直覺手術 (ISRG) 2021 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Q2 2021 Earnings Conference Call.

女士們、先生們，感謝你們的耐心等待，歡迎參加 Intuitive 2021 年第二季度收益電話會議。

(Operator Instructions) As a reminder, this conference is being recorded.

（操作員指示）謹此提醒，本次會議正在錄製中。

And at this time, I would like to turn the conference over to our host, Senior Director of Finance, Investor Relations for Intuitive, Mr. Calvin Darling.

現在，我想將會議交給我們的東道主、Intuitive 投資者關係高級財務總監 Calvin Darling 先生。

Please go ahead, sir.

請繼續，先生。

Thank you.

謝謝。

Good afternoon, and welcome to Intuitive's Second Quarter Earnings Conference Call.

下午好，歡迎參加 Intuitive 第二季度收益電話會議。

With me today, we have Gary Guthart, our CEO; Marshall Mohr, our CFO; and Jamie Samath, our Senior Vice President of Finance.

今天和我在一起的還有我們的首席執行官加里·古特特 (Gary Guthart)；馬歇爾·莫爾，我們的首席財務官；以及我們的財務高級副總裁 Jamie Samath。

Philip Kim, our Head of Investor Relations, will not be joining on today's call as he's currently on paternity leave following the birth of his daughter.

我們的投資者關係主管 Philip Kim 將不會參加今天的電話會議，因為他在女兒出生後目前正在休陪產假。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements.

在我們開始之前，我想通知您，今天電話會議中提到的評論可能被視為包含前瞻性陳述。

Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties.

由於某些風險和不確定性，實際結果可能與明示或暗示的結果存在重大差異。

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 April 21, 2021.

這些風險和不確定性在我們向美國證券交易委員會提交的文件中進行了詳細描述，包括我們於 2021 年 2 月 10 日提交的最新 10-K 表格；以及 2021 年 4 月 21 日提交的 10-Q 表。

Our SEC filings can be found through our website or at the SEC's website.

我們的 SEC 備案文件可以通過我們的網站或 SEC 網站找到。

Investors are cautioned not to place undue reliance on such forward-looking statements.

投資者應注意不要過分依賴此類前瞻性陳述。

Please note that this conference call will be available for audio replay on our website at intuitive.com on the latest Events section under our Investor Relations page.

請注意，本次電話會議將在我們網站直觀的投資者關係頁面下的最新活動部分進行音頻重播。

Today's press release and supplementary financial data tables have been posted to our website.

今天的新聞稿和補充財務數據表已發佈到我們的網站上。

Today's format will consist of providing you with highlights of our second quarter results as described in our press release announced earlier today followed by a question-and-answer session.

今天的形式將包括向您提供我們今天早些時候宣布的新聞稿中所述的第二季度業績亮點，然後是問答環節。

Gary will present the quarter's business and operational highlights.

加里將介紹本季度的業務和運營亮點。

Marshall will provide a review of our financial results.

馬歇爾將對我們的財務業績進行審查。

Jamie will discuss procedure and clinical highlights and provide an update of our financial outlook.

傑米將討論手術和臨床要點，並提供我們財務前景的最新信息。

And finally, we will host a question-and-answer session.

最後，我們將舉辦問答環節。

With that, I'll turn it over to Gary.

有了這個，我會把它交給加里。

Thank you for joining us today.

感謝您今天加入我們。

Our second quarter 2021 performance was encouraging, with use of our systems for procedures growing beyond pre-pandemic levels and healthy capital placements.

我們 2021 年第二季度的業績令人鼓舞，我們的程序系統使用量超出了大流行前的水平，資本配置也健康。

Looking at the past 8 quarters in context, our compound annual growth rate for procedures for the period Q2 2019 through Q2 2021 of 16.5% is approximately the growth we would have expected absent the pandemic.

縱觀過去 8 個季度，我們在 2019 年第二季度至 2021 年第二季度期間的程序複合年增長率為 16.5%，大約是我們在沒有大流行的情況下預期的增長。

The pandemic has reordered the quarter in which procedures were performed, and we believe it has delayed some procedures that are likely to return in the future and may cause a small number of patients to permanently forgo surgery.

疫情對進行手術的季度進行了重新排序，我們認為它推遲了一些可能在未來回歸的手術，並可能導致少數患者永久放棄手術。

To understand our system placement and capital performance over this period, we look to annual system utilization trends, which have recovered to utilization rates at the high end of our historical averages.

為了了解我們在此期間的系統佈局和資本績效，我們關注年度系統利用率趨勢，這些趨勢已恢復到歷史平均水平的高端利用率。

Taken together, this combination of a recovery in procedures and healthy utilization supports our solid capital placement trends and rounds out a healthy commercial recovery year-to-date.

總而言之，程序的恢復和健康利用的結合支持了我們穩健的資本配置趨勢，並實現了今年迄今為止的健康商業復甦。

Examining procedure trends more deeply.

更深入地檢查程序趨勢。

In the United States, procedure growth was strong in the quarter, driven by growth in bariatric surgery, hernia repair and cholecystectomy.

在美國，受減肥手術、疝氣修復和膽囊切除術增長的推動，本季度手術增長強勁。

Both gynecology and urology procedure annualized growth strengthened in the quarter, as pandemic pressures eased in the U.S. Annualized U.S. procedure growth rates are returning to historical levels for procedures with longer diagnostic pipelines as patients have started returning to screening and diagnostic testing.

隨著美國大流行壓力的緩解，婦科和泌尿科手術的年化增長在本季度有所加強。隨著患者開始返回篩查和診斷測試，具有較長診斷流程的美國手術年化增長率正在恢復到歷史水平。

Growth in our second largest market, China, continued to be strong with multiple specialties contributing.

我們的第二大市場中國的增長繼續強勁，多個專業做出了貢獻。

European procedure growth was generally healthy, though varied by country.

歐洲手術增長總體健康，但因國家而異。

Recovery in the U.K. was healthy in the quarter as NHS increased access to surgeries broadly.

隨著 NHS 廣泛增加手術機會，英國本季度的複蘇狀況良好。

The pandemic is not behind us and additional infection growth may again strain hospital resources and impact our results in the future.

大流行還沒有過去，感染的增加可能會再次導致醫院資源緊張，並影響我們未來的業績。

Jamie will take you through procedure dynamics in more detail later in the call.

傑米將在稍後的電話會議中向您詳細介紹過程動態。

On the capital side, new system placements continue to be healthy, with the United States, China, Germany, France and Japan, notable in the quarter.

在資本方面，新系統的投放繼續保持健康，其中美國、中國、德國、法國和日本在本季度尤為引人注目。

We know that new system placements are closely tied to anticipated procedure volumes and system utilization in mature markets.

我們知道，新系統的佈局與成熟市場中的預期程序量和系統利用率密切相關。

We continue to see significant utilization variance by region due to pandemic differences.

由於流行病的差異，我們繼續看到各地區的利用率存在顯著差異。

In the quarter, strong trade-ins of older generation systems for our fourth generation products and strength in multi-system deals, continue to support our thesis that customers that know us best continue to invest with us going forward.

本季度，我們第四代產品的老一代系統的強勁折價以及多系統交易的實力，繼續支持我們的論點，即最了解我們的客戶將繼續與我們一起投資。

We also saw an increase in our IDN customers opening new da Vinci and Ion programs in hospitals within their network that did not previously have an Intuitive robotics program, indicating their interest in diversifying access to Intuitive programs across their networks.

我們還發現，越來越多的IDN 客戶在其網絡內的醫院中開設新的達芬奇和Ion 項目，而這些醫院以前沒有Intuitive 機器人項目，這表明他們有興趣在其網絡中實現Intuitive 項目的多樣化訪問。

Looking to our finances in the quarter.

看看我們本季度的財務狀況。

Procedures recovered nicely in Q2, system placements came in above plan, and system ASP and I&A revenue per procedure tracked slightly above our expectations, together driving revenue of $1.46 billion in Q2.

第二季度程序恢復良好，系統佈局超出計劃，每個程序的系統 ASP 和 I&A 收入略高於我們的預期，共同推動第二季度收入達到 14.6 億美元。

Our pro forma spending grew over 24% from a year ago, representing increased investment in our business.

我們的預計支出比一年前增長了 24% 以上，這表明我們對業務的投資有所增加。

However, our expense growth rate was modestly lower than our plan, driven by pandemic-related factors.

然而，受疫情相關因素的影響，我們的費用增長率略低於我們的計劃。

COVID has delayed some work in R&D and clinical trials, leading to some underspend in programs, prototypes and some delay in hiring.

新冠疫情推遲了一些研發和臨床試驗工作，導致一些項目、原型方面的支出不足，以及招聘方面的一些延遲。

We expect these programs to continue their ramp as our labs and development programs recover efficiency.

隨著我們的實驗室和開發項目恢復效率，我們預計這些項目將繼續發展。

Travel and associated costs in support of our field have also not recovered to pre-pandemic levels.

支持我們領域的差旅費和相關費用也尚未恢復到大流行前的水平。

Field and marketing costs will tick up if the pandemic wanes.

如果疫情消退，現場和營銷成本將會上升。

In short, our commercial business has recovered more quickly than our spending due to the different ways that pandemic impacts our customers, our supply chains and our hiring.

簡而言之，由於疫情對我們的客戶、供應鍊和招聘的影響不同，我們的商業業務恢復速度快於支出。

Marshall will take you through our financial picture later in the call.

馬歇爾將在稍後的電話會議中向您介紹我們的財務狀況。

Turning to our innovation and commercialization efforts.

轉向我們的創新和商業化努力。

We are developing and deploying technology-enabled ecosystems 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.

我們正在開發和部署技術支持的生態系統，以支持客戶追求四重目標、更好的結果、更好的患者體驗、更好的護理團隊體驗以及更低的每次患者治療總成本。

We are in the execution and launch phase of 4 efforts.

我們正處於四項工作的執行和啟動階段。

First, we are broadening access to our advanced instruments for our da Vinci Fourth Generation Multiport Systems through pursuit of additional clearances and launches outside the U.S. Second, we are expanding our da Vinci SP offering by broadening its regional and clinical indications and by adding it to its suite of instruments and accessories.

首先，我們正在通過尋求美國境外的額外許可和發布來擴大達芬奇第四代多端口系統先進儀器的使用範圍。其次，我們正在通過擴大其區域和臨床適應症並將其添加到其儀器和配件套件。

Third, we are launching and refining our flexible diagnostic platform, Ion, by working with early customers to help establish high-performing sites and by improving our technology and supply chain capabilities.

第三，我們正在推出和完善我們靈活的診斷平台 Ion，通過與早期客戶合作幫助建立高性能站點並提高我們的技術和供應鏈能力。

Finally, we are strengthening our digital capabilities across our ecosystem.

最後，我們正在加強整個生態系統的數字能力。

Our fully integrated advanced instruments portfolio has been a strong addition to our multiport ecosystem, allowing for high-quality tissue interaction controlled from the surgeon's console while optimizing workflow.

我們完全集成的先進儀器產品組合是我們多端口生態系統的有力補充，允許從外科醫生控制台控制高質量的組織相互作用，同時優化工作流程。

These system-controlled staplers, vessel sealers and energy instruments support a range of procedures from bariatrics to colorectal procedures, to thoracic and gynecologic applications.

這些系統控制的吻合器、血管封閉器和能量儀器支持從減肥到結直腸手術，再到胸部和婦科應用的一系列手術。

Customer appreciation and recurring use of our products has been growing nicely.

客戶對我們產品的讚賞和重複使用一直在良好增長。

In Q2, we launched our SureForm stapling line in India.

第二季度，我們在印度推出了 SureForm 裝訂線。

We launched our Force bipolar energy instrument along with our extended use instruments program in Japan, and we launched our SynchroSeal energy instrument and E-100 energy generator in Korea.

我們在日本推出了 Force 雙極能量儀器以及擴展使用儀器計劃，並在韓國推出了 SynchroSeal 能量儀器和 E-100 能量發生器。

Turning to our single port system.

轉向我們的單端口系統。

We placed 4 SP systems in the quarter, bringing the total installed base to 79.

我們在本季度安裝了 4 個 SP 系統，使安裝總數達到 79 個。

SP procedures grew 133% year-over-year, with much of that growth coming from the United States.

SP 手術同比增長 133%，其中大部分增長來自美國。

First cases in our SP colorectal IDE trial were completed in the quarter as we seek to bring SP capability to additional procedures.

我們的 SP 結直腸 IDE 試驗的第一批病例已於本季度完成，我們尋求將 SP 功能引入其他程序。

We are also working on our regulatory filings to bring SP to Europe under the European Union's new medical device regulation framework.

我們還在準備監管備案，以便將 SP 引入歐洲，納入歐盟新的醫療器械監管框架。

Our flexible robotics program, first targeted towards diagnostic bronchoscopy, has had a strong quarter.

我們的靈活機器人項目首先針對診斷支氣管鏡檢查，該項目在本季度表現強勁。

We placed an additional 20 Ion systems in the quarter, bringing the installed base to 70.

我們在本季度另外安裝了 20 個 Ion 系統，使安裝數量達到 70 個。

Ion procedures grew sixfold over Q2 2020 to nearly 1,500 procedures in the quarter, reflecting recovery from the pandemic, the growth in new sites and growth in utilization at existing sites.

Ion 手術數量比 2020 年第二季度增長了六倍，達到近 1,500 台手術，反映了疫情的恢復、新站點的增長以及現有站點利用率的增長。

Our total Ion clinical experience is approximately 4,000 cases to date.

迄今為止，我們的 Ion 臨床總經驗約為 4,000 例。

Clinical trial sites completed enrollment for our PRECIsE clinical trial.

臨床試驗中心已完成 PRECIsE 臨床試驗的註冊。

Finally, our team is making good progress in scaling our operations.

最後，我們的團隊在擴大運營規模方面取得了良好進展。

Lastly, we continue to digitally enhance our ecosystem.

最後，我們繼續以數字方式增強我們的生態系統。

In the quarter, we continued to engage customers in data analytics and opportunity analysis for surgical programs, cornerstone of our Your Data, Your Truth analytics efforts.

本季度，我們繼續讓客戶參與手術項目的數據分析和機會分析，這是我們“您的數據，您的真相”分析工作的基石。

We have continued the launch of our My Intuitive app, including launching to first users in Europe.

我們繼續推出 My Intuitive 應用程序，包括向歐洲的首批用戶推出。

My Intuitive allows surgeons and care team members to access their data, to manage their profile, their learning and otherwise interact with Intuitive through an easy-to-use mobile app in the palm of their hand.

My Intuitive 允許外科醫生和護理團隊成員訪問他們的數據，管理他們的個人資料、學習情況，並通過手掌上易於使用的移動應用程序與 Intuitive 進行交互。

Our digital learning programs continue to be an important part of our overall learning initiatives.

我們的數字學習計劃仍然是我們整體學習計劃的重要組成部分。

These programs together trained over 2,200 care team members in the quarter, showing organizational strength and localizing programs and responding with agility to pandemic influenced demand.

這些計劃在本季度總共培訓了 2,200 多名護理團隊成員，展示了組織實力和本地化計劃，並靈活應對大流行影響的需求。

As the phases of the pandemic evolve, we're supporting our team in addressing the opportunities and challenges posed by the pandemic and the ways we work.

隨著大流行的各個階段的發展，我們正在支持我們的團隊應對大流行和我們的工作方式帶來的機遇和挑戰。

Intuitive has managed multiple ways of working for many years.

Intuitive 多年來一直管理著多種工作方式。

Roughly 1/3 of our team works in the manufacturer test and distribution of our products, another 1/3 works closely with customers in the field, and the remaining 1/3 have traditionally worked in lab and office environments.

我們團隊中大約 1/3 的人員從事產品的製造商測試和分銷工作，另外 1/3 的人員在現場與客戶密切合作，其餘 1/3 的人員傳統上在實驗室和辦公室環境中工作。

We're taking a first principles approach to return-to-office environments with our team, bringing back face-to-face interactions for those tasks best completed in person while enabling hybrid work environments for tasks that are well accomplished by distributed teams.

我們正在與我們的團隊一起採取首要原則方法返回辦公室環境，為那些最好親自完成的任務帶回面對面的互動，同時為那些由分佈式團隊很好地完成的任務提供混合工作環境。

Most of our offices globally are reopening with this hybrid approach.

我們在全球的大多數辦事處都以這種混合方式重新開放。

We anticipate iterating our approach as we learn and the year progresses.

隨著我們的學習和這一年的進展，我們預計會迭代我們的方法。

As I conclude, for the balance of the year, we're focused on the following: first, agile and flexible support for our customers globally as they need it, often addressing the return of surgical patients to treatment.

正如我總結的那樣，在今年剩下的時間裡，我們的重點是：首先，根據全球客戶的需要，為他們提供敏捷和靈活的支持，通常解決手術患者重返治療的問題。

Second, disciplined execution of our launches, including our advanced instruments, SP, Ion and digital efforts.

其次，嚴格執行我們的發布，包括我們的先進儀器、SP、離子和數字工作。

Third, driving depth and excellence in regional performance, particularly in Europe and Asia.

第三，推動區域績效的深度和卓越，特別是在歐洲和亞洲。

And finally, expanding our clinical, economic and analytical evidence base for key procedures and countries.

最後，擴大我們針對關鍵程序和國家的臨床、經濟和分析證據基礎。

I'll now turn the time over to Marshall to take you through our financial performance in greater detail.

現在我將把時間交給馬歇爾，讓您更詳細地了解我們的財務業績。

Good afternoon.

下午好。

I will describe the highlights of our performance on a non-GAAP or pro forma basis.

我將描述我們在非公認會計準則或預估基礎上的業績亮點。

I will also summarize our GAAP performance later in my prepared remarks.

我稍後還將在準備好的發言中總結我們的 GAAP 表現。

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

我們的預估結果與公認會計準則結果之間的對賬已發佈在我們的網站上。

COVID had a significant impact on da Vinci procedure volumes in the second quarter of 2020.

新冠疫情對 2020 年第二季度的達芬奇手術量產生了重大影響。

That impact was most pronounced in the U.S. and Europe, varied market to market, complicating year-over-year comparisons.

這種影響在美國和歐洲最為明顯，不同市場的情況各不相同，使得同比比較變得複雜。

In the U.S., as COVID continued to subside in the second quarter of 2021, we saw a lower impact on da Vinci procedures.

在美國，隨著新冠疫情在 2021 年第二季度繼續消退，我們發現對達芬奇手術的影響有所減輕。

Procedure growth in the U.S. was led by bariatric cholecystectomy and hernia procedures.

美國的手術增長以減肥膽囊切除術和疝氣手術為主導。

We also believe that growth benefited from some procedures that were previously deferred due to delays in testing and patient concern over COVID.

我們還認為，增長受益於之前由於檢測延遲和患者對新冠病毒擔憂而推遲的一些程序。

While there is likely some amount of backlog that has not yet been addressed, it is difficult to estimate the extent of the remaining backlog and when it will affect future procedure growth.

雖然可能還有一些積壓尚未得到解決，但很難估計剩餘積壓的程度以及何時會影響未來的程序增長。

In Europe, the impact of COVID in the second quarter of 2021 varied regionally with slower recovery in Italy and France, while we saw early stages of a recovery in the U.K. While there continues to be COVID hotspots within some of our Asia Pacific markets, overall procedures in the region performed well.

在歐洲，2021 年第二季度新冠疫情的影響因地區而異，意大利和法國的複蘇速度較慢，而英國則處於復甦的早期階段。雖然我們的一些亞太市場仍然存在新冠疫情熱點，但總體而言該地區的程序執行良好。

China growth in the second quarter continued to be far higher than our other regions, primarily reflecting the 40% system installation growth over the past year.

中國第二季度的增長繼續遠高於其他地區，主要反映了過去一年 40% 的系統安裝量增長。

Jamie will provide additional procedure commentary later in this call.

傑米稍後將在本次電話會議中提供額外的程序評論。

Hospitalizations of patients due to COVID have negatively impacted da Vinci procedures.

因新冠肺炎而住院的患者對達芬奇手術產生了負面影響。

To the extent that hospitalizations expand significantly due to COVID and its variants, like currently being experienced in parts of the world, it could negatively impact da Vinci procedures.

由於新冠病毒及其變種導致住院人數大幅增加，就像目前世界部分地區所經歷的那樣，這可能會對達芬奇手術產生負面影響。

Key business metrics for the second quarter were as follows: second quarter 2021 procedures increased approximately 68% compared with the second quarter of 2020 and increased approximately 13% compared with last quarter.

第二季度的主要業務指標如下：2021年第二季度流程較2020年第二季度增長約68%，較上季度增長約13%。

Compound annual growth between the second quarters of 2019 and 2021 was 16.5%.

2019年第二季度至2021年的複合年增長率為16.5%。

Second quarter system placements of 328 systems increased 84% compared with 178 systems for the second quarter of 2020 and increased 10% compared with 298 systems last quarter.

第二季度 328 個系統的系統投放量比 2020 年第二季度的 178 個系統增加了 84%，比上一季度的 298 個系統增加了 10%。

We expanded our installed base of da Vinci Systems over the last year by 10% to approximately 6,335 systems.

去年，我們將達芬奇系統的安裝基礎擴大了 10%，達到約 6,335 個系統。

This growth rate compares with 9% last year and 8% last quarter.

這一增長率與去年的 9% 和上季度的 8% 相比。

Utilization of clinical systems in the field, measured by procedures per system, increased approximately 55% compared with last year and increased 11% compared with last quarter.

按每個系統的程序衡量，現場臨床系統的利用率與去年相比增加了約 55%，與上一季度相比增加了 11%。

The compounded annual utilization growth rate between the second quarters of 2019 and 2021 was 6%.

2019年第二季度至2021年的複合年利用率增長率為6%。

Moving on to capital placements.

繼續進行資本配售。

System placements in the quarter reflected procedure growth and hospitals upgrading to -- in order to access or standardize on fourth-generation capabilities.

本季度的系統佈局反映了程序的增長和醫院的升級，以便獲得第四代功能或實現第四代功能的標準化。

Capital placements for the first 6 months of 2021 were in line with procedure and utilization growth.

2021 年前 6 個月的資本配售與程序和利用率增長一致。

Looking forward, we see the following capital revenue dynamics.

展望未來，我們看到以下資本收入動態。

Procedure growth drives capital purchases in many of our markets.

流程增長推動了我們許多市場的資本購買。

To the extent that COVID impacts procedures, it will also impact capital purchases.

就新冠疫情影響程序而言，它也會影響資本購買。

The trade in cycle has been a tailwind to system placements.

以舊換新周期一直是系統佈局的順風車。

However, as the installed base of older generation product declines, the number of trade-ins will decline over time.

然而，隨著老一代產品的安裝基數下降，以舊換新的數量也會隨著時間的推移而下降。

Leasing and alternative financing arrangements enable customer access to capital.

租賃和替代融資安排使客戶能夠獲得資金。

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.

雖然經營租賃系統的百分比按季度波動，但我們相信租賃佔銷售額的百分比將隨著時間的推移而增加，這將導致當前收入推遲到未來時期。

Macroeconomic conditions created by COVID could regionally impact hospital capital spending.

新冠疫情造成的宏觀經濟狀況可能會在區域範圍內影響醫院資本支出。

And as competition progresses in various markets, we will likely experience longer selling cycles and price pressures.

隨著各個市場競爭的加劇，我們可能會經歷更長的銷售週期和價格壓力。

Additional revenue statistics and trends are as follows: total second quarter revenue was $1.464 billion, representing a 72% increase from last year and a 13% increase from last quarter.

其他營收統計和趨勢如下：第二季度總營收為14.64億美元，較去年增長72%，較上季度增長13%。

The compound annual revenue growth rate between the second quarters of 2019 and 2021 was 15%.

2019年第二季度至2021年的複合年收入增長率為15%。

Second quarter revenue reflected growth in both procedures and system placements.

第二季度收入反映了程序和系統佈局的增長。

Leasing represented 33% of current quarter placements compared with 29% last year and 43% last quarter.

租賃佔當前季度安置的 33%，而去年為 29%，上季度為 43%。

In the quarter, we completed a number of placements with larger IDNs that prefer to purchase rather than lease product.

本季度，我們完成了許多大型 IDN 的安置，這些 IDN 更願意購買而不是租賃產品。

Leasing as a percentage of total sales lag has and will continue to fluctuate with customer and geographic mix.

租賃佔總銷售額的百分比已經並將繼續隨著客戶和地理組合的變化而波動。

However, we anticipate more customers will seek leasing or alternative financing arrangements than reflected in historical run rates.

然而，我們預計，與歷史運行率所反映的相比，更多的客戶將尋求租賃或替代融資安排。

38% of systems placed in the second quarter involved trade-ins, which is lower than the 40% last year, and the 44% last quarter.

第二季度投放的系統中有 38% 涉及以舊換新，低於去年的 40% 和上季度的 44%。

As customers continue to upgrade to fourth generation capabilities, the population of installed SIs is decreasing, particularly in the U.S. were 110 trade-ins were completed in the second quarter, leaving an installed base of SIs of approximately 500 systems.

隨著客戶不斷升級到第四代功能，已安裝的 SI 數量正在減少，特別是在美國，第二季度完成了 110 個以舊換新，剩下的 SI 安裝基數約為 500 個系統。

As a result, we expect lower trade-in transactions over time.

因此，我們預計隨著時間的推移，以舊換新交易將會減少。

Trade-in activity can fluctuate and be difficult to predict.

以舊換新活動可能會波動且難以預測。

Second quarter system average selling prices decreased to $1.55 million from $1.65 million for both the second quarter of 2020 and the first quarter of 2021.

第二季度系統平均售價從 2020 年第二季度和 2021 年第一季度的 165 萬美元下降至 155 萬美元。

The decrease relative to these prior periods reflects geographic mix and volume discounts provided to customers purchasing multiple systems.

相對於前期的下降反映了地理組合和向購買多個系統的客戶提供的批量折扣。

We recognized $26 million of lease buyout revenue in the second quarter compared with $9 million last year and $19 million last quarter.

我們在第二季度確認了 2600 萬美元的租賃買斷收入，而去年為 900 萬美元，上季度為 1900 萬美元。

Lease buyout revenue has varied significantly quarter-to-quarter and will likely continue to do so.

租賃買斷收入季度與季度之間存在顯著差異，並且可能會繼續如此。

Instrument and accessory revenue per procedure of $1,940 increased compared with $1,900 per procedure for the second quarter of last year, and decreased compared with $1,950 per procedure in the first quarter.

每次手術的儀器和配件收入為 1,940 美元，與去年第二季度每次手術的 1,900 美元相比有所增加，與第一季度每次手術的 1,950 美元相比有所下降。

Extended use instruments were introduced into the U.S. and Europe in the fourth quarter, in most other markets in the first 6 months of this year, except China due to regulatory timelines.

延長使用工具於第四季度引入美國和歐洲，今年前 6 個月引入大多數其他市場，但由於監管時間表的原因，除中國外。

In the U.S. and Europe, extended use instruments were nearly fully adopted in the second quarter.

在美國和歐洲，第二季度幾乎完全採用了擴展使用工具。

The year-over-year increase in I&A revenue per procedure reflects increased usage of our advanced instruments, partially offset by the impact of extended use instruments.

每個程序的 I&A 收入同比增長反映了我們先進儀器的使用增加，但部分被擴展使用儀器的影響所抵消。

We believe that globally, customers have had not completely adjusted their instrument buying patterns to reflect the additional uses per instrument.

我們認為，在全球範圍內，客戶尚未完全調整其儀器購買模式以反映每種儀器的額外用途。

Customer adjustment of buying patterns will reduce I&A revenue per procedure.

客戶對購買模式的調整將減少每個程序的 I&A 收入。

4 of the systems placed in the first quarter were SP Systems, reflecting continued measured rollout of SP.

第一季度部署的系統中有 4 個是 SP 系統，反映出 SP 的持續穩步推出。

Our installed base of SP Systems is now 79: 8 in Korea and 71 in the U.S. We completed first cases associated with a U.S. colorectal clinical trial in the second quarter.

目前，我們的 SP Systems 安裝基數為 79：韓國為 8，美國為 71。我們在第二季度完成了與美國結直腸臨床試驗相關的第一批病例。

We placed 20 Ion systems in the quarter, bringing the installed base to 70 systems.

我們在本季度安裝了 20 個 Ion 系統，使安裝數量達到 70 個系統。

There were nearly 1,500 Ion procedures completed in the second quarter.

第二季度完成了近 1,500 例 Ion 手術。

Ion system placements and procedures are excluded from our overall system and procedure counts.

離子系統放置和程序不包括在我們的整體系統和程序計數中。

The supply issues we called out in the first quarter did not impact Ion placements and procedures in this quarter.

我們在第一季度提出的供應問題並未影響本季度的 Ion 佈局和程序。

Our rollout of Ion will continue to be measured while we optimize training pathways in our supply chain.

我們將繼續衡量 Ion 的推出，同時優化供應鏈中的培訓路徑。

Outside the U.S., we placed 115 systems in the second quarter compared with 72 in the second quarter of 2020 and 108 systems last quarter.

在美國以外，我們第二季度部署了 115 個系統，而 2020 年第二季度部署了 72 個系統，上季度部署了 108 個系統。

Current quarter system placements included 63 into Europe, 16 into Japan and 19 into China compared with 18 into Europe, 18 into Japan and 21 into China in the second quarter of 2020.

當前季度的系統部署情況包括 63 個進入歐洲、16 個進入日本和 19 個進入中國，而 2020 年第二季度有 18 個進入歐洲、18 個進入日本和 21 個進入中國。

Moving on to gross margin and operating expenses.

接下來是毛利率和運營費用。

Pro forma gross margin for the second quarter of 2021 was 71.7% compared with 62.4% for the second quarter of 2020 and 71.8% last quarter.

2021 年第二季度預計毛利率為 71.7%，而 2020 年第二季度為 62.4%，上季度為 71.8%。

The second quarter of 2020 included $59 million of service credits issued in conjunction with our Customer Relief Program, higher period costs associated with lower production and higher excess and obsolete inventory charges.

2020 年第二季度包括與我們的客戶救濟計劃一起發放的 5900 萬美元的服務積分、與產量下降相關的較高期間成本以及較高的超額和過時庫存費用。

The first and second quarters of 2021 reflect leveraging fixed costs over higher production levels.

2021 年第一和第二季度反映了利用固定成本來提高生產水平。

Product and customer mix fluctuate quarter-to-quarter, which can cause fluctuations in gross margins.

產品和客戶結構按季度波動，可能導致毛利率波動。

COVID has impacted global supplies of semiconductors and other materials used in our products, while we carry safety stocks of critical components and are otherwise working to secure supply necessary to ensure fulfillment of customer demand, global shortages could result in higher production costs and production development and regulatory delays.

新冠疫情影響了我們產品中使用的半導體和其他材料的全球供應，雖然我們擁有關鍵零部件的安全庫存，並正在努力確保必要的供應，以確保滿足客戶需求，但全球短缺可能會導致更高的生產成本和生產開發以及監管延誤。

Pro forma operating expenses increased 24% compared with the second quarter of 2020 and increased 5% compared with last quarter.

預計運營費用較2020年第二季度增長24%，較上季度增長5%。

The increase compared to prior year reflects costs associated with higher headcount, increased variable compensation and increased spending in areas impacted by COVID.

與上一年相比的增長反映了與員工數量增加、可變薪酬增加以及受新冠疫情影響地區支出增加相關的成本。

Second quarter spending was below our expectations due to activities restricted by COVID, including clinical development, marketing events and travel costs.

由於受新冠疫情限制的活動（包括臨床開發、營銷活動和差旅費用），第二季度支出低於我們的預期。

In addition, COVID delayed some R&D work, resulting in underspend on prototypes.

此外，新冠疫情還推遲了一些研發工作，導致原型機支出不足。

We expect spending on activities restricted by COVID to increase as the impacts of the pandemic decline.

我們預計，隨著疫情影響的減弱，受新冠疫情限制的活動支出將會增加。

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 in the business.

我們還預計，隨著員工數量、基礎設施和其他支持領域的投資趕上業務的增長，支出佔收入的比例將會增加。

Finally, we expect to continue to invest in expanding and accelerating our ecosystem of products and capabilities.

最後，我們希望繼續投資擴大和加速我們的產品和功能生態系統。

Jamie will provide spend guidance later in this call.

傑米稍後將在本次電話會議中提供支出指導。

Our pro forma effective tax rate for the second quarter was approximately 25%.

我們第二季度的預計有效稅率約為 25%。

In the second quarter, we modified the useful life of a deferred tax asset, which resulted in a current charge to pro forma income.

在第二季度，我們修改了遞延稅資產的使用壽命，從而導致當期計入預計收入。

However, that charge generated -- that change generated a long-term benefit of $66 million that is recognized currently in GAAP income and will be recognized ratably over approximately 10 years in pro forma income.

然而，這一費用產生了——這一變化產生了 6600 萬美元的長期利益，目前已在 GAAP 收入中確認，並將在大約 10 年內按比例在預計收入中確認。

The charge associated with the deferred tax asset and a higher mix of U.S. income drove the 25% current quarter pro forma rate.

與遞延稅項資產相關的費用和較高的美國收入組合推動了本季度 25% 的預計稅率。

We expect our pro forma rate for the last 6 months of 2021 to be between 21% and 22% versus our previous guidance of 20% to 21%, reflecting a greater proportion of U.S. income for the year.

我們預計 2021 年最後 6 個月的預估利率將在 21% 至 22% 之間，而之前的指引為 20% 至 21%，反映了美國當年收入的更大比例。

Our actual tax rate will fluctuate with changes in the geographic mix of income, changes in taxation made by local authorities and with the impact of onetime items.

我們的實際稅率將隨著收入地理結構的變化、地方當局稅收的變化以及一次性項目的影響而波動。

Our second quarter pro forma net income was $477 million or $3.92 per share compared with $132 million or $1.11 per share for the second quarter of 2020 and $427 million or $3.52 per share for the last quarter.

我們第二季度預計淨利潤為 4.77 億美元，即每股 3.92 美元，而 2020 年第二季度為 1.32 億美元，即每股 1.11 美元，上一季度為 4.27 億美元，即每股 3.52 美元。

I will now summarize our GAAP results.

現在我將總結我們的 GAAP 結果。

GAAP net income was $517 million or $4.25 per share for the second quarter of 2021 compared with GAAP net income of $68 million or $0.57 per share for the second quarter of 2020 and GAAP net income of $426 million or $3.51 per share for the last quarter.

2021 年第二季度GAAP 淨利潤為5.17 億美元，即每股4.25 美元，而2020 年第二季度GAAP 淨利潤為6800 萬美元，即每股0.57 美元，上一季度GAAP 淨利潤為4.26 億美元，即每股3.51 美元。

The adjustments between pro forma and GAAP net income are outlined and quantified on our website.

我們的網站上概述並量化了預計淨利潤和公認會計準則淨利潤之間的調整。

We ended the quarter with cash and investments of $7.7 billion compared with $7.2 billion last quarter.

本季度結束時，我們的現金和投資為 77 億美元，而上季度為 72 億美元。

The increase in cash in the second quarter primarily reflected cash from operations and stock exercises.

第二季度現金的增加主要反映了來自運營和股票行使的現金。

We did not repurchase any shares in the quarter.

本季度我們沒有回購任何股票。

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

說到這裡，我想把它交給傑米。

Good afternoon.

下午好。

Our overall second quarter procedure growth was 68% compared to a decline of 19% during the second quarter of 2020, which reflected a significant adverse impact from the COVID-19 pandemic.

我們第二季度的整體程序增長了 68%，而 2020 年第二季度則下降了 19%，這反映了 COVID-19 大流行的重大不利影響。

The compound annual growth rate between the second quarter of 2019 and the second quarter of 2021 was 16.5%.

2019年第二季度至2021年第二季度的複合年增長率為16.5%。

In Q2, U.S. procedures grew 77% year-over-year, which equates to 16% on a 2-year compound annual growth rate basis.

第二季度，美國程序同比增長 77%，相當於 2 年復合年增長率為 16%。

OUS markets grew 51% year-over-year or 19% on a 2-year compound annual growth rate basis.

OUS 市場同比增長 51%，按 2 年復合年增長率計算為 19%。

In the U.S., Q2 procedure results were positively impacted by a continuing recovery from COVID-19, including, we believe, a number of procedures that had been previously deferred.

在美國，第二季度的手術結果受到了 COVID-19 持續復甦的積極影響，其中包括我們認為之前推遲的一些手術。

Q2 growth was driven by particular strength in benign procedures, including bariatrics, hernia repair, cholecystectomy and benign hysterectomy, reflecting in part, we believe, a partial catch-up in these procedures related to the previous deferral of elective surgeries.

第二季度的增長是由良性手術的特別強勁推動的，包括減肥、疝氣修復、膽囊切除術和良性子宮切除術，我們認為，這在一定程度上反映出這些手術與之前推遲的擇期手術有關。

General surgery growth in the U.S. was strong, and in addition to the positive impact from patient backlogs, reflected increasing access for surgeons to our fourth generation technology.

美國的普通外科增長強勁，除了患者積壓的積極影響之外，還反映出外科醫生越來越多地使用我們的第四代技術。

In the U.S., procedures that are dependent on diagnostic pipelines also grew, albeit at lower rates as compared to benign procedures.

在美國，依賴診斷管道的手術也在增長，儘管與良性手術相比速度較低。

Colorectal growth was strong, with solid growth in malignant hysterectomy, thoracic and prostatectomy procedures.

結直腸生長強勁，在惡性子宮切除術、胸部和前列腺切除術中生長牢固。

Based on market data, we believe that diagnostic pipelines in the U.S. began to recover from the impact of the pandemic in March, with a lag in the recovery of associated procedures.

根據市場數據，我們認為美國的診斷管道在3月份開始從疫情的影響中恢復，但相關程序的恢復存在滯後。

Second quarter OUS procedure volume grew approximately 51% compared with a 7% decline for the second quarter of 2020 and 23% growth last quarter.

第二季度 OUS 手術量增長約 51%，而 2020 年第二季度下降 7%，上一季度增長 23%。

Second quarter 2021 OUS procedure growth was driven by growth in prostatectomy procedures and earlier-stage growth in kidney cancer procedures, general surgery, gynecology and thoracic.

2021 年第二季度 OUS 手術的增長是由前列腺切除術手術的增長以及腎癌手術、普通外科、婦科和胸部手術的早期增長推動的。

China procedure growth remains strong and broad-based as a result of continued expansion of the installed base under the current quota.

由於當前配額下安裝基礎的持續擴大，中國的程序增長仍然強勁且基礎廣泛。

Growth in Japan was solid, but was impacted by a relatively slow rollout of vaccines and the impact of localized lockdowns as a result of ongoing efforts to prevent resurgences of COVID-19.

日本的增長穩健，但受到疫苗推出相對緩慢以及因持續努力防止 COVID-19 捲土重來而實施局部封鎖的影響。

In Europe, procedure growth varied by country based on the relative impact of and recovery from the pandemic.

在歐洲，根據大流行的相對影響和恢復情況，各個國家的手術增長有所不同。

Growth in the U.K. was strong, with a slower recovery in France, Italy and Germany.

英國增長強勁，法國、意大利和德國復甦緩慢。

Now turning to the clinical side of our business.

現在轉向我們業務的臨床方面。

Each quarter on these calls, we highlight certain recently published studies that we deem to be notable.

每個季度，我們都會在這些電話會議中重點介紹一些我們認為值得注意的最近發表的研究。

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.

然而，為了更全面地了解證據體系，我們鼓勵所有利益相關者徹底審查多年來發表的科學研究的廣泛細節。

During the quarter, a group from the Shenzhen Hospital Naval Medical University in China, published a meta-analysis in BMC cancer comparing robotic-assisted thoracic surgery versus video-assisted thoracic surgery, or VATs, for lung lobectomy or segmentectomy in patients with non-small cell lung cancer.

本季度，中國海軍軍醫大學深圳醫院的一個研究小組發表了一項關於BMC 癌症的薈萃分析，比較了機器人輔助胸腔手術與視頻輔助胸腔手術（VAT）在非肺葉切除或肺段切除術中的應用。小細胞肺癌。

The meta-analysis combined 18 studies across different countries containing over 11,000 patients, of which just over 5,000 received da Vinci robotic-assisted thoracic surgery and just over 6,000 received VATs.

這項薈萃分析綜合了不同國家的 18 項研究，涉及 11,000 多名患者，其中 5,000 多名患者接受了達芬奇機器人輔助胸腔手術，6,000 多名患者接受了增值稅。

The results of the meta-analysis found that robotic-assisted thoracic surgery compared to VATs was associated with, among others, the following significant findings: 50.4 milliliters lower blood loss, a 50% lower chance of conversion to an open procedure, a 1.1 day shorter stay in the hospital and a 10% less chance of patient experience to postoperative complication.

薈萃分析的結果發現，與 VAT 相比，機器人輔助胸外科手術具有以下重要發現：失血量減少 50.4 毫升，轉換為開放手術的機會減少 50%，手術時間減少 1.1 天。住院時間更短，患者出現術後並發症的機率降低10%。

The authors concluded, "The results revealed that robotic-assisted thoracic surgery is a feasible and safe technique compared with VATs in terms of short-term and long-term outcomes".

作者總結道：“結果表明，就短期和長期結果而言，與增值稅相比，機器人輔助胸外科手術是一種可行且安全的技術”。

In May of this year, Dr. Karl LeBlanc from our Lady of the Lake Medical Center in Baton Rouge, Louisiana, published results from a multi-center study comparing short-term outcomes for incisional hernia, published in the Hernia Journal entitled Robotic-Assisted Laparoscopic and Open Incisional Hernia Repair: Early Outcomes from the Prospective Hernia study.

今年5 月，路易斯安那州巴吞魯日聖母湖醫學中心的Karl LeBlanc 博士發表了一項多中心研究的結果，該研究比較了切口疝的短期結果，該研究發表在《Hernia Journal》上，題為“機器人輔助”腹腔鏡和開放切口疝修補術：前瞻性疝研究的早期結果。

The study contains 371 patients that underwent an incisional hernia repair procedure across 17 institutions within the United States between May 2016 and September 2019.

該研究包含 2016 年 5 月至 2019 年 9 月期間在美國 17 個機構接受切口疝修復手術的 371 名患者。

Of those patients, 43% were in the da Vinci robotic cohort, 35% in the laparoscopic cohort and 22% in the open cohort.

在這些患者中，43% 屬於達芬奇機器人隊列，35% 屬於腹腔鏡隊列，22% 屬於開腹隊列。

In reporting the results, adjusted using a propensity weighted approach, the authors noted that during the 2- to 4-week standard of care visit period, fewer patients report the need to take prescription pain medication for the robotic cohort as compared to the laparoscopic and open cohorts: 65.2% for the robotic cohort as compared to 78.8% for the laparoscopic cohort compared to 79.8% for the open cohort.

在報告使用傾向加權方法調整的結果時，作者指出，在 2 至 4 週的標準護理就診期間，與腹腔鏡和腹腔鏡組相比，報告需要為機器人隊列服用處方止痛藥的患者較少開放隊列：機器人隊列為65.2%，腹腔鏡隊列為78.8%，開放隊列為79.8%。

Conversion rates to open surgery were lower in the robotic group compared to the laparoscopic group, 0.6% as compared to 4.9% and reoperation rates in the 30 days post procedure were comparable between robotic and laparoscopic and lower for robotic as compared to open, 0.6% as compared to 3.1%.

與腹腔鏡組相比，機器人組的開腹手術轉換率較低，分別為0.6% 和4.9%，機器人組和腹腔鏡組術後30 天的再次手術率相當，機器人組的再手術率低於開腹手術組，為0.6%相比之下，為 3.1%。

The authors concluded in part, "When compared to open, the robotic-assisted surgery group is associated with a comparable operative time, shorter length of stay and lower reoperation rate through 30 days.

作者得出的部分結論是：“與開放手術相比，機器人輔助手術組的手術時間相當，住院時間較短，並且 30 天內的再次手術率較低。

The difference in the number of subjects reporting the need for prescription pain medication favored the robotic-assisted group in both comparisons."

在兩次比較中，報告需要處方止痛藥的受試者數量差異有利於機器人輔助組。”

I will now turn to our financial outlook for 2021.

我現在談談我們 2021 年的財務展望。

We continue to operate in a challenging supply chain environment and have experienced longer lead times and delayed deliveries from our suppliers.

我們繼續在充滿挑戰的供應鏈環境中運營，並經歷了供應商交貨時間延長和交貨延遲的情況。

While this did not have a material impact to our operating results in Q2, the outlook we are providing does not reflect any potential significant disruption or additional costs related to supply constraints.

雖然這並未對我們第二季度的經營業績產生重大影響，但我們提供的前景並未反映出任何潛在的重大中斷或與供應限制相關的額外成本。

We also note the increasing number of COVID-19 cases in certain geographies associated with the Delta variant.

我們還注意到，在某些地區，與 Delta 變種相關的 COVID-19 病例數量不斷增加。

The outlook we are providing on today's call does not reflect risks associated with a significant increase in COVID-related hospitalizations in relation to the Delta variant or other potential new variants.

我們在今天的電話會議上提供的前景並未反映出與 Delta 變種或其他潛在新變種相關的新冠肺炎相關住院人數大幅增加所帶來的風險。

Starting with procedures.

從程序開始。

Last quarter, we forecast 2021 procedure growth of 22% to 26%.

上季度，我們預測 2021 年流程增長 22% 至 26%。

Given the stronger recovery of procedures we have experienced so far, particularly in the U.S. and strength in U.S. general surgery, we are now increasing our forecast and expect full year 2021 procedure growth of 27% to 30%.

鑑於迄今為止我們所經歷的手術恢復情況較好，尤其是在美國，以及美國普外科的實力，我們現在提高了預測，預計 2021 年全年手術量將增長 27% 至 30%。

The high end of the range assumes strength in U.S. general surgery, a return to normalized diagnostic pipelines, the vaccines are effective against any new COVID-19 variants and the vaccine rollouts in OUS markets continue as currently expected by governments around the world.

該範圍的高端假設美國普通外科實力雄厚，診斷渠道恢復正常，疫苗對任何新的 COVID-19 變種有效，並且 OUS 市場的疫苗推出將按照世界各國政府目前的預期繼續進行。

Turning to gross profit.

轉向毛利潤。

On our last call, we forecast our 2021 full year pro forma gross profit margin to be within 70% and 71% of revenue.

在上次電話會議中，我們預測 2021 年全年預計毛利率將在收入的 70% 和 71% 以內。

We are now slightly increasing our forecast and expect full year gross profit margin to be between 70.5% and 71.5% of revenue.

我們現在小幅提高預測，預計全年毛利率將在收入的 70.5% 至 71.5% 之間。

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 pricing pressure.

我們的實際毛利率將隨季度而變化，很大程度上取決於產品、區域和以舊換新的組合、產品成本降低的影響以及製造效率和定價壓力。

With respect to operating expenses, on our last call, we forecast to grow full year pro forma 2021 operating expenses between 18% and 22% above 2020 levels.

關於運營費用，在我們上次電話會議中，我們預計 2021 年全年預計運營費用將比 2020 年水平增長 18% 至 22%。

We are refining our estimate and expect our full year pro forma operating expense growth to be between 17% and 21%.

我們正在完善我們的估計，預計全年預計運營費用增長將在 17% 至 21% 之間。

Consistent with the last quarter's forecast, we expect our noncash stock compensation expense to range between $450 million and $470 million in 2021.

與上季度的預測一致，我們預計 2021 年非現金股票補償費用將在 4.5 億美元至 4.7 億美元之間。

We expect pro forma other income, which is comprised mostly of interest income, to total between $50 million and $55 million in 2021.

我們預計 2021 年預計其他收入（主要由利息收入組成）總額將在 5000 萬美元至 5500 萬美元之間。

With regard to income tax, we expect the range of our second half 2021 pro forma tax rate to be between 21% and 22% of pretax income, slightly higher than the range we provided on the last call, reflecting a higher mix of U.S. income.

關於所得稅，我們預計 2021 年下半年預計稅率範圍將在稅前收入的 21% 至 22% 之間，略高於我們上次電話會議提供的範圍，反映出美國收入結構更高。

That concludes our prepared comments.

我們準備好的評論到此結束。

We will now open the call to your questions.

我們現在將開始電話詢問您的問題。

(Operator Instructions) And for our first question, we will go to Tycho Peterson.

（操作員說明）對於我們的第一個問題，我們將請教第谷·彼得森。

Congrats on the quarter.

恭喜本季度。

I guess, first question on guidance.

我想，第一個問題是關於指導的。

Obviously, you made some comments about variance and not factoring in kind of an increase.

顯然，您對差異發表了一些評論，但沒有考慮到增長。

And I know case rises have been largely decoupled from hospitalizations.

我知道病例的增加很大程度上與住院治療脫鉤。

But can you maybe just talk through the thought process there?

但你能談談那裡的思考過程嗎？

And how you're thinking about any potential risks in the back half of the year from the variant cases?

您如何看待下半年變異病例帶來的潛在風險？

Just -- thanks, Tycho.

只是——謝謝，第谷。

From the top, I think you said the right thing, which is there's a little bit of a decoupling thus far of infection from hospitalization.

從上面看，我認為你說的是​​對的，到目前為止，感染與住院治療之間存在一些脫鉤。

The number we're watching closely is hospitalization.

我們密切關注的數字是住院人數。

Jamie, I'll let you take it from there.

傑米，我會讓你從那裡拿走它。

Yes, Tycho.

是的，第谷。

We kind of outlined what was assumed in the high end of the procedure guidance.

我們概述了程序指南高端的假設內容。

From the low end perspective, the 27% reflected there is greater summer seasonality that reflects the possibility of an impact due to pent-up demand for vacation, especially for health care workers that have worked extensively during this period with COVID.

從低端角度來看，27% 的人反映夏季季節性較強，這反映出被壓抑的假期需求可能會受到影響，特別是對於在新冠疫情期間大量工作的醫護人員而言。

It also reflects lower diagnostic pipelines and perhaps some reluctance for patients to visit hospitals.

這也反映出診斷渠道的減少以及患者可能不願意去醫院。

In there is OUS markets continue to be choppy given that, in many cases, those markets are behind the U.S., for example, in their vaccination rollouts, and that leaves the possibility of continued resurgences and localized lockdowns.

海外市場繼續波動，因為在許多情況下，這些市場在疫苗接種方面落後於美國，這使得疫情持續復甦和局部封鎖的可能性存在。

That low end also reflects some impact of a resurgence in the U.S. But as you heard in our prepared comments, a significant increase in hospitalization is not reflected in the guidance range.

這一低端也反映了美國疫情復甦的一些影響。但正如您在我們準備好的評論中聽到的那樣，住院人數的顯著增加並未反映在指導範圍內。

Okay.

好的。

That's helpful.

這很有幫助。

Shifting to the extended use program.

轉向擴展使用計劃。

You've been out for around 6 months, smaller rollout in Europe in the fourth quarter.

你們已經退出了大約 6 個月，第四季度在歐洲推出了規模較小的版本。

Can you talk about kind of next steps to the program here, particular geographies you're targeting?

您能否在此談談該計劃的後續步驟以及您所針對的特定地區？

And then has the elasticity relative to the extended use program and the pricing adjustments played out relative to your expectations?

那麼，相對於延長使用計劃的彈性和定價調整是否符合您的預期？

Or any color you can provide on that?

或者你可以提供任何顏色嗎？

Yes, sure.

是的，當然。

We rolled out the extended use instruments in Europe and the U.S. back in the fourth quarter.

我們早在第四季度就在歐洲和美國推出了擴展使用工具。

And then now we have rolled it out to most other markets in the first 6 months of this year, except for China where there are longer regulatory time lines.

現在，我們已在今年前 6 個月將其推廣到大多數其他市場，但中國除外，因為那裡的監管時間較長。

It's a short period, but we believe that there is elasticity, and we've seen elasticity in markets where reimbursements are very low.

這是一個很短的時期，但我們相信存在彈性，而且我們已經在報銷非常低的市場中看到了彈性。

And we've received feedback -- positive feedback from surgeons who have indicated that system access has been a key driver for increased procedures.

我們收到了反饋——來自外科醫生的積極反饋，他們表明系統訪問是增加手術的關鍵驅動力。

And we think that the extended use instruments lowers barriers for purchases of systems.

我們認為，擴展使用工具降低了購買系統的障礙。

Having said all of that, it's been a short period since they've had extended use instruments.

話雖如此，他們已經有很短的一段時間沒有使用長期使用的儀器了。

Even though we've seen growth in the procedures that were specifically targeted by extended use instruments, it's hard to discern what is COVID-related versus what is not.

儘管我們已經看到長期使用儀器專門針對的程序有所增加，但很難辨別哪些與新冠病毒相關，哪些與新冠病毒無關。

And so we'll see over time, we'll be able to measure a little bit better over time, and we'll monitor it.

因此，隨著時間的推移，我們將看到，隨著時間的推移，我們將能夠更好地衡量，並且我們將對其進行監控。

Okay.

好的。

And last one on SP.

SP 上的最後一篇。

I know last quarter, you kind of brought up the concept of going after thoracic and some additional other areas.

我知道上個季度，您提出了追求胸部和其他一些區域的概念。

Can you maybe just talk a little bit about the road map?

您能簡單談談路線圖嗎？

And I think you've alluded to adding additional instruments and accessories, so can you talk on the hardware side as well?

我認為您已經提到要添加額外的儀器和配件，那麼您能談談硬件方面嗎？

Sure.

當然。

So right now, we talked in the script about adding our work or IDE around colorectal, we're excited about that.

所以現在，我們在腳本中討論了圍繞結直腸添加我們的工作或 IDE，我們對此感到興奮。

That will play out over the next several quarters as we accrue patients.

隨著我們不斷增加患者，這將在接下來的幾個季度中發揮作用。

And then given that it's cancer procedure, in some cases, it's a little bit longer follow-up.

然後考慮到這是癌症手術，在某些情況下，隨訪時間會更長一些。

So that's a multi-quarter conversation.

所以這是一個多季度的對話。

We're doing what we call the procedure development and the trial development around other indications, we think there'll be an opportunity in thoracic as well as other ones beyond it.

我們正在圍繞其他適應症進行所謂的程序開發和試驗開發，我們認為在胸部以及其他領域將會有機會。

The instrumentation updates, there are other things, imaging updates and software updates that are really all focused around right instruments, right features for the right extension or right expansion.

儀器更新，還有其他東西，成像更新和軟件更新，實際上都集中在正確的儀器、正確的功能、正確的擴展或正確的擴展上。

So our customers are asking us for advanced instrumentation.

因此，我們的客戶要求我們提供先進的儀器。

So energy and stapling and other things, we think that is possible.

所以能源和裝訂以及其他事情，我們認為這是可能的。

So we're making those investments to move that forward.

因此，我們正在進行這些投資以推動這一進程。

We think we can bring some outstanding imaging capabilities, including florescence imaging into that space.

我們認為我們可以將一些出色的成像功能（包括熒光成像）帶入該領域。

And we're building into the broader digital ecosystem for SP.

我們正在為 SP 構建更廣泛的數字生態系統。

Our focus right now is not rapid expansion of the installed base.

我們現在的重點不是安裝基礎的快速擴張。

Our focus is in clinical capability and productivity of the installed base we have.

我們的重點是我們現有客戶群的臨床能力和生產力。

In other words, happy, very satisfied customers.

換句話說，客戶很高興、非常滿意。

And sequential growth in what they can do with the system remains our focus on SP for now.

他們可以用系統做的事情的連續增長仍然是我們目前對 SP 的關注點。

Next, we'll go to Bob Hopkins with Bank of America.

接下來，我們將前往美國銀行的鮑勃霍普金斯。

So first question for me is just trying to dissect your procedure results a little bit more because some really interesting comments, that you saw strength in benign cases, some catch-up cases.

因此，我的第一個問題只是嘗試更多地剖析您的程序結果，因為一些非常有趣的評論，您在良性病例和一些追趕病例中看到了力量。

And then on a 2-year compounded basis, you're kind of where you thought you might be pre pandemic.

然後，以兩年復合計算，你可能處於大流行前的狀態。

I'm just curious from what you see out there, is this broadly reflective of what you think is going on in the marketplace for surgical procedures?

我只是很好奇您所看到的情況，這是否廣泛反映了您認為外科手術市場正在發生的情況？

Or is this simply and primarily just something about the pandemic accelerating the use of da Vinci and robotics surgery broadly?

或者這僅僅是因為大流行加速了達芬奇和機器人手術的廣泛使用？

I'll speak to my impression, but I caveat it, it's one person's impression.

我會談談我的印象，但我警告一下，這是一個人的印象。

So it's not a scientific study, just my view.

所以這不是科學研究，只是我的觀點。

I think what we're seeing is that the longer diagnostic pipelines have had this kind of double effect from the pandemic.

我認為我們所看到的是，更長的診斷管道產生了這種流行病的雙重影響。

Partly, it's delays in getting in and getting tested and starting the journey and then getting in and having a procedure or treatment, whatever that might be.

部分原因是延誤了入境、接受檢查、開始旅程、然後入境並進行手術或治療（無論是什麼）的延誤。

So from a core demand point of view or disease state, that's clearly out there and accumulating, and it has to get processed through.

因此，從核心需求或疾病狀態的角度來看，這顯然是存在的並且正在積累，並且必須得到處理。

On the benign side, often the diagnostic pipelines are shorter.

從好的方面來看，診斷流程通常較短。

You go from an issue to identification to closure more quickly.

您可以更快地從問題到識別，再到解決。

And I suspect that's most of what we're seeing, at least in the United States in terms of that.

我懷疑這就是我們所看到的大部分情況，至少在美國是這樣。

But I don't have scientific evidence.

但我沒有科學證據。

I think that's anecdotal.

我認為這是軼事。

Jamie, anything?

傑米，有什麼事嗎？

I would just add, Bob, as you saw the COVID hospitalization rates in the U.S. come down in March and into Q2, that freezed hospital resources to increase the level of surgery that we do.

我想補充一點，鮑勃，正如你所看到的，美國的新冠肺炎住院率在 3 月份和第二季度有所下降，這凍結了醫院資源以提高我們所做的手術水平。

And we also see, I think, increased patient confidence is a function of the improving vaccination rates.

我認為，我們還看到，患者信心的增強是疫苗接種率提高的結果。

And those 2 things come together, they also allow hospitals to start to address the backlog that's accumulated.

這兩件事結合在一起，也讓醫院能夠開始解決累積的積壓問題。

And I think for a subset of the benign procedures that have been kind of deferred elective procedures, hospitals can recover those pretty quickly.

我認為，對於部分良性手術（屬於推遲的擇期手術），醫院可以很快恢復。

Okay.

好的。

And then just one quick follow-up.

然後只是一個快速跟進。

Just to be clear on your answer to Tycho's question.

只是為了清楚地回答第谷的問題。

Just on the recent spread of COVID and variants and the potential impact on demand and hospitals' ability to do procedures, are you starting to see that impact now?

就最近新冠病毒及其變種的傳播以及對需求和醫院執行手術能力的潛在影響而言，您現在開始看到這種影響了嗎？

Or is it too early and you're just saying that might happen in the future?

或者現在還為時過早，您只是說將來可能會發生這種情況？

Yes.

是的。

We've seen that in some OUS markets.

我們已經在一些海外市場看到了這一點。

We're clearly seeing that in markets like India, Taiwan, there's been an impact in terms of how they've handled that from a health care system perspective and the resulting impact on our procedures.

我們清楚地看到，在印度、台灣等市場，他們從醫療保健系統的角度處理這一問題的方式以及由此對我們的程序產生的影響都受到了影響。

From a U.S. perspective, I think it's early, and I think we're simply acknowledging the risk.

從美國的角度來看，我認為現在還為時過早，而且我認為我們只是承認了風險。

I think the thing that we'd call out is it's not the case rates per se to monitor.

我認為我們要指出的是，監測的並不是病例發生率本身。

It's the impact on hospitalizations.

這是對住院治療的影響。

Lockdowns decrease patient mobility and willingness to go get their tests and then hospitalization diminishes ICU capacity.

封鎖降低了患者的活動能力和接受檢查的意願，然後住院治療又減少了 ICU 的容量。

So those are the drivers we watch.

這些就是我們觀察的車手。

Next we will go to Amit Hazan with Goldman Sachs.

接下來我們將和高盛一起去Amit Hazan。

Maybe start with Marshall on the first one and then go to Gary for the second one.

也許從馬歇爾開始第一個，然後再到加里做第二個。

Marshall, the operating margin coming in at the 43%, I'm just wondering how much we can extrapolate here?

馬歇爾，營業利潤率為 43%，我只是想知道我們可以在這裡推斷多少？

We heard your comments, but just kind of thinking a little bit longer-term than just the next couple of quarters.

我們聽到了您的評論，但只是考慮了比接下來幾個季度更長遠的問題。

You've got COVID.

你感染了新冠病毒。

I'm just curious what the net effect there is from the savings and expense perspective and R&D, whether this is maybe the beginning of you starting to see some leverage off of the 10% you've been at for the last couple of years.

我只是很好奇從節省和費用角度以及研發角度來看，這會產生什麼淨效應，這是否可能是您開始看到過去幾年 10% 的槓桿作用的開始。

And in an SG&A, kind of same kind of question.

在 SG&A 中，也有類似的問題。

You've been spending a lot there.

你在那里花了很多錢。

Are we starting to see leverage potentially that could enable a little bit better margins as we think about next year, year after?

當我們考慮明年、年復一年時，我們是否開始看到槓桿可能會帶來更好的利潤率？

I think there's elements of our spend that have been restrained because of -- restricted because of COVID and its impact.

我認為我們的支出中的某些部分由於新冠疫情及其影響而受到限制。

And I kind of articulated what those were, travel and so forth.

我闡明了這些是什麼，旅行等等。

And we expect those to come back as COVID goes away and the restrictions on travel and the restrictions on other activities go away.

我們預計，隨著新冠疫情的消失、旅行限制和其他活動的限制的取消，這些限制將會回來。

We also -- the business came back faster than we had anticipated.

我們的業務恢復速度也比我們預期的要快。

And so we have some catch-up to do in terms of infrastructure and support necessary to support the overall business.

因此，在支持整體業務所需的基礎設施和支持方面，我們還需要進行一些追趕。

And so we'll spend there.

所以我們會在那裡度過。

And so I think you're going to see this quarter was extraordinary in terms of the operating profit margin and that we'll -- it will be lower in future quarters, given what I just described.

因此，我認為您會看到本季度的營業利潤率非常出色，而且考慮到我剛才所描述的情況，未來幾個季度的營業利潤率將會更低。

In addition to that, we still think this is a great opportunity to continue to invest in the ecosystem of products and capabilities at this point in time before competition really gets any kind of toehold.

除此之外，我們仍然認為，在競爭真正立足之前，這是一個繼續投資產品和功能生態系統的絕佳機會。

And so we're going to continue to invest.

因此我們將繼續投資。

So I wouldn't start building lots of leverage into your models.

所以我不會開始在你的模型中建立大量的槓桿作用。

I think that would be a mistake.

我認為那是一個錯誤。

Well, I'll add one bit of color to that.

好吧，我會為此添加一點顏色。

I think that when you think about our product cycles, I would just have you look back earlier in the da Vinci experience in that these are long development cycles.

我認為，當您考慮我們的產品週期時，我會讓您回顧一下早期的達芬奇經驗，因為這些是漫長的開發週期。

At the time you receive a -- by the time you're at -- that market penetration rates that are significant.

當你收到——當你到達的時候——市場滲透率是顯著的。

And that is both painful and an opportunity.

這既是痛苦，也是機遇。

The painful part is the investment troughs are deep in the early and middle years of those product cycles.

痛苦的部分是，投資低谷在這些產品週期的早期和中期很深。

And we're early in the Ion product cycle, and we're early in the SP or early mid in SP.

我們處於 Ion 產品週期的早期，並且處於 SP 的早期或 SP 的早期中期。

So it takes a while.

所以需要一段時間。

But once you develop a really capable ecosystem, then it has a lot of platform use and that investment can be recovered over time.

但是，一旦你開發了一個真正有能力的生態系統，那麼它就會有大量的平台使用，並且隨著時間的推移，投資可以收回。

So it's hard to time it out, and it doesn't time out over 1 or 2 quarters, it times out over years.

所以很難超時，而且不會超時超過一兩個季度，而是會超時數年。

Gary, just with you, just thinking through the My Intuitive and what you're doing at the surgeon level.

加里，和你在一起，思考我的直覺以及你在外科醫生層面所做的事情。

And I'm actually curious more what's going on with service and software at the hospital-wide kind of department of surgery level.

事實上，我更好奇全醫院外科級別的服務和軟件的情況如何。

I don't know how much of an update you can give us, but just something on what's happening at that level in terms of software tools and services?

我不知道您能給我們提供多少更新，但只是介紹一下在軟件工具和服務方面發生的情況？

You're developing, trying to increase efficiency, decrease costs, that kind of thing.

你正在開發，試圖提高效率，降低成本，諸如此類的事情。

How close we are to maybe seeing something that you can monetize?

我們離看到可以貨幣化的東西還有多遠？

Just anything you could talk to there would be helpful.

只要你能在那裡交談的任何事情都會有幫助。

We think about digital as enabling and accelerating a lot of different parts of the ecosystem.

我們認為數字化能夠推動和加速生態系統的許多不同部分。

So when we talk about My Intuitive, that really is putting the power of interaction and data at the surgeon level in their hands or at the robotics coordinator level in their hands.

因此，當我們談論“我的直覺”時，這實際上是將外科醫生級別或機器人協調員級別的交互和數據的力量置於他們手中。

So we're excited about that because it gives them fast and easy access.

所以我們對此感到很興奮，因為它讓他們能夠快速、輕鬆地訪問。

It links into some of the other things you're talking about.

它鏈接到您正在談論的其他一些事情。

We are building tools and capabilities that allow hospital departments and departments of surgery to manage their program and look across programmatics for efficiency, for learning, for outcomes, and these things interlink.

我們正在構建工具和功能，使醫院科室和外科部門能夠管理他們的計劃，並通過計劃來提高效率、學習、結果以及這些事物的相互聯繫。

So short answer there is just kind of a reminder of what we're trying to do.

如此簡短的答案只是提醒我們正在努力做什麼。

We think there is an opportunity to accelerate learning and to drive increased insight for a surgeon into their own progress.

我們認為這是一個加速學習並提高外科醫生對自身進步的洞察力的機會。

We're doing that as a combination of My Intuitive plus some of the simulation work that we do, plus some of the machine learning and video analysis work that we do.

我們將“我的直覺”與我們所做的一些模擬工作以及我們所做的一些機器學習和視頻分析工作相結合。

We think there's an opportunity to look at correlations between surgeon performance and outcomes.

我們認為有機會研究外科醫生表現和結果之間的相關性。

And that has implications for the kind of imaging we do, it has implications for task analysis and training, and we're doing those things, and those can be aggregated across a surgical platform.

這對我們所做的成像類型有影響，對任務分析和培訓有影響，我們正在做這些事情，並且這些事情可以在手術平台上聚合。

And there's a lot of opportunities for OR efficiencies and standardization, controlling operating costs, controlling consumables costs.

手術室效率和標準化、控制運營成本、控制耗材成本都有很多機會。

Those things are ongoing now.

這些事情現在正在進行中。

So several of those things are in the markets, the very first kind of Gen 1, some of them are on Gen 2. Some of them are included in our service contracts, some of them are on a per use basis.

其中一些東西已經在市場上，第一種是 Gen 1，有些是 Gen 2。有些包含在我們的服務合同中，有些是按使用量計算的。

Some of them are fully included because we feel like they make us more efficient and to make them more efficient.

其中一些被完全包含在內，因為我們覺得它們讓我們更有效率，也讓他們更有效率。

So we don't really call them out as individual revenue lines.

因此，我們並沒有真正將它們稱為個人收入線。

I think they are ecosystem enablers and can result in very high customer satisfaction when done well.

我認為它們是生態系統的推動者，如果做得好，可以帶來非常高的客戶滿意度。

Next, we go over to Larry Beigelsen with Wells Fargo.

接下來，我們將採訪富國銀行的拉里·貝格爾森 (Larry Beigelsen)。

On a nice quarter.

在一個美好的季度。

One on procedures, one on competition.

一項是關於程序，一項是關於競爭。

So I apologize for the short-term oriented question, but you're the first large-cap company to report here.

因此，我對短期問題表示歉意，但您是第一家在這里報告的大型公司。

So be curious to hear from you on any procedure trends through the quarter in the U.S. and international.

因此，很想听聽您對本季度美國和國際手術趨勢的了解。

And regarding the backlog, how do you know there was catch-up and why won't that continue for the next few quarters?

關於積壓，你怎麼知道已經趕上了，為什麼在接下來的幾個季度這種情況不會持續下去？

And I have one follow-up.

我還有一個後續行動。

Yes.

是的。

Just in terms of intra-quarter procedure trends, if you're asking, Larry, month by month, there was nothing notable actually that we would call out.

就季度內程序趨勢而言，拉里，如果您逐月詢問，實際上我們沒有什麼值得注意的地方。

There was the usual impact of seasonality from vacations like Easter, but nothing notable within the quarter.

復活節等假期通常會受到季節性影響，但本季度沒有什麼值得注意的影響。

In terms of procedure categories, bariatrics continued the strength that we've seen for some time.

就手術類別而言，減肥治療延續了我們一段時間以來的強勁勢頭。

China continued the strength that we've seen over the last couple of quarters.

中國繼續保持過去幾個季度的強勁勢頭。

And U.S. general surgery, in particular, performed well.

尤其是美國的普通外科表現良好。

So I think those are the key kind of procedure highlights.

所以我認為這些是程序的關鍵亮點。

What was the second part of your question again, Larry?

拉里，你問題的第二部分又是什麼？

Yes.

是的。

I mean, how do you know there was catch-up from the backlog in Q2?

我的意思是，你怎麼知道第二季度的積壓工作已經趕上來了？

And I guess, why won't that continue?

我想，為什麼這種情況不會繼續下去呢？

It doesn't seem like the backlog would be exhausted just after 1 quarter?

好像積壓的訂單不會一季度就完結吧？

Yes.

是的。

So here's kind of where we stand with the backlog.

這就是我們目前的積壓情況。

We don't actually know how much backlog was resolved in the quarter, how much backlog is left or the timing of the recovery of that might be.

我們實際上不知道本季度解決了多少積壓，還剩下多少積壓，或者恢復的時間。

We have a broad range of estimates.

我們有廣泛的估計。

Frankly, the lack of precision in that estimate is such that it's probably not useful for us to share.

坦率地說，該估計缺乏精確性，因此我們分享它可能沒有用處。

And so we have some indications that we saw backlog reflected in the Q2 results.

因此，我們有一些跡象表明，我們在第二季度的業績中看到了積壓的情況。

But at this point, it's just too difficult to estimate.

但目前來說，估計太難了。

And therefore, kind of give you any additional color on.

因此，有點給你任何額外的顏色。

Yes.

是的。

I hear your question is asking us, how much is left?

我聽說你的問題是在問我們，還剩下多少？

How much of the catch-up is left?

還剩下多少追趕的機會？

There appears to be some.

似乎有一些。

It's hard to have a precise measure on it.

很難對其進行精確測量。

I think we're going to have to let it play for another few quarters to see.

我認為我們必須讓它再玩幾個季度才能看到結果。

Add to that, the uncertainty of wave 4, possibility of wave 4 makes it tough to put a number on, Larry.

除此之外，第四波的不確定性、第四波的可能性使得很難給出一個數字，拉里。

That's helpful, Gary.

這很有幫助，加里。

And just on competition, it does seem like the noise is increasing.

就競爭而言，噪音似乎確實在增加。

We could see one large competitor approved in the second half of this year.

我們可能會在今年下半年看到一個大型競爭對手獲得批准。

How are you thinking about competition?

您如何看待競爭？

Are you seeing any impact thus far?

到目前為止您看到任何影響了嗎？

Yes.

是的。

A couple of things.

有幾件事。

I think all of us know, and we, as consumers know that customers like choice, perfectly fair.

我想我們所有人都知道，而且我們作為消費者知道顧客喜歡選擇，這是完全公平的。

We've seen a few teams come out and field systems that are alternatives to ours.

我們已經看到一些團隊推出了可以替代我們系統的現場系統。

Transitory was out a few years ago and CMR has been out and now Medtronic.

幾年前，Transitory 已經問世，CMR 也已經問世，現在美敦力（Medtronic）也問世了。

A couple of things I'd say.

我想說幾件事。

One is we are focused on making sure that our ecosystem, our products, our systems, everything goes around it really delivers against the Quadruple Aim all the way through.

一是我們專注於確保我們的生態系統、我們的產品、我們的系統以及圍繞它的一切都能夠真正實現四重目標。

It's not just the robot.

這不僅僅是機器人。

Building a great robot is a hard first step.

建造一個偉大的機器人是艱難的第一步。

You have to do it.

你必須這樣做。

And -- but right now, I think that remains to be seen how strong those other systems are.

而且 - 但現在，我認為其他系統有多強大還有待觀察。

Even then, it's not enough.

即便如此，這還不夠。

Instruments and accessories, training programs, support staff, analytics capability, publication, scientific publications demonstrating what you've done, the analytics and evidence-based build are all, I think, important.

我認為，儀器和配件、培訓計劃、支持人員、分析能力、出版物、展示您所做工作的科學出版物、分析和基於證據的構建都很重要。

So I'd encourage those folks on the call, it's likely to be a comparison of ecosystems in delivering the Quad Aim over time.

因此，我鼓勵那些參加電話會議的人，這可能是對隨著時間的推移提供 Quad Aim 的生態系統進行比較。

That said, other teams are out.

也就是說，其他球隊都出局了。

They're calling on customers.

他們正在拜訪顧客。

They're giving their PowerPoints about what they think is going to happen next and some other things.

他們用幻燈片講述他們認為接下來會發生什麼以及其他一些事情。

And our posture to that has been -- it may delay some sales as we may have some competitive conversations and tenders, and we'll lose some.

我們對此的態度是——這可能會延遲一些銷售，因為我們可能會進行一些競爭性對話和招標，並且我們會失去一些。

What we've seen, though, is that what happens in the PowerPoints and what happens a year later is different.

但我們看到的是，PowerPoint 中發生的情況和一年後發生的情況是不同的。

And that if it hasn't delivered against the Quad Aim, if these systems can do some cases well, but not all cases well or they have stability issues or other things, that wears in pretty quickly.

如果它沒有針對 Quad Aim，如果這些系統可以很好地處理某些情況，但不是所有情況都很好，或者它們存在穩定性問題或其他問題，那麼它們會很快磨損。

We also find that our economic offerings with da Vinci X and EUP, we have choices that we ourselves can offer our customers.

我們還發現，通過 da Vinci X 和 EUP 提供的經濟產品，我們自己可以為客戶提供選擇。

So I think all of you on the call, you should expect increased alternatives for the customer base.

因此，我認為參加電話會議的所有人都應該期待為客戶群提供更多的選擇。

I think the noise levels will go up.

我認為噪音水平將會上升。

I think our customers will take their time to evaluate new things as they go.

我認為我們的客戶會花時間評估新事物。

We're okay.

我們沒事。

We're not frightened of that.

我們並不害怕這一點。

We think we stand up pretty well to those comparisons, and we're ready to help them pursue their aims as the year proceeds.

我們認為我們在這些比較中表現得非常好，並且我們準備在今年繼續幫助他們實現他們的目標。

Next, we're going to the line of Rick Wise with Stifel.

接下來，我們將前往 Rick Wise 和 Stifel 的路線。

Gary, maybe just at the beginning of your comments, I was struck that you emphasized that da Vinci utilization rates are, if I understood you correctly, at the high end of historical averages.

加里，也許就在您的評論開始時，我很驚訝您強調達芬奇利用率（如果我理解正確的話）處於歷史平均水平的高端。

Gosh, that's awfully encouraging sounding.

天哪，這聽起來非常令人鼓舞。

I just wondered, are you suggesting or should we be thinking that we could be in the front of a new wave of capital acquisition, with again, capital released because of the need to add additional systems to accommodate the expanding number of procedures?

我只是想知道，您是否建議或者我們應該考慮我們可能處於新一輪資本收購浪潮的前沿，因為需要添加額外的系統來適應不斷增加的程序數量，因此再次釋放資本？

The reason I mentioned it early is I think when we've had pretty strong capital quarters the last few, one of the things we want to look for is, are we building unused capacity into the field that -- where procedures softer that would stall us out.

我早些時候提到這一點的原因是，我認為當我們在過去的幾個季度擁有相當強勁的資本時，我們想要尋找的一件事是，我們是否正在將未使用的產能建設到該領域——在該領域，程序較軟，這會停滯不前我們出去。

And so we watch that number because we know it's highly sensitive.

所以我們關注這個數字，因為我們知道它非常敏感。

And we're pleased.

我們很高興。

Again, if you look across that 2-year period, try to look through the pandemic kind of ups and downs, what we're seeing is that procedure demand is there.

再說一遍，如果你回顧一下這兩年的時間，試著回顧一下大流行病的起起落落，我們會看到手術需求是存在的。

And the capital to support that demand has not run ahead of the procedure demand.

而支持這種需求的資本並沒有跑在流程需求之前。

In fact, our commentary is a little bit the opposite that these are being highly utilized.

事實上，我們的評論與這些被高度利用的情況有點相反。

That's great.

那太棒了。

That says that we're not putting out more capital than folks need, even though it's been healthy capital quarters, it means our customers are getting good benefit out of what they're using those systems for.

這意味著我們投入的資本並沒有超出人們的需求，儘管資本季度狀況良好，但這意味著我們的客戶從他們使用這些系統的用途中獲得了良好的收益。

Jamie in his commentary said that a lot of those procedures are benign procedures, many of them are shorter duration than longer or more complex disease states.

傑米在評論中表示，其中很多手術都是良性手術，其中許多手術的持續時間比更長或更複雜的疾病狀態要短。

That means that utilization will go up kind of naturally, that, that mix moves toward a higher utilization mix.

這意味著利用率會自然上升，即該組合朝著更高利用率的方向發展。

All of that, to me, indicates that the business feels in balance.

對我來說，所有這些都表明業務處於平衡狀態。

I'll caution that what the next couple of quarters or next 4 quarters looks like in terms of hospital access to capital and their decision-making, capital is always lumpy.

我要提醒大家的是，就醫院獲得資金及其決策而言，未來幾個季度或未來四個季度的情況如何，資本總是不穩定的。

It has been.

它一直。

Just so really speaking backward-looking, so far, so good.

真的是回顧過去，到目前為止，一切都很好。

Got you.

明白你了。

Gary, a separate topic.

加里，一個單獨的話題。

I've had the privilege of seeing Intuitive develop the use of robotics in multiple clinical indications over the years.

多年來，我有幸看到 Intuitive 在多種臨床適應症中開發機器人技術的應用。

And recently, we've had a series of very encouraging conversations on the adoption of bariatrics, very encouraging.

最近，我們就採用減肥療法進行了一系列非常令人鼓舞的對話，非常令人鼓舞。

And basically, still underpenetrated, big opportunity.

基本上，仍然滲透不足，這是一個巨大的機會。

Doctors talking to us about further expansion of utilization.

醫生與我們討論進一步擴大利用率。

And I'd just be curious to -- since you all are calling it out repeatedly as an important incremental growth driver, where are we now, in your view, in that, I'm sure, multiyear long-term adoption process?

我只是好奇——既然你們都反復強調它是一個重要的增量增長驅動力，那麼在你們看來，在我確信多年的長期採用過程中，我們現在處於什麼位置？

What's left to do from maybe a product or procedure or instrument point of view?

從產品、程序或儀器的角度來看，還需要做什麼？

Where are we going with this one?

我們要帶著這個去哪裡？

Let me start with why I think it's adopting, and I'm going to turn to Jamie as to where -- what inning of the baseball game are we in, I'll let Jamie take that.

讓我從為什麼我認為它會被採用開始，我將向杰米詢問我們在棒球比賽的哪一局，我會讓傑米來回答。

On the why side, it's -- bariatrics has been a little different than other procedure for us.

就原因而言，減肥治療與我們的其他手術略有不同。

It's a highly penetrated laparoscopic indication in the United States.

在美國，這是一種高度滲透的腹腔鏡適應症。

Having said that, it's a difficult procedure for surgeons to perform.

話雖如此，這對於外科醫生來說是一個困難的手術。

It's physically demanding.

這對體力要求很高。

And as we've said in the past, if we can bring the right system with the right instruments, the right imaging, and the right usability, the right ease of use, we think that surgeons will care.

正如我們過去所說，如果我們能夠帶來正確的系統、正確的儀器、正確的成像、正確的可用性、正確的易用性，我們認為外科醫生會關心的。

And we've seen both good clinical outcomes, but also high surgeon satisfaction and better ergonomics.

我們不僅看到了良好的臨床效果，而且還獲得了很高的外科醫生滿意度和更好的人體工程學設計。

I think that's what's been driving our success in the early market.

我認為這就是推動我們在早期市場取得成功的原因。

It's taking getting the advanced instruments, put them together as a set, getting our workflows and our clinical pathways right, and I think that's been powerful to date.

它需要獲得先進的儀器，將它們組合在一起，使我們的工作流程和臨床路徑正確，我認為迄今為止這已經很強大了。

And Jamie, as to kind of where we are.

傑米，關於我們現在的情況。

Yes.

是的。

Just a couple of comments.

只是幾點評論。

So bariatric obviously has been highly laparoscopically-penetrated historically.

因此，減肥治療在歷史上顯然已被腹腔鏡高度滲透。

From a market perspective, about 60%-ish or so are sleeves, about 15% are revisions.

從市場來看，大約60%左右是袖子，15%左右是改版。

In terms of our underlying numbers, we're growing at a little faster rate in the revision section, sleeves and bypass grow about the same rate.

就我們的基礎數據而言，我們在修訂部分的增長速度稍快一些，袖子和旁路的增長速度大致相同。

I think the product ecosystem with XI with a 60-millimeter stapler is in good shape, and we're getting good feedback from surgeons in that regard.

我認為帶有 60 毫米吻合器的 XI 產品生態系統狀況良好，並且我們從外科醫生那裡得到了這方面的良好反饋。

It is in fact a physically taxing procedure, as Gary described.

正如加里所描述的，這實際上是一個耗費體力的過程。

And so we see that as a benefit also with respect to feedback from surgeons.

因此，我們認為這對於外科醫生的反饋也是一個好處。

In terms of penetration or adoption, we're in the early to mid innings kind of range is what I'd say in the U.S. market.

就滲透率或採用率而言，我們處於早期到中期的範圍，這就是我在美國市場所說的。

Okay.

好的。

Well, thank you, and our moderator, that was our last question.

好的，謝謝您和我們的主持人，這是我們的最後一個問題。

In closing, we continue to believe there is a substantial and durable opportunity to fundamentally improve surgery and acute interventions.

最後，我們仍然相信存在大量且持久的機會從根本上改善手術和緊急干預措施。

Our teams continue to work closely with hospitals, physicians and care teams in pursuit of what our customers have termed the Quadruple Aim: Better, more predictable patient outcomes, better experiences for patients, better experiences for their care teams, and ultimately, a lower total cost to treat.

我們的團隊繼續與醫院、醫生和護理團隊密切合作，追求客戶所說的“四重目標”：更好、更可預測的患者治療結果、更好的患者體驗、更好的護理團隊體驗，以及最終更低的總治療費用治療費用。

We believe value creation in surgery and acute care is foundationally human.

我們相信手術和急症護理中的價值創造本質上是人的。

It flows from respect for and understanding of patients and care teams, their needs and their environment.

它源於對患者和護理團隊、他們的需求和環境的尊重和理解。

Thank you for your support on this extraordinary journey.

感謝您對這段非凡旅程的支持。

We look forward to talking with you again in 3 months.

我們期待 3 個月後再次與您交談。

Ladies and gentlemen, that does conclude your conference for today.

女士們、先生們，今天的會議到此結束。

Thank you for your participation and for using AT&T event conferencing.

感謝您的參與和使用 AT&T 活動會議。

You may now disconnect.

您現在可以斷開連接。