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，謝謝你們的支持。歡迎來到直觀的第三季度收益發布電話。 （操作員說明）

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.

提醒一下，本次會議正在錄製中。我現在想將會議轉交給我們的東道主投資者關係主管 Brian King 先生。請繼續。

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 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 Jamie Samath。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。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。這些風險和不確定性在我們提交給證券交易委員會的文件中進行了詳細描述，包括我們於 2022 年 2 月 3 日提交的最新 10-K 表格和 2022 年 7 月 22 日提交的 10-Q 表格。我們的 SEC 文件可通過我們的網站或 SEC 的網站。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 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活動部分。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. 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 將介紹本季度的業務和運營亮點，Jamie 將回顧我們的財務業績，然後我將討論程序和臨床亮點，並提供我們對 2022 年的最新財務展望。最後，我們將舉辦問答環節.

With that, I will turn it over to Gary.

有了這個，我會把它交給加里。

Thank you for joining us today.

感謝您今天加入我們。

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.

我們的業務基本面在第三季度得到加強，達芬奇程序與去年第三季度相比增長了 20%，並且我們在全球每個地區的表現都穩健。我們的資本配置反映了我們的安裝基礎增長了 13%，以滿足程序需求，同時每年每個系統的利用率持續增加，這對我們的客戶和我們來說都是健康的指標。 Ion 的安裝量、執行的程序和年化系統利用率也有所增加。供應鏈挑戰雖然仍然存在，但正在從大流行的高峰期減弱。

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.

仔細觀察程序，20% 的增長率高於上一季度的 14%，高於我們在大流行期間 16% 的 3 年復合年增長率。普外科是我們最大的手術類別，其增長速度是美國減肥手術、膽囊切除術、疝氣修復和其他前腸手術推動的任何類別中增長最快的。

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，一些國家發展良好，除了泌尿外科以外，用途廣泛。德國、英國和愛爾蘭、意大利和西班牙在本季度表現突出。

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，日本程序增長相對於第二季度加速，韓國增長保持穩健。除了泌尿外科，這兩個國家的程序也在多樣化。在中國，程序增長略高於我們的全球平均水平，部分原因是區域滾動封鎖繼續影響程序和使用。

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.

轉向資本。我們在本季度放置了 305 個系統，而去年第三季度為 336 個，上一季度為 279 個。強勁的程序需求支持本季度達芬奇安裝基數增長 13%。本季度每個系統的利用率增長了 7%，高於我們在大流行期間的 3 年復合年增長率 5%。利用率得益於去年美國手術季度疲軟的複蘇以及更多類型手術和更高數量類別的客戶表現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.

鑑於剩餘以舊換新機會的減少，Si 以舊換新繼續放緩。本季度離子放置從去年的 28 個和上個季度的 41 個增加到本季度的 50 個，反映了早期市場的持續增長。總體而言，我們的客戶正在獲取具有程序增長機會的系統。

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，我們通過適應症和區域監管擴展、滿足客戶需求的產品和服務創新以及產品質量和成本改進，繼續專注於我們的多端口腔內、單端口和數字平台。我們預計我們的新平台會隨著時間的推移接近我們的歷史貢獻率水平。年初至今的進展符合我們的預期。

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.

關於我們本季度的開支，我們減緩了員工人數的增長，以專注於深度整合過去幾個季度加入我們的員工。進入 2023 年，我們預計固定費用的增長率將放緩，因為我們在我們的賦能功能中尋求槓桿作用並對我們的一些遠期投資進行排序。

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.

我們有一個堅實的季度實現產品和服務里程碑。我們繼續在全球範圍內擴大對我們的多端口產品、培訓和服務的訪問。本季度的佼佼者包括創紀錄的全球季度新外科醫生培訓完成情況，以及英國皇家外科學院對我們的技術培訓途徑的認證。

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，我們在中國提交了註冊申請，並獲得了德國監管機構對離子消融技術的臨床研究批准，這開始了我們實現活檢以外干預的臨床之旅。離子程序在本季度增長了 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.

轉向我們的單端口平台 da Vinci SP。程序同比增長 46%，在韓國尤為強勁，我們的 SP 團隊在韓國推出了下一代 SP 儀器和我們的 Firefly 內窺鏡。我們還在本季度獲得了 PMDA 許可，日本市場 SP 涉及廣泛的臨床適應症，類似於 SP 在韓國的適應症。

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.

在我們的數字產品組合中，我們的 My Intuitive 應用程序和 PORTaL 在發布它們的地區被廣泛採用，作為達芬奇客戶的首選數字門戶。我們的室內計算平台 Intuitive Hub 的安裝量比去年第三季度增長了 21%，我們的中心安裝基礎的軟件更新提高了可用性並啟用了遠程呈現。

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.

總之，隨著嚴重的大流行影響減弱，我們的核心業務在本季度得到了加強。我們正在管理支出增長，同時投資於未來的核心增長機會。

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 Jamie，讓我們更詳細地了解我們的財務狀況和一些持續存在的宏觀經濟問題。

Good afternoon.

下午好。

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.

我將在非公認會計原則或備考基礎上描述我們表現的亮點。稍後我還將在準備好的評論中總結我們的 GAAP 表現。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。

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.

在第三季度，程序、達芬奇系統的安裝基礎和平均係統利用率的增長是健康的。這些關鍵業務驅動因素的優勢導致備考營業利潤率為 36%，備考每股收益為 1.19 美元。

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，我們看到強勢美元、揮之不去的供應鏈問題和通貨膨脹帶來的不利影響，與去年第三季度相比，這些因素共同對備考營業利潤率產生了約 2 個百分點的負面影響。我將帶您了解這些細節。

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%.

第三季度程序增長 20% 反映了美國程序增長 18% 和 OUS 程序增長 24%。鑑於去年 Delta 變體的影響，美國的程序增長反映了與去年同期相比的有利比較。在 3 年復合年增長率的基礎上，美國的程序增長了約 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.

在本季度我們的第二大市場中國，程序繼續從我們在上一季度財報電話會議上描述的與 COVID 相關的封鎖的影響中恢復過來。但是，隨著 COVID 病例的增加，我們繼續看到區域封鎖發生。

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.

轉向資本。我們在第三季度放置了 305 個系統，比我們去年放置的 336 個系統減少了 9%。第三季度的系統佈局包括大約 15 個系統，這些系統在上季度末由於組件供應延遲而延遲。

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.

本季度有 71 筆交易，而 2021 年第三季度為 136 筆，反映出已安裝基礎中剩餘的矽數量有所下降。截至第 3 季度末，安裝基數中約有 739 台 Sis，其中 191 台在美國。

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%.

不計貿易交易，全球系統佈局比去年增長 17%。達芬奇系統的安裝基數同比增長約 13%，與近期趨勢一致。與去年相比，該領域臨床系統的利用率（按每個系統的程序衡量）增加了近 7%。使用 3 年復合年增長率，第三季度利用率與歷史平均水平一致，增長近 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%.

美國的平均係統利用率同比增長 6%，比第二季度下降 1% 的情況有所改善。由於我們的程序和資本績效，第三季度收入為 15.6 億美元，比 2021 年第三季度增長 11%。按固定匯率計算，第三季度收入增長約 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%。在收入加權的基礎上，使用當前匯率，扣除第四季度的對沖，美元比第三季度實現的匯率高約 3%。其他收入統計數據和趨勢如下：在美國，我們在第三季度放置了 175 個系統，低於 2021 年第三季度的 227 個，反映了與以舊換新交易和充滿挑戰的宏觀經濟環境相關的 66 個系統的下降。在美國以外，我們在第三季度放置了 130 個系統，而去年為 109 個。當前季度系統安置包括 54 個進入歐洲、32 個進入日本和 14 個進入中國，而 2021 年第三季度有 47 個進入歐洲、20 個進入日本和 17 個進入中國。

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 年第三季度末，中國現有配額內剩餘 40 個系統，也可供已在 NMPA 完成本地註冊的 3 家國內競爭對手使用。今年到目前為止，通過分銷商服務的市場約佔系統佈局的 10%。我們的分銷合作夥伴以美元向我們購買產品，並以當地貨幣銷售。雖然到目前為止我們沒有受到重大影響，但美元走強降低了分銷商的利潤，並可能導致資本購買的延遲。

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.

租賃佔第三季度安置的 37%，而上一季度為 42%，2021 年第三季度為 41%。較低的租賃組合是客戶和區域組合的函數。雖然租賃會隨著季度的變化而波動，但我們仍然預計經營租賃下的配售比例將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.

第三季度系統平均售價為 150 萬美元，與上一季度一致。更高的以舊換新組合和 FX 的影響對系統 ASP 產生了負面影響，但被 Xi 雙控制台佈局的更高組合所抵消。我們在第三季度確認了 1700 萬美元的租賃收購收入，而上一季度為 2200 萬美元，去年為 2500 萬美元。租賃收購收入在每個季度之間變化很大，並且可能會繼續如此。

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.

每個程序的儀器和附件收入約為 1,800 美元，而上一季度和去年的收入約為 1,900 美元。與去年同期相比，外匯對每個程序的 I&A 產生了大約 50 美元的負面影響。同比減少的其餘部分主要是客戶訂購模式的結果。在本季度，由於供應鏈可預測性適度改善，我們在某些 OUS 市場的分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.

我們在本季度放置了 50 個 Ion 系統，而去年第三季度為 28 個。 Ion 系統的安裝基礎現在是 254 個系統，其中 112 個處於經營租賃安排下。第三季度約 6,400 次 Ion 程序同比增長 211%。 Ion 正在歐洲進行新的 MDR 監管審查程序，在本季度，我們將 Ion 提交給中國的監管程序。提醒一下，中國的監管審查時間表很長。

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.

繼續討論損益表的其餘部分。 2022 年第三季度的備考毛利率為 69.8%，而 2021 年第三季度為 71.3%，上一季度為 69.2%。第三季度備考毛利率包括與某些間接稅事項的有利結論有關的約 50 個基點的一次性收益。備考毛利率低於去年，主要是由於美元走強、供應鏈環境導致製造和物流效率低下、零部件價格上漲以及相對於收入的固定成本增加。本季度供應和庫存指標略有改善，但仍遠低於大流行前的水平。受員工人數增加、研發相關項目成本增加和差旅成本增加的推動，與 2021 年第三季度相比，備考運營費用增加了 24%。

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.

運營費用的增長主要是為了支持我們的 Ion 平台、下一代機器人技術能力、我們的數字能力和我們基礎設施的擴展，以使我們能夠有效地擴展。由於全球監管要求的提高以及我們將新平台擴展到 OUS 市場，我們也看到了更高的監管成本。

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 之前提到的，在本季度，我們放慢了招聘速度，增加了約 530 名員工，低於過去 3 個季度每個季度增加的 700 多名員工。展望 2023 年，我們預計我們的營業費用增長將低於今年的增長。運營費用增長率放緩反映了我們的一些基礎設施和業務流程改進投資的完成，以及我們對賦能功能的計劃槓桿作用。

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.

作為我們計劃過程的一部分，我們還對我們的資本支出優先事項進行了審查，我們將在下次電話會議上提供有關審查結果的最新信息。在這個框架內，鑑於我們看到的這些投資的回報情況，我們將繼續投資於我們的新平台、NSP、下一代能力和我們的數字生態系統。

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.

第三季度的備考其他收入為 720 萬美元，低於上一季度的 1040 萬美元，主要是由於美元持續走強導致資產負債表重新計量造成的匯兌損失的影響。我們第三季度的備考有效稅率為 23.4%，符合我們的預期。

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 年第三季度備考淨收入為 4.29 億美元或每股 1.19 美元，而去年第三季度為 4.35 億美元和每股 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.

第三季度的資本支出為 1.53 億美元，主要包括基礎設施投資，以擴大我們的設施足跡和提高製造能力。

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.

我現在將總結我們的 GAAP 結果。 2022 年第三季度的 GAAP 淨收入為 3.24 億美元或每股 0.90 美元，而 2021 年第三季度的 GAAP 淨收入為 3.81 億美元或每股 1.04 美元。備考和 GAAP 淨收入之間的調整在我們的概述和量化網站並包括與員工股票獎勵、員工股票薪酬、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.

我們在本季度末的現金和投資為 74 億美元，而第二季度末為 82 億美元。現金和投資的連續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所抵消。在本季度，除了上半年回購的 6.07 億美元股票外，我們還完成了 10 億美元的 ASR。

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，我們的稀釋後股票數量減少了約 700 萬股或 2%，我們還有剩餘的授權回購我們的 25 億美元股票。

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

有了這個，我想把它交給布賴恩，他將討論臨床亮點並提供我們對 2022 年的最新展望。

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.

我們 2022 年第三季度的整體程序增長為 20%，而 2021 年第三季度為 20%，上一季度為 14%。 2019年第三季度至2022年第三季度的3年復合年增長率為16%。在美國，2022 年第三季度的程序超出了我們的預期，同比增長 18%，而 2021 年第三季度和上一季度分別增長 16% 和 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.

程序增長反映了相對於去年第三季度的積極影響，後者受到 Delta 變量的影響。在 3 年復合年增長率的基礎上，美國的手術增長率為 13%。第三季度手術增長繼續受到普通外科手術的推動，在減肥、膽囊切除術和疝氣修復方面具有優勢。惡性手術，即結直腸和肺葉切除手術的趨勢也很強勁。婦科是我們在美國的第二大手術類別，也經歷了兩位數的增長，而更成熟的泌尿外科手術則以高個位數增長。

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%.

在美國以外，第三季度的手術量同比增長約 24%，而 2021 年第三季度和上一季度分別增長 30% 和 22%。在 3 年復合年增長率的基礎上，程序增長率為 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.

轉向歐洲。程序增長由德國、英國、意大利和西班牙的強勁增長帶動。在所有提到的地區，泌尿科以外的手術增長在普外科和婦科類別中都很強勁。特別是在德國，我們經歷了良性子宮切除術和結直腸手術的早期發展。在英國，良性子宮切除術、結腸直腸切除術和膽囊切除術引領了增長。雖然仍處於早期階段，但這些非泌尿外科手術的同比增長幾乎是泌尿外科手術的 4 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.

轉向亞洲。在日本，普外科和婦科的增長繼續強勁。我們在以胃切除術、直腸切除術和良性子宮切除術為首的這些類別中經歷了強勁的增長。新報銷的手術（即結腸切除術和腎切除術）的早期持續增長進一步促進了強勁的手術性能。

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 COVID 病例開始下降和解除封鎖限制，我們繼續看到第三季度前幾個月的複蘇。手術增長是由泌尿外科手術驅動的，特別是前列腺切除術和部分腎切除術，以及普通手術中結腸切除術的強勁增長。在本季度晚些時候，隨著 COVID 開始在各個地區重新出現並實施滾動封鎖，我們開始看到程序開始緩和。

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

韓國第三季度的手術增長也很穩健。程序繼續廣泛增長，SP 程序增長強勁。

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.

現在轉向我們業務的臨床方面。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。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。

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，在田納西州納什維爾舉行的年度 CHEST 會議上，來自馬薩諸塞州總醫院的 Eric Folk 博士介紹了 PRECISE 研究的初步性能更新。結果與去年發布的數據一致，並證明了通過具有強大安全性的離子程序獲得的樣本的診斷率和惡性腫瘤敏感性的令人鼓舞的結果。我們預計 PRECISE 的最終數據將在明年上半年發布。

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 Ion，來自明尼蘇達州羅切斯特和佛羅里達州傑克遜維爾梅奧診所的小組，由醫生 Alejandra Yu Lee-Mateus、Janani Reisenauer 和 Sebastian Fernandez-Bussy 領導，發表了呼吸病學回顧性病例係列，比較了 Ion 的性能腔內系統與 CT 引導的經胸方法進行肺部病變活檢。

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 名患者。 113 人接受了 Ion 手術，結節中位數為 18 毫米，112 人接受了經胸活檢，結節中位數為 16 毫米。在 Ion 組中，報告的惡性腫瘤的總體診斷率和敏感性分別為 87.6% 和 82.1%，這與經胸方法的相同結果相當。

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.

重要的是，Ion 入路的並發症發生率明顯低於經胸入路，差異為 13%。進一步的分析表明，與 Ion 手術相關的氣胸機率降低了大約 80%。作者部分得出結論，使用 Ion 的機器人輔助方法可以與經胸方法一樣準確地對具有相似或減少並發症的肺結節進行採樣，並且應將其視為結節活檢的一種手段。

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.

轉向手術側。博洛尼亞大學的 Leonardo 博士（聽不清）及其同事在《國際結直腸病雜誌》上發表了一項系統評價和薈萃分析，比較了機器人輔助和腹腔鏡左結腸切除術的方法。該分析包括來自 11 篇不同文章的數據，包括超過 52,000 名患者，其中機械臂超過 13,500 人，腹腔鏡手臂超過 39,000 人，報告的術前特徵沒有差異。在圍手術期結果方面，據報導，與腹腔鏡方法相比，機器人輔助方法的開放率降低了 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.

進一步的分析表明，機器人輔助方法轉換為開放的風險大約是腹腔鏡方法其餘部分的一半。此外，分析顯示腹腔鏡左結腸切除術後術後並發症的風險較高，而機器人輔助方法的淺表傷口感染率較低。

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.

分析還顯示，與膝關節組相比，機器人輔助方法的吻合口漏發生率降低了 30%。作者的部分結論是，與標準腹腔鏡方法相比，機器人左結腸切除術需要更少的轉換為開放手術，並且有必要進行更多的研究來強調使用機器人平台進行左結腸切除術的可能優勢。

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.

我現在將轉向我們對 2022 年的財務展望。從程序開始。在我們上次的電話會議上，我們預測 2022 年全年的程序增長在 14% 至 16.5% 的範圍內。我們現在正在提高我們的預測，並預計 2022 年全年手術增長 17% 至 18%。該範圍繼續反映與大流行病程相關的不確定性。該範圍的低端仍然假設在今年剩餘時間裡，新冠肺炎住院人數、區域封鎖和醫院人員壓力增加。

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.

在該範圍的高端，我們假設全球與 COVID-19 相關的住院人數在 2022 年剩餘時間內繼續下降，並且進一步復甦不會產生額外的重大影響。該範圍並未反映出與我們在大流行開始時所經歷的情況類似的重大材料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.

轉向毛利。在我們上次的電話會議上，我們預測我們 2022 年全年的備考毛利率將在 69% 和 70.5% 之間，預計將接近該範圍的下限。鑑於與供應鏈相關的投入成本增加以及美元走強的影響，我們現在正在調整我們對備考毛利率的估計，使其在淨收入的 69% 和 69.5% 以內。我們的實際毛利率將因產品、地區和以舊換新組合、外幣匯率波動以及新產品推出的影響而異。

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.

關於運營費用，在上次電話會議上，我們預測備考運營費用增長將在 23% 至 25% 之間。我們正在調整我們的估計，現在預計我們全年的備考運營費用增長將在 21% 至 23% 之間。我們正在將 2022 年非現金股票補償費用的估計範圍縮小到 5.2 億美元至 5.3 億美元之間。我們還將對主要包括利息收入的其他收入的估計更新為 2022 年的 4,000 萬美元至 5,000 萬美元之間，減少我們之前估計的 6000 萬美元和 7000 萬美元。減少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.

在上一季度的電話會議上，我們預測 2022 年的資本支出在 7 億美元至 8 億美元之間。我們現在將 2022 年的資本支出估計降低到 6 億美元至 7 億美元之間。關於所得稅，我們繼續估計我們 2022 年的備考稅率將在稅前收入的 22% 至 24% 之間。

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

我們準備好的發言到此結束。我們現在將打開您的問題的電話。

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

瑪吉，我想我們想繼續把問答環節帶到……

(Operator Instructions)

（操作員說明）

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

首先，我們有一個來自美國銀行的 Travis Steed 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?

祝賀好季度。也許，加里，關於資本銷售漏斗，也許你可以評論自今年年初以來，當你最初強調一個較慢的漏斗時，漏斗是如何變化的。只是試圖用較慢的漏斗來抵消 13% 的安裝基數增長。如果這被 7% 的更高利用率所抵消，那麼在未來的雙重配售中如何考慮資本？

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.

我們在資本方面看到的是，在我們看到健康的程序增長的地方，安裝基數的增長正在保持同步。你的問題是絕對正確的，即鏈接利用率的增長與安裝基數的增長有關。

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.

在利用率方面，7% 高於正常水平。我們認為，它有一個小神器，這是一年前的第三季度，由於 Delta 變體而受到了一點抑制。所以我認為很難每季度保持 7%。如果客戶能做到這一點，我們會很高興。這是——利用率對他們有好處，對我們有好處，而且很好。由於整個醫院的所有工作流程問題，不僅僅是機器人，而是整個系統，因此很難以持久的方式移動。所以我們兩者都看到了。

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.

我認為資本方面，我們在這裡看到的是，如果您可以成為醫院內的高優先級來獲得資本，就可以競爭資本。因此，資本環境與其說是容易的不如說是有競爭力的。如果你能在派對名單上名列前茅，那麼我們就會發現這個循環，我們在綠地和 Ion 的安裝基數增長中看到了這一點。

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

下一個問題來自高盛的 Amit Hazan。

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?

幾個問題，如果可以的話。首先，我想，也許只是想問一下您是如何考慮更成熟程序的管道的。如果我沒聽錯的話，你是泌尿科和婦科的高個位數，在美國是兩位數，相當不錯的數字。只是想確保那些是乾淨的。然後是關於您自己的來源、外部內部客戶討論的典型問題，您如何看待那些增長較慢的癌症程序的診斷管道，以及我們所處的位置或相對於低谷的方向去年觀察到的水平？

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生長質量問題，Brian，我要向你解釋。

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。而且我認為加里在之前的答案中提到了它，其中一個元素只是與去年的比較期。但在這些特定類別中仍然看到了真正健康的增長。正如我所說，婦科的增長，這是我們第二大手術類別，確實有，我想說，可能在低端有兩位數的增長，然後那些更成熟的泌尿科手術是那些高個位數，但它是從去年的比較來看真的很受歡迎，但仍然做得很好。

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.

在診斷管道上，我們繼續看到的大部分情況是相對穩定的，測試發生的數量大多略低於我們在大流行前看到的數量。我們在美國看到的最近趨勢中的一個例外是結腸鏡檢查的增加。我不會說這個證據表明這影響了達芬奇程序，因為這是最近的趨勢。顯然，我們對越來越多的患者能夠重新進行這些診斷測試這一事實感到鼓舞，我們將看看這在手術方面是如何發揮作用的。

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.

關於布萊恩的後續觀點，你的回答，我認為另一件事是，雖然我們在美國的泌尿科和婦科方面已經成熟，但那裡也有一點增長。但在美國、歐洲和亞洲之外，我們還比較早，我們認為在這兩個類別中，我們將繼續看到增長。

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，只是您在診斷方面的回答的後續要點。你說它開始回升，我們看到了一點點上升。絕對清楚的是，有一個低谷或一大群人沒有參與診斷管道，而且還沒有完全恢復。而且他們的疾病正在發展。這在文獻中也是絕對清楚的。因此，當他們在手術和達芬奇手術方面重新進入衛生系統時，這有多大以及看起來像什麼，你只需要拭目以待。這是一件很難衡量的事情。但我認為那裡有一個推注，考慮到疾病的進展，這是不幸的。

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

接下來，我們有一個來自富國銀行的拉里·比格森 (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。對我來說只有2個。加里，我想從你對明年運營支出支出的色彩評論開始。如果我們看看過去 5 年，你的每股收益增長速度快於銷售額——或者在 COVID 之前，對不起，4 到 5 年，今年，看起來收益可能會下降。每股收益增長的優先級有多少？你需要做什麼才能回到EPS增長快於銷售額的算法？我有一個後續行動。

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.

- 我們看著它。我們希望確保我們能夠有效地管理我們的開支和資本。在我們看到效率的地方，我們會追求它。這就是我一直在傳達的信息，這就是我在腳本中所說的內容。

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我們的生產力，並在我們引進的員工中更好地入職，幫助他們更快地提高生產力。我們認為在我們的新平台中確實存在很好的機會，我們一直在與您討論這些事情。離子生長良好。 SP，當我們追求更多的跡象時，我認為會非常強大，我們對目前市場上的多端口、我們正在做的事情以及我們的數字工具感到滿意。

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.

所以我們認為這些事情很重要。我們不想讓它們挨餓，但我們會對它們進行排序。所以這是一個平衡的方法。其中一些是確保我們的增長引擎保持完好，並且我們繼續創新。其他部分只是確保我們有效地利用資本，並且隨著我們的成長，我們正在建立一個精益組織。

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

傑米，你可以談談你所看到的費用特徵。

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，我只想提出一些框架性的評論。如果您查看我們提供的程序指南的中點，以 3 年復合年增長率為基礎，程序增長率約為 15%。剛剛超過 15%。您對我們的 OpEx 指導執行相同的操作，即不到 15%。所以在 3 年的複合年增長率的基礎上回到 2019 年，程序增長和支出增長相對一致。

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.

我要強調的還有另一件事。如果您查看第三季度報告的收入增長和同比增長 11%，如果您查看我們的經常性收入增長，那大約是我們總收入的 80%，即 16%。如果你在不變的貨幣基礎上進行調整，那就是 20% 的收入增長。與 20% 的程序增長相當。

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.

當您回顧 '18、'19 時，一般來說，程序增長和收入增長相對相似。由於我們已經描述了以舊換新交易量較低的原因，您現在看到了脫節，今年到目前為止的交易量比去年下降了 40%，而且您看到了外彙的影響，因為我們已經描述了。因此，今年的損益表會受到一些宏觀和長期層面的影響。特別是在支出方面，我們在腳本中進行了描述。

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.

我們已經開始完成一些基礎設施投資，這為我們創造了以較低增長率支出的機會。鑑於我們已經完成的工作和我們所做的投資，我們將在我們的支持功能中尋找一些影響力，特別是在我們進入明年時。

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 提到的最後一件事是，當您查看我們的管道時，您將對我們明年的一些程序化支出進行一些自然排序。這些因素影響了我們所描述的運營費用增長率放緩。

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。如果我可以偷偷溜進去 - 再溜進去。加里，你已經談到了世界各地手術的大量變化。您談到了開發工具來確定最佳實踐以減少變化並改善結果。你在那個過程中處於什麼位置？為了實現這一目標，您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。 - 有幾件事。在基線類型上，您需要收集足夠的正確數據來表徵護理團隊的可變性和患者的可變性。所以有一個病人群體，它有變異性，你也有護理團隊或醫生的變異性。並獲得正確的數據流，將它們存儲起來，並弄清楚如何對它們進行正確的評估或分析，管理這些數據，確保它被正確註釋。為了能夠尋找有意義的變異來源，您必須做一些基本的事情。

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.

在獲取正確的數據流、與我們的客戶進行正確的對話以及開始進行分析方面，我們已經走上了這條道路。所以我很興奮。

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.

當我們研究如何實現這一點時，我認為我們仍處於外科科學發現階段。我們與世界各地的許多頂級醫院、學術醫院合作，研究外科數據科學，開始找出變異來源並將其回歸因果關係，而不僅僅是相關性。所以我認為——基線就在那裡，收集和收集數據的能力。我認為我們與頂級研究人員的關係已經到位，我們開始看到看起來非常好的早期信號。

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.

我要說的最後一點是，我們可以做一些合乎邏輯且不是特別複雜的基本事情，可以幫助個性化的學習途徑和培訓途徑，我們現在開始著手解決。這是最先進入該領域的技術。所以我認為這是一個長期的旅程。我們就 Intuitive Hub 或那裡的一些基線功能與您討論了一些關於收集正確數據、以正確方式進行註釋並與正確的醫院客戶共享以獲得良好結果的內容。

Next, we have Robbie Marcus with JPMorgan.

接下來，我們有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?

祝賀你度過了一個美好的季度。也許只是為了更多地了解資本設備環境。您談到了這一點，很高興看到程序推動了安置量。但是，您是否看到任何變化，無論是在美國還是歐洲，因為我們處於世界各地不確定的經濟環境中，顯然還沒有出現在數字中，而只是看看是否有任何變化率或前景是否和現在的環境有什麼不同嗎？

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.

我只想強調幾件事。正如我們與客戶交談過的那樣，這主要是軼事，您確實看到一些輸入表明人員壓力正在緩解一點，特別是在休假率和勞動力成本方面。這兩個因素仍遠高於大流行前的水平，但您看到本季度有所改善，至少基於這些軼事和我們所看到的調查工作。

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.

在第二季度和第三季度，您看到客戶正在重新審查他們的資本預算，這導致資本投資出現一些延遲，顯然，他們重新確定了投資的優先級。我認為機器人手術仍然是一個對客戶具有潛在價值的領域。這確實會造成一些延誤。

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.

在 OUS 方面，到目前為止，我們還沒有看到這些客戶對資本支出的重大影響。一般來說，我們處於採用的早期階段。付款人結構不同。因此，至少到目前為止，我們在 OUS 市場上看到了不錯的資本數字，正如您從比較中看到的那樣。

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.

如果您查看第三季度的歐洲安置，它們增長了 15%。亞洲的配售額同比增長 36%。所以到目前為止我們還沒有看到任何東西。我想說顯然存在經濟風險，特別是在歐洲，那裡的能源狀況、烏克蘭和俄羅斯的情況。我們還沒有看到那些清單。

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

接下來，我們有一個來自 Richard Newitter 與 Truist 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)?

祝賀本季度。就您所做的支出排序評論而言，我們應該如何考慮下一代控制台系統的含義或種類以及您在管道中談到的一些其他類型的迭代技術進步.如果您願意的話，是否對新系統有任何影響，或者按照您所說的支出節奏擴展控制台（聽不清）？

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.

在整個平台上，我們致力於改進機器人系統方面或在那裡進行全面創新。我們致力於儀器和配件以及軟件更新，有時還提供合作產品。總的來說，我們在那些我們認為將對我們的客戶產生最大影響的事情上保持我們的優先級和節奏，使他們能夠獲得更好的結果或抓住他們今天沒有解決的新機會。我們繼續投資並高度重視質量改進和讓我們的客戶更加滿意的事情。

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.

其他一些往往是好主意，但可能不是很緊急的事情，那麼這些事情就會順理成章。這是我們經常進行的對話。我們必須以高優先級做什麼，並以高質量快速完成。之後可以排序的事情是什麼。從流程的角度來看，很難詳細回答您的問題。如果這對我們的客戶很重要，如果這是一個非常不滿意或高機會的事情，那麼這些事情就會首先得到解決。

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

接下來，我們有 Jayson Bedford 和 Raymond James 的產品線。

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?

一個我認為很有趣的話題。你提到了關於 Ion 的消融技術並在德國開始了試驗。你能多談談技術、試驗的規模和範圍，以及你可以在美國提供的任何類型的開始試驗的時間表嗎？

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.

好吧，我會談談動機。就試驗的細節而言，我沒有掌握它們，但我們的團隊可以在未來的電話中對此作出回應。在這裡，我們知道 Ion 可以深入肺部，我們知道外科醫生和介入肺病學家想要治療那裡的組織。他們希望能夠以一種或另一種方式參與其中。所以消融技術可以用於幾種不同的疾病狀態，我們對此非常感興趣，無論是不能手術的癌症，還是肺氣腫或慢性支氣管炎。因此，能夠通過能源導航到那裡最終將很重要。

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.

我相信我們在這裡談論的第一個是微波能源。人們還對其他一些能源感興趣。在某些情況下，我們正在自己開發它。在其他幾種情況下，我們正在與其他人合作。我們認為這將為 Ion 在肺部和其他地方的其他適應症打開大門。我們對此感到非常興奮。很抱歉，我們沒有掌握試驗的詳細信息，但我想我們的團隊將來會為您提供。

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

接下來，我們有 Matt Taylor 和 Jefferies 的產品線。

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?

祝賀一個不錯的季度。我想得到一些更新的想法。在最近和這次電話會議中，您被問到了一些關於此的問題，但也許您可以就您如何看待陷入衰退的醫院客戶的資本支出以及考慮如何比較這個問題向我們提供一些反饋與您過去看到的公司在較長時期內經歷的一些不同周期有何不同？也許做一些比較和對比，談談你看到的需求環境，以及你將如何競爭其他優先資本？

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.

就之前的周期而言，事實上，馬特這個週期有點有趣，因為我們在第一季度指出，我們看到第一季度和第二季度的資本管道出現了一些疲軟，並且在某種程度上，這種情況在第三季度繼續存在。如果我回顧 2008 年的前幾個週期，您會看到資本配置同比下降了 3 個季度。 2013 年，我認為我們看到了連續 5 個季度的資本配置下降。然後，當 COVID 在 2020 年再次出現時，連續三個季度。

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.

我只給出這些作為參考點。我認為我們不能說這些是關於如果以及何時美國或以後出現衰退可能會發生什麼的指示性。所以我認為，老實說，如果你看一下經濟預測的進展，在這一點上它非常複雜且難以判斷。所以我們只是給出那些歷史參考點。

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.

給我兩條評論。當然，衰退的發生、深度和形式，我們坐在這張桌子上是無法預測的。我可以談論的是與醫院高管的對話是如何進行的。我認為總的來說，他們的觀點是盡可能地為他們的患者群體服務，使用能夠以他們想要的價格獲得他們想要的結果的技術。

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。我認為無論是在產品方面，還是我們展示醫院經濟可行性和邊際收益收益的能力都是強大的。我認為這給了我們一些未來的力量。也就是說，這取決於它的難度和深度，然後就變成了他們想為患者群體提供什麼以及他們將不得不做出什麼樣的決定的問題。

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.

我還認為，相對於過去的周期，Intuitive 在租賃組合和其他一些方面的工具箱中有更多工具。很難預測它會走向何方。我認為我們展示價值和調整資本配置模式的能力比過去幾年要強一些。

And next, we have Adam Maeder with Piper Sandler.

接下來，我們有 Adam Maeder 和 Piper Sandler。

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.

祝賀你度過了一個美好的季度。我想問一下 Ion，如果我沒看錯的話，它的安裝量創下了記錄，而且還有一些非常好的銷量趨勢。那麼 Gary 或 Jamie，你能談談是什麼驅動了系統佈局的這種變化嗎？然後你引用了我認為今天早些時候在 CHEST 上展示的 PRECISE 數據以及明年即將出版的期刊。只需談談對未來採用的任何潛在影響。

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.

我會跳進去，傑米，你可以幫忙。我認為我們仍處於早期市場。我們對所獲得的增長和客戶反饋感到滿意——當我們與他們交談並調查我們的客戶時，他們對 Ion 產品的滿意度非常高。我認為這是由幾件事驅動的。從 PRECISE 試驗中得出的初步數據已經被討論過了，現在我認為後來的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.

我認為正在發生的另一件事是，當我們安裝了其他站點並幫助他們啟動他們的程序時，我認為他們能夠複製這些數據。我認為它被普遍採用。我認為這會產生復合效應。早期出版物在即將加入的新團隊手中重複使用的想法給了他們信心。這是肺病學界的一點點口耳相傳，讓他們相信他們可以獲得正在發表的內容。我認為這對我們來說很強大。

Jamie, any comments?

傑米，有什麼意見嗎？

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.

我只想說，我們在結構選擇方面得到了一些認可，特別是在導管直徑方面，這對較小病變的診斷產生了真正的影響，你可以在臨床數據中看到這一點。我認為工程和商業團隊在我們推出產品後的這段時間裡執行得非常好。

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.

而且我確實認為IP和產品用戶之間存在一種口口相傳的光環效應。我認為結合臨床數據，這對我們迄今為止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.

我不會具體描述我們是如何取得進展的，我認為我們已經取得了持續的進展。

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

接下來，我們有巴克萊銀行的 Matt Miksic 產品線。

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.

她是一個完美的季度。所以也祝賀這一點。 - 我只是想跟進你談到的一些事情，這些宏觀因素會稍微影響市場、你的客戶和你的業務，其中一個是其中一些中心的人員配置挑戰正面臨。好奇這究竟是如何影響程序恢復或系統需求在這裡演變的方式？然後到 23 年，只是好奇你談到的一些成本，每個人都在談論——我知道現在問這種問題還為時過早，但你現在關於我們應該如何考慮這些成本的想法在 23 年的發展中，它要么是上升並保持不變，要么是上升然後能夠被管理下來，或者只是根據你的成本結構以及它是如何增加的？您的任何想法將不勝感激。

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.

也許問題的第二部分，我會接受，馬特。所以我們不會給出任何關於 '23 數字的具體信息。我們會等到 1 月份，屆時我們通常會提供指導。我認為由於加里所描述的原因，我們就 2023 年的運營費用所說的話，該支出的增長率將低於我們在 2022 年經歷的增長率。其中一個重要組成部分是人數我們將在明年僱用。再一次，加里所描述的是，考慮到我們僱用的員工，我們將在一段時間內確保我們有效地接納這些新員工並讓他們進入生產力狀態，這將是一個我們要經歷那種吸收階段。

I'll let Gary respond to the first part.

我會讓 Gary 回應第一部分。

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 - 對不起，我只是錯過了問題的第一部分。你能重述那個嗎？

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。就在影響因素的背景下——你有一些流量恢復，你有什麼程序和系統——新的系統趨勢，人員配置——醫院人員配置或挑戰如何影響你的業務中的這些趨勢，如果有的話？

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，公平的問題。這真有趣。我認為那裡有一個看跌期權和一個看跌期權。當然，在艱難的一面，如果醫院人員配置確實受到挑戰，尤其是涉及手術室人員時，這可能會限制他們將執行的程序。總的來說，我認為人們為獲得 OR 人員支付了更多費用，因為他們認識到他們既想治療這些患者，而且這對醫院的收入線很重要。

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.

因此，它主要是通脹壓力，因為它與我們所在空間的手術室發生的事情有關。有趣的是，我們啟用的高質量 MIS 微創手術有助於抵消手術後的一些人員配備需求。實際上，這很清楚。因此，如果他們可以按照我們進行的手術類型進行手術，那麼將為他們節省一些人員配備方面的後端成本。所以那裡有一點蹺蹺板。到目前為止，我認為在人員限制方面並沒有很快改善。聽起來確實很穩定，並且可能略有改善。

Operator, we have time for one more question.

接線員，我們有時間再問一個問題。

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

好的。我們與摩根士丹利有 Drew Ranieri 的產品線。

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?

加里，也許只是在離子上。你能 - 我知道現在還處於早期階段，因為你在商業上建造細胞，但有幾個問題。一是你的供應是否因滿足需求而受到限制？然後，您能否告訴我們您在 Ion 的賬戶滲透方面處於什麼位置，無論是介入肺科醫師還是醫院層面？

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，我們正在努力滿足資本方面的需求。我想我們快到了。我們非常接近，非常接近平衡。我不認為我們領先或落後。同樣，在消耗品或每個程序方面，我們正在努力滿足需求。而且我認為我們稍微落後，不是領先，也不是落後。我們可能正在接近，但努力保持增長。

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.

所以在滲透方面，我認為我們進入股票組合和類似的事情有點早，我認為我們還沒有準備好描述我們在賬戶方面或肺病方面的位置。因此，我們將其保存以備將來調用。

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.

無論如何，謝謝你。那是我們的最後一個問題。最後，我們仍然相信存在從根本上改善手術和急性干預的實質性和持久的機會。我們的團隊繼續與醫院、醫生和護理團隊密切合作，以追求我們的客戶所說的四重目標：更好、更可預測的患者結果、更好的患者體驗、更好的護理團隊體驗，並最終降低總體護理費用。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。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。

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，我們設想了一個侵入性更小、效果更好的護理未來，疾病被更早地發現並迅速治療，這樣患者就可以回到最重要的事情上。

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

感謝您對這次非凡旅程的支持。我們期待在 3 個月後再次與您交談。

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.

謝謝你。女士們先生們，今天的會議到此結束。感謝您的參與和使用 AT&T Event Conferencing。您現在可以斷開連接。