直覺手術 (ISRG) 2021 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by. Welcome to the Intuitive Q3 2021 Earnings Release Conference Call. (Operator Instructions) And as a reminder, this conference call is being recorded.

女士們、先生們，感謝您的耐心等待。歡迎參加 Intuitive 2021 財年第三季財報電話會議。 （操作說明）提醒您，本次電話會議正在錄音。

I would now like to turn the call over to your host, Senior Vice President of Finance, Jamie Samath. Please go ahead, sir.

現在我將把電話交給主持人，財務高級副總裁傑米·薩馬斯先生。請您發言，先生。

Good afternoon, and welcome to Intuitive's third quarter earnings conference call. With me today, we have Gary Guthart, our CEO; Marshall Mohr, our CFO; and Brian King, our Treasurer.

下午好，歡迎參加Intuitive第三季財報電話會議。今天與我一同出席的有：執行長Gary Guthart、財務長Marshall Mohr和財務主管Brian King。

Before we begin, I would like to let you know that Philip Kim, our Head of Investor Relations for the last couple of years, has moved on to pursue his next opportunity. We appreciate his contributions and wish him well in his next endeavor. Joining us on the call today is Brian King, who has been our Treasurer for the last 7 years. Brian will be expanding his responsibilities to include the role of Head of Investor Relations.

在會議開始之前，我想告知各位，過去幾年一直擔任我們投資者關係主管的Philip Kim先生已離職，另謀發展。我們感謝他所做的貢獻，並祝福他在新的旅程中一切順利。今天參加電話會議的是Brian King先生，過去七年一直擔任我們的財務主管。 Brian先生的職責範圍將擴大，他將兼任投資人關係主管一職。

Moving on, 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 July 21, 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.

接下來，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我們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7月21日提交的10-Q表格。您可以透過我們的網站或SEC網站查閱我們提交給SEC的文件。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 third 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. Marshall will provide a review of our financial results. I will discuss procedure and clinical highlights and provide an update of our financial outlook. 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概述的第三季度業績；隨後進行問答環節。 Gary 將介紹本季的業務和營運亮點；Marshall 將回顧我們的財務表現；我將討論流程和臨床方面的亮點，並更新我們的財務展望；最後，我們將進行問答環節。

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. Our team performed well in the third quarter in the face of pandemic-related headwinds. The rise of the Delta variant and stresses in some hospitals pressured the demand for surgery. Global supply chain disruption has yet to abate, necessitating redirection of internal resources to continue to meet our customers' demand. Despite these challenges, growth in the use of our products continued in the quarter and capital demand remained robust. Our new platforms advanced in their commercialization, in their innovation and in their clinical programs.

感謝您今天蒞臨本次活動。儘管面臨疫情帶來的諸多挑戰，我們的團隊在第三季依然表現出色。 Delta 變異體的出現以及部分醫院的壓力導致手術需求承壓。全球供應鏈中斷問題尚未緩解，因此我們需要重新調配內部資源，以持續滿足客戶的需求。儘管面臨這些挑戰，本季我們產品的使用量仍維持成長，資金需求也保持強勁。我們的新平台在商業化、創新和臨床專案方面均取得了進展。

Turning first to procedures. The increased COVID burden tempered the recovery we saw in the second quarter, particularly in the month of August. The impact of the Delta variant drove procedures in the United States below our expectations at the start of the quarter with run rate stabilizing the last couple of weeks of September.

首先來看手術量。新冠疫情的加劇抑制了我們在第二季度看到的復甦勢頭，尤其是在8月。受達美航空變異株的影響，美國地區的手術量在本季初低於我們的預期，但9月最後幾週手術量趨於穩定。

Adoption continues in the United States driven particularly by benign general surgery procedures, including bariatric surgery, cholecystectomy and hernia repair. Trends in malignant procedures remain solid, including prostatectomy, hysterectomy, lobectomy and colon resection.

在美國，微創手術的普及率持續上升，這主要得益於良性一般外科手術的應用，例如減肥手術、膽囊切除術和疝氣修補術。惡性腫瘤手術的應用趨勢仍穩健，包括前列腺切除術、子宮切除術、肺葉切除術和結腸切除術。

Two trends that have emerged over the past few years are the increased use of da Vinci in benign procedures and rising use of our advanced instrumentation in targeted procedures. Both are the result of focusing on our customers' needs and delivering product and economic solutions to match.

過去幾年出現了兩大趨勢：一是達文西手術系統在良性手術中的應用日益廣泛；二是我們的先進儀器在標靶手術中的應用也日益增多。這兩大趨勢都源自於我們始終以客戶需求為中心，並提供與之相符的產品和經濟解決方案。

Outside the United States, procedure performance varied as a function of regional pandemic impact. In China, growth in the quarter was strong and spanned multiple specialties, reflecting continued adoption. In Japan and Korea, our procedure business remains healthy with slight sequential procedure growth Q2 to Q3 despite COVID-related surgery disruption. Germany, the U.K. and France had reasonable year-over-year procedure growth, and our customers are having success in diversifying procedure categories beyond urology.

除美國以外，手術量表現因地區疫情影響而異。在中國，本季成長強勁，涵蓋多個專科，反映出市場對該技術的持續接受。在日本和韓國，儘管受到新冠疫情相關手術中斷的影響，我們的手術業務依然保持健康，第二季至第三季較上季略有成長。德國、英國和法國的手術量較去年同期成長良好，我們的客戶在泌尿科以外的手術類別拓展方面也取得了成功。

Regarding the capital environment, new system placements continue to be robust. The United States had an outstanding capital quarter with a balanced mix of hospitals new to da Vinci as well as healthy incremental placements for existing customers and trade-ins of older technology. This performance has been driven by collaboration with U.S. integrated delivery networks as they thoughtfully manage and expand the capacity of their da Vinci fleets. Elsewhere, China, Japan and Europe had solid placements in the quarter, and our placements in Brazil showed strength.

就資本環境而言，新系統安裝量持續強勁。美國本季資本市場表現卓越，既有醫院首次引進達文西手術系統，也有現有客戶的穩健增量安裝，以及舊設備的置換。這一業績得益於與美國綜合醫療服務網絡的合作，他們精心管理並擴展了其達文西手術系統的容量。其他地區方面，中國、日本和歐洲本季系統安裝量穩健，我們在巴西的安裝量也表現強勁。

Turning to our newer platforms. Our single port system, da Vinci SP, had a solid quarter as we pursue additional indications. Placements of our flexible bronchoscopy platform, Ion, grew nicely sequentially Q2 to Q3, powered by continued strong customer experiences in the field.

接下來談談我們的新平台。我們的單孔手術系統達文西SP在本季表現穩健，我們正在積極拓展其適應症。我們的柔性支氣管鏡平台Ion的植入量在第二季度到第三季度之間實現了良好的環比增長，這主要得益於客戶在實際應用中持續給予的良好體驗。

Our finances were strong again this quarter, though they followed an unusual path. System strength and favorable system sales mix drove strong system revenue. Procedures grew at the low end of our expectations as a result of the Delta variant. Instrument and accessory revenue per procedure moved down modestly as benign procedures continue to make up more of the procedure mix and our extended use instrument program reaches equilibrium in the field.

本季我們的財務狀況依然強勁，儘管其走勢略顯特殊。系統實力和有利的系統銷售組合推動了系統收入的強勁成長。由於Delta變體的推出，手術量增長低於預期。隨著良性手術在手術組合中所佔比例的增加，以及我們的延展性器械項目在實際應用中達到平衡，每例手術的器械和配件收入略有下降。

Our spending grew sequentially and year-over-year as we continue to invest in expanding our new platforms and digital programs as well as build our go-to-market capabilities globally. Our expense growth was again modestly lower than planned, driven by some increase in time to fill open positions in a tight labor market, lower travel-related spending given the pandemic and some underspending in prototypes. We will continue to invest in programs that fulfill the mission and build the company.

我們的支出較上季和年比均有所成長，這得益於我們持續投資拓展新平台和數位化項目，以及提升全球市場拓展能力。由於勞動市場緊張導致招募週期延長、受疫情影響差旅支出減少以及原型開發投入不足，我們的支出成長再次略低於預期。我們將繼續投資於能夠實現公司使命並推動公司發展的各項計劃。

Turning to our innovation efforts. We develop and deploy technology-enabled solutions to support our customers' pursuit of the quadruple aim: better outcomes, better patient experiences, better care team experiences and lower total cost to treat per patient episode.

接下來談談我們的創新工作。我們開發並部署技術驅動型解決方案，以支援客戶實現四重目標：更好的治療效果、更好的病患體驗、更好的醫療團隊體驗以及更低的單次治療總成本。

I'd like to take a moment to overview the clinical status of our programs. For our da Vinci system, there are now over 9.7 million lifetime procedures performed with over 28,000 peer-reviewed clinical publications. Da Vinci X and Xi now have over 70 representative clinical uses, allowing broad use across multiple clinical specialties, from urology, to gynecology, thoracic surgery, general surgery and transoral surgery.

我想花一點時間概述一下我們計畫的臨床現狀。就我們的達文西手術系統而言，迄今已完成超過970萬例手術，並發表了超過28,000篇經同行評審的臨床論文。達文西X和Xi系統目前擁有超過70種代表性臨床應用，可廣泛應用於泌尿科、婦科、胸腔外科、一般外科和經口外科等多個臨床專科。

Tens of thousands of surgeons routinely use our multiport systems. We continue to invest in our multiport products, instruments and services to further expand their capabilities and indications. Leading surgeons continue to work with us to pursue new learning with several prospective studies ongoing.

數以萬計的外科醫生都在常規使用我們的多孔手術系統。我們將繼續投資多孔手術產品、器械和服務，以進一步拓展其功能和適應症。眾多頂尖外科醫師與我們持續合作，透過多項正在進行的前瞻性研究，不斷探索新的知識。

Our flexible bronchoscopy system, Ion, continues to build momentum clinically and commercially with several presentations and manuscripts updating Ion clinical progress at the 2021 CHEST conference this weekend. As described in yesterday's press release, early clinical trial results point to outstanding capability, allowing for definitive diagnosis of hard-to-reach lung lesions. Our teams are hard at work building our manufacturing and supply capabilities to meet rising demand.

我們的柔性支氣管鏡系統 Ion 在臨床和商業領域持續取得進展，本週末在 2021 年 CHEST 會議上，我們透過多篇報告和論文更新了 Ion 的臨床進展。正如昨天的新聞稿所述，早期臨床試驗結果表明該系統性能卓越，能夠對難以觸及的肺部病變進行明確診斷。我們的團隊正全力以赴提升生產和供應能力，以滿足不斷增長的市場需求。

Our single port system, SP, has a clinical database of 28 peer-reviewed clinical publications. There are currently several ongoing prospective studies for SP in Korea and the United States, including our IDE trial for colorectal indications. This quarter, we received FDA approval of our uniportal thoracic IDE. Broad SP adoption will be paced by additional regional and clinical clearances, which remain our focus for the SP program.

我們的單孔系統SP擁有包含28篇同儕審查臨床出版品的臨床資料庫。目前，韓國和美國正在進行多項SP前瞻性研究，包括我們針對大腸直腸適應症的IDE試驗。本季度，我們的單孔胸腔鏡IDE獲得了FDA批准。 SP的廣泛應用將透過獲得更多區域和臨床批准來推進，這仍然是我們SP計畫的重點。

Our digital solutions provide data-driven insights to surgeons, operative services and hospital administration. From virtual reality training, to efficiency insights, to custom comparative outcomes analysis, these tools are now routinely employed by our customers and our teams to improve programs. Our analytics program supported thousands of customers in the quarter.

我們的數位化解決方案為外科醫生、手術服務人員和醫院管理人員提供數據驅動的見解。從虛擬實境培訓到效率提升分析，再到客製化的對比結果分析，這些工具現在已被我們的客戶和團隊廣泛用於改善各項流程。本季度，我們的分析專案為數千家客戶提供了支援。

Turning to machine learning. Our teams are at the leading edge of ML-based clinical science for surgery through our collaborations with leading academic centers, informing algorithmic and scientific discovery. Taken together, these programs allow our customers to quantify our collective impact on the quadruple aim, core to our mission.

轉向機器學習。我們的團隊與頂尖學術中心合作，在基於機器學習的外科臨床科學領域處於領先地位，為演算法和科學發現提供資訊支援。這些項目共同幫助我們的客戶量化我們在實現我們使命核心——四重目標——方面所取得的集體成就。

Before turning the time over to Marshall, today, we announced some changes in responsibilities of our senior executive team. These changes are the result of a structured process over the past few years, and they are driven by our need to support growth in our product lines, commercial reach, operations capabilities and business infrastructure as we scale to meet the global opportunity to advance minimally invasive care.

在今天將發言時間交給馬歇爾之前，我們宣布了高階主管團隊職責的一些調整。這些調整是過去幾年系統性流程的結果，旨在支援產品線、商業覆蓋範圍、營運能力和業務基礎設施的成長，從而更好地掌握全球微創醫療發展機會。

Starting January 1, 2022, our Executive Vice President and Chief Business Officer, Dave Rosa, will take on an important new role of Executive Vice President and Chief Strategy and Growth Officer, leading our efforts to identify and realize long-term business opportunities, continuing to build the value of our integrated product offerings and ensuring our customers clearly understand the value of our ecosystem in creating successful minimally invasive programs.

自 2022 年 1 月 1 日起，我們的執行副總裁兼首席商務官 Dave Rosa 將擔任執行副總裁兼首席策略與成長官這一重要新職務，領導我們尋找和實現長期業務機會，繼續提升我們綜合產品組合的價值，並確保我們的客戶清楚地了解我們生態系統在創建成功的微創項目方面的價值。

Henry Charlton, currently General Manager of the U.S. and Europe, will succeed Dave as Chief Commercial Officer, overseeing global commercial sales, regional marketing and commercial enablement. Also, Marshall Mohr will take on an important new position as Executive Vice President, Global Business Services, leading Intuitive's continued growth in information technology, enterprise process, data and systems and global facilities. Jamie Samath will succeed Marshall as Chief Financial Officer.

現任美國及歐洲區總經理亨利·查爾頓將接替戴夫擔任首席商務官，負責全球商業銷售、區域行銷和商業賦能。此外，馬歇爾·莫爾將擔任全球業務服務執行副總裁這一重要新職位，領導Intuitive在資訊科技、企業流程、數據和系統以及全球設施方面的持續成長。傑米·薩馬斯將接替馬歇爾出任財務長。

They are each outstanding proven leaders and will report to me. We expect them to spearhead our efforts to achieve our mission and continue to position Intuitive as first choice of our customers in a growing marketplace.

他們都是傑出的、經驗豐富的領導者，將直接向我報告工作。我們期望他們能夠帶領我們實現使命，並繼續鞏固 Intuitive 在不斷成長的市場中作為客戶首選的地位。

I'll now turn the call over to Marshall, who will take you through our financial highlights in greater detail.

現在我將把電話交給馬歇爾，他將更詳細地向大家介紹我們的財務亮點。

Good afternoon. I will describe the highlights of our performance on a non-GAAP or pro forma basis. I will also summarize our GAAP performance later in my prepared remarks. A reconciliation between our pro forma and GAAP results is posted on our website. The information in our earnings release and within our prepared remarks reflects the 3-for-1 stock split completed earlier in October.

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。我們網站上已發布備考財務報表與GAAP財務報表的調節表。我們的獲利報告和發言稿中的資訊均已反映10月初完成的1拆3股票分割。

Overall, third quarter procedures grew 20% year-over-year and reflected the impact of Delta variant resurgence. COVID also impacted third quarter 2020 procedures, making year-over-year comparisons complicated. In the U.S., procedures grew 16%, reflecting the impact the COVID resurgence had on hospital resources regionally.

整體而言，第三季手術量年增20%，反映了德爾塔變異株疫情反彈的影響。新冠疫情也對2020年第三季的手術量造成了影響，使得年比數據比較變得複雜。在美國，手術量增加了16%，反映了新冠疫情反彈對各地醫院資源的影響。

The impact of the resurgence was most pronounced in August and early September, and regionally, in the South and Southeast. Later in the quarter, as COVID cases began to slow, procedures began to recover. However, it is difficult to estimate the extent to which this resurgence or future resurgences will impact da Vinci procedures.

疫情反彈的影響在8月和9月初最為顯著，尤其是在南部和東南部地區。本季後期，隨著新冠病例開始放緩，手術量也開始恢復。然而，目前難以估計這次疫情反彈或未來疫情反彈會對達文西手術造成多大影響。

Year-over-year OUS procedures grew 30%, with the impact of COVID varying regionally. In Europe, COVID had a greater impact in Italy and France and less in U.K. and Germany. While there continued to be COVID hotspots within some of our Asia Pacific markets, overall procedures in the region performed well. China growth in the third quarter continued to be far higher than other regions, primarily reflecting system installation growth over the past year.

與去年同期相比，OUS手術量增加了30%，但新冠疫情的影響因地區而異。在歐洲，義大利和法國受疫情影響較大，而英國和德國受到的影響較小。儘管亞太地區部分市場仍有疫情熱點，但該地區的整體手術量表現良好。第三季中國市場的成長速度持續遠高於其他地區，這主要反映了過去一年系統安裝的成長。

Relative to the beginning of the pandemic, many hospitals are able to better manage increased COVID patient hospitalization. However, staffing shortages and hospital supply chain issues are challenging some hospital capacities and could impact deferrable procedures, including da Vinci procedures going forward. Jamie will provide additional procedure commentary later in this call.

與疫情初期相比，許多醫院現在能夠更好地應對新冠肺炎患者住院人數的增加。然而，人員短缺和醫院供應鏈問題正在挑戰一些醫院的容量，並可能影響一些可推遲的手術，包括達文西手術。 Jamie 將在本次電話會議稍後提供更多關於手術方面的說明。

Key business metrics for the third quarter were as follows: third quarter 2021 procedures increased approximately 20% compared with third quarter 2020 and decreased approximately 3% compared with last quarter, compound annual growth between the second quarters of 2019 and 2021 was 13.5%, third quarter system placements of 336 systems increased 72% compared with 195 systems for the third quarter of 2020 and increased 2% compared with 328 systems last quarter. We expanded our installed base of da Vinci systems over the last year by 11% to approximately 6,525 systems. This growth rate compares with 8% last year and 10% last quarter.

第三季的關鍵業務指標如下：2021年第三季手術量較2020年第三季成長約20%，較上季下降約3%；2019年第二季至2021年第二季的複合年成長率為13.5%；第三季系統安裝量為336台，較2020年第三季成長約20%，第三季的系統安裝量為336台，較2020年第三季的195台成長72%，上232%成長232%。過去一年，我們的達文西手術系統安裝量增加了11%，達到約6,525台。這一成長率高於去年同期的8%和上季的10%。

Utilization of clinical systems in the field, measured by procedures per system, increased approximately 9% compared with last year and decreased 6% compared with last quarter. The compounded annual utilization growth rate between the third quarters of 2019 and 2021 was 3%.

以每套系統的操作例數衡量，臨床系統在現場的使用率較去年同期成長約9%，較上一季下降6%。 2019年第三季至2021年第三季的複合年增長率為3%。

Moving on to capital placement. System placements in the quarter reflected a continued trend of IDN multisystem purchases and were driven by procedure growth and hospitals upgrading in order to access or standardize on fourth-generation capabilities. Looking forward, we see the following capital revenue dynamics. Procedure growth drives capital purchases in many of our markets. To the extent that COVID impacts procedures, it will also impact capital purchases.

接下來談談資本配置。本季度系統配置反映了IDN多系統採購的持續趨勢，其驅動因素是手術量的增長以及醫院為獲得或標準化第四代功能而進行的升級。展望未來，我們預期資本收入將呈現以下動態。手術量的成長推動了我們許多市場的資本採購。新冠疫情對手術量的影響程度，也將影響資本採購。

The trade-in cycle has been a tailwind to system placements. However, as the installed base of older generation product declines, the number of trade-ins will decline over time. Leasing and alternative financing arrangements enable customer access to our systems. While the percentage of systems placed under operating leases fluctuates quarter-to-quarter, we believe leasing will increase as a percentage of sales over time, which will result in the deferral of otherwise current revenue into future periods. Macroeconomic conditions created by COVID could regionally impact hospital capital spending. And as competition progresses in various markets, we will likely experience longer selling cycles and price pressures.

以舊換新周期一直是系統部署的優良因素。然而，隨著老一代產品裝置量的下降，以舊換新的數量也會隨之減少。租賃和替代融資方案使客戶能夠獲得我們的系統。雖然以經營租賃方式部署的系統比例會逐季波動，但我們相信租賃在銷售額中所佔的比例會隨著時間的推移而增加，這將導致原本應計入當期的收入遞延至未來期間。新冠疫情造成的宏觀經濟環境可能會對區域性醫院的資本支出產生影響。隨著各市場競爭的加劇，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: Third quarter revenue was $1.4 billion, representing a 30% increase from last year and a 4% decrease from the last quarter. The compound annual revenue growth rate between the third quarters of 2019 and 2021 was 12%. The year-over-year revenue increase reflected growth in both procedures and system placements. The decrease relative to the second quarter of 2021 reflects lower instrument and accessory revenue associated with lower procedures and increased leasing as a percentage of placements.

其他營收統計及趨勢如下：第三季營收為14億美元，較去年同期成長30%，較上一季下降4%。 2019年第三季至2021年第三季的複合年營收成長率為12%。年比增長反映了手術量和系統安裝量的增長。與2021年第二季度相比的下降反映了器械和配件收入的減少，這主要是由於手術量減少以及租賃在安裝量中所佔比例的增加所致。

Leasing represented 41% of current quarter placements compared with 35% last year and 33% last quarter. Leasing as a percentage of total sales has and will continue to fluctuate with customer and geographic mix. However, we anticipate more customers will seek leasing or alternative financing arrangements than reflected in historical run rates.

本季租賃佔總交付量的41%，高於去年同期的35%和上季的33%。租賃佔總銷售額的比例一直以來都隨客戶和地理組成而波動，未來也將繼續如此。然而，我們預計未來尋求租賃或其他融資方式的客戶數量將高於歷史平均。

40% of systems placed in the third quarter involved trade-ins, which is consistent with the 40% last year and higher than the 38% last quarter. As customers continue to upgrade to fourth-generation capabilities, the population of installed Sis is decreasing, particularly in U.S., where 97 trade-ins were completed in the third quarter, leaving an installed base of Sis of approximately 425 systems. As a result, we expect lower trade-out transactions over time. Trade-in activity can fluctuate and be difficult to predict.

在第三季安裝的系統中，40%為以舊換新，與去年同期持平，高於上一季的38%。隨著客戶不斷升級到第四代功能，已安裝的系統整合系統（Si）數量正在減少，尤其是在美國，第三季完成了97筆以舊換新交易，目前Si的已安裝系統數量約為425套。因此，我們預期以舊換新交易量將隨時間推移而減少。以舊換新活動可能出現波動，難以預測。

Third quarter average selling prices increased to $1.57 million from $1.55 million for both the third quarter of 2020 and the second quarter of 2021. Average selling prices will fluctuate with geographic and product mix. Consistent with historical patterns, we expect a higher mix of systems sold to distributors in the fourth quarter which carry lower prices.

第三季平均售價從2020年第三季和2021年第二季的155萬美元增加至157萬美元。平均售價會隨地理和產品組合而波動。與歷史趨勢一致，我們預計第四季度將出售給分銷商的系統數量將增加，而這些系統的價格通常較低。

We recognized $25 million of lease buyout revenue in the third quarter compared with $17 million last year and $26 million last quarter. Lease buyout revenue has varied significantly quarter-to-quarter and will likely continue to do so. Instrument and accessory revenue per procedure of $1,900 decreased slightly compared with $1,910 per procedure for the third quarter of last year and decreased compared with $1,940 per procedure in the second quarter. The year-over-year change reflects increased usage of extended use instruments, mostly offset by increased usage of our advanced instruments. The decrease from the previous quarter reflects customers continuing to adjust their instrument buying patterns to reflect the additional uses per instrument included in extended use instruments.

第三季我們確認了2,500萬美元的租賃買斷收入，而去年同期為1,700萬美元，上季為2,600萬美元。租賃買斷收入季度間波動較大，且這種情況可能還會持續。每台手術的器械及配件收入為1,900美元，較去年同期的1,910美元略有下降，也較第二季的1,940美元有所下降。同比變化反映了延長使用壽命器械使用量的增加，但大部分都被我們先進器械使用量的增加所抵消。環比下降則反映了客戶持續調整其器械購買模式，以適應延長使用壽命器械的額外使用次數。

10 of the systems placed in the third quarter were SP systems. Our installed base of SP systems is now 89, 10 in Korea and 79 in the U.S. We continue our measured rollout of SP as we work on gathering clinical data to gain additional procedure clearances in the U.S.

第三季安裝的系統中，有10套是SP系統。目前，我們已安裝89套SP系統，其中10套在韓國，79套在美國。我們將繼續穩定地推廣SP系統，同時努力收集臨床數據，以獲得在美國的更多手術許可。

We placed 28 Ion systems in the quarter, bringing the installed base to 98 systems. There were approximately 2,000 Ion procedures completed in the third quarter. Ion system placements and procedures are excluded from our overall da Vinci system and procedure counts. Our rollout of Ion is progressing well.

本季我們安裝了28套Ion系統，使總裝機量達到98套。第三季共完成了約2000例Ion手術。 Ion系統的安裝和手術量不計入我們達文西手術系統和手術總量的統計中。 Ion系統的推廣進展順利。

Outside the U.S., we placed 109 systems in the third quarter compared with 79 in the third quarter of 2020 and 115 systems last quarter. Current quarter system placements included 47 into Europe, 20 into Japan and 17 into China compared with 39 into Europe, 15 into Japan and 12 into China in the third quarter of 2020. We also placed 9 systems in Brazil in the third quarter and now have placed 23 systems in Brazil over the past 4 quarters.

除美國以外，我們第三季共部署了109套系統，而2020年第三季為79套，上季為115套。本季部署的系統包括歐洲47套、日本20套和中國17套，而2020年第三季則分別為歐洲39套、日本15套和中國12套。此外，我們第三季還在巴西部署了9套系統，過去四個季度累計在巴西部署了23套系統。

Moving on to gross margin and operating expenses. Pro forma gross margin for the third quarter of 2021 was 71.3% compared with 70.2% for the third quarter of 2020 and 71.7% last quarter. The third quarter of 2020 included $23 million of service credits issued in conjunction with our Customer Relief Program, higher period costs associated with lower production levels and higher excess and obsolete inventory charges.

接下來是毛利率和營運費用。 2021年第三季的備考毛利率為71.3%，而2020年第三季為70.2%，上一季為71.7%。 2020年第三季的數據包括根據客戶紓困計畫發放的2,300萬美元服務抵免額、因產量下降而增加的期間成本以及更高的庫存積壓和報廢費用。

The decline in gross margin relative to the second quarter primarily reflects product mix. Product and customer mix fluctuate quarter-to-quarter, which can cause fluctuations in gross margins.

與第二季相比，毛利率下降主要反映了產品組合的變化。產品和客戶組合會隨季度波動，這會導致毛利率波動。

COVID has impacted global supplies of semiconductors and other materials used in our products. While to date, we've been able to secure supply necessary to ensure fulfillment of customer demand, our teams are expending significant time and effort to bridge future supply with demand. To date, we have experienced immaterial component cost increases and freight expedition fees. However, global shortages could result in future supply disruption as well as delayed development and regulatory activities. We also expect supply issues to result in higher production costs.

新冠疫情已對全球半導體及其他產品所需材料的供應造成影響。儘管迄今為止，我們已確保必要的供應以滿足客戶需求，但我們的團隊正投入大量時間和精力來彌補未來供需缺口。目前，我們僅面臨零件成本和貨運加急費用的微不足道的增長。然而，全球供應短缺可能導致未來供應中斷，並延誤研發和監管流程。我們預計供應問題也將導致生產成本上升。

Pro forma operating expenses increased 21% compared with the third quarter of 2020 and increased 2% compared with last quarter. The increase compared to the prior year reflects costs associated with higher headcount, increased variable compensation and increased spending in areas impacted by COVID. Third quarter spending was below our expectations due to delays in headcount hiring and lower spending on activities restricted by COVID, including clinical development, marketing events and travel costs.

經調整後的營運費用較2020年第三季成長21%，較上季成長2%。與上年同期相比的成長反映了員工人數增加、可變薪酬增加以及受新冠疫情影響領域支出增加的相關成本。第三季支出低於預期，原因是招募延遲以及受新冠疫情限制的活動支出減少，包括臨床開發、市場推廣活動和差旅費用。

In addition, COVID delayed some R&D work resulting in underspend on prototypes. We expect spending on activities restricted by COVID to increase as the impacts of the pandemic decline. We also expect spending to increase as a percentage of revenue as investments in headcount, infrastructure and other support areas catch up to the growth of the business. Finally, we expect to continue to invest in expanding and accelerating our ecosystem of products and capabilities. Jamie will provide spend guidance later in this call.

此外，新冠疫情延誤了部分研發工作，導致原型開發投入不足。我們預計，隨著疫情影響的減弱，受疫情限制的活動支出將會增加。同時，隨著對人員、基礎設施和其他支援領域的投資逐步跟上業務成長，我們預期支出佔收入的比例也會上升。最後，我們將繼續投資於拓展和加速我們的產品及能力生態系統。 Jamie 將在本次電話會議稍後提供支出指引。

Our pro forma effective tax rate for the third quarter was approximately 24%. We recorded expense of $11 million associated with periods prior to 2020 related to guidance recently provided by the IRS associated with stock-based compensation. We expect our pro forma tax rate for the fourth quarter to be approximately 21.5%. Our actual tax rate will fluctuate with changes in geographic mix of income, changes in taxation made by local authorities and with the impact of onetime items.

第三季的預計有效稅率約為24%。我們計入了1100萬美元的費用，該費用與2020年之前的期間相關，與美國國稅局近期發布的關於股權激勵的指導意見有關。我們預計第四季的預計稅率約為21.5%。實際稅率會因收入地域組成變化、地方稅收政策調整以及一次性項目的影響而波動。

Our third quarter pro forma net income was $435 million or $1.19 per share compared with $334 million or $0.92 per share for the third quarter of 2020 and $477 million or $1.31 per share for the last quarter. Third quarter 2021 and 2020 included pretax gains of approximately $8 million and $62 million associated with investments in companies that resulted from development agreements entered into in prior years.

我們第三季的備考淨利為4.35億美元，合每股1.19美元，而2020年第三季為3.34億美元，合每股0.92美元，上一季為4.77億美元，合每股1.31美元。 2021年和2020年第三季分別包含約800萬美元和6,200萬美元的稅前收益，這些收益與先前簽訂的開發協議所產生的對相關公司的投資有關。

I will now summarize our GAAP results. GAAP net income was $381 million or $1.04 per share for the third quarter of 2021 compared with GAAP net income of $314 million or $0.87 per share for the third quarter of 2020, and GAAP net income of $517 million or $1.42 per share for last quarter.

現在我將總結一下我們的GAAP業績。 2021年第三季GAAP淨利為3.81億美元，即每股1.04美元；而2020年第三季GAAP淨利為3.14億美元，即每股0.87美元；上一季GAAP淨利為5.17億美元，即每股1.42美元。

We ended the quarter with cash and investments of $8.2 billion compared with $7.7 billion last quarter. The increase in cash in the third quarter primarily reflected cash from operations and stock exercises. We did not repurchase any shares in the quarter.

本季末，我們持有的現金及投資總額為82億美元，高於上一季的77億美元。第三季現金增加主要反映了經營活動產生的現金流量和股票行使收益。本季我們沒有回購任何股票。

And with that, I'd like to turn it over to Jamie.

接下來，我想把麥克風交給傑米。

Thank you, Marshall.

謝謝你，馬歇爾。

Our overall third quarter procedure growth was approximately 20% compared to growth of 7% during the third quarter of 2020. Q3 procedure growth reflected 16% growth in U.S. procedures and 30% growth in OUS markets. In the U.S., procedures in Q3 were adversely impacted by an increase in COVID-related hospitalizations due to the Delta variant. Procedures were particularly impacted in those states with relatively lower vaccination rates.

與2020年第三季7%的成長率相比，我們第三季的整體手術量成長約為20%。第三季手術量成長主要體現在美國市場成長16%，以及美國境外市場成長30%。在美國，由於Delta變異株導致新冠肺炎相關住院人數增加，第三季的手術量受到不利影響。疫苗接種率相對較低的州受到的影響尤其顯著。

As the number of COVID-related hospitalizations peaked and began to improve in September, we saw U.S. procedures start to recover. Q3 growth reflected relative strength in bariatrics procedures, cholecystectomy and hernia repair. In the more mature procedure categories, year-over-year growth in prostatectomy was strong relative to historical averages and benign hysterectomy grew in the low single-digit range.

隨著新冠肺炎相關住院人數在9月達到高峰並開始好轉，我們看到美國的手術量也開始復甦。第三季度的成長反映了減肥手術、膽囊切除術和疝氣修補術的相對強烈。在較成熟的手術類別中，攝護腺切除術的年成長率高於歷史平均水平，而良性子宮切除術的成長率則處於個位數低位。

Third quarter OUS procedure volume grew approximately 30% compared with 9% growth for the third quarter of 2020. Third quarter 2021 OUS procedures were driven by growth in prostatectomy and earlier stage growth in general surgery, gynecology, kidney cancer procedures and thoracic surgery. China procedure growth remained strong and broad-based as a result of continued expansion of the installed base under the current quota and the addition and training of surgeons new to the da Vinci platform.

與2020年第三季9%的增幅相比，2021年第三季海外手術量成長約30%。 2021年第三季海外手術量的成長主要得益於攝護腺切除術的成長，以及一般外科、婦科、腎癌手術和胸腔外科早期手術量的成長。由於現有配額下設備安裝量的持續擴大，以及對新加入達文西手術平台的醫生進行培訓，中國市場的手術量增長依然強勁且覆蓋面廣。

Growth in Japan was solid but was impacted by localized lockdowns stemming from ongoing efforts to prevent resurgences of COVID. Growth in Korea was also solid, primarily driven by gynecology, urology and head and neck procedures. A little more than half of the procedures in these 3 key Asian markets are outside of urology.

日本的成長穩健，但受到為防止新冠疫情反彈而採取的局部封鎖措施的影響。韓國的成長也十分穩健，主要得益於婦科、泌尿科和頭頸外科手術的推動。在這三個亞洲主要市場中，超過一半的手術並非泌尿科手術。

In Europe, procedure growth varied by country based on the relative impact of the Delta variant and the impact of COVID-related mitigation measures. Growth in the U.K. and Germany was solid with procedure growth in France and Italy impacted by reduced capacity for surgery as hospitals reserved resources for potential increases in COVID patients.

在歐洲，手術量的成長因國家而異，這取決於Delta變異株的相對影響以及新冠疫情相關緩解措施的影響。英國和德國的成長穩健，而法國和義大利的手術量成長則受到醫院手術能力下降的影響，因為醫院需要將資源用於應對可能增加的新冠患者。

During Q3, customers in the U.S. and Europe effectively consumed their remaining inventory of 10-life instruments following the launch of extended use instruments in those regions in Q4 of last year. With this full adoption in the U.S., customers are benefiting from I&A per procedure costs that are reduced by approximately 10% in lower acuity procedures such as cholecystectomy and hernia repair. In Europe, customers are benefiting from an even larger reduction in I&A costs for targeted procedures.

第三季度，美國和歐洲的客戶基本上用完了去年第四季在這些地區推出的10年使用壽命器材的剩餘庫存。隨著美國全面採用這些器械，客戶在膽囊切除術和疝氣修補術等低風險手術中，每次手術的切口和穿刺成本降低了約10%。在歐洲，客戶在特定手術中，切口和穿刺成本的降低幅度更大。

While recent procedure trends are confounded by the various waves of the pandemic, we believe, based on customer feedback, the adoption of extended use instruments is having a positive impact on targeted procedures. In our new platform, Ion procedures increased almost fourfold as compared to Q3 of 2020, driven by a significant expansion of the number of systems at customers and an increase in usage in the existing installed base. Our single port platform, which is gated by additional regional and clinical clearances showed solid performance with almost 50% year-over-year procedure growth.

儘管近期手術流程趨勢受到疫情多波影響，但我們根據客戶回饋認為，延長使用壽命的器械應用對標靶手術產生了正面影響。在我們的新平台上，離子治療手術量較2020年第三季增加近四倍，這主要得益於客戶系統數量的顯著增加以及現有系統使用率的提高。我們的單埠平台獲得了額外的區域和臨床認證，表現穩健，手術量年增近50%。

Now turning to the clinical side of our business. Each quarter on these calls, we highlight certain recently published studies that we deem to be notable. However, to gain a more complete understanding of the body of evidence, we encourage all stakeholders to thoroughly review the extensive detail of scientific studies that have been published over the years.

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

During the quarter, Dr. Michael Kent from Beth Israel Deaconess Center, Harvard Medical School in Boston, Massachusetts, published results from a landmark multicenter pulmonary open, robotic and thoracoscopic lobectomy or PORTaL study in the Annals of Surgery. This retrospective study sponsored by Intuitive compared lobectomy outcomes associated with open VATS and robotic-assisted da Vinci surgery with over 6,000 cases included in this analysis.

本季度，來自馬薩諸塞州波士頓哈佛醫學院貝斯以色列女執事醫療中心的邁克爾·肯特博士在《外科年鑑》上發表了一項具有里程碑意義的多中心肺葉切除術（PORTaL）研究結果。這項由Intuitive公司贊助的回顧性研究比較了開放式胸腔鏡手術（VATS）和機器人輔助達文西手術的肺葉切除術結果，分析納入了6000多例病例。

After one-to-one propensity score matching, a comparison of open and da Vinci lobectomies with approximately 800 patients in each group showed a 2-day shorter length of stay and a 9.5% lower rate of prolonged hospital stay associated with da Vinci lobectomies. The da Vinci cohort also had an approximately 8-minute shorter mean OR time for cases without a concomitant procedure. Postoperative complications were approximately 9% lower with the da Vinci robotic approach. With regards to the propensity score match comparison of minimally invasive approaches with over 1,700 patients in each group, the da Vinci approach evidenced a 1.1-day shorter mean length of stay and a 6.1% low rate of conversion to thoracotomy when compared to VATS, with the differences in conversion rates reported for each tumor stage in the analysis.

經過一對一傾向評分配對後，每組約800例患者進行開放式肺葉切除術和達文西機器人輔助肺葉切除術的比較顯示，達文西機器人輔助肺葉切除術組的住院時間縮短2天，且延長住院率降低9.5%。對於無其他同期手術的病例，達文西機器人輔助組的平均手術室停留時間也縮短約8分鐘。達文西機器人輔助手術的術後併發症發生率降低約9%。在每組超過1700例患者的微創手術進行傾向評分配對比較時，與胸腔鏡輔助手術（VATS）相比，達文西機器人輔助手術的平均住院時間縮短1.1天，且轉為開胸手術的發生率降低6.1%。分析中報告了各腫瘤分期的轉為開胸手術率差異。

The authors concluded in part, "In this retrospective multi-institutional data analysis, both robotic-assisted and VATS lobectomy were associated with improved perioperative outcomes compared to open lobectomy. Robotic-assisted lobectomy was associated with additional differences compared to VATS such as a reduced length of stay and conversion rate."

作者在結論中部分指出：「在這項回顧性多中心數據分析中，與開胸肺葉切除術相比，機器人輔助肺葉切除術和胸腔鏡肺葉切除術均能改善圍手術期結局。與胸腔鏡肺葉切除術相比，機器人輔助肺葉切除術還具有其他優勢，例如住院時間更短、中轉開胸率更低。」

In August of this year, Professor Umberto Bracale from the University of Naples Federico II in Naples, Italy, published a systematic review with meta-analysis of transversus abdominis release or TAR for ventral hernia repair, assessing short-term outcomes of the open and robotic-assisted approaches. The meta-analysis combined 6 studies containing over 800 patients, of which just over 200 patients underwent robotic-assisted da Vinci surgery and just under 600 patients who underwent the open approach. Results of this meta-analysis found that the robotic-assisted approach was associated with a 4.4-day shorter length of stay, 64% lower risk of postoperative complications and 79% lower risk of developing systemic complications. Readmission and reoperations were comparable between both groups.

今年8月，義大利那不勒斯費德里科二世大學的翁貝托·布拉卡萊教授發表了一篇關於腹橫肌鬆解術（TAR）治療腹壁疝氣的系統性回顧和統合分析，評估了開放手術和機器人輔助手術的短期療效。此統合分析納入了6項研究，共涉及800餘例患者，其中200餘例接受了達文西機器人輔助手術，近600例接受了開放性手術。統合分析結果顯示，機器人輔助手術可使住院時間縮短4.4天，術後併發症風險降低64%，全身併發症風險降低79%。兩組患者的再入院率和再次手術率相當。

The authors concluded in part, "Based on the data from the meta-analysis, the robotic approach for TAR seems safe and feasible even in more difficult cases. Robotic-assisted TAR shows the common advantages of minimally invasive procedures that improve short-term outcomes with significant benefits in the early postoperative period."

作者在結論中部分指出：「根據薈萃分析的數據，即使在更複雜的病例中，機器人輔助全髖關節置換術（TAR）似乎也是安全可行的。機器人輔助全髖關節置換術展現了微創手術的常見優勢，能夠改善短期療效，並在術後早期帶來顯著益處。」

Lastly, as noted in yesterday's press release, preliminary results from the PRECIsE study evaluating outcomes associated with the Ion endoluminal system were presented at the annual CHEST conference. This preliminary analysis of 69 subjects showed a diagnostic yield of 83% with a sensitivity of malignancy of 84% to 88% from the biopsy of peripheral pulmonary nodules with a mean size of 17 millimeters. These initial outcomes regarding the performance of the Ion system are encouraging, and we look forward to the full study being published in the second half of 2022.

最後，如同昨天的新聞稿所述，評估 Ion 腔內系統相關療效的 PRECisE 研究的初步結果已在年度 CHEST 會議上公佈。這項針對 69 名受試者的初步分析顯示，該系統對平均大小為 17 毫米的周圍肺結節進行活檢，診斷率為 83%，惡性腫瘤敏感性為 84% 至 88%。這些關於 Ion 系統表現的初步結果令人鼓舞，我們期待研究的完整結果於 2022 年下半年發表。

I will now turn to our financial outlook for 2021. During Q3, we experienced a more challenging supply chain environment with a deterioration in on-time delivery performance from our suppliers. We also saw increased supply chain costs. While this did not have a material impact to our operating results in Q3, the outlook we are providing does not reflect any potential significant disruption or additional costs related to supply constraints.

接下來，我將談談我們對2021年的財務展望。第三季度，我們的供應鏈環境更具挑戰性，供應商的準時交貨率下降。同時，供應鏈成本也有所增加。雖然這並未對我們第三季的經營業績造成實質影響，但我們提供的展望並未反映任何潛在的重大供應中斷或與供應限制相關的額外成本。

Starting with procedures. Last quarter, we forecast 2021 procedure growth of 27% to 30%. Given Q3 results and the impact of the Delta variant, we are now narrowing our forecast and expect full year 2021 procedure growth of 27% to 29%. This procedure outlook does not reflect a significant impact from OR staffing shortages or a resurgence of COVID-19. The high end of the range assumes that COVID-19-related hospitalizations in the U.S. continue the recovery that began in September and that COVID-related mitigation measures in OUS markets continue to ease.

首先來看手術量。上季度，我們預測2021年手術量將成長27%至30%。鑑於第三季業績以及Delta變體的影響，我們現在縮小了預測範圍，預計2021年全年手術量將增加27%至29%。這項手術量預測並未反映手術室人員短缺或新冠疫情反彈帶來的重大影響。預測範圍的上限基於以下假設：美國新冠相關住院人數將延續9月開始的復甦勢頭，並且美國境外市場的新冠相關防控措施將繼續放鬆。

Turning to gross profit. On our last call, we forecast our 2021 full year pro forma gross profit margin to be within 70.5% and 71.5% of revenue. We now expect 2021 pro forma gross profit margin to be within 71% and 71.5% of revenue. This range does not reflect any significant disruption associated with the current supply chain challenges. Our actual gross profit margin will vary quarter-to-quarter depending largely on product, regional and trade-in mix the impact of product cost reductions and manufacturing efficiencies and competitive pricing pressure.

接下來談談毛利。在上一次電話會議上，我們預測2021年全年備考毛利率將佔營收的70.5%至71.5%。現在，我們預計2021年備考毛利率將佔營收的71%至71.5%。這一區間並未反映當前供應鏈挑戰帶來的任何重大影響。我們的實際毛利率將逐季波動，主要取決於產品、地區和以舊換新組合、產品成本降低和生產效率提升的影響以及競爭性定價壓力。

With respect to operating expenses, on our last call, we forecast to grow full year pro forma 2021 operating expenses between 17% and 21% above 2020 levels. We are refining our estimate and now expect our full year pro forma operating expense growth to be between 17% and 19%. We expect our noncash stock compensation expense to range between $450 million and $460 million in 2021. With regard to pro forma other income, which is comprised mostly of interest income, we expect a range of between $50 million and $55 million in 2021. Finally, with respect to income tax, we expect our Q4 2021 pro forma tax rate to be approximately 21.5% of pretax income.

關於營運費用，在上次電話會議上，我們預測2021年全年備考營運費用將比2020年水準成長17%至21%。我們正在調整預測，目前預計2021年全年備考營運費用成長率將在17%至19%之間。我們預計2021年非現金股權激勵費用將介於4.5億美元至4.6億美元之間。關於主要由利息收入構成的備考其他收入，我們預計2021年該項收入將在5,000萬美元至5,500萬美元之間。最後，關於所得稅，我們預計2021年第四季備考稅率約為稅前利潤的21.5%。

That concludes our prepared remarks. 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) We'll go first to Amit Hazan with Goldman Sachs.

（操作員指示）我們首先連線高盛的阿米特·哈贊。

I want to come back to the supply chain comment first. Just to ask you how visibility looks for componentry now versus maybe a little bit earlier this year, what lead times look like now, sounds tighter, just a little more color around that. And to what extent have you kind of already been able to either kind of double order or for lack of a better term, I guess, or stockpile this year and how viable of an option does that remain for you?

我想先回到供應鏈的問題。我想問一下，現在零件的供應情況與今年稍早相比如何？交貨週期現在怎麼樣？聽起來更緊了，希望能更詳細地了解一下。今年你們在多大程度上已經能夠加倍訂購，或者說，囤積庫存？這種做法對你們來說是否仍然可行？

Yes. I think, Amit, this is Marshall. The environment as it relates to supply chain has deteriorated, gotten more difficult over time. And as we said, we've dedicated substantial resources to dealing with those shortages and has not to date created an issue with us supplying customer demand. But there is a risk and it's a real risk. And so we call it out to make sure that everybody is aware of that. From the perspective of cost, we saw some increased material costs last quarter. They were not significant. And we also incurred some expediting fees associated with freight, again, not material. But going forward, we do expect cost, increased cost that will probably hit the margin in Q4 or Q1. It's hard to predict exactly how much. And so I think that kind of summarizes it for you. It's a difficult environment right now.

是的。我想，阿米特，我是馬歇爾。供應鏈環境確實惡化了，隨著時間的推移變得越來越困難。正如我們所說，我們投入了大量資源來應對這些短缺，到目前為止，還沒有影響到我們滿足客戶需求。但風險依然存在，而且是實實在在的風險。所以我們特此說明，確保每個人都意識到這一點。從成本角度來看，上個季度我們看到一些原料成本增加，但增幅不大。我們也產生了一些與貨運相關的加急費用，同樣，這些費用也不大。但展望未來，我們預期成本會增加，這可能會在第四季或第一季影響利潤率。很難準確預測具體影響幅度。我想以上總結應該夠了。目前的環境確實很艱難。

I'd just say, I think our supply chain and manufacturing teams are doing great. I think they're working in a tough macro environment, and that macro environment will clear up when it clears up.

我想說的是，我認為我們的供應鏈和製造團隊做得非常出色。我認為他們是在艱難的宏觀環境下工作，而這種宏觀環境會在情況好轉時隨之好轉。

Next question, we go to Larry Biegelsen with Wells Fargo.

下一個問題，我們請富國銀行的拉里·比格森回答。

Just 2 for me, one on Ion, Gary, and then one on procedures. So the PRECIsE data looked good yesterday. I guess the question is, do you think the early data suggests your shape-sensing technology can lead to better yields and lower pneumothorax rates versus your main competitor, which uses a different technology? And how much of a catalyst do you think the data from yesterday will be for Ion? And I just had one follow-up.

我只有兩個問題，一個是關於 Ion 的，Gary，另一個是關於手術流程的。所以昨天的 PRECisSE 數據看起來不錯。我想問的是，您認為早期數據是否表明，與使用不同技術的主要競爭對手相比，您的形狀感知技術能夠帶來更高的手術成功率和更低的胸膜炎發生率？您認為昨天的數據對 Ion 的發展有多大的推動作用？我剛剛還有一個後續問題。

Yes. I think that the architecture as a whole, the shape sensor, the way it works, the design choices about making a soft catheter that's quite thin and can go deep into the lung has been really strong for us, and I think the data speaks for itself. You can compare for yourself the data that folks using Ion are producing and that from Monarch. And we feel great about where we are.

是的。我認為，從整體架構、形狀感測器、工作原理以及設計上來說，我們選擇的這種纖細柔軟、能夠深入肺部的導管都非常出色，數據本身就足以說明一切。您可以自行比較使用 Ion 和 Monarch 裝置的使用者所產生的資料。我們對目前的進展感到非常滿意。

I think it is catalyzing. As we speak, I think that those results are helping us in the market. Our customers are giving us really good feedback. And we continue to invest in the operations part of that program as well as the innovation side. We feel really good about it.

我認為它起到了催化作用。就目前而言，我認為這些成果正在幫助我們在市場上取得成功。我們的客戶給了我們非常好的回饋。我們將繼續投資於該項目的營運和創新方面。我們對此感到非常滿意。

And then on procedures, I guess it sounds like most or if not all, major markets are moving in the right direction. I'd love to hear a little bit more color, particularly on the U.S. And it sounds like, Jamie, and by the way, congratulations on the new role. It sounds like we should expect normal seasonality in Q4. When we look at 2018 and 2019, the sequential procedure growth was very similar worldwide, U.S. and OUS. Is it possible that it could be a little stronger given that we're seeing a recovery?

至於手術量方面，我感覺到大部分（如果不是全部）主要市場都在朝著正確的方向發展。我很想了解更多細節，特別是關於美國的情況。傑米，順便恭喜你履新。聽起來我們應該預期第四季會出現正常的季節性波動。回顧2018年和2019年，全球、美國和美國以外地區的手術量較上月成長非常接近。考慮到目前經濟正在復甦，成長勢頭是否有可能更強勁一些？

Yes. Thank you, Larry, by the way. I would say this, what's reflected in the high end of our procedure guidance is really 2 things that COVID-19-related hospitalizations in the U.S. continue the recovery that began in September, and that was kind of in the middle part of September that, that recovery commenced. So there's a progression there that continues through Q4.

是的。順便說一句，謝謝你，拉里。我想說的是，我們手術指南中高端病例的出現，實際上反映了兩件事：一是美國新冠肺炎相關住院人數延續了9月份開始的復甦趨勢，而復甦的真正開始時間大約在9月中旬。因此，這種復甦勢頭將持續到第四季。

It also assumes that the mitigation measures in OUS markets, which are typically a little more conservative than we see in the U.S., continue to ease. And those also started to ease in September. At the low end, what we see is a slower recovery in the U.S. from what we saw in Q3 and choppiness OUS in terms of kind of the on/off of mitigation measures in various markets. And so that range of 27% to 29% that we provided really is just a function of the rate at which we recover from what occurred in Q3 with the Delta variant.

它還假設美國境外市場的緩解措施（通常比美國國內的更保守）將繼續放鬆。這些措施也已於9月開始放鬆。從低端來看，我們預計美國經濟復甦速度將比第三季放緩，而美國境外市場由於各個市場緩解措施的反覆調整，經濟波動較大。因此，我們提供的27%至29%的預測範圍，實際上取決於我們從第三季德爾塔效應的影響中恢復的速度。

A little color on that, it's me just jumping in. I think there's 2 things that are going on. One is, what will pace us is hospital availability for surgery, right? It's not infection rate. It's going to be resource consumption at the hospital and their ability to pivot their resources, both human capital and facilities back towards surgery. As you double-click on that, some of it is regional variance, but some of it is actually just hospital system variance. There's differences in how each hospital is managing it. So it's hard to generalize, I think, beware of averages.

我來補充一點，我先插一句。我認為目前有兩個因素在起作用。一是，決定我們行動速度的是醫院的手術資源可用性，對吧？感染率並不重要。關鍵在於醫院的資源消耗情況，以及他們能否將人力和設施等資源重新調配回手術領域。深入分析一下，你會發現其中一部分是地區差異，但實際上也存在醫院系統內部的差異。每家醫院的管理方式都不盡相同。所以很難一概而論，我認為要謹慎對待平均值。

Next question comes from Bob Hopkins with Bank of America.

下一個問題來自美國銀行的鮑伯霍普金斯。

Just to follow up on that last question. So for Jamie or Marshall, I guess. Therefore, does the procedure volumes that you are forecasting for Q4, is that assuming improving year-over-year growth in Q4 versus the year-over-year growth in Q3 or about the same?

關於上一個問題，我再補充一下。所以，對於Jamie或Marshall來說，我想應該是這樣。那麼，你們預測的第四季手術量，是基於第四季同比成長率高於第三季度，還是與第三季度基本持平的假設呢？

Yes. I think what's implied by the guidance that we provided, at the low end, Q4 year-over-year growth will be 15%. At the high end, it will be 22%. So you compare that to what we showed in Q3 of 20%. Then you see kind of the range is above and below what we recorded in Q3. And I think, again, it just reflects both the year-over-year comparison in terms of the base for Q4 in 2020 as well as the range of scenarios in terms of what actually occurs with procedures in Q4.

是的。我認為我們提供的業績指引暗示，第四季年成長率的下限是15%，上限是22%。這與第三季20%的成長率相比，可以看出成長區間高於或低於第三季的水平。我認為這不僅反映了2020年第四季的基數，也反映了第四季實際業務流程中可能出現的各種情況。

Okay. And then just one quick one for Gary. I was struck by your comments in your opening remarks about how your multiport systems now have 70 clinical uses. And I was curious if you could just elaborate on that a little bit. Is that 70 different surgical procedures or how are you characterizing clinical uses? That sounds like an interesting number.

好的。最後再問Gary一個問題。您在開場白中提到您的多端口系統目前有70種臨床應用，這讓我印象深刻。我想請您詳細解釋一下。這70種是指不同的外科手術，還是您如何定義臨床應用？這個數字聽起來很有趣。

Yes. That's right. It's the number of kind of different procedures that's described in our labeling as to where this might be used in the body or in a subspecialty. So you look at urology, there's a handful of different procedures that it can be used for and likewise, gynecology, general surgery. And as you just walked through, that's a set of procedures for which we've engaged the agency and put in our labeling. So they're quite broadly applied.

是的，沒錯。我們標籤上描述的是各種不同的手術操作，包括該藥品可能用於身體的哪個部位或哪個次專科。例如，泌尿外科就有很多不同的手術操作可以使用該藥品，婦科和一般外科也是如此。正如您剛才提到的，這些都是我們委託監管機構並已納入標籤的手術操作。因此，它們的適用範圍相當廣泛。

Okay. My model only has 10. So I guess I have some work to do.

好的。我的模型只有10個。看來我還有一些工作要做。

And we're not done. I think surgeons and we and regulatory agencies around the world continue to explore where else technologies like ours can go.

我們還沒完。我認為外科醫生、我們以及世界各地的監管機構都會繼續探索像我們這樣的技術還能應用在哪些領域。

Next question comes from Tycho Peterson with JPMorgan.

下一個問題來自摩根大通的泰科彼得森。

I want to see if you can elaborate a little bit more on the staffing shortage comments. I know this isn't maybe fully baked in the guidance, but how much risk do you think this presents? How widespread is it? Obviously, it's a very tight labor market, but is this something you're seeing across most of your customers? Or how would you characterize it?

我想請您就人員短缺問題再詳細闡述。我知道這可能沒有完全納入指導方針，但您認為這會帶來多大的風險？這種情況有多普遍？顯然，目前的勞動力市場非常緊張，但這種情況在您的大多數客戶中都存在嗎？或者您會如何描述這種情況？

You're referring to the customer side?

您指的是客戶面嗎？

Correct.

正確的。

Yes. Jamie, why don't you talk a little bit about it.

是的。傑米，你來談談這件事。

Yes. We've had anecdotal inputs from some customers that they're facing staffing shortages. Other customers have said to us that they're able to overcome those risks. And so given kind of the mix dynamics and the lack of clear evidence in terms of its impact on procedures. And what we've said is, the remainder of the year guidance does not reflect any significant disruption from OR staffing shortages, meaning that there's no deterioration in that phenomenon for hospitals.

是的。我們從一些客戶那裡了解到，他們正面臨人員短缺的問題。另一些客戶則表示，他們能夠克服這些風險。鑑於目前情況複雜多變，且尚無明確證據表明人員短缺會對手術流程造成影響，因此我們表示，今年剩餘時間的業績預期不會受到手術室人員短缺的嚴重影響，這意味著醫院的這一問題不會惡化。

Okay. And then another dynamic you flagged was just kind of the selling cycle. Obviously, early days on the competitive front. But on the back of the CE mark for Medtronic, I'm just curious, out of Europe, what you're hearing from your sales reps just in terms of early interest, potential demos, things like that?

好的。您提到的另一個動態因素是銷售週期。顯然，目前競爭還處於早期階段。但鑑於美敦力獲得了CE認證，我很好奇，在歐洲，您的銷售代表們了解到哪些關於早期市場興趣、潛在演示等方面的資訊？

Yes. I think with several of the other systems that are on the market and as you say, the most recent one, we see early engagement. Those first engagements tend to be a placement of clinical trial sites and training centers and so on. So they're not surprising. They're kind of the early access programs to get into the market. So far, there are a fair number of claims about what these new systems will do.

是的。我認為市面上其他一些系統，包括您提到的最新系統，都出現了早期推廣活動。這些早期推廣活動通常包括設立臨床試驗點和訓練中心等等。所以這並不令人意外。它們算是搶佔市場先機的早期准入項目。目前，關於這些新系統的功能，已經有許多說法了。

And I think the reality is time will tell. Their Gen 1 systems, I think evidence has to be generated to back up those claims. And so far, we don't see anything yet that looks like evidence, just a set of claims. So we'll keep serving our customer, doing what we can to make sure that they can achieve the quadruple aim and we'll see how other companies do.

我認為時間會證明一切。對於他們的第一代系統，我認為需要拿出證據來支持他們的說法。到目前為止，我們還沒有看到任何像樣的證據，只有一堆空洞的說法。所以我們會繼續服務客戶，盡我們所能確保他們能夠實現四重目標，然後看看其他公司表現如何。

Maybe last one. We on the sell-side always get the question about a new system from you guys. It seems like that's picked up a little bit lately. You're putting up good system numbers. I'm curious in your view, is that something the market needs right now? What are you willing to say if anything at all about the appetite for another system from you guys or anything you may be working on?

或許這是最後一個問題了。我們賣方總是被問到關於你們新系統的問題。最近似乎問更多了。你們的系統數據確實不錯。我很好奇，從你們的角度來看，市場現在需要這樣的系統嗎？你們是否願意透露一些關於市場對你們新系統的需求，或者你們正在研發的其他系統的資訊？

First thing is that, we think there is room for innovation on all the platforms we have. So whether it's multiport and Gen 4, we continue to innovate. We've done a lot of sequential innovation on Gen 4. So our X and Xi are different. We continue to invest both in incremental opportunities and in deeper, bigger opportunities on multiport. And as we're ready to roll those out, you'll hear about it.

首先，我們認為所有平台都有創新空間。無論是多埠平台還是第四代平台，我們都會持續創新。我們在第四代平台上已經進行了大量循序漸進的創新。因此，我們的 X 和 Xi 平台有所不同。我們將繼續投資於多埠平台上的增量機會和更深入、更大的發展機會。一旦準備好推出這些產品，我們會第一時間通知大家。

We brought to market SP. We continue to innovate on SP and get sequential products and clearances globally for SP. And likewise, Ion, which is having great success really in its first indication, but we think has opportunities deeper in the body and in different locations in the body, which will proceed and describe over time. So yes, I think you should expect continued innovation from us.

我們已將SP推向市場。我們持續在SP領域進行創新，並在全球內陸續獲得SP相關產品和上市許可。同樣，Ion在其首個適應症領域取得了巨大成功，但我們認為它在體內更深層和不同部位的應用潛力巨大，這些潛力將隨著時間的推移而逐步揭示。因此，我認為您可以期待我們持續的創新。

As to whether we think that we're in immediate need of something, we are innovating at a pace where we think we can bring things that matter to the quadruple aim, not so much an idea of what's our retail strategy, but more can we do something that changes quadruple aim or otherwise improves the customer experience. And that's what we're focused on.

至於我們是否認為目前迫切需要什麼，我們正在以這樣的速度進行創新：我們認為我們可以為四重目標帶來真正重要的東西，這並非關乎我們的零售策略，而是關乎我們能否做出一些改變四重目標或以其他方式改善客戶體驗的事情。而這正是我們關注的重點。

Next question comes from Rick Wise with Stifel.

下一個問題來自 Stifel 公司的 Rick Wise。

One focused question and then a larger picture one. Gary, in your opening comments, you mentioned that extended life instruments, if I understood you, have reached, I think your word was equilibrium. I just want to make sure I understood what you're implying. Does that suggest that the initial phase of adoption has happened and we're going to see better growth ex sort of an initial stocking ASP impact? And is there a second round of instruments? This has been so successful, how should we think about all that?

先問一個具體問題，然後再問一個更宏觀的問題。 Gary，你在開場白中提到，如果我理解正確的話，長壽債券已經達到了，我想你用的是「平衡」這個詞。我只是想確認一下我是否理解了你的意思。這是否意味著最初的推廣階段已經結束，我們將會看到更好的成長，例如，在最初的庫存平均售價（ASP）影響之後？是否還有第二輪債券發行？這項技術如此成功，我們該如何看待這一切？

With regard to what I meant by equilibrium, it was really that the initial stocking orders and the transition from older instruments to newer is largely taking place, but I'll let Jamie answer that more carefully than I just did.

至於我所說的平衡狀態，實際上是指最初的庫存訂單和從舊樂器向新樂器的過渡基本上已經完成，但我還是讓傑米來更仔細地回答這個問題吧。

Actually, I think that's right, Gary. There's a period of time when as we launched extended use instruments, customers in the U.S. and Europe in particular were ordering those instruments at a rate higher than their usage. As they consume their 10-life instruments, that took some time to get into parity. And so you saw in the end a positive benefit to I&A per procedure in Q1 and Q2, Q3 for those regions that largely came to parity.

實際上，我認為你說得對，加里。在我們推出長效器材的那段時間裡，尤其是在美國和歐洲，客戶的訂購量遠高於實際使用量。隨著他們逐漸消耗掉這些10年壽命的器械，需求和使用量需要一段時間才能達到平衡。因此，最終你會看到，在第一季、第二季和第三季度，那些需求和使用量基本上達到平衡的地區，每次手術的穿刺和抽吸成本都得到了提升。

We did launch extended use instruments later in Asia and some of the rest of the world countries. And so they are still kind of working their way to parity. So there will be small downward pressure on I&A per procedure, holding everything else equal as they get to parity looking forward.

我們後來在亞洲和世界其他一些國家推出了擴展使用範圍的器械。因此，這些國家仍在努力實現與傳統器械的平價競爭。展望未來，在其他條件不變的情況下，隨著這些器械逐漸達到平價競爭，每次手術的取石費用將略有下降。

The second half of your question, just to finish it, you talked about, are we done? Is that it for these kinds of ideas? And extended use instruments and da Vinci X, these were design and process investments that we made to pursue what we think of as the virtuous cycle. The idea that if we can improve quality and lower cost for our customers that they can use our products in more and different procedures and we're not done doing that. It may not look exactly like what we've done in the past. There are other things that we think we can do that allow them high-value systems at different price points or high-value instruments at different price points. So that line of reasoning has not exhausted itself.

關於您問題的後半部分，我再補充一下，您提到我們是否已經完成了？這類想法是否就此結束了？關於延長使用壽命的儀器和達文西X手術系統，這些都是我們在設計和流程方面的投資，旨在追求我們所謂的良性循環。我們的理念是，如果我們能夠提高產品品質並降低成本，客戶就可以在更多不同的手術中使用我們的產品。而我們在這方面的工作遠未結束。未來可能與我們過去的做法有所不同。我們認為還可以做其他事情，以不同的價格提供高價值的系統或儀器。所以，這條思路遠未窮盡。

All right. And Gary, just one last big picture question. Obviously, you've created 2 new senior leadership roles here for Marshall and for Dave Rosa. Maybe just if you could just flesh out your thinking. Is it simply and it would be enough that Intuitive has gotten so large and complex and the future is so bright, you just need more senior leadership, focused leadership? Or what are you charging? What are you expecting? What should we expect from Marshall and Dave in coming years?

好的。 Gary，最後一個比較宏觀的問題。顯然，你為Marshall和Dave Rosa設立了兩個新的高階領導職位。你能不能詳細解釋一下你的想法？只是因為Intuitive發展壯大、業務複雜，而且未來前景光明，所以需要更多高階領導，更專注的領導？還是說你有什麼要求？你對他們有什麼期望？未來幾年我們應該對Marshall和Dave抱持什麼樣的期待？

Thank you for that question. Over the last few years, we've had an expansion of business and expansion of opportunity, both are happening. On the business side, we want to make sure that we serve our customers at very high quality, quickly in local regions where we can and that we take advantage of a lot of the systems and enterprise data that we have to help drive the business in and help our customer. And that's something that Marshall has been doing, and I've asked him to double down on that, to make sure that we can really take advantage of our global scale and serve our customers and our business really well at that scale. And it's an opportunity and it's real work.

謝謝你的提問。過去幾年，我們的業務和機會都在不斷拓展。在業務方面，我們希望確保在力所能及的地區，以高效、優質的服務滿足客戶需求，並充分利用我們現有的系統和企業數據來推動業務發展，更好地服務客戶。馬歇爾一直在努力推進這項工作，我也要求他加倍投入，確保我們能夠真正發揮全球規模優勢，以同樣的規模為客戶和業務提供卓越的服務。這既是一個機遇，也是一項實實在在的工作。

The flip side is, I have never been more positive about the long-term opportunity for companies like ours that can master the kinds of things that we have to do to help minimally invasive care and interventions. And so there's real opportunity there. And I'd like us to get there quickly to have the agility and focus to be able to open new ideas and new architectures and new markets. And I can think of nobody more qualified to lead that effort than Dave Rosa, who has visited just about all parts of the company, started off as an engineer and scientist and has done many things for us. So we're really trying to get the advantages of scale to help our global customers and also be agile on capitalizing on growth opportunities as we see them.

另一方面，對於像我們這樣能夠掌握微創醫療和介入治療所需技術的公司而言，其長期發展機會從未像現在這樣充滿信心。因此，這裡蘊藏著真正的機會。我希望我們能夠迅速實現這一目標，從而擁有足夠的敏捷性和專注力，開拓新的理念、架構和市場。我認為沒有人比戴夫·羅薩更適合領導這項工作。他幾乎走遍了公司的各個部門，從一名工程師和科學家做起，為公司做出了許多貢獻。因此，我們正努力利用規模優勢為全球客戶提供服務，同時也要靈活地掌握我們所看到的成長機會。

Next question comes from Matt Taylor with UBS.

下一個問題來自瑞銀集團的馬特泰勒。

I was hoping maybe, Marshall, you could talk a little bit more about the supply chain issues from the standpoint of just helping us get visibility or understand how close you are to the edge there. And meaning, you keep calling out this risk that exists, but it sounds like you've been doing a really good job of managing things so far. Is there any benchmark numbers you can give us to help us understand what the lead times are in some of these key things that could get disrupted or the likelihood that it will happen. Is it getting better or is there a real risk of you not being able to ship some kind of product is, I guess, the core of the question.

馬歇爾，我希望你能從供應鏈的角度，更詳細地談談這個問題，幫助我們了解情況，或者說，了解你們離崩潰邊緣有多近。我的意思是，你一直在強調有這種風險，但聽起來你們目前為止的管理工作做得非常好。你能否提供一些基準數據，幫助我們了解一些關鍵環節的交貨週期，以及這些環節可能中斷的可能性？情況是在好轉，還是真的有無法交付某些產品的風險？我想，這才是問題的核心。

Well, I don't think I can say it's getting better. I actually think that it's a difficult situation and will continue for some time. If you think about the one that's been talked about the most is semiconductors. You've seen it in the auto industry as an issue in computers. And if you had to order any home goods that contained chips, you would know that there's a problem there.

嗯，我覺得情況並沒有好轉。實際上，我認為情況依然嚴峻，而且這種情況還會持續一段時間。想想看，人們談論最多的就是半導體產業。無論是汽車業還是電腦業，都存在這個問題。如果你要購買任何含有晶片的家居用品，你就會知道其中有問題。

That will take a long time to remedy. It takes a long time to build fabs. It takes a long time to produce product. And I think that will go well into next year are the predictions that we're hearing. I think Gary told you, our team has done a marvelous job so far. So I think there are issues on a regular basis. And the issues so far, our team has been able to resolve those.

解決這個問題需要很長時間。建造晶圓廠需要很長時間，生產產品也需要很長時間。而且，我們聽到的預測是，這種情況可能會持續到明年。我想加里已經告訴過你了，我們的團隊到目前為止做得非常出色。所以，我認為問題會經常出現。但到目前為止，我們的團隊都能夠解決這些問題。

I don't have any statistics to provide you on how often or what it means. I would just say that some, anecdotally, some lead times have extended beyond 6 months. That's not all products, and it's not an average you should apply to everything. But in some cases, it's pretty long. And so I think you -- it's a problem we highlight just to make sure that you're aware of the risk.

我沒有統計數據可以提供給您，說明這種情況發生的頻率或具體含義。我只能說，根據一些案例，有些產品的交貨週期確實超過了6個月。這並非所有產品的普遍情況，也不是您應該套用到所有情況的平均值。但在某些情況下，交貨週期確實相當長。因此，我認為——我們強調這個問題，只是為了確保您意識到其中的風險。

We have a follow-up question from Amit Hazan with Goldman Sachs.

我們收到來自高盛的 Amit Hazan 的後續問題。

Yes. So I thought maybe just to follow up on the supply chain question was just a little bit more on just inflationary headwinds generally. And Marshall, just how you're seeing labor cost growth today versus kind of early in the year or more normal times and raw material cost growth versus normal, more normal times? And just how to, for us to start thinking about these things along with what you commented on the supply chain for next year, just qualitatively as we start to think about where operating margins might go?

是的。所以我想就供應鏈問題再深入探討一下通膨帶來的不利影響。馬歇爾，您認為目前的勞動成本成長與年初或正常時期相比有何不同？原物料成本成長與正常時期相比又有何不同？結合您先前對明年供應鏈的評論，我們應該如何定性地思考這些問題，才能更好地預測明年的營業利潤率？

We've seen some cost increases. Again, they haven't been that significant. And frankly, our teams have done a marvelous job with sort of with efficiency and effectiveness to offset those increased costs. But we're hearing from suppliers that they're going to raise their prices. And so we're saying that, hey, we expect that costs will go up more. I'm not sure I want to say that the inflation word has hit us and it's here to stay, but we are seeing some suppliers raise cost.

我們確實看到了一些成本上漲。不過，漲幅不算大。坦白說，我們的團隊在提高效率和效益方面做得非常出色，足以抵消這些成本上漲的影響。但我們從供應商那裡了解到，他們即將漲價。因此，我們預計成本還會繼續上漲。我並不想說通貨膨脹已經到來並且會持續下去，但我們確實看到一些供應商提高了價格。

Our next question comes from Vijay Kumar with Evercore ISI.

下一個問題來自 Evercore ISI 的 Vijay Kumar。

Gary, maybe 2 quick ones for you. The PRECIsE study, 83% diagnostic resolution. Is that good enough, Gary? I mean, certainly, the headline numbers when you look at other studies, it's a good number, but I'm just curious, is this the point where the market awakens to these numbers and should we see an inflection in adoption of Ion?

Gary，或許我可以問你兩個問題。 PRECISE 研究顯示，診斷解析度為 83%。 Gary，這個數字夠好嗎？我的意思是，當然，如果你看看其他研究，這個數字確實不錯，但我只是好奇，市場是否已經意識到這些數據的重要性，Ion 的普及率是否會出現轉折點？

And just one quick one on 3Q. I know you called out the Delta, but was there any labor shortage impact in 3Q itself? Because historically, we haven't seen the pandemic impact where Intuitive has outperformed peers. It's just perhaps a little excessive in 3Q. Was there something else going on?

關於第三季度，我還有一個問題。我知道您提到了達美航空，但第三季本身是否有勞動力短缺的影響？因為從歷史數據來看，我們之前並沒有看到疫情對Intuitive的影響，而Intuitive的表現一直都優於同業。只是第三季的表現可能有點過頭了。是不是還有其他原因？

Okay. On the first one, in terms of diagnostic yield, you had said 82%. And I guess what I'd advise everybody is, there's a couple of numbers that are important and they stay linked together. And that is, what is the size of the lesion? And then what's the positive diagnostic rate, the ability to definitively diagnose? That's what the interventional pulmonologists are looking at.

好的。關於第一個問題，就診斷率而言，您提到了82%。我想提醒大家的是，有幾個數字很重要，而且它們密切相關。那就是病灶的大小。還有陽性診斷率，也就是確診的能力。介入性肺科醫師關注的就是這些。

So the bigger the lesion, if it's a 3-centimeter lesion, your diagnostic yield rate is going to go up, your definitive diag, because it's easier to hit. So you got to look at both numbers. It's not a single metric. So 82% for smaller lesions is leading as far as I can tell for endobronchial approaches for that approach. Some folks can get to higher yield rates, but they're hitting bigger targets. So you need to look at both, and that's what I encourage you to do.

所以，病灶越大，例如3公分的病灶，診斷率（確診率）就越高，因為比較容易定位。所以你需要同時考慮這兩個指標，而不是單一指標。就我所知，對於較小的病灶，82%的診斷率在支氣管內介入治療中處於領先地位。有些人能達到更高的診斷率，但他們的目標是更大的病灶。所以你需要同時考慮這兩個指標，這也是我建議你要做的。

The second thing that I advise you is that, there are other ways to examine or get a biopsy. There can be outside the body, CT-guided needle biopsies. And those outside the body CT-guided needle biopsies have high success rates at gathering the tissue, but they have a lower safety profile than the endobronchial approach. So there's kind of a third dimension, which is, did you get the tissue you needed to get a definitive diagnosis? How big was the lesion you were trying to target? And what was the complication rate?

我給你的第二點建議是，除了上述方法外，還有其他方法可以進行檢查或活檢。例如，體外CT引導下針吸活檢。體外CT引導下針吸切片的組織獲取成功率很高，但其安全性低於支氣管內切片。因此，還有第三個需要考慮的因素，那就是：你是否獲得了足夠的組織樣本來做出明確診斷？你想要定位的病灶有多大？併發症發生率是多少？

And we think that Ion is really good at managing all 3 of those relative to competitive approaches. And we're seeing a nice uptick as a result. And is that a tipping point? We'll see. So far so good. That's what we had expected. This kind of performance, that's what we were targeting. But we're pleased to see it being borne out over multiple sites and multiple customers, and we think that's going to be helpful.

我們認為，相對於競爭對手而言，Ion 在這三方面都做得非常出色。因此，我們看到業績有了顯著提升。這是否會成為一個轉捩點？我們拭目以待。目前為止一切順利。這正是我們所預期的。這種業績正是我們努力的目標。我們很高興看到它在多個站點和多個客戶身上都得到了驗證，我們認為這將大有裨益。

With regard to your second question, you were talking a little bit about, are we seeing an unusual or more aggressive slowdown because of Delta than perhaps others? What I'd encourage you to think about there is, where in the world everybody is exposed and where they're seeing their growth. So in our case, we have a certain regional profile and where our procedures are being done. Other companies may have much bigger exposure to, say, markets or countries that had a lower impact having to do with Delta. Frankly, I think, it's as simple as that, but time will tell on that as well.

關於你的第二個問題，你剛才提到，我們是否因為達美航空而看到比其他公司更嚴重的業務放緩？我想請你思考一下，每家公司在全球的業務覆蓋範圍以及成長點分別在哪裡。就我們而言，我們的業務具有一定的區域性，我們的營運也主要集中在這些區域。其他公司可能在受達美航空影響較小的市場或國家擁有更大的業務敞口。坦白說，我認為問題就這麼簡單，但時間會證明一切。

So let's go ahead and conclude. That was our last question. In closing, we continue to believe there's 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.

那麼，讓我們來總結一下。這是我們最後一個問題。總而言之，我們仍然相信，在從根本上改善外科手術和急診介入方面，存在著巨大且持久的機會。我們的團隊將繼續與醫院、醫生和護理團隊緊密合作，追求客戶所說的「四重目標」：更佳、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 follows from respect for and understanding of patients and care teams, their needs and their environment. Thank you for your support on this extraordinary journey. We look forward to speaking with you again in 3 months.

我們相信，外科手術和急診護理的價值創造以人為本。它源自於對病人和照護團隊、他們的需求以及他們所處環境的尊重和理解。感謝您在這段非凡旅程中給予的支持。我們期待三個月後再次與您交流。

Ladies and gentlemen, that does conclude your conference call for today. Thank you for your participation and for using AT&T Event Conferencing. You may now disconnect.

女士們、先生們，今天的電話會議到此結束。感謝您的參與以及使用AT&T會議服務。您現在可以斷開連線了。