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.

女士們，先生們，感謝您的支持，歡迎來到 Intuitive Q1 2021 收益發布。

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

（操作員說明）作為提醒，本次會議正在錄製中。

I would now like to turn the conference over to our host Philip Kim, Head of Investor Relations.

我現在想將會議轉交給我們的主持人，投資者關係主管 Philip Kim。

Please go ahead.

請繼續。

Good afternoon, and welcome to Intuitive's first quarter earnings conference call.

下午好，歡迎參加 Intuitive 第一季度財報電話會議。

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

今天和我在一起的是我們的首席執行官 Gary Guthart；我們的首席財務官 Marshall Mohr；以及我們的財務高級副總裁 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.

在開始之前，我想通知您，今天電話會議中提到的評論可能被視為包含前瞻性陳述。

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大不相同。

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.

這些風險和不確定性在我們提交給證券交易委員會的文件中進行了詳細描述，包括我們於 2021 年 2 月 10 日提交的最新表格 10-K。

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

我們的 SEC 文件可在我們的網站或 SEC 網站上找到。

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

告誡投資者不要過分依賴此類前瞻性陳述。

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

請注意，本次電話會議將在我們的網站上進行音頻重播，網址為：intuitive.com，位於我們投資者關係下的“最新活動”部分。

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。

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.

今天的形式將包括為您提供我們今天早些時候宣布的新聞稿中所述的第一季度業績的亮點，然後是問答環節。

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

Gary 將介紹本季度的業務和運營亮點。

Marshall will provide a review of our financial results.

Marshall 將對我們的財務業績進行審查。

I will discuss procedure and clinical highlights.

我將討論程序和臨床亮點。

And Jamie will review our financial outlook.

傑米將審查我們的財務前景。

Finally, we will host a question-and-answer session.

最後，我們將舉辦問答環節。

With that, I will turn it over to Gary.

有了這個，我會把它交給加里。

Thank you for joining us today.

感謝您今天加入我們。

Our first quarter of 2021 was a step in the right direction.

我們的 2021 年第一季度是朝著正確方向邁出的一步。

In the quarter, we saw a healthy recovery of surgery and use of our products.

在本季度，我們看到了手術和產品使用的健康恢復。

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.

2021 年第一季度繼續進行強勁的資本配置，安裝系統的利用率在整個季度有所增加，這表明我們的客戶需要重返手術室。

We're in the early innings of commercialization of 2 new platforms for Intuitive while advancing digital enablement of our ecosystem.

我們正處於 Intuitive 的兩個新平台商業化的早期階段，同時推進了我們生態系統的數字化支持。

Our teams are making good progress in all 3 areas.

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.

總體而言，我們看到了一些流行病的複蘇，但由於地區差異很大，改善並不均衡。

Our experience shows that our business rebounds as COVID drops.

我們的經驗表明，隨著 COVID 下降，我們的業務會反彈。

Starting with procedures.

從程序開始。

General surgery in the United States was a source of strength in the quarter, driven by bariatric surgery, cholecystectomy and other procedures.

在減肥手術、膽囊切除術和其他手術的推動下，美國的普通外科手術是本季度的力量來源。

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.

減肥手術一直處於多季度的增長軌跡，這是一致的開發和商業活動的結果，從一個有能力的系統開始，使用先進的儀器，並與一個專注的商業團隊相結合。

Ventral hernia surgery is recovering, with inguinal hernia tracking behind, aligned to hospital and patient prioritization.

腹疝手術正在恢復，腹股溝疝在後面，與醫院和患者的優先級保持一致。

In the U.S., gynecology and urology returned to growth after pandemic-related declines.

在美國，婦科和泌尿科在與大流行相關的下降後恢復了增長。

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繼續強勁增長，多個專業做出了貢獻。

Lastly, procedures that have long diagnostic journeys such as prostatectomy and thoracic surgery, remain below historical levels.

最後，諸如前列腺切除術和胸外科手術等診斷過程較長的手術仍低於歷史水平。

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

菲利普將在稍後的電話會議中詳細介紹過程動態。

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.

在資本方面，新系統配置繼續超出我們的預期，美國、中國、法國和英國在本季度脫穎而出。

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的預期程序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.

由於大流行差異，系統利用率在本季度平均增長，區域差異顯著。

Overall, capital strength indicates anticipation of future procedure opportunity by our customers.

總體而言，資本實力表明我們的客戶對未來程序機會的預期。

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.

大量系統是醫院和綜合交付網絡多系統交易的一部分，支持一個主題，即熟悉機器人輔助手術的客戶繼續向我們投資。

Lastly, the use of leasing and other alternative capital placement models ticked up again this quarter.

最後，本季度租賃和其他替代資本配置模式的使用再次增加。

Marshall will take you through capital placements in more detail later in the call.

Marshall 將在電話會議的稍後部分詳細介紹資本配置。

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.

縱觀我們在全球的業務，我們在中國的業務正在從一個很小的基數快速增長，我們對我們與復星醫藥的合資企業的表現感到滿意。

We believe there is significant long-term opportunity in China and remind you that it is currently a quota-controlled market.

我們相信中國存在重大的長期機會，並提醒您，中國目前是一個受配額控制的市場。

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.

我們預計中國在未來幾年將充滿活力和競爭力，我們正在對該市場進行投資，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.

在日本，增長保持健康，但低於大流行前的水平。

In Europe, our business in France and Germany have performed well, considering the pandemic.

在歐洲，考慮到大流行，我們在法國和德國的業務表現良好。

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.

在英國，嚴格控制的手術導致手術量下降，但我們也看到以增加資本配置的形式對機器人輔助手術的承諾增加，預計大流行後達芬奇手術將回歸。

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

意大利和西班牙在受到重大流行病影響後正在迅速恢復增長。

Speaking to our finances in the quarter, procedures recovered nicely in Q1.

談到我們在本季度的財務狀況，程序在第一季度恢復得很好。

System placements came in above plan and I&A revenue per procedure was above our expectations, together, driving 18% revenue growth over Q1 2020.

系統佈局超出計劃，每個程序的 I&A 收入高於我們的預期，共同推動 2020 年第一季度收入增長 18%。

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.

本季度產品毛利率強勁，主要是由於高於平均水平的系統平均售價、低於預期的超額和報廢費用以及我們工廠的產量增加。

Other spending was constrained in the quarter, driven by 3 factors.

本季度其他支出受到三個因素的限制。

First, travel and associated costs did not recur at pre-pandemic levels.

首先，旅行和相關費用並沒有在大流行前的水平上重現。

This spend will increase as COVID wanes and our customers and our staff reach immunity.

隨著 COVID 的消退以及我們的客戶和員工獲得免疫力，這筆支出將會增加。

Second, COVID delayed some work in R&D, leading to some underspend in prototypes.

其次，COVID 推遲了一些研發工作，導致原型支出不足。

We expect these programs to ramp up as COVID wanes and our labs and development programs recover efficiency.

我們預計這些計劃會隨著 COVID 的消退以及我們的實驗室和開發計劃恢復效率而增加。

Third, we deferred some investments in infrastructure that were unnecessary during the pandemic.

第三，我們推遲了一些在大流行期間不必要的基礎設施投資。

We think most of these factors will normalize over time, and we consider them onetime events related to the pandemic.

我們認為這些因素中的大多數會隨著時間的推移而正常化，我們認為它們是與大流行相關的一次性事件。

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.

我們仍處於全球開發機器人輔助手術的早期階段，我們將繼續投資於研發和我們的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.

正如我在電話會議開始時提到的那樣，我們正處於新平台商業化工作的早期階段，我們預計將在未來幾個季度發揮作用。

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.

我們的單端口手術平台 da Vinci SP 是我們在美國和韓國的首例重要附件，即我們的 SP 進入端口，它可以使手術靠近 [體壁] 並簡化助理外科醫生通過單個切口進入的過程。

The access port is an important -- is important in the SP ecosystem, facilitating access and workflow in many procedures in which SP is used.

訪問端口是重要的——在 SP 生態系統中很重要，它在許多使用 SP 的過程中促進訪問和工作流。

We've had very strong customer feedback on the port to date.

迄今為止，我們在港口收到了非常強烈的客戶反饋。

We are also increasing our investments to accelerate new indications in key countries.

我們還在增加投資，以加快在關鍵國家的新適應症。

In the U.S., we have 2 cleared indications for SP and expect to initiate cases as part of our colorectal IDE this quarter.

在美國，我們有 2 個明確的 SP 適應症，並希望在本季度作為我們結直腸 IDE 的一部分啟動案例。

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.

我們已經看到人們對 SP 在各種專業中的使用產生了濃厚的興趣，我們正在設計針對其他適應症的試驗，包括胸外科和其他外科學科。

Overall, we've received robust customer feedback for SPUs under existing clearances.

總體而言，在現有許可下，我們收到了關於 SPU 的強大客戶反饋。

Turning to our flexible robotics platform, Ion, we installed 14 systems in the quarter.

談到我們靈活的機器人平台 Ion，我們在本季度安裝了 14 個系統。

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.

我們正在從供應積壓中恢復過來，並滿足我們所有已安裝賬戶對離子程序的需求，同時努力滿足客戶庫存庫存請求和我們預計將在年中左右完成的內部庫存目標。

Our precise trial evaluating the ability to reach and diagnose suspicious pulmonary lesions is on track to finish enrollment by Q2 this year.

我們評估達到和診斷可疑肺部病變能力的精確試驗有望在今年第二季度完成入組。

Our Ion clinical performance is meeting our expectations and customer acceptance remains highly encouraging.

我們的 Ion 臨床表現符合我們的期望，客戶的接受度仍然非常令人鼓舞。

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.

在我們的數字生態系統支持中，作為我們分階段發布的一部分，我們在今年 4 月擴大了對我們的移動外科醫生門戶 My Intuitive 應用程序的訪問。

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.

My Intuitive 是一款移動應用程序，允許外科醫生管理他們的達芬奇體驗、登錄達芬奇系統、管理他們的培訓並從他們的手掌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.

我們的直觀遠程呈現計劃支持 2021 年第一季度所有病例觀察的 45%，高於一年前的不到 5%，這是大流行加速的一項重大成就，為我們的客戶提高了便利性並降低了我們團隊的成本。

Year-over-year surgical stimulation usage in the quarter grew roughly 46% over Q1 2020, validating the power of digital tools.

與 2020 年第一季度相比，本季度的手術刺激使用量同比增長約 46%，驗證了數字工具的力量。

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.

最後，作為我們機器人項目諮詢服務的一部分，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，這使我們的客戶能夠分析他們的達芬奇項目的相對錶現。

Now we retain part of customer engagement in the United States.

現在，我們在美國保留了部分客戶參與。

In conclusion, we're seeing adjustments in the health care system that favor our offerings.

總之，我們正在看到有利於我們產品的醫療保健系統的調整。

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.

在當前和大流行後的環境中，高質量 MIS 的貶值增加，對數字技術的開放程度增加，分析評估護理的使用增加，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.

我們已經並將繼續定位自己，以便在這種環境中表現良好。

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.

我將在非公認會計原則或備考基礎上描述我們表現的亮點。

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

稍後我還將在準備好的評論中總結我們的 GAAP 表現。

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

我們的備考結果和公認會計原則結果之間的對賬已發佈到我們的網站上。

Key business metrics for the first quarter were as follows:

第一季度的主要業務指標如下：

First quarter 2021 procedures increased approximately 16% compared with the first quarter of 2020, was approximately the same as last quarter.

與 2020 年第一季度相比，2021 年第一季度的程序增加了約 16%，與上一季度大致相同。

On a day-adjusted basis, procedures grew 18% year-over-year.

在每日調整的基礎上，程序同比增長 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.

與 2020 年第一季度的 237 個系統相比，第一季度 298 個系統的系統佈局增加了 26%，與上一季度的 326 個系統相比下降了 9%。

We expanded our installed base of da Vinci systems over the last year by 8% to approximately 6,142 systems.

去年，我們將達芬奇系統的安裝基礎擴大了 8%，達到約 6,142 個系統。

This growth rate compares with 11% last year and 7% last quarter.

這一增長率與去年的 11% 和上一季度的 7% 相比。

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.

按每個系統的程序衡量，臨床系統在該領域的利用率與去年相比增加了約 8%，與上一季度相比下降了 2%。

The impact of COVID on da Vinci procedures varied by region.

COVID 對達芬奇程序的影響因地區而異。

In the U.S., COVID resurgence affected procedures later in the fourth quarter continued well into January.

在美國，COVID 死灰復燃影響了第四季度晚些時候的程序，這一情況一直持續到 1 月份。

Then as COVID subsided, procedures experienced a steady improvement through February and March.

然後隨著 COVID 的消退，程序在 2 月和 3 月經歷了穩步改善。

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.

在歐洲，COVID 的傳播因地區而異，程序增長率與法國的強度和英國的同比下降混合。

While there have been COVID hotspots within some of our Asia Pacific markets, they tended to be isolated, and in general, procedures performed well.

儘管我們的一些亞太市場存在 COVID 熱點，但它們往往是孤立的，而且總體而言，程序表現良好。

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.

中國的增長遠高於其他地區，反映出去年第一季度新冠病毒對中國影響的嚴重性以及過去一年增加的系統安裝量。

Philip will provide additional procedure commentary later in this call.

菲利普將在本次電話會議稍後提供額外的程序評論。

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.

儘管與大流行開始時相比，今天的醫院有更好的能力來處理 COVID 患者，但 COVID-19 及其變體的死灰復燃，就像目前在歐洲和美國部分地區所經歷的那樣，對醫院護理能力提出了挑戰，並已經達芬奇程序產生了負面影響。

In addition, delays in diagnosis and treatment of underlying conditions have continued to negatively impact da Vinci procedures.

此外，對潛在疾病的診斷和治療的延誤繼續對達芬奇手術產生負面影響。

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.

雖然患者積壓，但無法預測這些患者最終何時會在治療中尋求診斷以及他們是否會接受手術治療。

Jamie will be providing procedure guidance later in this call.

Jamie 將在本次電話會議稍後提供程序指導。

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.

該指導基於我們在第一季度的經驗以及疫苗已經和預計將推出的速度。

Changes in the spread of COVID and its variance in the pace of vaccine rollouts could significantly impact our guidance.

COVID 傳播的變化及其疫苗推出速度的差異可能會對我們的指導產生重大影響。

Moving on to capital placements.

繼續進行資本配置。

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.

本季度的安置反映了程序增長、醫院採購系統為大流行後環境做準備，以及醫院升級以獲取或標準化第四代能力。

First quarter capital placements exceeded our expectations.

第一季度的資本配售超出了我們的預期。

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.

我們認為，總體而言，COVID 對醫院資本支出能力的影響較小，並且客戶認識到達芬奇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.

展望未來，我們看到以下資本收入動態： 程序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 COVID 影響程序而言，它也會影響資本購買。

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

租賃和替代融資安排使客戶能夠獲得資金。

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.

我們認為隨著時間的推移，租賃佔銷售額的百分比將增加，這將導致當前收入推遲到未來期間。

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.

然而，隨著老一代產品安裝基數的下降，以舊換新的數量將會下降。

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

COVID 創造的宏觀經濟條件可能會在區域內影響醫院的資本支出。

And as we face competition in various markets, we may experience longer selling cycles and price pressures.

而當我們面臨不同市場的競爭時，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 first quarter revenue was $1.292 billion, representing an 18% increase from last year and a 3% decrease from last quarter.

其他收入統計和趨勢如下： 第一季度總收入為 12.92 億美元，比去年增長 18%，比上季度下降 3%。

First quarter revenue growth reflected procedure growth and higher-than-expected system placements.

第一季度收入增長反映了程序增長和高於預期的系統佈局。

Leasing represented 43% of current quarter placements compared with 32% last year and 37% last quarter.

租賃佔當前季度安置的 43%，而去年為 32%，上季度為 37%。

Leasing as a percentage of total sales 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域組合而波動。

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

然而，考慮到醫院（聽不清），我們預計將有更多客戶尋求租賃或替代融資安排，而不是歷史運行率所反映的。

44% of systems placed in the first quarter involved trade-ins, which is lower than the 57% last year and 49% last quarter.

第一季度放置的系統中有 44% 涉及以舊換新，低於去年的 57% 和上一季度的 49%。

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。

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.

第一季度系統平均售價從去年的 144 萬美元和第四季度的 143 萬美元增加到 165 萬美元。

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.

相對於去年的增長反映了相對於我們的間接市場，中國和我們的直接市場的系統組合更高，雙控制台系統的更高組合以及以舊換新交易的比例更低。

The increase relative to last quarter reflects a higher mix of dual consoles and a lower proportion of trade-in transactions.

相對於上一季度的增長反映了更高的雙控制台組合和更低的以舊換新交易比例。

We recognized $19 million of lease buyout revenue in the first quarter compared with $12 million last year and $14 million last quarter.

我們在第一季度確認了 1900 萬美元的租賃收購收入，而去年同期為 1200 萬美元，上一季度為 1400 萬美元。

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

租賃收購收入在每個季度之間變化很大，並且可能會繼續如此。

Instrument and accessory revenue per procedure 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.

第一季度每項手術的儀器和附件收入為 1,950 美元，而去年第一季度每項手術的收入為 1,990 美元，而 2020 年第四季度每項手術的收入為 2,060 美元。

Extended use instruments were introduced in the U.S. and Europe in the fourth quarter.

第四季度在美國和歐洲推出了擴展使用工具。

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.

雖然我們看到這些市場中延長使用儀器的使用有所增加，但隨著客戶燒掉使用率較低的產品，未來幾個季度將全面採用。

In addition, we saw customers begin to adjust their instrument buying patterns to reduce their inventory levels to reflect the additional uses per instrument.

此外，我們看到客戶開始調整他們的儀器購買模式，以降低庫存水平，以反映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.

延長使用儀器的使用增加和客戶購買模式是第一季度每項手術的儀器和配件收入相對於前幾個季度下降的主要原因。

We expect this trend to continue over the next few quarters.

我們預計這一趨勢將在未來幾個季度持續下去。

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.

雖然我們預計與擴展使用工具相關的價格彈性能夠更大程度地滲透到可用市場，但這種好處會被 COVID 延遲，否則將需要時間。

6% of the systems placed in the first quarter were SP systems, reflecting a continued measured rollout of SP.

第一季度放置的系統中有 6% 是 SP 系統，這反映了 SP 的持續推出。

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.

我們的 SP 系統安裝基數現在是 75；韓國有 8 個，美國有 67 個。我們繼續衡量 SP 手術系統的推出，將系統交到經驗豐富的達芬奇用戶手中，同時我們在供應鏈中尋求更多適應症並優化培訓途徑。

We expect to initiate first cases associated with the U.S. colorectal trial in the next few months.

我們預計將在未來幾個月內啟動與美國結直腸試驗相關的第一批病例。

We placed 14 Ion systems in the quarter, bringing the installed base to 50 systems.

我們在本季度安裝了 14 個 Ion 系統，使安裝基礎達到 50 個系統。

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 last quarter had less of an impact on Ion placements and procedures this quarter.

我們上個季度提出的供應問題對本季度的離子放置和程序影響較小。

We expect to have resolved those supply issues this quarter.

我們預計本季度將解決這些供應問題。

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

在我們優化供應鏈中的培訓途徑的同時，我們將繼續衡量我們推出的 Ion。

Procedures under the precise study are expected to complete this quarter.

精確研究下的程序預計將在本季度完成。

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，我們在第一季度放置了 108 個系統，而 2020 年第一季度為 55 個，上一季度為 130 個。

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.

當前季度系統安置包括 59 個進入歐洲、8 個進入日本和 23 個進入中國，而 2020 年第一季度有 25 個進入歐洲、10 個進入日本和 9 個進入中國。

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.

本季度在歐洲放置的 59 個系統中有 22 個在英國。在英國等許多市場的放置可能會因季度而異。

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.

雖然我們對英國團隊的表現感到滿意，但我們預計未來幾個季度在英國的安置水平不會達到這種水平。

Moving on to gross margin and operating expenses.

繼續討論毛利率和運營費用。

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.

2021 年第一季度的備考毛利率為 71.8%，而 2020 年第一季度和第四季度均為 69.7%。

The first and fourth quarters of 2020 included higher period costs associated with lower production and higher excess and obsolete inventory charges.

2020 年第一季度和第四季度包括與較低產量以及較高的過剩和過時庫存費用相關的較高期間成本。

In addition, the first quarter of 2021 reflected leveraging fixed costs over higher production levels.

此外，2021 年第一季度反映了利用固定成本而不是更高的生產水平。

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

產品和客戶組合按季度波動，這可能導致毛利率波動。

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.

此外，如果收入受到 COVID-19 的壓力，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、間接費用吸收不足和產品利潤率下降。

COVID has impacted global supplies of semiconductors and other materials used in our products.

COVID 影響了我們產品中使用的半導體和其他材料的全球供應。

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.

雖然我們擁有關鍵部件的安全庫存，並且正在努力確保滿足客戶需求所需的供應，但全球短缺可能導致更高的生產成本或生產延遲。

Pro forma operating expenses increased 5% compared with the first quarter of 2020 and increased 2% compared with the fourth quarter of 2020.

備考運營費用較 2020 年第一季度增長 5%，較 2020 年第四季度增長 2%。

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.

2020 年第四季度包括向 Intuitive 基金會捐款 2500 萬美元，而 2021 年和 2020 年第一季度沒有捐款。

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.

與上一年相比的增長反映了與員工人數增加和可變薪酬增加相關的成本，部分被 COVID 影響地區的支出減少所抵消。

First quarter spending was below our expectations for the reasons outlined by Gary in his opening remarks.

由於加里在開幕詞中概述的原因，第一季度的支出低於我們的預期。

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.

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、面對面培訓、營銷活動和差旅成本）將隨著 COVID 的影響減少以及因 COVID 和其他時間問題而推遲的支出增加而增加。

Jamie will provide spend guidance later in this call.

Jamie 將在本次電話會議稍後提供支出指導。

Our pro forma effective tax rate for the first quarter was approximately 20%, meeting our expectations.

我們第一季度的備考有效稅率約為 20%，符合我們的預期。

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.

我們的實際稅率將隨著收入地域組合的變化、地方當局的稅收變化以及一次性項目的影響而波動。

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.

我們的 2020 年備考——我們 2020 年第一季度的備考淨收入為 4.27 億美元或每股 3.52 美元，而 2020 年第一季度為 3.23 億美元或每股 2.69 美元，上一季度為 4.34 億美元或每股 3.58 美元。

I will now summarize our GAAP results.

我現在將總結我們的 GAAP 結果。

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.

2021 年第一季度 GAAP 淨收入為 4.26 億美元，或每股 3.51 美元，而 2020 年第一季度 GAAP 淨收入為 3.14 億美元或每股 2.62 美元，上一季度 GAAP 淨收入為 3.65 億美元或每股 3.02 美元.

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.

備考和 GAAP 淨收入之間的調整在我們的網站上進行了概述和量化，包括：與員工股票獎勵、員工股票薪酬和知識產權費用、無形資產和收購相關項目的攤銷以及法律解決相關的超額稅收優惠。

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.

2020 年第四季度和 2021 年第一季度的 GAAP 淨收入還包括我們因購買某些技術而對私營公司的投資產生的 470 萬美元和 1430 萬美元的稅前收益。

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.

這些收益的稅後每股收益影響在第四季度為每股 0.03 美元，在第一季度為每股 0.09 美元。

These gains are excluded from our pro forma results.

這些收益不包括在我們的備考結果中。

We ended the quarter with cash and investments of $7.2 billion compared with $6.9 billion at December 31, 2020.

截至本季度末，我們的現金和投資為 72 億美元，而 2020 年 12 月 31 日為 69 億美元。

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

第一季度現金的增加主要反映了來自運營和股票交易的現金。

We did not repurchase any shares in the quarter.

我們在本季度沒有回購任何股票。

And with that, I'd like to turn it over to Philip, who will go over procedure performance.

有了這個，我想把它交給菲利普，他將檢查程序性能。

Thank you, Marshall.

謝謝你，馬歇爾。

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.

我們第一季度的整體程序增長同比增長 16%，而 2020 年第一季度增長 10%，上一季度增長 6%。

Our Q1 procedure growth was driven by 14% year-over-year growth in the U.S. and 23% growth OUS.

我們的第一季度程序增長是由美國 14% 的同比增長和 23% 的 OUS 增長推動的。

Procedures in the U.S. recovered steadily after January as COVID cases declined and the associated impact on hospital resources improved.

隨著 COVID 病例的下降以及對醫院資源的相關影響有所改善，美國的手術在 1 月份之後穩步恢復。

In the U.S., within general surgery, bariatric, cholecystectomy and hernia were the largest contributors to procedure growth within the quarter.

在美國，在普通外科手術中，減肥、膽囊切除術和疝氣是本季度手術增長的最大貢獻者。

Bariatrics growth remained strong with positive customer feedback on our advanced instrument portfolio.

由於客戶對我們先進的儀器組合的積極反饋，減肥藥的增長保持強勁。

Cholecystectomy growth was driven by the continued expansion of robotic procedures by general surgeons throughout their total practice.

膽囊切除術的增長是由普通外科醫生在整個實踐過程中不斷擴大機器人手術推動的。

Inguinal hernia growth trailed dental growth in the quarter.

本季度腹股溝疝的增長落後於牙科的增長。

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.

關於我們在美國更成熟的手術類別，第一季度婦科手術與上一年相比增長了兩位數，但由於 COVID 而出現負增長。

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.

雖然美國的 dVP 在第一季度從之前的下降中穩定下來，但仍不清楚受到診斷和治療延誤影響的患者最終何時會回來。

In aggregate, on a worldwide basis, prostatectomy in the first quarter largely stabilized.

總體而言，在全球範圍內，第一季度的前列腺切除術基本穩定。

More broadly, OUS procedure growth was driven by urology, earlier stage growth in general surgery, gynecology and thoracic procedures.

更廣泛地說，OUS 手術的增長是由泌尿科、普通外科、婦科和胸科手術的早期增長推動的。

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.

就 OUS 市場而言，中國程序增長強勁，並受益於 COVID 對 2020 年第一季度的嚴重影響以及過去一年安裝基數的增加。

China had broad-based growth in all procedure categories.

中國在所有程序類別中都有廣泛的增長。

In Japan, procedure growth moderated somewhat due to restrictions associated with COVID.

在日本，由於與 COVID 相關的限制，手術增長有所放緩。

Procedure growth in South Korea was encouraging with SP utilization continuing to be above Xi.

韓國的手術增長令人鼓舞，SP 利用率繼續高於 Xi。

In Europe, France had a solid quarter with broad-based strength in a wide range of procedure categories.

在歐洲，法國有一個穩固的季度，在廣泛的程序類別中具有廣泛的實力。

The U.K. remained challenged due to COVID.

由於COVID，英國仍然面臨挑戰。

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.

在這些電話會議的每個季度，我們都會重點介紹我們認為值得注意的某些最近發表的研究。

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.

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

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.

Mohamed A. Abd El Aziz 博士、Fabian Grass 和 David Larson 博士與 Mayo Clinic 的同事最近在 Surgical Endoscopy 上發表的一篇文章提供了一項真實世界研究的結果，該研究旨在分析選擇性結腸切除術期間的全國轉化趨勢到 MIS 的使用趨勢。

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.

在 2013 年 1 月至 2018 年 12 月期間，使用 ACS 國家手術質量改進計劃數據庫進行選擇性腹腔鏡或機器人輔助結腸切除術，共確定了 66,652 名患者。

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%.

與腹腔鏡手術相比，機器人輔助手術從 MIS 到開放手術的總體轉化率大約低 42%，分別為 4.9% 和 8.5%。

The rate was also lower for obese patients with a BMI greater than or equal to 36% versus 10.3%.

BMI 大於或等於 36% 的肥胖患者的發病率也低於 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.

作者部分總結道：“這項大規模研究確定了 6 年納入期間的轉化率呈下降趨勢，無論是整體還是肥胖患者，同時增加了機器人平台的利用率。

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."

鑑於轉換對患者結果的潛在負面影響，個別機構應考慮審查他們自己的轉換數據，因為這可能代表質量改進的機會。”

In February of this year, Dr. Amir Bastawrous, of the Swedish Cancer Institute in Seattle, Washington; and Dr. Robert Cleary of St.

今年 2 月，華盛頓西雅圖瑞典癌症研究所的 Amir Bastawrous 博士；和 St. 的 Robert Cleary 博士。

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.

密歇根州安娜堡的 Joseph Mercy 醫院發表了一項真實世界的觀察性研究，該研究比較了接受微創和開放結腸切除術的患者的長期阿片類藥物處方率。

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.

本研究利用 IBM MarketScan 研究數據庫，分析了 2013 年至 2017 年間通過開放式腹腔鏡或機器人輔助方法接受結腸切除術的 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.

在 1:1 傾向評分匹配分析中，將 MIS 和開放式方法與每組超過 5,000 名患者進行比較，MIS 方法的任何阿片類藥物長期處方的發生率顯著降低約 36%、13.3% 和 20.9%；附表 2 和 3 的阿片類藥物分別下降約 39%、11.7% 和 19.2%；術後 90 至 180 天，大劑量阿片類藥物分別降低了約 44%、4.3% 和 7.7%。

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.

觀察機器人輔助手術和腹腔鏡檢查之間的匹配分析，每組超過 1,100 名受試者，機器人輔助方法顯示高劑量阿片類藥物的長期處方率降低了約 45%，分別為 2.1% 和 3.8%。腹腔鏡方法。

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，與腹腔鏡方法相比，對於因非惡性疾病接受結腸切除術的受試者，機器人輔助方法顯示任何阿片類藥物、時間表 2 和 3 阿片類藥物和高劑量阿片類藥物的長期處方率顯著降低。

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."

作者部分總結道，“在機器人輔助手術中為某些結直腸手術選擇 MIS 選項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.

有了這個，我想把它交給傑米，他將審查我們的財務前景。

Good afternoon.

下午好。

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.

儘管 COVID-19 的持續影響仍然存在不確定性，並且考慮到住院覆蓋率趨勢和疫苗接種進展放緩，特別是在美國，占我們 2020 年程序的約 70%，但我們正在重新制定財務指導。

In providing this guidance, we note that there are emerging supply constraints in our supply chain, for example, in the semiconductor industry.

在提供本指南時，我們注意到我們的供應鏈中出現了新的供應限制，例如在半導體行業。

The outlook we are providing does not reflect any potential significant disruption or additional costs related to these supply constraints.

我們提供的前景並未反映與這些供應限制相關的任何潛在的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.

我們對 2021 年的財務展望如下：從手術開始，2020 年達芬奇手術總數增長約 1%，達到約 1,243,000 例全球手術。

For 2021 and we anticipate full year procedure growth within a range of 22% to 26%.

對於 2021 年，我們預計全年程序增長將在 22% 至 26% 之間。

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.

我們預計 2021 年的手術增長將繼續受到美國普通外科手術和美國以外的手術的推動，我們正處於早期採用階段。

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.

該範圍的高端假設 COVID 病例和對達芬奇程序的影響全年繼續下降，疫苗推出繼續保持世界各國政府目前預期的水平，患者積壓的恢復將取得進展。

Modeling quarterly results is difficult given the impact that COVID had on 2020 procedures.

鑑於 COVID 對 2020 年程序的影響，很難對季度結果進行建模。

Therefore, with respect to procedure seasonality, we expect similar quarterly patterns for 2019.

因此，關於程序的季節性，我們預計 2019 年的季度模式類似。

With respect to capital, system placements are generally driven by procedure demand, prompting hospitals to establish or expand robotic system capacity.

在資金方面，系統佈局通常由程序需求驅動，促使醫院建立或擴大機器人系統容量。

System placement demand is also the result of customers standardizing our fourth generation technology through trade-ins.

系統佈局需求也是客戶通過以舊換新將我們的第四代技術標準化的結果。

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.

基於許多因素，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、經濟周期和競爭因素，資本銷售在不同時期可能會有很大差異。

Within this framework, we'd expect 2021 capital placements generally be driven by procedures and the adequacy of existing capacity in the installed base.

在此框架內，我們預計 2021 年的資本配置通常由程序和已安裝基礎中現有容量的充足性驅動。

During the first quarter of 2021, 43% of systems shipped were under operating leases.

2021 年第一季度，43% 的出貨系統處於經營租賃狀態。

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.

我們預計，經營租賃下的系統比例將因季度而異，並且未來可能會繼續呈上升趨勢。

Turning to gross profit.

轉向毛利。

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.

我們 2020 年全年的備考毛利率為 68.4%，反映了固定的影響——相對於收入的固定間接費用較高、超額和過時的庫存費用較高，以及 2020 年第二季度實施的客戶救濟計劃。

Our full year 2019 pro forma gross profit margin was 71.7%.

我們 2019 年全年的備考毛利率為 71.7%。

In 2021, we expect our pro forma gross profit margin to be within a range of between 70% and 71% of revenue.

2021年，我們預計我們的備考毛利率將在收入的70%至71%之間。

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.

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、產品成本降低和製造效率的影響以及競爭性定價壓力。

With respect to operating expenses, in 2019, our pro forma operating expenses grew 27%.

在運營費用方面，2019 年，我們的備考運營費用增長了 27%。

And in 2020, given the impact of the pandemic, they grew 3%.

2020 年，鑑於大流行的影響，它們增長了 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.

到 2021 年，我們預計備考全年運營費用增長將在 18% 至 22% 之間，這反映了我們對數字生態系統、Ion、SP、OUS 擴展的投資增加，與監管相關的成本和基礎設施投資增加，以使我們能夠擴大規模.

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.

預計 2021 年的支出也將受到一年中更高的旅行率、增加的客戶培訓以及更大比例的親自舉辦的營銷活動和可變薪酬的影響。

We expect our noncash stock compensation expense to range between $450 million to $470 million in 2021 compared to $396 million in 2020.

我們預計 2021 年我們的非現金股票補償費用將在 4.5 億美元至 4.7 億美元之間，而 2020 年為 3.96 億美元。

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.

我們預計 2021 年主要由利息收入組成的備考其他收入總額將在 4500 萬美元至 5500 萬美元之間，反映出相對於 2020 年的較低利率。

With regard to income tax, in 2020, our pro forma income tax rate was 22.5%.

所得稅方面，2020年，我們的備考所得稅率為22.5%。

As we look forward, we estimate our 2021 pro forma tax rate to be between 20% and 21% of pretax income.

展望未來，我們估計 2021 年的備考稅率將在稅前收入的 20% 至 21% 之間。

Our 2021 outlook for the pro forma tax rate does not reflect any potential change in U.S. tax rates.

我們對 2021 年備考稅率的展望並未反映美國稅率的任何潛在變化。

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.

我們現在將打開您的問題的電話。

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

（操作員說明）首先，我們要去 Amit Hazan 的線路。

Can you hear me okay?

你能聽到我的聲音嗎？

We can.

我們可以。

Great.

偉大的。

I'd maybe burn the first question on just the guide.

我可能會在指南上燒掉第一個問題。

Obviously, appreciate that just given all the uncertainty on the procedure side.

顯然，鑑於程序方面的所有不確定性，請欣賞這一點。

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.

因此，鑑於您提供了這個數字，我想看看您是否會更進一步，並為我們提供更多關於您如何到達那裡的信息。

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.

顯然，我們都在試圖找出恢復正常的方法，但我懷疑這些潛在的為您重新獲得積壓的程序類別的桶，特別是在前列腺中。

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?

您能否談談您如何看待那些積壓的患者以及在您為今年餘下時間在程序方面製定本指南時恢復正常的情況？

Yes.

是的。

So maybe, Amit, I'll start with -- this is Jamie.

所以也許，阿米特，我會開始- 這是傑米。

I'll start with the low end of the procedure guidance.

我將從程序指南的低端開始。

So we considered 3 factors in the low end.

因此，我們在低端考慮了 3 個因素。

We see the possibility of extended impact of COVID in certain OUS geographies with slower vaccine rollouts and resurgences in some of those geographies.

我們看到 COVID 可能在某些 OUS 地區擴大影響，其中一些地區的疫苗推出速度較慢和死灰復燃。

We see that in parts of Europe currently.

我們目前在歐洲部分地區看到了這一點。

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，我們嵌入了程序指南的低端，在大流行期間受到影響的診斷管道的恢復速度較慢。

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.

然後是指南低端的第三項，是隨著我們競相推出疫苗並最終在某個時候在美國實現群體免疫，COVID 在美國出現區域性死灰復燃的可能性。

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.

關於積壓，積壓的實際累積有 3 個因素：較低的診斷管道、由於醫院系統被 COVID 病例淹沒而推遲的擇期手術以及在 COVID 死灰復燃期間患者不願接受手術。

These subcomponents, we think, get recovered over different periods of time.

我們認為，這些子組件會在不同的時間段內恢復。

The backlog is actually constantly netting between increases and recovery.

積壓實際上是不斷增加和恢復之間的淨額。

So the total accumulative backlog is difficult to predict.

所以總的累積積壓是很難預測的。

The rate of recovery is also difficult to predict, but we expect it to go through into 2022.

復甦的速度也很難預測，但我們預計它將持續到 2022 年。

And so the '21 procedure guidance that we provided reflects our best estimate of the range of the impact of backlog in the year.

因此，我們提供的 '21 程序指南反映了我們對今年積壓影響範圍的最佳估計。

Okay.

好的。

I appreciate that.

我很感激。

And I want to come back with the second question just to a topic that's been discussed before.

我想回到之前討論過的第二個問題。

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.

但我想，鑑於 COVID，再次提出來，這是門診手術中心和一般低視力手術的問題。

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.

我的意思是，特別是考慮到 COVID，對於 Intuitive 來說，似乎從來沒有比現在更合適的時間來討論和追逐這部分市場了。

And we still don't hear you talking about it that much.

而且我們仍然沒有聽到你這麼多談論它。

So I just -- it begs the question of what's holding you back?

所以我只是 - 它引出了一個問題，是什麼阻礙了你？

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.

而且我們知道反映答案似乎 - 反射類型的答案似乎在報銷方面，它可能不是最佳的。

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.

當我考慮到您在營銷方面向醫院推銷的優勢時，外科醫生受益，坦率地說，結果，這似乎比報銷所在的地方更重要和潛在有益。

So help us out here.

所以在這裡幫助我們。

Why are ambulatory surgery centers not a bigger opportunity for you right now?

為什麼門診手術中心現在對您來說不是一個更大的機會？

Yes, this is Gary.

是的，這是加里。

We are already in ambulatory surgery environments with our customers of different types, and we see healthy programs there.

我們已經與不同類型的客戶一起處於門診手術環境中，並且我們在那裡看到了健康的計劃。

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.

從擁有可以幫助他們的產品或可以幫助他們的服務或進行對話的方式的角度來看，我不認為我們正在苦苦掙扎。

I think all those things are in place.

我認為所有這些事情都已到位。

I do believe that over time, reimbursement matters, particularly in customers that operate in both environments, hospitals and ASCs.

我確實相信，隨著時間的推移，報銷會變得很重要，特別是對於在醫院和 ASC 兩種環境中運營的客戶而言。

For them, reimbursement matters.

對他們來說，報銷很重要。

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.

如果他們要轉移病人，但他們的收入有很大差異，那麼他們就會做出這些決定。

It may change over time.

它可能會隨著時間而改變。

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.

那——付款人最終決定做什麼，以及他們是否想創造一些激勵措施來幫助事情進入 ASC，我們將做好準備。

Long term, I'm bullish on that.

從長遠來看，我看好這一點。

I think the environment makes sense.

我認為環境是有道理的。

But economics and incentives really matter.

但經濟和激勵措施確實很重要。

It doesn't clear up your question.

它沒有解決你的問題。

It reinforces our position.

它鞏固了我們的立場。

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

接下來，我們將進入拉里·比格爾森的行列。

Gary, can you please provide more color on the Intuitive telepresence feature that you mentioned on this call?

Gary，您能否為您在本次電話會議中提到的 Intuitive Telepresence 功能提供更多色彩？

It's the first time I heard you talk about it, and that 45% of procedures was a pretty impressive number.

這是我第一次聽到你談論它，45% 的程序是一個令人印象深刻的數字。

Is that through your agreement with InTouch?

這是通過您與 InTouch 的協議嗎？

How is it being used by customers?

客戶如何使用它？

What are the benefits?

有什麼好處？

And how do you see that playing out post COVID?

您如何看待 COVID 後的情況？

And I had 1 follow-up.

我有 1 次跟進。

Yes.

是的。

So you're right.

所以你是對的。

It is the result of the technology and a collaborative agreement we signed with InTouch many years ago.

這是多年前我們與 InTouch 簽署的技術和合作協議的成果。

We brought a team over as well as some of the technology and have put it in our hands.

我們帶來了一個團隊以及一些技術，並將其交到我們手中。

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.

我所說的用例是讓有興趣觀察專家案例的人能夠通過安全網絡、高速流媒體在線登錄，並在達芬奇帳戶上查看該案例。

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.

這是從這些大容量賬戶轉移知識的重要組成部分，也是對正在考慮它的外科醫生的介紹性接觸。

So that has been great.

所以這很棒。

There are other use cases for streaming connections, video streaming connections into our products that I won't detail now.

還有其他用於流連接的用例，將視頻流連接到我們的產品中，我現在不會詳細說明。

It's pretty neat.

這很整潔。

And so prior, we had started that.

所以之前，我們已經開始了。

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.

我是一個信徒——或者我們，作為一家公司，相信這些訪問，將其視為一種外科手術式的 Face Time 或外科手術式的遠程 Skype。

That kind of access would be important to folks, and the pandemic really accelerated it.

這種訪問對人們來說很重要，而大流行確實加速了它。

And so we had the technology infrastructure in place.

所以我們有適當的技術基礎設施。

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.

隨著人們開始對使用數字工具進行學習和接觸變得更加開放，並希望遠離飛機和汽車，我們看到它真的在加速。

And that's what we've been touching on there.

這就是我們一直在討論的內容。

That's very helpful.

這很有幫助。

And then lastly, what response are you getting from the extended use program you introduced in Q4 2020?

最後，您從 2020 年第四季度推出的擴展使用計劃中得到了什麼回應？

Any changes to kind of the impact that we could see from that?

我們可以從中看到影響的任何變化？

And any color yet on demand elasticity?

以及任何顏色的按需彈性？

Yes.

是的。

Sure.

當然。

So we introduced extended use instruments into Europe and into the U.S. in Q4.

因此，我們在第四季度將擴展使用儀器引入歐洲和美國。

We did see increased usage of extended use instruments.

我們確實看到延長使用儀器的使用增加了。

They still have some level of inventory of shorter life use instruments and they're burning that off.

他們仍然有一定程度的壽命較短的儀器庫存，並且他們正在將其燒掉。

We also had commented last quarter that we saw stocking orders of extended use instruments.

我們還在上個季度評論說，我們看到了延長使用儀器的庫存訂單。

And we're seeing some adjustment of their buying patterns to recognize the increased number of uses per instrument.

我們看到他們的購買模式進行了一些調整，以認識到每種樂器的使用次數增加。

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.

因此，正如我所說，本季度每個手術的儀器和配件收入低於上一季度，主要反映了這些因素：擴展儀器的使用和庫存購買模式的調整。

I don't think it's exhausted the whole impact.

我不認為它已經耗盡了整個影響。

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.

我想如果你回到我們之前的腳本，你會看到我們說如果你在 2019 年實施這個，它會影響總收入約 1.5 億美元至 1.7 億美元，或約 7% 的 Ion [aid] per程序，到目前為止，我們只看到了其中的一部分。

When the rest of it will hit is questionable.

其餘的何時會擊中是值得懷疑的。

It will roll out over time as they continue to use those instruments and as we roll it out to other countries.

隨著他們繼續使用這些工具以及我們將其推廣到其他國家，它將隨著時間的推移而推出。

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

接下來，我們要去鮑勃霍普金斯的路線。

Great.

偉大的。

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.

我想就您提供的第一季度手術量數字提出一個或幾個問題，因為它顯然比共識估計要強得多。

And so Gary, I was just wondering a couple of quick things.

所以加里，我只是想知道一些快速的事情。

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.

是否可以安全地假設本季度末在程序增長方面明顯強於本季度初和中期。

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?

然後我只是想知道，加里，您認為值得一提的在地理上或按程序類型方面對您來說很突出的地方是什麼？

So your -- thanks for the question.

所以你的 - 謝謝你的問題。

So the first one, we definitely saw growth through the quarter, which was encouraging.

所以第一個，我們肯定看到了整個季度的增長，這是令人鼓舞的。

In terms of procedure types, I think there's this interesting mix.

在程序類型方面，我認為有這種有趣的組合。

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.

我認為，當人們回到醫院時，他們所做的優先事項是患者願望的混合，這取決於他們認為自己的病情可能是什麼，例如，減肥，以及醫院和外科醫生圍繞緊急情況進行的優先事項，例如，診斷出的癌症以及診斷管道的變化或挑戰。

I was pleased by U.S. general surgery.

我對美國的普通外科手術很滿意。

I think that, that has shown some resilience.

我認為，這表明了一些彈性。

A lot of that is benign procedures.

其中很多是良性程序。

And I think that, that has been kind of on the upside of our models.

我認為，這對我們的模型來說有點好處。

So, so far, so good.

所以，到目前為止，一切都很好。

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.

然後是一個後續行動，也是為了更好地了解本季度按地理位置劃分的程序量。

I'm just curious, on Europe, what's your take on how bad are things there for -- in your view?

我只是好奇，在歐洲，你認為那裡的情況有多糟糕——在你看來？

And just curious maybe how far below 16% was Europe in the quarter.

只是好奇，本季度歐洲的比例可能低於 16%。

Yes.

是的。

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.

我不會為你量化它，只是給你一點定性的顏色，馬歇爾，請跳進去幫忙。

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.

在英國，我們已經看到 NHS 堅定地做出優先級決定，這反映了我們在程序性能本身中看到的情況，而這種情況已被壓制。

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.

也就是說，我們還看到以資本收購和其他向我們表明他們正在轉向它的形式對 MIS 的承諾。

So there, it's kind of a mixed conversation.

因此，這是一種混合的對話。

France and Germany have been surprisingly good despite complexity with regard to the way COVID is rolling out.

儘管 COVID 的推出方式很複雜，但法國和德國的表現出人意料地好。

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.

然後，當我們觀察西班牙和意大利時，我們看到它真的緊隨其後，隨著 COVID 的緩解，手術又回來了，我們又回來了。

Overall, we feel like we have really good leadership teams in place in country.

總體而言，我們覺得我們在國家/地區擁有非常優秀的領導團隊。

We feel like we're in good connection with the health care systems.

我們覺得我們與醫療保健系統保持著良好的聯繫。

I think we're being agile and adaptable to meet their needs, which is really controlling what we can control.

我認為我們正在靈活地適應他們的需求，這實際上是在控制我們可以控制的東西。

And in that sense, I think the company is doing all right.

從這個意義上說，我認為公司做得很好。

Marshall, anything you'd add?

馬歇爾，你有什麼要補充的嗎？

No, I think it was great color.

不，我認為它的顏色很棒。

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.

我認為我要補充的唯一另一件事是 - 我們過去曾討論過，我們正在執行的許多程序都是泌尿外科的，而且我們正在某些國家/地區進行調整。

And we're starting to see some adoption in GYN and general surgeries in some countries, but we still have work to do.

我們開始在一些國家看到一些婦科和普通外科手術的採用，但我們仍有工作要做。

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

接下來，我們進入第谷彼得森的行列。

A couple of follow-ups.

幾個後續。

I'm curious what's baked into guidance on utilization given the extent of the you use instrument kind of commentary before.

考慮到您之前使用儀器的評論程度，我很好奇使用指南中包含了什麼。

What are you kind of modeling for utilization for the year?

你對今年的利用率有什麼樣的建模？

Yes.

是的。

I think I would refer Tycho back to 2019 patterns in terms of utilization.

我想我會在利用率方面將第谷提到 2019 年的模式。

Obviously, in the end, capital is going to be driven by procedure performance.

顯然，資本最終將由程序性能驅動。

So I think I would just refer to seasonal patterns in 2019 as a starting point.

所以我想我會以 2019 年的季節性模式作為起點。

Okay.

好的。

And then you've commented a couple of times on this call and other calls on the diagnostic pipelines being under pressure.

然後，您已經多次評論了這個電話和其他關於診斷管道面臨壓力的電話。

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?

您能否簡單談談它們如何作為一些更成熟程序的領先指標，尤其是 dVP？

Yes.

是的。

Jamie, why don't you jump in?

傑米，你為什麼不跳進去？

Yes.

是的。

So we have some market data, actually, for the U.S. What we see is -- and that's through February '21.

因此，實際上，我們有一些美國市場數據。我們看到的是——截至 21 年 2 月。

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.

我們看到的是大多數診斷測試，PSA測試，例如肺癌的CT掃描，我們看到這些在此期間被抑制了。

So we haven't seen them start to recover, at least in the data that we've seen so far.

所以我們還沒有看到它們開始恢復，至少在我們迄今為止看到的數據中是這樣。

And we see that reasonably correlated to the associated procedures.

我們看到與相關程序合理相關。

So PSA, dVP has been relatively weak during that period.

所以PSA、dVP在那段時間一直比較弱。

So has lobectomy.

肺葉切除術也是如此。

So so far, we haven't seen any evidence of recovery in diagnostic testing in the U. S.

到目前為止，我們還沒有看到美國診斷測試恢復的任何證據。

There are some anecdotes that it's starting to get better in March.

有一些軼事表明它在三月份開始好轉。

We'll see as it plays out.

我們將拭目以待。

Even after the diagnostic gets done, there's a work up -- a pipeline that has to be done.

即使在診斷完成之後，還有一個工作要做——一個必須完成的管道。

That said, I don't feel like we have any evidence that it's moving away from surgery.

也就是說，我覺得我們沒有任何證據表明它正在遠離手術。

So it appears, in those kind of cases, that it's building a backlog that ultimately will flow through.

因此，在這種情況下，它似乎正在建立一個最終會通過的積壓工作。

If PSA testing back in 2012 is a guide, it will take several quarters for that to work its way up.

如果將 2012 年的 PSA 測試作為一個指南，那麼它需要幾個季度才能逐步上升。

Okay.

好的。

And then last one on SP -- 2 quick ones, actually.

然後是 SP 上的最後一個——實際上是 2 個快速的。

Can you confirm you started the IDE trial for colorectal in the quarter?

您能否確認您在本季度開始了結直腸的 IDE 試用？

And then Gary, you mentioned thoracic surgery and other disciplines.

然後加里，你提到了胸外科和其他學科。

I'm just curious if you could talk a little bit about the road map, other areas you might go after with SP?

我只是想知道您是否可以談談路線圖，您可能會在 SP 中追求的其他領域？

Sure.

當然。

On the SP side, on the IDEs, the first cases are scheduled.

在 SP 方面，在 IDE 上，會安排第一個案例。

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.

我們已經 - 我們已經在我們正在處理的研究機構中完成了所有的文書工作，至少是第一個開始的，我們希望這會發生。

The first cases have not yet gone through.

第一批案件尚未審理完畢。

They should happen here in the next few weeks.

他們應該在接下來的幾週內發生在這裡。

Thoracic, that's the first time we've been telling you that we think that's interesting.

胸科，這是我們第一次告訴你我們認為這很有趣。

There are single-port opportunities for thoracic surgery and we are excited by them.

胸外科有單端口機會，我們對此感到興奮。

We're working through what those trials look like and having conversations with regulatory bodies to get it going.

我們正在研究這些試驗的樣子，並與監管機構進行對話以使其順利進行。

And given the current environment, we'll have concurrent trials for the colorectal and then thoracic.

鑑於目前的環境，我們將同時進行結腸直腸和胸部的試驗。

There are a couple of more indications beyond that.

除此之外還有一些跡象。

For competitive and other reasons, we're not yet ready to describe what those are going to be for us.

出於競爭和其他原因，我們還沒有準備好描述這些對我們來說會是什麼。

But SP's a platform, and we're excited by it.

但 SP 是一個平台，我們對此感到興奮。

So as we get closer and those things get closer to being filed as IDEs and trials, we'll describe them more fully.

因此，隨著我們越來越接近並且這些東西越來越接近作為 IDE 和試驗提交，我們將更全面地描述它們。

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

接下來，我們要去 Rick Wise 的路線。

I was hoping we could talk a little bit more, Gary, about Ion.

我希望我們能多談一點，Gary，關於 Ion。

We did a bunch of physician calls a month or so ago and heard really fantastic feedback.

大約一個月前，我們打了一堆醫生電話，聽到了非常棒的反饋。

The doctors were telling us about early signs of higher diagnostic yield, success in complex cases, noticeable functional benefits and features.

醫生們告訴我們關於更高診斷率的早期跡象、複雜病例的成功、顯著的功能優勢和特點。

All that left me optimistic about the PRECISE trial.

所有這些讓我對 PRECISE 試驗感到樂觀。

So a couple of things.

所以有幾件事。

Are you optimistic and hopeful about PRECISE?

您對 PRECISE 持樂觀態度和希望嗎？

I think you said it would be wrapped up, I just want to make sure I understand, by midyear.

我想你說它會結束，我只是想確保我明白，到年中。

When might we see the data?

我們什麼時候可以看到數據？

All the docs are anxious to see the data.

所有的文檔都急於看到數據。

And with some of the logistical issues resolved, could we -- should we expect an acceleration?

在解決了一些後勤問題後，我們是否應該期待加速？

Is it reasonable to think about, anticipate acceleration in Ion uptake in the second half and into '22?

考慮一下，預計下半年到 22 年離子吸收的加速是否合理？

Sure.

當然。

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

關於 PRECISE 審判的問題，菲爾，我會在時間方面向你求助？

Sure.

當然。

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.

因此，我們確認我們預計本季度的註冊將在第二季度結束，然後您將在明年 22 年下半年獲得最終數據讀數。

On the issue of -- you had said how are we feeling about it.

關於 - 你曾說過我們對此感覺如何。

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.

我認為我們正在閱讀和聽到您正在閱讀和聽到的內容，也就是與我們的客戶談論 Ion 兌現其承諾的能力。

So to reach into lung to get to diagnostic yields that folks have not seen with other technologies and to work in complex cases.

因此，要進入肺部以獲得人們在其他技術中沒有見過的診斷率，並在復雜的情況下工作。

So I'm feeling enthusiastic and bullish on it.

所以我對它充滿熱情和看好。

With regard to ramp, we are expecting Ion to continue to ramp through the year and into next year.

關於斜坡，我們預計 Ion 將在今年和明年繼續斜坡。

I don't see a step function change.

我沒有看到階躍函數發生變化。

I think it's a sequential ramp as we go.

我認為這是一個連續的斜坡。

And that's because it's an interesting and sophisticated technology.

那是因為它是一項有趣且複雜的技術。

So a lot of what we're working on is making sure that we can get the manufacturability where we need it.

因此，我們正在做的很多工作是確保我們能夠在需要的地方獲得可製造性。

Getting supply, stability, quality and predictability where we need it.

在我們需要的地方獲得供應、穩定性、質量和可預測性。

Iterating our design for manufacturing and working on additional indications because it's a platform.

迭代我們的製造設計並處理其他適應症，因為它是一個平台。

And we are doing all 4 of those things.

我們正在做所有這四件事。

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.

但我不認為投資者——由於這些事情的運作方式，應該期望你按下一個開關，它就會進入一個新的水平。

I think that it will climb each quarter and that's what we're working on.

我認為每個季度都會攀升，這就是我們正在努力的方向。

That meets our expectation and our experience in these kind of platforms.

這符合我們的期望和我們在這類平台上的經驗。

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

接下來，我們將介紹 Richard Newitter 的路線。

Just one on operating expense guidance.

只有一個關於運營費用的指導。

Thanks for the full year outlook.

感謝您的全年展望。

Just could you give us any sense of the quarterly pacing?

你能給我們任何關於季度節奏的感覺嗎？

Or would it be safe to assume the 2019 cadence commentary for procedures applies to OpEx too?

或者假設 2019 年程序的節奏評論也適用於運營支出是否安全？

Yes.

是的。

I think you should see, sequentially, operating expenses generally increase across the rest of the year.

我認為您應該看到，在今年剩餘時間裡，運營費用通常會依次增加。

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.

這實際上將取決於 COVID 繼續影響我們進行旅行、加速客戶培訓和親自舉辦營銷活動的能力。

But generally, I would expect it to ratably increase across the balance of the year.

但總的來說，我預計它會在今年餘下時間大幅增加。

Got it.

知道了。

And just same kind of topic here.

這裡只是同樣的話題。

On geographic investments and expansion that you started to get more aggressive on pre-pandemic, especially in India.

在地理投資和擴張方面，您開始在大流行前變得更加積極，尤其是在印度。

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?

鑑於該地區特別是在 COVID 問題上正在發生的事情，我們是否應該認為其中一些舉措會在 22 年及以後進一步推遲？

Or are those things that could resume as early as this year?

還是那些最早可以在今年恢復的事情？

Yes.

是的。

I'm sorry, I had a little bit of a hard time hearing you with regard to the referenced trial.

很抱歉，關於所引用的審判，我很難聽到你的聲音。

So go ahead and reask the question, if you would.

因此，如果您願意，請繼續重新提出問題。

Sorry, my connection's off.

抱歉，我的連接已關閉。

But just India, should we think of reinvestment in that region starting now?

但就印度而言，我們是否應該考慮從現在開始對該地區的再投資？

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?

或者鑑於 COVID 和那裡的情況，在 2022 年及以後，這是否是您所指的地理擴張支出的一部分？

Yes.

是的。

So with regard to India, clearly, current -- the current situation there is such that current procedures are impacted.

所以關於印度，很明顯，目前的情況是，目前的程序受到影響。

That said, I think that the long-term commitment we have to market is intact.

也就是說，我認為我們對市場的長期承諾是完整的。

Our teams are making really nice progress of building footprint and relationships to hospital systems.

我們的團隊在建立足跡和與醫院系統的關係方面取得了非常好的進展。

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.

因此，我預計隨著 COVID 開始在那裡得到更有力的管理，並且它開始恢復，我們將看到我們這邊的恢復。

It has not had us a retreat.

它沒有讓我們退縮。

Other places around the world, whether it's Japan or China or Europe, we continue to be interested and committed.

世界其他地方，無論是日本、中國還是歐洲，我們都將繼續保持興趣和承諾。

So not just India, but others as well.

因此，不僅是印度，其他國家也是如此。

And if you just asked your last question, then we'll go from there.

如果您剛剛問了最後一個問題，那麼我們將從那裡開始。

[Rich], any follow-ups?

[豐富]，有後續嗎？

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

接下來，我們繼續馬特泰勒的路線。

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.

我想很高興看到資本支出的強勁回報，你說的是客戶期待為機器人手術的數量和承諾做準備。

Do you think that there was a little bit of a bolus of kind of pent-up spending that came through in Q1?

您是否認為第一季度出現了一些被壓抑的支出？

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?

還是您認為這是基於您的積壓和您所看到的訂單的新採購模式的開始？

Matt, this is a subject of fearsome debate amongst us as a company.

馬特，這是我們作為一家公司的可怕辯論的主題。

Marshall, why don't you share your opinion.

馬歇爾，你為什麼不分享你的意見。

Well, I gave you a few different dynamics to consider as we go forward.

好吧，我給了你一些不同的動力來考慮我們前進的方向。

It's always hard to project out based on 1 quarter results.

總是很難根據第一季度的結果進行預測。

I guess we've had a couple of quarters that have been decent.

我想我們有幾個季度都不錯。

Is there -- was there -- I think part of your question was, is there pent-up spending?

有沒有——我認為你的部分問題是，有被壓抑的支出嗎？

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.

我只想說，我不知道這是否是被壓抑的支出，但我會明確地說，醫院的資本支出比我們預期的要多。

And as a -- and what's really driving then their spending on da Vinci capital is procedure growth.

作為一個 - 真正推動他們在達芬奇資本上的支出是程序增長。

Procedure growth's the #1 thing that drives capital.

程序增長是推動資本的第一大因素。

But also the trade-in cycle and the desire to access fourth generation product, including the extended use instruments we mentioned earlier.

還有以舊換新周期和使用第四代產品的願望，包括我們之前提到的擴展使用儀器。

And then finally, I think that you also have them getting ready for the post-pandemic environment.

最後，我認為你也讓他們為大流行後的環境做好準備。

And just a general recognition that da Vinci surgery meets their quadruple aim objectives better than other approaches.

並且只是普遍承認達芬奇手術比其他方法更能滿足他們的四重目標。

So...

所以...

All right.

好的。

Well, thank you.

嗯，謝謝。

Okay.

好的。

Well, that was our last question.

嗯，這是我們的最後一個問題。

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

最後，我們仍然相信，從根本上改善手術和急性干預是一個巨大而持久的機會。

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.

我們的團隊繼續與醫院、醫生和護理團隊密切合作，以追求我們的客戶所說的四重目標：更好、更可預測的患者結果、更好的患者體驗、更好的護理團隊體驗，並最終降低總體護理費用。

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

我們相信，手術和急症護理的價值創造從根本上說是人性化的。

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

感謝您對這段非凡旅程的支持，我們期待在 3 個月後再次與您交談。

And that does conclude our conference for today.

這確實結束了我們今天的會議。

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

感謝您的參與和使用 AT&T 會議服務。

You may now disconnect.

您現在可以斷開連接。