直覺手術 (ISRG) 2021 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Q4 2021 Earnings Release Call. (Operator Instructions) As a reminder, today's call is being recorded.

女士們，先生們，感謝您的支持，歡迎參加 Intuitive Q4 2021 收益發布電話會議。 （操作員說明）作為提醒，今天的通話正在錄音中。

I would now like to turn the conference over to your host, Brian King, Head of Investor Relations for Intuitive Surgical. Please go ahead.

我現在想將會議轉交給您的主持人，Intuitive Surgical 投資者關係主管 Brian King。請繼續。

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

謝謝你。下午好，歡迎參加 Intuitive 的第四季度收益電話會議。今天和我在一起的是我們的首席執行官 Gary Guthart；和我們的首席財務官 Jamie Samath。

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, 2021, and Form 10-Q filed on October 20, 2021. 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.

在開始之前，我想通知您，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於某些風險和不確定性，實際結果可能與明示或暗示的結果大不相同。這些風險和不確定性在我們的證券交易委員會文件中有詳細描述，包括我們於 2021 年 2 月 10 日提交的最新 10-K 表格和 2021 年 10 月 20 日提交的 10-Q 表格。我們的 SEC 文件可通過我們的網站或 SEC 的網站。告誡投資者不要過分依賴此類前瞻性陳述。

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

請注意，本次電話會議將在我們的網站上進行音頻重播，網址為：intuitive.com，位於我們投資者關係頁面下的“最新活動”部分。今天的新聞稿和補充財務數據表已發佈到我們的網站。

Today's format will consist of providing you with highlights of our fourth quarter results as described in our press release announced earlier today, followed by a question-and-answer session. Gary will present the quarter's business and operational highlights; Jamie will provide a review of our financial results; and I will discuss procedure and clinical highlights and provide our financial outlook for 2022. And finally, we will host a question-and-answer session.

今天的形式將包括為您提供我們今天早些時候宣布的新聞稿中所述的第四季度業績的亮點，然後是問答環節。 Gary 將介紹本季度的業務和運營亮點； Jamie 將對我們的財務業績進行審查；我將討論程序和臨床亮點，並提供我們對 2022 年的財務展望。最後，我們將舉辦問答環節。

And with that, I will turn it over to Gary.

有了這個，我會把它交給加里。

Thank you for joining us today. 2021 required agility as we drove through significant headwinds to support customers and manage our supply chain. Our teams performed well, helping customers return to surgery when COVID allowed them and maintaining the integrity of our supply chain and workforce.

感謝您今天加入我們。 2021 年需要敏捷性，因為我們克服了巨大的逆風來支持客戶和管理我們的供應鏈。我們的團隊表現出色，幫助客戶在 COVID 允許的情況下重返手術室，並保持了我們供應鍊和員工隊伍的完整性。

Given our recent press release updating procedures, capital placements and revenues, I'll be brief in describing our full year 2021 results and spend a little more time outlining our plans for 2022 and beyond.

鑑於我們最近的新聞稿更新程序、資本配置和收入，我將簡要介紹我們 2021 年的全年業績，並花更多時間概述我們 2022 年及以後的計劃。

Putting 2021 in context, demand for our robotically assisted interventions has been resilient during COVID. While these interventions get delayed during COVID peaks, they return as COVID wanes, and that is encouraging. Pandemic stresses on health care systems emphasize the need for the kind of high-quality, minimally invasive interventions our products enable.

以 2021 年為背景，在 COVID 期間對我們的機器人輔助干預措施的需求一直保持彈性。雖然這些干預措施在 COVID 高峰期被推遲，但隨著 COVID 的消退，它們又回來了，這是令人鼓舞的。大流行對醫療保健系統的壓力強調需要我們的產品支持的那種高質量、微創的干預措施。

MIS procedures allow greater use of ambulatory surgery, free up resources and ORs relative to other approaches and often enable faster patient return to home and overall recovery.

MIS 程序允許更多地使用非臥床手術，相對於其他方法釋放資源和手術室，並且通常使患者能夠更快地回家和整體康復。

In 2021, da Vinci procedures grew 28% compared to full year 2020, reflecting a partial recovery in surgery after the first wave of the pandemic. Over the 2-year period, 2020 and 2021, the compound annual growth rate in procedures was 14%. Capital installs were healthy in 2021, with our team placing 1,347 da Vinci and 93 Ion systems in the year, driving da Vinci placement growth of 44% over 2020 and at a CAGR of 10% over the past 2 years.

2021 年，達芬奇手術與 2020 年全年相比增長了 28%，反映了第一波大流行後手術的部分恢復。在 2020 年和 2021 年的 2 年期間，程序的複合年增長率為 14%。 2021 年的資本安裝很健康，我們的團隊在這一年放置了 1,347 個達芬奇和 93 個離子系統，推動達芬奇放置比 2020 年增長 44%，過去 2 年的複合年增長率為 10%。

With the 2-year CAGR in procedures of 14% and installed base growth of 10% over the same period, utilization of installed systems continue to climb through the pandemic. We think this is good for our customers and good for us. Jamie will give regional capital trends and Brian will give detailed procedure dynamics later in the call.

隨著 14% 的 2 年復合年增長率和同期 10% 的安裝基數增長，已安裝系統的利用率在大流行期間繼續攀升。我們認為這對我們的客戶和我們都有好處。 Jamie 將提供區域資本趨勢，Brian 將在電話會議稍後提供詳細的程序動態。

The past 2 years have stressed more than health systems. Our ability to attract, develop and retain outstanding staff remains a key focus for us. Our team has performed well, supporting our customers and each other. In the year, we added approximately 1,700 employees to our team with net head count growth of approximately 180 in R&D, 920 in operations and 340 in our commercial force. Of the 1,700 net additions, 700 were outside of the United States.

過去 2 年所強調的不僅僅是衛生系統。我們吸引、培養和留住優秀員工的能力仍然是我們關注的重點。我們的團隊表現良好，支持我們的客戶和彼此。這一年，我們的團隊增加了約 1,700 名員工，研發人員淨增長約 180 人，運營人員淨增 920 人，商務人員淨增長 340 人。在淨增加的 1,700 人中，有 700 人在美國以外。

Looking out over the next decade, we believe that the method we have developed to identify clinical need, then design a technology-enabled ecosystem for improving the Quadruple Aim, then deliver and train customers on this ecosystem can positively impact a broad set of minimally invasive interventions. The opportunity and challenge for Intuitive is to evolve our ecosystem to support our customers and ourselves at scale and to choose procedural opportunities and platform architectures that made sense.

展望未來十年，我們相信我們開發的用於識別臨床需求、設計技術支持的生態系統以改進 Quadruple Aim、然後在該生態系統上交付和培訓客戶的方法可以對廣泛的微創技術產生積極影響干預。 Intuitive 的機遇和挑戰是發展我們的生態系統，以大規模支持我們的客戶和我們自己，並選擇有意義的程序機會和平台架構。

Turning to investments in the midterm, our priority for use of our capital is to reinvest in the business, to develop new opportunities that improve the Quadruple Aim and to strengthen our operating capabilities at global scale. We are focused on driving a vital set of initiatives, and I'd like to describe the dynamics for you in a little more detail.

談到中期投資，我們使用資本的優先事項是對業務進行再投資，開發改善四重目標的新機會，並加強我們在全球範圍內的運營能力。我們專注於推動一系列重要舉措，我想更詳細地為您描述動態。

In multiport, we believe our Gen 4 architecture is outstanding and we've been adding capability to this product line since launch, including significant expansion and upgrades to energy and stapling product lines, improved endoscopic imaging, the introduction of da Vinci X, the introduction of extended use instruments, training technologies and finally, the introduction of new and upgraded connectivity and data management tools. Given the precision, robustness and overall performance of our Generation 4 robotics architecture, we will continue to innovate on this platform, bringing additional value to those customers who have standardized on Generation 4 fleets.

在多端口方面，我們相信我們的第 4 代架構非常出色，並且自推出以來我們一直在為該產品線添加功能，包括對能源和訂書機產品線的重大擴展和升級、改進的內窺鏡成像、達芬奇 X 的引入、擴展使用儀器、培訓技術，最後是引入新的和升級的連接和數據管理工具。鑑於我們第 4 代機器人架構的精確性、穩健性和整體性能，我們將繼續在這個平台上進行創新，為那些在第 4 代機隊上實現標準化的客戶帶來額外價值。

We are also investing in new core capabilities for our multiport systems, both Generation 4 and beyond that we'll describe as they get closer to market. You should expect continued innovation from us here.

我們還在為我們的多端口系統投資新的核心功能，包括第 4 代及之後的系統，我們將在它們更接近市場時對其進行描述。您應該期待我們在這裡不斷創新。

Turning to Ion. Our first indication addresses a large unmet need in lung cancer biopsy and our focus is fully enabling our production capability and customer ecosystem for this indication. There is strong demand for lung biopsy, and we are working to expand manufacturing capacity of all processes for greater quality and lower costs at scale and run trials and address regulatory requirements that enable global expansion. Over time, we plan for total Ion program profitability to approach that of our corporate average as we execute against our volume, design and process improvement goals. We are pursuing additional applications for Ion, and we'll describe them as we get closer to market.

轉向離子。我們的第一個適應症解決了肺癌活檢中未得到滿足的大量需求，我們的重點是充分利用我們的生產能力和客戶生態系統來適應這一適應症。對肺活檢有強烈的需求，我們正在努力擴大所有工藝的製造能力，以提高質量和大規模降低成本，並進行試驗並滿足監管要求，以實現全球擴張。隨著時間的推移，我們計劃在執行我們的數量、設計和流程改進目標時，使 Ion 項目的總盈利能力接近我們公司的平均水平。我們正在尋求 Ion 的其他應用，我們將在接近市場時對其進行描述。

For our single port system, da Vinci SP has the opportunity to change the standard of care in 2 different types of soft tissue surgery: those that require the extraction of tissue that can be done through a small single port and those procedures that benefit from narrow entry into the body as a whole. Where Ion, at its current stage of launch, has a single indication that represents a large patient population, SP's opportunity is the aggregation of several midsized indications.

對於我們的單端口系統，達芬奇 SP 有機會改變 2 種不同類型的軟組織手術的護理標準：那些需要通過小單端口提取組織的手術和那些受益於狹窄手術的手術整體進入身體。 Ion 在其當前推出階段有一個代表大量患者群體的單一適應症，而 SP 的機會是幾個中型適應症的聚合。

For example, SP use in transoral robotic surgery is growing steadily in the U.S. To broaden SP's applicability in the U.S. and other markets, we are undertaking clinical trials to support regulatory review. We believe that SP will serve several additional surgical specialties, which will allow our customers and us to leverage capital investments in the program. Like Ion, we plan for SP platform profitability to approach that of historical platforms over time, and we're encouraged by recent progress.

例如，SP 在經口機器人手術中的使用在美國穩步增長。為了擴大 SP 在美國和其他市場的適用性，我們正在進行臨床試驗以支持監管審查。我們相信 SP 將服務於其他幾個外科專科，這將使我們的客戶和我們能夠利用該計劃的資本投資。與 Ion 一樣，我們計劃讓 SP 平台的盈利能力隨著時間的推移接近歷史平台，我們對最近的進展感到鼓舞。

Our customer digital efforts now represent roughly 5% of our total operating expenses and drive the business in 4 ways. First, the use of data and digital tools by customers to analyze their operations helps improve outcomes, reduce costs and increase customer satisfaction and retention. Second, digital and internal investments can decrease our cost to serving our customer. Third, some of our digital tools generate revenue themselves. And finally, use of data and analytics internally can help our teams make better decisions.

我們的客戶數字化工作現在約占我們總運營費用的 5%，並以 4 種方式推動業務發展。首先，客戶使用數據和數字工具來分析他們的運營有助於改善結果、降低成本並提高客戶滿意度和保留率。其次，數字和內部投資可以降低我們為客戶服務的成本。第三，我們的一些數字工具自己產生收入。最後，在內部使用數據和分析可以幫助我們的團隊做出更好的決策。

Because digital and data tools span our platforms and are used externally and internally, we do not account for them using the same financial models as our platforms, nor do we break them out as stand-alone financial engines. That said, we do evaluate digital and data projects against internal strategic and return analysis.

由於數字和數據工具跨越我們的平台並在外部和內部使用，我們不會使用與我們平台相同的財務模型來解釋它們，也不會將它們作為獨立的金融引擎進行拆分。也就是說，我們確實根據內部戰略和回報分析評估數字和數據項目。

Over the past 5 years, the annual number of instruments we produce has grown roughly 200% and the annual number of systems we produce has more than doubled. The number of customer professionals trained annually has nearly doubled, and our engineering staff has nearly tripled. Our product volume growth has also allowed us to in-source some of our high-volume accessories while investing in automation. This has a threefold benefit: improving supply chain robustness, improving manufacturing quality and lowering unit costs.

在過去的 5 年裡，我們每年生產的儀器數量大約增長了 200%，我們每年生產的系統數量增加了一倍以上。每年培訓的客戶專業人員數量幾乎翻了一番，我們的工程人員幾乎增加了兩倍。我們的產品數量增長還使我們能夠在投資自動化的同時內購一些大批量配件。這具有三重好處：提高供應鏈穩健性、提高製造質量和降低單位成本。

As our training, R&D and manufacturing efforts move to scale, we're investing in infrastructure, factory builds, training center expansion and automation. These infrastructure investments are lumpy, and our current growth cycle requires building capacity. These projects have been planned over the past couple of years and will start amortizing first moderately in 2022 and more substantially in 2023 and '24, then normalizing over the next few years.

隨著我們的培訓、研發和製造工作規模化，我們正在投資於基礎設施、工廠建設、培訓中心擴建和自動化。這些基礎設施投資是不穩定的，我們當前的增長周期需要建設能力。這些項目是在過去幾年中計劃好的，將首先在 2022 年適度攤銷，並在 2023 年和 24 年更大幅度地攤銷，然後在未來幾年內正常化。

For example, over the next 4 years, we'll be growing and consolidating facilities for operations, R&D and customer training space in Atlanta; doubling our Mexicali manufacturing footprint; doubling our R&D design space and operation space as our California headquarters; and finally, consolidating and growing our commercial, training, operations and R&D space in Freiburg, Germany.

例如，在接下來的 4 年裡，我們將在亞特蘭大發展和整合運營、研發和客戶培訓空間的設施；將我們的墨西卡利製造足跡翻倍；將我們的研發設計空間和運營空間增加一倍，作為我們的加州總部；最後，鞏固和發展我們在德國弗萊堡的商業、培訓、運營和研發空間。

In summary, we'll build on our Generation 4 capabilities in multiport while innovating in clinical utility for multiport surgery broadly. We'll continue to bring our flexible endoscopy platform, Ion, to scale and drive capacity, quality and cost improvements while seeking to broaden access to new markets. In SP, we expect to expand indications in regional markets while driving manufacturing quality and scale. We will invest in regional training, R&D and manufacturing centers globally to support the growth of the business and pursue opportunities for operating leverage given volume, some of which we'll share with customers to catalyze elastic markets. Finally, we will continue to advance our digital efforts to enable fast, accurate and actionable decisions with our customers and for our company.

總而言之，我們將在多端口手術的第 4 代能力的基礎上，同時廣泛創新多端口手術的臨床應用。我們將繼續帶來我們靈活的內窺鏡平台 Ion，以擴大和推動容量、質量和成本的改進，同時尋求擴大進入新市場的機會。在 SP 方面，我們希望在提高製造質量和規模的同時擴大區域市場的適應症。我們將在全球範圍內投資區域培訓、研發和製造中心，以支持業務增長，並在給定數量的情況下尋求經營槓桿的機會，其中一些我們將與客戶分享以促進彈性市場。最後，我們將繼續推進我們的數字化工作，以便與我們的客戶和我們的公司做出快速、準確和可操作的決策。

Lastly, for 2022, particularly, we're focused on the following. First, outstanding customer support in the face of continued pandemic disruption. Second, execution of our robotic and digital platform expansion in pursuit of new indications and new markets. Third, general surgery growth in the United States. And finally, diversified growth outside the U.S. beyond urology.

最後，對於 2022 年，我們特別關注以下內容。首先，面對持續的大流行中斷，提供出色的客戶支持。其次，執行我們的機器人和數字平台擴展，以尋求新的適應症和新的市場。第三，美國普外科增長。最後，除了泌尿外科之外，美國以外的多元化增長。

As we turn to our financial report, I'd like to formally thank Marshall Mohr, our outgoing CFO and new Head of Global Business Services, for his outstanding stewardship over the past 15 years, and turn the time over to our incoming CFO, Jamie Samath, who will take you through financial matters in greater detail.

當我們轉向我們的財務報告時，我要正式感謝即將卸任的首席財務官兼新任全球商業服務主管 Marshall Mohr 在過去 15 年中的出色管理，並將時間轉交給我們即將上任的首席財務官 Jamie Samath，他將帶您更詳細地了解財務問題。

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. Reconciliation between our pro forma and GAAP results is posted on our website.

下午好。我將在非公認會計原則或備考基礎上描述我們表現的亮點。稍後我還將在準備好的評論中總結我們的 GAAP 表現。我們的備考結果和公認會計原則結果之間的對賬公佈在我們的網站上。

Q4 and 2021 revenue and procedures are in line with our preliminary press release of January 12. Before I dive into our Q4 results, let me start with a summary of our full year 2021 performance. Given the significant impact of COVID, we believe it's appropriate to review our 2021 results on both a year-over-year and a 2-year compound annual growth rate basis.

第四季度和 2021 年的收入和程序與我們 1 月 12 日的初步新聞稿一致。在深入探討第四季度的業績之前，讓我先總結一下我們 2021 年的全年業績。鑑於 COVID 的重大影響，我們認為在同比和 2 年復合年增長率的基礎上審查我們的 2021 年業績是適當的。

Procedures increased by 28% as compared to 2020 and increased by approximately 14% using a 2-year CAGR. We placed 1,347 systems of customers during the year, an increase of 44% as compared to 2020 and up 10% using a 2-year CAGR. As a result of this procedure and system placement performance, 2021 revenue increased by 31% year-over-year and increased by 13% using a 2-year CAGR.

與 2020 年相比，程序增加了 28%，使用 2 年的複合年增長率增加了約 14%。我們在這一年放置了 1,347 個系統的客戶，與 2020 年相比增長了 44%，使用 2 年的複合年增長率增長了 10%。由於此程序和系統放置性能，2021 年收入同比增長 31%，使用 2 年復合年增長率增長 13%。

Key business metrics for the fourth quarter were as follows. Fourth quarter procedures increased approximately 19% compared with the fourth quarter of 2020 and increased approximately 13% using a 2-year CAGR. During the quarter, procedures continued to recover in October and November from the impact of the Delta variant in Q3. However, in December, procedures were adversely impacted by the increase in hospitalizations in the U.S. and parts of Europe as the Omicron variant spread rapidly. This trend has worsened so far into January.

第四季度的主要業務指標如下。與 2020 年第四季度相比，第四季度的程序增加了約 19%，使用 2 年的複合年增長率增加了約 13%。在本季度，程序在 10 月和 11 月繼續從第三季度 Delta 變體的影響中恢復。然而，在 12 月，隨著 Omicron 變體迅速傳播，美國和歐洲部分地區住院人數增加對手術產生了不利影響。到 1 月份為止，這種趨勢已經惡化。

Fourth quarter system placements of 385 increased 18% from the 326 systems placed last year. As a result, net of trade-ins and retirements, we expanded our installed base of da Vinci systems over the last year by 12%. On a 2-year CAGR, our installed base is up 10%. Utilization of clinical systems in the field, measured by procedures per system, increased approximately 7% compared to last year and increased approximately 3% using a 2-year CAGR.

第四季度系統部署 385 個，比去年部署的 326 個系統增加了 18%。因此，扣除以舊換新和退役後，我們在去年將達芬奇系統的安裝基礎擴大了 12%。在 2 年的複合年增長率上，我們的安裝基數增長了 10%。以每個系統的程序衡量，該領域臨床系統的利用率與去年相比增加了約 7%，使用 2 年的複合年增長率計算增加了約 3%。

During the quarter, the supply chain environment became more challenging and remains highly dynamic. Our supply chain teams continue to work tirelessly with our supply chain partners to fulfill customer demand. In Q4, we experienced minor constraints in our ability to meet customer demand. For example, we had some limitations on supply of skill simulators. While these constraints were relatively minor and were immaterial to our overall Q4 financial results, they highlight the risk of potential significant disruption to our manufacturing operations due to the current supply chain challenges.

本季度，供應鏈環境變得更具挑戰性，並保持高度活躍。我們的供應鏈團隊繼續與我們的供應鏈合作夥伴孜孜不倦地合作，以滿足客戶的需求。在第四季度，我們在滿足客戶需求的能力方面遇到了一些小的限制。例如，我們對技能模擬器的供應有一些限制。雖然這些限制相對較小，對我們的整體第四季度財務業績無關緊要，但它們突顯了由於當前供應鏈挑戰而對我們的製造業務造成潛在重大破壞的風險。

U.S. procedures grew approximately 16% over Q4 2020 with relative strength in bariatrics, cholecystectomy and hernia repair. The December impact of the current wave of COVID on U.S. procedures varied by region, with a greater impact in the Northeast and Midwest. Benign procedures such as benign hysterectomy experienced a more significant impact in December, reflecting the deferrability of certain elective surgeries. In Europe, the impact on COVID on procedures in December was most notable in France and Italy.

美國的手術比 2020 年第四季度增長了約 16%，在減肥、膽囊切除術和疝氣修復方面具有相對優勢。當前 COVID 浪潮對美國程序 12 月的影響因地區而異，在東北部和中西部的影響更大。良性子宮切除術等良性手術在 12 月受到了更顯著的影響，這反映了某些擇期手術的延期。在歐洲，COVID 對 12 月程序的影響在法國和意大利最為顯著。

Despite the fact that hospitals are generally better equipped to handle COVID patients today compared to the outset of the pandemic, COVID-19 resurgences like those currently being experienced in the U.S. and parts of Europe have challenged hospital resources and have negatively impacted da Vinci procedures.

儘管與大流行開始時相比，今天的醫院通常能夠更好地處理 COVID 患者，但像目前在美國和歐洲部分地區所經歷的 COVID-19 死灰復燃已經對醫院資源構成挑戰，並對達芬奇程序產生了負面影響。

In the U.S., high COVID-related hospitalization rates have been exacerbated by staffing shortages. According to data reported by the Department of Health and Human Services, the proportion of hospitals reporting a critical staffing shortage doubled between July and December. In addition, delays in diagnosis and treatment of underlying conditions have and will also negatively impact da Vinci procedures.

在美國，人員短缺加劇了與 COVID 相關的高住院率。根據衛生與公眾服務部報告的數據，報告嚴重人員短缺的醫院比例在 7 月至 12 月期間翻了一番。此外，潛在疾病的診斷和治療延誤已經並將也將對達芬奇程序產生負面影響。

Q4 procedures in Asia were not significantly impacted by a resurgence in COVID, and we saw strong procedure growth across multiple specialties in China, Korea and Japan. While it is difficult to predict how long the current wave of COVID will last or the extent to which it will impact additional geographies, we expect that da Vinci procedures will be significantly adversely impacted in Q1. Brian will provide additional procedure commentary later in this call.

亞洲的第四季度程序並未受到 COVID 死灰復燃的顯著影響，我們看到中國、韓國和日本的多個專科的程序增長強勁。雖然很難預測當前的 COVID 浪潮將持續多長時間或它將在多大程度上影響其他地區，但我們預計達芬奇程序將在第一季度受到重大不利影響。 Brian 將在本次電話會議的稍後部分提供額外的程序評論。

Overall system placement results in Q4 were solid with U.S. placements of 235, up 20% from 196 in Q4 of 2020. System placements at greenfield customers were strong, up approximately 45% as compared to Q4 of 2020, driven by U.S. IDNs and new customers in OUS markets. Outside the U.S., we placed 150 systems in the fourth quarter compared with 130 in the fourth quarter of 2020. Current quota system placements included 63 into Europe, 37 into Japan and 14 into China, compared with 54 into Europe, 22 into Japan and 13 into China in the fourth quarter of 2020. Capital strength in Japan was driven primarily by new customers in the private sector.

第四季度的整體系統佈局結果穩健，美國佈局為 235，比 2020 年第四季度的 196 增長 20%。受美國 IDN 和新客戶的推動，新建客戶的系統佈局強勁，與 2020 年第四季度相比增長約 45%在 OUS 市場。在美國以外，我們在第四季度放置了 150 個系統，而 2020 年第四季度為 130 個。當前的配額系統放置包括歐洲 63 個、日本 37 個和中國 14 個，而歐洲 54 個、日本 22 個和 13 個2020 年第四季度進入中國。日本的資本實力主要由私營部門的新客戶推動。

As of the end of 2021, there were 63 systems remaining under the current quota in China, which may be accessible to competitors should they receive local regulatory clearance. Globally, trade and transactions represented 30% of placements in the quarter, down from 40% last quarter and 49% for 2020. The remaining installed base of SI systems in the U.S. is approximately 343 systems.

截至 2021 年底，中國現有配額內剩餘 63 個系統，如果獲得當地監管許可，競爭對手可能可以使用這些系統。在全球範圍內，貿易和交易占本季度安置的 30%，低於上一季度的 40% 和 2020 年的 49%。美國 SI 系統的剩余安裝基數約為 343 個系統。

We expect the volume of trade-ins to be significantly lower in 2022 as compared to 2021. Macroeconomic conditions created by COVID, including supply chain constraints and staffing shortages, are challenging and could impact hospital capital spending. In addition, as competition progresses in various markets, we will likely experience longer selling cycles and price pressure.

與 2021 年相比，我們預計 2022 年的以舊換新交易量將顯著降低。COVID 造成的宏觀經濟條件（包括供應鏈限制和人員短缺）具有挑戰性，並可能影響醫院的資本支出。此外，隨著各個市場競爭的加劇，我們可能會經歷更長的銷售週期和價格壓力。

Additional revenue statistics and trends are as follows. Total fourth quarter revenue was $1.55 billion, an increase of 17% from last year. Leasing represented 37% of Q4 placements compared with 41% last quarter and flat to Q4 of 2020. The lower leasing mix in Q4 relative to last quarter reflected higher multisystem placements with a couple of IDNs who prefer to purchase systems. While leasing will fluctuate from quarter-to-quarter, we continue to expect that the proportion of placements under operating leases will continue to increase over time.

其他收入統計數據和趨勢如下。第四季度總收入為 15.5 億美元，比去年增長 17%。租賃佔第四季度安置的 37%，而上一季度為 41%，與 2020 年第四季度持平。第四季度與上一季度相比較低的租賃組合反映了多系統安置的增加，其中一些 IDN 更願意購買系統。雖然租賃會隨著季度的變化而波動，但我們仍然預計經營租賃下的配售比例將隨著時間的推移而繼續增加。

Fourth quarter system average selling prices were $1.45 million, similar to $1.43 million last year and lower than $1.57 million last quarter. The sequential decline was primarily driven by a higher mix of bulk buy transactions with large customers. We recognized $26 million of lease buyout revenue in the fourth quarter compared with $25 million last quarter and $14 million last year. Lease buyout revenue has varied significantly quarter-to-quarter and will likely continue to do so.

第四季度系統平均售價為 145 萬美元，與去年同期的 143 萬美元相似，低於上季度的 157 萬美元。環比下降主要是由於與大客戶的大宗購買交易組合增加。我們在第四季度確認了 2600 萬美元的租賃收購收入，而上一季度為 2500 萬美元，去年為 1400 萬美元。租賃收購收入在每個季度之間變化很大，並且可能會繼續如此。

Instrument and accessory revenue per procedure was approximately $1,940 per procedure compared with $1,900 per procedure in the third quarter of 2021 and down 6% from $2,060 realized in the fourth quarter of last year. The year-over-year decrease primarily reflects the benefit of stocking orders in Q4 of 2020 associated with the launch of our extended use instruments program in the U.S. and Europe. The sequential increase primarily reflects continued growth of our advanced instrument portfolio.

每次手術的儀器和附件收入約為 1,940 美元，而 2021 年第三季度的每次手術收入為 1,900 美元，比去年第四季度的 2,060 美元下降 6%。同比下降主要反映了 2020 年第四季度的庫存訂單與我們在美國和歐洲推出擴展使用儀器計劃相關的好處。環比增長主要反映了我們先進儀器組合的持續增長。

As we highlighted recently, revenue for our advanced instrument portfolio has grown over a 5-year period at a compound annual growth rate of 35%, and we are starting to see early and accelerating adoption in OUS markets. 10 of the systems placed in the fourth quarter were SP systems, including 3 systems placed at customers in Korea. Our installed base of SP systems is now 99.

正如我們最近強調的那樣，我們先進儀器產品組合的收入在 5 年內以 35% 的複合年增長率增長，我們開始看到早期和加速在 OUS 市場的採用。第四季度放置的系統中有 10 個是 SP 系統，其中 3 個系統放置在韓國的客戶處。我們的 SP 系統安裝基數現在是 99。

During the quarter, we further developed our SP ecosystem, receiving 510(k) clearance for our Firefly imaging technology. We also received 510(k) clearance for enhancements to our SP instruments, including an extension of lives to 6 of our 8 instruments. Growth of the SP platform will continue to be gated by additional clinical indications and clearances in markets beyond the U.S. and Korea.

在本季度，我們進一步發展了我們的 SP 生態系統，我們的 Firefly 成像技術獲得了 510(k) 許可。我們還收到了 510(k) 許可，用於增強我們的 SP 儀器，包括延長我們 8 種儀器中的 6 種儀器的壽命。 SP 平台的增長將繼續受到美國和韓國以外市場的額外臨床適應症和許可的限制。

We placed 31 Ion systems in the quarter, bringing the installed base to 129 systems. Looking at the 93 Ion systems placed in 2021, 54% of those systems were placed under operating lease arrangements. For reference, the list price of our Ion system is $600,000 with ASPs generally a little below that level. As a reminder, Ion system placements and procedures are excluded from our overall system and procedure counts.

我們在本季度安裝了 31 個 Ion 系統，使安裝基礎達到 129 個系統。從 2021 年放置的 93 個 Ion 系統來看，這些系統中有 54% 是根據經營租賃安排放置的。作為參考，我們 Ion 系統的標價為 600,000 美元，平均售價通常略低於該水平。提醒一下，離子系統放置和程序不包括在我們的整體系統和程序計數中。

The entirety of our Ion installed base is with an existing da Vinci customers, the majority of which have large pulmonary and thoracic departments. Our Ion platform is also installed at the majority of accounts that have an IP fellowship program. We continue to be encouraged by customer feedback and look forward to the completion of our next major milestone, the full results from the PRECIsE study, which is expected in the second half of 2022.

我們的整個 Ion 安裝基礎都與現有的達芬奇客戶合作，其中大多數客戶擁有大型肺科和胸科。我們的 Ion 平台也安裝在大多數擁有 IP 獎學金計劃的賬戶中。我們繼續受到客戶反饋的鼓舞，並期待著完成我們的下一個重要里程碑，即 PRECISE 研究的全部結果，預計將於 2022 年下半年完成。

Moving on to gross margin and operating expenses. Pro forma gross margin for the fourth quarter of 2021 was 70.1% compared with 69.7% for the fourth quarter of 2020 and 71.3% last quarter. The fourth quarter of 2020 included higher period costs associated with lower production and higher excess and obsolete inventory charges. Pro forma gross margin was lower than last quarter primarily as a result of manufacturing inefficiencies and higher logistics costs associated with the supply chain environment, lower system ASPs and a higher mix of systems revenue.

繼續討論毛利率和運營費用。 2021 年第四季度的備考毛利率為 70.1%，而 2020 年第四季度為 69.7%，上一季度為 71.3%。 2020 年第四季度包括與較低產量以及較高的過剩和過時庫存費用相關的較高期間成本。預計毛利率低於上一季度，主要是由於製造效率低下和與供應鏈環境相關的更高物流成本、更低的系統平均售價和更高的系統收入組合。

Pro forma operating expenses increased 27% compared with the fourth quarter of 2020. The fourth quarter of 2021 included a $30 million contribution to the Intuitive Foundation compared with the $25 million contribution in the fourth quarter of 2020. The increase in fourth quarter operating expenses from a year ago reflected an increase in head count, increased variable compensation and higher travel costs.

與 2020 年第四季度相比，備考運營費用增加了 27%。與 2020 年第四季度的 2500 萬美元相比，2021 年第四季度包括對直覺基金會的 3000 萬美元捐款。一年前反映了員工人數增加、可變薪酬增加和差旅費用增加。

We finished 2021 with almost 9,800 employees, an increase of 21% from the end of 2020. We believe the opportunity in robotic-assisted interventions to be significant and are planning to increase our investments significantly in 2022. We are at the early stages of our newer platforms, SP and Ion, and we will continue to invest in our digital and data capabilities. Brian will provide operating expense guidance later in this call.

我們在 2021 年結束時擁有近 9,800 名員工，比 2020 年底增長了 21%。我們相信機器人輔助干預的機會是巨大的，併計劃在 2022 年顯著增加我們的投資。我們正處於我們的早期階段更新的平台，SP 和 Ion，我們將繼續投資於我們的數字和數據能力。布賴恩將在本次電話會議稍後提供運營費用指導。

As Gary described, we are also investing in our infrastructure to support our growth objectives and facilitate our ability to scale. In 2022, we expect a significant increase in capital expenditures, in the range of $700 million to $1 billion of capital investment for the year. A significant portion of this investment involves construction of facilities to provide incremental space for growth, to consolidate operations to enhance efficiency and to replace leased spaces with owned spaces. These capital investments also expand our OUS footprint in support of opportunities for growth in key international markets, where da Vinci procedures are in earlier stages of adoption. These are multiyear investments.

正如 Gary 所描述的，我們還在投資基礎設施以支持我們的增長目標並促進我們的擴展能力。到 2022 年，我們預計資本支出將顯著增加，全年資本投資在 7 億美元至 10 億美元之間。這項投資的很大一部分涉及設施建設，以提供增量增長空間，整合運營以提高效率，並用自有空間取代租賃空間。這些資本投資還擴大了我們的 OUS 足跡，以支持主要國際市場的增長機會，達芬奇程序在這些市場處於採用的早期階段。這些是多年投資。

Our pro forma effective tax rate for the fourth quarter was 19.5%, lower than our expectation, primarily due to a favorable U.S./OUS income mix. We expect that our pro forma tax rate will increase in 2022 due to a previous change in U.S. tax law that became effective on January 1, 2022. Brian will provide details later in this call.

我們第四季度的備考有效稅率為 19.5%，低於我們的預期，主要是由於有利的美國/美國收入組合。我們預計，由於美國稅法的先前變更於 2022 年 1 月 1 日生效，我們的備考稅率將在 2022 年增加。布賴恩將在本次電話會議稍後提供詳細信息。

Our fourth quarter 2021 pro forma net income was $477 million or $1.30 per share compared with $434 million or $1.19 per share for the fourth quarter of 2020.

我們 2021 年第四季度的備考淨收入為 4.77 億美元或每股 1.30 美元，而 2020 年第四季度為 4.34 億美元或每股 1.19 美元。

I will now summarize our GAAP results. GAAP net income was $381 million or $1.04 per share for the fourth quarter of 2021 compared with GAAP net income of $365 million or $1.01 per share for the fourth quarter of 2020. 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 IP charges, acquisition-related items and legal settlements.

我現在將總結我們的 GAAP 結果。 2021 年第四季度的 GAAP 淨收入為 3.81 億美元或每股 1.04 美元，而 2020 年第四季度的 GAAP 淨收入為 3.65 億美元或每股 1.01 美元。備考和 GAAP 淨收入之間的調整在我們的概述和量化網站並包括與員工股票獎勵、員工股票薪酬、無形資產攤銷和知識產權費用、收購相關項目和法律和解相關的超額稅收優惠。

We ended the year with cash and investments of $8.6 billion compared with $6.9 billion at December 31, 2020. The increase in cash in the fourth quarter primarily reflected cash generated from operations. We did not repurchase any shares during the quarter.

截至今年年底，我們的現金和投資為 86 億美元，而截至 2020 年 12 月 31 日為 69 億美元。第四季度現金的增加主要反映了運營產生的現金。我們在本季度沒有回購任何股票。

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

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

Thank you, Jamie. Overall procedure growth for the full year 2021 was approximately 28% as compared to 1% in 2020 and increased 14% using a 2-year compound annual growth rate. Overall procedure growth was comprised of 27% growth in the U.S. and 32% growth in OUS markets.

謝謝你，傑米。與 2020 年的 1% 相比，2021 年全年的整體程序增長約為 28%，並且使用 2 年的複合年增長率增長了 14%。整體程序增長包括美國 27% 的增長和 OUS 市場 32% 的增長。

In the U.S., fourth quarter growth was driven by growth in procedures within general surgery. Bariatrics, cholecystectomy and hernia repair were the largest contributors to procedure growth within the quarter. Fourth quarter OUS procedure volume grew approximately 28% compared with 11% for the fourth quarter of 2020 and 30% last quarter.

在美國，第四季度的增長是由普通外科手術的增長推動的。減肥、膽囊切除術和疝修補術是本季度手術增長的最大貢獻者。與 2020 年第四季度的 11% 和上一季度的 30% 相比，第四季度 OUS 程序量增長了約 28%。

In 2021, we non-urology specialties approached half of all OUS procedures and grew faster than urologic procedures. More specifically, at a region and country level, in China, Q4 procedures also had broad-based growth in urology, thoracic, general surgery and gynecology. General surgery, thoracic and gynecology procedures grew faster than urology and combined, made up more than total urology procedures in the fourth quarter.

2021 年，我們的非泌尿科專科接近了所有 OUS 手術的一半，並且增長速度快於泌尿科手術。更具體地說，在地區和國家層面，在中國，第四季度手術在泌尿外科、胸外科、普外科和婦科領域也有廣泛的增長。普外科、胸科和婦科手術的增長速度快於泌尿外科，並且在第四季度的總和超過了泌尿外科的總和。

In Japan, da Vinci Prostatectomy has emerged as standard of care for the surgical treatment of prostate cancer. We have also gained significant market share in other urologic procedures, including partial nephrectomy and cystectomy. The robust growth that we continue to see in Japan is now attributable to growth in general surgery, thoracic and gynecology procedures that were granted reimbursement status subsequent to urologic procedures. In Europe, procedure performance varied by country, but in procedures outside of urology, growth was driven by colorectal, hysterectomy for cancer and thoracic procedures.

在日本，達芬奇前列腺切除術已成為前列腺癌手術治療的標準護理。我們還在其他泌尿外科手術中獲得了重要的市場份額，包括部分腎切除術和膀胱切除術。我們在日本繼續看到的強勁增長現在歸因於普通外科、胸科和婦科手術的增長，這些手術在泌尿外科手術後獲得了報銷資格。在歐洲，手術表現因國家而異，但在泌尿外科以外的手術中，增長是由結直腸、癌症子宮切除術和胸外科手術推動的。

Now turning to the clinical side of our business. I'll highlight 2 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。我將重點介紹最近發表的兩項我們認為值得注意的研究。但是，為了更全面地了解證據主體，我們鼓勵所有利益相關者徹底審查多年來發表的科學研究的廣泛細節。

During the quarter, researchers from the University Hospital of Southern Jutland and the University of Southern Denmark published results from a systematic review and meta analysis, evaluating the short-term outcomes of robotic-assisted and laparoscopic colon surgery for patients with cancer. This analysis included 20 studies from 2005 to 2020, describing comparing outcomes from over 13,000 subjects with over 1,500 robotic-assisted procedures and over 12,000 laparoscopic procedures.

在本季度，南日德蘭大學醫院和南丹麥大學的研究人員公佈了系統回顧和薈萃分析的結果，評估了機器人輔助和腹腔鏡結腸手術對癌症患者的短期結果。該分析包括 2005 年至 2020 年的 20 項研究，描述了 13,000 多名受試者與 1,500 多項機器人輔助手術和 12,000 多項腹腔鏡手術的結果比較。

Between the 2 groups, a significant difference favoring the robotic-assisted approach demonstrated a 46% lower risk of anastomotic leakage. In addition, robotic-assisted colon surgery showed a 69% lower risk of conversion to open when compared to the laparoscopic approach, while also demonstrating a 15% reduction in the overall complication rate, favoring the robotic-assisted approach and a 7-hour reduction in time to regular diet.

在兩組之間，有利於機器人輔助方法的顯著差異表明吻合口漏的風險降低了 46%。此外，與腹腔鏡手術相比，機器人輔助結腸手術的中轉開腹風險降低了 69%，同時整體並發症發生率降低了 15%，有利於機器人輔助手術並減少 7 小時及時規律飲食。

Interestingly, a subgroup analysis was performed analyzing right-sided hemicolectomies, noting the prevalence of this procedure in the study is analyzed. And with over 850 subjects in the robotic-assisted group and over 3,000 subjects in the laparoscopic group, the robotic-assisted approach was similarly favored with regards to anastomotic leakage, rate of conversion to open and length of stay.

有趣的是，對右側半結腸切除術進行了亞組分析，並指出分析了該程序在研究中的普遍性。機器人輔助組有超過 850 名受試者，腹腔鏡組有 3,000 多名受試者，機器人輔助方法在吻合口漏、中轉率和住院時間方面同樣受到青睞。

The authors concluded in part, "robotic-assisted colon surgery showed advantages in colon cancer surgery regarding surgical efficacy and morbidity compared to laparoscopic colon surgery."

作者部分得出結論，“與腹腔鏡結腸手術相比，機器人輔助結腸手術在結腸癌手術中顯示出在手術效果和發病率方面的優勢。”

In November of last year, Christopher Seder from Rush University Medical Center in Chicago, published propensity-adjusted analysis comparing robotic-assisted and thoracoscopic anatomic lung resection in obese patients. Leveraging data from the Society of Thoracic Surgeons general thoracic database, Epithor, a French National Database and McMaster University thoracic surgical database, over 8,000 subjects were identified for analysis with over 2,100 robotic-assisted subjects and over 5,900 VATS subjects included.

去年 11 月，芝加哥拉什大學醫學中心的 Christopher Seder 發表了對肥胖患者進行機器人輔助和胸腔鏡解剖肺切除術的傾向調整分析。利用來自胸外科醫師協會普通胸科數據庫、Epithor、法國國家數據庫和麥克馬斯特大學胸外科數據庫的數據，確定了 8,000 多名受試者進行分析，其中包括 2,100 多名機器人輔助受試者和 5,900 多名 VATS 受試者。

After propensity score adjustments of the populations, the VATS patient showed a 15% rate of conversion to open compared to only 3% in the robotic cohort, which corresponded to risk of conversion 5x higher for the VATS approach. In addition, the robotic-assisted group demonstrated a shorter mean length of stay of approximately 0.7 days, 1% lower risk of respiratory failure and were more likely to be discharged home after the procedure.

在對人群進行傾向評分調整後，VATS 患者的開胸轉化率為 15%，而機器人隊列中僅為 3%，這對應於 VATS 方法的轉化風險高出 5 倍。此外，機器人輔助組的平均住院時間更短，約為 0.7 天，呼吸衰竭的風險降低了 1%，並且更有可能在手術後出院回家。

Of note, this analysis is the first propensity-adjusted analysis comparing VATS and robotic-assisted anatomic lung resection in obese patients as well as the first to pull contemporary international patient level data. The authors concluded in part, "Overall, these data suggest that obese patients with early stage nonsmall cell lung cancer undergoing minimally invasive anatomic lung resection with VATS have a higher rate of conversion to thoracotomy when compared to patients undergoing anatomic lung resection with robotic-assisted surgery."

值得注意的是，這項分析是第一個比較肥胖患者的 VATS 和機器人輔助解剖肺切除術的傾向調整分析，也是第一個提取當代國際患者水平數據的分析。作者部分總結道：“總體而言，這些數據表明，與接受機器人輔助解剖肺切除術的患者相比，接受 VATS 微創解剖肺切除術的肥胖早期非小細胞肺癌患者的開胸率更高。手術。”

I will now turn to our financial outlook for 2022. Starting with procedures. As described in our announcement earlier this month, total 2021 da Vinci procedures grew approximately 28% year-over-year and 14% at a 2-year compound annual growth rate to roughly 1,594,000 procedures performed worldwide.

我現在將轉向我們對 2022 年的財務展望。從程序開始。正如我們在本月早些時候的公告中所述，2021 年達芬奇手術總數同比增長約 28%，以 2 年復合年增長率增長 14%，達到全球約 1,594,000 例手術。

During 2022, we anticipate full year procedure growth within a range of 11% to 15%. This range reflects the uncertainty associated with the course of the pandemic. The low end of this range assumes ongoing COVID pressure and hospital staffing shortages, while the high end assumes no significant new surges after the current wave. In addition, this range does not contemplate any material supply chain disruptions throughout the year.

在 2022 年，我們預計全年程序增長將在 11% 至 15% 之間。該範圍反映了與大流行病程相關的不確定性。該範圍的低端假設持續的 COVID 壓力和醫院人員短缺，而高端假設在當前浪潮之後沒有顯著的新激增。此外，該範圍不考慮全年任何材料供應鏈中斷。

We expect 2022 procedure growth to continue to be driven by U.S. general surgery and procedure growth in OUS markets where we are at earlier stages of adoption. We expect similar seasonal timing of procedures in 2022 as we have experienced in previous years prior to COVID, with Q1 being seasonally -- the seasonally weakest quarter as patient deductibles are reset. We expect Omicron to have a significant adverse impact on procedures in the first quarter.

我們預計 2022 年的手術增長將繼續受到美國普通外科手術和 OUS 市場手術增長的推動，我們處於早期採用階段。我們預計 2022 年的程序的季節性時間安排與我們在 COVID 之前的前幾年經歷的相似，第一季度是季節性的——由於患者免賠額被重置，這是季節性最弱的季度。我們預計 Omicron 將在第一季度對程序產生重大不利影響。

With respect to revenue, as we have mentioned previously, capital sales are ultimately driven by procedure demand, catalyzing hospitals to establish or expand robotic system capacity. Capital sales can vary substantially from period-to-period based upon many factors, including U.S. health care policy, hospital capital spending cycles, reimbursement and government quotas, product cycles, economic cycles and competitive factors. Within this framework, we'd expect 2022 capital placement seasonality to generally follow historical patterns by quarter, but could also be impacted by hospital staff shortages and the allocation of resources to managing current care.

關於收入，正如我們之前提到的，資本銷售最終是由程序需求驅動的，促使醫院建立或擴大機器人系統能力。基於許多因素，包括美國醫療保健政策、醫院資本支出週期、報銷和政府配額、產品週期、經濟周期和競爭因素，資本銷售在不同時期可能會有很大差異。在此框架內，我們預計 2022 年的資本配置季節性將按季度大致遵循歷史模式，但也可能受到醫院人員短缺和管理當前護理的資源分配的影響。

During Q3 and Q4, 40% and 30%, respectively, of systems placements involve trade-ins of older systems to our da Vinci Xi. As we mentioned last quarter, we expect the volume of trade-ins to be significantly lower in 2022 as compared to 2021.

在第三季度和第四季度，分別有 40% 和 30% 的系統配置涉及將舊系統以舊換新到我們的 da Vinci Xi。正如我們上個季度提到的，我們預計 2022 年的以舊換新交易量將比 2021 年顯著降低。

Turning to gross profit. Our full year 2021 pro forma gross profit margin was 71.2%. In 2022, we expect our pro forma gross profit margin to be within a range of between 69.5% and 70.5% of net revenue. The slightly lower gross profit margin anticipated in 2022 reflects higher fixed costs from investments to drive growth of the business, strengthen our operating capabilities and also reflects the impact of higher supply chain costs. Our actual gross profit margin will vary quarter-to-quarter depending largely on product, regional and trade-in mix and the impact of new product introductions.

轉向毛利。我們 2021 年全年的備考毛利率為 71.2%。 2022年，我們預計我們的備考毛利率將在淨收入的69.5%至70.5%之間。預計 2022 年毛利率略低，反映了為推動業務增長、加強我們的運營能力而投資的固定成本較高，也反映了供應鏈成本上升的影響。我們的實際毛利率將隨季度變化，主要取決於產品、區域和以舊換新組合以及新產品推出的影響。

Turning to operating expenses. In 2021, our pro forma operating expenses grew 19%. In 2022, we expect pro forma operating expense growth to be between 21% and 27%. The operating expense growth reflects increased investment in R&D for our new product platforms, expanding OUS capabilities and the return of other spending that was previously restricted by COVID.

轉向運營費用。 2021 年，我們的備考運營費用增長了 19%。到 2022 年，我們預計備考運營費用增長將在 21% 至 27% 之間。運營費用的增長反映了我們對新產品平台研發投資的增加、OUS 能力的擴展以及之前受 COVID 限制的其他支出的回報。

We expect our noncash stock compensation expense to range between $510 million to $550 million in 2022 compared to $452 million in 2021. We expect other income, which is comprised mostly of interest income, to total between $45 million and $55 million in 2022.

我們預計 2022 年我們的非現金股票補償費用將在 5.1 億美元至 5.5 億美元之間，而 2021 年為 4.52 億美元。我們預計其他收入（主要包括利息收入）在 2022 年將在 4500 萬美元至 5500 萬美元之間。

With regard to income tax, in 2021, our pro forma income tax rate was 22.2%. As we look forward, we estimate our 2022 pro forma tax rate to be between 22% and 24% of pretax income, with the increase primarily due to a change in U.S. tax treatment of certain expenditures that was enacted in 2017, but became effective on January 1, 2022.

在所得稅方面，2021年，我們的備考所得稅率為22.2%。展望未來，我們估計 2022 年的備考稅率將在稅前收入的 22% 至 24% 之間，增加主要是由於 2017 年頒布的美國對某些支出的稅收待遇發生了變化，但在2022 年 1 月 1 日。

Lastly, we'd like to highlight that our Annual Sustainability Report will be available after this call on our Investor Relations website. In the latest report, we provide an overview of the current state of our sustainability strategy, areas of focus, key actions taken over the past year to develop sustainable solutions that meet our customer needs in new ways and our results achieved to date.

最後，我們要強調的是，我們的年度可持續發展報告將在本次電話會議之後在我們的投資者關係網站上提供。在最新報告中，我們概述了我們可持續發展戰略的現狀、重點領域、過去一年為開發可持續解決方案以新方式滿足客戶需求而採取的主要行動以及我們迄今為止取得的成果。

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

我們準備好的評論到此結束。我們現在將打開您的問題的電話。

(Operator Instructions) Our first question is going to come from the line of Larry Biegelsen from Wells Fargo.

（操作員說明）我們的第一個問題將來自富國銀行的 Larry Biegelsen。

Two questions for me. Gary, I wanted to start with a high-level question. You started using the slogan, at the point of possibility, recently, and you've talked about being at the point of possibility to build what's needed next. Can you talk about why you started using this new slogan? And what are the needs you're trying to address? And I had one follow-up.

我有兩個問題。加里，我想從一個高級問題開始。你最近開始使用這個口號，在可能性點上，你已經談到在可能性點上構建下一步需要的東西。你能談談你為什麼開始使用這個新口號嗎？您要解決的需求是什麼？我有一個跟進。

No. I think we have -- thanks, Larry. I think we have a broad opportunity as a company here to take the methods that we have designed around identifying clinical need, doing the design and development of tech-enabled ecosystems to address that need and then working with customers to deliver it and train it.

不，我想我們有——謝謝，拉里。我認為，作為一家公司，我們在這裡有一個廣泛的機會來採用我們設計的方法來識別臨床需求，設計和開發技術支持的生態系統來滿足這一需求，然後與客戶合作交付並培訓它。

And there's, I think, long term, a lot of opportunity. As we look out, there is substantial opportunity in existing markets and in new ones to do better for the quad aim. Doing this set, getting that set of ecosystem investments ready is a heavy work. It's a multiyear effort. But we think we've shown that it can be done. And I think that's really what we're talking about here is the ability to start to impact other opportunities in interventional markets as we go forward. And Ion is such an example.

我認為，從長遠來看，有很多機會。正如我們所看到的，現有市場和新市場都有大量機會為四邊形目標做得更好。做這一套，準備好一套生態系統投資是一項繁重的工作。這是多年的努力。但我們認為我們已經證明這是可以做到的。我認為我們在這裡真正談論的是隨著我們的前進開始影響干預市場中其他機會的能力。離子就是這樣一個例子。

And it seems like so far, you've mitigated potential supply constraints well. How are you trying to mitigate them going forward? And would you describe the situation is getting better or worse? And how concerned are you about that?

到目前為止，您似乎已經很好地緩解了潛在的供應限制。您將如何嘗試減輕它們的影響？你會描述情況是好轉還是惡化？你對此有多擔心？

Yes. Kind of -- I'll take the top and then I'll let Jamie take some more. At the very top part, it's kind of 3 big buckets. One of them is specific products themselves, semiconductors come to mind. The second bucket is some raw material constraints and the kinds of things we build. And the third is just logistics and motion and materials.

是的。有點——我會佔據上風，然後讓傑米再拿一些。在最頂部，它是 3 個大桶。其中之一是特定產品本身，例如半導體。第二個桶是一些原材料限制和我們建造的東西。第三個只是物流、運動和材料。

Jamie, I'll let you fill in that perspective.

傑米，我會讓你填寫這個觀點。

Larry, so I think we said in our prepared remarks, we saw the supply chain environment actually get worse in Q4, and we highlighted that we actually had some, as I call it, minor constraints in our ability to fulfill customer demand. You have a set of metrics there in the supply chain. One example we've given is on-time delivery from our suppliers was worse in Q4 as compared to Q3.

拉里，所以我認為我們在準備好的評論中說過，我們看到供應鏈環境在第四季度實際上變得更糟，我們強調我們實際上在滿足客戶需求的能力方面存在一些（我稱之為）小的限制。您在供應鏈中有一組指標。我們給出的一個例子是，與第三季度相比，第四季度供應商的準時交付情況更差。

As you look forward, I'd say that at this point, visibility is still not great. Kind of the best read that we have is the Q1 will be similar-ish to Q4, but I think we have to see -- wait and see what the impact of Omicron might be on our suppliers and just broadly. So I think we're continuing to navigate through it. As I said, our supply chain teams are really still in hand-to-hand combat every day working with our partners.

正如你所期待的那樣，我想說的是，在這一點上，能見度仍然不是很好。我們所擁有的最好的解讀是第一季度將與第四季度相似，但我認為我們必須看到 - 等等，看看 Omicron 可能對我們的供應商產生什麼影響，而且只是廣泛的影響。所以我認為我們正在繼續瀏覽它。正如我所說，我們的供應鏈團隊每天都在與我們的合作夥伴進行肉搏戰。

Our next question now will come from the line of Tycho Peterson from JPMorgan.

我們現在的下一個問題將來自摩根大通的 Tycho Peterson。

Gary, you talked about being at the end of the replacement cycle for a little while now. And obviously, you're retiring the S models. I'm curious how we should interpret that comment about being near the end of the replacement cycle. And as we think about maybe where you could be headed from an innovation standpoint, is it all about kind of driving down the length of procedures, making procedures easier with less training and expanding into newer indications? Or maybe just I'm curious, from a technology standpoint, if you could talk a little bit about at a high level where you're headed.

加里，你談到現在處於更換週期的最後一段時間。顯然，您正在淘汰 S 型號。我很好奇我們應該如何解釋關於更換週期即將結束的評論。當我們從創新的角度思考你可能會走向何方時，這是否只是為了縮短程序的長度，通過更少的培訓使程序更容易，並擴展到新的適應症？或者也許只是我很好奇，從技術的角度來看，如果你能在高層次上談談你的目標。

Yes. Let's talk for a moment about replacement cycles. I think you're referring to the SI. Jamie had mentioned it in his prepared remarks, and Brian had touched on it. I think they were pretty clear, and I won't go through that. I do think that from a business model point of view, we don't think that we need to drive capital upgrades on Intuitive's calendar to have a healthy business.

是的。讓我們談談更換週期。我想你指的是SI。傑米在他準備好的講話中提到了它，布賴恩也談到了它。我認為他們很清楚，我不會講這些。我確實認為，從商業模式的角度來看，我們認為我們不需要在 Intuitive 的日曆上推動資本升級才能擁有健康的業務。

What we look at is where can we drive the Quadruple Aim and how can we effectively do that for our customers. And in that setting, we have been investing in our Gen 4 platform and expansion. I talked about that in my prepared remarks as well. And it's been great for the customers and for us. That's not the only thing we'll do, but it's an important thing that we do.

我們關注的是我們可以在哪裡推動四重目標，以及我們如何有效地為我們的客戶做到這一點。在這種情況下，我們一直在投資我們的第 4 代平台和擴展。我在準備好的發言中也談到了這一點。這對客戶和我們來說都很棒。這不是我們要做的唯一事情，但這是我們要做的重要事情。

You had mentioned a little bit on the technology stack, what are the kinds of things we care about. And a lot of what we were driven by are what kinds of things can we do inside the body in imaging, in informatics that will dramatically change outcomes or the experience of the patients or the care team. And that has -- you can see that in the kinds of things that we've brought to market.

您在技術堆棧上提到了一點，我們關心的事情是什麼。很多我們的動力是我們可以在體內在成像中做什麼樣的事情，在信息學中，這將極大地改變結果或患者或護理團隊的體驗。這已經 - 你可以在我們推向市場的各種東西中看到這一點。

We have fantastic teams. We have things that we're working on that we have not yet discussed that we think will drive differences in outcomes. So it's not just working on new indications or just working on ease of use. I think those things are both important, but it's not limited to that. There are other things that are going on that we think can change the nature of our interaction with tissue and drive outcomes again and raise the bar there once more.

我們有很棒的團隊。我們有一些我們正在處理但尚未討論的事情，我們認為這些事情會導致結果的差異。因此，它不僅僅是研究新的適應症，也不僅僅是研究易用性。我認為這兩件事都很重要，但不僅限於此。我們認為還有其他正在發生的事情可以改變我們與組織相互作用的性質並再次推動結果並再次提高那裡的標準。

Jamie, anything you'd want to add on the issue of SI replacement cycle?

Jamie，關於 SI 更換週期問題，您有什麼要補充的嗎？

I would just maybe give you some numbers. In 2021, globally, we did about 510 trade-ins. About 80%-ish of those were in the U.S. U.S. has been driving those trade-ins. And so then if you compare that to the remaining installed base of 343, it's why we provided the commentary that we expect overall trade-in volume in '22 to be significantly lower than '21 just because the remaining installed base is being depleted.

我可能會給你一些數字。 2021 年，我們在全球範圍內進行了大約 510 次以舊換新。其中大約 80% 在美國。美國一直在推動這些以舊換新。因此，如果您將其與 343 的剩余安裝基數進行比較，這就是為什麼我們提供評論說，我們預計 22 年的整體以舊換新量將大大低於 21 年，因為剩餘的安裝基數正在耗盡。

Okay. That's helpful. And speaking of innovation, can you touch on some of the SP enhancements? You talked about 510 clearance for extension of life for some of the instruments. Can you just clarify exactly what you got through?

好的。這很有幫助。說到創新，你能談談SP的一些增強嗎？您談到了延長某些儀器壽命的 510 許可。你能澄清一下你到底經歷了什麼嗎？

Yes. So we've received, obviously, customer feedback along the way since we launched SP and some of our customers have asked for greater ability to do extraction. That's really around the range of motion within the anatomy of our instruments that do extraction and grip strength, as you grasp tissue. We've had customer feedback that we could improve the grip strength. And so along with the extension of lives, we responded to customer feedback and improved the instruments accordingly, as described.

是的。因此，很明顯，自從我們推出 SP 以來，我們已經收到了客戶反饋，我們的一些客戶要求更高的提取能力。當您抓握組織時，這實際上是在我們的器械解剖結構內的運動範圍內，這些器械可以進行提取和握力。我們有客戶反饋，我們可以提高握力。因此，隨著壽命的延長，我們回應了客戶的反饋並相應地改進了儀器，如前所述。

We've done some other things, too. We have, as you know, dual console that helps with training of new surgeons and teaching environments. We extended the dual console capability into the SP space recently. We've launched and then upgraded some of the accessories that go with SP. So part of the process, for those of you who've been with us for a while, is continuous innovation that these things don't end where they start, and that's been true for SP.

我們還做了一些其他的事情。如您所知，我們擁有雙控制台，可幫助培訓新外科醫生和教學環境。我們最近將雙控制台功能擴展到了 SP 領域。我們已經推出併升級了一些 SP 附帶的配件。因此，對於那些在我們這里工作了一段時間的人來說，這個過程的一部分是不斷創新，這些事情不會從開始的地方結束，對於 SP 來說也是如此。

Great. One last one, just on the head count. You started to call off highlighting all the additions last year. Should we think about kind of similar magnitude of increase in '22?

偉大的。最後一個，就在人數上。去年你開始取消突出顯示所有添加的內容。我們是否應該考慮 22 年類似的增長幅度？

I think if you look at the OpEx increase range that Brian provided, I think you can kind of draw a correlation between how head count has kind of correlated to spending increase and I think that's a relevant starting point for '22.

我認為，如果您查看 Brian 提供的 OpEx 增加範圍，我認為您可以在員工人數與支出增加之間建立相關性，我認為這是 22 年的相關起點。

We also gave you a mix in the script of kind of where they're headed, how much is R&D, how much is operations, commercial. And that's not a bad guide either as to kind of where the mix is going.

我們還在腳本中為您提供了他們的發展方向、研發費用、運營費用、商業費用等內容。對於混合的發展方向，這也不是一個糟糕的指南。

Our next question then will come from the line of Amit Hazan from Goldman Sachs.

我們的下一個問題將來自高盛的 Amit Hazan。

I'll start with a shorter-term one, and then a longer-term one for Gary. Shorter term, just on the first quarter, just realizing the moving parts and it's fluid inside of the quarter. But how much help can you give us as to what you've seen so far? How do we model procedures in this environment? You said severely impacted, but we got to -- we have to put a number out there. So I'm curious, how much help you can give us for where the procedures are down at the moment or how much they're down, that would be terrific.

我將從短期的開始，然後是加里的長期。短期來看，就在第一季度，剛剛意識到活動的部分，並且在季度內部是流動的。但是，到目前為止，您可以為我們提供多少幫助？我們如何在這種環境中為程序建模？你說受到了嚴重影響，但我們必須——我們必須在那裡公佈一個數字。所以我很好奇，你可以為我們提供多少幫助，說明目前程序在哪里或它們下降了多少，那將是非常棒的。

And then also, on capital. If you're seeing anything quite yet in terms of delays in capital spending because of everything going on at hospital level and how we should think about '22 for capital spending relative to last year, what you feel the environment is like?

然後，關於資本。如果您還看到由於醫院層面發生的一切而導致資本支出延遲的任何事情，以及我們應該如何看待與去年相比的 22 年資本支出，您覺得環境是什麼樣的？

Amit, I'll give you a couple of data points. So the greatest correlation we've seen historically on procedures is rates of hospitalizations. I believe that currently, U.S. hospitalizations related to COVID are beyond any of the previous waves. So I think you can kind of track how that has progressed so far and what some of the third parties are projecting for the remainder of the quarter. There's some modeling benefit to doing that.

阿米特，我會給你幾個數據點。因此，我們在歷史上看到的關於程序的最大相關性是住院率。我相信，目前，美國與 COVID 相關的住院人數超出了之前的任何一波浪潮。因此，我認為您可以跟踪到目前為止的進展情況以及一些第三方對本季度剩餘時間的預測。這樣做有一些建模的好處。

What I would point to is if you look at pre-COVID, so 2017, '18, '19, those -- the sequential change between Q4 and Q1 was about even, meaning it was about the same Q1 as Q4. So that's in a normal quarter. Most of the current wave will be in Q1. The impact of Omicron in Q4 was kind of later in the quarter. So I'd kind of start with a normal quarter would be flat sequentially and then model the rest of Q1 based on just hospitalization rates.

我要指出的是，如果你看一下 COVID 之前的情況，那麼 2017 年、'18 年、'19 年，那些 - 第四季度和第一季度之間的連續變化大約是均勻的，這意味著它與第一季度大致相同。所以這是一個正常的季度。當前的大部分浪潮將在第一季度。 Omicron 在第四季度的影響是在本季度晚些時候。所以我會從一個正常的季度開始，按順序持平，然後根據住院率對第一季度的剩餘時間進行建模。

With respect to capital, there's nothing at this point that we would call out. I do think that the combination of what's happening right now with COVID, along with staffing shortages, along with the extent to which the supply chain environment broadly could impact hospitals, could make it challenging for hospital capital spending. They may manage that more carefully in such an environment. But there's nothing specific that we would call out at this point.

關於資本，目前我們沒有什麼可以說的。我確實認為，當前與 COVID 一起發生的事情，加上人員短缺，以及供應鏈環境對醫院的廣泛影響，可能會給醫院的資本支出帶來挑戰。在這樣的環境中，他們可能會更謹慎地管理。但在這一點上，我們沒有什麼具體的要說的。

What was the third part of your question, Amit?

你的問題的第三部分是什麼，阿米特？

No. That was actually -- I just have a longer-term one for Gary on just given some of your comments that you made, it just kind of brings up in my mind just to ask you about what your thoughts generally are about a SaaS-type model and more specifically, the SimNow. We've talked to some of your customers over the past year or so. And it seems like some of them are being charged for SimNow software somewhere around $20,000 a year in the service line. And so I wanted to see how you would frame that specific opportunity inside of kind of thinking about it with your installed base? And then more broadly and more importantly, just to see -- if you could just talk to this kind of SaaS type of model and whether you'll -- we'll be seeing more of these types of offerings from you in the future?

不。那實際上是——我只是給 Gary 寫了一個長期的，剛剛給出了你的一些評論，它只是在我腦海中浮現，只是想問你對 SaaS 的總體看法-type 模型，更具體地說，是 SimNow。在過去一年左右的時間裡，我們已經與您的一些客戶進行了交談。似乎他們中的一些人在服務線上每年為 SimNow 軟件收取大約 20,000 美元的費用。所以我想看看你如何在你的安裝基礎上考慮這個特定的機會？然後更廣泛和更重要的是，只是想看看——如果你能談談這種 SaaS 類型的模型，你是否會——我們將來會看到更多這類產品？

Sure. On the issue of kind of recurring revenue or service models versus kind of capital single charge, we have taken a posture of being really flexible with what our customer wants. There are some really nice things about as the transition -- as the company has transitioned to a recurring model that customers can come to choose when they're ready to engage us and it doesn't require large upfront capital expenditures.

當然。在經常性收入或服務模式與資本單筆收費的問題上，我們採取了對客戶需求非常靈活的態度。過渡有一些非常好的事情——因為公司已經過渡到一種經常性模式，客戶可以在他們準備好與我們互動時選擇這種模式，並且不需要大量的前期資本支出。

For some things that are inherently services and if you think about simulation, it's not really about the hardware in the case of simulation. It's really about access to modules and modules that improve over time and modules that get built to be specific to competency-based training. Subscriptions make a lot of sense because you're not really trying to sell a piece of hardware, you're really helping them develop a training program over time. So we think increasingly, as our business in software and analytics and some of the digital tools that we're bringing come up, then subscriptions may make sense. And to the extent that they align with customers, we're happy to do it.

對於某些本質上是服務的事物，如果您考慮模擬，那麼在模擬的情況下，它實際上與硬件無關。這實際上是關於訪問模塊和模塊，這些模塊會隨著時間的推移而改進，以及專門針對基於能力的培訓而構建的模塊。訂閱很有意義，因為您並不是真的想出售一件硬件，而是隨著時間的推移幫助他們開發培訓計劃。因此，我們越來越多地認為，隨著我們在軟件和分析方面的業務以及我們帶來的一些數字工具的出現，訂閱可能是有意義的。如果他們與客戶保持一致，我們很樂意這樣做。

I also like the idea of recurring revenue and that it focuses the organization on earning the customer's business every day that it's a lot less lumpy for them and it's a lot less lumpy for us. And if we're bringing value and helping them achieve their Quadruple Aim goals, then they're happy to stay with us in those events.

我也喜歡經常性收入的想法，它將組織的重點放在每天為客戶贏得業務上，這對他們來說不那麼笨拙，對我們來說也不那麼笨拙。如果我們帶來價值並幫助他們實現他們的 Quadruple Aim 目標，那麼他們很樂意在這些活動中與我們在一起。

So I would expect that the recurring revenue portion of our business keeps creeping up as a percentage of total revenue over time. So long as customers are aligned to that, that that makes sense from their finances point of view, then that's what we'll pursue. And to the extent that they're interested in other models, then we are open-minded.

因此，我預計隨著時間的推移，我們業務的經常性收入部分佔總收入的百分比會不斷上升。只要客戶對此保持一致，從他們的財務角度來看這是有道理的，那麼這就是我們將追求的。如果他們對其他模型感興趣，那麼我們是開放的。

Our next question now comes from the line of Rick Wise from Stifel.

現在我們的下一個問題來自 Stifel 的 Rick Wise。

Gary, I thought I'd follow up on a couple of things. You highlighted very specifically for both Ion and da Vinci SP. This concept of margins aren't where they will be. And over time, you're going to bring the business to scale. I was wondering if you could expand on that, maybe give us a flavor for where margins are now? And how do we think about -- is this 2 years away? Is it 5 years away? How do we think about the trajectory going forward there?

加里，我想我會跟進幾件事。您特別強調了 Ion 和 da Vinci SP。這種利潤的概念不是他們將在的地方。隨著時間的推移，您將擴大業務規模。我想知道您是否可以對此進行擴展，也許可以讓我們了解一下現在的利潤在哪裡？我們怎麼想——這是兩年後的事嗎？是5年之後嗎？我們如何看待那裡的發展軌跡？

Thanks for the question. On the -- kind of where we're headed, we look at those architectures. And we think based on our experiences, understanding our supply chains, understanding what iterations and engineering and manufacturing look like that both of those platforms should be able to hit historical norms in the future years, and not forever in future years.

謝謝你的問題。在我們前進的方向上，我們著眼於那些架構。我們認為，根據我們的經驗，了解我們的供應鏈，了解迭代以及工程和製造的樣子，這兩個平台應該能夠在未來幾年達到歷史標準，而不是在未來幾年永遠達到標準。

That said, in the early innings here, you're at lower volumes relative to where you're going to be. You're also working through some manufacturing process improvements and doing some of the capital investments that you need to do in order to get unit cost down. I'll look to Jamie in terms of characterizing kind of roughly where they are.

也就是說，在這裡的早期階段，相對於你要去的地方，你的交易量較低。您還在進行一些製造工藝改進，並進行一些您需要做的資本投資，以降低單位成本。我會從 Jamie 的角度來描述他們的大致位置。

SP is a little more mature product line in our hands in terms of manufacturing, and our GM and her team over there are doing a really nice job identifying those opportunities and sequentially knocking them down over time, feels really good. Ion is a little earlier, and it's going through a little bit different growth ramp. And so it's going to have to work its way down that process. Although we also feel good about kind of the core architectures that would -- that give us some confidence that we can hit those objectives.

在製造方面，SP 在我們手中是一個更成熟的產品線，我們的總經理和她的團隊在識別這些機會並隨著時間的推移依次將它們擊倒時做得非常好，感覺非常好。 Ion 稍微早一點，它正在經歷一個有點不同的增長斜坡。所以它必須按照這個過程進行。儘管我們也對能夠實現這些目標的核心架構感到滿意——這讓我們有信心實現這些目標。

Jamie, anything that you would want to add?

傑米，你有什麼要補充的嗎？

Rick, I would split the question kind of into 2 categories. There's gross margin and then there's, let's call it, the equivalent of operating margin. On a gross margin basis, kind of the actions that we have to take to get both Ion and SP to kind of, let's call it, target gross margins are well understood, and it's really about execution over a period of time. A component of that will obviously be building scale. But I think those actions are well defined. They're a multiple-year effort.

里克，我會將問題分為兩類。有毛利率，然後有，我們稱之為，相當於營業利潤率。在毛利率的基礎上，我們必須採取某種行動來讓 Ion 和 SP 達到某種程度，我們稱之為目標毛利率，這實際上是關於一段時間內的執行。其中一個組成部分顯然是建立規模。但我認為這些行動定義明確。他們是多年的努力。

On the operating margin side, it's really what's revenue in relation to the amounts that we're investing. And that's obviously going to be a function of, in the case of Ion, how we adopt in lung cancer biopsy over time. And with SP, it's the additional indications and new geographies in terms of clearances. I don't have a scale for when we might reach those corporate average margins. I would say, though, for '22, given that SP and Ion are newer products, the gross margins there are dilutive as you'd expect.

在營業利潤率方面，這實際上是與我們投資金額相關的收入。對於 Ion 而言，這顯然是隨著時間的推移我們在肺癌活檢中採用的方式的一個函數。有了 SP，就許可而言，這是額外的跡象和新的地理區域。我沒有衡量我們何時可以達到這些公司平均利潤率的規模。不過，我想說的是，對於 22 年，鑑於 SP 和 Ion 是較新的產品，那裡的毛利率會像您預期的那樣稀釋。

Yes. And just a follow-up for me. I mean it's clear you highlighted multi -- sounds multiple ways that Asia from well this quarter, if I understood you correctly, procedures, I think you said robust. And I'm just thinking about that thought in conjunction with your comments about where you're investing. And it sounds like a lot of the investments were in Asia. And I was just wondering if we should just -- how do I ask this. Does this suggest that you're thinking as we look over the next 3 to 5 years that there's more growth opportunity for Intuitive in the Asia Pacific region? Or how do we -- how do I think about those 2 facts and those initiatives, if that makes any sense?

是的。對我來說只是一個後續行動。我的意思是很明顯，你強調了亞洲從本季度開始的多種方式，如果我理解正確的話，程序，我認為你說的是穩健的。我只是結合你對投資地點的評論來考慮這個想法。聽起來很多投資都在亞洲。我只是想知道我們是否應該——我該怎麼問這個問題。這是否表明在我們展望未來 3 到 5 年時，您認為 Intuitive 在亞太地區有更多的增長機會？或者我們如何 - 我如何看待這兩個事實和那些舉措，如果這有意義的話？

I'd characterize it a little bit differently, Rick. The starting point on Asia, it is clearly an interesting market, country by country. We are making investments in Asia. I don't think I'd say that they are the dominant investments, but they're substantial because we think there's substantial opportunity there to make a difference in those markets.

瑞克，我對它的描述會有所不同。亞洲的起點，顯然是一個有趣的市場，一個國家一個國家。我們正在亞洲進行投資。我不認為我會說它們是主要的投資，但它們很重要，因為我們認為那裡有很大的機會在這些市場上有所作為。

So it's a leg of growth, but not the only one. There are opportunities for us in other regions, whether it's Europe or elsewhere. There are also opportunities for us in other clinical indications and some of the clinical trial work we're doing as well as the expansion of platforms and other technologies that we're working on. So I'd characterize it as one of the legs, not necessarily the dominant leg.

因此，它是增長的一部分，但不是唯一的。我們在其他地區也有機會，無論是歐洲還是其他地方。我們在其他臨床適應症和我們正在進行的一些臨床試驗工作以及我們正在研究的平台和其他技術的擴展方面也有機會。所以我會把它描述為一條腿，不一定是優勢腿。

Jamie, anything you would like to add?

傑米，你有什麼要補充的嗎？

I would just say both regions are attractive to us. It's fair to say that at least in the last couple of years, Asia procedure growth has been a little ahead of Europe. But on a strategic view, both of those regions are attractive and we're investing accordingly.

我只想說這兩個地區對我們都很有吸引力。可以公平地說，至少在過去幾年中，亞洲程序的增長一直領先於歐洲。但從戰略角度來看，這兩個地區都很有吸引力，我們正在相應地進行投資。

Our next question now comes from the line of Matt Taylor from UBS.

現在我們的下一個問題來自瑞銀的馬特泰勒。

So I wanted to ask one on innovation and one on competition. So on innovation, I appreciate some of the color that you gave on multiport. And I guess I've also noticed that you've -- on your website, you've been hiring a lot of folks in kind of these endoluminal roles and looking at roles around things like node surgery. Could you talk about some of your investments there? Is there anything beyond what you're doing with SP and Ion that we should look out for? And overall, are there any bigger launches that we should expect this year, even if you're not going to tell them what they are, could you characterize what the cadence could look like of any kind of system upgrades or launches?

所以我想問一個關於創新和一個關於競爭的問題。所以關於創新，我很欣賞你在多端口上給出的一些顏色。而且我想我也注意到你已經 - 在你的網站上，你一直在僱用很多人擔任這些腔內角色，並關注諸如節點手術之類的角色。你能談談你在那裡的一些投資嗎？除了你對 SP 和 Ion 所做的事情之外，還有什麼我們應該注意的嗎？總的來說，今年我們應該期待什麼更大的發布，即使你不打算告訴他們它們是什麼，你能描述一下任何類型的系統升級或發布的節奏嗎？

Yes. On the -- with regard to kind of forecasting future launches, of course, we won't give you any detail here. We'll launch them when we're ready to launch. In terms of the framing of your question, we are routinely developing applications for the platforms we have, whether it's bariatrics and thoracic surgery in our multiport indications to new indications in SP, and we're doing some trials in thoracic surgery and colorectal, to new opportunities in flexible robotics and Ion.

是的。關於 - 關於預測未來發布的類型，當然，我們不會在這里為您提供任何細節。我們將在準備好發佈時發布它們。就您的問題的框架而言，我們正在定期為我們擁有的平台開發應用程序，無論是我們的多端口適應症中的減肥和胸外科手術，還是 SP 的新適應症，我們正在胸外科和結直腸癌方面進行一些試驗，以柔性機器人和 Ion 的新機遇。

And other platform investments that are currently not disclosed, the things that we're working on. So we're going to continue to do that. And some of them will come to fruition and be fantastic. And some of them may be things that we assess and then pivot as we learn more. So there's all of those things going on. And somebody was out scanning what we're hiring and scanning the kinds of patent applications we have. You'll see a great diversity of things we're interested.

以及其他目前未披露的平台投資，我們正在做的事情。所以我們將繼續這樣做。其中一些將取得成果並且非常棒。其中一些可能是我們評估的東西，然後隨著我們了解更多而轉向。所以所有這些事情都在發生。有人在外面掃描我們正在招聘的東西並掃描我們擁有的專利申請類型。你會看到我們感興趣的各種各樣的東西。

And it's a little bit like the first question on the call, when we say what are we talking about in terms of possibility. We really scour the acute intervention opportunity from the bottom of your feet to the top of your head and everything in between and start asking questions about whether we think there's a real opportunity for improvements in the quad aim and whether we could design a tech-enabled ecosystem to do something about it.

這有點像電話會議上的第一個問題，當我們說我們在談論可能性時。我們真的從腳底到頭頂以及介於兩者之間的所有東西都搜索了急性干預機會，並開始詢問我們是否認為有改進四邊形目標的真正機會以及我們是否可以設計一個技術支持的生態系統對此做點什麼。

And that's what informs a lot of that hiring. Some of it is near term in existing platforms. And some of it is future oriented on platforms that may come to pass. So that's kind of how we think about it.

這就是大量招聘的原因。其中一些在現有平台上是近期的。其中一些面向未來的平台可能會實現。這就是我們的想法。

Okay. And maybe just one on competition.

好的。也許只是一個關於競爭的。

Matt, we'll give you one follow-up.

馬特，我們會給你一個跟進。

Okay. Just on competition, you mentioned there's a potential for that to prolong selling cycle. It certainly doesn't seem like you're seeing any of that so far. Could you characterize whether there's been any change in the competitive environment to date versus a few quarters ago?

好的。就競爭而言，您提到有可能延長銷售週期。到目前為止，您似乎沒有看到任何這些。您能否描述一下與幾個季度前相比，迄今為止的競爭環境是否有任何變化？

Certainly, you can see that competition is active at accounts. I think we've characterized that mostly as kind of reciprocal arrangements with respect to training center investments or reciprocal research investments. I don't think we call out any specific significant impact yet on selling cycles. But certainly, you can see the potential for it over time.

當然，您可以看到帳戶中的競爭很活躍。我認為我們已經將其描述為關於培訓中心投資或互惠研究投資的互惠安排。我認為我們尚未對銷售週期提出任何具體的重大影響。但可以肯定的是，隨著時間的推移，你會看到它的潛力。

All right. Well, thank you all. That was our last question. In closing, we continue to believe there is a substantial and durable opportunity to fundamentally improve surgery and acute interventions. Our teams continue to work closely with hospitals, physicians and care teams in pursuit of what our customers have termed the Quadruple Aim: better, more predictable patient outcomes; better experiences for patients; better experiences for their care teams; and ultimately, a lower total cost of care.

好的。嗯，謝謝大家。那是我們的最後一個問題。最後，我們仍然相信存在從根本上改善手術和急性干預的實質性和持久的機會。我們的團隊繼續與醫院、醫生和護理團隊密切合作，以追求我們的客戶所說的四重目標：更好、更可預測的患者結果；為患者提供更好的體驗；為他們的護理團隊提供更好的體驗；並最終降低總護理成本。

We believe value creation in surgery and acute care is foundationally human. It flows from respect for and understanding of patients and care teams, their needs and their environment. At Intuitive, we envision a future of care that is less invasive and profoundly better where diseases are identified earlier and treated quickly so patients can get back to what matters most.

我們相信，手術和急症護理的價值創造從根本上說是人性化的。它源於對患者和護理團隊、他們的需求和環境的尊重和理解。在 Intuitive，我們設想了一個侵入性更小、更好的護理未來，即更早發現并快速治療疾病，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.

感謝您對這次非凡旅程的支持。我們期待在 3 個月後再次與您交談。

Ladies and gentlemen, that will conclude our conference for today. Thank you for your participation for using AT&T Event Services. You may now disconnect.

女士們，先生們，今天的會議到此結束。感謝您參與使用 AT&T Event Services。您現在可以斷開連接。