion的安裝基礎增長中都看到了這一點。

Next question from the line of Amit Hazan with Goldman Sachs.

接下來是來自高盛的 Amit Hazan 提出的問題。

A couple of questions, if that's okay. First, I think, maybe just to ask about how you're thinking about the pipeline for more mature procedures. If I heard you right, you were urology and gynecology up high single digits, double digits in the U.S., pretty good numbers. Just want to make sure those are clean. And then just kind of the typical question about your own sources, external internal customer discussions, just how you're thinking about the diagnostic pipeline for those slower growing cancer procedures and kind of where we are or where we're heading relative to the trough levels that were observed last year?

可以嗎？我想問幾個問題。首先，我想問您對成熟手術流程的看法。如果我沒理解錯的話，您提到美國泌尿科和婦科的成長率達到了個位數甚至兩位數，相當不錯。我想確認一下這些數據是否準確。然後，我想問一個比較常規的問題，關於您自身的資訊來源，包括與外部和內部客戶的討論，您是如何看待那些增長較慢的癌症診斷流程的？我們目前的狀況如何？與去年的低谷相比，我們未來的發展方向是什麼？

Okay. On the issue of kind of the quality of growth on urology and gynecology, Brian, I'm going to kick that to you.

好的。關於泌尿科和婦科的發展品質問題，布萊恩，我把這個問題交給你來回答。

Sure. And I think Gary touched on it on the previous answer, an element of that being just a comparison period from last year. But still seeing really healthy growth in those particular categories. As I called out, growth in gynecology, which is our second largest procedure category, did have, I'd say, double-digit growth probably in the lower end there and then those more mature urologic procedures being those high single digits, but it's really favoring from the comparison from last year, but still doing really well.

當然。我想Gary在先前的回答中已經提到了這一點，部分原因是與去年同期相比有所波動。但這些特定類別仍然保持著非常健康的成長。正如我之前提到的，婦科手術（我們第二大手術類別）的增長確實達到了兩位數，雖然可能只是低端部分，而泌尿外科手術的增長則在個位數以上，但與去年同期相比確實有所改善，而且整體表現依然非常出色。

On the diagnostic pipelines, what we continue to see for the most part is relatively steady in terms of the tests that are occurring mostly a little below the volumes that we saw pre-pandemic. The one exception that we've seen in the U.S. in kind of recent trends is a tick up in colonoscopies. I wouldn't say that this evidence that that's impacted da Vinci procedures yet as that's a recent trend. Obviously, we're encouraged by the fact that more patients are able to get back to having those diagnostic tests, and we'll see how that plays out in terms of surgery.

在診斷流程方面，我們看到大部分的偵測量仍然相對穩定，略低於疫情前的水平。美國近期出現的唯一例外是大腸鏡檢查數量略有上升。但我認為這還不足以對達文西手術產生影響，因為這只是近期的趨勢。顯然，我們很高興看到更多患者能夠恢復這些診斷檢測，至於這對外科手術的影響，我們將拭​​目以待。

On just a follow-up point to Brian, your answer, I think the other thing is that while we're mature in urology and gynecology in the United States, there's still a little growth there too. But outside the United States and Europe and Asia, we are still relatively early, and we think that in those 2 categories, we'll continue to see growth.

關於布萊恩的回答，我想補充一點，雖然美國的泌尿外科和婦科已經發展成熟，但仍有一些成長空間。但在美國以外的歐洲和亞洲，我們仍處於相對早期的階段，我們認為在這兩個領域，我們將持續看到成長。

Jamie, just a follow-up point on your answer on the diagnostics side. You were saying it started to come back, and we're seeing a little bit of an uptick. It is absolutely clear that there's been a trough or a bolus of people who stayed out of diagnostic pipelines, and that hasn't fully recovered. And their disease is progressing. That is also absolutely clear in the literature. So how big that is and what that looks like as they come back into the health system in terms of surgery and da Vinci surgery, you're just going to have to wait and see. It's a hard thing to measure. But I think there's a bolus out there, and it's unfortunate given disease progression.

傑米，關於你剛才提到的診斷方面，我還有一點要補充。你說診斷數量開始回升，我們也確實看到了一些增長。但很明顯，有一部分患者因為各種原因沒有接受診斷，導致診斷數量激增，而這種情況尚未完全恢復。他們的病情仍在發展中。這一點在文獻中也有明確記載。至於這部分患者的數量究竟有多大，以及當他們重新回到醫療系統接受手術和達文西機器人手術時，情況會如何，我們只能拭目以待。這很難衡量。但我認為目前確實存在一個患者群體，考慮到疾病的進展，這種情況令人遺憾。

And next, we have a question from the line of Larry Biegelsen with Wells Fargo.

接下來，我們來聽聽來自富國銀行的 Larry Biegelsen 的問題。

Congratulations. Just 2 for me. I wanted to start, Gary, with the color commentary you gave on OpEx spending next year. If we look at the last 5 years, you grew EPS faster than sales -- or pre-COVID, I'm sorry, 4 to the 5 years, this year, it looks like earnings will probably be down. How much of a priority is EPS growth? And what would need to happen for you to get back to the algorithm where you grew EPS faster than sales? And I have one follow-up.

恭喜！我只有兩個問題。 Gary，我想先談談你對明年營運支出（OpEx）的分析。回顧過去五年，你們的每股盈餘（EPS）成長速度超過了銷售額的成長速度——或者說，在新冠疫情爆發前，是過去五年中的四到五年。但今年，獲利似乎可能會下降。 EPS成長對你們來說有多重要？你們需要做些什麼才能讓EPS成長速度重回之前超過銷售成長的軌道？我還有一個後續問題。

The -- we watch it. We want to make sure that we're efficient stewards of our expenses and our capital. And where we see an efficiency, we'll pursue it. That's what I've been messaging and that's what I was talking about here in the script.

我們會密切注意。我們希望確保有效管理支出和資金。一旦發現提高效率的機會，我們就會加以利用。這就是我一直強調的，也是我剛才在稿子裡提到的。

We think there are opportunities for us to increase our productivity and to do a better job onboarding from the staff we've brought in, helping them become more productive more quickly. We think there are really good opportunities in our new platforms, the things we've been talking to you about. Ion is growing nicely. SP, as we pursue additional indications, I think will be quite strong and we're pleased with multiport currently what's in the market, the things we're working on as well as our digital tools.

我們認為，我們有機會提高生產力，並更好地指導新員工入職，幫助他們更快地提高工作效率。我們認為，我們新的平台（也就是我們之前和您討論過的那些平台）蘊藏著巨大的機會。 Ion 平台發展動能良好。隨著我們不斷拓展適應症，SP 平台我認為會非常強大。我們對目前市場上的多端口產品、我們正在研發的產品以及我們的數位化工具都感到滿意。

So we think those things are important. We don't want to starve them, but we will sequence them. So it's a balanced approach. Some of it is making sure that our growth engines remain intact, and we continue to innovate. Other parts are just making sure that we're being efficient with our use of capital and that we're building a lean organization as we grow.

所以我們認為這些都很重要。我們不想讓它們停滯不前，但我們會按部就班地進行。這是一種平衡的方法。一方面，我們要確保成長引擎保持暢通，並持續創新。另一方面，我們要確保有效率地運用資金，並在發展過程中打造精簡且有效率的組織架構。

Jamie, you can speak a little bit to the expense characterization as you see it.

Jamie，你可以根據你的看法，談談你對費用性質的看法。

There's just a couple of framing comments I'd make, Larry. If you look at the midpoint of the procedure guidance we provided, on a 3-year CAGR basis, that's procedure growth of about 15%. Just over 15%. You do the same for our OpEx guidance, that's just under 15%. So kind of back to 2019 on a 3-year CAGR basis, procedure growth and spending growth relatively in line.

拉里，我還有幾點補充說明。如果你看我們提供的流程指導的中點，以三年複合年增長率計算，流程成長率約為15%，略高於15%。同樣的方法也適用於我們的營運支出指導，略低於15%。所以，從2019年至今，以三年複合年增長率計算，流程成長率和支出成長率大致一致。

Just one other thing I'd highlight to make a point. If you look at the reported revenue growth for Q3 and 11% year-over-year, if you look at our recurring revenue growth, that's about 80% of our total revenue, 16%. If you adjust that on a constant currency basis, it's 20% revenue growth. And so comparable with the 20% procedure growth.

我還有一點要強調。如果您看一下第三季公佈的營收成長，年增11%，那麼如果您看一下我們的經常性收入成長，這大約佔總營收的80%，也就是16%。若以固定匯率調整，營收成長率為20%。這與20%的手術量成長率相當。

When you look back at '18, '19, generally, procedure growth and revenue growth are relatively similar. You're seeing a disconnect right now for the reasons we've described the lower trade-in volumes, trade-in volumes so far this year are down 40% from the prior year, and you're seeing the impact of FX, as we've described. And so there are some macro and secular level impacts on what's happening in the P&L this year. Specifically on spending, we kind of described it in the script.

回顧2018年和2019年，整體而言，手術量成長和收入成長相對接近。但目前兩者出現了脫節，原因正如我們之前所述，包括以舊換新量下降（今年迄今的以舊換新量比去年同期下降了40%）以及匯率波動的影響。因此，今年的損益表受到一些宏觀和長期因素的影響。具體到支出方面，我們在腳本中已經有所描述。

There are some infrastructure investments that we've been making that start to complete, and that creates the opportunity for us to spend at a lower growth rate. And given the work that we've done and the investments that we've made, we are going to look for some leverage in our enabling functions, particularly as we get into next year.

我們一直在進行的一些基礎設施投資項目已開始竣工，這為我們以較低的成長率進行支出創造了機會。鑑於我們已經完成的工作和投資，我們將在各項職能部門尋求一些槓桿作用，尤其是在明年。

Final thing that Gary mentioned was as you look at kind of our pipeline, there's some natural sequencing that you'll do with respect to some of our programmatic spending next year. And those factors play into the slowing operating expense growth rate that we've described.

Gary最後提到的一點是，當我們審視我們的廣告投放管道時，會發現明年我們在程序化廣告支出方面存在一些自然的排序。而這些因素也導致了我們先前提到的營運費用成長速度放緩。

That's super helpful. If I could sneak one in -- one more in. Gary, you've talked about a huge amount of variation in surgery around the world. You've talked about developing tools to identify best practices to reduce the variation and improve outcomes. Where are you in that process? And what are the capabilities you still need to develop to make that a reality?

這非常有幫助。如果可以的話，我還想再補充一點。加里，你之前提到世界各地手術方式的巨大差異。你也提到開發工具來識別最佳實踐，從而減少差異並改善手術效果。目前你們在這方面進展如何？為了實現這個目標，你們還需要開發哪些能力？

Yes, I love that question. The -- there's a couple of things. On the kind of the baseline, you need to gather enough of the right data to characterize variability of care teams and variability of patients. So there's a patient population, it's got variability, and you've got care team or physician variability as well. And getting the right data streams, getting them stored and figuring out how to do the right kind of assessment or analysis on them, curating that data, making sure it's annotated properly. Some basic stuff that you have to do to be able to look for meaningful sources of variation.

是的，我喜歡這個問題。 ——這裡面有幾個面向。首先，關於基線，你需要收集足夠的正確數據來描述醫療團隊和患者的差異。患者群體本身就存在差異，醫療團隊或醫生之間也存在差異。其次，你需要取得正確的數據流，將其儲存起來，並找到合適的評估或分析方法，整理數據，確保數據標註正確。這些都是你必須要做的基本工作，才能找到有意義的差異來源。

We're well down that pathway in terms of getting the right data streams, having the right conversations with our customers and starting to do the analysis. So I'm excited by it.

我們在獲取正確資料流、與客戶進行有效溝通以及開始進行分析方面已經取得了顯著進展。所以我對此感到興奮。

As we look at how to deliver that, we're still in a, I think, surgical science discovery phase. We are partnered with many of the top hospitals, academic hospitals around the world looking at surgical data science, starting to figure out sources of variation and drawing it back to causality, not just correlation. So I think -- the baseline is there, the ability to collect and gather that data. I think our relationships with top-tier researchers are in place, and we're starting to see early signals that look really good.

在探討如何實現這一目標時，我認為我們仍處於外科科學探索階段。我們與世界各地許多頂尖醫院和學術醫院建立了合作關係，共同研究外科資料科學，開始探討變異來源，並追溯其因果關係，而不僅僅是相關性。因此，我認為──基礎已經具備，我們有能力收集和整理這些資料。我認為我們與頂尖研究人員的關係已經建立，我們開始看到一些非常積極的早期跡象。

Final point I'd make is there are some basic things we can do that are logical and not extraordinarily complicated that can help personalized learning pathways and training pathways, and we're starting to work through that now. That's kinds of technologies that will come out into the field first. So I think it was a long-term journey. Some of the things we talked to you about Intuitive Hub or some of the baseline capabilities there in terms of the right data collected, annotated the right way and shared with the right hospital customers to get us good outcomes.

最後我想說的是，我們可以做一些合乎邏輯且並不特別複雜的基本事情，這些事情可以幫助我們建立個人化的學習路徑和訓練路徑，而我們現在正在著手研究這些。這類技術將率先應用於實際場景。所以我認為這是一段長期的歷程。我們之前和您談過Intuitive Hub，或者說它的一些基礎功能，例如收集正確的數據、以正確的方式進行標註，並與合適的醫院客戶共享，從而幫助我們取得良好的成果。

Next, we have Robbie Marcus with JPMorgan.

接下來是摩根大通的羅比馬庫斯。

Congratulations on a nice quarter. Maybe just to dial in a little bit more on the capital equipment environment. You touched on this, and it's great to see procedures driving placement volumes. But are you seeing any changes, whether it's in the U.S. or Europe as we're in an uncertain economic environment around the world, it's clearly not showing up in the numbers yet, but just seeing if there's any rate of change or if the outlook is any different than the current environment?

恭喜你們本季業績出色。或許我們可以更深入探討資本設備市場的狀況。您剛才也提到了這一點，很高興看到採購流程推動了採購量的成長。但是，鑑於目前全球經濟環境不明朗，無論是在美國還是歐洲，您是否觀察到任何變化？雖然這些變化尚未在數據中體現出來，但您是否了解是否存在任何變化趨勢，或者未來的前景是否與當前環境有所不同？

Just a couple of things I'd highlight. As we've spoken to customers, and this is mostly anecdotal, you do see some input that staffing pressures are easing a little bit, particularly with respect to vacation rates and labor costs. Those 2 factors are still way above pre-pandemic levels, but you see a little bit of improvement in the quarter, at least based on both those anecdotes and the survey work that we've seen.

我想重點強調幾點。正如我們與客戶溝通後所了解到的（雖然這主要是一些零散的回饋），人員配備壓力確實有所緩解，尤其是在休假率和勞動成本方面。這兩個因素仍然遠高於疫情前的水平，但至少根據這些零散的回饋和我們看到的調查結果，本季的情況略有改善。

In Q2 and Q3, you saw customers going through the process of reexamining their capital budgets, and that causes some delays in capital investments and obviously, they reprioritize what they invest in. I think robotic surgery is still an area of potential value for customers. That does cause some delays.

在第二季和第三季度，我們看到客戶重新審視了他們的資本預算，這導致了一些資本投資的延遲，顯然，他們也重新調整了投資的優先順序。我認為機器人手術對客戶來說仍然是一個具有潛在價值的領域。但這確實造成了一些延遲。

On the OUS side, we haven't seen a significant impact yet so far in terms of capital spending by those customers. Generally, we are at earlier stages of adoption. The payer structures are different. And so, so far, at least, what we've seen is kind of nice capital numbers in the OUS markets, as you can see from the kind of comparisons.

就美國境外市場而言，目前我們尚未看到這些客戶的資本支出受到顯著影響。整體而言，我們仍處於早期採用階段。支付結構也有所不同。因此，至少到目前為止，正如您從對比數據中看到的那樣，美國境外市場的資本支出數據相當不錯。

If you look at European placements in Q3, they were up 15%. Placements in Asia were up 36% year-over-year. So we haven't seen anything so far. I would say there are obviously economic risks, particularly in Europe with the energy situation there, the situation with Ukraine and Russia. We haven't seen those manifest yet.

如果看一下第三季歐洲的職位分配情況，會發現成長了15%。亞洲的職位分配情況較去年同期成長了36%。所以目前為止，我們還沒有看到任何明顯的跡象。當然，經濟風險仍然存在，尤其是在歐洲，考慮到那裡的能源狀況以及烏克蘭和俄羅斯的局勢。但我們尚未看到這些風險顯現出來。

And next, we have a question from the line of Richard Newitter with Truist.

接下來，我們來解答來自 Truist 的 Richard Newitter 提出的問題。

Congratulations on the quarter. Just with respect to the spending sequencing comments that you made, what should we be thinking about that with respect to implications or kind of a next-gen console system and some of the other types of iterative technology advancements you've talked about in the pipeline. Is there any implication for a new system, if you will, or extend console in the cadence of the spending you're talking about (inaudible)?

恭喜您本季業績出色。關於您提到的支出順序問題，我們應該如何看待這些支出對下一代主機系統以及您提到的其他一些正在研發中的迭代技術進步的影響？這些支出是否意味著會推出新系統，或以您所說的步調擴展主機產品線？ （聽不清楚）

Across the platforms, we work on improvements to the robot system side or full innovation there. We work on instruments and accessories and software updates and sometimes partnered product. In general, we maintain our priority and our cadence on those things that we think are going to have the biggest impact to our customers that allow them to get better outcomes or to address new opportunities that they're not addressing today. We continue to invest and have a high priority on quality improvements and things that will make our customers more satisfied.

在各個平台上，我們致力於改進機器人系統，甚至進行全面創新。我們也致力於儀器、配件、軟體更新以及合作產品的研發。總的來說，我們會優先考慮並按部就班地推進那些我們認為能夠對客戶產生最大影響、幫助他們獲得更佳成果或把握當前尚未開發的全新機遇的項目。我們將持續投資，並高度重視品質改善以及能提升顧客滿意度的各項措施。

Some other things that tend to be great ideas, but perhaps are not highly urgent, then those things will sequence out. And that's a conversation we routinely have. What do we have to do at high priority and do it at high quality quickly. What are the things that can sequence after that. So hard to answer your question in detail from a process point of view. If it matters a lot to our customers, if it's a high dissatisfier or high opportunity, those things get put in line first.

有些想法很好，但可能不太緊迫，那麼這些事情會按順序處理。我們常常會討論這個問題：哪些事情必須優先處理，並且要快速高品質地完成？哪些事情可以排在後面？從流程的角度來看，很難詳細回答你的問題。如果某件事對我們的客戶至關重要，或者它會導致客戶極度不滿，又或者它蘊藏著巨大的商機，那麼這些事情就會優先處理。

And next, we have the line of Jayson Bedford with Raymond James.

接下來，讓我們來看看 Jayson Bedford 與 Raymond James 的合作系列。

One topic that I thought was interesting. You mentioned ablation technology with respect to Ion and starting a trial in Germany. Can you talk a bit more about the technology and the size and scope of the trial and maybe any type of timeline you can offer in the U.S. in terms of starting a trial?

我覺得您提到的一個主題很有趣。您提到了Ion公司的消融技術，以及在德國啟動的臨床試驗。您能否詳細介紹這項技術、試驗的規模和範圍，以及在美國啟動試驗的大致時間表？

Well, I'll talk a little bit about the motivation. In terms of the details of the trial, I don't have them at our fingertips, but our team can respond to that in a future call. Here we know that Ion can navigate in deep into the lung, we know that surgeons and interventional pulmonologists want to treat tissue there. They want to be able to engage with it one way or another. So ablative technology can be used for a couple of different disease states, and we have high interest in that, whether it's inoperable cancer or whether it's something for emphysema or chronic bronchitis. So being able to navigate there with an energy source will ultimately be important.

好的，我先簡單談談我們的動機。關於試驗的具體細節，我目前還無法提供，但我們的團隊可以在下次電話會議中解答。我們知道離子束可以深入肺部，外科醫生和介入性肺科醫生也希望治療肺部組織。他們希望能夠以某種方式與肺部組織互動。消融技術可以用於治療多種不同的疾病，我們對此非常感興趣，無論是無法手術的癌症，還是肺氣腫或慢性支氣管炎等疾病。因此，能夠利用能量源深入肺部進行治療最終至關重要。

The first one that we're talking about here, I believe, is a microwave energy source. There are some other energy sources that people are interested in. In some cases, we're developing it ourselves. And in several other cases, we're partnering with others. And we think that will open the door to additional indications for Ion in the lung and elsewhere. We're pretty excited about it. Apologies for not having the details of the trial at our fingertips, but I imagine our team will get that to you in the future.

我認為，我們在這裡討論的第一種能源是微波能源。還有一些其他的能源也引起了人們的興趣。在某些情況下，我們正在自主研發；而在其他情況下，我們則與其他公司合作。我們認為這將為離子技術在肺部及其他部位的應用開闢新的途徑。我們對此感到非常興奮。很抱歉我們目前還沒有掌握試驗的詳細信息，但我相信我們的團隊會在未來盡快向您提供這些資訊。

And next, we have the line of Matt Taylor with Jefferies.

接下來，我們來看看 Matt Taylor 與 Jefferies 的合作。

Congrats on a nice quarter. I wanted to get some updated thoughts. You've been asked a little bit about this in the recent past and on this call, but maybe you could give us some feedback on how you're thinking about capital spending from hospital customers going into recession and thinking about how this one could compare to what you've seen in the past with some of the different cycles that the company has gone through over a longer period of time? Maybe do some compare and contrast and talk about the demand environment that you see out there and how you're going to compete for other priorities for capital?

恭喜貴公司本季業績優異。我想了解一些最新的情況。最近一段時間以及這次電話會議上，您都被問到過一些相關問題，但您能否就醫院客戶在經濟衰退期間的資本支出情況，以及您如何看待此次經濟衰退與公司過去經歷的不同周期相比有何異同，提供一些反饋？能否進行一些比較分析，談談您觀察到的市場需求環境，以及您將如何爭取其他優先資本？

Just with respect to prior cycles, and this one actually, Matt, is a little interesting in so far as we indicated in Q1, we saw some softness in the capital pipeline in Q1 and Q2 and to some extent, that continued in Q3. If I look back at prior cycles in 2008, you saw 3 quarters of a year-over-year decline in capital placements. 2013, I think we saw 5 quarters in a row of declining capital placements. And then when COVID hit in 2020, again, 3 quarters in a row.

就以往的周期而言，馬特，這次的周期確實有點意思。正如我們在第一季指出的，第一季和第二季的資本流入有所疲軟，而且這種疲軟的局面在某種程度上延續到了第三季。回顧之前的周期，例如2008年，資本投入連續三個季度較去年同期下降。 2013年，資本投入連續五季下降。然後，2020年新冠疫情爆發後，資本投入又連續三個季度下降。

I only give those as reference points. I don't think we can say that those are indicative as to what may happen if and when there's a recession in the U.S. or beyond. So I think, honestly, if you look at the progression of the economic projections, it's pretty complex and hard to call at this point. So we just give those historical reference points.

我只是把這些數據當作參考。我認為我們不能說這些數據能夠預示美國乃至其他地區一旦出現經濟衰退會發生什麼事。所以說實話，如果你看看經濟預測的發展歷程，你會發現情況相當複雜，現在很難做出預測。因此，我們只是提供這些歷史參考點。

Two comments for me. Of course, the occurrence, the depth and the shape of a recession, impossible for us sitting at this table to predict. What I can talk about is how the conversations with hospital executives have gone. I think in general, their perspective is to serve their patient population as best they can with technologies that will get the outcomes they want at the price points they want.

我有兩點要說。當然，經濟衰退的發生、深度和形態，是我們這些坐在這裡的人無法預測的。但我可以談談我和醫院高層的對話。我認為，總的來說，他們的想法是盡最大努力，利用能夠以他們期望的價格達到預期療效的技術，為患者提供最好的服務。

I think we've been doing well with that. I think both on the product side and our ability to demonstrate economic viability and contribution margin gains for hospitals has been powerful. And I think that gives us some strength going into the future. That said, depending on how hard and deep it is, then it becomes a question of what they want to offer their patient population and what kind of decisions they're going to have to make.

我認為我們在這方面做得很好。無論是產品方面，或是我們向醫院證明經濟可行性和利潤率提升的能力，都表現出色。我認為這為我們未來的發展奠定了基礎。話雖如此，這取決於問題的嚴重程度和深度，最終還是要看他們想為患者群體提供什麼，以及他們需要做出什麼樣的決定。

I also think that relative to past cycles, Intuitive has a couple of more tools in the toolbox in terms of leasing portfolios and some other things. Hard to predict where it will go. I think our ability to both demonstrate value and adjust to capital placement models, it's a little stronger than it was in past years.

我也認為，與以往的周期相比，Intuitive 在租賃組合和其他方面擁有更多工具。很難預測它未來的走向。我認為，我們展現價值和調整資本配置模式的能力，比往年略強。

And next, we have Adam Maeder with Piper Sandler.

接下來是亞當·梅德和派珀·桑德勒。

Congratulations on a nice quarter. I wanted to ask about Ion, which if I'm looking at it correctly, had a record placement for installs with also some very nice volume trends. So Gary or Jamie, can you just talk about kind of what's driving that inflection in system placements? And then you referenced the PRECIsE data that was presented at CHEST, I think, earlier today as well as the journal publication coming next year. Just talk about any potential impact to adoption looking forward.

恭喜你們季度業績出色。我想問一下關於 Ion 的問題，如果我沒理解錯的話，它的安裝量創下了歷史新高，而且銷售成長趨勢也非常好。 Gary 或 Jamie，你們能否談談是什麼因素推動了系統安裝量的激增？另外，你們提到了今天稍早在 CHEST 會議上展示的 PRECisE 數據，以及明年即將發表的期刊論文。請談談這些數據對未來市場普及可能產生的影響。

I'll jump in and Jamie, you can help. I think we're still in the early market. We're pleased with the growth and the customer feedback that we've been getting the -- and when we talk to them and survey our customers, their satisfaction levels are very high with the Ion product. I think it's driven by a couple of things. The preliminary data that's come out of the PRECIsE trial that's already been talked out and now the later data, I think, was attractive to the customer base.

我來說兩句，Jamie，你來幫忙。我覺得我們目前還處於市場初期。我們對目前的成長情況以及收到的客戶回饋都很滿意——當我們與客戶溝通並進行調查時，他們對Ion產品的滿意度非常高。我認為這主要受兩方面因素驅動。首先是之前討論過的PRECIsE試驗的初步數據，其次是後續數據，我認為這些數據對客戶群很有吸引力。

I think the other thing going on is that as we've installed additional sites and helped them bring their programs up, I think they're able to replicate that data. I think that it's being commonly adopted. And I think that is having a compounding effect. The idea that the early publications are being repeated in the hands of new teams that are coming on board gives them confidence. And this is a little bit of word of mouth amongst the pulmonology community, gives them confidence that they can get what's being published. And I think that's been strong for us.

我認為另一個正在發生的事情是，隨著我們安裝了更多網站並幫助他們建立程序，我認為他們能夠復現這些數據。我認為這種方法正在被廣泛採用。而且我認為這會產生疊加效應。早期發表的研究成果能夠被新加入的團隊重複使用，這增強了他們的信心。這在肺病學界也起到了一定的口碑傳播作用，讓他們相信自己能夠獲得已發表的研究成果。我認為這對我們來說非常有利。

Jamie, any comments?

傑米，你有什麼要說的嗎？

I would just say there's some endorsement of the architectural choices that we made with respect in particular to the diameter of the catheter, which makes a real difference to diagnosis of smaller lesions and you see that in the clinical data. I think that the engineering and the commercial teams have really executed really well through the period since we launched the product.

我想說，我們在導管直徑方面的設計選擇得到了認可，這對於診斷較小的病灶至關重要，臨床數據也證實了這一點。我認為，自產品上市以來，工程團隊和銷售團隊都表現出色。

And I do think that there's a halo effect of kind of word of mouth across IPs and users of the product. And I think in combination with clinical data, that's had a positive effect on our progress so far.

而且我認為，口碑傳播確實會對IP用戶和產品用戶產生一種光環效應。我認為，結合臨床數據，這已經對我們目前的進展產生了積極影響。

I wouldn't characterize how we've progressed so far as an inflection specifically, I think we've made continued progression.

我不會把我們目前的進展具體描述為一個轉捩點，我認為我們一直在持續進步。

Next, we have the line of Matt Miksic with Barclays.

接下來，我們來看看馬特·米克西奇與巴克萊銀行的合作。

Her is a perfect quarter. So congrats on that as well. The -- I just wanted to follow up on a couple of things you talked about in terms of the macro factors kind of affecting the market and your customers and your business a little bit, one being kind of the staffing challenges that some of these centers are facing. Curious how that is at all is affecting the way either procedures are coming back or demand for system is evolving here? And then into '23, just curious some of the costs that you've talked about, everyone's talked about -- I know it's early to ask this kind of question, but your thoughts at this point as to how we should think about those costs evolving in '23, it's either sort of rising and staying or rising and then being able to be managed down or just in terms of your cost structure and how it's increased? Any thoughts you have would be greatly appreciated.

這是個完美的季度，所以也恭喜你。我只是想就你之前提到的幾個影響市場、客戶和業務的宏觀因素再補充一些內容，其中之一是部分中心面臨的人員配備挑戰。我想知道這會對手術流程的恢復或系統需求的改變產生怎樣的影響？另外，關於2023年，我想問你提到的一些成本問題，大家都在討論這些成本——我知道現在問這個問題可能有點早，但你認為這些成本在2023年會如何變化？是會持續上漲並保持不變，還是會上漲但可以透過控制來降低，或只是成本結構上的成長？非常感謝你的任何想法。

Maybe the second part of the question, I'll take, Matt. So we're not going to give anything specific with respect to '23 numbers. We'll wait until January to do that when we conventionally provide guidance. I think what we've said with respect to operating expenses in 2023 for the reasons Gary described, the growth rate for that spending will be lower than the growth rate that we experienced in 2022. And a significant component of that is the number of people that we will hire next year. And again, what Gary described was given the employees that we've hired, there's a period here where we're going to ensure that we effectively onboard those new hires and get them to a state of productivity, and this will be a period for us to go through that kind of absorption phase.

馬特，或許我來回答問題的第二部分。關於2023年的具體數字，我們暫時不會給予任何具體資訊。我們會等到明年一月，按照慣例發布業績指引。正如加里所說，我們先前對2023年營運支出的預測是，該項支出的成長率將低於2022年的成長率。其中一個重要因素是我們明年將要招募的人員數量。加里也提到，鑑於我們已經招募了員工，我們需要一段時間來確保新員工能夠順利融入團隊，並達到一定的生產力水平。這段時間我們將經歷一個過渡期。

I'll let Gary respond to the first part.

第一部分就讓加里來回答。

Yes. Matt, could you -- I'm sorry, I just missed a little bit of that first part of the question. Can you just restate that one?

是的。馬特，你能──抱歉，我剛才沒聽清楚問題的第一部分。你能再說一次嗎？

Sure. Just in the context of factors affecting the -- you have some flows recovery, what have you of procedures and system -- new system trends, how staffing -- hospital staffing or challenges there are affecting those trends in your business, if at all?

當然。只是在影響流程恢復的因素背景下——您有一些流程和系統方面的恢復措施，例如新的系統趨勢、人員配備——醫院人員配備或面臨的挑戰，這些因素是否會影響您業務中的這些趨勢？

Yes, fair question. It's interesting. I think there's a put and a take there. On the tough side, of course, if hospital staffing is really challenged, particularly as it relates to OR staff, that can limit procedures that they'll perform. In general, I think that folks are paying more to get OR staffed, recognizing they want to both treat those patients and it's important to the revenue line of the hospital.

是的，問得好。這很有意思。我認為這裡有利有弊。當然，棘手的一面是，如果醫院人員配備確實捉襟見肘，尤其是手術室人員，這可能會限制他們所進行的手術。總的來說，我認為人們願意支付更高的費用來確保手術室人員配備充足，因為他們既希望治療這些病人，也明白這對醫院的收入至關重要。

So it's primarily inflationary pressure as it relates to what's happening in the OR in our space. The interesting part is that high-quality MIS, minimally invasive surgery, of which we enable helps to offset some of the staffing requirements post-surgery. It's quite clear, actually. So if they can do the procedure then the types of surgeries we do, it will save them some back-end costs in staffing. So there's a little bit of a seesaw there. So far, I don't think it's improving in terms of staffing constraints very quickly. It does sound like it's stabilized and maybe on the slight upside of improvement.

所以，就我們這個領域而言，手術室裡發生的事情主要受到通膨壓力的影響。有趣的是，我們支持的高品質微創手術（MIS）有助於抵消部分術後人員配備需求。這一點顯而易見。如果他們能夠進行我們所做的這類手術，就能為他們節省一些後續的人員成本。所以，這方面存在著一種拉鋸戰。到目前為止，我認為人員配備方面的限制並沒有很快改善。聽起來情況已經趨於穩定，或許略有改善。

Operator, we have time for one more question.

操作員，我們還有時間再問一個問題。

All right. We have the line of Drew Ranieri with Morgan Stanley.

好的。我們現在有了德魯·拉涅利與摩根士丹利的合作方案。

Gary, just maybe on Ion. Can you -- I know it's early days as you're kind of building the cells commercially, but a couple of questions. One is are you supply constrained at all from meeting demand? And then can you just give us a sense of maybe where you are in account penetration for Ion, whether it's to interventional pulmonologist or at a hospital level?

Gary，或許可以談談Ion。我知道現在還處於早期階段，你們還在進行電池的商業化生產，但我有幾個問題。首先，你們的供給是否受到限制，無法滿足市場需求？其次，能否簡單介紹一下Ion在客戶滲透率方面的情況，例如在介入性肺科醫生或醫院層面？

On the supply side, we are working extremely hard to meet demand on the capital side. I think we're about there. We're pretty close, pretty close to balanced. I don't think we're way ahead or way behind. And likewise, on the consumable or per procedure side, we are working extremely hard to meet demand. And I think we're slightly behind, not way ahead and not way behind. We're probably running close but pushing hard to keep growing.

在供應方面，我們正竭盡全力滿足資金方面的需求。我認為我們基本上實現了平衡，非常接近目標。我認為我們既沒有大幅領先，也沒有大幅落後。同樣，在耗材或單次手術方面，我們也在盡力滿足需求。我認為我們略微落後，既沒有大幅領先，也沒有大幅落後。我們可能正在努力追趕，以保持成長。

So on the penetration side, I think we're a little bit early to go into share mix and things like that, I think we're not quite ready to describe where we are either on the account side or on the pulmonology side. So we'll save that for a future call.

所以，就市場滲透率而言，我認為現在討論市場份額組成之類的指標還為時過早，無論是客戶層面還是肺科層面，我們都還沒有準備好描述我們目前的狀況。所以我們會把這些留到下次電話會議討論。

Anyway, thank you. That was our last question. In closing, we continue to believe there is a substantial and durable opportunity to fundamentally improve surgery and acute interventions. Our teams continue to work closely with hospitals, physicians and care teams in pursuit of what our customers have termed the quadruple aim: better, more predictable patient outcomes, better experiences for patients, better experiences for their care teams and, ultimately, a lower total cost of care. We believe value creation in surgery and acute care is foundationally human. It flows from respect for and understanding of patients and care teams, their needs and their environment.

總之，謝謝。這是我們最後一個問題。最後，我們仍然相信，在從根本上改善外科手術和急診介入方面，存在著巨大且持久的機會。我們的團隊將繼續與醫院、醫生和護理團隊緊密合作，追求客戶所說的「四重目標」：更佳、更可預測的患者治療效果，更佳的患者體驗，更佳的護理團隊體驗，以及最終更低的醫療總成本。我們認為，外科手術和急診護理的價值創造本質上是人性化的。它源自於對病人和照護團隊、他們的需求以及他們所處環境的尊重和理解。

At Intuitive, we envision a future of care that is less invasive and profoundly better, where diseases are identified earlier and treated quickly so patients can get back to what matters most.

在 Intuitive，我們設想未來的醫療保健將更加微創、更有效，疾病能夠更早被發現並迅速治療，讓患者能夠重返最重要的生活。

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的支持。我們期待三個月後再次與您交流。

Thank you. And ladies and gentlemen, that does conclude our conference for today. Thank you for your participation and for using AT&T Event Conferencing. You may now disconnect.

謝謝大家。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會議服務。您現在可以斷開連線了。