直覺手術 (ISRG) 2021 Q1 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Q1 2021 Earnings Release. (Operator Instructions) As a reminder, this conference is being recorded. I would now like to turn the conference over to our host Philip Kim, Head of Investor Relations. Please go ahead.

女士們、先生們，感謝你們的耐心等待，歡迎參加 Intuitive 2021 年第一季財報發布會。（操作說明）提醒各位，本次會議正在錄音。現在我將把會議交給我們的主持人，投資者關係主管菲利普金。請繼續。

Good afternoon, and welcome to Intuitive's first quarter earnings conference call. With me today, we have Gary Guthart, our CEO; Marshall Mohr, our Chief Financial Officer; and Jamie Samath, our Senior Vice President, Finance.

下午好，歡迎參加 Intuitive 第一季財報電話會議。今天和我在一起的有：我們的執行長 Gary Guthart；我們的財務長 Marshall Mohr；以及我們的高級副總裁兼財務主管 Jamie Samath。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are described in detail in our Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 10, 2021. Our SEC filings can be found throughout our website or at the SEC's website. Investors are cautioned not to place undue reliance on such forward-looking statements.

在開始之前，我想告知各位，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於存在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的證券交易委員會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。您可以在我們網站或美國證券交易委員會（SEC）的網站上找到我們提交給SEC的文件。投資者應注意，不要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. Today's press release and supplementary financial data tables have been posted to our website. Today's format will consist of providing you with highlights of our first 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 Jamie will review our financial outlook. Finally, we will host a question-and-answer session. With that, I will turn it over to Gary.

請注意，本次電話會議的音訊回放將在我們網站intuitive.com的「投資者關係」欄位下的「最新動態」部分提供。今天的新聞稿和補充財務數據表已發佈在我們的網站上。今天的會議形式將包括：首先向您介紹我們今天早些時候發布的新聞稿中所述的第一季業績亮點，然後進行問答環節。Gary 將介紹本季的業務和營運亮點。馬歇爾將對我們的財務表現進行評估。我將討論手術流程和臨床要點。傑米將審閱我們的財務前景。最後，我們將舉行問答環節。接下來，我將把麥克風交給蓋瑞。

Thank you for joining us today. Our first quarter of 2021 was a step in the right direction. In the quarter, we saw a healthy recovery of surgery and use of our products. Strong capital placements continued in Q1 2021, and utilization of installed systems increased through the quarter, indicating a need by our customers to return to surgery. We're in the early innings of commercialization of 2 new platforms for Intuitive while advancing digital enablement of our ecosystem. Our teams are making good progress in all 3 areas.

感謝您今天蒞臨。2021年第一季我們朝著正確的方向邁出了一步。本季度，我們看到手術量和我們產品的使用量均呈現健康復甦態勢。2021 年第一季度，強勁的資本投入持續，已安裝系統的利用率在本季度不斷提高，這表明我們的客戶需要恢復手術。我們正處於 Intuitive 兩個新平台商業化的早期階段，同時也正在推動我們生態系統的數位化賦能。我們的團隊在所有三個領域都取得了良好的進展。

Overall, we're seeing some pandemic recovery, but improvement has been uneven with significant regional variation. Our experience shows that our business rebounds as COVID drops.

整體而言，我們看到疫情有所好轉，但改善並不均衡，存在顯著的區域差異。我們的經驗表明，隨著新冠疫情的消退，我們的業務也會反彈。

Starting with procedures. General surgery in the United States was a source of strength in the quarter, driven by bariatric surgery, cholecystectomy and other procedures. Bariatric surgery has been on a multi-quarter growth trajectory, the result of aligned development and commercial activity, starting with a capable system, using advanced instruments and combined with a focused commercial team. Ventral hernia surgery is recovering, with inguinal hernia tracking behind, aligned to hospital and patient prioritization.

首先從流程入手。在美國，普通外科手術是本季的強勁成長點，這主要得益於減重手術、膽囊切除術和其他手術。減重手術已經連續幾季保持成長勢頭，這是研發和商業活動協調一致的結果，從擁有先進的儀器和功能強大的系統開始，再到擁有專注的商業團隊。腹壁疝氣手術正在恢復，腹股溝疝氣手術則相對滯後，這與醫院和患者的優先順序有關。

In the U.S., gynecology and urology returned to growth after pandemic-related declines. Growth in our second largest market, China, continued to be strong with multiple specialties contributing.

在美國，婦科和泌尿科在經歷了疫情相關的下滑後恢復了增長。我們第二大市場中國的成長動能依然強勁，多個專業領域都做出了貢獻。

Lastly, procedures that have long diagnostic journeys such as prostatectomy and thoracic surgery, remain below historical levels. Philip will take you through procedure dynamics in more detail later in the call.

最後，像是攝護腺切除術和胸腔外科手術這類診斷過程較長的手術，其數量仍低於歷史水準。Philip 將在稍後的通話中更詳細地向您介紹流程細節。

On the capital side, new system placements continue to exceed our expectations with the United States, China, France and the U.K. standing out in the quarter. We know that new system placements are closely tied to anticipated procedure volumes and system utilization in mature markets.

在資本方面，新系統部署繼續超越我們的預期，其中美國、中國、法國和英國在本季表現突出。我們知道，在成熟市場中，新系統的部署與預期的手術量和系統利用率密切相關。

System utilization grew in the quarter on average with significant regional variance due to pandemic differences. Overall, capital strength indicates anticipation of future procedure opportunity by our customers. A significant number of systems were part of multisystem deals by hospitals and integrated delivery networks, supporting a theme in which customers who know robotic-assisted surgery well continue to invest with us.

本季系統利用率平均成長，但由於疫情差異，各地區之間存在顯著差異。整體而言，雄厚的資金實力顯示我們的客戶對未來業務發展機會抱持預期。大量系統是醫院和綜合醫療服務網絡的多系統交易的一部分，這印證了「熟悉機器人輔助手術的客戶繼續與我們進行投資」這一主題。

Lastly, the use of leasing and other alternative capital placement models ticked up again this quarter. Marshall will take you through capital placements in more detail later in the call.

最後，本季租賃和其他替代資本配置模式的使用量再次上升。馬歇爾將在稍後的電話會議中更詳細地向您介紹資金配置。

Surveying our business around the world, our business in China is growing quickly from a small base, and we are pleased with the performance of our joint venture with Fosun Pharma. We believe there is significant long-term opportunity in China and remind you that it is currently a quota-controlled market. We expect China to be dynamic and competitive in coming years, and we're investing in the market to bolster our place as a leading provider to the Chinese health care system.

縱觀我們在全球的業務，我們在中國的業務正從小規模迅速增長，我們對與復星醫藥的合資企業的表現感到滿意。我們認為中國市場具有巨大的長期發展機會，並提醒您，目前中國市場實施配額管制。我們預計中國在未來幾年將充滿活力和競爭力，我們正在投資中國市場，以鞏固我們作為中國醫療保健系統領先供應商的地位。

In Japan, growth remains healthy, though below pre-pandemic levels. In Europe, our business in France and Germany have performed well, considering the pandemic. In the U.K., tightly controlled surgery resulted in procedure declines, but we've also seen an increased commitment to robotic-assisted surgery in the form of increased capital placements, anticipating a return of da Vinci surgery post pandemic.

日本經濟成長依然健康，但低於疫情前水準。考慮到疫情的影響，我們在歐洲法國和德國的業務表現良好。在英國，嚴格控制的手術導致手術量下降，但我們也看到，隨著資本投入的增加，人們對機器人輔助手術的投入也隨之增加，預計疫情後達文西手術將會回歸。

Italy and Spain are rapidly returning to growth after substantial pandemic impacts.

義大利和西班牙在經歷了疫情的巨大衝擊後，正在迅速恢復經濟成長。

Speaking to our finances in the quarter, procedures recovered nicely in Q1. System placements came in above plan and I&A revenue per procedure was above our expectations, together, driving 18% revenue growth over Q1 2020. The product gross margins were strong in the quarter, largely due to above-average system ASPs, lower-than-expected excess and obsolescence charges and higher volumes through our factories.

就本季財務狀況而言，第一季各項業務都已恢復良好。系統安裝量超出計劃，每次手術的 I&A 收入也超出預期，兩者共同推動 2020 年第一季營收成長 18%。本季產品毛利率表現強勁，主要原因是系統平均售價高於平均水平，滯銷和報廢費用低於預期，以及工廠產量增加。

Other spending was constrained in the quarter, driven by 3 factors. First, travel and associated costs did not recur at pre-pandemic levels. This spend will increase as COVID wanes and our customers and our staff reach immunity.

本季其他支出受到限制，主要受以下三個因素影響。首先，旅行及相關費用並未恢復到疫情前的水準。隨著新冠疫情減弱，我們的客戶和員工獲得免疫力，這項支出將會增加。

Second, COVID delayed some work in R&D, leading to some underspend in prototypes. We expect these programs to ramp up as COVID wanes and our labs and development programs recover efficiency.

其次，新冠疫情延誤了一些研發工作，導致原型製作上的投入不足。我們預計隨著新冠疫情的消退以及我們的實驗室和研發項目恢復效率，這些項目將會加速推進。

Third, we deferred some investments in infrastructure that were unnecessary during the pandemic. We think most of these factors will normalize over time, and we consider them onetime events related to the pandemic. We are still in the early stages of developing robotic-assisted surgery globally, and we will continue investing in R&D and our regional capabilities to realize these opportunities.

第三，我們延後了一些在疫情期間不必要的基礎投資。我們認為這些因素大多會隨著時間的推移而恢復正常，我們將它們視為與疫情相關的一次性事件。我們目前仍處於全球機器人輔助手術發展的早期階段，我們將繼續投資研發和提升區域能力，以實現這些機會。

As I mentioned at the start of the call, we are in the early phases of our commercialization efforts for new platforms, which we expect to play out over future quarters. Our single port surgery platform, da Vinci SP, we performed our first cases in the U.S. and Korea of an important accessory, our SP access port, which enables surgery close to the [body wall] and eases assistant surgeon access through the single incision. The access port is an important -- is important in the SP ecosystem, facilitating access and workflow in many procedures in which SP is used. We've had very strong customer feedback on the port to date.

正如我在電話會議開始時提到的，我們正處於新平台商業化工作的早期階段，我們預計這項工作將在未來幾季逐步展開。我們採用單孔手術平台達文西 SP，在美國和韓國進行了首例手術，該平台配備了重要的附件——SP 接入端口，可實現靠近[體壁]的手術，並方便助手外科醫生通過單個切口進行操作。接入連接埠在 SP 生態系統中非常重要，它有助於在許多使用 SP 的流程中進行存取和工作流程。到目前為止，我們收到了客戶對該港口的非常積極的回饋。

We are also increasing our investments to accelerate new indications in key countries. In the U.S., we have 2 cleared indications for SP and expect to initiate cases as part of our colorectal IDE this quarter. We've seen strong interest in SP use in various specialties, and we're in the process of designing trials for additional indications, including thoracic surgery and other surgical disciplines. Overall, we've received robust customer feedback for SPUs under existing clearances.

我們也正在加大投資，以加快在重點國家推出新療法。在美國，我們有 2 個 SP 適應症獲得批准，預計將在本季啟動結直腸 IDE 的病例研究。我們看到各個專科對 SP 的使用表現出濃厚的興趣，我們正在設計針對其他適應症的試驗，包括胸腔外科和其他外科領域。總體而言，我們已收到客戶對現有許可下的 SPU 的正面回饋。

Turning to our flexible robotics platform, Ion, we installed 14 systems in the quarter. We are recovering from our supply backlog and are meeting demand for ion procedures at all our installed accounts while working to fill customer inventory stocking requests and our internal inventory goals, which we expect to complete around midyear. Our precise trial evaluating the ability to reach and diagnose suspicious pulmonary lesions is on track to finish enrollment by Q2 this year. Our Ion clinical performance is meeting our expectations and customer acceptance remains highly encouraging.

在本季度，我們為柔性機器人平台 Ion 安裝了 14 套系統。我們正在從供應積壓中恢復過來，並滿足所有已安裝客戶的離子治療需求，同時努力滿足客戶的庫存補充要求和內部庫存目標，我們預計將在年中左右完成這些目標。我們正在進行一項精準的試驗，旨在評估能否發現和診斷可疑的肺部病變，預計今年第二季完成招募工作。我們的離子臨床表現符合預期，客戶接受度也令人非常鼓舞人心。

In our digital ecosystem enablement, we broadened access to our mobile surgeon portal, the My Intuitive app, this April as part of our phased launch. My Intuitive is a mobile app that allows surgeons to manage their da Vinci experience, log into da Vinci systems, manage their training and view their operative data from the palm of their hand.

作為我們分階段推出計劃的一部分，今年 4 月，我們在數位化生態系統賦能方面擴大了行動外科醫生入口網站 My Intuitive 應用程式的存取權。My Intuitive 是一款行動應用程序，外科醫生可以透過它管理他們的達文西手術體驗、登入達文西系統、管理他們的培訓，並隨時隨地查看他們的手術數據。

Our Intuitive telepresence program supported 45% of all case observations in Q1 2021, up from less than 5% a year ago, a significant achievement accelerated by the pandemic, improving convenience for our customers and reducing costs for our team. Year-over-year surgical stimulation usage in the quarter grew roughly 46% over Q1 2020, validating the power of digital tools. Finally, our team made significant progress in automating customer-facing analytics as part of our robotics program consulting services, which allow our customers to analyze the relative performance of their da Vinci programs. Now we retain part of customer engagement in the United States.

2021 年第一季度，我們的直覺式遠距呈現程序支援了 45% 的所有病例觀察，而一年前這一比例還不到 5%，這一重大成就得益於疫情的加速發展，提高了客戶的便利性，降低了我們團隊的成本。與 2020 年第一季相比，本季外科刺激的使用量年增約 46%，驗證了數位工具的強大作用。最後，作為我們機器人程式諮詢服務的一部分，我們的團隊在自動化面向客戶的分析方面取得了重大進展，這使得我們的客戶能夠分析其達文西程式的相對表現。現在我們仍然保留著一部分美國客戶互動。

In conclusion, we're seeing adjustments in the health care system that favor our offerings. Increased depreciation of high-quality MIS in the current and post-pandemic environment, increased openness to digital technologies, increased use of analytics to assess care and increasing sensitivity by health systems to total cost to treat.

總之，我們看到醫療保健系統正在做出有利於我們服務的調整。在當前和後疫情時代，高品質 MIS 的貶值加劇，對數位技術的開放程度提高，更多地使用分析來評估護理，以及衛生系統對治療總成本的敏感性增加。

We have and will continue to position ourselves to perform well in this environment. I'll now turn the time over to Marshall to take you through our financial performance in greater detail.

我們已經並將繼續調整自身定位，以適應這種環境並取得良好業績。現在我將時間交給馬歇爾，讓他更詳細地向大家介紹我們的財務表現。

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 to our website.

午安.我將以非GAAP或備考財務報表為基礎，介紹我們業績的亮點。我稍後將在準備好的發言稿中總結我們的GAAP表現。我們已在網站上公佈了模擬財務報表與GAAP財務報表之間的調節表。

Key business metrics for the first quarter were as follows:

第一季主要業務指標如下：

First quarter 2021 procedures increased approximately 16% compared with the first quarter of 2020, was approximately the same as last quarter. On a day-adjusted basis, procedures grew 18% year-over-year.

2021 年第一季手術量比 2020 年第一季成長了約 16%，與上一季大致相同。按日調整後，手術量年增 18%。

First quarter system placements of 298 systems increased 26% compared with 237 systems for the first quarter of 2020 and decreased 9% compared with the 326 systems last quarter. We expanded our installed base of da Vinci systems over the last year by 8% to approximately 6,142 systems. This growth rate compares with 11% last year and 7% last quarter.

第一季系統安裝量為 298 套，比 2020 年第一季的 237 套成長了 26%，比上一季的 326 套下降了 9%。過去一年，我們的達文西手術系統安裝量增加了 8%，達到約 6,142 套。這一成長率與去年同期的 11% 和上一季的 7% 相比有所下降。

Utilization of clinical systems in the field measured by procedures per system increased approximately 8% compared with last year and decreased 2% compared with last quarter.

與去年相比，臨床系統在現場的使用率（以每個系統的手術量衡量）增加了約 8%，與上一季相比下降了 2%。

The impact of COVID on da Vinci procedures varied by region. In the U.S., COVID resurgence affected procedures later in the fourth quarter continued well into January. Then as COVID subsided, procedures experienced a steady improvement through February and March. In Europe, the spread of COVID varied regionally and procedure growth rates were mixed with strength in France and a year-over-year decline in the U.K.

新冠疫情對達文西手術的影響因地區而異。在美國，新冠疫情的再次爆發影響了第四季後期的手術流程，這種情況一直持續到1月。隨著新冠疫情的消退，手術流程在二月和三月期間穩步改善。在歐洲，新冠疫情的傳播情況因地區而異，手術量成長率也參差不齊，法國成長強勁，而英國則較去年同期下降。

While there have been COVID hotspots within some of our Asia Pacific markets, they tended to be isolated, and in general, procedures performed well. China growth was far higher than other regions reflecting the severity of the COVID impact on China in the first quarter of last year and the additional system installations over the past year.

雖然我們在亞太地區的某些市場出現了新冠疫情熱點地區，但這些地區往往是孤立的，而且總體而言，各項防治措施都執行良好。中國的成長速度遠高於其他地區，這反映了去年第一季新冠疫情對中國的嚴重影響，以及過去一年新增的系統安裝量。

Philip will provide additional procedure commentary later in this call.

Philip將在本次通話稍後提供更多程序說明。

Despite the fact that hospitals are better equipped to handle COVID patients today compared with the outset of the pandemic, resurgences of COVID-19 and its variants, like those currently being experienced in parts of Europe and the U.S., have challenged hospital care capabilities and have negatively impacted da Vinci procedures. In addition, delays in diagnosis and treatment of underlying conditions have continued to negatively impact da Vinci procedures. While there is a backlog of patients, it is unpredictable when those patients will ultimately seek diagnosis in treatment and whether they will be treated in surgery.

儘管與疫情爆發初期相比，如今醫院在應對新冠患者方面裝備更加完善，但新冠疫情及其變種的捲土重來，例如目前在歐洲和美國部分地區正在經歷的疫情，已經對醫院的護理能力提出了挑戰，並對達文西手術產生了負面影響。此外，對潛在疾病的診斷和治療延誤也持續對達文西手術產生負面影響。雖然目前有大量積壓病人，但這些病人最終何時會尋求診斷和治療，以及他們是否會接受手術治療，都是無法預測的。

Jamie will be providing procedure guidance later in this call. That guidance is based on our experience in the first quarter and the pace at which vaccines have been and are forecasted to be rolled out. Changes in the spread of COVID and its variance in the pace of vaccine rollouts could significantly impact our guidance.

Jamie將在本次通話稍後提供操作流程指導。該指導意見是基於我們第一季的經驗以及疫苗已經和預計推出的速度而製定的。新冠疫情傳播的變化以及疫苗推廣速度的差異可能會對我們的預測產生重大影響。

Moving on to capital placements. Placements in the quarter reflected procedure growth, hospitals purchasing systems in preparation for a post-pandemic environment, and hospitals upgrading in order to access or standardize on fourth generation capabilities. First quarter capital placements exceeded our expectations. We believe that generally, COVID has had less of an impact on hospital capital spending capacity and that customers recognize that da Vinci surgery meets their quadruple aim objectives better than other surgical approaches.

接下來是資金配置環節。本季的部署反映了手術量的成長、醫院為應對後疫情時代而採購系統，以及醫院為了獲得或標準化第四代功能而進行的升級。第一季的資金募集情況超出了我們的預期。我們認為，整體而言，新冠疫情對醫院資本支出能力的影響較小，而且客戶也意識到，達文西手術比其他手術方法更能滿足他們的四重目標。

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.

展望未來，我們看到以下資本收入動態：手術量成長推動了我們許多市場的資本購買。新冠疫情對生產流程的影響程度，必然也會對資本採購產生影響。

Leasing and alternative financing arrangements have enabled customers access to capital. 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.

租賃和替代融資安排使客戶能夠獲得資金。我們認為，隨著時間的推移，租賃收入佔銷售額的比例將會增加，這將導致原本會在當期產生的收入推遲到未來時期。

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.

舊機置換週期對系統部署起到了促進作用。然而，隨著老一代產品的裝機量下降，以舊換新的數量也會下降。

Macroeconomic conditions created by COVID could regionally impact hospital capital spending. And as we face competition in various markets, we may experience longer selling cycles and price pressures. Additional revenue statistics and trends are as follows: Total first quarter revenue was $1.292 billion, representing an 18% increase from last year and a 3% decrease from last quarter.

新冠疫情造成的宏觀經濟狀況可能會對區域醫院的資本支出產生影響。隨著我們在各個市場面臨競爭，我們可能會經歷更長的銷售週期和價格壓力。其他營收統計數據和趨勢如下：第一季總營收為 12.92 億美元，比去年同期成長 18%，比上一季下降 3%。

First quarter revenue growth reflected procedure growth and higher-than-expected system placements. Leasing represented 43% of current quarter placements compared with 32% last year and 37% last quarter. Leasing as a percentage of total sales has and will continue to fluctuate with customer and geographic mix. However, given hospital (inaudible), we anticipate more customers will seek leasing or alternative financing arrangements than reflected in historical run rates.

第一季營收成長反映了手術量成長和系統安裝量高於預期。本季租賃佔總投放量的 43%，而去年同期為 32%，上季為 37%。租賃額佔總銷售額的百分比過去和將來都會隨著客戶和地理組合的變化而波動。然而，考慮到醫院（聽不清楚），我們預計會有更多的客戶尋求租賃或替代融資安排，而不是像歷史運作率所反映的那樣。

44% of systems placed in the first quarter involved trade-ins, which is lower than the 57% last year and 49% last quarter. Trade-in activity can fluctuate and be difficult to predict.

在第一季安裝的系統中，有 44% 是舊機置換，低於去年的 57% 和上一季的 49%。以舊換新活動可能會出現波動，難以預測。

First quarter system average selling prices increased to $1.65 million from $1.44 million last year and $1.43 million in the fourth quarter. The increase relative to last year reflects a higher mix of systems placed in China and our direct markets relative to our indirect markets, a higher mix of dual console systems and a lower proportion of trade-in transactions. The increase relative to last quarter reflects a higher mix of dual consoles and a lower proportion of trade-in transactions. We recognized $19 million of lease buyout revenue in the first quarter compared with $12 million last year and $14 million last quarter. Lease buyout revenue has varied significantly quarter-to-quarter and will likely continue to do so.

第一季系統平均售價從去年的 144 萬美元增加到 165 萬美元，而第四季為 143 萬美元。與去年相比，成長反映出在中國和我們的直接市場銷售的系統數量相對於間接市場有所增加，雙主機系統的數量有所增加，以及以舊換新交易的比例有所下降。與上一季相比，成長反映出雙主機組合比例更高，而以舊換新交易比例更低。第一季我們確認了 1,900 萬美元的租賃買斷收入，而去年同期為 1,200 萬美元，上一季為 1,400 萬美元。租賃買斷收入季度間波動較大，而且這種情況可能會持續下去。

Instrument and accessory revenue per procedure for the first quarter of $1,950 decreased compared with $1,990 per procedure for the first quarter of last year and $2,060 per procedure in the fourth quarter of 2020.

第一季每台手術的器械和配件收入為 1,950 美元，低於去年第一季的每台手術 1,990 美元和 2020 年第四季的每台手術 2,060 美元。

Extended use instruments were introduced in the U.S. and Europe in the fourth quarter. While we saw increased usage of extended use instruments in these markets, full adoption will occur over the next few quarters as customers burn off lower use product. In addition, we saw customers begin to adjust their instrument buying patterns to reduce their inventory levels to reflect the additional uses per instrument.

第四季度，美國和歐洲推出了延長使用期限的醫療器材。雖然我們看到這些市場對延長使用壽命的儀器的使用量有所增加，但隨著客戶逐漸用完使用頻率較低的產品，未來幾季內將會全面普及。此外，我們還看到客戶開始調整他們的儀器購買模式，以減少庫存水平，從而反映出每台儀器的額外用途。

Increased usage of extended use instruments and customer buying patterns are the primary reasons for the decrease in instrument and accessory revenue per procedure in the first quarter relative to prior quarters. We expect this trend to continue over the next few quarters. While we expect price elasticity associated with extended use instruments to enable greater penetration into available markets, that benefit is delayed by COVID and otherwise will take time.

與前幾季相比，第一季每次手術的器械和配件收入下降的主要原因是延長使用期限器械的增加以及顧客購買模式的變化。我們預計這一趨勢將在未來幾季持續下去。雖然我們預期與延長使用期限工具相關的價格彈性將使其能夠更廣泛地滲透到現有市場，但新冠疫情延遲了這項益處，否則還需要時間。

6% of the systems placed in the first quarter were SP systems, reflecting a continued measured rollout of SP. Our installed base of SP systems is now 75; 8 in Korea and 67 in the U.S. Our rollout of the SP Surgical System continues to be measured putting systems in the hands of experienced da Vinci users while we pursue additional indications and optimize training pathways in our supply chain. We expect to initiate first cases associated with the U.S. colorectal trial in the next few months.

第一季部署的系統中，有 6% 是 SP 系統，反映出 SP 正在穩定推廣。我們目前已安裝 SP 系統 75 套；其中 8 套在韓國，67 套在美國。我們繼續穩定地推廣 SP 手術系統，將系統交付給經驗豐富的達文西用戶，同時我們也在尋求其他適應症並優化供應鏈中的培訓途徑。我們預計將在未來幾個月內啟動與美國大腸直腸癌試驗相關的首批病例。

We placed 14 Ion systems in the quarter, bringing the installed base to 50 systems. Ion system placements and procedures are excluded from our overall system and procedure counts. The supply issues we called out last quarter had less of an impact on Ion placements and procedures this quarter. We expect to have resolved those supply issues this quarter. Our rollout of Ion will continue to be measured while we optimize training pathways in our supply chain. Procedures under the precise study are expected to complete this quarter.

本季我們安裝了 14 套 Ion 系統，使已安裝系統總數達到 50 套。離子系統植入和手術不計入我們的系統和手術總數。我們在上個季度指出的供應問題對本季離子植入和手術的影響較小。我們預計本季將解決這些供應問題。我們將繼續衡量 Ion 的推廣情況，同時優化供應鏈中的訓練路徑。預計該項具體研究的程序將於本季完成。

Outside of the U.S., we placed 108 systems in the first quarter compared with 55 in the first quarter of 2020 and 130 systems last quarter.

在美國以外，我們第一季安裝了 108 套系統，而 2020 年第一季為 55 套，上一季為 130 套。

Current quarter system placements included 59 into Europe, 8 into Japan and 23 into China compared with 25 into Europe, 10 into Japan and 9 into China in the first quarter of 2020. 22 of the 59 systems placed in Europe this quarter were in the U.K. Placements in many markets like the U.K. can vary significantly quarter-to-quarter. While we are pleased with the performance of the U.K. team, we do not anticipate this level of placements in the U.K. in future quarters.

本季系統部署包括歐洲 59 套、日本 8 套和中國 23 套，而 2020 年第一季則為歐洲 25 套、日本 10 套和中國 9 套。本季在歐洲部署的 59 套系統中，有 22 套位於英國。像英國這樣的許多市場的部署情況可能會逐季度發生顯著變化。雖然我們對英國團隊的表現感到滿意，但我們預計未來幾季在英國的職位安排不會達到這樣的水平。

Moving on to gross margin and operating expenses. Pro forma gross margin for the first quarter of 2021 was 71.8% compared with 69.7% for both the first and fourth quarters of 2020. The first and fourth quarters of 2020 included higher period costs associated with lower production and higher excess and obsolete inventory charges. In addition, the first quarter of 2021 reflected leveraging fixed costs over higher production levels.

接下來分析毛利率和營運費用。2021 年第一季的備考毛利率為 71.8%，而 2020 年第一季及第四季的備考毛利率均為 69.7%。2020 年第一季和第四季由於產量下降以及過剩和過時庫存費用增加，導致期間成本上升。此外，2021 年第一季也體現了利用固定成本提高產量的策略。

Product and customer mix fluctuate quarter-to-quarter, which can cause fluctuations in gross margins. In addition, if revenues are pressured by COVID-19, production levels may operate at below normal levels which may result in higher labor costs and under-absorbed overhead and reduced product margins.

產品和客戶組合每季都會波動，這會導致毛利率波動。此外，如果 COVID-19 導致收入承壓，生產水平可能會低於正常水平，這可能會導致勞動力成本上升、管理費用吸收不足以及產品利潤率下降。

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 or production delays.

新冠疫情影響了全球半導體及我們產品所用其他材料的供應。雖然我們儲備了關鍵零件的安全庫存，並且正在努力確保必要的供應以滿足客戶需求，但全球短缺可能會導致生產成本上升或生產延誤。

Pro forma operating expenses increased 5% compared with the first quarter of 2020 and increased 2% compared with the fourth quarter of 2020. The fourth quarter of 2020 included a $25 million contribution to the Intuitive foundation, while there were no contributions in the first quarters of 2021 and 2020.

預計營運費用較 2020 年第一季成長 5%，較 2020 年第四季成長 2%。2020 年第四季向 Intuitive 基金會捐贈了 2,500 萬美元，而 2021 年和 2020 年第一季則沒有捐贈。

The increase compared to the prior year reflects costs associated with higher headcount and increased variable compensation, partially offset by lower spending in areas impacted by COVID. First quarter spending was below our expectations for the reasons outlined by Gary in his opening remarks.

與前一年相比，成長反映了人員增加和可變薪酬增加帶來的成本，但部分被受新冠疫情影響地區的支出減少所抵消。第一季支出低於我們的預期，原因如 Gary 在開場白中所述。

Looking to the remainder of the year, we expect spending impacted by COVID-19, including clinical development, in-person training, marketing events and travel costs to increase as COVID's impacts decrease and spending deferred due to COVID and other timing matters to increase. Jamie will provide spend guidance later in this call.

展望今年剩餘時間，我們預計受 COVID-19 影響的支出（包括臨床開發、現場培訓、行銷活動和差旅費用）將隨著 COVID-19 影響的減弱而增加，同時由於 COVID-19 和其他時間因素而推遲的支出也將增加。Jamie將在本次電話會議稍後提供支出方面的指導意見。

Our pro forma effective tax rate for the first quarter was approximately 20%, meeting our expectations. 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. Our pro forma 2020 -- our first quarter 2020 pro forma net income was $427 million or $3.52 per share compared with $323 million or $2.69 per share for the first quarter of 2020 and $434 million or $3.58 per share for last quarter.

第一季的預期實際稅率約為 20%，符合我們的預期。我們的實際稅率會隨著收入地域組成的變化、地方政府稅收政策的變化以及一次性項目的影響而波動。我們 2020 年的備考業績－我們 2020 年第一季的備考淨收入為 4.27 億美元，即每股 3.52 美元，而 2020 年第一季為 3.23 億美元，即每股 2.69 美元，上一季為 4.34 億美元，即每股 3.58 美元。

I will now summarize our GAAP results.

現在我將總結一下我們的GAAP業績。

GAAP net income was $426 million, or $3.51 per share for the first quarter of 2021, compared with GAAP net income of $314 million or $2.62 per share for the first quarter of 2020 and GAAP net income of $365 million or $3.02 per share for last quarter. The adjustments between pro forma and GAAP net income are outlined and quantified on our website and include: excess tax benefits associated with employee stock awards, employee stock-based compensation and IP charges, amortization of intangibles and acquisition-related items and legal settlement.

2021 年第一季 GAAP 淨利潤為 4.26 億美元，即每股 3.51 美元，而 2020 年第一季 GAAP 淨利潤為 3.14 億美元，即每股 2.62 美元，上一季 GAAP 淨利潤為 3.65 億美元，即每股 3.02 美元。網站上列出了備考淨收入與 GAAP 淨收入之間的調整，並進行了量化，其中包括：與員工股票獎勵、員工股票薪酬和知識產權費用相關的超額稅收優惠、無形資產攤銷和收購相關項目以及法律和解。

GAAP net income for the fourth quarter of 2020 and the first quarter of 2021 also included pretax gains of $4.7 million and $14.3 million on our investments in private companies resulting from our purchases of certain technologies. The EPS impact of these gains, net of tax, was $0.03 per share in the fourth quarter and $0.09 per share in the first quarter. These gains are excluded from our pro forma results.

2020 年第四季和 2021 年第一季的 GAAP 淨收入還包括因我們收購某些技術而對私人公司投資獲得的稅前收益 470 萬美元和 1,430 萬美元。這些收益扣除稅項後，第四季每股收益為 0.03 美元，第一季每股收益為 0.09 美元。這些收益未計入我們的模擬業績中。

We ended the quarter with cash and investments of $7.2 billion compared with $6.9 billion at December 31, 2020. the increase in cash in the first quarter primarily reflected cash from operations and stock exercises. We did not repurchase any shares in the quarter. And with that, I'd like to turn it over to Philip, who will go over procedure performance.

本季末，我們的現金和投資總額為 72 億美元，而截至 2020 年 12 月 31 日為 69 億美元。第一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入。本季我們沒有回購任何股票。接下來，我將把發言權交給菲利普，他將介紹手術流程。

Thank you, Marshall. Our overall first quarter procedure growth was 16% year-over-year compared to 10% growth during the first quarter of 2020 and 6% growth last quarter. Our Q1 procedure growth was driven by 14% year-over-year growth in the U.S. and 23% growth OUS.

謝謝你，馬歇爾。我們第一季的整體手術量年增了 16%，而 2020 年第一季成長了 10%，上一季成長了 6%。第一季手術量成長主要得益於美國市場年增 14% 和美國境外市場年增 23%。

Procedures in the U.S. recovered steadily after January as COVID cases declined and the associated impact on hospital resources improved. In the U.S., within general surgery, bariatric, cholecystectomy and hernia were the largest contributors to procedure growth within the quarter. Bariatrics growth remained strong with positive customer feedback on our advanced instrument portfolio. Cholecystectomy growth was driven by the continued expansion of robotic procedures by general surgeons throughout their total practice. Inguinal hernia growth trailed dental growth in the quarter.

1 月之後，隨著新冠病例減少以及對醫院資源的影響改善，美國的醫療程序穩步恢復。在美國，在一般外科手術中，減重手術、膽囊切除術和疝氣手術是本季手術量成長的最大貢獻者。減重手術業務成長勢頭強勁，客戶對我們先進的器械產品組合給予了正面的回饋。膽囊切除術的成長是由普通外科醫生在其整個執業範圍內不斷擴大機器人手術所推動的。本季腹股溝疝氣的成長速度落後於牙齒的成長速度。

With respect to our more mature procedure categories in the U.S., Q1 gynecology procedures grew double digits the prior year growth comparison that was negative due to COVID. While dVP in the U.S. stabilized in Q1 from previous declines, it remains unclear when patients who have been impacted from delays in diagnosis and treatment will ultimately come back.

就我們在美國較成熟的手術類別而言，第一季婦科手術量實現了兩位數的增長，而去年同期由於新冠疫情的影響，增長率為負。雖然美國 dVP 在第一季從先前的下滑趨勢中趨於穩定，但受診斷和治療延誤影響的患者何時才能最終恢復治療仍不清楚。

In aggregate, on a worldwide basis, prostatectomy in the first quarter largely stabilized. More broadly, OUS procedure growth was driven by urology, earlier stage growth in general surgery, gynecology and thoracic procedures.

整體而言，從全球來看，第一季攝護腺切除手術量基本上趨於穩定。更廣泛地說，OUS 手術的成長是由泌尿外科、早期一般外科、婦科和胸腔外科手術所推動的。

With respect to OUS markets, China procedure growth was strong and benefited from the severe first quarter 2020 impact of COVID and an increase in the installed base over the past year. China had broad-based growth in all procedure categories.

就海外市場而言，中國手術量成長強勁，受益於 2020 年第一季 COVID 疫情的嚴重影響以及過去一年安裝基數的成長。中國在所有手術類別中都實現了全面增長。

In Japan, procedure growth moderated somewhat due to restrictions associated with COVID. Procedure growth in South Korea was encouraging with SP utilization continuing to be above Xi. In Europe, France had a solid quarter with broad-based strength in a wide range of procedure categories. The U.K. remained challenged due to COVID.

在日本，由於新冠疫情相關的限制措施，手術量的成長放緩。韓國的手術量成長令人鼓舞，SP 使用率持續高於 Xi。在歐洲，法國本季表現穩健，在各種手術類別中均展現強勁實力。英國仍受到新冠疫情的挑戰。

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.

現在我們來談談我們業務的臨床方面。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，為了更全面地了解證據體系，我們鼓勵所有利害關係人徹底審查多年來發表的大量科學研究的細節。

A recent article by Dr. Mohamed A. Abd El Aziz, Fabian Grass, and David Larson, with colleagues from the Mayo Clinic published in Surgical Endoscopy provided results from a real-world study aimed to analyze national trends of conversion during elective colectomies in addition to MIS utilization trends. Using the ACS National Surgical Quality Improvement Program database for elective laparoscopic or robotic-assisted colectomy between January 2013 and December 2018, a total of 66,652 patients were identified. Overall conversion rates from MIS to open were approximately 42% lower for robotic-assisted procedures when compared to laparoscopic procedures, 4.9% versus 8.5%. The rate was also lower for obese patients with a BMI greater than or equal to 36% versus 10.3%.

梅奧診所的 Mohamed A. Abd El Aziz 博士、Fabian Grass 和 David Larson 及其同事最近在《外科內視鏡》雜誌上發表了一篇文章，提供了一項真實世界研究的結果，該研究旨在分析擇期結腸切除術期間的轉換率的全國趨勢以及微創手術的使用趨勢。利用 ACS 國家外科品質改進計畫資料庫，對 2013 年 1 月至 2018 年 12 月期間擇期腹腔鏡或機器人輔助結腸切除術的患者進行分析，共確定了 66,652 名患者。與腹腔鏡手術相比，機器人輔助手術從微創手術到開腹手術的整體轉換率降低了約 42%，分別為 4.9% 和 8.5%。BMI 大於或等於 36% 的肥胖患者的盛行率也低於 10.3%。

The authors concluded in part, "This large-scale study identified a decreasing trend in conversion rates 6-year inclusion period, both overall and in patients with obesity, paralleling, increased utilization of the robotics platform. Given the potential negative impact of conversion on patient outcomes, individual institutions should consider a review of their own conversion data as this may represent an opportunity for quality improvement."

作者們在部分結論中指出：「這項大規模研究發現，在為期 6 年的納入期內，無論是總體而言還是在肥胖患者中，轉化率都呈下降趨勢，這與機器人平台的使用率增加相平行。鑑於轉診可能對患者預後產生負面影響，各醫療機構應考慮審查自身的轉診數據，因為這可能代表著一次改善醫療品質的機會。

In February of this year, Dr. Amir Bastawrous, of the Swedish Cancer Institute in Seattle, Washington; and Dr. Robert Cleary of St. Joseph Mercy Hospital in Ann Arbor, Michigan, published a real-world observational study, which compared the rates of long-term opioid prescriptions for patients who underwent minimally invasive and open colectomies. This study utilized the IBM MarketScan research database and analyzed 14,887 eligible patients who underwent a colon resection via the open laparoscopic or robotic-assisted approach between 2013 and 2017.

今年二月，來自華盛頓州西雅圖瑞典癌症研究所的 Amir Bastawrous 博士和來自聖路易斯聖路易斯大學的 Robert Cleary 博士。密西根州安娜堡的約瑟夫·默西醫院發表了一項真實世界的觀察性研究，比較了接受微創結腸切除術和開放式結腸切除術的患者長期服用阿片類藥物的比例。本研究利用 IBM MarketScan 研究資料庫，分析了 2013 年至 2017 年間透過開放式腹腔鏡或機器人輔助方法進行大腸切除術的 14,887 名符合條件的患者。

In the 1:1 propensity score matched analysis comparing the MIS and open approaches with over 5,000 patients in each arm, the MIS approach has significantly lower incidence rate of long-term prescriptions of any opioids by approximately 36%, 13.3% versus 20.9%; schedule 2 and 3 opioids by approximately 39%, 11.7% versus 19.2%; and high-dose opioids by approximately 44%, 4.3% versus 7.7%, from 90 to 180 days postoperatively. Looking at the matched analysis between robotic-assisted surgery and laparoscopy with over 1,100 subjects in each group, the robotic-assisted approach demonstrated approximately 45% lower long-term prescription rates of high-dose opioids, 2.1% versus 3.8% when compared to the laparoscopic approach.

在對微創手術和開放手術進行 1:1 傾向評分配對分析中，每組有超過 5000 名患者，結果顯示，微創手術在術後 90 至 180 天內，長期服用任何阿片類藥物的發生率顯著降低約 36%（13.3% 對 20.9%）；服用 2 類藥物和 3%（3% 19%）； 19.2%）；服用高劑量鴉片類藥物的發生率顯著降低約 44%（4.3% 對 7.7%）。機器人輔助手術和腹腔鏡手術進行配對分析，每組超過 1100 名受試者，結果顯示，與腹腔鏡手術相比，機器人輔助手術長期高劑量鴉片類藥物處方率降低了約 45%，分別為 2.1% 和 3.8%。

Furthermore, in subgroup analyses, the robotic-assisted approach showed significantly lower rates of long-term prescriptions in any opioids, schedule 2 and 3 opioids and high-dose opioids compared to the laparoscopic approach for subjects undergoing colectomy for nonmalignant conditions.

此外，在亞組分析中，與腹腔鏡手術相比，機器人輔助手術在非惡性疾病結腸切除術患者中，長期處方任何阿片類藥物、2 類和 3 類阿片類藥物以及高劑量阿片類藥物的比例明顯更低。

The authors concluded in part, "Choosing an MIS option in robotic-assisted surgery for some colorectal operations is a modifiable factor that may contribute to less long-term opioid use."

作者們在結論中指出：“對於某些結直腸手術，選擇機器人輔助微創手術方案是一個可改變的因素，可能有助於減少長期阿片類藥物的使用。”

And with that, I'd like to turn it over to Jamie, who will review our financial outlook.

接下來，我將把發言權交給傑米，他將回顧我們的財務前景。

Good afternoon. While there continues to be uncertainty regarding the ongoing impact of COVID-19 and given moderating coverage hospitalization trends and vaccination progress, particularly in the U.S., which accounted for approximately 70% of our 2020 procedures, we are reestablishing our financial guidance.

午安.儘管 COVID-19 的持續影響仍然存在不確定性，考慮到覆蓋率住院趨勢和疫苗接種進展有所緩和，尤其是在美國（美國約占我們 2020 年手術量的 70%），我們正在重新制定我們的財務指導。

In providing this guidance, we note that there are emerging supply constraints in our supply chain, for example, in the semiconductor industry. The outlook we are providing does not reflect any potential significant disruption or additional costs related to these supply constraints.

在提供此指導時，我們注意到我們的供應鏈中出現了一些新的供應限制，例如半導體行業。我們提供的展望並未反映這些供應限制可能造成的任何重大中斷或額外成本。

Our financial outlook for 2021 is as follows: starting with procedures, total 2020 da Vinci procedures grew approximately 1% to roughly 1,243,000 procedures performed worldwide. For 2021 and we anticipate full year procedure growth within a range of 22% to 26%. We expect 2021 procedure growth to continue to be driven by U.S. general surgery and procedures outside of the United States where we are at earlier stages of adoption.

我們對 2021 年的財務展望如下：首先是手術量，2020 年達文西手術總量成長約 1%，達到全球約 1,243,000 例。2021 年，我們預計全年手術量成長將在 22% 至 26% 之間。我們預計 2021 年手術量的成長將繼續由美國普通外科手術以及我們目前處於早期推廣階段的美國以外地區的手術量推動。

The high end of the range assumes that COVID cases and the impact on da Vinci procedures continue to decline throughout the year, the vaccine rollouts continue at the level currently expected by governments around the world, and that recovery of patient backlog will progress. Modeling quarterly results is difficult given the impact that COVID had on 2020 procedures. Therefore, with respect to procedure seasonality, we expect similar quarterly patterns for 2019.

該範圍的高端假設 COVID 病例和對達文西手術的影響在全年持續下降，疫苗推廣繼續按照世界各國政府目前預期的水平進行，並且患者積壓的恢復將取得進展。鑑於新冠疫情對 2020 年手術流程的影響，對季度業績進行建模十分困難。因此，就手術季節性而言，我們預期 2019 年的季度模式與往年類似。

With respect to capital, system placements are generally driven by procedure demand, prompting hospitals to establish or expand robotic system capacity. System placement demand is also the result of customers standardizing our fourth generation technology through trade-ins.

就資金而言，系統部署通常受手術需求驅動，促使醫院建立或擴大機器人系統容量。系統部署需求也是客戶透過以舊換新方式對我們第四代技術進行標準化改造的結果。

Capital sales can vary substantially from period-to-period based upon many factors, including government health care policies, hospital capital spending cycles, reimbursement and government quotas, product cycles, economic cycles and competitive factors. Within this framework, we'd expect 2021 capital placements generally be driven by procedures and the adequacy of existing capacity in the installed base.

資本銷售額會因多種因素而隨時間發生顯著變化，包括政府醫療保健政策、醫院資本支出週期、報銷和政府配額、產品週期、經濟週期和競爭因素。在此框架下，我們預計 2021 年的資本配置將主要受程序和已安裝基礎現有產能的充足性所驅動。

During the first quarter of 2021, 43% of systems shipped were under operating leases. We expect that the proportion of systems placed under operating leases will vary from quarter-to-quarter and could continue to trend up in the future.

2021 年第一季度，出貨系統中有 43% 為經營租賃系統。我們預計，採用經營租賃方式部署的系統比例將逐季度變化，未來可能會繼續呈上升趨勢。

Turning to gross profit. Our full year 2020 pro forma gross profit margin was 68.4%, reflecting the impact of fixed -- higher fixed overhead costs relative to revenue, higher excess and obsolete inventory charges, and the customer relief program that was implemented in the second quarter of 2020. Our full year 2019 pro forma gross profit margin was 71.7%. In 2021, we expect our pro forma gross profit margin to be within a range of between 70% and 71% of revenue. Our actual gross profit margin will vary quarter-to-quarter, depending largely on product, regional trade-in mix, the impact of product cost reductions and manufacturing efficiencies and competitive pricing pressure. With respect to operating expenses, in 2019, our pro forma operating expenses grew 27%. And in 2020, given the impact of the pandemic, they grew 3%.

接下來討論毛利。我們 2020 年全年備考毛利率為 68.4%，反映了固定成本的影響——相對於收入而言較高的固定管理費用、較高的超額和過時庫存費用，以及 2020 年第二季度實施的客戶救濟計劃。我們 2019 年全年以準備考試計算的毛利率為 71.7%。2021年，我們預計我們的備考毛利率將達到營收的70%至71%。我們的實際毛利率會因季度而異，主要取決於產品、區域以舊換新組合、產品成本降低和生產效率提高的影響以及競爭性定價壓力。就營運費用而言，2019 年，我們的備考營運費用增加了 27%。2020年，受疫情影響，成長了3%。

In 2021, we expect pro forma full year operating expense growth to be between 18% and 22%, reflecting increases in investments in our digital ecosystem, Ion, SP, OUS expansion, higher regulatory-related costs and infrastructure investments to allow us to scale.

2021 年，我們預計全年營運費用成長將達到 18% 至 22%，這反映了我們在數位生態系統、Ion、SP、OUS 擴張方面的投資增加，監管相關成本上升以及為擴大規模而進行的基礎設施投資。

2021 spending also expected to be impacted by a return over the course of the year to higher rates of travel, increased customer training and a greater proportion of marketing events being held in person and by a variable compensation. We expect our noncash stock compensation expense to range between $450 million to $470 million in 2021 compared to $396 million in 2020. We expect pro forma other income, which is comprised mostly of interest income, to total between $45 million and $55 million in 2021, reflecting lower interest rates relative to 2020.

預計 2021 年的支出也將受到以下因素的影響：全年旅行頻率的提高、客戶培訓的增加、更多行銷活動以線下形式舉行以及可變薪酬。我們預計 2021 年的非現金股票補償支出將在 4.5 億至 4.7 億美元之間，而 2020 年為 3.96 億美元。我們預計 2021 年其他收入（主要包括利息收入）總額將在 4,500 萬美元至 5,500 萬美元之間，反映出利率相對於 2020 年有所下降。

With regard to income tax, in 2020, our pro forma income tax rate was 22.5%. As we look forward, we estimate our 2021 pro forma tax rate to be between 20% and 21% of pretax income. Our 2021 outlook for the pro forma tax rate does not reflect any potential change in U.S. tax rates.

關於所得稅，2020 年，我們的預計所得稅稅率為 22.5%。展望未來，我們預計 2021 年的預期稅率將在稅前收入的 20% 至 21% 之間。我們對 2021 年預計稅率的預測並未反映美國稅率的任何潛在變化。

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

我們的發言到此結束。現在開始回答各位的問題。

(Operator Instructions) First, we're going to the line of Amit Hazan.

（操作說明）首先，我們要去阿米特·哈讚的生產線。

Can you hear me okay?

你聽得清楚我說話嗎？

We can.

我們可以。

Great. I'd maybe burn the first question on just the guide. Obviously, appreciate that just given all the uncertainty on the procedure side.

偉大的。我可能會把第一個問題直接寫在指南上。當然，考慮到程序方面存在許多不確定因素，這一點值得理解。

And so given that you gave that number, I want to see if you'd go a step further and just give us a little bit more color as to how you got there. We're obviously all kind of trying to figure out recovery back to normal, but also these potential buckets of recapturing backlog of procedure categories for you, particularly in prostate, I suspect. Can you just talk to how you thought about those backlog of patients and that return to normal as you develop this guide for the rest of the year on the procedure side?

既然你給了這個數字，我想看看你是否能更進一步，給我們詳細介紹一下你是如何得出這個數字的。我們顯然都在努力恢復正常，但同時也在努力幫您重新處理積壓的手術項目，特別是前列腺手術，我懷疑是這樣。您能否談談您是如何考慮積壓的患者，以及在您制定今年剩餘時間的手術流程指南時，如何讓這些患者恢復正常就醫流程？

Yes. So maybe, Amit, I'll start with -- this is Jamie. I'll start with the low end of the procedure guidance.

是的。那麼，阿米特，或許我應該先介紹一下──這位是傑米。我先從操作指南的入門部分講起。

So we considered 3 factors in the low end. We see the possibility of extended impact of COVID in certain OUS geographies with slower vaccine rollouts and resurgences in some of those geographies. We see that in parts of Europe currently.

所以我們考慮了低端的 3 個因素。我們看到，由於疫苗推廣速度較慢，以及部分地區疫情反彈，新冠疫情可能會在某些美國境外地區產生長期影響。目前在歐洲部分地區可以看到這種情況。

Secondly, we embedded in the lower end of the procedure guidance, a slower recovery of diagnostic pipelines that have been impacted during the pandemic.

其次，我們在程序指南的下半部中加入了對疫情期間受影響的診斷流程進行緩慢恢復的考慮。

And then the third item in the low end of the guidance, is the possibility of regionalized resurgence of COVID in the U.S. as we race towards the rollout of vaccines and, ultimately, at some point, achieve herd immunity in the U.S.

指導意見中較低的第三項是，隨著我們加速推廣疫苗，並最終在某個時候在美國實現群體免疫，美國可能會出現 COVID-19 的區域性複燃。

With respect to the backlog, the backlog's accumulated really for 3 factors: lower diagnostic pipelines, deferred elective surgery as hospital systems get inundated with COVID cases and patient reluctance to undergo surgery during COVID resurgences. These subcomponents, we think, get recovered over different periods of time. The backlog is actually constantly netting between increases and recovery. So the total accumulative backlog is difficult to predict. The rate of recovery is also difficult to predict, but we expect it to go through into 2022. And so the '21 procedure guidance that we provided reflects our best estimate of the range of the impact of backlog in the year.

關於積壓病例，積壓病例的累積實際上是由以下三個因素造成的：診斷流程減少、由於醫院系統被新冠病例淹沒而推遲擇期手術，以及新冠疫情再次爆發期間患者不願接受手術。我們認為，這些子成分會在不同的時間內恢復。積壓情況實際上一直在增長和恢復之間不斷平衡。因此，積壓訂單的總數很難預測。復甦速度也很難預測，但我們預計復甦將持續到 2022 年。因此，我們提供的 2021 年程序指南反映了我們對當年積壓工作影響範圍的最佳估計。

Okay. I appreciate that. And I want to come back with the second question just to a topic that's been discussed before. But I figured, in light of COVID, to bring it up again, which is this is a question of ambulatory surgery centers and lower acuity procedures generally. I mean, especially given COVID, it just seems like there's never been more of an optimal time for Intuitive to discuss and go after this part of the market. And we still don't hear you talking about it that much. So I just -- it begs the question of what's holding you back? And we know that the reflect answers seems -- reflex kind of answer seem to be on the reimbursement side and that it may not be optimal.

好的。我很感激。我想就之前討論過的話題再提第二個問題。但考慮到新冠疫情，我覺得有必要再提出這個問題，那就是門診手術中心和一般低危險手術的問題。我的意思是，尤其是在新冠疫情的影響下，現在似乎是 Intuitive 公司討論並進入這部分市場的最佳時機。我們還是很少聽到你談論這件事。所以，這就引出了一個問題：是什麼阻礙了你？我們知道，反思性的回答似乎——反射性的回答似乎傾向於報銷方面，這可能不是最佳選擇。

When I think about your advantages that you pitched to hospitals on the marketing side, the surgeon benefit, frankly, the outcomes, that seems to be a lot more important and potentially beneficial than where reimbursement lies. So help us out here. Why are ambulatory surgery centers not a bigger opportunity for you right now?

當我想到你在行銷方面向醫院推銷的優勢時，坦白說，外科醫生的獲益以及手術結果，似乎比報銷方式更重要，也更有潛在益處。所以請幫幫我們。為什麼現在對你來說，門診手術中心不是更大的商機？

Yes, this is Gary. We are already in ambulatory surgery environments with our customers of different types, and we see healthy programs there. I don't think we are struggling from the point of view of having a product that can help them or services that can help them or a way to have a conversation. I think all those things are in place. I do believe that over time, reimbursement matters, particularly in customers that operate in both environments, hospitals and ASCs. For them, reimbursement matters. If they're going to move a patient, but they get a big difference in the revenue, then they're going to make those decisions.

是的，這是加里。我們已經與不同類型的客戶在門診手術環境中合作，並且我們看到了良好的專案進展。我認為，從擁有能夠幫助他們的產品或服務，或能夠與他們對話的方式來看，我們並不感到困難。我認為這些都已經準備就緒了。我相信，隨著時間的推移，報銷問題會變得非常重要，尤其是對於那些在醫院和門診手術中心這兩種環境中運作的客戶而言。對他們來說，報銷很重要。如果他們要轉移病人，但這樣做會造成收入上的巨大差異，那麼他們就會做出轉移病人的決定。

It may change over time. And that -- what payers ultimately decide to do and whether they want to create some incentives to help things move into ASCs, we'll be ready. Long term, I'm bullish on that. I think the environment makes sense. But economics and incentives really matter. It doesn't clear up your question. It reinforces our position.

隨著時間的推移，情況可能會改變。至於支付方最終決定怎麼做，以及他們是否希望創造一些激勵措施來幫助醫療服務轉移到門診手術中心，我們已經準備好了。從長遠來看，我看好這一點。我認為這種環境做法是合理的。但經濟因素和激勵機制確實很重要。這並沒有解答你的問題。這鞏固了我們的立場。

And next, we'll go into the line of Larry Biegelsen.

接下來，我們將介紹拉里·比格爾森。

Gary, can you please provide more color on the Intuitive telepresence feature that you mentioned on this call? It's the first time I heard you talk about it, and that 45% of procedures was a pretty impressive number. Is that through your agreement with InTouch? How is it being used by customers? What are the benefits? And how do you see that playing out post COVID? And I had 1 follow-up.

Gary，能否詳細介紹一下您在這通電話中提到的直覺式遠端呈現功能？這是我第一次聽你談到這件事，45% 的手術率確實是一個相當驚人的數字。這是透過你和InTouch的協議達成的嗎？用戶是如何使用它的？有哪些好處？那麼，您認為新冠疫情後這種情況會如何發展？我還有 1 次後續跟進。

Yes. So you're right. It is the result of the technology and a collaborative agreement we signed with InTouch many years ago. We brought a team over as well as some of the technology and have put it in our hands.

是的。你說得對。這是多年前我們與 InTouch 簽署的技術合作協議的成果。我們帶來了一個團隊以及一些技術，並將它們掌握在我們手中。

The use case I was talking about there is the ability for people who are interested in observing a case by an expert, to log in online through a secure network, high-speed streaming, and view that case on da Vinci accounts. And that's an important part of both knowledge transfer from those high-volume accounts, as well as an introductory exposure for surgeons who are thinking about it. So that has been great.

我當時提到的使用場景是，有興趣旁聽專家病例的人可以透過安全網路、高速串流媒體在線登錄，並在達文西帳戶上查看該病例。這對於從這些大客戶那裡進行知識轉移來說非常重要，對於正在考慮從事外科手術的外科醫生來說也是一個重要的入門機會。所以這真是太好了。

There are other use cases for streaming connections, video streaming connections into our products that I won't detail now. It's pretty neat. And so prior, we had started that. I was a believer -- or we, as a company, were believers that those kinds of access, think of it as kind of surgical Face Time or surgical Skype over a distance. That kind of access would be important to folks, and the pandemic really accelerated it. And so we had the technology infrastructure in place. And as people started to be more open to the use of digital tools to do their learning and exposure and wanted to stay off the planes and out of cars, we saw it really accelerate. And that's what we've been touching on there.

串流媒體連接、視訊串流連接到我們產品中還有其他一些應用場景，我現在就不詳細介紹了。真不錯。因此，在此之前，我們已經開始了這項工作。我當時相信——或者說，我們公司當時相信——這種遠端存取方式，可以把它想像成遠端的FaceTime或Skype手術。這種取得途徑對人們來說非常重要，而疫情確實加速了這一進程。因此，我們的技術基礎設施已經到位。隨著人們開始更加樂於使用數位工具進行學習和交流，並且希望減少乘坐飛機和汽車的次數，我們看到這種情況真的加速發展了。這就是我們一直在討論的內容。

That's very helpful. And then lastly, what response are you getting from the extended use program you introduced in Q4 2020? Any changes to kind of the impact that we could see from that? And any color yet on demand elasticity?

那很有幫助。最後，您在 2020 年第四季推出的延長使用計畫得到了怎樣的回饋？由此會產生哪些影響變化？目前還有哪些顏色對需求彈性有影響？

Yes. Sure. So we introduced extended use instruments into Europe and into the U.S. in Q4. We did see increased usage of extended use instruments. They still have some level of inventory of shorter life use instruments and they're burning that off.

是的。當然。因此，我們在第四季度將擴展使用工具引入了歐洲和美國。我們確實看到延長使用時間的儀器的使用量增加。他們還有一些使用壽命較短的儀器庫存，他們正在逐步淘汰這些庫存。

We also had commented last quarter that we saw stocking orders of extended use instruments. And we're seeing some adjustment of their buying patterns to recognize the increased number of uses per instrument.

我們上個季度也提到，我們看到了延長使用期限儀器的庫存訂單。我們看到他們的購買模式正在做出一些調整，以適應每個樂器使用次數的增加。

So the quarter, as I called out, instrument and accessory revenue per procedure was lower than last quarter, and it primarily reflects those factors: the use of extended instruments and adjustments of inventory buying patterns.

正如我之前提到的，本季每台手術的器械和配件收入低於上一季度，這主要反映了以下因素：使用擴展型器械和調整庫存購買模式。

I don't think it's exhausted the whole impact. I think if you go back to our previous script, you'd see that we said that had you implemented this in 2019, it would have affected total revenue by about $150 million to $170 million, or about 7% of Ion [aid] per procedure, and we've only seen a part of that so far. When the rest of it will hit is questionable. It will roll out over time as they continue to use those instruments and as we roll it out to other countries.

我認為這還沒有完全揭示其影響。我認為，如果你回顧我們之前的腳本，你會發現我們說過，如果在 2019 年實施這項措施，總收入將減少約 1.5 億美元至 1.7 億美元，或每台手術 Ion [aid] 的約 7%，而到目前為止，我們只看到了其中的一部分。其餘部分何時到來尚不確定。隨著他們繼續使用這些儀器，以及我們將其推廣到其他國家，這項技術將逐步推廣開來。

And next, we're going to the line of Bob Hopkins.

接下來，我們要介紹鮑伯霍普金斯的比賽。

Great. I wanted to ask a question or a few questions on just the first quarter procedure volume numbers that you provided because it was obviously a lot stronger than consensus estimates. And so Gary, I was just wondering a couple of quick things. Is it safe to assume that the end of the quarter was materially stronger than the beginning and middle of the quarter in terms of procedure growth. And then I was just wondering what stood out to you, Gary, either geographically or by procedure type in the quarter that you think is worth calling out?

偉大的。我想就您提供的第一季手術量數據問一兩個問題，因為顯然比普遍預期要好得多。所以，加里，我只是想問你幾個簡單的問題。是否可以認為，就手術量成長而言，本季末比本季初和中期強勁得多？那麼，Gary，我想知道你覺得本季在地理位置或程式類型方面有哪些值得特別指出的亮點？

So your -- thanks for the question. So the first one, we definitely saw growth through the quarter, which was encouraging.

所以你的——謝謝你的提問。所以第一個方面，我們確實看到了本季的成長，這令人鼓舞。

In terms of procedure types, I think there's this interesting mix. The prioritization that folks are making as they come back in the hospitals, I think, is a mixture of patient desire, depending on what they think their condition might be, for example, bariatrics, and hospital and surgeons prioritization around urgency, for example, diagnosed cancers and changes or challenges to the diagnostic pipeline. I was pleased by U.S. general surgery. I think that, that has shown some resilience. A lot of that is benign procedures. And I think that, that has been kind of on the upside of our models. So, so far, so good.

就手術類型而言，我認為有一個有趣的組合。我認為，人們在重返醫院後所做的優先排序，是病患意願（取決於他們認為自己的病情，例如是否需要進行減重手術）和醫院及外科醫生根據緊急程度（例如已確診的癌症以及診斷流程的變化或挑戰）所做的優先排序的混合體。我對美國的普通外科手術感到滿意。我認為這展現了一定的韌性。其中很多都是良性手術。我認為這算是我們模型的優點。目前為止，一切順利。

And then one follow-up just on that also to get a little bit of a better flavor for procedure volumes in the quarter by geography. I'm just curious, on Europe, what's your take on how bad are things there for -- in your view? And just curious maybe how far below 16% was Europe in the quarter.

然後，我們再進行一次後續調查，以便更了解本季按地區劃分的手術量。我只是好奇，關於歐洲，你覺得那裡的情況有多糟？ ——在你看來？我只是好奇，歐洲本季的佔比與 16% 相比究竟有多低？

Yes. I won't quantify it for you, but just to give you a little bit of qualitative color, and Marshall, please jump in and help. In the U.K., we've seen NHS make priority decisions firmly and that reflects what we see in the procedure performance itself, which has been suppressed. That said, we're also seeing commitments to MIS in the form of capital acquisition and other things that indicate to us that they're rotating toward it. So there, it's kind of a mixed conversation.

是的。我不會幫你量化，但只是為了給你一些定性上的感覺，馬歇爾，請你也來幫忙。在英國，我們看到 NHS 堅定地做出優先事項決定，這反映在手術執行情況本身上，而手術執行情況卻受到了抑制。也就是說，我們也看到他們在資本收購和其他方面對管理資訊系統 (MIS) 做出了承諾，這表明他們正在向 MIS 轉型。所以，這算是一場褒貶不一的討論。

France and Germany have been surprisingly good despite complexity with regard to the way COVID is rolling out. And then as we look at Spain and Italy, we see it really just follow, as COVID eases, surgery comes back and we come back with it.

儘管新冠疫情的傳播方式十分複雜，但法國和德國的表現卻出乎意料地好。然後，當我們看看西班牙和義大利時，我們發現情況確實如此，隨著新冠疫情的緩解，手術恢復了，我們也隨之恢復了。

Overall, we feel like we have really good leadership teams in place in country. We feel like we're in good connection with the health care systems. I think we're being agile and adaptable to meet their needs, which is really controlling what we can control. And in that sense, I think the company is doing all right. Marshall, anything you'd add?

總的來說，我們感覺我們在國內擁有非常優秀的領導團隊。我們感覺與醫療保健系統保持著良好的聯繫。我認為我們正在靈活應變，以滿足他們的需求，這實際上就是控制我們能夠控制的事情。從這個意義上講，我認為公司做得還不錯。馬歇爾，你還有什麼要補充的嗎？

No, I think it was great color. I think the only other thing I would add is the -- we've talked about in the past that a lot of the procedures we're performing are urologic, and we're in the process, in certain countries, of pivoting. And we're starting to see some adoption in GYN and general surgeries in some countries, but we still have work to do.

不，我覺得顏色很棒。我覺得我唯一要補充的是──我們過去曾討論過，我們正在進行的許多手術都是泌尿科手術，而且在某些國家，我們正在進行轉型。在一些國家，我們已經開始看到婦科和普通外科領域採用這種方法，但我們仍有許多工作要做。

And next, we go into the line of Tycho Peterson.

接下來，我們來看看泰科·彼得森的生平。

A couple of follow-ups. I'm curious what's baked into guidance on utilization given the extent of the you use instrument kind of commentary before. What are you kind of modeling for utilization for the year?

還有一些後續問題。鑑於先前關於「你使用工具」這類評論的廣泛程度，我很好奇在利用指南中具體包含了哪些內容。你們對今年的利用率做了怎樣的建模預測？

Yes. I think I would refer Tycho back to 2019 patterns in terms of utilization. Obviously, in the end, capital is going to be driven by procedure performance. So I think I would just refer to seasonal patterns in 2019 as a starting point.

是的。我認為 Tycho 應該參考 2019 年的使用模式。顯然，最終資本將取決於流程績效。所以我認為，可以先以 2019 年的季節性模式作為起點。

Okay. And then you've commented a couple of times on this call and other calls on the diagnostic pipelines being under pressure. Can you just talk a little bit about how they are looking as a leading indicator to some of the more mature procedures, dVP in particular?

好的。然後，您曾多次就此次通話和其他通話發表評論，指出診斷流程面臨壓力。您能否簡單談談它們作為一些更成熟的手術（特別是dVP）的領先指標，其前景如何？

Yes. Jamie, why don't you jump in?

是的。傑米，為什麼不跳進去呢？

Yes. So we have some market data, actually, for the U.S. What we see is -- and that's through February '21. What we see is most of the diagnostic tests, PSA testing, for example, CT scans on lung cancer, we see that those have been suppressed during this period. So we haven't seen them start to recover, at least in the data that we've seen so far. And we see that reasonably correlated to the associated procedures. So PSA, dVP has been relatively weak during that period. So has lobectomy. So so far, we haven't seen any evidence of recovery in diagnostic testing in the U. S.

是的。所以，我們實際上有一些美國市場數據。我們看到的是—截至 2021 年 2 月。我們看到，在此期間，大多數診斷測試，例如 PSA 測試、肺癌 CT 掃描等，都受到了抑制。所以，至少從我們目前看到的數據來看，還沒有看到它們開始復甦。我們發現這與相關程序有相當的相關性。因此，在此期間 PSA、dVP 指標相對較弱。肺葉切除術也是如此。所以到目前為止，我們還沒有看到美國診斷檢測出現任何恢復跡象。

There are some anecdotes that it's starting to get better in March. We'll see as it plays out. Even after the diagnostic gets done, there's a work up -- a pipeline that has to be done. That said, I don't feel like we have any evidence that it's moving away from surgery. So it appears, in those kind of cases, that it's building a backlog that ultimately will flow through. If PSA testing back in 2012 is a guide, it will take several quarters for that to work its way up.

有傳聞稱，三月情況開始好轉。我們拭目以待。即使診斷完成，還需要進行後續檢查——一系列流程必須完成。也就是說，我覺得我們沒有任何證據表明它正在擺脫手術。所以，在這些情況下，似乎會造成積壓，而這些積壓最終都會解決。如果以 2012 年的 PSA 檢測結果為參考，那麼 PSA 值需要幾個季度才能上升。

Okay. And then last one on SP -- 2 quick ones, actually. Can you confirm you started the IDE trial for colorectal in the quarter? And then Gary, you mentioned thoracic surgery and other disciplines. I'm just curious if you could talk a little bit about the road map, other areas you might go after with SP?

好的。最後是關於SP的——實際上是兩個簡短的。能否確認你們在本季啟動了大腸直腸癌的IDE試驗？然後，Gary，你提到了胸腔外科和其他學科。我只是好奇您能否談談未來的發展規劃，以及SP未來可能涉足的其他領域？

Sure. On the SP side, on the IDEs, the first cases are scheduled. We have -- we've got all the paperwork done in our research institutions that we're working through, at least the first starting ones, and we expect that to happen. The first cases have not yet gone through. They should happen here in the next few weeks.

當然。在 SP 端，在 IDE 中，第一批案例已經安排好了。我們已經完成了研究機構的所有文書工作，至少是最初的幾個，我們預計這將會發生。首批案件尚未處理完畢。這些活動應該會在接下來的幾週內在這裡舉行。

Thoracic, that's the first time we've been telling you that we think that's interesting. There are single-port opportunities for thoracic surgery and we are excited by them. We're working through what those trials look like and having conversations with regulatory bodies to get it going. And given the current environment, we'll have concurrent trials for the colorectal and then thoracic. There are a couple of more indications beyond that. For competitive and other reasons, we're not yet ready to describe what those are going to be for us. But SP's a platform, and we're excited by it. So as we get closer and those things get closer to being filed as IDEs and trials, we'll describe them more fully.

胸腔，這是我們第一次告訴你，我們覺得這很有趣。胸腔外科手術出現了單孔手術的機會，我們對此感到非常興奮。我們正在研究這些試驗的具體方案，並與監管機構進行溝通，以推動試驗的進行。鑑於目前的情況，我們將同時進行結直腸和胸腔的試驗。除此之外，還有一些其他跡象。出於競爭和其他方面的原因，我們目前還不便透露這些對我們來說意味著什麼。但SP是一個平台，我們對此感到興奮。所以隨著我們越來越接近，這些內容也越來越接近作為 IDE 和試驗提交，我們將對它們進行更全面的描述。

And next, we're going to the line of Rick Wise.

接下來，我們要介紹的是瑞克懷斯的生產線。

I was hoping we could talk a little bit more, Gary, about Ion. We did a bunch of physician calls a month or so ago and heard really fantastic feedback. The doctors were telling us about early signs of higher diagnostic yield, success in complex cases, noticeable functional benefits and features. All that left me optimistic about the PRECISE trial. So a couple of things.

蓋瑞，我原本希望我們能再多談談 Ion 的事。大約一個月前，我們進行了一系列與醫生的電話訪談，並收到了非常好的回饋。醫生告訴我們，早期症狀包括更高的診斷率、複雜病例的成功率、明顯的功能性益處和特徵。這一切都讓我對PRECISE試驗充滿信心。有兩件事。

Are you optimistic and hopeful about PRECISE? I think you said it would be wrapped up, I just want to make sure I understand, by midyear. When might we see the data? All the docs are anxious to see the data. And with some of the logistical issues resolved, could we -- should we expect an acceleration? Is it reasonable to think about, anticipate acceleration in Ion uptake in the second half and into '22?

您對 PRECISE 抱有樂觀和希望嗎？我想你說過這件事會在年中之前結束，我只是想確認我的理解是否正確。我們什麼時候能看到這些數據？所有醫生都迫不及待想看到數據。隨著一些後勤問題的解決，我們是否可以——或者說是否應該期待經濟加速發展？是否有理由認為，在下半年以及 2022 年，離子吸收量會加速成長？

Sure. On the issue of the PRECISE trial, Phil, I'll turn to you in terms of timing?

當然。關於PRECISE審判的問題，菲爾，我想請你談談時間安排的問題？

Sure. So we confirm that we would expect enrollment to end this quarter in Q2, and then you'd have final data readout in the back half of next year, '22.

當然。因此，我們確認預計招生工作將於本季（第二季）結束，最終數據將於明年下半年（2022 年）公佈。

On the issue of -- you had said how are we feeling about it. I think we are reading and hearing what you are reading and hearing also in terms of talking to our customer about the ability of Ion to deliver on its promises. So to reach into lung to get to diagnostic yields that folks have not seen with other technologies and to work in complex cases. So I'm feeling enthusiastic and bullish on it.

關於這個問題——你曾問過我們對此有何感受。我認為，就與客戶討論 Ion 能否兌現承諾而言，我們和你們一樣，都在關注和了解這個問題。因此，要深入肺部，獲得其他技術無法獲得的診斷結果，並處理複雜的病例。所以我對它充滿熱情，非常看好。

With regard to ramp, we are expecting Ion to continue to ramp through the year and into next year. I don't see a step function change. I think it's a sequential ramp as we go. And that's because it's an interesting and sophisticated technology. So a lot of what we're working on is making sure that we can get the manufacturability where we need it. Getting supply, stability, quality and predictability where we need it. Iterating our design for manufacturing and working on additional indications because it's a platform. And we are doing all 4 of those things. But I don't think investors -- because of the way these things work, should expect that you flip a switch and it just goes to the next level. I think that it will climb each quarter and that's what we're working on. That meets our expectation and our experience in these kind of platforms.

關於產能爬坡，我們預計 Ion 的產能爬坡將在今年持續到明年。我沒有看到階躍式變化。我認為這是一個循序漸進的過程。這是因為它是一項有趣且複雜的技術。因此，我們目前的工作重點是確保我們能夠達到所需的生產能力。在我們所需的地方獲得供應、穩定性、品質和可預測性。我們正在不斷迭代設計以適應生產需求，並研究其他適應症，因為它是一個平台。我們正在做這四件事。但我認為，由於事情的運作方式，投資人不應該期望你只需要撥動一個開關，它就能自動進入下一個階段。我認為它每季都會成長，這也是我們努力的方向。這符合我們的預期，也符合我們在這類平台的經驗。

And next, we're going to the line of Richard Newitter.

接下來，我們要介紹理查紐維特的生產線。

Just one on operating expense guidance. Thanks for the full year outlook. Just could you give us any sense of the quarterly pacing? Or would it be safe to assume the 2019 cadence commentary for procedures applies to OpEx too?

只有一則關於營運費用指引的資訊。感謝您提供的全年展望。能否大致介紹一下季度進度？或者，是否可以合理假設 2019 年針對流程的節奏評論也適用於營運支出？

Yes. I think you should see, sequentially, operating expenses generally increase across the rest of the year. It's really going to be a function of the extent to which COVID continues to impact our ability to incur travel, accelerate customer training and hold marketing events in person. But generally, I would expect it to ratably increase across the balance of the year.

是的。我認為你會看到，從長遠來看，營運費用在今年剩餘的時間裡總體呈現成長趨勢。這實際上取決於 COVID-19 疫情在多大程度上繼續影響我們的旅行能力、加快客戶培訓以及舉辦線下行銷活動。但總的來說，我預計在今年剩餘的時間裡，它將穩定成長。

Got it. And just same kind of topic here. On geographic investments and expansion that you started to get more aggressive on pre-pandemic, especially in India. Just in light of what's been going on in that region specifically with the COVID problem, should we be thinking that some of those initiatives postpones even further out in '22 and beyond? Or are those things that could resume as early as this year?

知道了。這裡也是類似的話題。在疫情爆發前，你們開始加強對地域投資和擴張的力度，尤其是在印度。鑑於該地區目前的新冠疫情情勢，我們是否應該考慮將其中一些措施進一步推遲到 2022 年及以後？或者說，這些事情最快可能在今年就能恢復？

Yes. I'm sorry, I had a little bit of a hard time hearing you with regard to the referenced trial. So go ahead and reask the question, if you would.

是的。抱歉，關於您提到的審判，我剛才有點聽不清楚。如果你願意的話，請再問一次這個問題。

Sorry, my connection's off. But just India, should we think of reinvestment in that region starting now? Or in light of COVID and the situation there, is something in 2022 and beyond, is that part of the spending in geographic expansion you referred to?

抱歉，我的網路連線中斷了。但就印度而言，我們是否應該考慮從現在開始對該地區進行再投資？或者，考慮到新冠疫情及當地情況，2022 年及以後，這是否是您提到的地域擴張支出的一部分？

Yes. So with regard to India, clearly, current -- the current situation there is such that current procedures are impacted. That said, I think that the long-term commitment we have to market is intact. Our teams are making really nice progress of building footprint and relationships to hospital systems. And so I expect as COVID starts to become managed there a little bit more forcefully, that -- and it starts to recover, we'll see a recovery on our side. It has not had us a retreat.

是的。所以就印度而言，很顯然，目前的情況是，目前的程序受到了影響。也就是說，我認為我們對市場的長期承諾仍然不變。我們的團隊在拓展業務範圍和與醫院系統建立關係方面取得了非常好的進展。因此，我預計隨著新冠疫情在那邊得到更有力的控制，並且開始復甦，我們這邊也會出現復甦。它沒有給我們留下退路。

Other places around the world, whether it's Japan or China or Europe, we continue to be interested and committed. So not just India, but others as well. And if you just asked your last question, then we'll go from there. [Rich], any follow-ups?

世界其他地方，無論是日本、中國或歐洲，我們都持續保持興趣和投入。所以不只印度，其他國家也一樣。如果你剛問完最後一個問題，那我們就從這裡開始。Rich，還有什麼後續問題嗎？

Next, we go on to the line of Matt Taylor.

接下來，我們來看看馬特泰勒的比賽。

I guess it was good to see that the strong return of capital spending, and you're talking about customers looking forward to prepare for volumes and commitment to robotic surgery. Do you think that there was a little bit of a bolus of kind of pent-up spending that came through in Q1? Or do you think this is the start of a new pattern of purchasing based on your backlog and what you're seeing with your orders?

很高興看到資本支出獲得了強勁的回報，客戶們也期待為機器人手術的規模和投入做好準備。你認為第一季是否出現了一波被壓抑的消費釋放？或者，您認為這是根據您的積壓訂單和您觀察到的訂單情況而製定的新採購模式的開始嗎？

Matt, this is a subject of fearsome debate amongst us as a company. Marshall, why don't you share your opinion.

馬特，這在我們公司內部是一個引發激烈爭論的議題。馬歇爾，為什麼不分享一下你的看法呢？

Well, I gave you a few different dynamics to consider as we go forward. It's always hard to project out based on 1 quarter results. I guess we've had a couple of quarters that have been decent.

好的，我給你列舉了一些我們接下來需要考慮的不同因素。根據一個季度的業績來預測未來總是很困難的。我想我們已經有好幾季表現不錯了。

Is there -- was there -- I think part of your question was, is there pent-up spending? I would just say, I don't know if it's pent-up spending, but I would say that clearly, the hospitals had more capital spend than we had anticipated. And as a -- and what's really driving then their spending on da Vinci capital is procedure growth. Procedure growth's the #1 thing that drives capital. But also the trade-in cycle and the desire to access fourth generation product, including the extended use instruments we mentioned earlier.

是否存在──或曾經存在──我認為你的問題的一部分是，是否存在被壓抑的消費？我只想說，我不知道這是否是積壓的支出，但很明顯，醫院的資本支出比我們預期的要多。而真正推動他們在達文西手術系統上投入資金的，是手術量的成長。手術量的成長是推動資本成長的首要因素。但還有以舊換新的週期以及對第四代產品（包括我們前面提到的延長使用期限的工具）的需求。

And then finally, I think that you also have them getting ready for the post-pandemic environment. And just a general recognition that da Vinci surgery meets their quadruple aim objectives better than other approaches. So...

最後，我認為他們也在為疫情時代做好準備。人們普遍認為，達文西手術比其他方法更能實現其四重目標。所以...

All right. Well, thank you. Okay. Well, that was our last question.

好的。謝謝。好的。好了，這是我們最後一個問題。

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. 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, and we look forward to talking with you again in 3 months.

最後，我們仍然相信，從根本上改善外科手術和急診幹預措施存在著巨大而持久的機會。我們的團隊繼續與醫院、醫生和護理團隊密切合作，追求客戶所稱的四重目標：更好、更可預測的患者治療效果，更好的患者體驗，更好的護理團隊體驗，以及最終更低的醫療總成本。我們認為，外科手術和急診護理中的價值創造本質上是人性的。這是出於對患者和護理團隊、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的支持，我們期待3個月後再次與您交流。

And that does conclude our conference for today. Thank you for your participation and for using AT&T conferencing service. You may now disconnect.

今天的會議就到此結束。感謝您的參與以及使用AT&T電話會議服務。您現在可以斷開連線了。