直覺手術 (ISRG) 2022 Q4 法說會逐字稿

Ladies and gentlemen, good afternoon. Thank you for standing by, and welcome to the Intuitive Quarter 4 2022 Earnings Release. (Operator Instructions). And as a reminder, today's conference is being recorded. At this time, I'd like to turn the conference over to our host, Head of Investor Relations, Mr. Brian King, please go ahead.

女士們，先生們，下午好。感謝您的支持，歡迎來到 Intuitive 2022 年第四季度收益發布。 （操作員說明）。提醒一下，今天的會議正在錄製中。現在，我想把會議轉交給我們的主持人，投資者關係主管 Brian King 先生，請繼續。

Good afternoon, and welcome to Intuitive's fourth quarter earnings conference call. With me today, we have Gary Guthart, our CEO; and Jamie Samath, our CFO.

下午好，歡迎來到 Intuitive 的第四季度收益電話會議。今天和我一起的是我們的首席執行官 Gary Guthart；和我們的首席財務官 Jamie Samath。

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 October 21, 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.

在我們開始之前，我想通知您，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於某些風險和不確定性，實際結果可能與明示或暗示的結果存在重大差異。這些風險和不確定性在我們提交給美國證券交易委員會的文件中有詳細描述，包括我們於 2022 年 2 月 3 日提交的最新 10-K 表格和 2022 年 10 月 21 日提交的 10-Q 表格。我們的 SEC 文件可以通過以下方式找到我們的網站或 SEC 的網站。提醒投資者不要過分依賴此類前瞻性陳述。

Please note that this conference call will be available for audio replay on our website at intuitive.com on the Events section under our Investor Relations page. Today's press release and supplementary financial data tables have been posted to our website. Today's format will consist of providing you with highlights of our fourth quarter results as described in our press release announced earlier today, followed by a question-and-answer session.

請注意，本次電話會議可在我們網站 intuitive.com 的投資者關係頁面下的“活動”部分進行音頻重播。今天的新聞稿和補充財務數據表已發佈到我們的網站上。今天的形式包括為您提供我們今天早些時候發布的新聞稿中描述的第四季度業績的亮點，然後是問答環節。

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 2023. And finally, we will host a question-and-answer session. And with that, I will turn it over to Gary.

Gary 將介紹本季度的業務和運營亮點。傑米將對我們的財務業績進行審查。然後我將討論程序和臨床亮點，並提供我們對 2023 年的最新財務展望。最後，我們將舉行問答環節。有了這個，我會把它交給加里。

Thank you for joining us today. The fundamentals of our business were healthy in Q4 and for the full year 2022. Procedure growth for the full year approached pre-pandemic levels, installed base growth was solid, and customers concurrently increased utilization of existing systems. Our investments in product development extended our multiport, single-port and flexible robotics ecosystems through new instrument accessories, digital products and indication expansions. Finally, the fine work of our operations teams and supply partners largely mitigated the supply chain challenges that persisted through the year.

感謝您今天加入我們。我們業務的基本面在第四季度和 2022 年全年都是健康的。全年的程序增長接近大流行前的水平，安裝基礎增長穩固，客戶同時增加了現有系統的利用率。我們在產品開發方面的投資通過新的儀器配件、數字產品和適應症擴展擴展了我們的多端口、單端口和靈活的機器人生態系統。最後，我們的運營團隊和供應合作夥伴的出色工作在很大程度上緩解了全年持續存在的供應鏈挑戰。

Turning first to procedures. We saw 18% procedure growth for the quarter and the full year. Areas of strength included general surgery in the United States, particularly benign procedures such as bariatric surgery, cholecystectomy and hernia repair. Colon and rectal procedure growth also continued. Strong growth beyond urology outside the U.S. was accretive to our global performance. We attribute this diversification to the value of our ecosystems and our strategic investments in organization, clinical trials, data products and market access. Regionally, the United States, Japan, Europe and India stood out in the quarter and year.

首先談到程序。我們看到本季度和全年的程序增長了 18%。優勢領域包括美國的普通外科手術，尤其是減肥手術、膽囊切除術和疝修補術等良性手術。結腸和直腸手術的增長也在繼續。美國以外泌尿外科領域的強勁增長促進了我們的全球業績。我們將這種多元化歸因於我們生態系統的價值以及我們在組織、臨床試驗、數據產品和市場准入方面的戰略投資。從地區來看，美國、日本、歐洲和印度在季度和年度表現突出。

Procedure growth in China was hampered by the COVID wave in Q4 with procedures progressively declining starting in November through the end of '22. Ion procedures showed continued strength with 218% growth in '22 compared with '21, and SP procedures grew 38% over the same period, with the majority of its growth coming from Korea. Global core procedure areas of urology and gynecology moved toward recovery in the year, both exceeding their 3-year compound annual growth rates in '22. On the capital front, we placed 369 systems in Q4 compared with 385 in Q4 2021. For the full year, we placed 1,264 systems compared with 1,347 in '21. Our installed base growth rate was 12% for multiport, 149% for Ion and 22% for SP in 2022.

中國的手術增長受到第四季度 COVID 浪潮的阻礙，從 11 月到 22 年底，手術逐漸減少。與 21 年相比，離子手術在 22 年增長了 218%，並且 SP 手術在同一時期增長了 38%，其中大部分增長來自韓國。泌尿外科和婦科的全球核心手術領域在這一年走向復甦，均超過了 22 年的 3 年復合年增長率。在資本方面，我們在第四季度放置了 369 個系統，而 2021 年第四季度為 385 個。全年，我們放置了 1,264 個系統，而 2021 年為 1,347 個。到 2022 年，我們的多端口安裝基數增長率為 12%，Ion 為 149%，SP 為 22%。

Overall, our capital placement trends showed sustained demand for additional capacity in multiport and strong interest in expanding capacity for Ion with several hospitals now operating multiple Ion systems in their programs and variable demand for SP as we continue to pursue our additional indications. System utilization is an important predictor of future demand and utilization grew 5% for multiport in the year and 10% for Ion. Utilization was roughly flat for SP over the year, however, utilization increased by 9% in Q4 measured year-over-year as our organization incorporated learnings.

總體而言，我們的資本配售趨勢表明，對多端口額外容量的持續需求以及對擴大 Ion 容量的濃厚興趣，幾家醫院現在在其項目中運行多個 Ion 系統，並且隨著我們繼續追求我們的額外適應症，對 SP 的需求不斷變化。系統利用率是未來需求的重要預測指標，當年多端口的利用率增長了 5%，Ion 增長了 10%。全年 SP 的利用率大致持平，但是，由於我們的組織吸收了經驗教訓，第四季度的利用率同比增長了 9%。

Touching on our finances, revenue grew 9% in 2022. Revenue was impacted by the strength of the dollar in the year and the decline of the trade-in population of third-generation multiport systems. Our expenses landed at the higher end of our spend guidance reflecting continued R&D investments that support the growth of our platforms and digital products, expansion of our manufacturing and commercial capabilities and capital amortization driven by expansion of our global footprint.

談到我們的財務，2022 年的收入增長了 9%。收入受到當年美元走強和第三代多端口系統以舊換新人口減少的影響。我們的支出處於我們支出指導的較高端，反映了持續的研發投資，這些投資支持我們的平台和數字產品的增長、我們的製造和商業能力的擴展以及我們全球足跡擴張推動的資本攤銷。

Structurally, we have been increasing our own capital expenditures as we continue to build the company to supply the globe at industrial scale. This is an important investment as several procedures using our systems have become the standard of care in several countries. We have been vertically integrating key technologies to develop a more robust supply chain and bring important products to market at attractive price points. These investments include increased ownership of our imaging pipelines, strategic instrument and accessory technologies and software and digital products that allow us to serve our customers.

在結構上，我們一直在增加自己的資本支出，因為我們繼續建設公司以工業規模供應全球。這是一項重要的投資，因為使用我們系統的多個程序已成為多個國家/地區的護理標準。我們一直在垂直整合關鍵技術，以開發更強大的供應鏈，並以極具吸引力的價格將重要產品推向市場。這些投資包括增加對我們的成像管道、戰略儀器和附件技術以及軟件和數字產品的所有權，使我們能夠為客戶提供服務。

The investments make our business more capital intensive than years past, in support of industrial dependability, a more robust supply chain and lower product costs. I'd also like to take a moment to walk through our platform investments. Intuitive starts with the end in mind. Coordinating our efforts to enable our customers' pursuit of the quadruple aim in specific procedures, for example, those in general surgery. We design all our systems to allow for the addition of new functionality over time. For our multiport platform, this design philosophy has enabled us to continuously strengthen our fourth-generation da Vinci Xi by adding new regulatory clearances, a new model with the da Vinci X, new instruments and accessories, new imaging capabilities and new software products.

這些投資使我們的業務比過去幾年更加資本密集，以支持工業可靠性、更強大的供應鍊和更低的產品成本。我還想花點時間介紹一下我們的平台投資。直覺以終為始。協調我們的努力，使我們的客戶能夠在特定程序（例如普通外科手術）中實現四重目標。我們設計所有系統以允許隨著時間的推移添加新功能。對於我們的多端口平台，這種設計理念使我們能夠通過增加新的監管許可、帶有達芬奇 X 的新型號、新儀器和配件、新成像功能和新軟件產品來不斷加強我們的第四代達芬奇 Xi。

These products include our stapling lot of instruments as well as our advanced energy instruments, which contributed approximately $890 million in revenue in '22 with revenue growth of 18% in the year and are a key enabler of the general surgery growth discussed a minute ago. We added 65 representative clinical procedure indications in the United States to our fourth-generation multiport platform since its launch. Our multiport indications now spans 6 surgical categories and total over 70 procedure indications for multiport platforms in the United States today.

這些產品包括我們的大量裝訂儀器以及我們的高級能量儀器，它們在 22 年貢獻了大約 8.9 億美元的收入，當年收入增長了 18%，並且是一分鐘前討論的普通外科手術增長的關鍵推動因素。自第四代多端口平台推出以來，我們在美國增加了 65 個具有代表性的臨床程序適應症。我們的多端口適應症現在涵蓋 6 個手術類別，並且在當今美國的多端口平台上總共有 70 多個手術適應症。

We routinely improve our platform operating systems with roughly 10 significant fourth-generation OS releases since launch and dozens of smaller software upgrades. We launched our next-generation Xi visualization, Endoscope Plus, and have been integrating digital products, including virtual reality training Intuitive Hub and the My Intuitive app. We expect to launch additional Gen 4 compatible products and operating system software this year. Concurrently, we invest in new generations of our multiport platform that bring new and significantly enhanced capabilities. For our multiport system development programs, we prioritize as follows: our highest priority is the improvement of core surgical capability targeting improved patient outcomes, often through innovation in robot and instrument precision, imaging and sensing while focusing on dependability and product quality. Next, we designed to improve usability, care team's skill acquisition and analytic power, including digital products for the operating room, personalized learning for care teams and efficiency analysis and services for surgical programs.

自發布以來，我們通過大約 10 個重要的第四代操作系統版本和數十個較小的軟件升級定期改進我們的平台操作系統。我們推出了下一代 Xi 可視化 Endoscope Plus，並一直在整合數字產品，包括虛擬現實培訓 Intuitive Hub 和 My Intuitive 應用程序。我們預計今年將推出更多 Gen 4 兼容產品和操作系統軟件。同時，我們投資於新一代多端口平台，帶來新的和顯著增強的功能。對於我們的多端口系統開發計劃，我們優先考慮如下：我們的首要任務是提高核心手術能力，以改善患者結果，通常通過機器人和儀器精度、成像和傳感方面的創新，同時關注可靠性和產品質量。接下來，我們旨在提高可用性、護理團隊的技能獲取和分析能力，包括手術室的數字產品、護理團隊的個性化學習以及手術程序的效率分析和服務。

Next, we designed platforms and their ecosystems that can lower the total cost to treat per patient episode. And finally, we designed with the flexibility to add future capability to systems post launch. Given the time required to design and validate new architectures at any given moment, we're typically developing more than 1 system architecture beyond that in the market.

接下來，我們設計了平台及其生態系統，可以降低每次患者發作的總治療成本。最後，我們的設計具有靈活性，可以在系統發布後增加未來的功能。鑑於在任何給定時刻設計和驗證新架構所需的時間，我們通常會開發超過市場上的系統架構。

In the current global regulatory environment, core technology changes often require human clinical trials and substantial review. These are multiyear investment cycles, and we're making good progress. As we start this year, we do not currently expect a new multiport system launch in 2023.

在當前的全球監管環境中，核心技術的改變往往需要進行人體臨床試驗和大量審查。這些是多年投資週期，我們正在取得良好進展。從今年開始，我們目前預計 2023 年不會推出新的多端口系統。

Turning to Ion. Adoption has been healthy based on its ability to meet an unmet clinical need in lung biopsy. We're focused on improving the manufacturability, cost and robustness of Ion products to support its rapid growth in the U.S. We have also submitted a regulatory dossier for a review in Europe, Korea and in China's green channel. We expect clearance in Europe in 2023. We don't have a firm forecast on the time for Ion clearance in China at this time given pandemic-related adjustments ongoing in the Chinese health care system.

轉向離子。基於其滿足肺活檢未滿足的臨床需求的能力，採用情況良好。我們專注於提高 Ion 產品的可製造性、成本和穩健性，以支持其在美國的快速增長。我們還提交了一份監管檔案，供歐洲、韓國和中國的綠色通道審查。我們預計 2023 年在歐洲獲得批准。鑑於中國醫療保健系統正在進行與大流行相關的調整，我們目前對 Ion 在中國的批准時間沒有明確的預測。

Ion is also a platform with strong opportunities for future clinical applications. We're conducting advanced development and clinical research to extend Ion into other indications in the lung. While our Ion flexible robotics offers an opportunity to provide value in the body outside the lung, our focus is on completing what we started for pulmonologists and thoracic surgeons.

Ion 也是一個為未來臨床應用提供強大機會的平台。我們正在進行先進的開發和臨床研究，以將 Ion 擴展到肺部的其他適應症。雖然我們的 Ion 柔性機器人技術提供了在肺外的身體中提供價值的機會，但我們的重點是完成我們為肺科醫生和胸外科醫生開始的工作。

Our single-port platform, da Vinci SP, has supported strong adoption in Korea and has recently obtained PMDA clearance with broad indications in Japan. We expect first installs of SP in Japan in the coming months. Next, we plan to submit our dossier on da Vinci SP to our notified body in Europe midyear 2023. So far, customer feedback on the clinical utility for SP has been healthy with strong multi-specialty use of SP in Korea.

我們的單端口平台 da Vinci SP 在韓國得到廣泛採用，最近在日本獲得了具有廣泛適應症的 PMDA 許可。我們預計未來幾個月將在日本首次安裝 SP。接下來，我們計劃在 2023 年年中向我們在歐洲的公告機構提交有關達芬奇 SP 的檔案。到目前為止，客戶對 SP 臨床效用的反饋是健康的，在韓國對 SP 的多專業使用很強勁。

In the United States, some indications have required prospective clinical trials, and we're currently conducting IDE trials in colorectal surgery and thoracic surgery. We're pursuing additional indications for SP beyond these 2, and we'll share more information on these indications in 2023 as the requirements for our regulatory pathway for them are established. We're continuing to invest significant resources in R&D, where the portfolio we have under development positioned to support leadership in existing categories and expansion into new ones. Our capital investments will increase to support supply chain robustness, product cost reduction and global industrial scale.

在美國，一些適應症需要前瞻性臨床試驗，我們目前正在結直腸外科和胸外科進行 IDE 試驗。除了這 2 個，我們正在尋求 SP 的其他適應症，並且隨著我們對它們的監管途徑的要求的建立，我們將在 2023 年分享更多關於這些適應症的信息。我們將繼續在研發方面投入大量資源，我們正在開發的產品組合定位於支持在現有類別中的領導地位並擴展到新類別。我們將增加資本投資，以支持穩健的供應鏈、降低產品成本和擴大全球產業規模。

On the SG&A front, we are making some foundational investments, and we'll turn to pursue leverage in enabling functions. Recognizing economic conditions for 2023 are hard to forecast, we're targeting a deceleration of fixed cost growth rate in '23 relative to '22. We expect pro forma operating margins to fluctuate in the next several quarters and then improve over the midterm.

在 SG&A 方面，我們正在進行一些基礎性投資，我們將轉向追求支持功能的影響力。認識到 2023 年的經濟狀況難以預測，我們的目標是使 23 年的固定成本增長率相對於 22 年有所下降。我們預計備考營業利潤率將在未來幾個季度波動，然後在中期有所改善。

In closing, our priorities for 2023 are as follows: first, increased adoption and focused procedures defined by country through outstanding training, commercial and market access execution; second, pursuit of expanded indications and launches for our new platforms; third, excellent performance in the continuity of supply, product quality and services provision as we emerge from pandemic stresses; and finally, pursuit of increased productivity and our functions that benefit from scale.

最後，我們 2023 年的優先事項如下：首先，通過出色的培訓、商業和市場准入執行，增加國家定義的採用和重點程序；第二，尋求擴大我們新平台的適應症和發布；第三，在我們擺脫大流行壓力的情況下，在供應連續性、產品質量和服務提供方面表現出色；最後，追求提高生產力和我們受益於規模的職能。

I'll now turn the time over to Jamie, who will take you through our finances in greater detail.

我現在將時間交給 Jamie，他將帶您更詳細地了解我們的財務狀況。

Good afternoon. 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.

下午好。我將在非 GAAP 或備考基礎上描述我們的業績亮點。我還將在稍後準備好的評論中總結我們的 GAAP 表現。我們的備考結果與 GAAP 結果之間的對賬已發佈在我們的網站上。

Q4 and 2022 revenue and procedures are in line with our preliminary press release of January 11. I will briefly review full year 2022 performance before describing our Q4 results in greater detail. 2022 procedures grew by 18% as compared to 2021 or 15% on a 3-year compound annual growth rate basis. During the year, we placed 1,264 systems at customers, down 6% year-over-year, driven by a decline in trading volumes of 165 systems due to the declining population of SIs in the field. Recurring revenue, which is correlated to ongoing use of our products represented 79% of total revenue and grew 15% over the prior year. Total revenue of $6.2 billion increased 9% year-over-year and grew approximately 12% on a constant currency basis.

第四季度和 2022 年的收入和程序與我們 1 月 11 日的初步新聞稿一致。在更詳細地描述我們的第四季度結果之前，我將簡要回顧一下 2022 年全年的業績。與 2021 年相比，2022 年的程序增長了 18%，按 3 年復合年增長率計算增長了 15%。年內，我們向客戶提供了 1,264 個系統，同比下降 6%，這是由於該領域 SI 數量的減少導致 165 個系統的交易量下降。與我們產品的持續使用相關的經常性收入佔總收入的 79%，比上一年增長 15%。總收入 62 億美元，同比增長 9%，按固定匯率計算增長約 12%。

Pro forma operating margin was 35% of revenue and reflected the impact of several headwinds, FX, supply chain challenges and inflation together adversely impacted 2022 pro forma operating margin by approximately 1 percentage point. During the year, we repurchased $2.6 billion of our stock or approximately 11.2 million shares, and we have a remaining authorization to repurchase our shares of $1.5 billion.

預計營業利潤率為收入的 35%，反映了多種逆風、外匯、供應鏈挑戰和通貨膨脹的影響，共同對 2022 年預計營業利潤率產生了約 1 個百分點的不利影響。年內，我們回購了價值 26 億美元的股票或約 1120 萬股股票，我們還有剩餘的授權可以回購價值 15 億美元的股票。

Turning to Q4. With respect to capital performance, we placed 369 systems, 4% lower than the 385 systems we placed in the fourth quarter of last year. There were 110 trading transactions in the quarter as compared to 117 last year. 51 of the 110 trading transactions were with OUS customers higher than recent trends primarily driven by customers in Japan and Brazil. As of the end of Q4, there were approximately 620 SIs remaining in the installed base, of which 134 are in the U.S.

轉向第四季度。在資本績效方面，我們放置了 369 個系統，比去年第四季度放置的 385 個系統低 4%。本季度有 110 筆交易，而去年為 117 筆。 110 筆交易中有 51 筆是與 OUS 客戶進行的，高於主要由日本和巴西客戶推動的近期趨勢。截至第 4 季度末，已安裝基礎中還剩下大約 620 個 SI，其中 134 個在美國。

Given the continuing decline of older generation systems in the field, we expect trade-in volumes to decline significantly in 2023. Q4 revenue was $1.66 billion, an increase of 7% from last year. On a constant currency basis, fourth quarter revenue grew approximately 10%. For full year 2022, revenue denominated in non-USD currencies represented 24% of total revenue. The U.S. dollar has weakened recently, and as a result, on a revenue-weighted basis using current rates, the U.S. dollar is approximately 100 basis points stronger than the average rates realized in 2022. Additional revenue statistics and trends are as follows: in the U.S., we placed 181 systems in the fourth quarter, lower than the 235 systems we placed last year, reflecting cautious capital spending by customers given the macroeconomic environment and a decline of 21 systems associated with trade-in transactions. Average system utilization in the U.S. increased by 6%, reaching an all-time high. Outside the U.S. we placed 188 systems in Q4 compared with 150 systems last year.

鑑於老一代系統在該領域的持續下降，我們預計 2023 年以舊換新量將大幅下降。第四季度收入為 16.6 億美元，比去年增長 7%。按固定匯率計算，第四季度收入增長約 10%。 2022 年全年，以非美元貨幣計價的收入佔總收入的 24%。美元最近走弱，因此，在使用當前匯率的收入加權基礎上，美元比 2022 年實現的平均匯率強約 100 個基點。其他收入統計和趨勢如下：在在美國，我們在第四季度放置了 181 個系統，低於我們去年放置的 235 個系統，反映出客戶在宏觀經濟環境下謹慎的資本支出以及與以舊換新交易相關的 21 個系統的減少。美國的平均係統利用率增長了 6%，達到歷史最高水平。在美國以外，我們在第四季度放置了 188 個系統，而去年為 150 個系統。

Current quarter system placements included 70 into Europe, 51 into Japan and 14 into China compared with 63 into Europe, 37 into Japan and 14 into China in the fourth quarter of 2021. As of the end of 2022, there were 34 systems remaining under the current quota in China. There are now 4 local competitors that are registered in China and they're active in tenders under the existing quota. Delays in the granting of a new quota in China will constrain our ability to further grow the installed base and limit capacity for procedure growth. Leasing represented 42% of Q4 placements compared with 37% last quarter and last year. The higher lease mix was primarily driven by the mix of customers in the U.S., who prefer to lease and reflected in part an increase in placements acquired under usage-based arrangements. While leasing will fluctuate from quarter-to-quarter, we continue to expect that the proportion of placements under operating leases will increase over time.

當前季度的系統部署包括 70 個進入歐洲、51 個進入日本和 14 個進入中國，而 2021 年第四季度有 63 個進入歐洲、37 個進入日本和 14 個進入中國。截至 2022 年底，還有 34 個系統留在中國目前的配額。現在有 4 個在中國註冊的本地競爭者，他們在現有配額下積極參與投標。在中國延遲授予新的配額將限制我們進一步擴大安裝基礎的能力，並限製程序增長的能力。租賃佔第四季度配售的 42%，而上一季度和去年均為 37%。較高的租賃組合主要受美國客戶組合的推動，他們更喜歡租賃，部分反映了根據使用情況安排獲得的配售增加。雖然租賃將按季度波動，但我們繼續預計經營租賃下的配售比例將隨著時間的推移而增加。

Q4 system average selling prices were $1.43 million as compared to $1.45 million last year. System ASPs were negatively impacted by FX, partially offset by a favorable regional mix and a higher mix of Xi jewel placements. We recognized $17 million of lease buyout revenue in the fourth quarter compared with $17 million last quarter and $26 million in Q4 of 2021. da Vinci instrument and accessory revenue per procedure was approximately $1,820 compared with approximately $1,800 last quarter and $1,940 last year.

第 4 季度系統平均售價為 143 萬美元，而去年為 145 萬美元。系統 ASP 受到外彙的負面影響，部分被有利的區域組合和更高的 Xi 珠寶放置組合所抵消。我們在第四季度確認了 1,700 萬美元的租賃買斷收入，而上一季度為 1,700 萬美元，2021 年第四季度為 2,600 萬美元。達芬奇儀器和配件每次手術的收入約為 1,820 美元，而上一季度約為 1,800 美元，去年為 1,940 美元。

On a year-over-year basis, FX negatively impacted I&A per procedure by approximately $50 and customer ordering patterns had a negative impact of approximately $40 per procedure as customers, particularly in the U.S. and China, reduced their inventory levels.

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，而客戶訂購模式對每個程序產生了大約 40 美元的負面影響，因為客戶（尤其是美國和中國的客戶）降低了庫存水平。

Turning to our Ion platform. In 2022, we tripled procedures to just over 23,000 and doubled system placements to 192 as compared to 2021. In Q4, we placed 67 Ion systems as compared to 31 in Q4 of 2021. The installed base of Ion systems is now 321 systems, of which 132 are under operating lease arrangements. Fourth quarter Ion procedures of approximately 7,900 increased 169% as compared to last year. Leveraging previous investments we have made in our da Vinci ecosystem during the quarter, we commenced the launch of My Intuitive app for Ion users, providing them real-time access and insights to their Ion usage statistics.

轉向我們的 Ion 平台。與 2021 年相比，到 2022 年，我們的程序增加了兩倍，達到 23,000 多個，系統安置增加了一倍，達到 192 個。在第四季度，我們安置了 67 個 Ion 系統，而 2021 年第四季度為 31 個。Ion 系統的安裝基數現在是 321 個系統，其中其中 132 家處於經營租賃安排之下。第四季度約 7,900 例 Ion 手術與去年相比增長了 169%。利用我們在本季度對達芬奇生態系統所做的投資，我們開始為 Ion 用戶推出 My Intuitive 應用程序，為他們提供實時訪問和洞察他們的 Ion 使用統計數據。

Moving on to the rest of the P&L. Pro forma gross margin for the fourth quarter of 2022 was 68.2% compared with 70.1% for the fourth quarter of 2021 and 69.8% last quarter. As a reminder, last quarter's gross margin included a one-time 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 increased fixed costs relative to revenue, the stronger U.S. dollar and higher component pricing. The supply chain environment was challenging in Q4 and indicators of supply and inventory health did not improve as compared to last quarter. Higher fixed costs relative to revenue reflect a combination of manufacturing-related inefficiencies given the environment and investments for future growth.

繼續討論損益表的其餘部分。 2022 年第四季度的備考毛利率為 68.2%，而 2021 年第四季度為 70.1%，上一季度為 69.8%。提醒一下，上一季度的毛利率包括與某些間接稅事項的有利結果相關的約 50 個基點的一次性收益。預計毛利率低於去年，這主要是由於相對於收入的固定成本增加、美元走強和組件定價上漲。第四季度供應鏈環境充滿挑戰，供應和庫存健康指標與上一季度相比沒有改善。相對於收入較高的固定成本反映了在環境和未來增長投資的情況下與製造相關的低效率。

Fourth quarter pro forma operating expenses increased 19% compared with last year, driven by increased headcount, higher travel costs, increased customer training activities and higher R&D-related project costs. Fourth quarter 2021 operating expenses included a $30 million contribution to the Intuitive Foundation, which can support their efforts for the next couple of years and did not repeat in 2022. The pace at which we are increasing headcount continued to moderate in Q4 with net additions of about 330 employees in the quarter compared to a net increase of approximately 530 employees last quarter. More than half of the employees we added in Q4 were production staff in our instrument factory in Mexico to support procedure growth. While we are slowing our hiring pace and pursuing leverage in our enabling functions, we are planning for balanced growth in operating expenses in 2023 given the opportunity to advance our next-generation robotics capabilities and the relatively earlier stage of our investments in Ion, SP and digital.

受員工人數增加、差旅成本增加、客戶培訓活動增加以及研發相關項目成本增加的推動，第四季度預估運營費用比去年同期增長 19%。 2021 年第四季度的運營支出包括對 Intuitive Foundation 的 3000 萬美元捐款，這可以支持他們未來幾年的努力，並且在 2022 年不會重複。我們增加員工人數的速度在第四季度繼續放緩，淨增加了本季度約有 330 名員工，而上一季度淨增約 530 名員工。我們在第四季度新增的員工中有一半以上是墨西哥儀器工廠的生產人員，以支持程序的增長。雖然我們正在放慢我們的招聘步伐並在我們的支持職能中尋求槓桿作用，但我們計劃在 2023 年實現運營支出的平衡增長，因為有機會提升我們的下一代機器人技術能力以及我們在 Ion、SP 和數字的。

In 2023, we expect a significant increase in expenses related to clinical trials. Brian will provide our outlook for operating expenses later in this call. As we look forward to our growth plans over the next several years, we are planning to make significant capital expenditures. Capital expenditures for 2022 were $532 million, and we expect 2023 capital expenditures in a range of $800 million to $1 billion, of which approximately 2/3 will be for facilities to expand our manufacturing capacity. Our manufacturing investment plans include advanced proprietary facilities for production of new products and the Ion platform in California and da Vinci systems in Georgia.

到 2023 年，我們預計與臨床試驗相關的費用將大幅增加。布賴恩將在本次電話會議稍後提供我們對運營費用的展望。在我們期待未來幾年的增長計劃時，我們計劃進行大量資本支出。 2022 年的資本支出為 5.32 億美元，我們預計 2023 年的資本支出在 8 億至 10 億美元之間，其中約 2/3 將用於擴大我們的製造能力的設施。我們的製造投資計劃包括用於生產新產品的先進專有設施以及加利福尼亞州的 Ion 平台和佐治亞州的達芬奇系統。

Internationally, we are increasing our product development capacity in Germany, building a new low-cost endoscope manufacturing facility in Bulgaria and establishing manufacturing capacity for domestic Xi production in China. We will also be expanding the footprint of our high-volume, low-cost instrument site in Mexico to support procedure growth across all of our platforms. These investments allow us to consolidate our manufacturing into larger centralized hubs, such as our headquarter campus in Sunnyvale, California and our East Coast hub just outside of Atlanta, while we will co-locate surgeon training, technology development and manufacturing capacity. These are multiyear investments. And as a result, we expect depreciation expense to increase in 2023 and increase more significantly in 2024.

在國際上，我們正在提高我們在德國的產品開發能力，在保加利亞建立一個新的低成本內窺鏡製造工廠，並在中國建立國內 Xi 生產的製造能力。我們還將擴大我們在墨西哥的高容量、低成本儀器站點的足跡，以支持我們所有平台的程序增長。這些投資使我們能夠將我們的製造整合到更大的集中中心，例如我們位於加利福尼亞州桑尼維爾的總部園區和我們位於亞特蘭大郊外的東海岸中心，同時我們將外科醫生培訓、技術開發和製造能力放在一起。這些是多年投資。因此，我們預計折舊費用將在 2023 年增加，並在 2024 年增加得更多。

Pro forma other income was $21.8 million for Q4, higher than $7.2 million in the prior quarter, primarily due to lower foreign exchange losses from remeasurement of the balance sheet and higher interest income. Our pro forma effective tax rate for the fourth quarter was 18.2% lower than prior quarters, primarily as a result of a more favorable geographical earnings mix and a discrete tax benefit of $7 million associated with the foreign tax matter. Fourth quarter 2022 pro forma net income was $439 million or $1.23 per share compared with $473 million or $1.29 per share for the fourth quarter of last year.

第 4 季度的備考其他收入為 2180 萬美元，高於上一季度的 720 萬美元，這主要是由於重新衡量資產負債錶帶來的匯兌損失減少以及利息收入增加。我們第四季度的備考有效稅率比前一季度低 18.2%，這主要是由於更有利的地域收益組合和與外國稅務相關的 700 萬美元的離散稅收優惠。 2022 年第四季度備考淨收入為 4.39 億美元或每股 1.23 美元，而去年第四季度為 4.73 億美元或每股 1.29 美元。

I will now summarize our GAAP results. GAAP net income was $325 million or $0.91 per share for the fourth quarter of 2022 compared with GAAP net income of $381 million or $1.04 per share for the fourth 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. We ended the year with cash and investments of $6.7 billion compared with $7.4 billion at the end of Q3. The sequential reduction in cash and investments reflected share repurchases of $1 billion and capital expenditures, partially offset by cash from operating activities. And with that, I would like to turn it over to Brian, who will discuss clinical highlights and provide our outlook for 2023.

我現在將總結我們的 GAAP 結果。 2022 年第四季度的 GAAP 淨收入為 3.25 億美元或每股 0.91 美元，而 2021 年第四季度的 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，包括與員工股票獎勵、員工股票補償、無形資產攤銷、訴訟費用和戰略投資損益相關的超額稅收優惠。我們在年底的現金和投資為 67 億美元，而第三季度末為 74 億美元。現金和投資的連續減少反映了 10 億美元的股票回購和資本支出，部分被經營活動產生的現金所抵消。說到這裡，我想把它交給布賴恩，他將討論臨床亮點並提供我們對 2023 年的展望。

Thank you, Jamie. Overall procedure growth for the full year 2022 was 18% and increased 15% on a 3-year compound annual growth basis. Overall procedure growth was comprised of 16% growth in the U.S. and 22% growth outside of the U.S. In the U.S., fourth quarter 2022 procedures grew 18% year-over-year compared to 16% for the fourth quarter of 2021 and 18% last quarter. The U.S. procedure growth rate reflected a favorable comparison to the quarter a year ago, given the impact of the Omicron variant in December of last year.

謝謝你，傑米。 2022 年全年的整體流程增長率為 18%，在 3 年復合年增長率的基礎上增長了 15%。整體程序增長包括美國 16% 的增長和美國以外地區 22% 的增長。在美國，2022 年第四季度程序同比增長 18%，而 2021 年第四季度和去年同期分別增長 16% 和 18%四分之一。考慮到去年 12 月 Omicron 變體的影響，美國手術增長率與去年同期相比表現良好。

On a 3-year compound annual growth basis, U.S. procedure growth was 13%. Outside of the U.S., fourth quarter procedure volume grew approximately 18% year-over-year compared to 28% for the fourth quarter of 2021 and 24% last quarter. On a 3-year compound annual growth basis, procedure growth was 19%. Turning to Europe. Procedure growth in the quarter was led by strong growth in U.K., Germany and Italy. In the regions noted, procedure growth outside of urology was strong in general surgery and gynecology categories. Specifically in the U.K., we experienced strong early-stage growth in colorectal surgery and continued strong growth in hysterectomy.

在 3 年復合年增長率的基礎上，美國手術增長率為 13%。在美國以外，第四季度手術量同比增長約 18%，而 2021 年第四季度和上一季度分別為 28% 和 24%。在 3 年復合年增長率的基礎上，手術增長率為 19%。轉向歐洲。本季度的程序增長是由英國、德國和意大利的強勁增長帶動的。在所指出的地區，泌尿外科以外的手術在普通外科和婦科類別中增長強勁。特別是在英國，我們經歷了結直腸手術的強勁早期增長和子宮切除術的持續強勁增長。

Turning to Asia. Growth outside of China continued to be solid with notable strength in capital and procedure growth in Japan. Procedure growth in Korea was healthy and India and Taiwan continue to experience strong early-stage growth. In Japan, as Jamie noted earlier, 51 systems were placed in the country, the most in a single quarter. Overall procedure growth in Japan for the quarter was led by general surgery with strong early stage growth in colon resection and cystectomy and also in urology with newly reimbursed nephrectomy procedures.

轉向亞洲。中國以外的增長繼續穩健，日本的資本和程序增長顯著。韓國的程序增長健康，印度和台灣繼續經歷強勁的早期增長。在日本，正如 Jamie 之前指出的那樣，該國部署了 51 個系統，是單季度最多的。日本本季度的整體手術增長由普外科引領，結腸切除術和膀胱切除術的早期增長強勁，泌尿外科新近報銷的腎切除術也有強勁增長。

In China, midway through the fourth quarter, we observed the decline in procedures. Towards the end of the quarter, we saw a significant decline in procedure volume as hospitals were dealing with increasing COVID cases once the Zero-COVID policy was removed. As a result, China procedures experienced a modest year-over-year decline in Q4.

在中國，在第四季度中期，我們觀察到手術數量有所下降。到本季度末，我們看到手術量顯著下降，因為一旦取消零 COVID 政策，醫院就會處理越來越多的 COVID 病例。因此，中國手術在第四季度同比略有下降。

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. While still in the early stages of adoption in the U.S., robotic-assisted bariatric surgery has been one of the fastest-growing procedures in general surgery for Intuitive. In October 2022, the American Society for Metabolic and Bariatric Surgery and International Federation for the Surgery of Obesity and Metabolic Disorders released major updates to the 1991 National Institute of Health guidelines that recommended lowering the BMI for metabolic and bariatric surgery, or MBS, from 40 to 35, regardless of the presence, absence or severity of comorbidities. These guidelines note that, "MBS is now preferably performed using minimally invasive surgical approaches, laparoscopic or robotic." "MBS is the most effective evidence-based treatment for obesity across all BMI classes."

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，我們都會重點介紹某些我們認為值得注意的最近發表的研究。然而，為了更全面地了解證據，我們鼓勵所有利益相關者徹底審查多年來發表的科學研究的廣泛細節。雖然在美國仍處於採用的早期階段，但機器人輔助減肥手術已成為 Intuitive 普通外科手術中增長最快的手術之一。 2022 年 10 月，美國代謝和減肥手術學會和國際肥胖和代謝紊亂外科聯合會發布了對 1991 年美國國立衛生研究院指南的重大更新，建議將代謝和減肥手術 (MBS) 的 BMI 從 40 降低至 35，無論合併症是否存在或嚴重程度如何。這些指南指出，“MBS 現在最好使用微創手術方法、腹腔鏡或機器人進行。” “MBS 是針對所有 BMI 類別的肥胖症最有效的循證治療方法。”

In another bariatric analysis, Dr. Wayne Barley from St. Luke's University Hospital in Bethlehem, Pennsylvania, recently published a descriptive analysis from the NBA SIP database identifying the proportion of MBS procedures in the U.S. performed between 2015 and 2020. Using a robotic or laparoscopic approach and found up to a threefold difference in the proportion of various robotic-assisted MBS cases per year. We believe our investments in advanced instruments and surgeon training are helping to drive adoption of robotic-assisted surgery in bariatrics. We look forward to continuing to support surgeons and their care teams as they provide high-quality robotic minimally invasive care for an even greater portion of the population under the new guidelines.

在另一項減肥分析中，賓夕法尼亞州伯利恆聖盧克大學醫院的 Wayne Barley 博士最近發表了一項來自 NBA SIP 數據庫的描述性分析，確定了 2015 年至 2020 年間美國進行的 MBS 手術的比例。使用機器人或腹腔鏡方法，發現每年各種機器人輔助 MBS 病例的比例差異高達三倍。我們相信，我們在先進儀器和外科醫生培訓方面的投資有助於推動機器人輔助手術在減肥領域的應用。我們期待繼續支持外科醫生及其護理團隊，因為他們根據新指南為更多人提供高質量的機器人微創護理。

A recent rectal cancer study by Dr. Fang from Fudan University in Shanghai and on behalf of the Real Study Group, published short-term outcomes from a multicenter randomized controlled trial (inaudible). This study impaired robotic-assisted and laparoscopic approaches performed by experienced surgeons for middle and low rectal cancer across 11 hospitals in China, with approximately 580 cases included in each approach.

上海復旦大學方博士最近代表 Real Study Group 進行的一項直腸癌研究發表了一項多中心隨機對照試驗（聽不清）的短期結果。這項研究由經驗豐富的外科醫生在中國 11 家醫院對中低位直腸癌進行機器人輔助和腹腔鏡手術，每種手術包括約 580 例病例。

With respect to perioperative outcomes, the rate of patients with a positive circumferential margin was 3.2% lower in the robotic-assisted group as well as a 3.6% higher rate of complete macroscopic resection. Furthermore, patients in the laparoscopic arm experienced a 2.2% higher rate of conversion to open. A 3.3% higher rate of intraoperative complications was also reported in the laparoscopic group. Notably, 5.8% less abdominal perineal resections were performed in the robotic group. Postoperatively, patients in the robotic-assisted arm also had a faster gastrointestinal recovery postoperatively as well as a 1 day shorter length of stay an approximately 7% lower rate of postoperative complications with the (inaudible) grade of 2 or higher.

關於圍手術期結果，機器人輔助組圓周切緣陽性患者的比例降低了 3.2%，而完全宏觀切除的比例提高了 3.6%。此外，腹腔鏡組的患者轉為開腹手術的比例高出 2.2%。腹腔鏡組的術中並發症發生率也高出 3.3%。值得注意的是，機器人組的腹部會陰切除術減少了 5.8%。術後，機器人輔助臂中的患者術後胃腸道恢復更快，住院時間縮短 1 天，2 級或更高級別（聽不清）的術後並發症發生率降低約 7%。

In summary, the authors concluded that short-term outcomes suggests that for middle and low rectal cancer Robotic surgery by experienced surgeons resulted in better quality resection than conventional laparoscopic surgery with less surgical trauma and better postoperative recovery. I will now turn to our financial outlook for 2023. Starting with procedures. For 2023, we anticipate full year procedure growth within a range of 12% to 16%. The low end of the range assumes continued choppiness with COVID hospitalizations and staffing pressure at hospitals globally throughout the year. In addition, it assumes ongoing staffing, significant challenges with COVID in China and uncertainty with the timing of the new capital quota. At the high end of the range, we assume no new significant impact from COVID throughout 2023, and assume continued growth in general surgery in the U.S. and diversified growth beyond urology outside of the U.S.

總之，作者得出結論，短期結果表明，對於中低位直腸癌，經驗豐富的外科醫生進行的機器人手術比傳統腹腔鏡手術的切除質量更好，手術創傷更小，術後恢復更好。我現在將談談我們對 2023 年的財務展望。從程序開始。對於 2023 年，我們預計全年手術增長率將在 12% 至 16% 之間。該範圍的低端假設全年因 COVID 住院治療和全球醫院的人員配備壓力而持續波動。此外，它假設持續的人員配置、中國 COVID 的重大挑戰以及新資本配額時間的不確定性。在該範圍的高端，我們假設 COVID 在整個 2023 年不會產生新的重大影響，並假設美國普通外科的持續增長以及美國以外泌尿外科以外的多元化增長。

The range does not reflect significant material, supply chain disruptions or hospital capacity constraints similar to what we experienced at the start of the pandemic. Beyond the uncertainty with COVID in China, we expect similar seasonal timing of procedures in 2023 as we have experienced before the pandemic, with the first quarter being the seasonally weakest quarter as patient deductibles are reset. With respect to revenue, as we have mentioned previously, capital sales are ultimately driven by procedure demand, catalyzing hospitals to establish or expand robotic system capacity.

該範圍並未反映與大流行開始時類似的重大材料、供應鏈中斷或醫院容量限制。除了 COVID 在中國的不確定性之外，我們預計 2023 年的程序季節性時間與我們在大流行之前經歷的類似，第一季度是季節性最弱的季度，因為患者免賠額被重置。關於收入，正如我們之前提到的，資本銷售最終是由程序需求驅動的，從而催化醫院建立或擴大機器人系統能力。

Capital sales can vary substantially from period to period based upon many factors, including national health care policies, hospital capital spending cycles, reimbursement and government quotas, product cycles, economic cycles and competitive factors. Turning to gross profit. Our full year 2022 pro forma gross profit margin was 69.2%. In 2023, we expect our pro forma gross profit margin to be within 68% and 69% of net revenue. The lower estimate of pro forma gross profit margin in 2023 reflects the impact of higher infrastructure investment costs, higher supply chain costs, and a greater mix of new products, in particular, from our Ion platform.

根據許多因素，包括國家醫療保健政策、醫院資本支出週期、報銷和政府配額、產品週期、經濟周期和競爭因素，資本銷售在不同時期可能會有很大差異。轉向毛利。我們 2022 年全年的備考毛利率為 69.2%。到 2023 年，我們預計我們的備考毛利率將在淨收入的 68% 和 69% 之間。 2023 年備考毛利率的較低估計反映了基礎設施投資成本上升、供應鏈成本上升以及新產品組合增加的影響，尤其是我們的 Ion 平台。

Our actual gross profit margin will vary quarter-to-quarter depending largely on product, regional and trade-in mix, procedure mix and volumes fluctuations in foreign currency rates and the potential impact of competitive pricing. Turning to operating expenses. In 2022, our pro forma operating expenses grew 23%. In 2023, we expect pro forma operating expense growth to be between 9% and 13%. The operating expense growth reflects investments to advance our platform capabilities, digital products, along with continued expansion into markets outside of the U.S. and spending to support regulatory clearances and clinical trials. We expect our noncash stock compensation expense to range between $610 million to $640 million in 2023. We expect other income, which is comprised mostly of interest income to total between $140 million and $160 million in 2023. With regard to income tax, in 2022, our pro forma income tax rate was 21.8%. As we look forward, we estimate our 2023 pro forma tax rate to be between 22% and 24% of pretax income.

我們的實際毛利率每個季度都會有所不同，這在很大程度上取決於產品、區域和以舊換新組合、程序組合和外幣匯率的數量波動以及競爭性定價的潛在影響。轉向運營費用。 2022 年，我們的備考運營費用增長了 23%。 2023 年，我們預計備考營業費用增長率將在 9% 至 13% 之間。營業費用的增長反映了為提升我們的平台能力、數字產品而進行的投資，以及對美國以外市場的持續擴張以及支持監管許可和臨床試驗的支出。我們預計 2023 年我們的非現金股票補償費用將在 6.1 億美元至 6.4 億美元之間。我們預計其他收入（主要包括利息收入）到 2023 年總計在 1.4 億美元至 1.6 億美元之間。關於所得稅，2022 年，我們的預估所得稅率為 21.8%。展望未來，我們估計 2023 年的備考稅率將在稅前收入的 22% 至 24% 之間。

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

我們準備好的評論到此結束。我們現在將打開您的問題的電話。

(Operator Instructions)

（操作員說明）

Our first question today comes from Robbie Marcus, representing JPMorgan.

我們今天的第一個問題來自代表摩根大通的 Robbie Marcus。

Maybe to start, the OpEx guide came in a lot better than expected but balance that with taking it longer to get through the regulatory cycles and bring to market with a new robot. So maybe you could talk about what exactly is taking longer? Are there certain trials that maybe had to be done in the past that are now being required? And is this global regulatory lengthening of time or are there specific markets that are taking longer to come with a new robot?

也許首先，OpEx 指南比預期的要好得多，但要平衡它需要更長的時間才能通過監管週期並將新機器人推向市場。那麼也許你可以談談究竟是什麼花費了更長的時間？是否有某些在過去可能必須進行的試驗現在需要進行？這種全球監管時間是否延長，或者是否有特定市場需要更長時間才能推出新機器人？

All right. Thanks, Robbie. I think we've been sharing with you over several quarters now. In terms of new technologies and new indications, we've seen in many of the core markets, not every single one, but many of them additional data requirements. That changed probably 4 years ago, but has been playing all the way through. So it's not so much that the environment has changed over that period, just the implications of that. And you see that in things like SP, our SP trials, 5 or 6 years ago would have come to market differently and they're requiring some prospective human clinical work. That's not unique to SP. It really has to do with what the underlying technologies are and what new indications might be.

好的。謝謝，羅比。我想我們已經在幾個季度內與您分享了。在新技術和新適應症方面，我們在許多核心市場都看到了，不是每一個，但其中許多都有額外的數據要求。這可能在 4 年前發生了變化，但一直在發揮作用。因此，與其說是環境在那個時期發生了變化，不如說是其影響。你會看到像 SP 這樣的東西，我們的 SP 試驗，5 或 6 年前會以不同的方式進入市場，他們需要一些前瞻性的人體臨床工作。這不是 SP 獨有的。這確實與基礎技術是什麼以及可能有哪些新適應症有關。

So I think that is playing through relative to prior iterations of systems and features. That's true. Certainly in the United States, we've seen with the European regulatory changes over the years, increased data requirements in Europe and then it kind of varies by country from there. In terms of OpEx, perhaps I'll let you ask a follow-up question for Jamie on that one.

所以我認為這是通過相對於之前的系統和功能迭代來進行的。確實如此。當然，在美國，我們已經看到多年來歐洲監管的變化，歐洲增加的數據要求，然後它因國家而異。就 OpEx 而言，也許我會讓你就那個問題向 Jamie 提出一個後續問題。

Yes. And Jamie, maybe to follow up on the OpEx and I'll tie in CapEx here. There is a good investment there for the future. Maybe talk to where you're seeing the decrease in OpEx, SG&A versus R&D? And where the lower spending growth rate year-over-year is coming from?

是的。傑米，也許要跟進運營支出，我會在這裡加入資本支出。那裡對未來有很好的投資。也許談談你看到 OpEx、SG&A 與 R&D 相比減少的地方？同比較低的支出增長率從何而來？

Yes. It's fair, Robbie, that we're investing differentially across the areas of investment and the functions within the company. Our priorities for '23 with respect to operating expenses to drive growth in the areas of focus, and we're being focused there. We're looking to execute some opportunities to expand markets by gaining additional clinical indications and geographical clearances. And obviously, we want to advance our technology. Within SG&A, what you see in subsets of the G&A functions is us looking to pursue leverage as we've described. And generally, from an R&D perspective, there are some investments that, as Gary has previously referenced were sequencing, and that's partly motivated by the way in which headcount has expanded over, let's say, the last year or 2, and we've moderated our headcount growth as described, and that gives us the opportunity to absorb some of that headcount.

是的。羅比，我們在公司內部的投資領域和職能部門進行差異化投資是公平的。我們 23 年在運營支出方面的優先事項是推動重點領域的增長，我們正專注於此。我們希望通過獲得更多的臨床適應症和地理許可來抓住一些機會來擴大市場。顯然，我們希望提升我們的技術。在 SG&A 中，您在 G&A 職能的子集中看到的是我們尋求追求我們所描述的槓桿作用。一般來說，從研發的角度來看，有一些投資，正如 Gary 之前提到的那樣是排序，這在一定程度上是由於員工人數增加的方式，比方說，去年或兩年，我們已經緩和了如上所述，我們的員工人數增長，這讓我們有機會吸納部分員工人數。

So there's differential investment within SG&A and R&D. If I look at R&D and SG&A kind of in aggregate, they're likely to grow at relatively similar rates next year.

因此，在 SG&A 和 R&D 中存在不同的投資。如果我從總體上看 R&D 和 SG&A，它們明年可能會以相對相似的速度增長。

Then we'll go to the line of Larry Biegelsen with Wells Fargo.

然後我們將與 Wells Fargo 一起去 Larry Biegelsen 的路線。

One, on your -- Gary, your new system comments and one on the industrial scale comments that you made today at JPMorgan. So you talked about core technology changes often requiring the clinical trials and that you won't launch a multiport system in 2023. So Gary, my question is: a, will you start a clinical trial and a new system in '23; and b, if you did start a clinical trial, would you disclose that publicly even if the trial were outside the U.S., say, in a developing market?

一個，關於你的 - 加里，你的新系統評論和一個關於你今天在摩根大通所做的工業規模評論。所以你談到核心技術變化通常需要臨床試驗，你不會在 2023 年推出多端口系統。所以加里，我的問題是：a，你會在 23 年開始臨床試驗和新系統嗎？ b，如果你確實開始了一項臨床試驗，即使試驗是在美國境外進行的，比如在發展中市場，你會公開披露嗎？

Across our systems, we are doing trials in all sorts of places for all sorts of reasons, whether it's SPI or otherwise. And -- so the answer there is we have some places where those are publicly disclosed per normal rules. For competitive reasons, we don't try to detail them too much, and that's the position we'll take going forward.

在我們的系統中，出於各種原因，我們正在各種地方進行試驗，無論是 SPI 還是其他。而且 - 所以答案是我們有一些地方按照正常規則公開披露這些內容。出於競爭原因，我們不會嘗試對它們進行過多詳細說明，這就是我們將採取的立場。

Good. fair enough. And Gary, you talked a lot about -- you used the term industrial scale a lot recently. What does that mean exactly? And what are the implications for Intuitive financially?

好的。很公平。加里，你談了很多——你最近經常使用工業規模這個詞。這到底是什麼意思？對 Intuitive 的財務影響是什麼？

I'll take what does it mean, and I'll ask Jamie to help me on detailing on the finance side. One of the things that's going on is that we are becoming well integrated into many surgical practices in several countries. I think that's a great opportunity for us and a serious responsibility.

我會理解這是什麼意思，我會請 Jamie 幫助我詳細說明財務方面的問題。正在發生的事情之一是我們正在很好地融入幾個國家的許多外科手術。我認為這對我們來說是一個很好的機會，也是一項嚴肅的責任。

As we've seen in the last couple of years with regard to supply chain robustness and other things, making sure that -- we have supply chain stability that we want vertically integrating where we can. We have been doing that. A lot of the imaging pipeline work that we've done. We think that both gives us higher quality. It allows us to lower cost to the customer and it gives us robustness. We can plan for that robustness. That's true not only in imaging, but in some core technologies and instruments and accessories. And we think those are good long-term investments. So that's been really positive. There's another place where our digital tools and our digital products, one of the things that's going on that I think is powerful for the company is not just product architecture, but business architecture. And what I mean by that is that our supply chain can support multiple platforms in multiple countries around the world. It can -- by that, I mean, multiport, single-port and Ion, our digital products architecture also is seamless and can integrate and support those platforms. So that gives us a great quality advantage. It gives us a leverage capability and allows us to lower the total cost for our customers and the cost to serve for our customers. Those things take some planning and some forward investment, and it can be in core technology. For example, in digital, it can be in facilities in manufacturing base so we can build our products. But it's that opportunity. It's a global opportunity to help support the standard of care in multiple countries. I think that the customer advantages are quite clear. And I think the cost robustness and long-term durability advantages for the company are quite clear. But that takes some capital investment that will play out over time. Jamie, any help you'll give?

正如我們在過去幾年中看到的關於供應鏈穩健性和其他方面的情況，確保 - 我們擁有我們希望盡可能垂直整合的供應鏈穩定性。我們一直在這樣做。我們已經完成了很多成像管道工作。我們認為兩者都給了我們更高的質量。它使我們能夠降低客戶的成本，並賦予我們穩健性。我們可以計劃這種穩健性。不僅在成像方面如此，在一些核心技術和儀器配件方面也是如此。我們認為這些都是很好的長期投資。所以這真的很積極。我們的數字工具和數字產品還有另一個地方，我認為對公司來說很強大的事情之一不僅僅是產品架構，還有業務架構。我的意思是，我們的供應鏈可以支持全球多個國家的多個平台。它可以——我的意思是，多端口、單端口和 Ion，我們的數字產品架構也是無縫的，可以集成和支持這些平台。所以這給了我們很大的質量優勢。它為我們提供了槓桿能力，使我們能夠降低客戶的總成本和為客戶提供服務的成本。這些事情需要一些規劃和一些前瞻性投資，它可以是核心技術。例如，在數字領域，它可以在製造基地的設施中，這樣我們就可以製造我們的產品。但這就是機會。這是幫助支持多個國家的護理標準的全球機會。我認為客戶優勢非常明顯。而且我認為公司的成本穩健性和長期耐用性優勢非常明顯。但這需要一些資本投資，隨著時間的推移會發揮作用。傑米，你能幫忙嗎？

I would just say industrial operating -- industrial scale is linked to the capital expenditure plans that we've described, the $800 million to $1 billion of investment in '23. I'd just add the financial ROI calculations on those investments are relatively straightforward. And we think there are real advantages in having large, highly automated factories that run at scale and that's an advantage both for us and for our customers. So the return calculations are relatively straightforward and they're essentially the incremental gross margin dollars we can drive from growth.

我只想說工業運營——工業規模與我們描述的資本支出計劃有關，即 23 年的 8 億至 10 億美元投資。我只想添加這些投資的財務投資回報率計算相對簡單。我們認為擁有大規模、高度自動化的大型工廠具有真正的優勢，這對我們和我們的客戶都是一個優勢。因此，回報計算相對簡單，它們本質上是我們可以從增長中獲得的增量毛利率美元。

Next question will come from the line of Travis Steed with Bank of America.

下一個問題將來自美國銀行的 Travis Steed。

Just curious, Gary, I mean you mentioned no new multiport platform in '23, but curious how you're thinking about upgrades to Gen 4, but that's mostly just around the software upgrades you mentioned or if we could see something more material with capability upgrades on hardware imaging or things that bring the customer procedure down?

只是好奇，加里，我的意思是你在 23 年沒有提到新的多端口平台，但很好奇你是如何考慮升級到第 4 代的，但這主要是圍繞你提到的軟件升級，或者我們是否能看到更多具有能力的材料硬件映像升級或降低客戶程序的事情？

Yes. We continue to add capabilities into Gen 4. We expect to do so this year as well. Some of it will be in advanced instrumentation. We are doing some nice work in our energy systems on the -- both on the hardware side and some of the software side, and we think there's some capability improvements that we're going to be developing over time around core imaging capability in Gen 4. So we continue to make progress.

是的。我們將繼續為第 4 代添加功能。我們預計今年也會這樣做。其中一些將用於高級儀器。我們在我們的能源系統方面做了一些不錯的工作——無論是在硬件方面還是在一些軟件方面，我們認為我們將隨著時間的推移圍繞第 4 代的核心成像能力開發一些能力改進. 所以我們不斷進步。

Okay. But not saying if anything to come to '23 or not on that front? And then while I have you, just any early comments on the capital funnel in '23. I think last year, kind of January, February time frame is when customers are evaluating budget. So I just want to make sure things seem fairly stable with the capital funnel.

好的。但沒有說在這方面是否有任何關於 23 年的事情？然後，當我有你的時候，只是對 23 年資本漏斗的任何早期評論。我認為去年，大約在 1 月、2 月的時間範圍內，客戶正在評估預算。所以我只想確保資本漏斗看起來相當穩定。

On the capital funnel side, what I'd say is, given the macro inputs from customers are our sense is that they are still relatively cautious. I think there's quite a bit of uncertainty still in the macro. And while, for example, staffing shortages have improved, they're still quite a bit worse than pre-pandemic levels in terms of labor costs, vacancy rates for hospitals. So they are being careful from a financial perspective and they're cautious given macroeconomic uncertainty. I think our experiences in the second half of '22 has been where customers are seeing nice growth in their robotics programs. da Vinci stays as a relatively high priority in terms of their capital budgets. But beyond the fact that they're cautious, I wouldn't say there's anything specific I'd highlight in terms of '23 outlook.

在資本漏斗方面，我要說的是，鑑於客戶的宏觀投入是我們的感覺，他們仍然相對謹慎。我認為宏觀仍然存在相當多的不確定性。例如，雖然人員短缺情況有所改善，但在勞動力成本、醫院空缺率方面，仍比大流行前的水平差很多。因此，他們從金融角度謹慎行事，並且鑑於宏觀經濟的不確定性，他們也持謹慎態度。我認為我們在 22 年下半年的經驗是，客戶看到他們的機器人程序取得了不錯的增長。達芬奇在其資本預算方面仍然是一個相對較高的優先事項。但除了他們持謹慎態度這一事實之外，我不會說我在 23 世紀展望方面有什麼特別強調的。

And our next question will come from the line of Rick Wise with Stifel.

我們的下一個問題將來自 Rick Wise 與 Stifel 的對話。

Gary, starting off maybe with the new system, thank you for being so clear about your thoughts about the timing of a new system, i.e., not in '23. But at a high level, could you talk to us about your thinking about why or why not? I mean, I know obviously, you've -- you're always -- the company is for your entire history, you're always thinking about what's next and getting ready for it. But how are you -- is it the technology that you wanted to have isn't ready yet? Or this is more about competitive positioning or the difficult external environment on capital makes you hesitant to go ahead this year. Just trying to understand your thinking about it and what that might say about the future?

加里，也許從新系統開始，謝謝你對新系統時間的想法如此清楚，即不是在 23 年。但在更高的層面上，你能和我們談談你對為什麼或為什麼不這樣做的想法嗎？我的意思是，我很明顯地知道，你已經 - 你一直 - 公司是你的整個歷史，你總是在思考下一步會發生什麼並為此做好準備。但是你好嗎——你想要的技術還沒有準備好嗎？或者更多的是競爭定位，或者資金上的艱難外部環境讓你今年猶豫不決。只是想了解您對此的想法以及對未來的看法？

Yes. We -- thank you for the question. We think mostly about what can we do that changes the experience of surgery for the patient in terms of outcomes and the care teams in terms of how they deliver that set of outcomes. And what we can do in terms of technology basis, products and services and training that can help that happen. That is the primary thing. That's the thing that is front and center.

是的。我們——謝謝你提出這個問題。我們主要考慮的是，我們可以做些什麼來改變患者在結果方面的手術體驗，以及護理團隊如何提供這些結果的體驗。以及我們在技術基礎、產品和服務以及培訓方面可以做些什麼來幫助實現這一目標。這是首要的事情。這就是最重要的事情。

And we do design studies, research, usability effort, all the things you would expect for us to make progress. And then we try to advance that as quickly as reasonably we can given the environment that we're in. We don't do too much perfection of timing about what we think the hospital capital environment is going to be. We don't -- you can imagine somebody doing that, that is not my highest motivation. I think these things are sophisticated enough and complex enough to bring to market that trying to time it perfectly with regard to the macroeconomic environment is not what we're really driven by. We work closely with our technologists who are, I think, spectacular. We work closely with regulatory bodies around the world to understand what their needs and requirements are. And of course, we work very closely with key customers to understand whether the things we think matter. And those are the things that we really do and once we find a pathway, then we work down that pathway.

我們進行設計研究、研究、可用性工作，以及您希望我們取得進步的所有事情。然後我們嘗試在我們所處的環境下盡快合理地推進這一點。我們不會對我們認為醫院資本環境將會發生的事情做太多的時間安排。我們不——你可以想像有人這樣做，這不是我的最高動機。我認為這些東西足夠複雜，足以推向市場，試圖根據宏觀經濟環境完美地安排時間並不是我們真正的動力。我們與我們的技術人員密切合作，我認為他們非常了不起。我們與世界各地的監管機構密切合作，了解他們的需求和要求。當然，我們與主要客戶密切合作，以了解我們認為的事情是否重要。這些是我們真正要做的事情，一旦我們找到一條路，我們就會沿著這條路走下去。

I have to say that supply chain disruptions that have happened in the last 3 years have impacted not only production capability, but impact new product development as well because that puts waves and ripples into what kind of items people can procure for prototypes and other forms of focus. So there's a little bit of that in there, too.

我不得不說，過去 3 年發生的供應鏈中斷不僅影響了生產能力，還影響了新產品開發，因為這對人們可以為原型和其他形式的產品採購什麼樣的物品產生了波瀾和漣漪。重點。所以里面也有一點。

And just as a follow-up, just if you could expand further on your China comments, particularly related to new tender quota expectations. And I just want to make sure I'm understanding carefully or we're all understanding your thoughts or your embedded thoughts about procedure recovery as flow as the year unfolds?

作為後續行動，如果你能進一步擴展你對中國的評論，特別是與新的招標配額預期相關的評論。我只是想確保我仔細理解，或者我們都理解你的想法或你對程序恢復的內在想法，隨著這一年的展開？

Yes. I think what we're saying is we saw China procedures impacted in November. That got more severe in December, has continued so far in the early part of January, and we expect, therefore, procedures in China to be at least impacted in Q1 and perhaps beyond. And I think it's difficult for us to predict, given the relatively unique situation China is in relative to the Zero COVID policy that they have had. So we're not making any specific predictions as to when and how that might recover. Brian laid out how that's reflected in the procedure guidance that we provided. Separately, on the quota, we're in the third year again of kind of new quota period, the last 2 quotas have been issued in the third year. We only use that as a historical reference, nothing more. We don't have any particular insight as to when a new quota might come.

是的。我認為我們所說的是我們看到中國程序在 11 月受到了影響。這種情況在 12 月變得更加嚴重，一直持續到 1 月初，因此我們預計中國的程序至少會在第一季度甚至以後受到影響。而且我認為我們很難預測，因為中國相對於他們所擁有的零 COVID 政策而言是相對獨特的情況。因此，我們不會就何時以及如何恢復做出任何具體預測。布賴恩闡述了這如何反映在我們提供的程序指南中。另外，在配額方面，我們又進入了新配額期的第三年，最後兩個配額已在第三年發放。我們僅將其用作歷史參考，僅此而已。對於新的配額何時到來，我們沒有任何特別的見解。

And our next question will be from the line of Matt Taylor with Jefferies.

我們的下一個問題將來自 Jefferies 的 Matt Taylor。

I wanted to ask one on China. You talked about the uncertainty with refreshing the quota and then some new local competitors that are competing for tenders. I wondered if you could kind of flesh that out a little bit and talk about any insight you have into when and how much the quota could be? And then could you give us a flavor for how competitive you think the local competitors will be to compete for the tenders in China and beyond?

我想問一個關於中國的問題。你談到了刷新配額的不確定性，然後談到了一些正在競標的新本地競爭對手。我想知道你是否可以稍微充實一下，並談談你對配額何時以及多少的任何見解？然後你能給我們介紹一下你認為本地競爭對手在中國及其他地區競爭招標的競爭力嗎？

I would just say that underlying demand for robotic technology in China, if you take a mid- and long-term view is quite strong. And our experience so far has been that surgeons care about the capability and feature set of the products that they use there.

我只想說，如果你從中長期的角度來看，中國對機器人技術的潛在需求是相當強勁的。到目前為止，我們的經驗是外科醫生關心他們在那裡使用的產品的功能和特性集。

Again, we don't have any particular insight with respect to timing and size of quota. We saw the last quota we received was higher than the previous one, but we have no ability to predict that it will be larger again. So we'd love to be able to give you greater clarity than that. But what's the second part of your question, Matt?

同樣，我們對配額的時間和規模沒有任何特別的了解。我們看到我們收到的最後一個配額高於前一個，但我們無法預測它會再次變大。因此，我們希望能夠為您提供比這更清晰的信息。但是你的問題的第二部分是什麼，馬特？

Why don't I take that one. That was a little bit about local competition and what kinds of things we're seeing. First, I think the entry of quota competitors in China is natural and should be expected. I think in some ways, it's probably a net positive in terms of how people think about the quota. That's more people advocating for the value of this in the market, it's probably a net positive over time, therefore, for market development also. In the near term, early markets, we've seen this everywhere around the world with new systems entering -- the very early entry is different than the middle is different than the late. And the early, there tend to be a lot of placements, a lot of things around clinical trials, a lot of things around setting up early capacity that are, in some sense, not indicative of value-based or feature-based competition, and we're going to see some of that early on.

我為什麼不拿那個。那是關於本地競爭以及我們所看到的事情的一點點。首先，我認為中國配額競爭者的進入是自然而然的，也是意料之中的。我認為在某些方面，就人們如何看待配額而言，這可能是一個淨積極因素。越來越多的人在市場上倡導這種價值，隨著時間的推移，這可能是一個淨積極因素，因此，對於市場發展也是如此。在短期內，早期市場，我們在世界各地都看到了這種情況，新系統進入——早期進入不同於中期進入不同於後期進入。早期，往往有很多安置，很多圍繞臨床試驗的事情，很多圍繞建立早期能力的事情，在某種意義上，並不表示基於價值或基於功能的競爭，並且我們將在早期看到其中的一些。

And then after that wave goes through putting your clinical trial systems out, then it starts to settle down, and you see a little bit more of what the core competitive dynamics look like. So we're really, really in the early innings with what we're seeing in China competitors. I expect them to be active and assertive.

然後在這一波浪潮通過你的臨床試驗系統推出之後，它開始穩定下來，你會看到更多的核心競爭動態。所以我們真的，真的處於我們在中國競爭對手中看到的早期階段。我希望他們積極主動。

Next, the line of Anthony Petrone, representing the Mizuho Group.

接下來是代表瑞穗集團的 Anthony Petrone。

One, on overall pricing as it relates to just the update here on the multiport system and then a follow-up on procedure volumes, specifically in the U.S. On pricing, just trying to understand the dynamics here. We have higher input costs as it relates to R&D there's inflation, and there's a heavy CapEx cycle. So you can sort of, on the one hand, push that through the higher pricing for NextGen robot. But on the other side, we have, obviously, hospitals somewhat constrained here and Intuitive now has a licensing model. So when we think about an elongated regulatory cycle, how does that influence the pricing strategy on the next-gen robot? And then just quickly on procedures, the lower BMI threshold, the new guideline, 40 to 35, it seems like a big deal. Is that contemplated in the 12% to 16% procedure guidance?

第一，關於整體定價，因為它僅與多端口系統的更新有關，然後是程序量的跟進，特別是在美國。關於定價，只是想了解這裡的動態。我們有更高的投入成本，因為它與研發有關，存在通貨膨脹，而且資本支出週期很長。因此，一方面，您可以通過提高 NextGen 機器人的價格來推動這一點。但另一方面，很明顯，醫院在這方面受到了一定的限制，而 Intuitive 現在有了許可模式。因此，當我們考慮延長監管週期時，這將如何影響下一代機器人的定價策略？然後就快點上程序，降低 BMI 門檻，新的指導方針，40 到 35，看起來很重要。 12% 到 16% 的程序指南中是否考慮到了這一點？

Just with respect to pricing, I'll only comment on current products in the portfolio, as you described. What we're seeing is core costs in our supply chain, the prices we pay our suppliers, the wage costs we pay our production staff. They have gone up, and that looks sticky. We have a routine process we use to monitor pricing on an ongoing basis. We'll continue that process.

正如您所描述的，就定價而言，我只會評論產品組合中的當前產品。我們看到的是我們供應鏈中的核心成本，我們支付給供應商的價格，我們支付給生產人員的工資成本。它們上升了，看起來很粘。我們有一個常規流程，用於持續監控定價。我們將繼續這個過程。

There's nothing that we would highlight at this point with respect to any specific decisions that we've made relative to pricing, but it's something that we're monitoring carefully through the existing processes that we have. With respect to your question on bariatrics and the change in BMI guidelines, I think it's really early to determine what effect, if anything, that might have in terms of the total surgical TAM for bariatrics. And so therefore, there's nothing reflected in the 12% to 16% guidance that we provided, and I wouldn't expect it to move that quickly. And there are -- by the way, in bariatrics, there are kind of real protocols patients have to go through with respect to a set of activities that they undertake before they become eligible for surgery, even with this change in guidelines.

關於我們就定價做出的任何具體決定，我們目前沒有什麼要強調的，但我們正在通過我們現有的流程仔細監控這一點。關於你關於減肥的問題和 BMI 指南的變化，我認為現在確定對減肥的總手術 TAM 可能有什麼影響（如果有的話）還為時過早。因此，我們提供的 12% 到 16% 的指導中沒有任何反映，我不希望它移動得那麼快。還有——順便說一句，在減肥治療中，即使指南發生了這種變化，患者在符合手術條件之前就他們所進行的一系列活動必須經歷一些真實的協議。

Maybe I'd add a tiny bit on pricing and margin. On the pricing side, we look all the way across the total cost of ownership for our customers and make sure that's matched to value. So what's the value we bring and then what is the pricing that does that. We do that, as Jamie said, routinely, and we do it by country. It's a global look.

也許我會在定價和利潤方面增加一點點。在定價方面，我們會全面考慮客戶的總擁有成本，並確保其與價值相匹配。那麼我們帶來的價值是什麼，那麼這樣做的定價是多少。正如傑米所說，我們經常這樣做，而且我們按國家/地區這樣做。這是全球視野。

With regard to some of the pressures on margin, whether they're inflationary or what have you, Jamie's point, some of those are sticky. We understand the levers that we have, whether it's in design or scale or production or other opportunities. And we're in pursuit of those. I don't think we're confused about where to go from here. Some of them take a little while. So some of the investments we're making, some of the automation that we talked about, some of the factory automation we're talking about, those are things that give us better control of cost over time. And so I don't think we're confused or really caught off guard by some of the changes of the cost influence.

關於保證金的一些壓力，無論它們是通貨膨脹還是你有什麼，傑米的觀點，其中一些是粘性的。我們了解我們擁有的槓桿，無論是在設計、規模、生產還是其他機會方面。我們正在追求這些。我不認為我們對從這裡去哪裡感到困惑。其中一些需要一些時間。所以我們正在進行的一些投資，我們談到的一些自動化，我們正在談論的一些工廠自動化，這些都是讓我們隨著時間的推移更好地控製成本的東西。因此，我認為我們不會對成本影響的某些變化感到困惑或真的措手不及。

And we have a question from the line of Shagun Singh with RBC.

我們有來自 RBC 的 Shagun Singh 的問題。

Just a clarification and then one on Ion. On the new system, you said not '23, but could we expect something in '24? Or if you have to initiate a clinical trial and depending on the size of multiport are we looking at a launch beyond the '24 time line? Just any preliminary color would be helpful.

只是一個澄清，然後是一個關於 Ion 的說明。在新系統上，你說的不是 23 年，但我們可以期待 24 年的東西嗎？或者，如果您必須啟動臨床試驗，並且根據多端口的大小，我們是否正在考慮在 24 小時後推出？任何初步顏色都會有所幫助。

And then you did talk about the lowering the total cost to treat as well as expansion in different kinds of procedures. Any color beyond what you provided on the call on what kind of advancements or any look into what could allow you to achieve that in the new system? And then on Ion, I was just wondering if you could talk a little bit about the expected impact of the full set of the PRECISE 2-year results. And also any progress that you're making on indication expansion and the ablation technology.

然後你確實談到了降低治療總成本以及擴大不同類型的程序。除了你在電話會議上提供的關於什麼樣的進步或任何可以讓你在新系統中實現這一目標的任何研究以外的任何顏色？然後關於 Ion，我只是想知道您是否可以談談整套 PRECISE 2 年結果的預期影響。以及您在適應症擴展和消融技術方面取得的任何進展。

Okay. Nothing further to detail on multiport beyond what we've discussed already. With regard to opportunities for our platforms period, we have opportunities across our set. We'll -- I talked to you a little bit about what we're doing in SP already. We'll detail that more as it unfolds in 2023 as to where we see opportunity for SP to create indication expansions and to open new procedure markets for us, which we're excited about.

好的。除了我們已經討論過的內容之外，沒有關於多端口的進一步細節。關於我們平台時期的機會，我們在整個系列中都有機會。我們將 - 我已經和你談過我們在 SP 中所做的事情。隨著它在 2023 年的展開，我們將詳細說明我們看到 SP 在哪裡創造適應症擴展並為我們打開新程序市場的機會，我們對此感到興奮。

On the Ion front, you asked a little bit about the PRECISE tier data. I don't have anything more to detail on that. Feedback from the field we have outside of that specific study has been that it's delivering on the promise. Folks are finding that it's usable that it is supplying the outcome that they had hoped and we're seeing that reflected in the adoption. So we're pleased with that.

在 Ion 方面，您詢問了一些關於 PRECISE 層數據的問題。我沒有更多的細節。我們在該特定研究之外的領域的反饋是它正在兌現承諾。人們發現它是有用的，因為它提供了他們希望的結果，我們看到這反映在採用中。所以我們對此感到滿意。

With regard to ablation, we are -- as we said last quarter, we're just at the early innings of engaging customers in Europe and looking at the trial data. We're excited by it. I think there are several indications in the long that we'll pursue over time. We'll detail those more as we get more experience and more time.

關於消融，正如我們上個季度所說，我們正處於吸引歐洲客戶和查看試驗數據的早期階段。我們對此感到興奮。我認為，隨著時間的推移，我們將追求長期的幾個跡象。隨著我們獲得更多經驗和更多時間，我們將詳細介紹這些內容。

There are opportunities outside the long to, I want to be clear. We think those are interesting, but they're not areas of current focus. We really think, finish the job we started. We have great engagement with pulmonologists and thoracic surgeons. We have opportunity to continue to support them to make our products ever easier, more robust and to move the margin structure where we want it to go. We're going to focus on that. And then we'll move to other indications in the lung. And then from after that, we'll have earned our opportunity to do the next step. So thank you for the questions there. That was our last question.

長來之外有機會，我想說清楚。我們認為這些很有趣，但它們不是當前關注的領域。我們真的認為，完成我們開始的工作。我們與肺科醫生和胸外科醫生有很好的合作。我們有機會繼續支持他們，讓我們的產品變得更簡單、更強大，並將利潤率結構轉移到我們想要的地方。我們將專注於此。然後我們將轉向肺部的其他適應症。然後從那以後，我們將贏得進行下一步的機會。謝謝大家的提問。這是我們的最後一個問題。

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.

最後，我們仍然相信有大量和持久的機會從根本上改善手術和急性干預措施。我們的團隊繼續與醫院、醫生和護理團隊密切合作，以實現我們的客戶所說的四重目標：更好、更可預測的患者結果；為患者提供更好的體驗；為他們的護理團隊提供更好的體驗；並最終降低總護理成本。我們相信手術和急症護理的價值創造從根本上講是人性化的。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. Thank you for your support on this extraordinary journey. We look forward to talking with you again in 3 months.

在 Intuitive，我們設想了一種侵入性更小、效果更好的未來護理，在這種情況下，可以更早地發現疾病並迅速治療，這樣患者就可以恢復到最重要的狀態。感謝您對這段非凡旅程的支持。我們期待在 3 個月後再次與您交談。

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

女士們，先生們，我們今天的會議到此結束。感謝您的參與和使用 AT&T 活動服務。您現在可以斷開連接。