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，感謝您的耐心等待，歡迎參加 Intuitive 2023 年第二季財報發表會。 （操作說明）提醒各位，本次電話會議正在錄音。現在我將把電話交給主持人，投資者關係主管 Brian King 先生。請您發言。

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第二季財報電話會議。今天與我一起出席的有我們的執行長Gary Guthart和財務長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.

在會議開始之前，我想告知各位，今天電話會議中提及的評論可能包含前瞻性陳述。由於某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定性已在提交給美國證券交易委員會（SEC）的文件中詳細描述，包括我們於2023年2月10日提交的最新10-K表格和於2023年4月20日提交的10-Q表格。您可以透過我們的網站或SEC網站查閱我們的SEC文件。投資者請勿過度依賴此類前瞻性陳述。

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

請注意，本次電話會議的音訊回放可在我們網站intuitive.com的「投資者關係」頁面下的「活動」欄位中找到。今天的新聞稿和補充財務數據表已發佈在我們的網站上。

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

今天的會議形式如下：首先，我們將重點介紹今天早些時候發布的新聞稿中概述的第二季度業績；隨後進行問答環節。 Gary 將介紹本季的業務和營運亮點；Jamie 將回顧我們的財務表現；之後，我將討論流程和臨床方面的亮點，並提供我們最新的 2023 年財務展望。最後，我們將進行問答環節。接下來，我將把發言權交給 Gary。

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.

感謝您今天蒞臨本次活動。第二季度，我們業務的基本面表現良好，流程和利用率均實現強勁成長，資本投入也十分充足。隨著客戶日常使用對我們產品的依賴日益加深，我們的產品營運團隊在瞬息萬變的供應鏈環境中持續提升產能並保證交付。

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.

本季度，我們的研發工作持續取得進展，包括我們的 Intuitive 生態系統取得了積極的發展里程碑，涵蓋系統、儀器、配件、數位工具和新適應症。

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.

首先來看手術量，本季成長了22%。成長強勁的領域包括一般外科和婦科良性疾病治療，尤其是在美國。一般外科手術量的成長主要由膽囊切除術和疝氣修補術所推動。大腸直腸手術量的增長也較為穩健。本季全球手術量成長同樣強勁，這主要得益於中國市場的復甦以及日本、德國和英國市場的持續成長。

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.

離子治療手術持續強勁成長，2023 年第二季成長 145%。 SP 手術成長顯著，該季度全球成長 40%，主要得益於美國市場成長加速。

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.

在資本投入方面，我們第二季新增了331套系統，而去年同期為279套。目前，我們的臨床裝置量包括7,900套多端口達文西手術系統、435套Ion手術系統和142套單端口達文西手術系統。總體而言，我們的資本投入趨勢反映了市場對多端口手術系統新增產能的需求、對Ion手術系統的強勁需求以及隨著我們不斷拓展單端口手術適應症，市場對單端口手術系統的穩定需求。

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（定義為每季度每台已安裝臨床系統的手術量）在全球範圍內同比增長 9%，創下新高，這得益於客戶在我們系統上開展了多種多樣的手術。我們相信，從改善患者預後、提高外科醫生滿意度到降低每次治療的總成本，四重目標均得到提升，這些實際應用證據支撐了系統利用率的增長。

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.

接下來談談我們的財務狀況。本季我們的營收成長了15%。我們的資本支出和營運支出均在預期範圍內，這反映了我們持續加大研發投入，以支援平台和數位化工具的成長、擴大生產和商業佈局以及資本攤銷。我們將繼續投資於研發、生產和商業運營，以工業規模服務我們的全球市場。未來幾年，隨著重大營運擴張和其他項目的完成，這些投資可能會出現波動。

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.

退一步講，我們發現四重目標才是我們正確的方向，它著重於在特定手術和患者群體中取得可證明的療效改善，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.

隨著電子病歷的普及，我們與客戶攜手分析這些數據，建構基於真實世界證據和大數據方法的體系，以衡量各國、各地區和各醫療系統在四重目標上的改進。結合我們在培訓服務和產品方面的生態系統投資，以及能夠從手術數據中產生可操作情報的數位化工具，我們可以幫助客戶分析其項目，推薦並支持旨在提升績效和降低總成本的行動。這個整合式業務系統透過提供可操作且可衡量的步驟，協助客戶實現建立強大的管理資訊系統 (MIS) 專案的目標。

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

我們的方法也具有可擴展性，適用於我們的達文西平台和 Ion 平台，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.

接下來談談我們的生態系投資。我們在拓展產品和服務至新的臨床領域和地區方面取得了穩步進展。就達文西多端口手術系統而言，我們近期已獲得中國國家藥品監督管理局（NMPA）批准，可在國內生產達文西Xi手術系統。這意味著我們的達文西Xi手術系統將能夠參與近期更新的國家配額中本地採購部分的招標。

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.

我們的達文西SP團隊近期取得了多項里程碑式的成就。我們完成了結直腸和胸腔IDE試驗的患者招募工作，繼續推進SP在日本的第一階段上市，並已向歐洲提交了SP的CE認證申請文件。

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.

接下來我們來看看Ion系統。我們的團隊在英國安裝了首套Ion系統，並啟動了首批手術。在數位化工具方面，我們已啟動CASE Insights的第一階段發布，CASE Insights是我們計算觀察工具的名稱。 CASE Insights是一款能夠與達文西手術系統和醫院數據協同工作的工具，它建立人工智慧模型，用於發現手術技巧、患者群體和手術結果之間的關聯。我們第一階段的發佈建立在過去幾年與臨床研究合作夥伴共同努力的基礎上，旨在完善客觀的績效指標，並將其與可操作的改進措施聯繫起來，從而改善手術結果、縮短培訓時間並提高手術項目的效率。

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，這些計算工具能夠利用真實世界的即時數據，顯著提陞技能和成果，並為未來的產品和自動化發展提供資訊。儘管如此，功能開發雖然快捷，但長期驗證卻十分艱辛。我們是一家以科學為導向的機構，將透過驗證路徑，力求長期成功。我們預計，未來幾季內，CASE Insights 不會帶來實質的收入。

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，我們的核心業務發展勢頭良好。我們看到，利用由分析驅動的整合生態系統，在長期內實現四重目標方面存在著巨大的機遇，我們正在調整投資節奏，以加速這一機會的實現。現在，我將時間交給傑米，他將更詳細地為大家介紹我們的財務狀況。

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.

午安.我會先介紹我們依照非GAAP準則或備考財務報表編製的績效重點。稍後，我也會在我的發言稿中概述我們按GAAP準則編制的業績。我們網站上已公佈備考財務報表與GAAP財務報表的調節表。

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.

第二季度全球手術量成長 22%，其中美國手術量成長 19%，美國以外地區手術量成長 28%。第二季度手術量受益於患者入院人數的增加，因為醫院（尤其是美國的醫院）正在努力收治那些在疫情期間診斷和/或治療延誤的患者。

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.

與上季所述一致，新加入達文西手術平台的醫師為手術量成長做出了顯著貢獻，這不僅體現了我們強大的培訓能力，也反映了越來越多接受達文西培訓的住院醫師和專科醫師畢業生。在我們重點關注的手術領域之一——減肥手術中，本季美國市場的成長速度有所放緩。一些客戶表示，他們發現患者對減重藥物的興趣增加。目前尚無法斷定成長放緩是患者評估這些新藥療法期間的暫時性停滯，還是會持續的趨勢。

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，本季達文西手術系統在減重手術市場持續擴大市場佔有率。美國手術量成長28%，主要得益於中國、英國、德國和日本市場的強勁成長。中國市場的強勁成長主要得益於近期新冠疫情影響的持續復甦，以及與去年第二季（同樣受到疫情影響）相比的良好基數效應。

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.

與上個季度的評論一致，美國以外地區的非神經外科手術增長呈上升趨勢，增長約 35%，這主要得益於結直腸手術、子宮切除術和胸腔外科手術的增長。

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.

接下來看其他關鍵指標。第二季度，達文西手術系統的裝置量增加了13%，略高於8,000台，這主要是由於手術量成長導致對額外容量的需求增加。平均係統利用率年增近9%，反映出美國短時良性手術的比例不斷上升，以及客戶在面臨財務壓力的情況下優先使用現有設備。

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.

在資本績效方面，我們第二季共安裝了331套系統，超出預期。本季資本表現強勁，主要體現在向分銷商交付的系統數量增加，以及美國地區多系統交易數量較近期趨勢有所增長，部分原因是原定於未來幾季交付的系統提前至第二季度完成。

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.

儘管第二季系統安裝量超出預期，但鑑於持續的財務壓力，客戶（尤其是美國客戶）在資本支出方面似乎仍保持謹慎。去年第二季我們共安裝了279套系統，需要說明的是，由於本季供應鏈面臨挑戰，約有15套系統的出貨從6月延後到7月。

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.

第二季營收為18億美元，年增15%。以固定匯率計算，第二季營收成長約17%。經常性收入佔總營收的85%，高於2019年全年的72%，較上年增長20%，主要得益於手術量增長和經營租賃模式下系統裝機量的增加。

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.

其他營收統計數據和趨勢如下：在美國，我們第二季安裝了157套系統，而去年同期為150套。在美國以外地區，我們第二季安裝了174套系統，而去年同期為129套。本季安裝的系統包括歐洲76套、日本33套和中國16套，去年同期分別為歐洲78套、日本18套和中國15套。

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第十四個五年期機器人手術系統配額，共559套。根據新配額，我們合資公司獲得的機器人手術系統中，預計絕大多數將在2024年至2027年間完成部署。我們注意到，越來越多的本土競爭對手參與了國家配額下的招標。此外，由於省級政府政策調整和市場競爭，我們在2023年面臨中國市場的價格壓力。這些因素導致我們在中國的業務流程、系統部署和收入前景有更大的不確定性。

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，在安裝的331套系統中，有60套用於交易，而去年同期為56套。截至第二季末，已安裝的系統整合商（SI）數量約為500套，其中97套位於美國。

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.

第二季租賃佔總部署量的50%，而上一季和去年同期這一比例均為42%。在美國，第二季78%的系統部署採用經營租賃方式，而上一季這一比例為59%。美國經營租賃比例的上升主要是由於客戶越來越傾向於我們基於使用量的租賃模式，部分原因是許多客戶面臨資本預算限制和持續的財務壓力。

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，部分客戶選擇租賃模式是為了保持升級到下一代技術的靈活性。鑑於這些因素以及我們與海外客戶的租賃項目尚處於早期階段，我們預計隨著時間的推移，採用經營租賃方式的設備比例將會增加。

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.

第二季系統平均售價為139萬美元，而上季為147萬美元。系統售價季減的主要原因是X型設備購買交易佔比增加以及地理分佈變化。第二季我們確認了1,200萬美元的租賃買斷收入，而上季為2,400萬美元，2022年第二季為2,300萬美元。達文西手術器械及配件的單次手術收入約為1,840美元，而上季約為1,780美元，去年同期約為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.

從季度來看，每項手術的[INA]費用增加主要是由於我們上個季度描述的INA價格上漲和客戶訂購模式所致。

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.

接下來談談我們的Io平台。第二季度，我們共安裝了59套Ion系統，而2022年第二季為41套。第二季Ion系統手術量約12,700例，較去年同期成長145%。本季度，我們在英國市場首次安裝了Ion系統。在歐洲市場推廣的初期階段，我們專注於收集臨床數據，以支援我們的醫保報銷策略。在第二季安裝的系統中，有12套是SP系統，而上季為10套。 SP手術量成長了40%，系統平均利用率的成長速度也從上季的12%加快，較去年同期成長了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.

接下來來看損益表的其他部分。第二季的備考毛利率為68.5%，高於上一季的67.2%和去年同期的69.2%。備考毛利率低於去年同期，主要原因是Ion業務的收入佔比增加，而Ion業務目前的利潤率遠低於達文西手術系統，且系統售價也較低。

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，降低產品成本和提高生產效率是我們團隊中期工作的重中之重。第二季備考營運費用年增12%，主要原因是去年新增員工人數、可變薪酬增加、原型製作費用增加以及為支持業務成長而開展的客戶培訓相關費用增加。

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.

第二季備考營運費用佔收入的 33%，而 2022 年全年則佔收入的 35%，這部分反映了我們在支援職能方面的計畫性槓桿作用。

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.

第二季資本支出為1.78億美元，主要用於基礎建設投資，以擴大生產設施規模並提高產能。第二季備考有效稅率為22.3%，與預期相符。第二季備考淨利為5.07億美元，合每股1.42美元，去年同期為4.15億美元，合每股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業績。 2023年第二季GAAP淨利為4.21億美元，即每股1.18美元，而2022年第二季GAAP淨利為3.08億美元，即每股0.85美元。備考淨利潤與GAAP淨利潤之間的調整項已在我們的網站上列出並量化，其中包括與員工股票獎勵、員工股票期權激勵、無形資產攤銷以及戰​​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.

本季末，我們的現金及投資總額為71億美元，高於上一季的66億美元。現金及投資的環比成長主要反映了經營活動產生的現金流量和員工股票行權所得，但部分被資本支出所抵銷。接下來，我將把發言權交給布萊恩，他將介紹臨床方面的亮點，並提供我們最新的2023年展望。

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。我們第二季的整體手術量年增22%，而2022年第二季為14%，上季為26%。在美國，2023年第二季的手術量年增19%，而2022年第二季為11%，上季為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.

第二季成長持續主要得益於一般外科手術的強勁成長，其中膽囊切除術和疝氣修補術表現尤為突出。減重手術在本季成長良好，但如前所述，增速低於前期。在美國以外地區，第二季手術量成長28%，高於2022年第二季的22%和上一季的28%。 2023年第二季度美國以外地區的手術量成長主要得益於一般外科手術的持續成長，尤其是大腸直腸手術的強勁成長，其次是胸腔外科手術的成長。

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.

泌尿外科業務持續保持健康成長，腎臟手術是主要成長動力，前列腺切除術也維持了兩位數的成長。在歐洲，英國、德國和西班牙的業務成長強勁。在上述所有地區，大腸直腸手術和子宮切除術均是推動手術量成長的主要因素。

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，中國引領了成長，我們看到受新冠疫情影響的手術量持續復甦，並且受益於與去年同期受影響的手術量相比的有利基數效應。

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.

手術量的成長主要得益於泌尿外科的強勁成長，尤其是攝護腺切除術和腎臟手術。在日本，一般外科手術量的成長最為顯著，其中結直腸切除術和胃切除術的貢獻最大。印度和台灣雖然仍處於早期應用階段，但婦科和一般外科手術量均呈現強勁成長。

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.

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

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，來自中國重慶大學第二附屬醫院的張博士發表了一篇系統性回顧與統合分析，比較了機器人輔助右半結腸切除術與腹腔鏡右半結腸切除術的療效。此統合分析發表於《結直腸外科技術》雜誌，共納入42篇研究，涉及15241例患者，其中機器人輔助右半結腸切除術組超過2700例，腹腔鏡組超過12000例。分析內容包括所有患者的預後以及體內吻合和體外吻合的預後。

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.

從整體人群來看，作者報告稱，機器人輔助手術可使住院時間縮短約半天，中轉開腹手術的風險降低51%，併發症風險降低12%。值得注意的是，在專門比較體內吻合結果的亞組中，機器人輔助右半結腸切除術組的住院時間縮短約16小時，中轉開腹手術的風險降低65%。在體外吻合術亞組中，機器人輔助手術可使整體併發症風險降低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".

作者們得出的部分結論是：“機器人右半結腸切除術的安全性和有效性優於腹腔鏡右半結腸切除術，尤其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.

康乃狄克州丹伯里醫院的村井醫師發表了一項臨床研究，比較了機器人輔助和視訊輔助胸腔鏡手術的療效。該研究利用美國國家癌症資料庫，對兩種手術方式進行肺葉切除術的療效進行了比較。研究對象為病因複雜的患者，例如接受新輔助治療的非小細胞肺癌（N1.2期）或腫瘤直徑大於5公分的患者。研究共納入9,500名受試者，其中2,100多名接受機器人輔助手術，超過7,000名接受傳統胸腔鏡手術。

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，在分析轉為開胸手術率時，作者報告稱，機器人手臂組的轉為開胸手術率比人工手臂組低7.7%，而人工手臂組的轉為開胸手術風險約為人工手臂組的兩倍。作者總結道：“總之，我們對國家癌症數據庫的分析表明，機器人肺葉切除術在復雜肺切除方面取得了與[R0]切除術相似的圍手術期結果（聽不清）肺葉切除術，唯一的區別在於機器人肺葉切除術的轉為開胸手術率較低。”

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.

接下來，我將談談我們對2023年的財務展望。首先是手術量。在上一次電話會議上，我們預測2023年全年手術量成長率介於18%至21%之間。現在，我們上調了預測，預計2023年全年手術量成長率將達到20%至22%。預測範圍的下限反映了以下幾個方面的不確定性：隨著患者重返醫療機構，手術量持續增長的不確定性能否持續；美國減肥手術增長率持續放緩；以及可能影響醫院和患者支出的宏觀經濟挑戰。預測範圍的上限則基於以下假設：宏觀經濟挑戰不會對醫院手術量產生重大影響，且美國減重手術成長率將繼續維持第二季的成長速度。此預測範圍並未考慮重大的原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.

接下來談談毛利。我們仍預計2023年全年備考毛利率將在68%至69%之間。實際毛利率將因產品、地區和以舊換新組合以及新產品上市的影響而逐季波動。

With respect to operating expenses. On our last call, we forecast pro forma operating expense growth to be between 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.

關於營運費用。在上一次電話會議上，我們預測備考營運費用成長率將在11%至15%之間。我們正在調整這項預測，目前預計全年備考營運費用成長率將在12%至15%之間。此外，我們也將2023年非現金股權激勵費用的預測範圍從先前的6億至6.3億美元縮小至6億至6.2億美元。

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.

我們上調了其他收入（主要包括利息收入）的預期，預計2023年總額將在1.6億美元至1.8億美元之間，高於先前預估的1.4億美元至1.6億美元。此次上調主要反映了利率上升。關於資本支出，我們繼續預期在8億美元至10億美元之間，主要用於計畫中的設施建設活動。

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，我們仍預期2023年的預計稅率為稅前所得的22%至24%。以上就是我們準備好的發言。現在開始接受提問。

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

（操作員說明）我們來解答來自富國銀行 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，我只有兩個問題。一個是關於人工智慧的宏觀問題，另一個是關於手術流程成長的問題。加里，人工智慧現在顯然正處於風口浪尖。我很好奇，Intuitive公司在人工智慧的應用上投入了哪些精力？是影像處理、機器人運動控制還是訓練？我很想聽聽你的看法，然後我還有一個後續問題。

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。那我就先從人工智慧說起吧。我們先來談談它是什麼。對我們來說，它是一套基於基礎架構的數位工具，可以在此基礎上運用各種機器學習技術，包括電腦視覺。我們已經在這方面投入了一段時間。十多年前，我們就開始為手術機器人開發物聯網。我們建構了網路安全且符合隱私保護規定的基礎架構，使我們能夠存取資料。所以，這方面有一些非常重要的基礎工作。這算是第一步。

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.

第二步是與客戶合作，彙總有意義的數據。人工智慧的效用取決於輸入資料的品質。因此，對我們來說，這些數據包括機器人數據，以及與客戶合作收集的電子病歷數據。我們已經這樣做了好幾年了。我認為，基於這些數據，就可以開始進行分析性檢查。你可以對數據進行分析，尋找相關性。有時只需要一些簡單的數學運算。這就能讓你進行大數據探索，我們可以做一些簡單的事情來幫助客戶提高效率，並發現其中的差異。

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，我們可以進一步投資於電腦視覺等領域，我們一直在這樣做；還可以投資於預測分析，即研究外科數據科學，了解患者群體的差異以及手術中發生的事情，並開始創建工具，數位工具，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方面。

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.

所以，對於您提到的許多方面，我們已經有所涉獵，而且已經有一段時間了。正如我在腳本中所說，功能性內容可以快速推進。我認為，真正有效的驗證需要時間，尤其是基於結果或介入性驗證。因此，我們將以嚴謹的態度完成這些驗證工作。所以我預計我們會繼續沿著這條道路前進。

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.?

這很有幫助。關於手術流程，我想問一下，您提到第二季度會進行一些追趕。您認為目前還有多少積壓的延期手術需要處理？您上次電話會議談到了診斷性手術。您對今年剩餘時間美國的減重手術市場有何預測？這是否意味著國際市場將持續強於美國市場？

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.

我想先簡單談談疫情期間被邊緣化的病患群體，然後把評估工作交給傑米。關於疫情應對措施，很難準確估計有多少人原本在診斷流程中卻沒能接受檢測。我們會查看現有數據來進行評估。我認為這種情況不會在一個季度內完全恢復。根據我們過去的經驗，醫療資源利用率的下降通常持續數年，可能需要幾個季度才能完全恢復。至於需要多長時間，我認為很難估計。目前來看，情況還不錯。

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手術的問題，我把這個問題交給傑米回答。他在事先準備好的發言稿中已經稍微談到了這一點。

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。我們在第二季度觀察到成長速度放緩。我們從客戶那裡了解到，患者的興趣程度已經下降，他們現在開始考慮藥物治療而非手術。根據這些客戶回饋，目前尚不清楚家長和患者評估藥物治療方案的持續時間，而且這顯然是一個複雜的問題。因此，我們在業績指引中表示，今年剩餘時間裡，美國減重手術的成長率上限與第二季的預期一致；下限則認為，隨著患者對減重藥物的了解不斷加深，成長率將在今年內繼續略有放緩。顯然，患者在選擇這些藥物時需要考慮許多因素，例如費用、副作用、停藥後體重反彈等。但我認為，從我們的角度來看，我們對長期影響的理解還處於早期階段。

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發揮作用，而且這種作用會持續較長時間。至於今年餘下時間會發生什麼，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.

我們來看下一個問題。請看美國銀行的崔維斯·史蒂德的回答。

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?

我想問一下關於中國和中國配額的問題，以及您認為現在有了更多本土企業，機會如何？你們也有本土版的習近平，關於減肥手術，也想快速問一下。手術量大約是10萬例嗎？我只是想了解目前的手術機會或影響規模。

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?

我們認為，在美國，機器人手術的市場規模約為每年20萬例，這是一個比較適合的規模。至於市場滲透率，如果按四分位數劃分，我們大概處於第二個四分位數的起始位置。崔維斯，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.

會議討論了中國和中國配額，以及如何看待與上個季度相比，中國市場出現的機遇，因為當時有更多本土玩家，但現在又出現了本土版的習近平。

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，很明顯，機會增加了，因為配額從之前的225套增加到了559套，但現在也有5家本土企業。政府肯定會關注本土企業的成功。我們相信外科醫生很重視手術系統的表現和功能，所以我認為，達文西手術系統在差異化方面做得越好，對我們越有利。

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.

我們看到，越來越多的本地企業參與配額分配的招標。配額由中央政府分配給各省，然後透過招標程序分配。因此，從最終確定分配到最終名額到最終確定名額之間需要一段時間。這就是為什麼我們在事先準備好的演講稿中提到，我們認為大部分配額，也就是我們合資企業贏得的名額，將在2024年至2027年期間獲得。

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.

我還描述了一些導致價格壓力和日益激烈的競爭出現更大波動性的因素。所以我認為，在未來一年左右的時間裡，我們將密切關注這些因素。

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?

好的。還有一個問題想問加里。我聽說醫院為了保留升級到下一代系統的機會，正在增加租賃規模。所以，您能否就此高屋建瓴地談談，例如FDA的審批流程以及您去年遇到的供應鏈瓶頸問題？還有，您是如何考慮逐步升級到第四代系統，還是直接採用全新平台的？

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，我們看到的挑戰點有所減少，但仍存在一些問題。因此，我們投入了大量精力，確保在業務穩定成長的同時，能夠滿足客戶的需求。他們指出供應鏈挑戰的範圍有所改善，但也提醒說，仍有一些環節需要關注。

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.

我們持續推進多項工作。如您所知，我們一直在研發下一代平台，這通常是我們的日常工作。至於選擇升級現有平台還是直接遷移到下一代，我們主要考慮的是客戶能從這種切換中獲得哪些價值，以及升級與平台切換相比的便利性和經濟性。我們預計兩者都會進行。由於開發一個平台需要時間，我們通常會同時研發接下來的兩代平台，而不僅僅是下一代。目前的情況也並無二致。

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他們所推進的升級和技術感到非常滿意。我想說的是，就優先順序而言，我們最關心的是能否真正改善患者的治療效果，或是能否讓更多患者受益於（聽不清楚）手術。所以我們著重關注這一點。我們致力於改善外科醫生和護理團隊的體驗，無論是在人體工學方面，還是在工作流程等方面，以及他們對我們系統的感知。我們努力提高整體專案的效率。我們將致力於提高醫院計畫的效率，並努力降低每位患者每次治療的總成本。

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

當我們發現能夠實現這一點的功能集和技術時，我們會非常興奮，並大力推廣它們。

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?

恭喜你們季度業績出色！我聽說原型開發成本增加。所以我想在這裡碰碰運氣，我知道你們不會透露下一代系統何時推出，或者是否會推出。但我還是想了解一下，如果真的推出下一代系統，會產生哪些影響？你們現在有很多租約。客戶可以選擇升級嗎？這是否會隨著收入的增加而實現？我們該如何看待原型開發成本，以及它究竟是做什麼用的？

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，我不會透露原型開發的具體費用，而且這筆費用分散在多個專案中。與上一季相比，第二季的原型開發費用往往波動較大。恰好，第二季原型開發費用是我們支出的主要驅動因素之一。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.

隨著租賃安裝系統佔比的提高，目前已安裝系統中約有 2000 套系統採用租賃方式。這些租賃系統通常都包含技術過時條款。這在一定程度上反映了我們推出 Xi 系統時收到的客戶回饋。因此，這項條款已成為我們經營租賃協議中的常規內容，它通常允許客戶將現有租賃協議更改為任何下一代技術的租賃協議。順便一提，這並非固定價格，需要協商。因此，關於價格方面，我不再贅述。

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?

太好了。傑米，或許我還能再問你一個關於財務方面的問題。又一個季度現金流表現良好，資產負債表上的現金超過70億美元。利率高企，通貨膨脹也居高不下。你打算如何最大化利用這些現金？我們應該如何安排優先事項？

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以往保持一致。我們的首要任務是投資於業務發展，包括資本支出（正如您從我們的業績指引中看到的，今年的資本支出水準相對較高）以及對營運費用的有機成長。

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，我們會從外部引進能夠賦予我們差異化能力或加速市場競爭的技術。這通常包括授權協議、智慧財產權收購或補充收購。同時，我們也會持續尋找機會向股東返還現金。我認為這對我們大有裨益。回顧過去18個月，我們以平均每股234美元的價格回購了1,260萬股股票，總額達30億美元。我們之所以這樣做，很大程度是出於機會主義，因為這反映了公司所處的發展階段。我們在機器人領域仍處於相對早期的階段，我們尋求的是成長，我認為這對我們大有裨益。

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

我們的下一個問題來自 Stifel 公司的 Rick Wise。

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，我最近參觀了幾個歐洲醫院和機器人手術計畫。坦白說，我對Intuitive在歐洲的商業影響力印像比以往任何時候都更加深刻。但我尤其感興趣的是一位經驗豐富的機器人外科醫生談論未來的發展方向。他似乎更關注那些能讓一切變得更好、更快、更清晰等等的賦能技術，而不是系統本身。這些技術包括手術過程中整合CT影像疊加，以及將CT和手術結合的擴增實境工具，以及下一代螢火蟲系統。他設想了虛擬尺、雙SureForm 45和60縫合器以及觸覺回饋。我的意思是，這真是太令人著迷了。這些是你們優先考慮的創新嗎？你們希望讓像他這樣的醫生對這些技術感到興奮嗎？這是你們正在研究的方向嗎？

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.

您列出的清單很長。我認為其中一些非常重要，也是我們已經討論過並與大家分享過的。我認為，提高外科醫生即時識別組織的準確率至關重要，而我們可以透過多種方式實現這一點。例如，您提到的螢光成像以及其他先進的成像技術，這些技術使外科醫生能夠看到組織表面之下、超越普通白光成像所能觀察到的範圍。我們堅信這些技術有助於改善臨床結果，並且我們對影像融合或資料融合技術充滿熱情，並正在加大投入。這些技術包括CT影像疊加、術前MRI和CT掃描的分割，以及在手術過程中即時應用這些技術的能力。我們認為，這些技術能夠改變手術結果，並提高手術室的效率。

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感測能力也非常強大且重要。至於之前提到的人工智慧、機器學習和機器視覺，它們可以協同工作。高畫質影像能夠展現組織表面之下的景象，結合電腦視覺和人工智慧模型，可以提供一些預測分析，我認為這非常強大，能夠幫助外科醫生獲得更好的手術效果，減少併發症。所以我和那位外科醫生一樣，感到非常興奮。

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?

好的。再補充一點。我記得你們好像對所有儀器的價格都上調了5%。我不確定我記得對不對，好像是從6月1號開始生效的。上調生效了嗎？對上一季業績有幫助嗎？我是否可以認為，這會在下半年及以後起到一定的抵消作用，或者說對儀器業務帶來一些利好？

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.

里克，這項措施基本上是在第二季實施的。我認為，在第二季初效果並不明顯，大約只有半個季度受益於價格上漲。我們對價格上漲影響的預估與上個季度一致，預計全年營收和利潤將增加約1億美元。再次強調，價格上漲的影響主要體現在第二季的一半，而全部影響則體現在第三季和第四季。

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.

再次提醒一下，我們這次提價的動機是，我們一直以來在定價方面都比較保守。過去幾年，我們的原材料和人力成本都有所上漲。雖然我們透過提高效率和規模優勢抵消了大部分成本，但我們覺得是時候將部分成本回饋給客戶了，這就是這項提價的原因。

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

我們來看下一位。我這位是來自 Truist Security 的 Richard。

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?

我是Richard Newitter。 Jamie，或許對你來說，20%到22%的指導值非常健康。我只是好奇這個範圍的下限是多少。你特別提到你考慮了減肥手術的成長趨勢，認為會從第二季度的水平略有下降。你認為下降的速度是多少才能達到這個範圍的下限？比如下降多少？你是如何決定自己的基準線的？

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，里克，考慮到美國減肥手術在我們整體手術量中所佔的比例，我不想在這方面說得太具體。我們顯然可以看到第一季到第二季之間的成長，我認為第三季和第四季的成長模式是溫和穩定的。這方面的整體影響顯然取決於我們減重手術業務的規模。它並沒有出現大幅下滑。

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。我們不妨繼續討論一下減肥手術這個話題。想想看，如果我們從地域或手術類別的角度來考慮，哪些方面可能接近拐點，就像幾年前的減肥手術一樣，您認為哪些手術類別或地區可能會出現超額收入，從而抵消減肥手術可能出現的任何增長放緩？

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.

我不會從超額收益的角度來回答這個問題，但我可以談談我們目前看到健康成長的領域。以我們重點關注的七大市場為例，即中國、日本、韓國、德國、法國、英國和義大利，這些市場普遍呈現出從泌尿科手術向其他癌症手術領域拓展的趨勢。具體情況因市場而異，但總體而言，這些領域包括子宮切除術、胸腔外科手術和大腸直腸手術。我們看到這些領域正處於推廣應用的早期階段，這也是為什麼我們之前提到，目前我們的泌尿外科以外的業務（OUS）大約有一半來自泌尿外科以外的領域。本季度，該領域的業務成長了35%，與第一季的情況一致，第一季的業務也成長了35%。因此，我們對這些重點關注的大市場充滿信心，並將繼續推動其他癌症手術領域的業務發展。

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.

如果逐個市場來看，中國的情況比較獨特。例如，肝臟和胰臟手術在日本發展良好，胃癌治療在韓國也很成功，甲狀腺手術也是如此。但真正重要的是後續的手術。

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.

我想稍微回顧一下減肥手術，我們收到了一些相關問題，所以想強調一點。我們與外科醫生、肥胖症專家和藥理學家交流，這是我們盡職調查的一部分。目前來看，市場將會調整以適應藥物治療方案的變化。然而，藥物似乎並不能治癒肥胖症，也未必是快速治癒的途徑。我們溝通的對象，包括一些非外科醫生和非外科醫生出身的醫生，都強烈認同手術和其他幹預措施仍將是治療的重要組成部分。

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.

短期內，我認為市場會逐漸調整，以了解這些藥物的作用，但它們並非治癒方法，停藥率仍然很高，而且沒有從藥物中獲益的患者群體也相當龐大。因此，我認為我們需要一個調整期，這一點我們應該有所了解。但隨著人們探索各種治療途徑，並尋求應對肥胖挑戰的長期持久解決方案，這或許在未來幾季成為一種利好因素。

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

接下來，我們將介紹 BTIG 的 Ryan Zimmerman。

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?

或許可以問問傑米。從費用管理的角度來看，我的意思是，流程成本的成長速度略高於營運支出——營運支出預期比預期高出約 50 個基點。所以我想問傑米，你對費用管理有什麼看法？我們不僅要考慮下半年，還要考慮到 2024 年，你應該讓部分成本優勢發揮作用，還是應該把這些成本再投資到研發中？

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，我們在發揮自身職能方面設定了具體目標，這些目標我們之前已經闡述過。我認為我們有能力實現這些目標。

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.

今年我們對營運費用預期所做的調整，主要取決於我們的營收表現，包括可變薪酬以及為支持更高的手術量所需的現場銷售代表人數。至於其他營運費用的投資，我們基本上維持今年的計畫。

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.

展望2024年，我不會具體描述支出相對於流程收入的走向，我們會在一月進行討論。但有一些因素需要考慮。今年我們有8億至10億美元的巨額資本支出投資，這些投資將在明年開始產生額外的折舊費用。其中一部分將計入銷售成本，另一部分將計入營運費用。因此，在營運費用方面存在一定的阻力。這些投資主要用於設施建設，並計劃於中期實施，這意味著在達到滿載或充分利用之前，這些設施的效率會比較低。

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 2024 年充分利用我們的賦能功能，至於結果如何，我們將在 1 月公佈，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，這很有幫助。然後我注意到，這其實是問Gary的，你之前也提到過，但你好像是第一次披露了按使用量計費的租賃協議與固定租金經營租賃協議的比例。 Gary，我想知道，這說明了什麼？我們從中看到了哪些趨勢，反映了我們客戶的健康狀況以及他們隨著時間推移的偏好？

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，這是一個很好的問題。我認為我們可以看出，沒有一種模式可以適用於所有人。有些人仍然樂於購買設備，他們認為這是取得系統最經濟的方式。他們信心十足，會選擇購買。而有些人資金緊張、稀缺，或他們更關注未來的技術保護條款，因此他們更傾向於租賃。還有一些人正在考慮擴張，但對業務量成長的速度不太確定，對他們來說，基於使用量的租賃安排可以為他們提供一些關於業務成長時間和速度的保障。

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.

我們的分析能力和財務彈性都相當不錯。因此，我們會以比較直接的方式進行討論，我認為市場最終會趨於穩定。如果你問我們是否對某種模式有明顯的偏好，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.

順便一提，此次揭露的動機很簡單，就是這些模式的採用速度成長如此之快，我們認為有必要公開透明地說明這種結構在經營租賃和租賃安排中所佔的比例。如果從整體使用模式和經濟目標出發，評估我們所有基於使用量的租賃安排，平均而言，它們的表現略高於預期。所以到目前為止，它們的表現良好。當然，這其中也包含不同客戶和系統的具體情況。有些表現超出預期，有些則低於預期。但我認為，我們經營這個專案的部分原因在於，我們會仔細審視：它是否真正降低了客戶加速成長的障礙？它是否為我們和客戶帶來了經濟效益？隨著我們和客戶信心的增強，這也是該專案得以如此迅速擴展的部分原因。

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

接下來我們訪問下一位嘉賓，摩根士丹利的安德魯·拉涅利。

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?

關於減重手術，或許還有一個後續問題，但想換個角度問。我們和一些一般外科醫師也聊過，他們似乎認為這些新藥可能會為一些原本不適合手術的病人開闢新的治療途徑。 Gary，你對此有什麼看法？你認為GLP-1類藥物短期內會對減重手術造成一定影響嗎？但同時也會為其他治療途徑打開大門嗎？

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，我們也聽到了一些類似的說法。我們廣泛地走訪了客戶，了解他們的回饋。藥物輔助治療或許可以發揮一定作用，正如您所說，這可能會使某些患者群體最終需要接受手術治療。有些人開始服用藥物後，確實獲得了預期的療效，但藥物的副作用、費用或生活方式的改變，都可能導致他們難以堅持治療。文獻中有很多關於這方面的報導。因此，這部分患者可能會尋求其他治療方案。

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.

我認為我們只能走一步看一步了。目前我們還沒有找到靈丹妙藥，一種無需改變行為或其他生活方式就能治癒疾病的藥——而且這種可能性似乎不大。因此，我認為我們會看到一個調整期，至於這個調整期會持續多久，我們誰也不知道。但我們知道，事後手術和機械幹預仍然會發揮作用。我認為我們已經做好了充分的準備。正如傑米所提到的，即使在當前環境下，市場份額似乎仍在朝著我們有利的方向發展。所以我們會密切注意。

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

在您的討論中，有沒有哪些手術類別最能帶來益處？

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

這是一個很好的問題。我們現在進行調查可能為時過早，無法給出確切的答案。

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.

好的。這是我們最後一個問題，謝謝。最後，我們仍然相信，在從根本上改善外科手術和急診介入方面，存在著巨大且持久的機會。我們的團隊將繼續與醫院、醫生和護理團隊緊密合作，追求客戶所說的「四重目標」：更好、更可預測的患者治療效果，更佳的患者體驗，更佳的護理團隊體驗，以及最終更低的治療總成本。

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，外科手術和急診護理的價值創造以人為本。它源自於對患者及其照護團隊、他們的需求以及他們所處環境的尊重和理解。在Intuitive，我們展望未來，希望醫療照護更加微創、更有高效，疾病能夠更早被發現並迅速治療，讓患者能夠盡快回歸最重要的生活。

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

感謝您在這段非凡旅程中的支持。我們期待三個月後再次與您交流。

Thank you. 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，本次會議到此結束。感謝各位的參與。現在可以斷開連線了。祝您愉快。