直覺手術 (ISRG) 2023 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Q2 2023 earnings release. (Operator Instructions) As a reminder, today's call is being recorded. I will now turn the call over to your host, Head of Investor Relations, Brian King. Please go ahead, sir.

女士們、先生們，感謝你們的支持，歡迎閱讀 Intuitive 2023 年第二季度財報。 （操作員說明）謹此提醒，今天的通話正在錄音。現在我將把電話轉給主持人投資者關係主管布萊恩·金 (Brian King)。請繼續，先生。

Thank you. Good afternoon, and welcome to Intuitive's Second Quarter Earnings Conference Call. With me today, we have Gary Guthart, our CEO; and Jamie Samath, our CFO.

謝謝。下午好，歡迎參加 Intuitive 第二季度收益電話會議。今天和我在一起的還有我們的首席執行官加里·古特特 (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 and Form 10-Q filed on April 20, 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的證券交易委員會文件中詳細描述，包括我們於 2023 年 2 月 10 日提交的最新 10-K 表格和 2023 年 4 月 20 日提交的 10-Q 表格。我們的 SEC 文件可以通過我們的網站或 SEC 網站找到。投資者應注意不要過分依賴此類前瞻性陳述。

Please note that this conference call will be available for audio replay on our website at intuitive.com on the Events section under our Investor Relations page. Today's press release and supplementary financial data tables have been posted to our website.

請注意，本次電話會議將在我們網站直觀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 second quarter results as described in our press release announced earlier today, followed by a question-and-answer session. Gary will present the quarter's business and operational highlights, Jamie will provide a review of our financial results, then I will discuss procedure and clinical highlights and provide our updated financial outlook for 2023. And finally, we will host a question-and-answer session. And with that, I will turn it over to Gary.

今天的形式將包括向您提供我們今天早些時候宣布的新聞稿中所述的第二季度業績亮點，然後是問答環節。 Gary 將介紹本季度的業務和運營亮點，Jamie 將回顧我們的財務業績，然後我將討論程序和臨床要點，並提供我們最新的 2023 年財務展望。最後，我們將舉辦問答環節。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 the second quarter with strong procedure and utilization growth and strong capital placements. Our product operations teams continue to build capacity and deliver in a dynamic supply chain environment as customers increasingly rely upon us for routine use.

感謝您今天加入我們。第二季度我們的業務基本面保持健康，流程和利用率強勁增長，資本配置強勁。隨著客戶越來越依賴我們的日常使用，我們的產品運營團隊繼續在動態的供應鏈環境中建設產能和交付。

Our research and development efforts continued to build momentum in the quarter, including positive development milestones for our Intuitive ecosystem, including systems, instruments, accessories, digital tools and new indications.

我們的研發工作在本季度繼續保持勢頭，包括我們的直觀生態系統的積極發展里程碑，包括系統、儀器、配件、數字工具和新適應症。

Turning first to procedures, growth in the quarter was 22%. Areas of strength included general surgery and gynecology for benign conditions, particularly in the United States. General surgery procedure growth was led by cholecystectomy and hernia repair. Colon and rectal procedure growth was healthy. Global procedure growth was also strong in the quarter, led by a recovery in China and continued strength in Japan, Germany and the U.K.

首先來看流程，本季度增長率為 22%。優勢領域包括良性疾病的普通外科和婦科，尤其是在美國。膽囊切除術和疝氣修復術帶動了普通外科手術的增長。結腸和直腸手術生長健康。在中國經濟復甦以及日本、德國和英國持續強勁的帶動下，本季度全球手術增長也強勁。

Ion procedures showed continued strength with 145% growth in Q2 of '23. SP procedure growth was accretive with 40% global growth in the quarter, driven by accelerating growth in the United States.

Ion 程序表現出持續的強勁勢頭，23 年第二季度增長了 145%。在美國加速增長的推動下，本季度 SP 程序增長加速，全球增長 40%。

On the capital front, we placed 331 systems in Q2 compared with 279 systems in Q2 of last year. Our clinical installed base now stands at 7,900 multiport da Vinci systems, 435 Ion systems and 142 single-port da Vinci systems. Overall, our capital placement trends reflected demand for additional capacity in multiport, strong interest in our Ion system and stable demand for SP as we build our SP indications.

在資本方面，我們第二季度投放了 331 個系統，而去年第二季度投放了 279 個系統。我們的臨床安裝基地目前擁有 7,900 個多端口達芬奇系統、435 個 Ion 系統和 142 個單端口達芬奇系統。總體而言，我們的資本配置趨勢反映了對多端口額外容量的需求、對我們的 Ion 系統的強烈興趣以及在我們建立 SP 適應症時對 SP 的穩定需求。

System utilization defined as procedures per installed clinical system per quarter grew 9% globally year-over-year, reaching a new high as customers adopt a broad mix of procedures on our systems. We believe real-world evidence of improvements across the quadruple aim from better patient outcomes to surgeon satisfaction and lower total cost to treat per patient episode underpin this increasing utilization.

系統利用率（定義為每季度每個已安裝臨床系統的程序）在全球範圍內同比增長 9%，隨著客戶在我們的系統上採用廣泛的程序組合而達到新高。我們相信，現實世界的證據表明，從更好的患者治療效果到外科醫生滿意度，以及更低的每次患者治療總成本等四重目標的改善，支撐了這種不斷增長的利用率。

Turning to our finances. Our revenue grew 15% in the quarter. Our capital and operating expenses were within our spend guidance, reflecting continued investments in R&D to support growth of our platforms and digital tools, expansion of our manufacturing and commercial footprints and capital amortization. We will continue investing in R&D, manufacturing and commercial operations to serve our global markets at industrial scale. These investments are likely to be lumpy over the next couple of years as significant operations expansions and other projects complete.

轉向我們的財務。本季度我們的收入增長了 15%。我們的資本和運營支出在我們的支出指導範圍內，反映出對研發的持續投資，以支持我們的平台和數字工具的增長、擴大我們的製造和商業足跡以及資本攤銷。我們將繼續投資研發、製造和商業運營，以工業規模服務全球市場。隨著重大業務擴張和其他項目的完成，這些投資在未來幾年可能會出現波動。

Taking a step back, we have found that the quadruple aim is the right north star for us, focusing on demonstrable improvements to outcomes across specific procedures and patient populations, increasing patient and care team satisfaction and lowering the total cost to treat per patient episode.

退後一步，我們發現四重目標對我們來說是正確的北極星，重點是對特定程序和患者群體的結果進行明顯的改善，提高患者和護理團隊的滿意度，並降低每次患者治療的總成本。

As electronic medical records have been adopted, we have partnered with our customers to analyze this data, building real-world evidence and big data approaches to measure quadruple aim improvements within countries, regions and health systems. Paired with our ecosystem investments in training services and products and powered by digital tools that can generate actionable intelligence from surgical data, we can help our customers analyze their programs, recommend and support actions to improve performance and lower total costs. This integrated business system is catalyzing our customers' goal of strong MIS programs by servicing actionable and measurable steps.

隨著電子病歷的採用，我們與客戶合作分析這些數據，建立真實世界的證據和大數據方法來衡量國家、地區和衛生系統內的四重目標改進。結合我們在培訓服務和產品方面的生態系統投資，並由可從手術數據生成可操作情報的數字工具提供支持，我們可以幫助客戶分析他們的計劃，建議和支持行動，以提高績效並降低總成本。這個集成的業務系統通過為可操作和可衡量的步驟提供服務，促進客戶實現強大的 MIS 計劃目標。

Our approach is scalable for us too, working for our da Vinci platforms and for Ion and opening the door to future opportunities.

我們的方法對我們來說也是可擴展的，適用於我們的達芬奇平台和 Ion，並為未來的機會打開了大門。

Turning to our ecosystem investments. We're making solid progress extending our offerings to new clinical domains and new regions. For da Vinci multiport, we recently obtained NMPA registration for Xi local production in China. This means our da Vinci Xi will be able to compete for the locally sourced tender subset of the recently released updated national quota.

轉向我們的生態系統投資。我們在將我們的產品擴展到新的臨床領域和新地區方面取得了紮實的進展。對於達芬奇多端口，我們最近獲得了 NMPA 註冊，可在中國進行本地生產。這意味著我們的 da Vinci Xi 將能夠競爭最近發布的更新的國家配額中的本地招標子集。

Our da Vinci SP team achieved several milestones recently. We completed patient enrollment for our colorectal and Thoracic IDE trials, continued our first phase of launch of SP in Japan and submitted our CE mark dossier for SP in Europe.

我們的達芬奇 SP 團隊最近取得了多個里程碑。我們完成了結直腸和胸部 IDE 試驗的患者登記，繼續在日本推出 SP 的第一階段，並提交了歐洲 SP 的 CE 標誌檔案。

Turning to Ion. Our team installed their first Ion system in the U.K. and initiated first cases. For our digital tools, we have initiated our Phase I launch of CASE Insights, our name for our computational observer. CASE Insights is a tool that works with the da Vinci system and hospital data to build AI models that find correlations between surgical technique, patient populations and surgical outcomes. Our first phase of launch builds on work over the past few years with our clinical research partners to refine objective performance indicators and link them to actionable changes to improve outcomes, shortened training times and improve surgical program efficiency.

轉向離子。我們的團隊在英國安裝了他們的第一個 Ion 系統並啟動了第一個案例。對於我們的數字工具，我們已經啟動了 CASE Insights 的第一階段啟動，這是我們計算觀察者的名稱。 CASE Insights 是一款與達芬奇系統和醫院數據配合使用的工具，可構建人工智能模型，以發現手術技術、患者群體和手術結果之間的相關性。我們的第一階段啟動建立在過去幾年與臨床研究合作夥伴的合作基礎上，旨在完善客觀績效指標，並將其與可操作的變革聯繫起來，以改善結果、縮短培訓時間並提高手術計劃效率。

We think these computational tools can make a significant impact using real-world and real-time data to improve skills and outcomes and to inform future product and automation opportunities. That said, features can be built quickly but long-term validation is arduous. We're a science-driven organization and will work through validation pathways in pursuit of long-term success. We do not expect material revenue from CASE insights for the next several quarters.

我們認為這些計算工具可以利用真實世界和實時數據來提高技能和成果，並為未來的產品和自動化機會提供信息，從而產生重大影響。也就是說，功能可以快速構建，但長期驗證卻很困難。我們是一個以科學為驅動的組織，將通過驗證途徑來追求長期成功。我們預計未來幾個季度不會從 CASE 洞察中獲得實質性收入。

In closing, our core business has momentum. We see a significant long-term opportunity to improve the quadruple aim using our integrated ecosystem powered by analytics and we are pacing our investments to catalyze that opportunity. I'll now turn the time over to Jamie, who will take you through our finances in greater detail.

最後，我們的核心業務勢頭強勁。我們看到了利用分析支持的集成生態系統來改善四重目標的重大長期機會，並且我們正在調整投資節奏以催化這一機會。現在我將把時間交給傑米，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。我將描述我們在非公認會計準則或預估基礎上的業績亮點。我稍後還將在準備好的發言中總結我們的 GAAP 表現。我們的預估結果與公認會計準則結果之間的對賬已發佈在我們的網站上。

Global procedure growth in Q2 of 22% and reflected U.S. procedure growth of 19% and 28% procedure growth outside of the U.S. Procedures in Q2 benefited from higher patient admissions as hospitals, particularly in the U.S. catch up with patients whose diagnosis and/or treatment was delayed during the pandemic.

第二季度全球手術增長 22%，反映了美國手術增長 19% 和美國以外的手術增長 28%。第二季度的手術受益於醫院入院患者數量的增加，特別是在美國，醫院趕上了在大流行期間診斷和/或治療被延遲的患者。

Consistent with our comments last quarter, our contributions to procedure growth from surgeons new to the da Vinci platform was strong, reflecting both the strength of our training capabilities and an increasing number of graduates of residency and fellowship programs who are trained on da Vinci. Within one of our target procedure areas, bariatric surgery, our growth rate in the U.S. slowed during the quarter. Some customers have indicated that they are seeing increased patient interest in weight loss drugs. It is too early to conclude if the slowing growth is a temporary pause as patients evaluate these new drug therapies or if it's a trend that continues.

與我們上季度的評論一致，我們對新接觸達芬奇平台的外科醫生的手術增長做出了強勁的貢獻，這既反映了我們培訓能力的實力，也反映了越來越多的住院醫師和研究員項目的畢業生接受了達芬奇的培訓。在我們的目標手術領域之一——減肥手術中，我們在美國的增長率在本季度放緩。一些客戶表示，他們看到患者對減肥藥物的興趣增加。現在斷定增長放緩是否是患者評估這些新藥療法時的暫時停頓，或者是否是一種持續的趨勢還為時過早。

We believe that during the quarter, da Vinci continued to gain market share in the bariatric surgical market. Our U.S. procedure growth of 28% reflected strength in China, the U.K., Germany and Japan. Strong procedure growth in China was driven by a continued recovery from more recent COVID-related impacts and a favorable comparison to Q2 last year, which was also impacted by the pandemic.

我們認為本季度達芬奇在減肥手術市場的市場份額繼續增加。我們在美國的業務增長了 28%，反映出中國、英國、德國和日本的實力。中國業務的強勁增長是由於近期新冠疫情相關影響的持續復甦以及與去年第二季度（也受到疫情影響）的良好比較所推動的。

Consistent with our comments last quarter, growth in non-neurology procedures outside of the United States was accretive, growing at approximately 35% driven by increases in colorectal, hysterectomy and thoracic procedures.

與我們上季度的評論一致，在結直腸、子宮切除術和胸部手術增加的推動下，美國以外的非神經科手術數量增長了約 35%。

Turning to other key metrics. In Q2, the installed base of da Vinci Systems grew 13% to just over 8,000 systems driven primarily by demand for additional capacity given procedure growth. Average system utilization grew almost 9% year-over-year reflecting an increasing mix of short duration benign procedures in the U.S. and customers prioritizing use of their existing assets given the financial pressures they face.

轉向其他關鍵指標。第二季度，達芬奇系統的安裝基數增長了 13%，達到 8,000 多個系統，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近 9%，反映出美國越來越多的短期良性程序以及考慮到面臨的財務壓力而優先使用現有資產的客戶。

With respect to capital performance, we placed 331 systems in the second quarter ahead of our expectations. Capital strength in the quarter included a higher number of placements to our distributors and a higher number of multi-system deals in the U.S. relative to recent trends, reflecting in part, certain placements accelerated into Q2 from future quarters.

在資本表現方面，我們第二季度放置了 331 個系統，超出了我們的預期。與最近的趨勢相比，本季度的資本實力包括向我們的分銷商的配售數量增加以及在美國的多系統交易數量增加，這在一定程度上反映出某些配售從未來幾個季度開始加速進入第二季度。

Despite Q2 system placements being ahead of our expectations, customers, particularly in the U.S. appear to be cautious in their capital spending given ongoing financial pressures. We placed 279 systems in Q2 of last year, which, as a reminder, reflected a delay in the shipment of approximately 15 systems from June into July as a result of supply chain challenges we encountered during the quarter.

儘管第二季度的系統佈局超出了我們的預期，但考慮到持續的財務壓力，客戶（尤其是美國客戶）似乎對其資本支出持謹慎態度。去年第二季度，我們放置了 279 個系統，提醒一下，由於我們在本季度遇到供應鏈挑戰，從 6 月到 7 月大約有 15 個系統的發貨出現延遲。

Q2 revenue was $1.8 billion, an increase of 15% year-over-year. On a constant currency basis, second quarter revenue grew approximately 17%. Recurring revenue represented 85% of total revenue as compared to 72% for the full year 2019 and grew 20% over last year, driven by procedure growth and an increase in the installed base of systems under operating lease arrangements.

第二季度營收為 18 億美元，同比增長 15%。按固定匯率計算，第二季度收入增長約 17%。經常性收入佔總收入的 85%，而 2019 年全年則為 72%，並且比去年增長 20%，這主要是受到程序增長和經營租賃安排下系統安裝基數增加的推動。

Additional revenue statistics and trends are as follows: in the U.S., we placed 157 systems in the second quarter compared to 150 systems placed last year. Outside the U.S., we placed 174 systems in Q2 compared with 129 systems last year. Current quarter system placements included 76 into Europe, 33 into Japan and 16 into China compared with 78 into Europe, 18 into Japan and 15 into China in Q2 of last year.

其他收入統計數據和趨勢如下：在美國，我們第二季度放置了 157 個系統，而去年放置了 150 個系統。在美國以外，我們在第二季度部署了 174 個系統，而去年為 129 個系統。當前季度的系統投放量包括歐洲 76 個、日本 33 個和中國 16 個，而去年第二季度歐洲有 78 個，日本有 18 個，中國有 15 個。

During the quarter, the China National Health Commission published the 14th 5-year quota of 559 robotic systems. For those systems awarded to our JV under the new quota, we expect a significant majority to be placed in 2024 through 2027. We are seeing increasing participation of local competitors in tender processes under the national quota. In addition, during 2023, we have experienced pricing pressure in China as a result of provincial government policy changes and competition. These dynamics create greater variability in the outlook for our procedure, system placement and revenue performance in China.

本季度，中國國家衛生健康委員會公佈了“十四五”機器人系統的559個配額。對於根據新配額授予我們合資企業的系統，我們預計絕大多數將在 2024 年至 2027 年期間安裝。我們看到當地競爭對手越來越多地參與國家配額下的招標過程。此外，2023年，由於省級政府政策變化和競爭，我們在中國經歷了價格壓力。這些動態給我們在中國的程序、系統佈局和收入表現的前景帶來了更大的可變性。

In Q2, 60 of the 331 systems placed were trading transactions compared to 56 trading transactions in the second quarter of last year. As of the end of Q2, there are approximately 500 SIs remaining in the installed base, of which 97 are in the U.S.

第二季度，331 個系統中的 60 個為交易交易，而去年第二季度為 56 個交易交易。截至第二季度末，已安裝的 SI 數量約為 500 個，其中 97 個位於美國。

Leasing represented 50% of Q2 placements compared with 42% for both last quarter and last year. In the U.S., 78% of system placements in Q2 were under operating lease arrangements compared to 59% last quarter. The higher rate of operating leases in the U.S. is primarily driven by an increasing customer preference for our usage-based leasing models in part due to capital budget constraints and continuing financial pressures faced by many of our customers.

租賃佔第二季度投放量的 50%，而上季度和去年均為 42%。在美國，第二季度 78% 的系統部署是根據經營租賃安排進行的，而上季度這一比例為 59%。美國經營租賃率上升的主要原因是客戶對我們基於使用的租賃模式的偏好不斷增加，部分原因是資本預算限制和我們許多客戶面臨的持續財務壓力。

In addition, some customers are choosing leasing structures to preserve flexibility to upgrade to next-generation technology. As a result of these dynamics 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.

此外，一些客戶正在選擇租賃結構，以保持升級到下一代技術的靈活性。由於這些動態以及我們與海外客戶的租賃計劃的早期階段，我們仍然預計經營租賃下的安置比例將隨著時間的推移而增加。

Q2 system average selling prices were $1.39 million as compared to $1.47 million last quarter. The sequential decrease in system SPs was primarily driven by a higher mix of X placements for purchase deals and geographical mix. We recognized $12 million of lease buyout revenue in the second quarter compared with $24 million last quarter and $23 million in Q2 of 2022. Da Vinci instrument and accessory revenue per procedure was approximately $1,840 compared with approximately $1,780 last quarter and $1,900 last year.

第二季度系統平均售價為 139 萬美元，上季度為 147 萬美元。系統 SP 的環比下降主要是由於購買交易和地理組合的 X 展示位置組合增加所致。我們在第二季度確認了 1200 萬美元的租賃買斷收入，而上季度為 2400 萬美元，2022 年第二季度為 2300 萬美元。達芬奇儀器和配件每次手術的收入約為 1,840 美元，而上季度約為 1,780 美元，去年為 1,900 美元。

On a sequential basis, higher [INA] per procedure was driven primarily by the INA price increase we described last quarter and customer ordering patterns.

按順序來看，每個程序的 [INA] 較高，主要是由我們上季度描述的 INA 價格上漲和客戶訂購模式驅動的。

Turning to our Ion platform. In Q2, we placed 59 Ion systems as compared to 41 in Q2 of 2022. Second quarter Ion procedures of approximately 12,700 increased 145% as compared to last year. During the quarter, we placed our first Ion system in the U.K. market and in this early phase of our European launch, we are focused on the collection of clinical data in support of our reimbursement strategy. 12 of the systems placed in the second quarter were SP systems, compared to 10 systems last quarter. SP procedures grew by 40% and average system utilization growth accelerated from last quarter's 12%, increasing by 14% compared to Q2 of last year.

轉向我們的 Ion 平台。第二季度，我們放置了 59 個 Ion 系統，而 2022 年第二季度為 41 個。第二季度 Ion 程序約為 12,700 個，與去年相比增加了 145%。本季度，我們在英國市場投放了第一個 Ion 系統，在歐洲推出的早期階段，我們專注於收集臨床數據以支持我們的報銷策略。第二季度投放的系統中有 12 個是 SP 系統，而上季度有 10 個系統。 SP 程序增長了 40%，平均係統利用率增長從上季度的 12% 加快，與去年第二季度相比增長了 14%。

Moving on to the rest of the P&L. Pro forma gross margin for the second quarter was 68.5% compared with 67.2% last quarter and 69.2% last year. Pro forma gross margin was lower than last year, primarily due to a higher mix of Ion revenue which currently carries significantly lower margins as compared to the da Vinci business and lower system SP.

繼續討論損益表的其餘部分。第二季度預計毛利率為 68.5%，上季度為 67.2%，去年為 69.2%。預估毛利率低於去年，主要是由於 Ion 收入組合較高，目前與達芬奇業務相比，其利潤率明顯較低，且系統 SP 較低。

As we described last quarter, improving product costs and manufacturing efficiency is a priority for our teams over the medium term. Second quarter pro forma operating expenses increased 12% year-over-year, driven primarily by increased headcount added throughout last year, higher variable compensation, increased prototype expenses and increased expenses associated with customer training in support of procedure growth.

正如我們上季度所述，提高產品成本和製造效率是我們團隊中期內的首要任務。第二季度預計運營費用同比增長 12%，主要是由於去年全年員工人數增加、可變薪酬增加、原型費用增加以及與支持流程增長的客戶培訓相關的費用增加。

Pro forma operating expenses represented 33% of revenue in Q2 compared to 35% of revenue for the full year 2022, reflecting in part planned leverage in our enabling functions.

預計運營費用佔第二季度收入的 33%，而 2022 年全年則佔收入的 35%，這在一定程度上反映了我們支持職能中計劃的槓桿作用。

Capital expenditures in Q2 were $178 million, primarily comprised of infrastructure investments to expand our facilities footprint and increase manufacturing capacity. Our pro forma effective tax rate for the second quarter was 22.3%, consistent with our expectations. Second quarter pro forma net income was $507 million or $1.42 per share compared with $415 million or $1.14 per share for Q2 of last year.

第二季度的資本支出為 1.78 億美元，主要包括基礎設施投資，以擴大我們的設施足跡並提高製造能力。我們第二季度的預計有效稅率為 22.3%，與我們的預期一致。第二季度預計淨利潤為 5.07 億美元，即每股 1.42 美元，而去年第二季度為 4.15 億美元，即每股 1.14 美元。

I will now summarize our GAAP results. GAAP net income was $421 million or $1.18 per share for the second quarter of 2023 compared with GAAP net income of $308 million or $0.85 per share for the second 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 and gains and losses on strategic investments.

現在我將總結我們的 GAAP 結果。 2023 年第二季度的 GAAP 淨利潤為 4.21 億美元，即每股 1.18 美元，而 2022 年第二季度的 GAAP 淨利潤為 3.08 億美元，即每股 0.85 美元。預計和 GAAP 淨利潤之間的調整在我們的網站上進行了概述和量化，其中包括與員工股票獎勵、員工股票薪酬、無形資產攤銷以及戰​​略投資損益相關的超額稅收優惠。

We ended the quarter with cash and investments of $7.1 billion compared with $6.6 billion last quarter. The sequential increase in cash and investments reflected cash from operating activities, proceeds from employee stock exercises partially offset by capital expenditures. And with that, I would like to turn it over to Brian, who will discuss clinical highlights and provide our updated outlook for 2023.

本季度結束時，我們的現金和投資為 71 億美元，而上季度為 66 億美元。現金和投資的環比增長反映了來自經營活動的現金、員工股票行使的收益，部分被資本支出所抵消。接下來，我想將其交給 Brian，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 second quarter procedure growth was 22% year-over-year compared to 14% for the second quarter of 2022 and 26% last quarter. In the U.S., second quarter 2023 procedure growth was 19% year-over-year compared to 11% for the second quarter of 2022 and 26% last quarter.

謝謝你，傑米。我們第二季度的整體流程同比增長 22%，而 2022 年第二季度為 14%，上一季度為 26%。在美國，2023 年第二季度手術量同比增長 19%，而 2022 年第二季度為 11%，上一季度為 26%。

Q2 growth continued to be driven by strong growth in procedures within general surgery, with particular strength in cholecystectomy and hernia repair. Bariatrics growth was healthy in the quarter but as noted earlier, growth was lower than in prior periods. Outside of the U.S., second quarter procedure volume grew 28% compared with 22% for the second quarter of 2022 and 28% last quarter. Second quarter 2023 OUS procedure growth was driven by continued growth in general surgery, primarily from strong growth in colorectal procedures, followed by growth in thoracic procedures.

第二季度的增長繼續受到普通外科手術強勁增長的推動，尤其是膽囊切除術和疝氣修復術。本季度減肥治療業務增長健康，但如前所述，增長低於前期。在美國之外，第二季度的手術量增長了 28%，而 2022 年第二季度為 22%，上一季度為 28%。 2023 年第二季度 OUS 手術的增長是由普通外科的持續增長推動的，主要是結直腸手術的強勁增長，其次是胸部手術的增長。

Growth in urology continued to be healthy, led by kidney procedures, along with continued double-digit growth in prostatectomy. In Europe, we experienced strong growth in the U.K., Germany and Spain. In all the regions noted, procedure growth was driven by colorectal and hysterectomy procedures.

在腎臟手術的帶動下，泌尿外科繼續健康增長，前列腺切除術也持續兩位數增長。在歐洲，我們在英國、德國和西班牙經歷了強勁增長。在所有提到的地區，手術增長都是由結直腸和子宮切除手術推動的。

In Asia, growth was led by China, where we saw a continuing recovery in procedures that were impacted by COVID and benefiting from a favorable comparison to procedure volume that was impacted in the same quarter a year ago.

在亞洲，增長由中國引領，我們看到受新冠疫情影響的手術持續復甦，並受益於與去年同期受影響的手術量相比的有利結果。

Procedure growth was led by strong growth in urology, namely prostatectomy and kidney procedures. In Japan, growth was led by general surgery with the largest procedure contributions coming from colorectal and gastrectomy procedures. While still at earlier stages of adoption, India and Taiwan, both demonstrated strong growth in gynecology and general surgery procedures.

泌尿外科手術的強勁增長帶動了手術的增長，即前列腺切除術和腎臟手術。在日本，增長由普通外科帶動，其中最大的手術貢獻來自結直腸和胃切除手術。儘管仍處於早期採用階段，但印度和台灣在婦科和普通外科手術方面均表現出強勁增長。

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。每個季度，我們都會在這些電話會議中重點介紹一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體系，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。

This past May, [Dr. Zhang] from the second affiliated hospital of [Chongqing] University in China, published a systematic review in meta-analysis comparing outcomes of robotic right colectomy procedures with outcomes associated with laparoscopic right colectomy. Published in techniques in Coloproctology, this meta analysis evaluated a total of 15,241 patients across 42 studies with over 2,700 subjects in the robotic right colectomy group and over 12,000 subjects in the laparoscopic group and included outcomes associated with the entire population as well as outcomes for both intracorporeal and extracorporeal anastomosis.

今年五月，[博士。來自中國[重慶]大學第二附屬醫院的張博士發表了一篇薈萃分析系統綜述，比較了機器人右結腸切除術與腹腔鏡右結腸切除術的結果。這項薈萃分析發表在《結腸直腸學技術》上，評估了 42 項研究中總共 15,241 名患者，其中機器人右結腸切除術組有超過 2,700 名受試者，腹腔鏡組有超過 12,000 名受試者，包括與整個人群相關的結果以及體內和體外吻合術的結果。

Looking at the population overall, the authors reported among other outcomes, an approximately half day shorter length of hospital stay, 51% lower risk of conversion to laparotomy and a 12% lower risk of complications with a robotic approach. Notably, in the subgroup specifically comparing outcomes for procedures within Intracorporeal anastomosis. The robotic right colectomy group was associated with a shorter length of hospital stay by approximately 16 hours and a 65% lower risk of conversion to laparotomy. Within the extracorporeal anastomosis subgroup, the robotic-assisted approach was associated with a 40% lower risk of overall complications.

縱觀總體人群，作者報告了其他結果，其中包括住院時間縮短了大約半天，轉為剖腹手術的風險降低了 51%，機器人手術的並發症風險降低了 12%。值得注意的是，在亞組中專門比較了體內吻合手術的結果。機器人右結腸切除術組的住院時間縮短了約 16 小時，並且轉換為剖腹手術的風險降低了 65%。在體外吻合術亞組中，機器人輔助方法的總體並發症風險降低了 40%。

The authors concluded in part that, "The safety and efficacy of robotic right colectomy is superior to laparoscopic right colectomy, especially when an Intracorporeal anastomosis has performed".

作者的部分結論是，“機器人右結腸切除術的安全性和有效性優於腹腔鏡右結腸切除術，特別是在進行體內吻合術時”。

Turning to a clinical study reporting outcomes for robotic-assisted and video-assisted thoracoscopic surgery, [Dr. Murai] from Danbury Hospital in Connecticut, published outcomes comparing lobectomies performed with either approach using the National Cancer database. This study focused on patients with complex etiology, such as non-small cell lung cancer who have received neoadjuvant therapy at [N1.2] disease or had a tumor greater than 5 centimeters and compared 9,500 subjects with over 2,100 in the robotic arm and over 7,000 in the [bats] arm.

轉向報告機器人輔助和視頻輔助胸腔鏡手術結果的臨床研究，[Dr.康涅狄格州丹伯里醫院的 Murai] 發表了使用國家癌症數據庫比較兩種方法進行的肺葉切除術的結果。這項研究重點關注病因複雜的患者，例如接受過[N1.2]疾病新輔助治療或腫瘤大於5厘米的非小細胞肺癌患者，並比較了9,500名受試者，其中超過2,100名受試者使用機械臂，超過7,000名受試者使用[蝙蝠]臂。

Notably, when analyzing rates of conversions to open, the authors reported a 7.7% lower rate of conversion to open in the robotic arm with an approximately 2x higher risk of conversion associated with the bats group. The authors concluded, "In summary, our analysis of the National Cancer Database suggests that robotic lobectomy for complex lung resections achieved similar perioperative outcomes and [R0] resections (inaudible) lobectomy with the exception of a lower rate of conversion to thoracotomy".

值得注意的是，在分析打開的轉換率時，作者報告說，機械臂中打開的轉換率降低了 7.7%，而與蝙蝠組相關的轉換風險大約高出 2 倍。作者總結道：“總之，我們對國家癌症數據庫的分析表明，用於復雜肺切除的機器人肺葉切除術實現了與 [R0] 切除（聽不清）肺葉切除術相似的圍手術期結果，但轉換為開胸術的比率較低”。

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 18% to 21%. We are now increasing our forecast and expect full year 2023 procedure growth of 20% to 22%. The low end of the range reflects uncertainty around the duration of elevated procedure volumes with patients returning to healthcare, continued slowing of bariatric growth rates in the U.S. and macroeconomic challenges that could impact hospitals and patient spending. At the high end of the range, we assume macroeconomic challenges do not have a significant impact on hospital procedure volumes, and bariatric growth rates in the U.S. continue at the rate we saw in Q2. The range does not reflect significant material supply chain disruptions or hospital capacity constraints.

我現在將談談我們 2023 年的財務展望。從程序開始。在上次電話會議中，我們預測 2023 年全年手術增長將在 18% 至 21% 的範圍內。我們現在提高了預測，預計 2023 年全年流程增長 20% 至 22%。該範圍的低端反映出隨著患者返回醫療保健而增加的手術量持續時間的不確定性、美國減肥增長率的持續放緩以及可能影響醫院和患者支出的宏觀經濟挑戰。在該範圍的高端，我們假設宏觀經濟挑戰不會對醫院手術量產生重大影響，並且美國的減肥增長率繼續保持我們在第二季度看到的速度。該範圍並未反映出重大的材料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.

轉向毛利潤。我們繼續預計 2023 年全年預計毛利率將在 68% 和 69% 之間。我們的實際毛利率將隨季度而變化，很大程度上取決於產品、區域和以舊換新的組合以及新產品推出的影響。

With respect to operating expenses. On our last call, we forecast pro forma operating expense growth to be between 11% and 15%. We are adjusting our estimate and now expect our full year pro forma operating expense growth to be between 12% and 15%. We are also updating our estimate for noncash stock compensation expense to range $600 million to $620 million in 2023, narrowing the range from our previous estimate of $600 million to $630 million.

關於運營費用。在上次電話會議中，我們預計預計運營費用增長將在 11% 至 15% 之間。我們正在調整我們的估計，現在預計全年預計運營費用增長將在 12% 至 15% 之間。我們還將 2023 年非現金股票補償費用的估計更新為 6 億至 6.2 億美元，將範圍從之前估計的 6 億美元縮小至 6.3 億美元。

We are increasing our estimate for other income which is comprised mostly of interest income, to total between $160 million and $180 million in 2023, an increase from our previous estimate of $140 million and $160 million. The increase primarily reflects the rise in interest rates. With regard to capital expenditures, we continue to estimate a range of $800 million to $1 billion, primarily for planned facility construction activities.

我們正在提高對主要由利息收入組成的其他收入的預測，到 2023 年，總額將達到 1.6 億至 1.8 億美元，高於我們之前預測的 1.4 億至 1.6 億美元。這一增長主要反映了利率的上升。關於資本支出，我們繼續估計在 8 億至 10 億美元之間，主要用於計劃的設施建設活動。

With regard to income tax, we continue to estimate our 2023 pro forma tax rate to be between 22% and 24% of pretax income. That concludes our prepared comments. We will now open the call to your questions.

關於所得稅，我們繼續預計 2023 年預計稅率為稅前收入的 22% 至 24%。我們準備好的評論到此結束。我們現在將開始電話詢問您的問題。

(Operator Instructions) We go through the first question from the line of Larry Biegelsen, Wells Fargo.

（操作員說明）我們將回答來自富國銀行拉里·比格爾森 (Larry Biegelsen) 的第一個問題。

Gary, just two for me. One big picture question on AI and second, on procedure growth. So AI is obviously having its moment in the sun here, Gary. I'm curious, where is Intuitive spending time in applying AI? Is it imaging, movement of the robot, training? I'd love to hear your thoughts, and then I have one follow-up.

加里，只給我兩個。第一個是關於人工智能的大問題，第二個是關於程序增長的問題。加里，人工智能顯然正在大放光彩。我很好奇，Intuitive把AI的時間花在哪裡了？是成像、機器人的運動、訓練嗎？我很想听聽你的想法，然後我會有一個後續行動。

Yes. Well, I'll start on AI. Let's talk about what it is. For us, it's a suite of digital tools that rests on a baseline and then can be built upon using various machine learning techniques including computer vision. We've been at it for some time. We started the Internet-of-Things for surgical robots over a decade ago. We built the baseline of cyber secure privacy-compliant pipes that allow us to get access to the data. So there's some foundational work that was important. That's kind of step 1.

是的。好吧，我將從人工智能開始。我們來談談它是什麼。對於我們來說，它是一套基於基線的數字工具，然後可以使用包括計算機視覺在內的各種機器學習技術進行構建。我們已經這樣做有一段時間了。十多年前，我們開始為手術機器人開發物聯網。我們建立了符合網絡安全隱私的管道的基線，使我們能夠訪問數據。因此，一些基礎工作非常重要。這就是第 1 步。

Step 2 is to collaborate with customers and aggregate data that is meaningful. AI is only as good as the quality of the data that you feed it. And so for us, that has been robot data, some other data in electronic medical record data in partnership with our customer base. We've been doing that for several years now. From that, I think you can start to do analytic inspections. You can do analysis on the data, look for correlations. Sometimes it's pretty simple math. That gets you big data explorations, some simple things that we can do to help our customers become more efficient and to expose variation.

第 2 步是與客戶協作並彙總有意義的數據。人工智能的好壞取決於你提供給它的數據的質量。對我們來說，這就是機器人數據，以及與我們的客戶群合作的電子病歷數據中的一些其他數據。我們這樣做已經好幾年了。從那時起，我認為你可以開始進行分析檢查。您可以對數據進行分析，尋找相關性。有時這是非常簡單的數學。這讓您可以進行大數據探索，我們可以做一些簡單的事情來幫助我們的客戶提高效率並揭示變化。

Over time, you can invest further in things like computer vision, which we have been doing and into predictive analytics, the idea that you can look at surgical data science, understand the variation of patient populations and what's happening in surgery and start to create tools, digital tools that can help improve outcomes or speed learning curves or lower operating costs and we're going to work on all of those things.

隨著時間的推移，您可以進一步投資於我們一直在做的計算機視覺和預測分析等方面，您可以研究手術數據科學，了解患者群體的變化以及手術中發生的情況，並開始創建工具，數字工具，可以幫助改善結果或加快學習曲線或降低運營成本，我們將致力於所有這些事情。

So of the things you mentioned, we have our toe in the water in many, and we've had for some time. As I said in the script, the feature content can be moved pretty quickly. I think the validations take real time to do well, particularly outcome-based or interventional validations. And so we're going to go through and do that with real rigor. So I expect us to continue down that pathway.

因此，對於你提到的事情，我們在很多方面都已經嘗試過，而且已經嘗試了一段時間了。正如我在腳本中所說，功能內容可以非常快速地移動。我認為驗證需要實時才能做好，特別是基於結果或乾預的驗證。因此，我們將非常嚴格地進行並做到這一點。所以我希望我們繼續沿著這條路走下去。

That's very helpful. And then on procedures, I'm just wondering, you talked about some catch-up in Q2. How are you thinking about how much of the backlog of deferred procedures is still left? You talked about the diagnostic procedures on the last call. And any color on what you're assuming for bariatrics here for the rest of the year? And does that mean international will continue to be stronger than the U.S.?

這非常有幫助。然後關於程序，我只是想知道，您談到了第二季度的一些追趕。您如何看待延期程序的積壓還剩下多少？您在上次通話中談到了診斷程序。您對今年剩餘時間的減肥治療有何看法？這是否意味著國際將繼續比美國更強大？

Let me talk a little bit about, I think, the patient population that moved to the sidelines during the pandemic, and then I'll turn the assessment over to Jamie. On the kind of the pandemic response, it's hard to exactly estimate how many folks would have been in diagnostic pipelines that did not get their tests. We do look at the data that's available to do that. I don't think it will clear in just one quarter. I think our past experience on these things is that lower utilization happened over a several year period, and it will probably take many quarters for it to fully recover. How long that is, I think it's very, very hard to estimate. So far, so good.

我想，讓我談談在大流行期間轉而觀望的患者群體，然後我將把評估交給傑米。關於大流行的應對措施，很難準確估計有多少人在診斷過程中沒有得到測試。我們確實會查看可用的數據。我認為這種情況不會在一個季度內就清楚。我認為我們過去在這些方面的經驗是，利用率較低是在幾年內發生的，並且可能需要很多季度才能完全恢復。那到底有多長，我認為這是非常非常難以估計的。到目前為止，一切都很好。

You asked a question about bariatrics, I'm going to turn that over to Jamie. He spoke about it a little bit in his prepared remarks.

你問了一個關於減肥的問題，我會把這個問題轉給傑米。他在準備好的發言中談到了這一點。

Yes. What we saw in Q2 was that growth rate slowed. We have some input from customers that the level of patient interest is such that patients are now considering drugs versus surgery. It's unclear yet based on that set of inputs from customers the duration of that evaluation by parents and patients and obviously, it's layered. So what we did for our guidance was we just said at the high end for the remainder of the year, the bariatrics growth rate in the U.S. is consistent with what we saw in Q2. And at the low end, we said that the growth rate continues to slow a little bit over the course of the year as patients become increasingly educated about the weight loss drugs. And obviously, there's a number of factors that patients have to consider with respect to those drugs, cost, side effects, what happens if they come off the drugs and regain weight, et cetera. But I think from our perspective, we're early in understanding what the longer-term impact will be.

是的。我們在第二季度看到的是增長率放緩。我們從客戶那裡得到了一些意見，表明患者的興趣程度使得患者現在正在考慮藥物還是手術。根據客戶的這組輸入，目前尚不清楚父母和患者評估的持續時間，顯然，它是分層的。因此，我們在指導中所做的只是在今年剩餘時間內的高端表示，美國的減肥增長率與我們在第二季度看到的一致。在低端，我們說，隨著患者對減肥藥物的了解越來越多，增長率在這一年中繼續略有放緩。顯然，患者必須考慮這些藥物的許多因素、成本、副作用、停藥後體重反彈會發生什麼等等。但我認為從我們的角度來看，我們很早就了解了長期影響將會是什麼。

Customers have said that they have confidence that there is a role for surgery in weight loss and that will endure over kind of the longer term. What happens in for the rest of the year, I think we'll see.

顧客表示，他們相信手術在減肥方面有一定作用，並且這種作用會長期持續。今年剩下的時間裡會發生什麼，我想我們拭目以待。

We'll go to the next question. Go to the line of Travis Steed, Bank of America.

我們將討論下一個問題。前往美國銀行 Travis Steed 的專線。

I did want to ask about China and the China quota and how you think the opportunity is now that there's more local players, but you also have the local version of Xi and on the bariatrics, just a quick follow-up on that, too. Is that around 100,000 procedures. Just trying to think about sizing that their active surgery opportunity or impact?

我確實想問有關中國和中國配額的問題，以及您認為現在有更多本地參與者的機會，但您也有本地版本的習近平和減肥藥，這也是對此的快速跟進。大約有100,000道程序。只是想考慮一下他們的主動手術機會或影響的大小？

We've set the market size in the U.S. is about 200,000 procedures annually for what we think is a good mesh for robotics. And in terms of where we are in penetration, we're kind of at the -- if I put it in quartiles, we're at the beginning of the second quartile. What was your first question, Travis?

我們將美國的市場規模設定為每年約 200,000 台手術，我們認為這是一個良好的機器人網絡。就我們的滲透率而言，我們處於——如果我把它放在四分位數中，我們就處於第二個四分位數的開頭。特拉維斯，你的第一個問題是什麼？

It was on China and the China quota and how to think about that opportunity there versus last quarter, given there's more local players, but now you have the local version of Xi.

這是關於中國和中國的配額，以及如何考慮與上季度相比的機會，因為有更多的本地參與者，但現在你有了本地版本的習近平。

Yes. I mean, obviously, there's increased opportunity in the sense that this quota is 559 systems relative to the prior quota of 225 systems, but you also have now 5 local players. There will be government interest in success of local players. We do believe the surgeons care about capability and feature set and so the extent to which da Vinci continues to be differentiated, I think, is to our advantage.

是的。我的意思是，顯然，相對於之前 225 個系統的配額，這個配額為 559 個系統，機會有所增加，但現在也有 5 個本地玩家。政府會對本地企業的成功感興趣。我們確實相信外科醫生關心能力和功能集，因此我認為達芬奇繼續保持差異化的程度對我們有利。

In the -- and we are seeing those local players increasingly participate in tenders with respect to how that quota will be allocated. So it gets allocated from the central government to the provinces and then it goes through tender processes. So there is some time before that results in placements and that's why we said in our prepared remarks, we think the bulk of the subset of that quota, our JV wins will be in '24 through '27.

在 - 我們看到這些本地參與者越來越多地參與有關如何分配配額的招標。所以它是從中央政府分配到各省，然後通過招標程序。因此，在產生安置之前還有一段時間，這就是為什麼我們在準備好的發言中說，我們認為該配額的大部分子集，我們的合資企業獲勝將在 24 年到 27 年期間。

I also described some dynamics that create greater variability with respect to pricing pressure and increasing competition. So I think for us, that's something that we're going to watch carefully over the next year or so.

我還描述了一些在定價壓力和日益激烈的競爭方面造成更大變化的動態。所以我認為對我們來說，這是我們將在未來一年左右仔細觀察的事情。

Great. And a question for Gary. Just I heard the comment on hospitals leasing more to preserve the upgrade option for the next-gen system. So maybe just talk high level, the pipeline comments on the FDA and kind of supply chain bottlenecks that you saw last year? And then and how you're thinking about incremental upgrade to the Gen 4 versus kind of new platforms?

偉大的。還有一個問題要問加里。我剛剛聽到有關醫院租賃更多資金以保留下一代系統升級選項的評論。那麼，也許只是談談高層，對 FDA 的管道評論以及您去年看到的供應鏈瓶頸？然後，您如何考慮增量升級到第 4 代而不是新平台？

Sure. On the supply chain health side, we are seeing fewer pockets of challenge, but some pockets nonetheless. So there's been significant focus and attention to make sure that we're supplying our customers what they need as we go through a pretty nice procedure growth curve. So they're calling out improvement in the breadth of supply chain challenge, but cautioning that there are still some pockets that need attention or require attention.

當然。在供應鏈健康方面，我們看到的挑戰較少，但仍然存在一些挑戰。因此，在我們經歷相當不錯的流程增長曲線時，我們非常重視並確保我們能夠為客戶提供他們所需要的東西。因此，他們呼籲改善供應鏈挑戰的廣度，但警告稱仍有一些領域需要關注或需要關注。

We continue to work on multiple things. As you know, we're working on next generations of our platforms, in general, that is a routine activity for us. How we make the decision between upgrading a current generation versus moving it to the next generation really is around customer value of that switch and the convenience and economics of doing an upgrade versus a platform changeover. And we expect to do some of both. We are usually working on the next two generations because of the time it takes to develop a platform, not just the next one, but the next one after that. And current time is really no different.

我們繼續致力於多項工作。如您所知，我們正在開發下一代平台，總的來說，這對我們來說是一項例行活動。我們如何在升級當前一代還是將其轉移到下一代之間做出決定，實際上取決於該轉換的客戶價值以及升級與平台轉換的便利性和經濟性。我們希望兩者兼而有之。我們通常會致力於接下來的兩代產品，因為開發一個平台需要時間，不僅是下一個平台，而且是之後的下一個平台。現在的時間也確實沒有什麼不同。

We're pleased with the performance of our engineering teams and prosecuting those upgrades and technologies. What I will say is prioritization wise, what we care about is can we improve patient outcomes in a real way or open a new population of patients to the benefits of (inaudible) surgery. So we look at that. We look to improve the surgeon and care team experience, whether that's in their ergonomics or their workflow and the like with which they perceive our systems. We work to improve efficiencies of overall programs. We'll work on things that make hospital programs more efficient and we work to lower the total cost to treat per patient episode.

我們對工程團隊的表現以及執行這些升級和技術感到滿意。我要說的是，優先順序是明智的，我們關心的是我們能否真正改善患者的治療效果，或者讓新的患者群體受益於（聽不清）手術的好處。所以我們看看這個。我們希望改善外科醫生和護理團隊的體驗，無論是在他們的人體工程學還是工作流程等方面，以及他們對我們系統的感知。我們致力於提高整體計劃的效率。我們將致力於提高醫院項目的效率，並努力降低每位患者的治療總成本。

And when we find feature sets and technologies that do that, then we get pretty excited about them and drive them hard.

當我們找到可以做到這一點的功能集和技術時，我們會對它們感到非常興奮並努力推動它們。

Our next question is from the line of Robbie Marcus, JPMorgan.

我們的下一個問題來自摩根大通的羅比·馬庫斯。

Congrats on a really nice quarter. I heard the comment on prototype expenses are increasing. So I figure I'll try my luck here, and I know you're not going to tell us when a next-gen or if the next-gen system is coming. But I want to ask around just implications if and when one does, you have a lot of leases now. Do they have the option to upgrade? And will that come through at higher revenues? And how do we think about the prototyping expense and really what that's for?

恭喜您度過了一個非常美好的季度。我聽說有關原型費用的評論正在增加。所以我想我會在這裡碰碰運氣，我知道你不會告訴我們下一代何時出現或下一代系統是否即將到來。但我想問一下，如果有人這樣做，你現在有很多租約，這會產生什麼影響。他們可以選擇升級嗎？這會帶來更高的收入嗎？我們如何看待原型製作費用以及它的真正用途是什麼？

Yes, I'm not going to be specific on the prototype expense and it's distributed across a number of programs. Prototype expenses tend to be lumpy within Q2 relative to the comparison point. It just so happened to be a quarter where that was one of the direct drivers of our expenditure. Nothing more than that, I would say.

是的，我不會具體說明原型費用，它分佈在多個項目中。與比較點相比，第二季度的原型費用往往比較不穩定。恰好在這個季度，這是我們支出的直接驅動因素之一。我想說，僅此而已。

As we've grown the proportion of the installed basis under leases, I think it's about 2,000 systems now that are under lease in the installed base. Generally, they have a technology obsolescence clause. That's kind of in part a reflection of customer feedback from when we launched Xi. So that's routinely in our operating lease arrangements and that cause generally gives customers the opportunity to change that existing lease to the lease of any new next-generation technology. And that is not a specified price, by the way, that's to be negotiated. So I wouldn't say anything more about price.

隨著我們增加了租賃安裝基礎的比例，我認為現在安裝基礎中約有 2,000 個系統處於租賃狀態。一般來說，他們有技術過時條款。這在一定程度上反映了我們推出 Xi 時的客戶反饋。因此，這在我們的經營租賃安排中很常見，這通常會讓客戶有機會將現有租賃更改為任何新的下一代技術的租賃。順便說一句，這並不是一個具體的價格，而是需要協商的。所以我不會再多說什麼關於價格的事情。

Great. And maybe, Jamie, one more for you on the financial side. Another nice quarter of cash flow generation, north of $7 billion on the balance sheet. Interest rates, high inflation, high as well. How are you thinking about maximizing the cash here? And how should we think about the priorities?

偉大的。傑米，也許在財務方面還可以為您提供一份。又一個現金流產生良好的季度，資產負債表上超過 70 億美元。利率高，通貨膨脹也高。您如何考慮最大化這裡的現金？我們應該如何考慮優先事項？

With respect to capital allocation, I think our priorities are consistent for how they've been for some time now. Our first priority is to invest in the business, both in capital expenditures, which as you've seen by our guidance are relatively high to our history this year and in organically investing in operating expenses.

關於資本配置，我認為我們的優先事項與一段時間以來的情況是一致的。我們的首要任務是投資於業務，包括資本支出（正如您從我們的指導中看到的那樣，這對於我們今年的歷史而言相對較高）以及有機投資於運營支出。

Second is to acquire technology externally that gives us a differentiated capability or accelerate us in the marketplace. That's generally license arrangements, IP acquisition or tuck-in acquisitions. And we continue to look at returning cash to shareholders opportunistically. And I think that's served us well. If you look at kind of the last 18 months, we repurchased 12.6 million shares for $3 billion at an average price of $234 and we did that opportunistically in large part because it reflects kind of the stage of the company. We're relatively early in the robotics space where we look for growth, and I think that's served us well.

其次是從外部獲取技術，以賦予我們差異化的能力或加速我們進入市場。這通常是許可安排、知識產權收購或隱藏收購。我們繼續考慮機會性地向股東返還現金。我認為這對我們很有幫助。如果你看看過去 18 個月的情況，我們以 234 美元的平均價格以 30 億美元的價格回購了 1260 萬股股票，我們這樣做在很大程度上是機會主義的，因為它反映了公司的階段。我們在機器人領域相對較早，我們尋求增長，我認為這對我們很有幫助。

Our next question is from the line of Rick Wise, Stifel.

我們的下一個問題來自 Rick Wise，Stifel。

Gary, I recently visited several European hospitals and robotic programs. And frankly, and honestly came way more impressed than ever with Intuitive's European commercial presence reputation. But I was particularly intrigued to hear one particularly high-volume robotic surgeon talk about what's next. And it seemed less focused on systems and very much focused on enabling technologies that make everything better, faster, clearer, et cetera. And they included things like integrated CT image overlays during procedures. That aspect of augmented reality tools that bring CT and surgery together, next generation firefly. He was dreaming of virtual [rulers], dual [SureForm] 45 and 60 staplers and haptic feedback. I mean that was -- it was fascinating to hear. Are these the kinds of innovations that are priorities for you? And are these the kind of things you want to make docs like that excited about? Is that what you're -- the kind of stuff you're working on?

加里，我最近參觀了幾家歐洲醫院和機器人項目。坦率地說，老實說，Intuitive 在歐洲的商業形象聲譽比以往任何時候都更加令人印象深刻。但我特別感興趣的是聽到一位產量特別高的機器人外科醫生談論接下來會發生什麼。它似乎不太關注系統，而是非常關注使一切變得更好、更快、更清晰等的支持技術。它們還包括在手術過程中集成 CT 圖像疊加等內容。增強現實工具將 CT 和手術結合在一起，即下一代螢火蟲。他夢想著虛擬 [標尺]、雙 [SureForm] 45 和 60 訂書機以及觸覺反饋。我的意思是——這聽起來很有趣。這些是您優先考慮的創新嗎？這些是你想讓文檔感到興奮的事情嗎？這就是你所從事的工作嗎？

You had a long list. I think several of those are important and things that we have talked about and have shared with the world. I think the idea of higher confidence ability to identify tissue in real time for the surgeon, and we can do that in a few different ways. So the florescence imaging, that you described and other advanced imaging technologies that give surgeons the ability to see beyond the surface of the tissue and beyond what you can see with normal white-light imaging, we absolutely think that's helping clinical outcomes and we're excited about and investing in image fusion or data fusion, and that's the CT overlay, the segmentation of preoperative MR and CT scans and the ability to use that in real time during the case, we think, can change outcomes and change efficiency in the OR.

你有一個很長的清單。我認為其中有一些很重要，我們已經討論過並與世界分享了這些事情。我認為外科醫生實時識別組織的可信度更高，我們可以通過幾種不同的方式來做到這一點。因此，您所描述的熒光成像和其他先進成像技術使外科醫生能夠看到組織表面之外的情況，超出了正常白光成像所能看到的範圍，我們絕對認為這有助於臨床結果，我們對圖像融合或數據融合感到興奮並進行投資，這就是 CT 疊加、術前 MR 和 CT 掃描的分割以及在病例中實時使用它的能力，我們認為，可以改變手術室的結果和效率。

Other types of analytic and sensing capabilities, we think are really powerful and important. And to the earlier question about AI, machine learning, machine vision, these things work together. So high-definition images that show you things beyond the surface of the tissue plus computer vision, plus AI models can give you some predictive analytics that I think are really powerful and would help surgeons get to better outcomes, reduce complications. So I am like that surgeon, quite excited.

我們認為其他類型的分析和傳感能力確實強大且重要。對於之前關於人工智能、機器學習、機器視覺的問題，這些東西是協同工作的。因此，高清圖像可以向您展示組織表面之外的事物，加上計算機視覺和人工智能模型，可以為您提供一些我認為非常強大的預測分析，並將幫助外科醫生獲得更好的結果，減少並發症。所以我就像那位外科醫生一樣，非常興奮。

Great. Just a follow-up, quick follow-up. You -- I think, if I remember correctly, took a 5% across-the-board price hike on instrumentation. I don't know if I'm remembering correctly, that was to kick in like June 1. Did that happen? Did it help the quarter? And should I assume that it's going to be a little bit of an offset or a little bit of an instrument tailwind in the second half and beyond?

偉大的。只是跟進，快速跟進。如果我沒記錯的話，我想你們將儀器儀表價格全面上漲了 5%。我不知道我是否記錯了，那是從 6 月 1 日開始的。有發生過嗎？這對本季度有幫助嗎？我是否應該假設下半年及以後會出現一點偏移或儀器順風？

It was largely implemented in Q2, Rick. It wasn't effective at the beginning of the quarter, I'd say, roughly half of the quarter benefited from the price increase. Our estimate for the impact of the price increase is consistent with what we said last quarter, roughly about $100 million impact to revenue and profit for the year. Again, you get kind of half an impact in Q2 and the full impact in Q3 and Q4.

它主要是在第二季度實施的，Rick。我想說，它在季度初並沒有效果，大約一半的季度受益於價格上漲。我們對價格上漲影響的估計與我們上季度所說的一致，對全年收入和利潤的影響大約為 1 億美元左右。同樣，您會在第二季度受到一半影響，在第三季度和第四季度受到全部影響。

A reminder, our motivations on that, we've been quite conservative on pricing. Our input pricing in the last few years has gone up in terms of raw material and labor content. We have offset most of that through efficiency and scale advantages, but we felt like it was time to share some of that with our customers, and that was what was behind the price increase.

提醒一下，我們的動機是，我們在定價方面一直相當保守。過去幾年我們的投入價格在原材料和勞動力含量方面有所上升。我們通過效率和規模優勢抵消了大部分損失，但我們覺得是時候與客戶分享其中一些了，而這就是價格上漲背後的原因。

We go to the next line. I have Richard of Truist Security.

我們轉到下一行。我有 Truist Security 的理查德。

Richard Newitter here. Jamie, maybe for you on the guidance, 20% to 22%, very healthy. I'm just curious on thinking about the low end of the range there. You specifically mentioned you contemplate bariatric surgery growth trends, eroding a little bit from the 2Q levels. What's the pace of erosion there that you're thinking about that would get you to the low end? Like how much erosion, how did you establish a baseline for yourself?

理查德·紐特在這裡。 Jamie，也許給你指導，20%到22%，非常健康。我只是好奇地思考一下該範圍的低端。您特別提到您考慮減肥手術的增長趨勢，較第二季度的水平略有下降。您認為侵蝕的速度是多少，會使您達到低端？比如侵蝕程度，你是如何為自己建立基線的？

Yes, I don't want to get too specific there, Rick, given just the relative size of bariatrics in the U.S. to our overall procedures. We can obviously see the progression between Q1 and Q2, I'd call it a moderate, steady progression in the model in Q3 and Q4. The overall impact on that is obviously a function of the size of the bariatrics business for us. It's not some dramatic falloff.

是的，我不想說得太具體，瑞克，考慮到美國減肥治療與我們整體程序的相對規模。我們可以明顯地看到 Q1 和 Q2 之間的進展，我將其稱為 Q3 和 Q4 模型中適度、穩定的進展。對此的總體影響顯然取決於我們減肥業務的規模。這不是什麼戲劇性的衰退。

Okay. That's helpful. And just maybe sticking on the same topic here on bariatrics. Just thinking about the areas that you could offset that as we think of procedure categories geographically or by category that could be nearing an inflection point like Bariatric got to several years ago, what procedure categories or geographies would you call out that you think could lead to overage there to offset any potential incremental slowdown in bariatrics, if any?

好的。這很有幫助。也許只是在減肥方面堅持相同的主題。只要考慮一下您可以抵消的領域，當我們從地理角度或按可能接近幾年前減肥治療這樣的拐點的類別來考慮手術類別時，您會指出哪些手術類別或地理位置可能會導致那裡的超額，以抵消減肥治療中任何潛在的增量放緩（如果有的話）？

I'm not going to answer that in terms of overage, but I'll say where we're seeing healthy growth. If you take our largest 7 markets, which is a focus for us, so China, Japan, South Korea, Germany, France, U.K. and Italy, what you're seeing in those markets is generally a progression beyond urology into the next set of cancer procedures. It's market by market. But generally, that's hysterectomy, thoracic and colorectal procedures. And we're seeing them on the early stages of an adoption curve, and that's why we've talked about our OUS business now is about half outside of urology or beyond urology. This quarter, it grew 35% that subset. That's consistent with what we saw in Q1. That subset also grew 35%. So I think we're excited in those larger markets where we have that focus and continue to drive the adoption curve in that next set of procedures.

我不會用超齡來回答這個問題，但我會說我們在哪些方面看到了健康增長。如果你看一下我們最大的七個市場，這是我們關注的焦點，即中國、日本、韓國、德國、法國、英國和意大利，你在這些市場中看到的通常是從泌尿外科到下一組癌症手術的進展。這是逐個市場的。但一般來說，是子宮切除術、胸部和結直腸手術。我們看到它們處於採用曲線的早期階段，這就是為什麼我們現在談論我們的 OUS 業務大約一半在泌尿外科之外或超越泌尿外科。本季度，該子集增長了 35%。這與我們在第一季度看到的情況一致。該子集也增長了 35%。因此，我認為我們對那些更大的市場感到興奮，我們專注於這些市場，並繼續推動下一組程序的採用曲線。

If you look at market by market, you have some unique dynamics in China. You see liver and pancreas procedure doing well in Japan, treatment of stomach cancer in Korea, for example, you see thyroid. But it's really that next step procedures.

如果逐個市場觀察，你會發現中國有一些獨特的動態。你會看到日本的肝臟和胰腺手術進展順利，韓國的胃癌治療效果很好，例如，你會看到甲狀腺。但這確實是下一步的程序。

Just I want to just step back a little bit on bariatrics, we've had a few questions on it and just make a point. As we go out and talk to surgeons, we talk to obesity physicians and pharmacologists, which we do in terms of our diligence. The sense here is that the market is going to adjust to the change in treatment pathway as it relates to drugs. However, it doesn't look like the drugs are a cure and may not be a fast path to cure and a strong consensus among those we speak to, including people who are not surgeons, physicians who are not surgeons is that the surgery and other interventions are going to remain an important part of the interaction.

只是我想稍微退一步討論減肥問題，我們對此提出了一些問題，只是提出一個觀點。當我們出去與外科醫生交談時，我們與肥胖醫生和藥理學家交談，我們是根據我們的勤奮程度來做到這一點的。這裡的意思是，市場將適應與藥物相關的治療途徑的變化。然而，藥物看起來並不是一種治愈方法，也可能不是治癒的快速途徑，我們採訪過的人（包括非外科醫生、非外科醫生的醫生）一致認為，手術和其他干預措施仍將是相互作用的重要組成部分。

As the -- in the near term, I think the market will adjust to understand what role the drugs will play but they're not cures and the discontinued rate remains pretty high, and the populations of patients who don't get any benefit from the drugs also remain significant. So I think there's an adjustment period here and we should be aware of it. But that may become a tailwind in future quarters as folks work through those sets of pathways and look at long-term and durable solutions into the obesity challenges.

在短期內，我認為市場將進行調整，以了解這些藥物將發揮什麼作用，但它們並不能治癒疾病，而且停藥率仍然很高，而且沒有從這些藥物中獲益的患者群體也仍然很大。所以我認為這裡有一個調整期，我們應該意識到這一點。但這可能會成為未來幾個季度的順風車，因為人們將通過這些途徑努力並尋找長期且持久的解決方案來應對肥胖挑戰。

We'll go to the next line of Ryan Zimmerman, BTIG.

我們將轉到 Ryan Zimmerman 的下一句，BTIG。

Maybe one for Jamie. On the expense management standpoint, I mean, procedures are going up a little bit faster than expense -- OpEx guidance by about 50 basis points or so in and so I'm just wondering, Jamie, kind of what your views are on expense management and letting some of that leverage flow through as we think about not just the back half of the year, but into '24 versus maybe reinvesting that in R&D?

也許是給傑米的。從費用管理的角度來看，我的意思是，程序的增長速度比費用快一點——運營支出指導大約增加了 50 個基點左右，所以我只是想知道，Jamie，您對費用管理有何看法，並讓一些槓桿流動，因為我們不僅考慮今年下半年，而且考慮到 24 年，而不是將其再投資於研發？

Yes. For this year, we have specific objectives with respect to leverage in our enabling functions, which we've described previously. And that's a set of objectives that I think we intend to fulfill.

是的。今年，我們在利用我們的支持職能方面製定了具體目標，我們之前已對此進行了描述。我認為這是我們打算實現的一系列目標。

Largely, what you see in the adjustments we've made to our operating expense guidance for this year is a function of our top line performance, both in variable compensation and in the number of reps we need in the field to support a higher procedure base. For the rest of kind of operating expense set of investments, we're holding to -- we're largely holding to our plan for this year.

很大程度上，您在我們對今年運營費用指南所做的調整中看到的是我們的頂線績效的函數，無論是可變薪酬還是我們在現場支持更高程序基礎所需的代表數量。對於其餘的運營費用投資組合，我們基本上堅持今年的計劃。

When you project into '24, I'm not going to kind of describe the direction of where spend will go relative to procedural revenue, we'll do that in January. But you have a couple of dynamics. We have a significant CapEx investments this year, $800 million to $1 billion, that will start to create incremental depreciation expense next year. A chunk of that will be in COGS and a chunk of that will be in operating expenses. So you have kind of an operating expense headwind coming there. And those investments being largely facilities, they are planned for the medium term, meaning they're inefficient for a period until you get to full occupancy or full utilization.

當你預測到 24 年時，我不會描述相對於程序收入的支出方向，我們將在 1 月份這樣做。但你有一些動力。我們今年有大量資本支出投資，達 8 億至 10 億美元，這將在明年開始產生增量折舊費用。其中一部分將用於銷貨成本，另一部分將用於運營費用。所以你會遇到運營費用方面的阻力。這些投資主要是設施，它們是中期規劃的，這意味著它們在一段時間內效率低下，直到完全入住或充分利用。

On the other side, we'll continue to look to leverage our enabling functions into '24, where that shakes out, we'll do in January because we have to complete our planning process in the back half of this year.

另一方面，我們將繼續尋求在 24 世紀充分利用我們的支持功能，我們將在一月份完成這一工作，因為我們必須在今年下半年完成我們的規劃流程。

Okay. That's very helpful. And then I noticed, and this is kind of directed at Gary, you commented on this a little earlier, but you disclosed for the first time, I believe the proportion of lease agreements that are usage-based versus fixed operating lease agreement. And I'm wondering, Gary, what that says and the trends that we see there about the health of our customers and what their preference is over time?

好的。這非常有幫助。然後我注意到，這是針對加里的，您早些時候對此發表了評論，但您第一次披露，我相信基於使用的租賃協議與固定經營租賃協議的比例。加里，我想知道這說明了什麼以及我們在客戶健康方面看到的趨勢以及隨著時間的推移他們的偏好是什麼？

Yes, it's a good question. I think we see that one size doesn't fit all. There are some folks for whom they still remain happy about capital purchases. They see it as the cheapest way for them to access systems. They have high confidence and they're going to buy. There are some folks for whom capital is tight, scarce and or they're interested in future technology protection clauses, and they would rather lease. And there are some folks who are looking at expansions, are a little bit unsure about how fast volume might ramp and for them, usage-based arrangements give them some protections about ramp timing and speed.

是的，這是一個好問題。我認為我們看到一種方法並不適合所有情況。有些人仍然對資本購買感到高興。他們認為這是訪問系統最便宜的方式。他們信心十足，願意購買。對於一些人來說，資金緊張、稀缺，或者他們對未來的技術保護條款感興趣，他們寧願租賃。有些人正在考慮擴展，但有點不確定容量的增長速度，對他們來說，基於使用的安排為他們提供了有關增長時間和速度的一些保護。

Our analytical capabilities are pretty good, and our finance flexibility is pretty good. And as a result, we'll have that conversation pretty direct way, and I think the market starts to settle where it settles. If you ask, do we have a strong preference for one of those models, the answer is not really.

我們的分析能力非常好，我們的財務靈活性也非常好。因此，我們將以非常直接的方式進行對話，我認為市場開始穩定下來。如果你問，我們是否對其中一種模型有強烈的偏好，答案是否定的。

The motivation by the way, for the new disclosure was simply the rate at which those adoption of those models have grown, we felt, okay it was important to be transparent as to what portion of operating leases and placements that structure was. If you kind of assess all of our usage-based arrangements in aggregate life today relative to usage patterns and economic objectives in total, on average, they're slightly above our expectations. So they performed well so far. That's obviously a blend across different customers and systems. Some are overperforming, some are underperforming. But I think part of the way that we've operated the program is to look carefully. Is it actually reducing barriers for accelerated growth of our customers? And is it producing the economic results for us and our customers and as we and customers have gained confidence, that's part of the reason why it's expanded the way it has.

順便說一句，新披露的動機只是這些模型的採用率的增長，我們認為，好吧，重要的是要透明地了解該結構佔經營租賃和配售的比例。如果您相對於總體使用模式和經濟目標來評估我們今天在總生活中所有基於使用的安排，平均而言，它們略高於我們的預期。所以到目前為止他們表現得很好。這顯然是不同客戶和系統的融合。有些表現出色，有些則表現不佳。但我認為我們運作該計劃的部分方式是仔細觀察。它真的減少了客戶加速增長的障礙嗎？它是否為我們和我們的客戶帶來了經濟成果？隨著我們和客戶獲得了信心，這就是它如此擴張的部分原因。

And we'll go to the next line. Go to the line of Andrew Ranieri, Morgan Stanley.

我們將轉到下一行。請轉到摩根士丹利的安德魯·拉涅利 (Andrew Ranieri) 的路線。

Maybe just one other follow-up question on bariatrics, but maybe a different angle. I mean, we've talked to some general surgeons too, that mean they're kind of suggesting that these new drugs might even open up potential procedure categories where these patients might not have been suited to have surgery. Gary, kind of like what are your views on this? Do you see some near-term disruption from GLP-1s on the bariatric side but maybe this opening doors for other procedure categories?

也許只是關於減肥的另一個後續問題，但也許是一個不同的角度。我的意思是，我們也與一些普通外科醫生進行了交談，這意味著他們暗示這些新藥甚至可能開闢潛在的手術類別，這些患者可能不適合進行手術。加里，你對此有何看法？您是否認為 GLP-1 在減肥方面近期會帶來一些干擾，但這可能為其他手術類別打開大門？

Yes. That's a little bit of the narrative we're hearing too. We go out and canvas our customers pretty widely. There may be a role for kind of new adjuvant use of drugs and then as you say, that may condition some patient populations to be beneficiaries of surgery downstream. There may be folks who start the drugs, get the benefits that they were hoping for, but either the side effects or the cost or the change lifestyle that the drugs are implying, make it hard to sustain. There's a fair amount of that in the literature. So that may -- that population may look for other solutions.

是的。這也是我們聽到的一些敘述。我們出去廣泛地考察我們的客戶。某種新的輔助藥物使用可能會發揮作用，然後正如您所說，這可能會使某些患者群體成為下游手術的受益者。可能有人開始服用藥物，獲得了他們所希望的好處，但藥物所暗示的副作用、成本或生活方式的改變，使其難以維持。文獻中有相當多的內容。因此，人們可能會尋找其他解決方案。

I think we're just going to have to work through it and see. What we don't see yet is a magic pill, one that cures it and doesn't require behavior change or other lifestyle modification and that -- and it seems unlikely. And as a result, I think we're going to see an adjustment, how long that adjustment period lasts, none of us know. But we know that there will be a role for surgical and mechanical intervention after the fact. And I think we're well positioned. And as Jamie had mentioned, it looks like even in the current environment, the share continues to move our way. So we're going to stay close to it.

我認為我們必須先解決這個問題然後再看看。我們還沒有看到一種神奇的藥丸，一種可以治愈它並且不需要改變行為或其他生活方式改變的藥物——而且這似乎不太可能。因此，我認為我們將會看到調整，調整期會持續多久，我們誰也不知道。但我們知道事後手術和機械干預將會發揮作用。我認為我們處於有利位置。正如傑米（Jamie）所提到的，即使在當前環境下，該份額仍繼續朝著我們的方向發展。所以我們將繼續靠近它。

Is there any procedure categories that are coming up in your conversations that stand the most benefit?

您的談話中是否出現了最有利的程序類別？

It's a good question. We're probing probably too soon for us to give you a definitive answer.

這是一個好問題。我們的調查可能還為時過早，無法給您明確的答案。

Right. That was our last question, and thank you. 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 to treat.

正確的。這是我們最後一個問題，謝謝。最後，我們仍然相信存在大量且持久的機會從根本上改善手術和緊急干預措施。我們的團隊繼續與醫院、醫生和護理團隊密切合作，以實現客戶所說的四重目標。更好、更可預測的患者治療結果、更好的患者體驗、更好的護理團隊體驗，並最終降低總治療成本。

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's less invasive and profoundly better where diseases 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中的價值創造本質上是人的。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，我們設想了一個侵入性更小、效果更好的未來護理，可以更早地發現疾病并快速治療，以便患者能夠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 3 個月後再次與您交談。

Thank you. Ladies and gentlemen, that does conclude your conference. We do thank you for joining. You may now disconnect. Have a good day.

謝謝。女士們、先生們，你們的會議到此結束。我們非常感謝您的加入。您現在可以斷開連接。祝你有美好的一天。