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，感謝您的耐心等待，歡迎參加 Intuitive 2021 財年第四季財報電話會議。 （操作說明）提醒您，本次電話會議正在錄音。

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

現在我將會議交給主持人，直覺外科公司投資人關係主管布萊恩金。請開始吧。

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。下午好，歡迎參加Intuitive第四季財報電話會議。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, 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2021年2月10日提交的最新10-K表格和於2021年10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 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，本次電話會議的音訊回放可在我們網站intuitive.com的「投資者關係」頁面下的「最新動態」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 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所述的第四季度業績；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；我將討論流程和臨床方面的亮點，並展望 2022 年的財務前景。最後，我們將進行問答環節。

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

接下來，我將把麥克風交給蓋瑞。

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.

感謝您今天蒞臨本次活動。 2021年，我們克服了重重困難，靈活應對，為客戶提供支援並管理供應鏈。我們的團隊表現出色，在疫情允許的情況下幫助客戶恢復手術，並維護了供應鏈和員工隊伍的穩定性。

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.

鑑於我們最近發布的新聞稿更新了流程、資本配置和收入情況，我將簡要介紹我們 2021 年全年業績，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.

回顧2021年，在新冠疫情期間，市場對我們機器人輔助手術的需求仍然強勁。雖然這些手術在疫情高峰期有所延誤，但隨著疫情消退，它們又會恢復，這令人鼓舞。疫情對醫療系統帶來的壓力凸顯了我們產品所支持的高品質、微創手術的必要性。

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.

微創手術可以更多地用於門診手術，與其他方法相比可以釋放資源和手術室，並且通常能夠讓患者更快地回家並實現整體康復。

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，達文西手術量較2020年全年成長28%，反映出疫情第一波衝擊後外科手術業務的部分復甦。 2020年至2021年兩年間，手術量複合年增長率為14%。 2021年，設備安裝狀況良好，我們的團隊當年共安裝了1,347台達文西手術系統和93台Ion手術系統，達文西手術系統安裝量較2020年增長44%，過去兩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.

過去兩年，手術量複合年增長率達 14%，同期裝置容量成長 10%，疫情期間已安裝系統的使用率持續攀升。我們認為這對我們的客戶和我們自己都是利好消息。稍後，Jamie 將介紹區域資本趨勢，Brian 將詳細闡述手術量動態。

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.

過去兩年，我們面臨的壓力遠不止醫療系統。吸引、培養和留住優秀人才仍然是我們工作的首要任務。我們的團隊表現出色，為客戶和彼此提供了強有力的支援。在過去一年中，我們新增了約1700名員工，其中研發部門淨增加約180人，營運部門淨增加約920人，銷售部門淨增加約340人。在這1700名新增員工中，有700名來自美國以外的地區。

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，我們開發的這套方法——先識別臨床需求，然後設計一個技術驅動的生態系統來改進四重目標，最後交付並培訓客戶使用這個生態系統——能夠對廣泛的微創手術產生積極影響。 Intuitive 面臨的機會和挑戰在於，如何發展我們的生態系統，以大規模地支持我們的客戶和我們自身，並選擇真正合理的手術機會和平台架構。

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.

展望中期投資，我們的首要任務是將資金用於業務再投資，開發能夠提升「四重目標」的新機遇，並加強我們在全球的營運能力。我們正致力於推動一系列至關重要的舉措，我想更詳細地向大家介紹這些舉措的具體內容。

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.

在多端口手術領域，我們相信我們的第四代架構卓越非凡。自產品線推出以來，我們不斷為其增添功能，包括大幅擴展和升級能量和縫合產品線、改進內視鏡成像、推出達文西X手術系統、推出擴展型器械、培訓技術，以及最終推出全新升級的連接和數據管理工具。鑑於我們第四代機器人架構的精準性、穩健性和整體性能，我們將繼續在此平台上進行創新，為已採用第四代設備的客戶帶來更多價值。

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.

我們也正在投資開發多埠系統的新核心功能，包括第四代及以後的產品，我們將在產品接近市場時進行詳細介紹。您可以期待我們在這方面持續創新。

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.

接下來談談 Ion。我們的首個適應症旨在滿足肺癌活檢領域巨大的未滿足需求，目前我們的重點是全面提升產能並完善客戶生態系統，以支持該適應症。肺活檢的需求強勁，我們正努力擴大所有製程的生產能力，以期在規模化生產中實現更高的品質和更低的成本，同時開展臨床試驗並滿足監管要求，從而實現全球擴張。隨著時間的推移，我們計劃透過實現產量、設計和製程改進目標，使 Ion 專案的整體獲利能力逐步接近公司平均值。我們正在探索 Ion 的其他應用，並將在接近上市時公佈相關資訊。

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.

對於我們的單孔系統而言，達文西SP有望改變兩種不同類型軟組織手術的治療標準：一是需要透過單一小孔切除組織的手術，二是受益於全身小切口的手術。目前，Ion系統僅針對單一適應症，但其目標患者群體龐大；而SP系統的優點在於整合多個中等規模的適應症。

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，在美國，SP在經口機器人手術中的應用正在穩定成長。為了擴大SP在美國及其他市場的應用範圍，我們正在進行臨床試驗以支援監管批准。我們相信SP將服務更多外科專科，這將使我們的客戶和我們本身能夠更好地利用在該專案中的資本投資。與Ion一樣，我們計劃SP平台的獲利能力隨著時間的推移逐步接近以往平台的水平，並且我們對近期的進展感到鼓舞。

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.

目前，我們面向客戶的數位投資約佔總營運支出的5%，並從四個方面推動業務發展。首先，客戶利用數據和數位化工具分析營運情況，有助於改善績效、降低成本並提高客戶滿意度和留存率。其次，數位化和內部投資可以降低我們服務客戶的成本。第三，我們的一些數位化工具本身就能創造收入。最後，內部數據和分析的應用可以幫助我們的團隊做出更明智的決策。

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.

由於數位化和數據工具涵蓋我們所有平台，並應用於內部和外部，因此我們不採用與平台相同的財務模型對其進行核算，也不將其作為獨立的財務引擎進行單獨分析。儘管如此，我們仍會根據內部策略和回報分析來評估數位化和數據項目。

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.

過去五年，我們儀器的年產量增加了約200%，系統年產量增加了一倍以上。每年接受培訓的客戶專業人員數量幾乎翻了一番，工程人員數量也增加了近兩倍。產品銷售的成長也使我們能夠將部分大批量配件的生產納入內部，同時投資自動化。這帶來了三重好處：增強供應鏈的穩健性、提高製造品質和降低單位成本。

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、研發和生產規模不斷擴大，我們正在增加對基礎設施、工廠建設、培訓中心擴建和自動化方面的投資。這些基礎設施投資並非一次性投入，而我們目前的成長週期也需要不斷提升產能。這些項目已在過去幾年中規劃完畢，並將於2022年開始逐步攤銷，2023年和2024年攤銷幅度更大，之後將在未來幾年內逐步恢復正常。

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，我們將擴大和整合位於亞特蘭大的營運、研發和客戶培訓設施；將我們在墨西卡利的生產規模擴大一倍；將我們在加州總部的研發設計空間和營運空間擴大一倍；最後，整合並擴大我們在德國弗萊堡的商業、培訓、營運和研發空間。

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，我們將鞏固第四代多端口技術，同時在多端口手術的臨床應用方面進行創新。我們將持續擴大柔性內視鏡平台 Ion 的規模，提升產能、品質並降低成本，同時尋求拓展新市場。在 SP 領域，我們計劃在區域市場拓展適應症，同時提升生產品質和規模。我們將投資全球區域培訓、研發和生產中心，以支援業務成長，並尋求利用規模優勢實現營運槓桿的機會，其中部分機會將與客戶分享，以促進彈性市場的擴張。最後，我們將持續推動數位轉型，以便與客戶和公司共同做出快速、準確且切實可行的決策。

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，針對2022年，我們將重點放在以下幾個面向。首先，在疫情持續影響下，我們將提供卓越的客戶支援。其次，我們將推動機器人和數位化平台的拓展，以開拓新的適應症和市場。第三，我們將致力於在美國發展一般外科業務。最後，我們將拓展美國以外地區（泌尿科以外）的多元化業務。

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.

在我們開始財務報告之前，我謹正式感謝即將卸任的首席財務官兼新任全球業務服務主管馬歇爾·莫爾先生在過去 15 年中的出色領導，並將時間交給即將上任的首席財務官傑米·薩馬斯先生，他將更詳細地向大家介紹財務事宜。

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.

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，我將在準備好的演講稿中概述我們按GAAP準則編制的業績。備考財務報表與GAAP財務報表的調節表已發佈在我們的網站上。

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.

第四季和2021年的收入和業務流程與我們1月12日發布的初步新聞稿一致。在深入探討第四季業績之前，請容許我先概述我們2021年全年的業績。鑑於新冠疫情的重大影響，我們認為有必要從同比和兩年複合年增長率兩個角度來審視我們2021年的業績。

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，手術量增加了 28%，以兩年複合年增長率計算，成長約 14%。年內，我們為客戶安裝了 1,347 套系統，與 2020 年相比成長了 44%，以兩年複合年增長率計算，成長了 10%。由於手術量和系統安裝量的良好表現，2021 年營收年增 31%，以兩年複合年增長率計算，成長了 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.

第四季的關鍵業務指標如下。第四季手術量較2020年第四季成長約19%，以兩年複合年增長率計算成長約13%。本季度，手術量在10月和11月持續從第三季Delta變異株的影響中恢復。然而，12月，由於Omicron變異株迅速蔓延，美國和歐洲部分地區的住院人數增加，手術量受到不利影響。這一趨勢在1月進一步惡化。

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.

第四季系統安裝量為385套，較去年同期的326套成長18%。因此，扣除以舊換新和退役設備後，我們達文西手術系統的裝機量較去年增加了12%。以兩年複合年增長率計算，我們的裝機量成長了10%。臨床系統在現場的使用率（以每套系統完成的手術量衡量）較去年增長約7%，以兩年複合年增長率計算，增長約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，且仍處於高度動態變化之中。我們的供應鏈團隊與供應鏈夥伴持續不懈努力，以滿足客戶需求。第四季度，我們在滿足客戶需求方面遇到了一些小的瓶頸。例如，技能模擬器的供應受到一定限制。雖然這些限制相對較小，對我們第四季的整體財務業績影響不大，但它們凸顯了當前供應鏈挑戰可能導致我們的生產營運出現重大中斷的風險。

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.

2020年第四季，美國手術量成長約16%，其中減重手術、膽囊切除術和疝氣修補術表現相對強勁。新冠疫情在12月對美國手術量的影響因地區而異，東北部和中西部地區受到的影響更大。良性手術，例如良性子宮切除術，在12月受到的影響更為顯著，這反映出某些擇期手術可以延後。在歐洲，新冠疫情對12月手術量的影響在法國和義大利最為明顯。

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.

儘管與疫情爆發初期相比，如今醫院在應對新冠患者方面總體上更加得心應手，但像目前美國和歐洲部分地區正在經歷的新冠肺炎疫情反彈，已經對醫院資源構成了挑戰，並對達文西手術產生了負面影響。

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，新冠肺炎相關的高住院率因醫護人員短缺而加劇。根據美國衛生與公共服務部公佈的數據，7月至12月期間，報告嚴重人手短缺的醫院比例翻了一番。此外，潛在疾病的診斷和治療延誤已經並將繼續對達文西手術產生負面影響。

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.

亞洲第四季的手術量並未受到新冠疫情反彈的顯著影響，我們在中國、韓國和日本的多個專科領域均實現了強勁的手術量增長。雖然目前難以預測新冠疫情的持續時間及其對其他地區的影響程度，但我們預計達文西手術量將在第一季受到顯著的負面影響。布萊恩將在本次電話會議稍後提供更多關於手術量的分析。

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.

第四季整體系統部署績效穩健，美國地區部署235套系統，較2020年第四季的196套成長20%。新建客戶的系統部署表現強勁，較2020年第四季成長約45%，主要得益於美國IDN（整合交付網路）及美國境外市場新客戶的推動。在美國以外地區，第四季共部署150套系統，而2020年第四季為130套。目前配額涵蓋的系統部署包括歐洲63套、日本37套和中國14套，而2020年第四季分別為歐洲54套、日本22套和中國13套。日本市場的強勁成長主要得益於私部門新客戶的加入。

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，中國現有配額下還剩63套系統，如果競爭對手獲得當地監管部門的批准，則可能獲得這些配額。在全球範圍內，本季貿易和交易佔總安裝量的30%，低於上季的40%和2020年的49%。美國剩餘的SI系統安裝基數約為343套。

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.

我們預計2022年的舊機置換量將顯著低於2021年。新冠疫情帶來的宏觀經濟情勢，包括供應鏈受阻和人員短缺等問題，都構成了挑戰，並可能影響醫院的資本支出。此外，隨著各市場競爭加劇，我們可能會面臨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。第四季總營收為15.5億美元，較去年同期成長17%。租賃佔第四季部署總量的37%，低於上季的41%，與2020年第四季持平。第四季租賃佔比低於上季度，反映出多系統部署比例較高，部分綜合交付網路（IDN）傾向購買系統。儘管租賃佔比會隨季度波動，但我們仍然預計，經營租賃部署的比例將隨著時間的推移而持續成長。

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.

第四季系統平均售價為145萬美元，與去年同期的143萬美元基本持平，但低於上一季的157萬美元。環比下降的主要原因是與大客戶的大量採購交易佔比增加。第四季我們確認了2,600萬美元的租賃買斷收入，高於上一季的2,500萬美元和去年同期的1,400萬美元。租賃買斷收入的季度間波動較大，預計未來仍將如此。

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.

器械及配件的單次手術收入約為1,940美元，而2021年第三季為1,900美元，較去年第四季的2,060美元下降6%。年比下降主要反映了2020年第四季因在美國和歐洲推出延展性器材項目而獲得的庫存訂單收益。環比成長主要反映了我們先進器械產品組合的持續成長。

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.

正如我們近期重點介紹的，過去五年，我們先進儀器產品組合的收入複合年增長率達到35%，並且我們開始看到這些產品在海外市場得到早期且加速的推廣應用。第四季安裝的系統中，有10套是SP系統，其中包括3套安裝在韓國客戶處。目前，我們的SP系統裝置量已達99套。

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.

本季度，我們進一步發展了SP生態系統，Firefly成像技術獲得了510(k)許可。此外，我們的SP儀器增強功能也獲得了510(k)許可，其中包括延長8台儀器中6台的使用壽命。 SP平台的成長將繼續受到美國和韓國以外市場更多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.

本季我們安裝了 31 套 Ion 系統，使總裝機量達到 129 套。回顧 2021 年安裝的 93 套 Ion 系統，其中 54% 的系統採用營業租賃方式。作為參考，我們 Ion 系統的標價為 60 萬美元，平均售價通常略低於此價格。需要注意的是，Ion 系統的安裝和手術數量不計入我們的系統和手術總數。

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.

我們所有 Ion 系統的安裝用戶均為達文西手術系統的現有客戶，其中大多數擁有龐大的肺科和胸腔外科。此外，大多數設有感染預防與治療專科醫師訓練課程的機構也安裝了我們的 Ion 平台。客戶的回饋持續激勵我們，我們期待下一個重要里程碑的完成—PRECIsE 研究的完整結果將於 2022 年下半年公佈。

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.

接下來是毛利率和營運費用。 2021年第四季的備考毛利率為70.1%，而2020年第四季為69.7%，上一季為71.3%。 2020年第四季包含因產量下降和庫存積壓及報廢費用增加而導致的較高期間成本。備考毛利率低於上一季的主要原因是生產效率低下、供應鏈環境導致的物流成本上升、系統平均售價下降、系統收入佔比上升。

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.

2021年第四季備考營運費用較2020年第四季成長27%。 2021年第四季捐款給直覺基金會3,000萬美元，而2020年第四季捐款金額為2,500萬美元。第四季營運費用較上年同期成長，主要原因是員工人數增加、可變薪資提高以及差旅費用上漲。

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.

截至2021年底，我們擁有近9,800名員工，較2020年底成長21%。我們認為機器人輔助介入領域蘊藏著巨大的發展機遇，並計劃在2022年大幅增加相關投資。我們目前正處於新平台SP和Ion的早期研發階段，並將持續加大對數位化和資料能力的投入。 Brian將在本次電話會議稍後提供營運費用的預期。

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所述，我們也在投資基礎設施，以支持我們的成長目標並提升規模化能力。 2022年，我們預期資本支出將大幅成長，年度資本投資額將介於7億至10億美元之間。這筆投資的很大一部分將用於建造新設施，以提供更多成長空間，整合營運以提高效率，並將租賃空間替換為自有空間。這些資本投資也將擴大我們在美國境外的業務範圍，以支持在關鍵國際市場（達文西手術尚處於早期應用階段）的成長機會。這些都是多年期投資。

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.

我們第四季的備考實際稅率為19.5%，低於預期，主要原因是美國境內/境外所得組成較為有利。我們預計，由於美國稅法先前的一項變更已於2022年1月1日生效，我們的備考稅率將在2022年上升。布萊恩將在本次電話會議稍後提供詳細資訊。

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 年第四季的備考淨收入為 4.77 億美元，即每股 1.30 美元，而 2020 年第四季的備考淨收入為 4.34 億美元，即每股 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.

現在我將總結我們的GAAP業績。 2021年第四季GAAP淨利為3.81億美元，合每股1.04美元，而2020年第四季GAAP淨利為3.65億美元，合每股1.01美元。備考淨利潤與GAAP淨利潤之間的調整項目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、無形資產攤銷和知識產權費用、收購相關項目以及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.

截至年底，我們的現金及投資總額為86億美元，而2020年12月31日為69億美元。第四季現金增加主要反映了經營活動產生的現金流。本季我們沒有回購任何股票。

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

接下來，我將把發言權交給布萊恩，他將討論臨床亮點並展望 2022 年。

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。 2021年全年手術量整體成長約28%，而2020年僅1%，以兩年複合年增長率計算則增加了14%。其中，美國市場成長27%，美國以外市場成長32%。

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，第四季的成長主要得益於一般外科手術量的成長。其中，減重手術、膽囊切除術和疝氣修補術是本季手術量增加的主要貢獻者。第四季美國外科手術量成長約28%，而2020年第四季為11%，上一季為30%。

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，非泌尿科專科手術量接近所有體外超音波手術的一半，且成長速度超過泌尿外科手術量。更具體地說，從區域和國家層級來看，在中國，第四季泌尿外科、胸腔外科、一般外科和婦科手術量均呈現全面成長。其中，一般外科、胸腔外科和婦科手術量的成長速度超過泌尿外科，且三者合計在第四季度超過了泌尿外科手術總量。

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，達文西攝護腺切除術已成為攝護腺癌外科治療的標準療法。我們在其他泌尿外科手術領域，包括部分腎切除術和膀胱切除術，也獲得了顯著的市場份額。我們在日本持續強勁的成長，主要歸功於一般外科、胸腔外科和婦科手術的成長，這些手術在泌尿科手術後也獲得了健保報銷資格。在歐洲，手術表現因國家而異，但在泌尿外科以外的手術領域，成長主要由大腸直腸手術、子宮癌切除術和胸腔外科手術推動。

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.

現在我們來談談業務的臨床方面。我將重點介紹兩項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。

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.

本季度，南日德蘭大學醫院和南丹麥大學的研究人員發表了一項系統性回顧和統合分析的結果，評估了機器人輔助結腸手術和腹腔鏡結腸手術治療結腸癌患者的短期療效。該分析納入了2005年至2020年間的20項研究，比較了超過13,000名受試者的治療結果，其中包括超過1500例機器人輔助手術和超過12,000例腹腔鏡手術。

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.

兩組患者中，機器人輔助手術組的吻合口滲漏風險顯著降低46%。此外，與腹腔鏡手術相比，機器人輔助結腸手術的轉為開腹手術風險降低了69%，整體併發症發生率降低了15%，且恢復正常飲食的時間縮短了7小時。

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.

值得注意的是，一項針對右半結腸切除術的次族群分析指出，該手術在本研究中較為常見。機器人輔助組有超過850例患者，腹腔鏡組有超過3000例患者，結果顯示，在吻合口滲漏、中轉開腹率和住院時間方面，機器人輔助手術同樣具有優勢。

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."

作者們得出的部分結論是：“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的療效和併發症方面顯示出優勢。”

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，芝加哥拉許大學醫學中心的克里斯多福‧塞德發表了一項傾向性評分調整分析，比較了機器人輔助和胸腔鏡解剖性肺切除術在肥胖患者中的療效。該研究利用了胸腔外科醫師協會一般胸腔外科資料庫、法國國家資料庫Epithor以及麥克馬斯特大學胸腔外科資料庫的數據，共納入8,000多名受試者進行分析，其中2,100多位接受了機器人輔助手術，5,900多位接受了胸腔鏡輔助手術。

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.

在對族群進行傾向評分調整後，VATS 組患者的轉開胸手術率為 15%，而機器人輔助手術組僅 3%，VATS 組的轉開胸手術風險是機器人輔助手術組的 5 倍。此外，機器人輔助手術組的平均住院時間更短（約 0.7 天），呼吸衰竭風險降低 1%，術後出院的可能性更高。

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，這項分析是首個對肥胖患者進行傾向性評分調整後比較胸腔鏡輔助肺切除術和機器人輔助肺解剖切除術的分析，也是首個納入最新國際患者層面數據的分析。作者在結論中指出：“總體而言，這些數據表明，與接受機器人輔助肺解剖切除術的患者相比，接受胸腔鏡輔助肺解剖切除術的早期非小細胞肺癌肥胖患者中，轉為開胸手術的比例更高。”

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.

接下來，我將談談我們對2022年的財務展望。首先是手術量。正如我們本月稍早發布的公告所述，2021年達文西手術總量年增約28%，兩年複合年增長率達14%，全球手術量約為159.4萬例。

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.

我們預計2022年全年手術量成長率將介於11%至15%之間。這一區間反映了疫情發展帶來的不確定性。此區間的下限假設新冠疫情持續蔓延，醫院人員短缺；而上限則假設當前疫情後不會出現新的疫情高峰。此外，該區間並未考慮全年可能出現的任何重大供應鏈中斷。

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年手術量成長將繼續由美國一般外科手術以及我們目前處於早期推廣階段的美國境外市場（OUS）的手術量成長所驅動。我們預計2022年的手術量季節性變化與新冠疫情前的往年類似，第一季通常是淡季，因為患者自付額會進行調整。我們預計Omicron將對第一季的手術量產生顯著的負面影響。

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.

關於收入方面，正如我們之前提到的，資本支出最終受手術需求驅動，促使醫院建立或擴大機器人系統。資本支出會因許多因素而顯著波動，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、經濟週期以及競爭因素。在此框架下，我們預計2022年的資本投入季節性將大致遵循歷史季度模式，但也可能受到醫院人員短缺以及資源分配用於維持現有醫療服務的影響。

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.

第三季和第四季，分別有40%和30%的系統安裝涉及用舊系統置換我們的達文西Xi手術系統。正如我們上個季度所提到的，我們預計2022年的置換量將比2021年大幅下降。

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.

接下來談談毛利。我們2021年全年的備考毛利率為71.2%。 2022年，我們預期備考毛利率將佔淨收入的69.5%至70.5%之間。 2022年毛利率預計略有下降，主要反映了為推動業務成長、提升營運能力而進行的投資帶來的固定成本增加，以及供應鏈成本上升的影響。我們的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。

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.

接下來談談營運費用。 2021年，我們的備考營運費用成長了19%。我們預計2022年備考營運費用成長率將在21%至27%之間。營運費用成長反映了我們對新產品平台研發投入的增加、OUS能力的拓展以及先前受新冠疫情影響而限制的其他支出的恢復。

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 年非現金股票補償支出將在 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 2022 年其他收入（主要包括利息收入）總額將在 4,500 萬美元至 5,500 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.

關於所得稅，2021 年我們的預計所得稅稅率為 22.2%。展望未來，我們預計 2022 年的預計稅率將在稅前收入的 22% 至 24% 之間，增長的主要原因是美國對某些支出的稅收處理方式發生了變化，該變化於 2017 年頒布，但於 2022 年 1 月 1 日生效。

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，我們想強調的是，我們的年度永續發展報告將在本次電話會議結束後發佈在我們的投資人關係網站上。在最新報告中，我們概述了我們目前的永續發展策略、重點領域、過去一年為開發滿足客戶需求的創新永續解決方案所採取的關鍵行動，以及我們迄今為止的成果。

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

我們的發言到此結束。現在開始接受各位提問。

(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。 Gary，我想先問一個比較宏觀的問題。你最近開始使用「在可能性之點」這個口號，你也說過要站在可能性之點去建構下一步所需的東西。可以談談你為什麼開始使用這個新口號嗎？你想解決哪些需求？我還有一個後續問題。

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，我認為我們有——謝謝你，拉里。我認為我們公司在這裡擁有廣闊的機會，可以運用我們圍繞識別臨床需求而設計的方法，設計和開發技術賦能的生態系統來滿足這些需求，然後與客戶合作交付和培訓這些系統。

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。展望未來，無論是在現有市場還是新興市場，都存在著巨大的機會，可以更好地實現四重目標。完成這一系列投資，並準備好這套生態系統投資方案，是一項艱鉅的工作，需要數年時間。但我們認為，我們已經證明了這是可以實現的。我認為，我們真正想表達的是，隨著我們不斷推進，我們有能力開始影響其他幹預市場的機會。 Ion 就是一個很好的例子。

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，你們似乎已經很好地緩解了潛在的供應限制。接下來你們打算如何應對？你們覺得目前的狀況是在好轉還是惡化？你們對此有多擔心？

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，差不多──我先說最上面那部分，然後讓傑米再補充一些。最上面那部分大致可以分為三大類。第一類是具體的產品本身，例如半導體。第二類是一些原材料的限制以及我們生產的產品類型。第三類就是物流、運輸和材料。

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

傑米，這部分就交給你補充吧。

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，我想我們在事先準備好的發言稿中提到過，第四季度供應鏈環境實際上惡化了，我們也強調了我們在滿足客戶需求方面確實存在一些，我稱之為“小問題”的限制。供應鏈中有一系列指標。我們舉的一個例子是，與第三季相比，第四季供應商的準時交貨率有所下降。

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.

展望未來，我認為目前情況依然不明朗。我們目前能做出的最佳預測是第一季業績將與第四季大致相同，但我認為我們必須拭目以待，看看Omicron事件會對我們的供應商以及整個產業產生怎樣的影響。因此，我認為我們仍在努力應對。正如我所說，我們的供應鏈團隊每天都在與合作夥伴並肩作戰，努力克服重重困難。

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

接下來，我們將向摩根大通的泰科彼得森提出一個問題。

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，你之前提到產品更新換代週期即將結束。顯然，你們正在逐步淘汰S系列機型。我很好奇我們應該如何理解你剛才說的「接近產品更新換代週期結束」這句話。從創新角度來看，你們未來的發展方向是否在於縮短手術時間、簡化手術流程、減少訓練投入、拓展新的適應症？或者，從技術角度來說，我更想聽聽你們未來的發展方向。

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。我們來談談設備更新周期。我想你指的是系統整合（SI）。 Jamie 在他的演講稿中提到了這一點，Brian 也略有提及。我認為他們解釋得很清楚，我就不再贅述了。我的確認為，從商業模式的角度來看，我們認為 Intuitive 並不需要為了維持業務健康而刻意安排資本升級。

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.

我們關注的是如何在四重目標下推動業務發展，以及如何有效地為客戶實現這一目標。為此，我們一直在投資第四代平台及其擴展。我在事先準備好的發言稿中也談到了這一點。這對客戶和我們本身都大有裨益。這並非我們唯一的工作，但卻是我們正在做的重要工作之一。

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.

您剛才稍微提到了技術棧，以及我們關注的重點。我們關注的許多方面在於，在影像學和資訊學領域，我們能在體內做些什麼，從而顯著改善病患或醫護團隊的治療效果和體驗。這一點，您可以從我們推向市場的產品中看出。

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.

我們擁有非常優秀的團隊。我們正在進行一些尚未公開討論的研究，我們認為這些研究將顯著改善治療效果。因此，我們的工作不僅僅是開發新的適應症或提升易用性。我認為這兩方面都很重要，但並非全部。我們也正在進行其他一些研究，我們認為這些研究能夠改變我們與組織相互作用的方式，再次推動治療效果的改善，並再次提升治療標準。

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

Jamie，關於SI更換週期的問題，還有什麼要補充的嗎？

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.

我可以提供一些數據。 2021年，我們在全球範圍內完成了大約510筆舊車置換交易。其中約80%發生在美國。美國一直是舊車置換的主要動力。因此，如果將這個數字與剩餘的343輛新車相比，這就是為什麼我們預計2022年的整體舊車置換量將顯著低於2021年的原因，因為剩餘的新車基數正在減少。

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，您能談談SP的一些改進嗎？您提到過一些儀器的510認證可以延長使用壽命。能詳細說明一下具體情況嗎？

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。自從SP產品推出以來，我們當然收到了不少客戶回饋，其中一些客戶希望我們能提供更強大的拔牙功能。這主要體現在我們拔牙器材的活動範圍和抓握力上，也就是抓取組織時所需的力道。我們收到客戶回饋，認為可以提升抓握力。因此，在延長產品使用壽命的同時，我們也根據客戶回饋對器械進行了相應的改進，如前文所述。

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.

我們也做了一些其他的事情。如您所知，我們擁有雙控制台，它有助於新外科醫生的培訓和教學環境的建立。最近，我們將雙控制台功能擴展到了SP領域。我們推出了一些SP配套的配件，並對其進行了升級。對於那些一直關注我們的朋友來說，持續創新是我們發展歷程的一部分，我們所做的一切不會止步於最初的起點，SP正是如此。

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?

好的。最後一個問題，關於人數統計。你去年開始不再重點介紹新增人員。我們是否應該考慮2022年也實現類似規模的成長？

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，如果你看布萊恩提供的營運支出成長範圍，你就能看出人員數量與支出成長之間的某種關聯，我認為這是 2022 年的一個相關起點。

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.

我們在腳本中也大致說明了他們的發展方向，研發、營運和商業投入的比例。這對於預測未來的發展趨勢也有一定的參考價值。

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

那麼，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.

我先說說短期情況，然後再說長期情況，這是給Gary的。短期方面，就第一季而言，主要是了解各環節的變化，季內情況瞬息萬變。您能就目前觀察到的情況提供多少幫助？在這種環境下，我們該如何模擬流程？您提到受到嚴重影響，但我們需要—我們必須給出一個具體的數字。所以我很想知道，您能否告訴我們目前哪些流程受到影響，或是受影響的程度，那就太好了。

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?

此外，關於資本支出方面，您是否已經看到由於醫院層面發生的一切而導致資本支出延遲的情況？我們該如何看待2022年的資本支出與去年相比的情況？您覺得目前的狀況如何？

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，我提供你一些數據點。從歷史資料來看，手術量與住院率的相關性最高。我認為目前美國新冠肺炎相關的住院人數已經超過了以往任何一波疫情。所以我覺得你可以大致了解目前的進展情況，以及一些第三方機構對本季剩餘時間的預測。這樣做對建模是有益的。

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.

我想指出的是，如果你回顧新冠疫情爆發前的數據，例如2017、2018、2019年，那麼第四季和第一季之間的變化基本上持平，也就是說第一季和第四季的數據大致相同。這指的是正常的季度情況。而目前這波疫情的大部分衝擊應該會集中在第一季。第四季Omicron的影響出現得比較晚。因此，我會先假設正常的季度數據環比持平，然後僅根據住院率來模擬第一季剩餘部分的情況。

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.

就資本支出而言，目前我們沒有特別需要指出的。我認為，目前新冠疫情的影響，加上人員短缺，以及供應鏈環境可能對醫院造成的巨大衝擊，都可能使醫院的資本支出面臨挑戰。在這種環境下，醫院可能會更謹慎地管理資金。但就目前而言，我們沒有什麼具體需要指出的問題。

What was the third part of your question, Amit?

阿米特，你問題的第三部分是什麼？

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，其實——我只是想就您剛才的一些發言，向 Gary 提出一個更長期的問題。這讓我想到，您對 SaaS 模式，特別是 SimNow，有什麼看法。過去一年左右，我們和您的一些客戶聊過。他們似乎每年要為 SimNow 軟體支付約 2 萬美元的服務費。所以我想聽聽您如何看待這種模式，尤其是在您現有客戶群的背景下？更重要的是，我想了解一下——您能否談談這種 SaaS 模式，以及未來我們是否會看到您推出更多類似的產品？

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。關於經常性收入或服務模式與一次性資本投入模式之間的區別，我們一直秉持著靈活的態度，盡力滿足客戶的需求。隨著公司轉型為經常性收入或服務模式，客戶可以根據自身情況選擇合適的模式，而無需預先投入大量資金，這其中有許多優勢。

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.

對於某些本質上屬於服務性質的事物，例如模擬，其核心並非硬體本身，而是對模組的訪問，以及隨著時間推移不斷改進的模組和專為基於能力的培訓而構建的模組。訂閱模式非常合理，因為我們並非在推銷硬件，而是在幫助客戶逐步開發培訓項目。因此，我們認為，隨著我們在軟體、分析以及一些數位化工具領域的業務不斷發展，訂閱模式將越來越適用。只要符合客戶的需求，我們都樂於提供這種模式。

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.

我也很喜歡經常性收入的概念，它能讓公司專注於每天贏得客戶的業務，這樣對客戶和我們來說，收入波動都小得多。如果我們能為他們創造價值，幫助他們實現四重目標，那麼他們就樂意在這些時候繼續與我們合作。

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，我預期我們業務中經常性收入佔總收入的比例會隨著時間的推移而不斷上升。只要客戶認同這一點，並且從他們的財務角度來看這種模式合理，我們就會繼續推行。如果他們對其他模式感興趣，我們也持開放態度。

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

我們現在要問的下一個問題來自 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?

Gary，我想就幾個問題再問一下。你特別提到了Ion和da Vinci SP這兩款產品。你說目前的利潤率還未達到預期水準。隨著時間的推移，你們會逐步擴大業務規模。我想請你詳細解釋一下，例如目前的利潤率大概是多少？我們該如何看待未來兩年或五年的發展前景？

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.

感謝您的提問。關於我們未來的發展方向，我們會研究這些架構。根據我們的經驗，以及對供應鏈、迭代、工程和製造流程的了解，我們認為這兩個平台在未來幾年內應該都能達到歷史平均水平，但並非永遠如此。

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.

話雖如此，目前你們的產量還處於初期階段，遠低於你們未來的發展目標。你們也在進行一些生產流程改進，並進行一些必要的資本投資，以降低單位成本。我會請傑米來大致描述他們目前的狀況。

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.

SP產品線在我們這裡製造方面已經比較成熟了，我們的總經理和她的團隊在識別機會方面做得非常出色，並且隨著時間的推移，他們正在逐步抓住這些機會，這讓我們感到非常欣慰。 Ion產品線則處於早期階段，它的成長曲線略有不同，因此它需要經歷一個循序漸進的過程。不過，我們對核心架構也充滿信心，這讓我們有理由相信我們能夠實現這些目標。

Jamie, anything that you would want to add?

傑米，你還有什麼要補充的嗎？

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.

Rick，我會把這個問題分成兩類來討論。一類是毛利率，另一類是，我們姑且稱之為營業利益率。就毛利率而言，為了讓Ion和SP都達到我們所謂的目標毛利率，我們需要採取的措施已經很明確了，關鍵在於一段時間內的執行。其中當然包括規模擴張。但我認為這些措施已經很明確了，而且需要多年的努力。

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.

就營業利益率而言，關鍵在於收入與我們投資額的比率。顯然，就 Ion 而言，這取決於我們隨著時間的推移在肺癌活檢領域的應用。而對於 SP 而言，則取決於其新增適應症和核准的新地域。我目前無法預測何時才能達到公司平均利潤率。不過，考慮到 SP 和 Ion 都是較新的產品，2022 年的毛利率預計會像預期一樣降低整體利潤率。

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。我還有一個後續問題。我的意思是，您顯然強調了「多方面」——聽起來像是從多個方面——從本季度開始，如果我理解正確的話，您提到了「穩健的流程」。我正在思考這一點，並結合您對投資方向的評論。聽起來很多投資都集中在亞洲。我只是想問一下──我該怎麼問呢？這是否意味著您認為未來3到5年，Intuitive在亞太地區還有更大的成長機會？或者，我們該如何看待這兩個事實和這些措施？如果我的表達夠清晰的話。

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.

里克，我的看法可能略有不同。就亞洲市場而言，它顯然是一個很有趣的市場，每個國家的情況都不一樣。我們正在亞洲進行投資。我並不認為這些投資是主要的，但它們規模相當可觀，因為我們認為在這些市場中存在著巨大的機遇，可以發揮重要作用。

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.

所以，這只是成長的一個方面，並非唯一方面。我們在其他地區，無論是歐洲或其他地區，都存在發展機會。此外，我們在其他臨床適應症領域，以及我們正在進行的一些臨床試驗工作，還有我們正在研發的平台和其他技術的拓展，也都蘊藏著機會。因此，我認為它只是眾多成長點之一，而非主導成長點。

Jamie, anything you would like to add?

傑米，你還有什麼要補充的嗎？

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.

我想說的是，這兩個地區對我們來說都很有吸引力。公平地說，至少在過去幾年裡，亞洲的手術量成長略高於歐洲。但從戰略角度來看，這兩個地區都對我們很有吸引力，我們也正在相應地進行投資。

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

接下來的問題來自瑞銀集團的 Matt Taylor。

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的問題，一個關於競爭的問題。關於創新，我很欣賞您對多埠技術的闡述。我還注意到，在您的網站上，您一直在招募許多腔內手術的人才，也正在關注淋巴結手術等相關職位。您能否談談您在這些領域的投資？除了您在SP和Ion方面的投入之外，還有哪些值得我們關注的項目？總的來說，今年我們是否可以期待一些大型產品發布？即使您不方便透露具體內容，能否大致描述一下系統升級或產品發布的節奏？

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。至於預測未來產品發布，我們當然不會在此透露任何細節。我們會在準備好時發布。就您提出的問題而言，我們正在持續開發現有平台的應用，無論是多端口適應症中的減肥手術和胸腔外科手術，還是SP的新適應症，我們都在不斷探索，目前我們正在進行一些胸腔外科和結直腸手術的試驗，同時也在柔性機器人和Ion平台的新機遇中尋求發展。

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.

還有一些目前尚未公開的平台投資項目，我們正在進行中。我們會繼續推進這些項目。其中一些最終會取得成功，非常棒。而另一些項目，我們可能需要評估，並根據了解的深入調整方向。總之，這些項目都在進行中。有人查看了我們的招聘資訊和專利申請情況。你會發現我們感興趣的領域非常廣泛。

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.

這有點像是電話會議的第一個問題，我們會問，就可能性而言，我們到底在討論什麼。我們會從頭到腳，仔細審視所有可能的干預機會，並開始詢問我們是否認為在四個指標方面存在真正的改進機會，以及我們是否可以設計一個技術驅動的生態系統來實現這一目標。

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.

這就是我們招募決策的主要依據。有些是針對現有平台的短期招聘，有些則是針對未來可能出現的平台的招聘。這就是我們思考這個問題的方式。

Okay. And maybe just one on competition.

好的。或許可以就競爭方面談一點。

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

馬特，我們會給你一個後續問題。

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。關於競爭，您提到競爭有可能延長銷售週期。但目前看來，您似乎還沒有看到這種情況。您能否描述一下，與幾個季度前相比，目前的競爭環境發生了哪些變化？

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，你可以看到客戶之間的競爭非常活躍。我認為我們主要將其描述為在培訓中心投資或研發投資方面存在的互惠安排。目前我們還沒有發現對銷售週期有任何明顯的重大影響。但隨著時間的推移，這種影響的可能性是顯而易見的。

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，謝謝大家。這是我們最後一個問題。最後，我們仍然相信，在外科手術和急診介入方面，存在著巨大且持久的改善空間。我們的團隊將繼續與醫院、醫生和護理團隊緊密合作，致力於實現客戶所稱的「四重目標」：更佳、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；以及最終更低的醫療總成本。

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 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，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，疾病能夠被更早發現並快速地治療，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。

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。感謝您使用AT&T活動服務參與本次會議。您現在可以斷開連線了。