直覺手術 (ISRG) 2023 Q1 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Quarter 1 2023 earnings release. (Operator Instructions) As a reminder, this call is being recorded.

女士們，先生們，感謝你們的支持，歡迎來到 Intuitive 2023 年第一季度收益發布。 （操作員說明）提醒一下，此通話正在錄音中。

I'd now like to turn the conference over to our host, Head of Investor Relations, Mr. Brian King. Please go ahead.

我現在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 first 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 第一季度收益電話會議。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 10, 2023. 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 2023 年 2 月 10 日提交的最新 10-K 表格。我們的 SEC 文件可以通過我們的網站或 SEC 的網站找到。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.

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。

Today's format will consist of providing you with highlights of our first 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. And 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.

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一季度業績的亮點，然後是問答環節。 Gary 將介紹本季度的業務和運營亮點。傑米將對我們的財務業績進行審查。我將討論程序和臨床重點，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。

And 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. Use of our products grew strongly in the first quarter versus a year ago, helped by positive surgical trends and strong execution by our team. New capital installs were likewise strong as customers built their da Vinci and Ion system capacity to meet demand. Revenue grew 14% on the back of this continued adoption.

感謝您今天加入我們。與一年前相比，第一季度我們產品的使用量增長強勁，這得益於積極的手術趨勢和我們團隊的強大執行力。隨著客戶建立達芬奇和 Ion 系統容量以滿足需求，新的資本安裝同樣強勁。在這種持續採用的支持下，收入增長了 14%。

Some manufacturing and supply challenges this quarter negatively impacted our product margins. This is an opportunity for sharper execution going forward. Our R&D and innovation engines are making good progress with the strength in Ion adoption, progress in our digital efforts and indication expansions for Ion and SP. Overall, our core business remains strong with some near-term procedure and product cost dynamics that we'll discuss today.

本季度的一些製造和供應挑戰對我們的產品利潤率產生了負面影響。這是未來更嚴格執行的機會。我們的研發和創新引擎在 Ion 採用方面的實力、我們的數字化工作取得進展以及 Ion 和 SP 的適應症擴展方面取得了良好進展。總體而言，我們的核心業務依然強勁，我們今天將討論一些近期程序和產品成本動態。

Starting with procedures, we saw a surprising strength in the quarter led by general surgery in the United States and procedure growth beyond urology outside the United States. On a procedure basis, cholecystectomy, bariatric surgery and hernia repair led the way.

從手術開始，我們看到本季度在美國普通外科和美國以外泌尿外科以外的手術增長方面表現出驚人的實力。在手術基礎上，膽囊切除術、減肥手術和疝修補術處於領先地位。

All our major regions performed well. Standouts included India, Spain, U.K., Japan, Germany and Italy. U.S. performance was significantly above trend, and China is recovering from lows in Q4, though not yet meeting our expected 2023 run rate.

我們所有的主要地區都表現良好。表現突出的國家包括印度、西班牙、英國、日本、德國和意大利。美國的表現明顯高於趨勢，中國正在從第四季度的低點中復蘇，但尚未達到我們預期的 2023 年運行率。

Given that first quarter of the year exceeded our procedure expectations, we're reviewing underlying drivers. The return of patients to health care providers and diagnostic pipelines post-pandemic continues, with evidence of both an increased patient census and some diagnostic pipelines running above pre-pandemic levels after several years of lag. We also see a commitment by our hospital customers to work through staffing constraints to maintain surgical volume.

鑑於今年第一季度超出了我們的程序預期，我們正在審查潛在的驅動因素。大流行後患者繼續返回醫療保健提供者和診斷管道，有證據表明患者普查增加，一些診斷管道在滯後幾年後運行高於大流行前水平。我們還看到我們的醫院客戶承諾通過人員配置限制來維持手術量。

Lastly, customers are expressing confidence in our products as a clinically and economically sustainable path forward for minimally invasive surgery. Taken together, we see continued share gain from open surgery and laparoscopy in several procedures and in several countries as evidence accumulates in our favor.

最後，客戶對我們的產品表示有信心，認為我們的產品是微創手術在臨床和經濟上可持續發展的途徑。總而言之，隨著對我們有利的證據不斷積累，我們看到開放手術和腹腔鏡檢查在多個手術中和多個國家的份額持續增加。

Strong growth in procedures and a capable product portfolio has supported a healthy capital placement quarter. Worldwide, we placed 312 da Vinci systems and 55 Ion systems in Q1 compared with 311 da Vinci systems and 34 Ion systems in Q1 2022.

程序的強勁增長和強大的產品組合支持了健康的資本配售季度。在全球範圍內，我們在第一季度放置了 312 個達芬奇系統和 55 個離子系統，而在 2022 年第一季度放置了 311 個達芬奇系統和 34 個離子系統。

Capital placements were healthy in the United States, our distribution markets, the U.K. and in India in the quarter. Our product portfolio and our teams are competing effectively with the offerings of a growing set of competitors, notably in OUS markets where customers have had more time to evaluate the relative strengths of our offerings.

本季度，美國、我們的分銷市場、英國和印度的資本配置狀況良好。我們的產品組合和我們的團隊正在與越來越多的競爭對手的產品進行有效競爭，特別是在 OUS 市場，客戶有更多時間來評估我們產品的相對優勢。

Procedures per system per quarter grew 13% during Q1 versus a year ago. Systems are being used more hours per operating day, and customers are increasing the mix of shorter-duration procedures. Both trends are good, long-term indicators for our business. Customers are finding more value in their systems and are moving more of their procedure volume onto our devices compared to other surgical approaches.

第一季度每個系統每個季度的程序與一年前相比增長了 13%。系統在每個工作日的使用時間越來越長，客戶越來越多地使用持續時間較短的程序。這兩種趨勢都是我們業務的良好長期指標。與其他手術方法相比，客戶正在他們的系統中發現更多價值，並將更多的手術量轉移到我們的設備上。

Turning to our finances. Our revenue growth of 14% reflects the strength of our procedures and capital placements, while average selling prices remained stable. Our margins were pressured primarily by charges taken in our stapling line due to a raw material lot non-conformance that necessitated scrapping instruments. We also experienced lower manufacturing yields during the bring-up of new production lines in our high-volume production facilities to support multiport accessory and Ion catheter growth. Customer availability was briefly impacted for stapling but has since recovered, and we're working on bringing customer stocking levels back to their prior levels. For our Ion catheters and our multiport accessories, we're investing in capabilities to increase yield and robustness in the face of rising demand. We have worked through the issues that drove the bulk of these scrap charges in the quarter.

轉向我們的財務。我們 14% 的收入增長反映了我們程序和資本配置的實力，而平均售價保持穩定。由於原材料批次不合格，需要報廢儀器，我們的利潤率主要受到裝訂線收費的壓力。在我們的大批量生產設施中引入新生產線以支持多端口配件和離子導管增長的過程中，我們的製造產量也有所下降。客戶可用性因裝訂而受到短暫影響，但此後已恢復，我們正在努力使客戶庫存水平恢復到之前的水平。對於我們的離子導管和我們的多端口配件，我們正在投資提高產量和穩健性的能力，以應對不斷增長的需求。我們已經解決了導致本季度產生大部分廢品費用的問題。

Finally, in SG&A and R&D, we're spending roughly to plan while continuing to pursue productivity improvements post-pandemic. Jamie and Brian will take you through our finances and forward outlook in more detail shortly.

最後，在 SG&A 和 R&D 方面，我們的支出大致用於計劃，同時繼續追求大流行後的生產力提高。 Jamie 和 Brian 稍後將帶您更詳細地了解我們的財務狀況和前瞻性展望。

On new products and indications, we've had a productive quarter. We received our CE mark for Ion, and we expect to launch in the U.K. as our first entry into the European region. As we focus on scaling Ion, we initiated our first high-volume production lines in our Mexicali facility, increasing production volume 50% over just the prior quarter.

在新產品和適應症方面，我們有一個富有成效的季度。我們的 Ion 獲得了 CE 標誌，我們預計將在英國推出，這是我們首次進入歐洲地區。由於我們專注於擴展 Ion，我們在墨西卡利工廠啟動了第一條大批量生產線，產量僅比上一季度增加了 50%。

In digital, our simulation subscription installed base grew 36% year-over-year as virtual reality training becomes more deeply embedded in the training pathway. Our intuitive hub installed base grew 41% year-over-year and utilization during da Vinci cases grew 80% year-over-year as customers use our Intuitive Hub computing system to record and analyze procedures more routinely.

在數字方面，隨著虛擬現實培訓更深入地融入培訓途徑，我們的模擬訂閱安裝基數同比增長 36%。隨著客戶使用我們的 Intuitive Hub 計算系統更常規地記錄和分析程序，我們的 Intuitive Hub 安裝基礎同比增長 41%，達芬奇案例期間的利用率同比增長 80%。

Turning to SP. We received new indications for SP in the United States through a 510(k) clearance in urology, covering simple prostatectomy, removal of a noncancerous prostate for treatment of advanced benign prostate hyperplasia. We also installed our first da Vinci SP system in Japan, and they completed their first set of cases.

轉向SP。我們通過泌尿外科 510(k) 許可在美國獲得了 SP 的新適應症，包括簡單的前列腺切除術、去除非癌性前列腺以治療晚期良性前列腺增生。我們還在日本安裝了我們的第一個達芬奇 SP 系統，他們完成了他們的第一套案例。

For 2023, our priorities are as follows. First, we're focused on increased adoption for our priority procedures in countries through outstanding training, commercial and market access execution. Second, we're pursuing expanded indications and launches for our new platforms. Third, we're focused on excellence and continuity of supply, product quality and services provision as we emerge from pandemic stresses. And finally, we're pursuing increased productivity in our functions that benefit from scale. You can see from our first quarter results the relevance of these priorities and our urgency in pursuing them.

對於 2023 年，我們的優先事項如下。首先，我們專注於通過出色的培訓、商業和市場准入執行，提高我們優先程序在各國的採用率。其次，我們正在為我們的新平台尋求擴展適應症和發布。第三，隨著我們擺脫大流行病的壓力，我們專注於供應、產品質量和服務提供的卓越和連續性。最後，我們正在追求從規模中獲益的職能部門的生產力提高。您可以從我們第一季度的業績中看出這些優先事項的相關性以及我們追求這些優先事項的緊迫性。

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。

Before I dive into the details of our Q1 results, I will expand on the 2 areas of note in the quarter, and as Gary highlighted, procedure growth and gross margin.

在我深入探討第一季度業績的細節之前，我將詳細介紹本季度的兩個值得注意的領域，正如加里強調的那樣，程序增長和毛利率。

Global procedure growth in Q1 of 26% came in well above our expectations with notable strength in the U.S. where procedures also grew by 26%. As a reminder, procedures in Q1 of last year reflected an adverse impact from COVID in the early part of the quarter in the U.S. and the latter part of the quarter in Korea and China. We believe that the return of patients to normalized health care routines, including diagnostics, and improved staffing levels have positively impacted this quarter's procedures. However, it is difficult to precisely characterize or estimate the degree or duration of this impact.

第一季度全球手術增長 26% 遠高於我們的預期，美國的增長勢頭也很明顯，美國的手術也增長了 26%。提醒一下，去年第一季度的程序反映了 COVID 在本季度初期對美國以及本季度後期對韓國和中國的不利影響。我們認為，患者恢復正常的醫療保健程序（包括診斷）和人員配備水平的提高對本季度的程序產生了積極影響。然而，很難準確描述或估計這種影響的程度或持續時間。

Looking at the monthly trends in the U.S., January and February were particularly strong relative to historical seasonality. However, in March, we saw more normalized growth rates. Outside of the U.S. procedure growth of almost 28% was also ahead of our expectations, with growth outperforming expectations across all our major international markets.

從美國的月度趨勢來看，1 月和 2 月相對於歷史季節性尤為強勁。然而，在 3 月份，我們看到了更加正常化的增長率。在美國以外，近 28% 的程序增長也超出了我們的預期，增長超過了我們所有主要國際市場的預期。

In the first quarter, non-urology procedures represented roughly half of our total OUS procedures and grew 35% from quarter 1 of last year. Brian will provide additional commentary and our updated procedure outlook later in the call.

在第一季度，非泌尿外科手術約占我們 OUS 手術總數的一半，比去年第一季度增長 35%。 Brian 將在稍後的電話會議中提供更多評論和我們更新的程序展望。

Pro forma gross margin in Q1 was below our expectations at 67.2%, lower than last quarter's 68.2% and last year's 69.8%. Q1 results reflected onetime adverse impacts of approximately 100 basis points relating to manufacturing-related issues and an increase in inventory reserves, as Gary detailed. While we largely resolved these onetime items in the quarter, we see opportunity to strengthen our manufacturing operations and improve product costs. This is a priority for our business unit and operations teams and aligns with our capital investment plans, as we described on last quarter's call.

第一季度的備考毛利率低於我們預期的 67.2%，低於上一季度的 68.2% 和去年的 69.8%。正如加里詳述的那樣，第一季度業績反映了與製造相關問題和庫存儲備增加有關的約 100 個基點的一次性不利影響。雖然我們在本季度基本上解決了這些一次性項目，但我們看到了加強製造業務和降低產品成本的機會。正如我們在上個季度的電話會議上所述，這是我們業務部門和運營團隊的優先事項，並符合我們的資本投資計劃。

Turning to other key metrics. In Q1, the installed base of da Vinci systems grew 12% to almost 7,800 systems driven primarily by demand for additional capacity given procedure growth. Average system utilization grew 13% year-over-year, significantly above long-term trends, driven by notable strength in procedure volumes in January and February and by an increasing mix of shorter-duration benign procedures in the U.S. While we do not expect this level of utilization growth to continue, we actively support our customers as they increase utilization of their da Vinci systems which, in turn, lowers their per procedure costs.

轉向其他關鍵指標。在第一季度，達芬奇系統的安裝基數增長了 12%，達到近 7,800 個系統，這主要是由於程序增長對額外容量的需求所致。平均係統利用率同比增長 13%，明顯高於長期趨勢，這是受 1 月和 2 月手術量顯著強勁以及美國越來越多的短期良性手術組合所推動。雖然我們預計不會出現這種情況為了繼續提高利用率水平，我們積極支持我們的客戶，因為他們增加了達芬奇系統的利用率，這反過來又降低了他們的每個程序成本。

With respect to capital performance, we placed 312 systems in the first quarter, ahead of our expectations, with notable strength in OUS markets. Current quarter placements were roughly even with the 311 systems we placed in the first quarter of last year. There were 67 trade-in transactions in the quarter as compared to 108 last year. Excluding trade-in transactions, net new system placements increased 21% over the first quarter of last year. As of the end of Q1, there are approximately 560 Sis remaining in the installed base, of which approximately 110 are in the U.S.

在資本表現方面，我們在第一季度投放了 312 個系統，超出了我們的預期，在 OUS 市場上具有顯著的優勢。當前季度的安置與我們去年第一季度安置的 311 系統大致持平。本季度有 67 筆以舊換新交易，而去年為 108 筆。不包括以舊換新交易，淨新系統安置比去年第一季度增長了 21%。截至第一季度末，已安裝的基數中還剩下大約 560 個 Sis，其中大約 110 個在美國。

Q1 revenue was $1.7 billion, an increase of 14%. On a constant currency basis, first quarter revenue grew approximately 17%. Recurring revenue represented 81% of total revenue and grew 21% over last year driven by procedure growth and an increase in the installed base of systems under operating lease arrangements. Within I&A revenue for our advanced technology categories, stapler and energy, revenue grew a combined 26% over Q1 of last year.

第一季度收入為 17 億美元，增長 14%。按固定匯率計算，第一季度收入增長約 17%。經常性收入佔總收入的 81%，比去年增長 21%，這主要受程序增長和經營租賃安排下系統安裝基數增加的推動。在我們先進技術類別、訂書機和能源的 I&A 收入中，收入比去年第一季度增長了 26%。

Additional revenue statistics and trends are as follows. In the U.S., we placed 141 systems in the first quarter, lower than the 186 systems we placed last year, reflecting a decline of 51 systems associated with trade-in transactions. Outside the U.S., we placed 171 systems in Q1 compared with 125 systems last year. Current quarter system placements included 101 into Europe, 16 into Japan and 18 into China compared with 78 into Europe, 19 into Japan and 9 into China in Q1 of last year. First quarter system placement performance in Europe included 32 placements in the U.K. driven by timing of the NHS budget period, which closes each year at the end of March. We placed 12 systems in India, a quarterly high for us, which, in part, stems from our recent procedure growth there. In Q1, procedures in India grew 55%, albeit from a relatively small base.

其他收入統計和趨勢如下。在美國，我們在第一季度放置了 141 個系統，低於我們去年放置的 186 個系統，反映出與以舊換新交易相關的 51 個系統的減少。在美國以外，我們在第一季度放置了 171 個系統，而去年為 125 個系統。當前季度的系統佈局包括 101 個進入歐洲、16 個進入日本和 18 個進入中國，而去年第一季度有 78 個進入歐洲、19 個進入日本和 9 個進入中國。歐洲第一季度的系統安置業績包括在英國的 32 個安置，這是由 NHS 預算期的時間推動的，該預算期每年 3 月底結束。我們在印度放置了 12 個系統，這對我們來說是一個季度的高點，這在一定程度上源於我們最近在那裡的程序增長。第一季度，印度的手術增長了 55%，儘管基數相對較小。

Reviewing the capital performance in the quarter, we do not expect the strength in U.K. and India to repeat in the remainder of the year. Customers, particularly in the U.S. and Europe, continue to be challenged by staffing, inflation, debt servicing costs and other financial pressures. And as a result, we expect customers to continue to be cautious in their overall capital spending.

回顧本季度的資本表現，我們預計英國和印度的強勢在今年餘下時間不會重現。客戶，尤其是美國和歐洲的客戶，繼續面臨人員配備、通貨膨脹、償債成本和其他財務壓力的挑戰。因此，我們預計客戶在總體資本支出方面將繼續保持謹慎。

Leasing represented 42% of Q1 placements compared with 42% last quarter and 35% last year. We are increasingly seeing customers address system access and capital budget barriers by choosing our usage-based leasing models. The proportion of placements under this structure continue to increase, particularly in the U.S. As a result of this trend and the earlier stage of our leasing program with OUS customers, we continue to expect that the proportion of placements under operating leases will increase over time.

租賃佔第一季度的 42%，而上一季度為 42%，去年為 35%。我們越來越多地看到客戶通過選擇我們基於使用的租賃模式來解決系統訪問和資本預算障礙。這種結構下的配售比例繼續增加，特別是在美國。由於這種趨勢以及我們與 OUS 客戶的租賃計劃處於早期階段，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。

Q1 system average selling prices were $1.47 million as compared to $1.43 million last quarter. The sequential increase in system ASPs was primarily driven by a lower mix of trade-ins. We recognized $24 million of lease buyout revenue in the first quarter compared with $17 million last quarter and $16 million in Q1 of 2022.

第一季度系統平均售價為 147 萬美元，而上一季度為 143 萬美元。系統 ASP 的連續增長主要是由較低的以舊換新組合推動的。我們在第一季度確認了 2400 萬美元的租賃買斷收入，而上一季度為 1700 萬美元，2022 年第一季度為 1600 萬美元。

da Vinci instrument and accessory revenue per procedure was approximately $1,780 compared with approximately $1,820 last quarter and $1,870 last year. On a year-over-year basis, FX negatively impacted I&A per procedure by approximately $40, and ordering patterns in China had a negative impact of approximately $50 per procedure as our channel partners continue to manage their inventory levels in a dynamic environment. On a sequential basis, the primary driver of the decline in I&A per procedure of $40 was customer ordering patterns in the U.S.

達芬奇儀器和配件每次手術的收入約為 1,780 美元，而上一季度約為 1,820 美元，去年為 1,870 美元。與去年同期相比，外匯對每個程序的 I&A 產生了大約 40 美元的負面影響，而中國的訂購模式對每個程序產生了大約 50 美元的負面影響，因為我們的渠道合作夥伴繼續在動態環境中管理他們的庫存水平。按順序計算，每程序 I&A 下降 40 美元的主要驅動因素是美國的客戶訂購模式。

Turning to our Ion platform. In Q1, we placed 55 Ion systems as compared to 34 in Q1 of 2022. First quarter Ion procedures of approximately 10,200 increased 159% as compared to last year. During the quarter, we received CE mark clearance for our Ion platform in Europe where we will initially focus on the U.K. market and on the collection of clinical data in support of our European reimbursement strategy. Regulatory processes for Ion continue to progress in Korea and China. Ten of the systems placed in the first quarter were SP systems, including our first placement in Japan following clearance last quarter. SP procedures grew by 37% and average system utilization increased by 12% compared to Q1 of last year.

轉向我們的 Ion 平台。在第一季度，我們放置了 55 個 Ion 系統，而 2022 年第一季度為 34 個。第一季度約 10,200 個 Ion 程序與去年相比增加了 159%。在本季度，我們的 Ion 平台在歐洲獲得了 CE 標誌許可，我們將首先專注於英國市場和臨床數據的收集，以支持我們的歐洲報銷戰略。 Ion 的監管程序在韓國和中國繼續取得進展。第一季度放置的系統中有 10 個是 SP 系統，包括我們在上個季度獲得批准後在日本的首次放置。與去年第一季度相比，SP 程序增長了 37%，平均係統利用率增長了 12%。

Moving on to the rest of the P&L. As previously referenced, pro forma gross margin for Q1 was 67.2%. And in addition to the onetime impacts described earlier, pro forma gross margin reflects the impact of higher component and labor costs and, relative to the year-ago period, a stronger U.S. dollar. Gross margin for our Ion platform is currently considerably below our da Vinci business, resulting in an adverse mix impact to gross margin given the higher growth rates of our Ion business. The key area of focus for our Ion and manufacturing teams over the next 18 months is to improve supply stresses, strengthen manufacturing capabilities and lower our product costs.

繼續討論損益表的其餘部分。如前所述，第一季度的備考毛利率為 67.2%。除了前面描述的一次性影響外，預計毛利率還反映了組件和勞動力成本上升以及與去年同期相比美元走強的影響。我們 Ion 平台的毛利率目前大大低於我們的達芬奇業務，鑑於我們 Ion 業務的較高增長率，這對毛利率產生了不利的組合影響。在接下來的 18 個月裡，我們的 Ion 和製造團隊的重點關注領域是改善供應壓力、加強製造能力和降低我們的產品成本。

I&A prices have remained the same for the life of Xi. However, given the durability of component cost increases throughout the pandemic, we are executing an increase to the list price of da Vinci I&A from approximately 5% over the next couple of months. This increase reflects only a portion of the increased component labor costs reflected in our gross margin. We expect the impact of this decision to be an increase in revenue and operating profit of approximately $100 million in 2023.

在習近平的一生中，I&A 價格一直保持不變。然而，鑑於在整個大流行期間組件成本增加的持久性，我們將在未來幾個月內將 da Vinci I&A 的定價從大約 5% 上調。這一增長僅反映了我們毛利率中反映的組件勞動力成本增加的一部分。我們預計該決定的影響將是 2023 年收入和營業利潤增加約 1 億美元。

First quarter pro forma operating expenses increased 20% year-over-year driven primarily by increased head count added throughout last year, higher variable compensation, higher travel costs and increased expenses associated with customer training. Operating expenses were moderately above our expectations due to higher variable compensation and training costs related to our procedure performance in the quarter. On a sequential basis, operating expenses were up 1%, including the annual reset of certain payroll taxes. Head count increased by approximately 330 in Q1, of which roughly half are in support of revenue growth.

第一季度預估運營費用同比增長 20%，主要原因是去年全年新增員工人數增加、可變薪酬增加、差旅成本增加以及與客戶培訓相關的費用增加。由於本季度與我們的程序績效相關的可變薪酬和培訓成本較高，運營費用略高於我們的預期。按順序計算，運營費用增長了 1%，其中包括某些工資稅的年度重置。第一季度員工人數增加了約 330 人，其中約一半用於支持收入增長。

Capital expenditures in Q1 were $197 million, primarily comprised of infrastructure investments to expand our facilities footprint and increase manufacturing capacity, including automation of certain production lines.

第一季度的資本支出為 1.97 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，包括某些生產線的自動化。

Our pro forma effective tax rate for the first quarter was 22.1%, consistent with our expectations. First quarter pro forma net income was $437 million or $1.23 per share compared with $413 million or $1.13 per share for the first quarter of last year.

我們第一季度的備考有效稅率為 22.1%，符合我們的預期。第一季度預估淨收入為 4.37 億美元或每股 1.23 美元，而去年第一季度為 4.13 億美元或每股 1.13 美元。

I will now summarize our GAAP results. GAAP net income was $355 million or $1 per share for the first quarter of 2023 compared with GAAP net income of $366 million and also $1 per share for the first quarter of 2022. 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, gains and losses on strategic investments.

我現在將總結我們的 GAAP 結果。 2023 年第一季度 GAAP 淨收入為 3.55 億美元或每股 1 美元，而 2022 年第一季度 GAAP 淨收入為 3.66 億美元和每股 1 美元。備考淨收入和 GAAP 淨收入之間的調整概述和量化我們的網站，包括與員工股票獎勵、員工股票補償、無形資產攤銷、戰略投資損益相關的超額稅收優惠。

We ended the quarter with cash and investments of $6.6 billion compared with $6.7 billion at the end of last year. The sequential reduction in cash and investments reflected share repurchases and capital expenditures partially offset by cash from operating activities.

本季度結束時，我們的現金和投資為 66 億美元，而去年年底為 67 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被經營活動產生的現金部分抵消。

During the quarter, we spent $350 million to repurchase 1.5 million of our shares at an average price of $230 per share. From the beginning of 2022 through the end of Q1 this year, we have repurchased 12.6 million shares at an average price of $234 per share and have $1.1 billion remaining under current Board authorization to repurchase our shares.

本季度，我們斥資 3.5 億美元以每股 230 美元的平均價格回購了 150 萬股股票。從 2022 年初到今年第一季度末，我們以平均每股 234 美元的價格回購了 1260 萬股股票，根據董事會目前的授權，我們還有 11 億美元用於回購我們的股票。

And with that, I would like to turn it over to Brian who will discuss clinical highlights and provide our updated outlook for 2023.

就此，我想把它交給布賴恩，他將討論臨床亮點並提供我們對 2023 年的最新展望。

Thank you, Jamie. Our overall first quarter procedure growth was 26% year-over-year compared to 19% for the first quarter of 2022 and 18% last quarter. In the U.S., first quarter 2023 procedure growth was 26% year-over-year compared to 16% for the first quarter of 2022 and 18% last quarter. Q1 growth continued to be driven by strong growth in procedures within general surgery. Specifically, growth was led by cholecystectomy, bariatrics, hernia repair and other procedures.

謝謝你，傑米。我們第一季度的總體程序同比增長 26%，而 2022 年第一季度和上季度分別為 19% 和 18%。在美國，2023 年第一季度手術量同比增長 26%，而 2022 年第一季度和上季度分別為 16% 和 18%。第一季度的增長繼續受到普通外科手術強勁增長的推動。具體來說，增長是由膽囊切除術、減肥、疝修補術和其他手術帶動的。

Outside of the U.S., first quarter procedure volume grew 28% compared with 25% for the first quarter of 2022 and 18% last quarter. First quarter 2023 OUS procedure growth was driven by continued growth in general surgery and gynecology categories, primarily from colon resection and hysterectomy. Growth in urology continued to be solid led by kidney procedures, along with continued double-digit growth in prostatectomy.

在美國以外，第一季度的手術量增長了 28%，而 2022 年第一季度和上一季度分別增長了 25% 和 18%。 2023 年第一季度 OUS 手術的增長是由普通外科和婦科類別的持續增長推動的，主要來自結腸切除術和子宮切除術。在腎臟手術的帶動下，泌尿外科繼續穩步增長，同時前列腺切除術繼續保持兩位數增長。

In Europe, we experienced strong growth in the U.K., Germany, Italy and France. In all the regions noted, procedure growth was driven by strong growth in colorectal and hysterectomy. Urology was also solid, with particular strength in kidney procedures. Outside of those procedures, in Germany, we also saw strong growth in hernia repair. And in France, growth in lung resection was also strong.

在歐洲，我們在英國、德國、意大利和法國經歷了強勁增長。在所有提到的地區，手術的增長是由結直腸和子宮切除術的強勁增長推動的。泌尿科也很紮實，尤其擅長腎臟手術。除了這些手術之外，在德國，我們還看到疝修補術的強勁增長。在法國，肺切除術的增長也很強勁。

In Asia, growth beyond urology was also led by general surgery and gynecology procedures. In Japan, growth was led by colon resection, a newly reimbursed procedure in 2022 that provided the most incremental cases this quarter. Growth was also robust in rectal resection and gastrectomy and continued early-stage growth in kidney procedures. In China, procedures started to recover in February from the impact of COVID, exceeding our expectations for the quarter but still below prior averages. Growth in urology was solid, in particular with growth in prostatectomy and kidney procedures.

在亞洲，普通外科和婦科手術也帶動了泌尿科以外的增長。在日本，增長由結腸切除術引領，這是一種 2022 年新報銷的手術，在本季度提供了最多的增量病例。直腸切除術和胃切除術的增長也很強勁，腎臟手術的早期增長也在持續。在中國，程序從 2 月開始從 COVID 的影響中恢復，超出了我們對該季度的預期，但仍低於之前的平均水平。泌尿科增長穩健，尤其是前列腺切除術和腎臟手術的增長。

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。

Starting with the clinical study for benign general surgery, Dr. Courtney Collins from Ohio State University Wexner Medical Center published outcomes comparing robotic versus open retromuscular ventral hernia repairs in older adults using prospectively collected data from the Abdominal Core Health Quality Collaborative, a national hernia-specific registry.

從良性普通外科手術的臨床研究開始，來自俄亥俄州立大學韋克斯納醫學中心的 Courtney Collins 博士發表了使用從 Abdominal Core Health Quality Collaborative 前瞻性收集的數據比較老年人機器人與開放性肌後腹疝修補術的結果，這是一個國家疝氣-具體註冊表。

Published in the Annals of Surgery, over 1,100 patients over the age of 65 were included in a propensity matched analysis, with 350 patients in the robotic arm and approximately 750 patients in the open arm. This study reported the median length of stay associated with the robotic-assisted approach was 1/4 of the length of stay for patients undergoing an open repair, with a 1-day stay in the robotic-assisted arm and a 4-day stay in the open arm.

發表在《外科年鑑》上，超過 1,100 名 65 歲以上的患者被納入傾向匹配分析，其中 350 名患者使用機械臂，大約 750 名患者使用張開臂。這項研究報告說，與機器人輔助方法相關的中位住院時間是接受開放修復術患者住院時間的 1/4，機器人輔助臂住院 1 天，手術臂住院 4 天。張開手臂。

While complication rates were similar between both groups, it was notable that median 1-year quality-of-life scores using the HerQLes quality-of-life survey tool trended favorably for patients in the robotic-assisted arm. The authors concluded, in part, that the results suggest that robotic approach may have at least short-term benefits to appropriate older patients undergoing retromuscular ventral hernia repair, including shorter length of stay with relatively low risk of complications, with the important note that surgeon comfort and knowledge of the likely complexity of a repair should always guide operative approach in any patient.

雖然兩組之間的並發症發生率相似，但值得注意的是，使用 HerQLes 生活質量調查工具的 1 年生活質量中位數得分對機器人輔助臂中的患者有利。作者的部分結論是，結果表明，機器人方法可能至少對接受肌後腹疝修補術的適當老年患者有短期益處，包括住院時間較短，並發症風險相對較低，重要的是外科醫生舒適度和對修復可能複雜性的了解應始終指導任何患者的手術方法。

Now turning to a report published in January of this year. Dr. Sameh Emile from the Cleveland Clinic Florida reported outcomes for robotic-assisted versus laparoscopic resection of T4 rectal cancer in the British Journal of Surgery. This study, leveraging data from the National Cancer Database and after a 1:1 propensity score matching, compared 470 patients undergoing a minimally invasive resection for nonmetastatic T4 rectal cancer, with 235 subjects in each of the laparoscopic and robotic-assisted cohorts.

現在轉向今年 1 月發布的一份報告。來自佛羅里達州克利夫蘭診所的 Sameh Emile 博士在英國外科雜誌上報告了機器人輔助與腹腔鏡切除 T4 直腸癌的結果。這項研究利用國家癌症數據庫的數據，並在進行 1:1 傾向評分匹配後，比較了 470 名接受微創切除術的非轉移性 T4 直腸癌患者，腹腔鏡和機器人輔助隊列各有 235 名受試者。

Notably, rates of conversions in the robotic-assisted group were approximately half the rate of conversion in the laparoscopic group, with 8.9% in the robotic group versus 17.9% in the laparoscope group. Further analysis demonstrated that risk of conversion to open was 45% lower in the robotic-assisted group when compared to the laparoscopic group. In addition, patients who underwent a robotic-assisted procedure had a 1 day shorter length of stay compared to patients in the laparoscopic arm. The authors concluded, in part, that robotic-assisted resections of T4 rectal cancer were associated with a significantly lower conversion rate and shorter hospital stay than laparoscopic surgery.

值得注意的是，機器人輔助組的轉化率約為腹腔鏡組轉化率的一半，機器人組為 8.9%，腹腔鏡組為 17.9%。進一步分析表明，與腹腔鏡組相比，機器人輔助組轉為開腹手術的風險降低了 45%。此外，與接受腹腔鏡手術的患者相比，接受機器人輔助手術的患者住院時間縮短了 1 天。作者的部分結論是，與腹腔鏡手術相比，機器人輔助 T4 直腸癌切除術的轉化率顯著降低，住院時間更短。

I will now turn to our financial outlook for 2023, starting with procedures. On our last call, we forecasted full year 2023 procedure growth within a range of 12% to 16%. We are now increasing our forecast and expect full year 2023 procedure growth of 18% to 21%. This range continues to reflect the uncertainty associated with the course of the pandemic and macroeconomic risks.

我現在將從程序開始談談我們對 2023 年的財務展望。在我們上次電話會議上，我們預測 2023 年全年手術增長率將在 12% 至 16% 之間。我們現在正在提高我們的預測，預計 2023 年全年手術增長率將達到 18% 至 21%。這一範圍繼續反映與大流行和宏觀經濟風險的過程相關的不確定性。

The low end of the range still assumes continued choppiness with COVID hospitalizations, uncertainty with the timing of the capital quota in China for the remainder of the year, macroeconomic challenges that could impact hospitals and patient spending and a moderation in procedures from elevated levels experienced in January and February this year.

該範圍的低端仍然假設 COVID 住院人數持續波動、今年剩餘時間中國資本配額時間的不確定性、可能影響醫院和患者支出的宏觀經濟挑戰以及程序從高水平經歷的緩和今年一月和二月。

At the high end of the range, we assume COVID-related hospitalizations around the world continue to decline throughout 2023, a capital quota in China is available and macroeconomic challenges do not impact hospital procedure volumes. 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.

在該範圍的高端，我們假設 2023 年全球與 COVID 相關的住院人數繼續下降，中國有資本配額，宏觀經濟挑戰不會影響醫院手術量。該範圍並未反映出類似於我們在大流行開始時所經歷的重大物質供應鏈中斷或醫院容量限制。

Turning to gross profit. We continue to expect our 2023 full year pro forma gross profit margin to be within 68% and 69%. Our actual gross profit margin will vary quarter-to-quarter depending largely on product, regional and trade-in mix and the impact of new product introductions.

轉向毛利。我們繼續預計我們 2023 年全年的備考毛利率將在 68% 和 69% 之間。我們的實際毛利率將在很大程度上取決於產品、區域和以舊換新組合以及新產品推出的影響，每個季度都會有所不同。

With respect to operating expenses, on our last call, we forecast pro forma operating expense growth to be between 9% and 13%. We are increasing our estimate and now expect our full year pro forma operating expense growth to be between 11% and 15%. The increased operating expense growth reflects higher variable compensation and other costs related to higher procedure growth performance.

關於運營費用，在我們上次電話會議上，我們預測備考運營費用增長將在 9% 至 13% 之間。我們正在增加我們的估計，現在預計我們全年的備考營業費用增長將在 11% 到 15% 之間。運營費用增長的增加反映了更高的可變薪酬和與更高的程序增長性能相關的其他成本。

We are also updating our estimate for noncash stock compensation expense to range between $600 million to $630 million in 2023, a decrease from our previous estimate of $610 million to $640 million. We continue to expect other income, which is comprised mostly of interest income, to total between $140 million and $160 million in 2023. With regard to capital expenditures, we continue to estimate a range of $800 million to $1 billion for planned facility construction activities.

我們還將對 2023 年非現金股票補償費用的估計更新為 6 億美元至 6.3 億美元，低於我們之前估計的 6.1 億美元至 6.4 億美元。我們繼續預計 2023 年其他收入（主要包括利息收入）總額將在 1.4 億至 1.6 億美元之間。關於資本支出，我們繼續估計計劃中的設施建設活動將在 8 億至 10 億美元之間。

With regard to income tax, we continue to estimate our 2023 pro forma tax rate to be between 22% and 24% of pretax income.

關於所得稅，我們繼續估計我們 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) We'll first go to Travis Steed with Bank of America.

（操作員說明）我們將首先與美國銀行一起去 Travis Steed。

I'll start out with the 26% procedure growth. Can you just comment a little bit on how much of this is just a better hospital environment, better procedure environment, versus maybe some uptick in share gains from robotics? And a little bit more color on the January, February versus the March, just curious if you think this is some kind of temporary catch-up here or some sustained better procedure environment kind of moving forward.

我將從 26% 的程序增長開始。你能稍微評論一下這在多大程度上只是更好的醫院環境、更好的手術環境，而不是機器人技術帶來的份額收益的一些上漲？ 1 月、2 月與 3 月的顏色更多一點，只是好奇你是否認為這是某種暫時的赶超，或者某種持續的更好的程序環境正在向前發展。

Travis, this is Jamie. I think there are 4 drivers on the 26%. We do think there's a little bit of a soft comp on the base period given some impacts from COVID in Q1 of '22. You have 3 other drivers. We think there is some backlog effect from patients generally returning to more normalized health care routines given the effect of the pandemic over several years. Included within that is diagnostic pipelines, we see the last year or so of diagnostic pipelines being above pre-Covid levels. Second effect, there is some strength in the U.S. in general surgery, particularly behind general surgery. And in our OUS markets, the non-urology side of our procedure categories are growing nicely. .

特拉維斯，這是傑米。我認為 26% 上有 4 個驅動程序。考慮到 22 年第一季度 COVID 的一些影響，我們確實認為基期有一些軟補償。您還有其他 3 名司機。我們認為，鑑於大流行的影響已持續數年，患者通常會恢復更正常的醫療保健程序，這會產生一些積壓效應。其中包括診斷管道，我們看到去年左右的診斷管道高於 Covid 之前的水平。第二個影響，美國在普外科方面有一定的優勢，特別是在普外科之後。在我們的 OUS 市場中，我們手術類別的非泌尿科方面增長良好。 .

We also think that relative to Q4, staffing has improved. It's not where it was pre-COVID, but I think that's allowed for some incremental procedures to be performed. We don't have good estimates as to where the kind of various outperformance is between those categories that we described, market data lags there. Certainly, there's some market share gains, particularly in benign general surgery in the U.S.

我們還認為，相對於第四季度，人員配置有所改善。它不是 COVID 之前的地方，但我認為這允許執行一些增量程序。對於我們所描述的這些類別之間的各種出色表現的類型，我們沒有很好的估計，市場數據滯後於此。當然，市場份額有所增加，尤其是在美國的良性普通外科手術領域。

What was the second part of your question, Travis?

特拉維斯，你問題的第二部分是什麼？

Just more about the January, February versus the March and if it was more of an early part of the catch-up, I think you answered part of that, versus some sustained better environment here into April. .

更多關於 1 月、2 月與 3 月的比較，如果它更像是追趕的早期部分，我想你回答了部分問題，而不是 4 月的一些持續更好的環境。 .

Yes. January, in particular, was very strong. That also probably reflects in part a little bit of the comp. February continues to be strong, and I characterize March as a normalized growth rate. I'm not going to give you the percentages, though, I think that can be misleading. Early part of April, it's difficult to look at just a couple of weeks. But I'd say generally, it's consistent with what we've seen in March. We've seen some third-party data through end of February, just with respect to total U.S. inpatient admissions, and that shows kind of the same trends in terms of a strong January, February.

是的。一月份尤其強勁。這也可能部分反映了比賽的一點點。 2 月繼續強勁，我將 3 月描述為正常增長率。不過，我不會給你百分比，我認為這可能會產生誤導。 4 月初，很難只看幾個星期。但我想說的是，總體而言，這與我們在 3 月份看到的情況一致。我們已經看到了截至 2 月底的一些第三方數據，僅與美國住院總人數有關，這顯示了與 1 月和 2 月強勁趨勢相同的趨勢。

Great. That's helpful. And then I wanted to ask about the price increase on I&A. Is it like across the board for just the U.S.? I assume, but I wanted to clarify that. And the math I was doing of about 150 basis points on margin but the gross margin guide still staying the same at 68% to 69%, so I just wanted to make sure I understood the moving parts on the margin side and how you're incorporating that into the overall margin guidance.

偉大的。這很有幫助。然後我想問一下 I&A 的價格上漲。它是否像美國一樣全面？我假設，但我想澄清一下。我計算的利潤率約為 150 個基點，但毛利率指南仍保持在 68% 至 69% 不變，所以我只是想確保我了解利潤率方面的變動部分以及您的情況將其納入整體保證金指導。

Yes. So the 5% is in the vast majority of our markets, a couple of smaller markets, where local dynamics are such that we have to take a look at that more carefully. That doesn't go into effect for the full year, that's in the next couple of months that we'll implement that. I think if you look at the gross margin impact of the $100 million, depending on where you're modeling revenue, I think you have to do it with and without revenue and gross margin dollars to do the impact to gross margin percentage. I think it's less than the number that you described. And yes, it is reflected in the gross margin guidance that we provided. So what you have there is the puts and takes of the Q1 performance, our updated outlook for the rest of the year and then you add in the effect of the price increase.

是的。所以 5% 在我們的絕大多數市場中，一些較小的市場，當地的動態是如此，我們必須更仔細地看看。這不會在全年生效，我們將在接下來的幾個月內實施。我認為，如果你看看 1 億美元對毛利率的影響，取決於你在哪裡建模收入，我認為你必須在有收入和沒有收入和毛利率的情況下進行計算，才能對毛利率百分比產生影響。我認為這比你描述的數字要少。是的，它反映在我們提供的毛利率指導中。所以你所擁有的是第一季度業績的看跌期權，我們對今年剩餘時間的最新展望，然後你加上價格上漲的影響。

And next, we'll go to Robbie Marcus with JPMorgan.

接下來，我們將與摩根大通一起去 Robbie Marcus。

Great. I just want to say congrats on a great quarter. Maybe if I could ask on placements, the net placements were well above consensus here in the first quarter, really strong showing, flat with last year pretty much, despite lower trade-ins. But that comes with your comments that it's still a fairly tight capital environment. So in a normal environment, how much better do you think you'd be doing on placements? And are you seeing an improvement at all in the capital equipment environment? It's certainly not holding you back here. But I'm just really curious where you think you could go if the environment was a bit healthier.

偉大的。我只想對一個偉大的季度表示祝賀。也許如果我可以問一下配售，第一季度的淨配售遠高於共識，表現非常強勁，與去年基本持平，儘管以舊換新較低。但這伴隨著你的評論，即它仍然是一個相當緊張的資本環境。因此，在正常環境中，您認為您在安置方面的表現會好多少？您是否看到資本設備環境有所改善？它當然不會阻止你回到這裡。但我真的很好奇，如果環境更健康一點，你認為你可以去哪裡。

Yes. I would say that the environment is still challenging for hospitals. There's no question that they are encountering relatively significant financial pressures. Generally, we see customers, particularly in the U.S. and Europe, prioritizing their capital investment dollars based on where they see the greatest ROIs and where they have opportunities to gain market share. And so us, where we see that evidence is in where they start to have procedure growth, that means they're out of capacity and they look to invest in da Vinci to expand capacity given the economic evidence that they've accumulated with the experience of their programs.

是的。我想說的是，環境對醫院來說仍然充滿挑戰。毫無疑問，他們正面臨著較大的財務壓力。一般來說，我們看到客戶，尤其是美國和歐洲的客戶，根據他們看到的最高投資回報率以及他們有機會獲得市場份額的地方來優先考慮他們的資本投資。所以我們，我們看到證據表明他們開始有程序增長的地方，這意味著他們的能力不足，他們希望投資達芬奇以擴大能力，因為他們已經積累了經驗的經濟證據他們的節目。

Hard to answer your question directly in terms of what would the capital environment be if it were in, let's say, normalized times. For us, I think we're focused on this period on offering customers flexibility in how they acquire capital, meeting them with their financial objectives and serving their objectives in expanding their robotic programs.

很難直接回答你的問題，如果它在，比方說，正常化時代，資本環境會是什麼樣子。對我們來說，我認為我們在這一時期的重點是為客戶提供他們如何獲得資本的靈活性，滿足他們的財務目標，並為他們擴大機器人項目的目標服務。

Great. And maybe just a quick follow-up. Jamie, as we think about your OpEx progression through the year, it came in a bit higher than the Street had in first quarter. How should we think about that flowing through the rest of the year? And was there anything or any kind of big quarters that we should be thinking about in our progression through the year?

偉大的。也許只是快速跟進。傑米，當我們考慮您全年的運營支出進展時，它比第一季度的華爾街略高。我們應該如何看待今年餘下時間的流動情況？在這一年的進展中，我們應該考慮什麼或任何類型的大季度？

Yes. I would say roughly, depending on where you are in the range, Q2 and Q3 operating expenses should be roughly similar to Q1, and you start to see a less of effect just from the payroll tax reset in Q2 and Q3 as those max out, and you should see Q4 seasonally higher.

是的。我會粗略地說，根據你在範圍內的位置，第二季度和第三季度的運營支出應該與第一季度大致相似，而且你開始看到第二季度和第三季度的工資稅重置的影響較小，因為那些已經達到最大值，你應該會看到第四季度季節性走高。

Next, we'll go to Larry Biegelsen with Wells Fargo.

接下來，我們將與富國銀行一起去拉里比格爾森。

Gary, you've talked about competition potentially lengthening the capital placement cycle. But my question is, if there's an effort by a competitor to discount I&A by 30% or so, how would this impact your procedures? And secondly, Gary, why is this the right time to increase price in I&A? And I had one follow-up.

加里，你談到競爭可能會延長資本配售週期。但我的問題是，如果競爭對手努力將 I&A 折扣 30% 左右，這將如何影響您的程序？其次，Gary，為什麼現在是提高 I&A 價格的合適時機？我有一個後續行動。

Yes. On the first question of what's real pricing out there, there's a few competitors out there, a couple are trumpeting marketing claims about how much they're going to reduce I&A pricing. When we see them in tenders, when we actually see what's written down, we don't see the marketing claim. So I don't know that that's been realized yet or if it's something they want to do in the future, if they're really going to deliver, I don't know. .

是的。關於什麼是實際定價的第一個問題，那裡有一些競爭對手，一些人正在大肆宣揚他們將降低多少 I&A 定價的營銷聲明。當我們在招標中看到它們時，當我們實際看到寫下的內容時，我們看不到營銷聲明。所以我不知道這是否已經實現，或者這是否是他們將來想要做的事情，如果他們真的要交付，我不知道。 .

But we do have real-world evidence of engagement in our OUS markets with most of these competitors. And what we find is that the reality is we have a very strong portfolio, we can hit multiple price points because we have different systems that can hit it at different places. The other thing that goes on is that it's more than just whatever a company supplies to get to the total price per procedure. So if a new competitor enters and they have a short procedure set, in other words, they don't have everything you need, the customer will have to go to third-parties to fill it out to finish the case. Often in marketing materials, they don't make that clear, "Hey, you got to have more to get the case done." But in a tender, you do, which is, "Hey, this is all the stuff that it really takes to get a procedure done."

但我們確實有真實世界的證據表明我們與大多數這些競爭對手在我們的 OUS 市場上有合作。我們發現，現實是我們擁有非常強大的產品組合，我們可以達到多個價格點，因為我們有不同的系統可以在不同的地方達到它。另一件事是，要達到每個程序的總價格，不僅僅是公司提供的任何東西。所以如果有新的競爭者進入，他們的流程很短，換句話說，他們沒有你需要的一切，客戶將不得不去第三方填寫以完成案例。通常在營銷材料中，他們並沒有說清楚，“嘿，你必須有更多才能完成這個案子。”但在招標中，你會說，“嘿，這是完成程序真正需要的所有東西。”

So we're feeling pretty good about where we are with regard to our ability to deliver economic value that really matters to our customer. I think that we're having real exchanges with them about what that looks like. So that's kind of a baseline. We have been investing in the virtuous cycle, manufacturing capabilities. Some of the capital you hear us investing is both facilities and automation, getting our factories in the right places in the world for logistics and for labor. We're doing those things to be able to lower our product costs, increase our quality as we get volume. That has been lumpy. I wish it was smoother, but it's been a lumpy process for us.

因此，我們對提供對客戶真正重要的經濟價值的能力感到非常滿意。我認為我們正在與他們就這看起來像什麼進行真正的交流。所以這是一個基線。我們一直在投資於良性循環、製造能力。你聽到我們投資的一些資本既是設施又是自動化，讓我們的工廠在世界上合適的地方進行物流和勞動力。我們正在做這些事情是為了能夠降低我們的產品成本，在我們獲得產量時提高我們的質量。那是塊狀的。我希望它更順利，但這對我們來說是一個崎嶇不平的過程。

So the timing for us in terms of price increase is really not about a specific issue. It's not about a specific competitive issue or scrap. It's really around looking at the input costs that we're seeing over the last couple of years and component supply that comes to us from others and labor content, labor costs, and saying, "Hey, we're going to have to move a little bit here going forward." That doesn't diminish the other programs that we've done to make sure we're bringing value to our customers, extended life instruments and other price points that we can help them with.

所以我們提價的時機真的不是一個具體的問題。這與特定的競爭問題或報廢無關。這實際上是在查看我們在過去幾年中看到的投入成本和來自其他公司的組件供應以及勞動力內容、勞動力成本，然後說，“嘿，我們將不得不搬家向前一點點。”這並沒有減少我們為確保我們為客戶帶來價值、延長使用壽命的儀器和我們可以幫助他們的其他價格點而所做的其他計劃。

That's very helpful, Gary. Just one on Ion, we estimate Ion sales exceeded $140 million last year. It could drive a couple of hundred basis points of revenue growth this year. Thank you for giving the procedure numbers on this call. My question is when are you going to start to break out Ion revenues and just maybe talk about the ramp in Europe.

這很有幫助，加里。就 Ion 而言，我們估計 Ion 去年的銷售額超過 1.4 億美元。它可能會推動今年收入增長數百個基點。感謝您在此電話中提供程序編號。我的問題是你什麼時候開始公佈 Ion 的收入，也許只是談論歐洲的增長。

So the first question of kind of breakouts in your estimates, I'll let Jamie answer that, and I'll talk a little bit about Europe.

所以第一個關於你估計的突破的問題，我會讓傑米回答這個問題，我會談談歐洲。

It's a little early at this point. It's 2% to 3% of procedures and revenue. I think we want to give it a little more time, get a little more experience in the marketplace, execute some of the commercial activities that we have for the year. When it becomes a bigger portion of the total, maybe a year from now, we would look to do some guidance and give greater disclosure.

現在還為時過早。它佔程序和收入的 2% 到 3%。我想我們想給它更多的時間，在市場上獲得更多的經驗，執行我們今年的一些商業活動。當它在總數中所佔比例更大時，也許是一年後，我們會尋求提供一些指導並提供更多信息。

On Europe, this first year, as we go in, we'll be relatively modest in terms of revenue and installs. I think we'll start the process. We're excited about some of the sites and clinical trial work that we need to do. We do have to do some evidence generation in Europe. We do want to look at some of the reimbursement capabilities that are going to be important for broader market access. So year 1 is really about establishing evidence, having the right conversations and building the database so that reimbursement and broader use can be deployed.

在歐洲，第一年，隨著我們進入，我們在收入和安裝方面將相對溫和。我想我們會開始這個過程。我們對我們需要做的一些網站和臨床試驗工作感到興奮。我們確實必須在歐洲做一些證據生成。我們確實想研究一些對更廣泛的市場准入很重要的報銷能力。因此，第一年實際上是關於建立證據、進行正確的對話和建立數據庫，以便可以部署報銷和更廣泛的使用。

And next, we'll go to Jayson Bedford with Raymond James.

接下來，我們將和雷蒙德·詹姆斯一起去傑森·貝德福德。

Just a couple of questions. Just on China, I assume there was a backlog built in December and January and part of February. I don't know if you commented on March trends there, but can you comment on procedure growth in China in the quarter? And to the extent that you do believe there is a backlog, do you expect a bolus of growth in that geography over the next quarter or 2?

只是幾個問題。就中國而言，我假設在 12 月和 1 月以及 2 月的部分時間存在積壓。我不知道你是否評論了 3 月份的趨勢，但你能評論一下該季度中國的程序增長嗎？就您確實認為存在積壓的程度而言，您是否預計下一季度或第二季度該地區會出現快速增長？

Jayson, this is Brian. Good to hear from you. If you recall really at the end of last year, we had highlighted that we saw a significant impact from COVID at the end of the quarter to procedure volumes. And what we saw was that, that actually carried over into the beginning of this year. What we were highlighting in our prepared remarks was we definitely saw an impact in China continue through January, started to see a recovery in February and a bit into March. I guess I would say overall, I think procedures in China exceeded our expectations, but it just still was below our overall, say, long-run averages over time. So it's probably all that I could say. Anything beyond that, I couldn't say if there's anything different in March versus February.

傑森，這是布萊恩。很高興聽到你的消息。如果您還記得去年年底，我們曾強調我們在本季度末看到了 COVID 對手術量的重大影響。我們看到的是，這實際上延續到了今年年初。我們在準備好的發言中強調的是，我們確實看到中國的影響持續到 1 月，2 月開始復蘇，3 月開始復蘇。我想我會說總體而言，我認為中國的程序超出了我們的預期，但它仍然低於我們的總體水平，比如說，隨著時間的推移，長期平均水平。所以這可能是我能說的全部。除此之外，我不能說 3 月與 2 月是否有任何不同。

I would just add, Jayson, there may be still some unmet backlog in China. If there is, it's probably relatively small, and it's captured within the procedure range that we provided.

我只想補充一點，Jayson，中國可能還有一些未滿足的積壓工作。如果有的話，應該是比較小的，在我們提供的程序範圍內抓到的。

Okay. And just another quick clarification question. The supply challenges impacted margins. Was there an impact on revenue in the quarter? I'm just curious how long it will take to replenish the normal inventory levels at the customer level.

好的。還有一個快速澄清的問題。供應挑戰影響了利潤率。對本季度的收入有影響嗎？我只是好奇在客戶層面補充正常庫存水平需要多長時間。

Yes, there was not an impact to revenue that I'd highlight in Q1. It was really just the gross margin impact of about 100 basis points that we highlighted. With respect to inventory, if I just look at the big picture, we've been trying to replenish inventory targets for each of our critical parts for some time. We've been supply constrained for a good portion of the pandemic. Inventory health improved in Q1 relative to Q4, but we still have a number of parts where we have to get to our target levels. And that will probably take us over the course of the rest of the year.

是的，我在第一季度強調的收入沒有受到影響。這實際上只是我們強調的大約 100 個基點的毛利率影響。關於庫存，如果我只看大局，一段時間以來，我們一直在努力為每個關鍵部件補充庫存目標。在大流行的很大一部分中，我們一直受到供應限制。相對於第四季度，第一季度的庫存狀況有所改善，但我們仍有許多部分需要達到目標水平。這可能會讓我們度過今年餘下的時間。

Just a note, supply chain shocks through the last couple of years depleted inventory. Now we're building it back up. And given some of the lack of smoothness, we're probably holding a little more inventory than we would in more smooth times. That little additional inventory increases risk at some point. So we saw that in this quarter, we will work through it this year, but I think that risk still exists a little bit as inventory levels are higher than they were in the last 2, 3 years as we recover.

請注意，過去幾年的供應鏈衝擊耗盡了庫存。現在我們正在重建它。考慮到一些不平穩的情況，我們持有的庫存可能比平穩時期多一點。在某些時候，少量的額外庫存會增加風險。所以我們看到在這個季度，我們將在今年解決這個問題，但我認為風險仍然存在一點，因為隨著我們的複蘇，庫存水平高於過去 2、3 年的水平。

And next, we'll go to Richard Newitter with Truist Securities.

接下來，我們將前往 Truist Securities 的 Richard Newitter。

Congrats on the quarter. I have 2 quick ones on SP. I think you had said that FP procedures grew 37% and in the quarter. If you could just remind us kind of how that stacked up for the last 2 quarters. And then the second one on SP, just the new indication there for BPH, how significant is that? And maybe just talk a little bit about how expansive that is for you? And then I have one follow-up.

祝賀這個季度。我在 SP 上有 2 個快速的。我想你說過 FP 程序在本季度增長了 37%。如果你能提醒我們過去兩個季度的情況如何。然後是關於 SP 的第二個，只是 BPH 的新適應症，這有多重要？也許只是談談這對你來說有多廣闊？然後我有一個跟進。

Yes. I'll let Jamie take the trend data, and I can talk about BPH.

是的。我讓 Jamie 拿趨勢數據，我可以談談 BPH。

The '22 procedure growth rate for SP, I think...

SP 的 '22 程序增長率，我認為......

It looks like Brian is looking it up. I'm going to do the second question first, and then Brian is going to come back and save the day. On BPH, so there are a lot of different treatments for BPH. It's a quite common condition. At smaller prostate sizes, when it's caught earlier, there are pharmacologic approaches. There are some minimally invasive in-office approaches. Those tend to delay further onset. They don't tend to cure. So folks, over time, fail out. And as they fail out of those other procedures, surgery becomes increasingly important.

看起來 Brian 正在查找它。我先做第二個問題，然後 Brian 會回來挽救局面。關於 BPH，所以 BPH 有很多不同的治療方法。這是一種很常見的情況。對於較小的前列腺，當它被較早發現時，有藥理學方法。有一些微創的辦公室方法。這些往往會延遲進一步發作。他們不傾向於治愈。所以人們，隨著時間的推移，失敗了。當他們在其他手術中失敗時，手術變得越來越重要。

SP, early days, looks to be quite interesting. It's a minimally invasive approach. It can deal with advanced stage disease that we think other approaches are not handling well at all. And so as we get involved, I think that's another arrow in the quiver of an SP urologist. I think that helps them. We're already engaged with those customers, and it may give us a lead to participate in a bigger part of that market as time goes on.

SP，早期，看起來很有趣。這是一種微創方法。它可以處理我們認為其他方法根本無法處理的晚期疾病。因此，當我們參與進來時，我認為這是 SP 泌尿科醫生箭袋中的另一支箭。我認為這對他們有幫助。我們已經與這些客戶進行了接觸，隨著時間的推移，這可能會讓我們領先於參與該市場的更大部分。

Back to the trend data, I'll go back.

回到趨勢數據，我回去。

Yes. If I just take '22 as a whole, SP procedures grew 38%, so relatively consistent.

是的。如果我將 22 年作為一個整體，SP 程序增長了 38%，因此相對一致。

Great. And just on the benign procedure commentary, it was such an enormous step-up, particularly in the U.S. I appreciate the easier comps. But were the benign procedures, that potentially saw a little bit of disproportionate lift this quarter, confined just to general surgery benign procedures? Or was it also inclusive of benign GYN? I'm just trying to get a sense for kind of where this procedure strength really derived.

偉大的。就良性程序評論而言，這是一個巨大的進步，尤其是在美國。我很欣賞更簡單的補償。但是，本季度可能會看到一些不成比例的提升的良性手術是否僅限於普通外科良性手術？或者它是否也包括良性 GYN？我只是想了解一下這種程序強度的真正來源。

Relative to trend lines, we saw benign strength in GYN also. So benign GYN growth rates were higher than we've seen in recent times and higher than long-term trend rates. And we think that speaks to kind of this backlog of patients' return to normal health care routines, et cetera. That's part of what's reflected in those growth rates.

相對於趨勢線，我們也看到了 GYN 的良性力量。因此，良性的 GYN 增長率高於我們最近看到的增長率，也高於長期趨勢增長率。我們認為這說明了患者恢復正常醫療保健程序等方面的積壓。這是這些增長率所反映的部分內容。

At the risk of being redundant, I think there's 2 concepts that are worth stitching together. One of them is that utilization went up 13% in the quarter procedures per system per year. So folks are using capital more frequently. There was an increase in the benign side. So we're seeing a rotation of mix, putting of those procedures onto systems that they own already. That was a big step-up. I think it speaks to how hospitals are thinking about robotic-assisted surgery programs and how they're thinking about capital.

冒著冗餘的風險，我認為有兩個概念值得拼接在一起。其中之一是每個系統每年的季度程序利用率上升了 13%。所以人們更頻繁地使用資本。良性方面有所增加。所以我們看到了混合的輪換，將這些程序放到他們已經擁有的系統上。那是一個很大的進步。我認為這說明了醫院如何考慮機器人輔助手術項目以及他們如何考慮資本。

And the simple answer is they're looking to see greater capital productivity out of what they already own and they see through real-world evidence, the ability to look into their own electronic medical record data, that their outcomes are really good with robotic-assisted surgery and their contribution margins are really healthy. So rotations on to those systems are happening. And I think that's been an acceleration at least in this quarter. So we'll see if it holds through the year, but I think it tells you a little bit about the capital environment and it tells you a little bit about the commitment toward robotic-assisted surgery, particularly in higher-volume, shorter-duration procedures.

簡單的答案是，他們希望從他們已經擁有的資產中看到更高的資本生產率，並且他們通過現實世界的證據，查看他們自己的電子病歷數據的能力，他們的結果非常好，機器人 -輔助手術及其邊際收益非常健康。因此，這些系統的輪換正在發生。我認為至少在本季度這是一個加速。所以我們會看看它是否會持續到今年，但我認為它告訴你一些關於資本環境的信息，它告訴你一些關於機器人輔助手術的承諾，特別是在更大的體積，更短的持續時間程序。

Next, we'll go to Matt Taylor with Jefferies.

接下來，我們將與 Jefferies 一起去 Matt Taylor。

So I just wanted to ask one. Because you had this outperformance in the procedures and talked about increased procedure guidance for the year, could you unpack that at all geographically or just by area? It sounds like general surgery is very strong. But just any more color on expectations for procedure growth in these different geographies with some of the fluctuations that we're seeing or by category would be great.

所以我只想問一個。因為你在程序中表現出色，並談到了今年增加的程序指導，你能從地理上或僅按地區來解包嗎？聽起來普外科很強。但是，只要對這些不同地區的程序增長的預期有更多的顏色，我們看到的或按類別的一些波動就會很好。

Yes, I would say our major international markets, so in Europe, Germany, France, U.K., Italy; in Asia, China, Japan, South Korea, they all performed well in the quarter. They all exceeded our expectations. And what we're seeing within those markets is nice growth in non-urology, so hysterectomy, colorectal, thoracic, depending on the market. We're starting to see, albeit at early stages, some of those procedures in those markets starting to get into an adoption curve. So I think that we're relatively optimistic on the outlook for those markets. Our expectations are reflected in the procedure guidance range that Brian provided .

是的，我會說我們的主要國際市場，所以在歐洲，德國，法國，英國，意大利；在亞洲，中國、日本、韓國在本季度都表現出色。他們都超出了我們的預期。我們在這些市場中看到的是非泌尿外科的良好增長，因此子宮切除術、結腸直腸癌、胸部切除術取決於市場。我們開始看到，儘管處於早期階段，但這些市場中的一些程序開始進入採用曲線。所以我認為我們對這些市場的前景相對樂觀。我們的期望反映在 Brian 提供的程序指導範圍內。

And just one follow-up on the kind of the China disruption, how are you seeing that come back now? Are there any other geographies where you're still seeing any notable disruption and any recovery expectations you can provide?

只是關於中國中斷的一種後續行動，你如何看待這種情況現在又回來了？在其他任何地區，您是否仍然看到任何明顯的中斷和您可以提供的任何恢復預期？

So I think Brian described what happened in Q1. We saw an impact in January in China. It started to recover in February and March. I think that the dynamics in China are relatively choppy, and I think it's a relatively dynamic market. So rest of the year, I think, there is relatively hard to predict. With respect to COVID impacts in the other markets, nothing that I would highlight. I do think that the financial pressures, staffing dynamics have as much of an impact in many of the European markets as they do the U.S.

所以我認為布賴恩描述了第一季度發生的事情。我們在一月份在中國看到了影響。它在二月和三月開始恢復。我認為中國的動態相對起伏不定，我認為這是一個相對活躍的市場。所以今年剩下的時間，我認為，相對難以預測。關於 COVID 對其他市場的影響，我不想強調什麼。我確實認為，財務壓力、人員動態對許多歐洲市場的影響與對美國的影響一樣大。

Yes, I'll speak to my perspective on China a little bit. I think it's a little bit different market for us than other places. The earlier questioner asked do we think there'll be a backlog and it will recover. Certainly, as they reopen, there'll be a backlog of patients that need to come back to surgery. We're such a tiny part of the overall surgery market, and we're so small relative to the total market size given the constraints of the quota, that how much of that comes to us and go somewhere else is going to be hard for us to predict. We're just going to have to live through it. So that's kind of number one. .

是的，我會談談我對中國的看法。我認為我們的市場與其他地方有點不同。較早的提問者問我們是否認為會有積壓並且會恢復。當然，隨著他們重新開放，將會有大量需要返回手術的患者。我們在整個外科手術市場中只佔很小的一部分，而且由於配額的限制，我們相對於整個市場規模來說是如此之小，以至於很難有多少人來到我們這裡並轉移到其他地方我們來預測。我們將不得不忍受它。所以這是第一位的。 .

The second one is the demand side is really high. The demand for additional systems and for training and patient demand for high-quality MIS is really good. We're waiting on clarity on additional quota, which is throttling the market right now. So those are the 2 things that I think have to clear up. We'll see patients come back at some rate. Whether they wait to get a robotic surgery in queue or they jump out of queue to get it, any way that they need to get it, that's going to be hard for us to know personally. And we'll see as the government responds to release of new quota..

第二個是需求端真的很高。對附加系統的需求以及對高質量 MIS 的培訓和患者需求確實很好。我們正在等待額外配額的明朗化，這目前正在抑制市場。所以這些是我認為必須澄清的兩件事。我們會看到患者以某種速度回歸。他們是等著排隊等機器人手術，還是跳出隊列去接受手術，他們需要以何種方式接受手術，這對我們個人來說很難知道。我們將看到政府對新配額的發布做出回應。

And next, we go to Drew Ranieri with Morgan Stanley.

接下來，我們和摩根士丹利一起去德魯拉涅利。

Gary, just maybe on placements for a moment, you touched on this earlier. But can you give us any more context specifically in the U.S. of like what you're seeing in terms of capacity expansion versus new accounts, just adopting robotics after 20 years? I would just like to hear your perspective there. And I have a follow-up.

加里，也許只是暫時的展示位置，你早些時候談到了這一點。但是你能給我們更多具體在美國的背景嗎？比如你在產能擴張和新客戶方面看到的情況，20 年後才採用機器人技術？我只想听聽你的觀點。我有一個後續行動。

I'll kick the first part on expansion into greenfields versus accounts that are already owned to Jamie. I ask you, Jamie, to think a little bit about there's corporate ownership IDNs and there's hospital-level ownership within those IDNs as to whether they had a robotics program or not. So perhaps tease those 2 apart a little bit.

我將開始第一部分關於擴展到綠地與 Jamie 已經擁有的賬戶。 Jamie，我請你稍微考慮一下公司所有權 IDN，這些 IDN 中有醫院級別的所有權，以確定他們是否有機器人計劃。所以也許把這兩個分開一點。

If you look at maybe a 5-quarter average, Drew, in the U.S., about 20-ish percent of the persistent placements is for greenfield accounts. But those greenfield accounts are really at hospitals that are part of a regional or national IDN that have not had a robotics program. Generally, they have a higher mix of benign procedures, benign general surgery in particular. And as the IDN at large has seen growing economic and clinical evidence for those procedures, particularly on the economic side, they've started to establish robotics programs in those greenfield accounts, again, as part of an existing IDN that we do business with. If you look at kind of the trend line, last couple of quarters, we've seen a little less greenfield mix in the system placements. I don't know that that's a trend. On a 5- or 6-quarter basis, it's relatively stable.

如果你看一下 5 個季度的平均值，德魯，在美國，大約 20% 的持續配售是用於綠地賬戶。但是那些未開發的帳戶實際上是在屬於區域或國家 IDN 的醫院中，這些 IDN 還沒有機器人程序。一般來說，他們有更多的良性手術組合，尤其是良性普通手術。隨著整個 IDN 看到這些程序的經濟和臨床證據越來越多，特別是在經濟方面，他們已經開始在這些綠地賬戶中建立機器人程序，再次作為與我們有業務往來的現有 IDN 的一部分。如果你看一下趨勢線，過去幾個季度，我們看到系統佈局中的綠地組合有所減少。我不知道那是一種趨勢。在 5 或 6 個季度的基礎上，它相對穩定。

Just adding a little bit to your perspective, as we sit with our IDN-level customers and talk about this, one of the things that has been really exciting for us is, in the last few years, the ability to analyze carefully with the kind of data we can bring and the kind of data those IDNs have in terms of their electronic medical record to both understand which hospitals would benefit from robotic programs and what the total profitability is in their hands when they do it, that resolution has gotten a lot better. The quality of those conversations is fantastic. The confidence, I think, they have to reinvest because they can see the data in their own hands, even if they don't have it at a particular hospital, somewhere in their network, they have it and they can do that analysis. That has changed the nature of the conversation in the last few quarters, and I think you're starting to see a reflection of that now.

在我們與 IDN 級別的客戶坐在一起討論這個問題時，請稍微補充一下您的觀點，其中一件讓我們真正感到興奮的事情是，在過去的幾年中，我們能夠仔細分析我們可以帶來的數據以及這些 IDN 在其電子病歷方面擁有的數據類型，以了解哪些醫院將從機器人程序中受益以及他們這樣做時的總盈利能力是多少，該決議得到了很多更好的。這些對話的質量非常好。我認為，他們必須重新投資信心，因為他們可以看到自己手中的數據，即使他們在特定醫院、他們網絡中的某個地方沒有數據，他們也有數據並且可以進行分析。這改變了過去幾個季度對話的性質，我認為你現在開始看到這一點的反映。

And Gary, just with about 4,700 systems in the U.S. right now, as you're thinking about competition eventually entering the U.S., kind of what are your thoughts on robotic practices being multidisciplinary in robotic systems versus standardization, which has been kind of a key effort of yours over the past several years?

加里，現在美國祇有大約 4,700 個系統，當你考慮競爭最終進入美國時，你對機器人系統中的多學科機器人實踐與標準化有何看法，這一直是一個關鍵你這幾年的努力？

Yes. Thank you. I think that not all customers are the same. There are different customers that have a different mission. Some customers view themselves as wanting to be test sites for anything that comes out, and they will do that. Some customers want to be training facilities and, as a result, want to be able to train anybody from any setting in allcomers. So we're going to see some cross-system sites.

是的。謝謝。我認為並非所有客戶都是一樣的。不同的客戶有不同的使命。一些客戶認為自己希望成為任何出現的產品的試驗場，他們會這樣做。一些客戶希望成為培訓機構，因此希望能夠培訓來自任何環境的任何人。因此，我們將看到一些跨系統站點。

But I think that's different. I think that's not the majority of the market. I think a lot of the market is going to be interested in great outcomes, high applicability of their systems, so that they can be used across multiple procedure categories and serious dependability. These are now being used more frequently. They're a part of everyday surgery for tens of thousands of surgeons now. And I think in that category, the bulk of the market, repeatability, dependability, outstanding outcomes, great access, great regulatory approvals and a lot of confidence in the company that can deliver it, I think those things are going to be assets. We'll see. I don't have a crystal ball. We'll see how it plays out. But so far, so good.

但我認為那是不同的。我認為這不是市場的大多數。我認為很多市場都會對他們系統的出色結果、高適用性感興趣，以便它們可以跨多個程序類別使用並具有高度的可靠性。這些現在被更頻繁地使用。現在，它們已成為成千上萬外科醫生日常手術的一部分。我認為在這一類別中，大部分市場、可重複性、可靠性、出色的成果、良好的准入、良好的監管批准以及對能夠提供它的公司的極大信心，我認為這些東西將成為資產。我們拭目以待。我沒有水晶球。我們將看看結果如何。但到目前為止，還不錯。

We'll go ahead and close from here. Thank you. In closing, we continue to believe there's a substantial and durable opportunity to fundamentally improve surgery and acute interventions more broadly. 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.

我們將繼續並從這里關閉。謝謝。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更廣泛的急性干預措施。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；最終，降低總護理成本。

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

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。在 Intuitive，我們設想了一種侵入性更小、效果更好的未來護理，可以更早地發現疾病並迅速治療，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.

感謝您對這段非凡旅程的支持。我們期待在 3 個月後再次與您交談。

Thank you. And that does conclude the call for today. Thanks for your participation of using AT&T Teleconference. You may now disconnect.

謝謝。這確實結束了今天的呼籲。感謝您參與使用 AT&T 電話會議。您現在可以斷開連接。