直覺手術 (ISRG) 2020 Q4 法說會逐字稿

Ladies and gentlemen, thank you for your patience in holding, and welcome to the Intuitive Fourth Quarter of 2020 Earnings Release. (Operator Instructions) Just a brief reminder, today's conference is being recorded.

女士們、先生們，感謝您的耐心等待，歡迎參加 Intuitive 2020 年第四季財報發布會。 （操作說明）溫馨提示：本次發表會正在錄音。

Now happy to turn the conference over to Head of Investor Relations, Philip Kim.

現在很高興將會議交給投資者關係主管Philip Kim。

Good afternoon, and welcome to Intuitive's fourth quarter earnings conference call. With me today, we have Gary Guthart, our CEO; and Marshall Mohr, our Chief Financial Officer.

下午好，歡迎參加Intuitive第四季財報電話會議。今天與我一同出席的有我們的執行長Gary Guthart和財務長Marshall Mohr。

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 or 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 7, 2020, and Form 10-Q filed on October 19, 2020. Our SEC filings can be found through our website or at the SEC's website.

在會議開始之前，我想告知各位，今天電話會議中提及的評論可能包含前瞻性陳述。由於某些風險或不確定因素，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定因素已在提交給美國證券交易委員會（SEC）的文件中詳細描述，包括我們於2020年2月7日提交的最新10-K表格和於2020年10月19日提交的10-Q表格。您可以透過我們的網站或SEC網站查閱我們提交給SEC的文件。

Investors are cautioned not to place undue reliance on such forward-looking statements. Please note that this conference call will be available for audio replay on our website at intuitive.com on the Latest Events section under our Investor Relations page. Today's press release and supplementary financial data tables have been posted to our website.

投資者請勿過度依賴此類前瞻性陳述。請注意，本次電話會議的音訊回放可在我們網站intuitive.com的「投資者關係」頁面下的「最新動態」欄位中找到。今天的新聞稿和補充財務數據表已發佈在我們的網站上。

Today's format will consist of providing you with highlights of our fourth quarter results as described in our press release announced earlier today, followed by a question-and-answer session. Gary will present the quarter's business and operational highlights. Marshall will provide a review of our financial results. Then I will discuss procedure and clinical highlights. And finally, we will host a question-and-answer session.

今天的會議形式如下：首先，我們將重點介紹今天早些時候發布的新聞稿中概述的第四季度業績；隨後進行問答環節。 Gary 將介紹本季的業務和營運亮點；Marshall 將回顧我們的財務表現；之後，我將討論流程和臨床方面的亮點；最後，我們將進行問答環節。

With that, I will turn it over to Gary.

接下來，我將把麥克風交給蓋瑞。

Thank you for joining us today. Our fourth quarter capped a year in which the pandemic challenged our customers and our business. It highlighted some core strengths for the company, introduced some obstacles to overcome and triggered some changes for us.

感謝您今天蒞臨本次活動。第四季為充滿挑戰的一年畫上了句號，疫情為我們的客戶和業務都帶來了嚴峻考驗。疫情凸顯了公司的核心優勢，也帶來了一些需要克服的障礙，並促使我們做出一些改變。

To put the year and quarter in context, let me first review some of the numbers. Procedures grew 6% year-over-year for the fourth quarter and 1% for the full year over 2019, resulting in approximately 1.25 million procedures in 2020. We placed 326 systems in the quarter, down from 336 systems in Q4 of 2019. For the full year, we placed 936 systems in 2020, down from 1,119 systems in 2019. Finally, revenue fell 3% in 2020 as the result of delays in surgical procedures as hospitals focused on treating COVID patients.

為了更好地理解本年度和本季的情況，我先回顧一些數據。 2020年第四季手術量年增6%，全年年增1%，總計約125萬例。本季我們安裝了326套系統，低於2019年第四季的336套。 2020年全年，我們安裝了936套系統，低於2019年的1119套。最後，由於醫院將重心放在治療新冠肺炎患者上，導致手術延誤，2020年收入下降了3%。

Digging a little deeper, our core business remains healthy. After the first surge of COVID abated during this past summer, our customers returned to more routine use of our systems and solutions. We believe that the Intuitive ecosystem enabled increased access to and practice of high-quality minimally invasive surgery, which may have helped hospitals conserve valuable intensive care resources during the pandemic.

深入分析後發現，我們的核心業務依然穩健。今年夏天第一波新冠疫情消退後，我們的客戶恢復了對我們系統和解決方案的常規使用。我們相信，Intuitive 生態系統促進了高品質微創手術的普及和發展，這可能有助於醫院在疫情期間節省寶貴的重症監護資源。

Despite pressure on utilization of our systems due to COVID, our hospital customers continue to invest in building their Intuitive's robotics programs with additional systems, evidenced by a 7% increase in the clinical installed base in 2020. We saw committed customers strengthening their programs, likely due to their analysis of how well the Intuitive ecosystem satisfied their quadruple aim objectives, better outcomes, better care team experiences, better patient experiences and lower total cost to treat per patient episode. Lastly, we believe our investments in our analytics programs have helped customers routinely analyze their performance, supporting their programmatic insights in the year.

儘管受新冠疫情影響，我們的系統利用率面臨壓力，但我們的醫院客戶仍持續投資，透過增購系統來建構其Intuitive機器人專案。 2020年臨床安裝基數成長7%便印證了這一點。我們看到，一些忠實客戶正在加強其項目，這很可能是因為他們分析了Intuitive生態系統如何有效地滿足其四重目標：更好的治療效果、更好的醫護團隊體驗、更好的患者體驗以及更低的單次治療總成本。最後，我們相信，我們對分析專案的投入幫助客戶定期分析其績效，從而為他們在這一年的專案洞察提供了支持。

Our confidence in our core business and our long-term opportunity remains robust. In spite of near term uncertainty, which is as follows: first, the pandemic is resurgent in many regions, powered now by more contagious variants. While hospitals have better protocols to manage patients today than they did earlier in 2020, our weekly surgical data in December 2020 and continuing today shows another clamp down on surgeries.

我們對核心業務和長期發展機會的信心依然強勁。儘管短期內存在以下不確定性：首先，疫情在許多地區捲土重來，且這次疫情是由更具傳染性的變種病毒引發的。雖然醫院目前擁有比2020年初更完善的病患管理方案，但我們2020年12月及之後每週的手術數據顯示，手術量再次受到限制。

Furthermore, we believe diagnostic procedures are slowing in hard-hit regions. With diagnostic procedures running significantly below pre-pandemic levels, patients and hospitals will acutely feel the impact through disease progression and the more complex therapies necessary when patients do return for care. This delay in diagnostic pipelines will likely take several quarters to resolve, even after the threat of COVID begins to abate.

此外，我們認為疫情嚴重地區的診斷流程正在放緩。由於診斷流程遠低於疫情前水平，患者和醫院將深刻感受到疾病進展以及患者復診時所需更複雜療法帶來的衝擊。即使新冠疫情威脅開始減弱，這種診斷流程的延誤也可能需要幾個季度才能解決。

Second, we know that future of new capital installs are highly sensitive to utilization rates. Delayed surgeries will also impact the growth of surgical departments, pressuring new system installs until excess capacity is consumed. Third, in countries where the government pays the health care bill, budget strain and economic fallout from COVID may impact health care spending in new and variable ways in different countries.

其次，我們知道未來新增資本投入與使用率高度相關。手術延期也會影響外科部門的發展，進而對新系統的安裝造成壓力，直到過剩產能被消耗殆盡。第三，在政府承擔醫療費用的國家，預算壓力和新冠疫情帶來的經濟影響可能會以不同的方式影響各國的醫療支出。

Lastly, the trend that started prior to the pandemic for increased data requirements and longer clearance time lines from regulators in the United States and Europe for our industry has continued this year. Taken together, these obstacles make predictions for the next several quarters difficult.

最後，疫情前就已開始的美國和歐洲監管機構對我們行業數據要求增加、審批時間延長的趨勢，今年仍在持續。綜上所述，這些障礙使得未來幾季的預測變得困難。

As I mentioned earlier, 2020 has broadly eliminated some longer-term trends in health care that validate our thesis. The increased pressure on health care systems to conserve acute care resources for the sickest patients may have accelerated investments that enable patients to get the care they need with fast recovery, minimizing consumption of scarce hospital resources and reducing complications. The compounding value of analyzing real-time data and offline health care data to drive insights, to drive better care has become obvious this year. Lastly, we saw an acceleration of remote technology used to enable proctoring, learning and analysis.

正如我之前提到的，2020 年在很大程度上改變了醫療保健領域的一些長期趨勢，而這些趨勢恰恰印證了我們的論點。醫療保健系統面臨越來越大的壓力，需要將急診資源留給病情最嚴重的患者，這可能加速了相關投資，使患者能夠獲得所需的快速康復護理，從而最大限度地減少稀缺醫院資源的消耗並降低併發症的發生率。分析即時數據和離線醫療保健數據以獲得洞察並改進護理的複合價值在今年變得顯而易見。最後，我們也看到遠距技術在監考、學習和分析方面的應用加速發展。

I've heard it said that in good times, we develop ourselves to become who we want to be while hard times reveal who we really are. In the year, we set our priorities based on our values. We implemented community relief and customer relief, launched our extended use instruments program, mobilized local and remote training resources to support customers differently and continued to listen carefully to our customers to best understand their needs. We've seen positive customer response to this approach, which is reflected in our Net Promoter Score. You can find more information on these scores in our JPMorgan Healthcare Conference presentation from this month posted on our website.

我曾聽人說過，順境中我們努力成為理想中的自己，而逆境則讓我們看清自己的本質。今年，我們以自身價值觀為指導，並制定了各項工作重點。我們實施了社區救助和客戶救助計劃，推出了延期使用工具項目，調動了本地和遠端培訓資源，以不同的方式為客戶提供支持，並持續認真傾聽客戶的聲音，以更好地了解他們的需求。我們看到了客戶對這一做法的正面回饋，這體現在我們的淨推薦值 (NPS) 上。您可以在我們網站上發布的本月摩根大通醫療保健大會簡報中找到更多關於這些評分的資訊。

Over the past several years, we've been building our capabilities in different countries to better serve their health care systems. I'd like to take a moment to take you through how we performed outside the United States in the year.

過去幾年，我們一直在不同國家提升自身能力，以便更好地服務當地的醫療保健系統。我想藉此機會向大家介紹一下我們在過去一年中在美國以外地區的業務表現。

Turning first to Asia. Our business in Japan is moving beyond urology, given reimbursements for a broad slate of procedures obtained in Japan in 2018 and 2020. Government hospitals in Japan have been conserving resources for COVID care, and the pandemic has introduced noticeable delays as the health care system reacts to outbreaks.

首先來看亞洲。鑑於日本在2018年和2020年對一系列手術都給予了醫保報銷，我們在日本的業務正在超越泌尿科的範疇。日本的公立醫院一直在為新冠肺炎的治療儲備資源，而疫情的爆發也導致醫療系統在應對疫情時出現了明顯的延誤。

In Korea, our business continues to be dynamic with an innovation-oriented customer group adopting new products like our da Vinci SP. In China, we saw accelerated customer acceptance of our partnership with Fosun Pharma and our products, with growth in procedures and the business overall outpacing our pre-pandemic plans. In 2020, China emerged as our #2 procedure market.

在韓國，我們的業務持續蓬勃發展，客戶群積極擁抱創新，並持續採用我們的達文西SP等新產品。在中國，客戶對我們與復星醫藥的合作以及我們產品的接受度顯著提升，手術量和整體業務增長均超過了疫情前的預期。 2020年，中國成為我們第二大手術市場。

Turning to Europe. Our team in Germany has had success in engaging larger German hospital groups with increased system placements broadening our market access. Constraints on elective surgery have been implemented assertively in Germany in light of COVID.

展望歐洲市場。我們在德國的團隊已成功與多家大型德國醫院集團建立合作關係，增加了系統部署，從而擴大了我們的市場准入。鑑於新冠疫情的影響，德國已嚴格限制擇期手術。

In Germany, France, U.K., Italy and the Nordics, our goals have been to broaden da Vinci use beyond Urology. Progress therein has been hampered significantly by COVID. Lastly, we see relatively low public sector reimbursements in Europe for benign procedures. Innovations from Intuitive like da Vinci S and our extended use instruments are providing an option for more price-sensitive customers in these markets.

在德國、法國、英國、義大利和北歐國家，我們的目標是將達文西手術系統的應用範圍擴展到泌尿外科以外的領域。然而，新冠疫情嚴重阻礙了這一進程。此外，我們發現歐洲公共部門對良性手術的報銷比例相對較低。 Intuitive 公司推出的創新產品，例如達文西 S 手術系統和我們其他擴展用途的器械，為這些市場中對價格更敏感的客戶提供了新的選擇。

With regard to our innovation and product engines, we spent time walking through our progress at the JPMorgan Healthcare Conference this month and our presentation is available online at our website, intuitive.com. I'd recommend to the interested listener a review of those materials for greater insight into our progress.

關於我們的創新和產品引擎，我們本月在摩根大通醫療保健大會上詳細介紹了我們取得的進展，相關簡報已發佈在我們的網站intuitive.com上。我建議有興趣的聽眾查閱這些資料，以便更深入地了解我們的進展。

Summarizing briefly here, we're making good progress in advancing many elements of our ecosystem, including our advanced instruments, deepening our imaging and informatics programs, including our augmented reality program, Iris, and extending the launches of our new platforms. We grew the installed base in procedures for our single-port platform, da Vinci SP. We're focused on advancing clinical indications for SP in several regions as well as extending its instrument and accessory portfolio.

簡而言之，我們在推動生態系統的許多方面都取得了良好進展，包括先進儀器的研發、影像和資訊學專案的深化（例如擴增實境專案Iris），以及新平台的推廣。我們單孔平台da Vinci SP的手術量已顯著成長。我們正致力於在多個地區拓展SP的臨床適應症，並豐富其儀器和配件產品線。

For our flexible robotics platform, Ion, we saw strong clinical results and demand in the year but met manufacturing and supply performance challenges in the fourth quarter as catheter demand outpaced our forecasting models, and the need for important quality improvement implementations and COVID quarantines hampered our production. We are currently shipping Ion product and expect to meet the demand curve in the first half of 2021.

我們的彈性機器人平台 Ion 在過去一年中取得了強勁的臨床成果和市場需求，但在第四季度，由於導管需求超出預期，加之需要實施重要的品質改進措施以及新冠疫情隔離措施阻礙了生產，我們在製造和供應方面面臨挑戰。目前，我們已恢復 Ion 產品的出貨，並預計在 2021 年上半年滿足市場需求。

Before Marshall takes you through our finances in detail, I'd like to touch on our financial strategy. Our operating model withstood the strains of 2020 well, starting with our decision several years ago to shift to greater flexibility in system placement models, the incorporation of sales, leasing and risk-shared models allowed us to meet customers' needs during a disruptive time.

在馬歇爾詳細介紹我們的財務狀況之前，我想先談談我們的財務策略。我們的營運模式經受住了2020年的考驗，這要從幾年前我們決定轉向更靈活的系統部署模式開始說起。銷售、租賃和風險共擔模式的引入，使我們能夠在動盪時期滿足客戶的需求。

Our investments in advanced instruments, including stapling and energy have been fruitful with growing revenues, improving margins and growing customer appreciation for advanced instruments. We've been investing capital in our manufacturing methods to increase quality and lower our costs, which in turn has allowed us to extend savings to our customers to allow them greater flexibility and deploying our products in more cost-sensitive environments. This has triggered a virtuous cycle that allows us greater volume, which in turn gives us greater ability to invest in higher volume processes. We'll continue to invest in this cycle going forward.

我們在先進儀器（包括裝訂和能源技術）方面的投資已取得豐碩成果，收入成長，利潤率提高，客戶對先進儀器的認可度也日益提升。我們持續投資於生產工藝，以提高產品品質並降低成本，從而將節省的成本回饋給客戶，使他們擁有更大的靈活性，並能在對成本更為敏感的環境中部署我們的產品。這形成了一個良性循環，使我們能夠擴大產量，進而更有能力投資於更高產量的生產流程。我們將繼續投資於這個循環。

We believe we are still in the early innings of a long opportunity to substantially improve the quadruple aim in acute medical interventions using robotics, computing, advanced imaging and informatics. As a result, we continue to invest in our innovation engines to create and pursue these opportunities.

我們相信，利用機器人技術、電腦技術、先進影像技術和資訊學，我們仍處於大幅提升急性醫療幹預四重目標的早期階段。因此，我們將繼續投資於創新引擎，以創造和掌握這些機會。

In closing, our priorities for 2021 are as follows: first, we'll support our customers' recovery of surgery during and post-pandemic; second, we'll focus on outstanding regional performance; third, we'll advance our priority programs and launches, SP, Ion, imaging and analytics, including new indications; and finally, continued expansion of clinical, economic and analytical evidence base for key procedures and countries.

最後，我們2021年的工作重點如下：首先，我們將支持客戶在疫情期間和疫情後進行手術恢復；其次，我們將專注於卓越的區域業績；第三，我們將推進我們的重點項目和產品發布，包括SP、Ion、成像和分析，以及新的適應症；最後，繼續擴大關鍵手術和國家的臨床、經濟和分析證據基礎。

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

現在我將把電話交給馬歇爾，他將更詳細地為您講解財務事宜。

Good afternoon. I will describe the highlights of our performance on a non-GAAP or pro forma basis. I will also summarize our GAAP performance later in my prepared remarks. A reconciliation between our pro forma and GAAP results is posted on our website. Revenue and procedures are consistent with our preliminary press release of January 13.

午安.我會先介紹我們依照非GAAP準則或備考財務報表編製的績效重點。稍後，我將在準備好的演講稿中概述我們按GAAP準則編制的業績。我們網站上已公佈備考財務報表與GAAP財務報表的調節表。收入和營運流程與我們1月13日發布的初步新聞稿一致。

Key business metrics for the fourth quarter were as follows: fourth quarter 2020 procedures increased approximately 6% compared with the fourth quarter of 2019 and increased approximately 10% compared with last quarter. Fourth quarter system placements of 326 systems decreased 3% compared with 336 systems last year and increased 67% compared with 195 systems last quarter. We expanded our installed base of da Vinci Systems over last year by 7% to approximately 5,989 systems. This growth rate compares with 8% in the last quarter and 12% last year.

第四季的關鍵業務指標如下：2020年第四季手術量較2019年第四季成長約6%，較上季成長約10%。第四季系統安裝量為326套，較去年同期的336套下降3%，但較上季的195套成長67%。達文西手術系統的裝機量較去年同期成長7%，達到約5,989套。這一成長率低於上季的8%和去年同期的12%。

Utilization of clinical systems in the field, measured by procedures per system, declined approximately 2% compared with last year and increased 8% compared with last quarter. The impact of COVID on da Vinci procedures vary by region. Resurgence of COVID in parts of Europe had significant impacts on procedures, including in Italy, U.K., Nordics and France. While the impact of COVID on procedures in the Asia Pacific region, including China, Japan and Korea, was far less significant.

以每台系統的手術量衡量，臨床系統在現場的使用率較去年同期下降約2%，較上一季成長8%。新冠疫情對達文西手術的影響因地區而異。歐洲部分地區（包括義大利、英國、北歐和法國）新冠疫情的再次爆發對手術量造成了顯著影響。而亞太地區（包括中國、日本和韓國）新冠疫情對手術量的影響則小得多。

In the U.S., fourth quarter procedure growth was impacted by the COVID resurgence, resulting in 5% year-over-year growth compared to 7% growth in the third quarter. The resurgence in U.S. and Europe was more acute and had a greater impact on procedures late in the quarter, a trend that continued into January.

在美國，受新冠疫情反彈的影響，第四季手術量成長放緩，年比僅成長5%，而第三季則成長了7%。美國和歐洲的疫情反彈更為嚴重，對第四季末的手術量造成了更大的影響，這一趨勢一直持續到1月。

The impact of a resurgence can be significant. For example, in California, the fourth quarter COVID resurgence turned a year-over-year da Vinci procedure growth in October of 8% to a year-over-year decline of 6% in December.

疫情反彈的影響可能非常顯著。例如，在加州，第四季新冠疫情反彈導致10月達文西手術量較去年同期成長8%，而12月則較去年同期下降6%。

We also believe that reduced diagnosis reflecting patient concern over COVID exposure has impacted certain procedures globally. This has had its most pronounced effect on prostatectomies.

我們也認為，由於患者擔心感染新冠病毒，診斷率下降，這在全球範圍內影響了某些醫療程序。其中，前列腺切除術受到的影響最為顯著。

Despite the fact that hospitals are better equipped to handle COVID patients today compared to the outset of the pandemic, COVID-19 resurgences 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 will also continue to negatively impact da Vinci procedures.

儘管與疫情初期相比，如今醫院在應對新冠患者方面擁有更完善的設備，但像目前歐洲和美國部分地區正在經歷的疫情反彈，仍然對醫院的救治能力構成了挑戰，並對達文西手術造成了負面影響。此外，潛在疾病的診斷和治療延誤也將繼續對達文西手術產生不利影響。

Uncertainties in this COVID environment are not predictable, and the vaccine rollout and its impact on controlling COVID spread is also not predictable. Given these uncertainties, we are not providing procedure guidance at this time. Philip will provide additional procedure commentary later in this call.

目前新冠疫情情勢充滿不確定性，疫苗推廣及其對控制疫情傳播的影響也難以預測。鑑於這些不確定性，我們目前暫不提供操作指引。 Philip 將在本次電話會議稍後提供更多操作說明。

Fourth quarter capital placements exceeded our expectations, reflecting several factors. In certain cases, hospitals exhausted 2020 budgets and spend capacities. And in some cases, hospitals purchased systems in preparation for post-pandemic environment. We also experienced a higher level of trade-ins of SI systems for fourth generation systems, reflecting hospital desire to standardize fleet and to avail themselves to fourth generation technology of lower cost extended use instruments.

第四季資本投入超出預期，這反映了多種因素。部分醫院已用完2020年的預算和支出能力。另一些醫院則為應對疫情後的新環境而購置了系統。此外，我們還觀察到，醫院將部分系統置換為第四代系統的數量增加，這反映出醫院希望實現設備標準化，並採用成本更低、使用壽命更長的第四代技術。

Looking forward, we see the following capital revenue headwinds. Utilization declined 2% year-over-year, resulting in excess system capacity at hospitals. We expect customers to fill existing system capacity before purchasing additional capital. Some of the fourth quarter capital placements reflected hospitals exhausting 2020 budgets. As budgets reset for 2021, hospitals could reduce their capital spend, particularly as COVID strains hospital profitability.

展望未來，我們預期資本收入將面臨以下不利因素。利用率較去年同期下降2%，導致醫院系統容量過剩。我們預期客戶會在購買額外資本之前先充分利用現有系統容量。第四季部分資本支出反映出醫院已用完2020年的預算。隨著2021年預算的重新調整，醫院可能會減少資本支出，尤其是在新冠疫情對醫院獲利能力帶來壓力的情況下。

We expect leasing to continue to increase as a percentage of overall placements. Macroeconomic conditions created by COVID could also impact hospital capital spending. And as we face competition in various markets, we may experience longer selling cycles and price pressures.

我們預計租賃在整體安置中所佔比例將持續上升。新冠疫情帶來的宏觀經濟環境變化也可能影響醫院的資本支出。此外，由於我們在各個市場面臨競爭，銷售週期可能會延長，價格也會承壓。

Additional revenue statistics and trends are as follows: total fourth quarter revenue was $1.329 billion, representing a 4% increase from last year and a 23% increase from last quarter. Fourth quarter revenue benefited from U.S. customer stocking of extended use instruments and higher-than-expected system placements.

其他營收統計及趨勢如下：第四季總營收為13.29億美元，較去年同期成長4%，較上一季成長23%。第四季營收成長得益於美國客戶對延長使用壽命儀器的庫存增加以及系統安裝量超出預期。

Leasing represented 37% of current quarter placements compared with 35% last quarter. Fourth quarter placements included some larger IDN transactions where the IDN prefers purchase transactions. Excluding those transactions, leasing as a percentage of total placements would have been several percentage points higher. In an environment of COVID-19 as economic pressures increase, we anticipate more customers will seek leasing or alternative financing arrangements than reflected in historical run rates.

本季租賃佔總部署量的37%，高於上季的35%。第四季的部署包含一些規模較大的IDN交易，而IDN則更傾向於購買交易。若剔除這些交易，租賃佔總部署量的比例將高出幾個百分點。在新冠疫情影響下，隨著經濟壓力的增加，我們預計會有更多客戶尋求租賃或其他融資方案，這一比例將高於歷史水準。

Approximately half of the systems placed in the fourth quarter involve trade-ins, which is higher than the 40% last quarter and higher than the average over the last couple of years. Trade-in activity can fluctuate and be difficult to predict.

在第四季安裝的系統中，約有一半是舊機置換，高於上一季的40%，也高於過去幾年的平均值。舊機置換活動可能波動較大，難以預測。

Fourth quarter average selling prices declined to $1.43 million from $1.61 million last year and $1.55 million in the third quarter. The decrease relative to last year reflects a lower mix of systems placed in China and Japan and a higher proportion of trade transactions. The decrease relative to last quarter reflects a higher proportion of trade-in transactions and a higher mix of indirect market placements.

第四季平均售價從去年同期的161萬美元和第三季的155萬美元下降至143萬美元。與去年同期相比的下降反映了銷往中國和日本的系統數量減少，以及貿易交易比例的增加。與上一季相比的下降則反映了以舊換新交易比例的增加和間接市場投放比例的上升。

We recognized $14 million of lease buyout revenue in the fourth quarter compared with $17 million last quarter and $34 million last year. Lease buyout revenue has varied significantly quarter-to-quarter and will likely continue to do so.

第四季我們確認了1,400萬美元的租賃買斷收入，而上一季為1,700萬美元，去年同期為3,400萬美元。租賃買斷收入季度間波動較大，這種情況可能會持續下去。

Instrument and accessory revenue per procedure increased to approximately $2,060 per procedure compared with $1,910 per procedure in the third quarter of 2020 and $1,980 realized in the fourth quarter of last year.

每次手術的器械和配件收入增加到每次手術約 2,060 美元，而 2020 年第三季度每次手術的收入為 1,910 美元，去年第四季度的收入為 1,980 美元。

The entirety of the increase compared to the third quarter reflects U.S. hospital stocking extended use instruments. We launched extended use instruments early in the quarter in the U.S. and mid-quarter in Europe. We will launch extended use instruments in other markets in 2021 and 2022, depending on regulatory requirements.

與第三季相比，全部成長都反映了美國醫院儲備了延長使用期限的醫療器材。我們在本季初在美國推出了延長使用期限的醫療器械，並於季度中期在歐洲推出了。我們將根據監管要求，於2021年和2022年在其他市場推出延長使用期限的醫療器材。

Going forward, we expect customers to adjust their instrument buying patterns and reduce their inventory levels to reflect the additional uses per instrument. In addition, extended use instruments and lower instrument pricing will result in lower I&A revenue per procedure to Intuitive.

展望未來，我們預期客戶將調整其儀器採購模式並降低庫存水平，以反映每台儀器的額外使用次數。此外，延長儀器使用期限和降低儀器價格將導致 Intuitive 公司每次手術的器械及耗材（I&A）收入減少。

The impact and timing of customer buying patterns and lower per-use revenue will likely begin to impact revenues in the first quarter but will depend on customer inventory practices and procedure volumes. While we expect price elasticity associated with extended use instruments to enable greater penetration into available markets, that benefit will be delayed by COVID and, otherwise, will take time.

客戶購買模式和單次使用收入下降的影響及其發生時間可能會在第一季開始對收入產生影響，但這取決於客戶的庫存管理方式和手術量。我們預計，與延長使用壽命相關的器材價格彈性將有助於公司更好地滲透到現有市場，但新冠疫情會延遲這項益處的顯現，即便沒有疫情，也需要一段時間才能實現。

12 of the systems placed in the fourth quarter were SP systems, reflecting continued measured rollout of SP and the impact of COVID-19. Our installed base of SP systems is now 69: 8 in Korea and 61 in the U.S. Our rollout of the SP surgical system will continue 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 a U.S. colorectal clinical trial this quarter.

第四季安裝的系統中，有12套是SP系統，反映了SP系統持續穩定推廣以及新冠疫情的影響。目前，我們已安裝69套SP系統：韓國8套，美國61套。我們將繼續穩定地推廣SP手術系統，優先將系統交付給經驗豐富的達文西手術系統用戶，同時探索更多適應症並優化供應鏈中的訓練路徑。我們預計將在本季啟動與美國大腸直腸癌臨床試驗相關的首批病例。

We placed 4 Ion systems in the quarter, beginning -- bringing the installed base to 36 systems. Ion system placements and procedures are excluded from our overall system and procedure counts. Ion system placements were affected by supply chain issues described by Gary earlier in the call. We expect to remediate these supply issues in the first half of 2021. 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 in the second quarter of 2021.

本季我們安裝了4組Ion系統，使總安裝量達到36套。 Ion系統的安裝和手術數量不計入我們的系統和手術總數。 Ion系統的安裝受到了Gary在電話會議早些時候提到的供應鏈問題的影響。我們預計在2021年上半年解決這些供應問題。在優化供應鏈訓練路徑的同時，我們將繼續評估Ion系統的推廣。 PRECISE研究下的手術預計將於2021年第二季完成。

Outside the U.S., we placed 130 systems in the fourth quarter compared with 140 in the fourth quarter of 2019 and 79 systems last quarter. Current quarter system placements included 54 into Europe, 22 into Japan and 13 into China compared with 54 into Europe, 26 into Japan and 39 into China in the fourth quarter of 2019. System placements into China in the fourth quarter of 2019 were higher as hospitals accelerated tenders in anticipation of the possibility of higher tariffs.

除美國以外，我們第四季共部署了130套系統，而2019年第四季為140套，上季為79套。本季系統部署包括歐洲54套、日本22套和中國13套，而2019年第四季分別為歐洲54套、日本26套和中國39套。 2019年第四季在中國的系統部署量較高，因為醫院預期關稅可能上漲，因此加快了招標流程。

Moving on to gross margin and operating expenses. Pro forma gross margin for the fourth quarter of 2020 was 69.7% compared with 72.2% for the fourth quarter 2019 and 70.2% last quarter. The fourth quarter of 2020 included higher period costs associated with lower production and higher excess and obsolete inventory charges. The decrease relative to the fourth quarter of 2019 reflects higher period costs associated with lower production, higher excess and obsolete inventory charges and lower system ASPs.

接下來分析毛利率和營運費用。 2020年第四季的備考毛利率為69.7%，而2019年第四季為72.2%，上一季為70.2%。 2020年第四季毛利率上升，主要原因是產量下降以及庫存積壓和報廢費用增加。與2019年第四季相比，毛利率下降則反映了產量下降、庫存積壓和報廢費用增加以及系統平均售價下降等因素導致的期間成本上升。

As 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. In addition, product and customer mix fluctuate quarter-to-quarter and could cause fluctuations in gross margins.

受新冠疫情影響，營收面臨壓力，生產水平可能低於正常水平，這可能導致勞動力成本上升、管理費用攤銷不足以及產品利潤率下降。此外，產品和客戶組合會隨季度波動，也可能導致毛利率波動。

Pro forma operating expenses decreased 6% compared with the fourth quarter of 2019 and increased 11% compared with the third quarter of 2020. The fourth quarter of 2020 includes a $25 million contribution to the Intuitive Foundation compared with a $5 million contribution in the fourth quarter of 2019 and no contribution last quarter.

經核算，營運費用較 2019 年第四季下降 6%，較 2020 年第三季成長 11%。 2020 年第四季向直覺基金會捐款 2,500 萬美元，而 2019 年第四季捐款 500 萬美元，上一季則無捐款。

Fourth quarter operating expenses continued to reflect reduced spending on activities directly impacted by COVID-19, including marketing events, travel and in-person training as well as lower variable compensation. These costs will naturally increase as the impact of COVID declines.

第四季營運支出持續反映出受新冠疫情直接影響的活動支出減少，包括行銷活動、差旅和線下培訓，以及可變薪資降低。隨著新冠疫情影響的減弱，這些成本自然會增加。

We continue to believe we have a unique opportunity to expand the benefits of computer-aided surgery and acute interventions around the world, and we'll continue to invest in the business for the long term. During this period of COVID, we continue to invest in product development activities, including informatics, advanced imaging, advanced instruments and our Ion and SP platforms. Accordingly, you should expect the growth rate of R&D expenses in 2021 to significantly exceed the 2020 growth rate. We expect the growth rate of SG&A expenses to also increase significantly in 2021 compared to 2020.

我們依然堅信，我們擁有獨特的機遇，能夠將電腦輔助手術和急診介入治療的益處推廣至全球，並將繼續對該業務進行長期投資。在新冠疫情期間，我們持續投資於產品研發活動，包括資訊學、先進影像、先進儀器以及我們的In和SP平台。因此，預計2021年研發費用的成長率將顯著高於2020年的成長率。我們預計2021年銷售、管理及行政費用（SG&A）的成長率也將較2020年大幅提高。

SG&A spending can be categorized as follows: investments in OUS markets will increase over 2020 spend as we expand our capabilities and investment in clinical data. Variable compensation will increase over 2020 as we reset goals and targets. Core spending on resources and infrastructure will increase over 2020 to prepare for a post-COVID environment. Spend on activities impacted by COVID like travel, marketing events and in-person training will increase as the impact of COVID declines.

銷售、管理及行政費用 (SG&A) 可歸納如下：隨著我們拓展業務能力和加大臨床數據投入，2020 年在美國境外市場的投資將有所增加；隨著我們重新設定目標，2020 年的浮動薪酬將有所增加；為應對後疫情時代，2020 年用於資源和基礎設施的核心支出（例如疫情活動

Our pro forma effective tax rate for the fourth quarter was 20.7% compared with our expectations of 20% to 21%, primarily reflecting the geographic mix of income. Our actual tax rate will fluctuate with changes in the geographic mix of income, changes in taxation made by local authorities and with the impact of onetime items. Our fourth quarter 2020 pro forma net income was $436 million or $3.58 per share compared with $426 million or $3.48 per share for the fourth quarter of 2019 and $341 million or $2.77 per share for last quarter.

我們第四季的備考有效稅率為20.7%，低於我們先前預期的20%至21%，這主要反映了收入的地域組成。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調整以及一次性項目的影響而波動。我們2020年第四季的備考淨利為4.36億美元，合每股3.58美元，而2019年第四季為4.26億美元，合每股3.48美元，上一季為3.41億美元，合每股2.77美元。

I will now summarize our GAAP results. GAAP net income was $364 million or $3.02 per share for the fourth quarter of 2020 compared with GAAP net income of $363 million or $2.99 per share for the fourth quarter of 2019 and GAAP net income of $317 million or $2.60 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 settlements.

現在我將總結我們的GAAP業績。 2020年第四季GAAP淨利為3.64億美元，合每股3.02美元；而2019年第四季GAAP淨利為3.63億美元，合每股2.99美元；上一季GAAP淨利為3.17億美元，合每股2.60美元。備考淨利潤與GAAP淨利潤之間的調整項目已在我們的網站上列出並量化，其中包括與員工股票獎勵、員工股票期權和知識產權費用相關的超額稅收優惠、無形資產攤銷、收購相關項目以及法律和解費用。

GAAP net income for the fourth quarter and third quarters of 2020 also included pretax gains of $4.7 million and $61.7 million on our investments in private entities, 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 $0.39 per share in the third quarter. These gains are excluded from our pro forma results.

2020年第四季和第三季的GAAP淨利潤分別包含因收購特定技術而產生的470萬美元和6,170萬美元的稅前收益，這些收益來自我們對非上市公司的投資。扣除稅項後，這些收益對第四季每股收益的影響為0.03美元，對第三季每股收益的影響為0.39美元。這些收益已從我們的備考業績中剔除。

We ended the quarter with cash and investments of $6.9 billion compared with $6.4 billion at September 30, 2020 and $5.8 billion at December 31, 2019. The increase in cash in the fourth quarter reflected cash from operations, a reduction in inventory and overall working capital and stock exercises. We repurchased $34 million of shares in the quarter with an average price of -- at an average price of $661.10 per share.

截至本季末，我們的現金及投資總額為69億美元，高於2020年9月30日的64億美元及2019年12月31日的58億美元。第四季現金增加主要反映了經營活動產生的現金流量、存貨和整體營運資本的減少以及股票行使。本季我們回購了價值3,400萬美元的股票，平均回購價格為每股661.10美元。

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

接下來，我將把發言權交給菲利普，他將回顧我們的手術過程。

Thank you, Marshall. Our overall fourth quarter procedure growth was 6% compared to 19% growth during the fourth quarter of 2019 and 7% growth last quarter. Our Q4 procedure growth was driven by 5% growth in the U.S. and 11% growth OUS. Resurgences of COVID in the U.S. and Europe impacted our growth rates in the quarter, and we saw procedure growth rates decline as the quarter progressed, particularly late in the quarter.

謝謝馬歇爾。我們第四季的整體手術量成長率為6%，而2019年第四季為19%，上一季為7%。第四季手術量的成長主要得益於美國市場5%的成長和美國以外地區11%的成長。美國和歐洲新冠疫情的再次爆發影響了本季的成長率，我們看到隨著季度的推進，手術量成長率有所下降，尤其是在季度末。

With respect to key contributors to growth, overall procedures in China and bariatrics in the U.S. were the largest drivers of procedure growth in Q4. In the U.S., within General Surgery, bariatric, cole and hernia were the largest contributors to procedure growth within the quarter. Bariatrics may be benefiting from certain patients prioritizing weight loss as obesity is a significant COVID risk factor. In addition, we continue to receive positive reviews of our short-form 60 stapler, which provides surgeons an optimized robotic toolset and feedback for bariatric procedures.

就主要成長貢獻因素而言，第四季中國整體手術量和美國減重手術量是推動手術量成長的主要因素。在美國，在一般外科領域中，減重手術、結腸切除術和疝氣手術是本季手術量成長的主要貢獻者。由於肥胖是新冠肺炎的重要風險因素，部分患者優先考慮減肥，這可能促進了減重手術的發展。此外，我們持續收到客戶對我們短款60型吻合器的正面評價，該產品為外科醫生提供了一套優化的機器人手術工具，並能為減重手術提供回饋。

In China, procedure growth accelerated as new systems installed under the quota began to provide additional capacity for incremental growth. Q4 China procedures had broad-based growth in urology, thoracic, general surgery and gynecology.

在中國，隨著配額下新安裝的系統開始提供額外的產能，手術量成長加速。第四季度，中國泌尿外科、胸腔外科、一般外科和婦科的手術量均有全面成長。

With respect to our more mature procedure categories in the U.S., Q4 gynecology procedure growth was up, reflecting growth in cancer procedures, partially offset by declines in benign procedures. On a worldwide basis, dVP procedures in the fourth quarter declined year-over-year and had similar trends as we described last quarter. COVID is impacting the diagnostic and patient pipeline related to dVP.

就我們在美國較成熟的手術類別而言，第四季度婦科手術量增長，主要得益於癌症手術量的增長，但部分被良性手術量的下降所抵消。在全球範圍內，第四季dVP手術量年減，趨勢與上季類似。新冠疫情正在影響與dVP相關的診斷和患者需求。

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

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

Dr. Clark A. Wilson and Jihad Kaouk from the Cleveland Clinic and colleagues in a paper published in neurology described their experience evaluating robotic-assisted radical prostatectomy with da Vinci SP through an extraperitoneal approach and enhanced recovery protocol for same-day surgery. 60 subjects with organ-confined disease underwent an SP procedure with no patients requiring conversion to another approach.

克利夫蘭診所的克拉克·A·威爾遜博士和吉哈德·卡烏克博士及其同事在《神經病學》雜誌上發表的一篇論文中，描述了他們使用達文西SP機器人輔助系統，透過腹膜外入路和快速復健方案進行當日手術，評估機器人輔助根治性前列腺切除術的經驗。 60名患有局限性前列腺癌的患者接受了SP手術，無一例患者需要轉為其他手術入路。

Median length of stay for all patients was 4.2 hours. 75% of all patients enrolled were discharged on the day of surgery and 96% of patients discharged within 24 hours, when excluding those either with surgery after 6:00 p.m or with preplanned admissions due to patient preference or significant comorbidities.

所有患者的中位住院時間為 4.2 小時。在排除下午 6 點後接受手術或因患者意願或嚴重合併症而預先計劃入院的患者後，75% 的入院患者在手術當天出院，96% 的患者在 24 小時內出院。

The authors concluded a robotic-assisted radical prostatectomy with the da Vinci SP system and extraperitoneal approach can be performed safely and reproducibly as the same-day surgery. This publication adds to the number of early studies around the emerging SP technology, demonstrating encouraging results within robotic-assisted radical prostatectomy as a same-day surgery and acceptable, very operative, functional and short-term oncological outcomes in the hands of experienced surgeons for the appropriate patients. We look forward to the growth of the body of evidence around da Vinci SP.

作者得出結論，使用達文西SP系統和腹膜外入路進行機器人輔助根治性前列腺切除術，可以安全、可重複地作為日間手術完成。該研究進一步豐富了新興SP技術的早期研究，表明經驗豐富的外科醫生為合適的患者實施機器人輔助根治性前列腺切除術作為日間手術，取得了令人鼓舞的結果，並獲得了可接受的、手術效果極佳的、功能性良好的以及短期腫瘤學療效。我們期待未來關於達文西SP系統的證據體系能夠持續改善。

Lastly, we'd like to highlight that our second annual sustainability report will be available after the call on our Investor Relations website.

最後，我們想強調的是，我們的第二份年度永續發展報告將在電話會議結束後發佈在我們的投資人關係網站上。

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

我們的發言到此結束。現在開始接受各位提問。

(Operator Instructions) First, we go to the line of Amit Hazan with Goldman Sachs.

（操作說明）首先，我們連線高盛的 Amit Hazan。

I thought maybe I'd first go to your comments, in general, on hospital capital spending and maybe try to reconcile some of them. I think if you go back to last week, you cited hospitals with 7-plus systems were up strongly. And here, you're still citing lower utilization as the key headwind.

我想先談談您對醫院資本支出的整體看法，並嘗試解釋其中的一些觀點。我記得上週您提到，擁有7個以上醫療系統的醫院支出大幅增加。而現在，您仍然認為利用率下降是主要不利因素。

And so I'm just wondering, are you otherwise seeing a skewing towards newer customers And just trying to get my hands around, I have to imagine it's complicated and hospital systems are different, but how much more color you can provide around kind of some of these different data points that you've provided?

所以我想知道，您是否也觀察到新客戶增加的情況？我只是想弄清楚，我知道這很複雜，醫院系統也不一樣，但您能否就您提供的這些不同的數據點提供更多細節？

Yes. I think that -- go ahead.

是的，我覺得──請繼續。

Why don't I jump in, Marshall, and then I'll kick it back to you. Amit, thanks for the question. We were talking about earlier in the month here. We think there's some budget flushing that happened at the end of 2020.

馬歇爾，不如我先插一句，然後再把問題丟給你。阿米特，謝謝你的提問。我們之前討論過這個月早些時候的事情。我們認為2020年底可能進行了一些預算削減。

How strong that will be into 2021? Did they pull forward spending that would otherwise normally have been in '21? Hard to say.

這種勢頭會延續到2021年嗎？他們是否提前支出了原本應該在2021年進行的開支？很難說。

Having said that, if you look at where we were winning relative to other priorities, even if there is some budget pull forward, large customers were -- that already had robotics programs were expressing confidence with us, which we think is a positive.

話雖如此，但如果你看看我們相對於其他優先事項所取得的成就，即使預算有所提前削減，那些已經擁有機器人項目的大客戶仍然對我們表示信任，我們認為這是一個積極的信號。

The caution we're sending you now in this call is just that, over time, there'll be an equilibration, which is there is some excess capacity in the field because COVID is suppressing procedures.

我們現在透過這次電話會議向您傳達的警告是，隨著時間的推移，情況會趨於平衡，因為新冠疫情抑制了手術流程，所以目前該領域存在一些過剩產能。

And at some point, COVID will lift and that capacity will be absorbed. Some folks will invest ahead, getting ready and being able to work on backlog and others will be conservative and wait till they consume that capacity. Forecasting that is hard. And so that's how we're trying to help you navigate through this.

總有一天，新冠疫情會過去，這些產能會被消化掉。有些人會提前投資，做好準備，以便處理積壓訂單；而有些人則會比較保守，等到產能被消耗殆盡後再行動。預測這一點很難。所以，這就是我們努力幫助您應對這種情況的方式。

But Marshall, please clean up anything that you need to do in that answer.

但是馬歇爾，請你把答案裡需要修改的地方都整理一下。

No, you hit it perfectly.

不，你打得非常完美。

Okay. And as my follow-up, and separate on data and digital engagements to date. Again, kind of going off of a comment you made last week just hospital analytics and you talked about the 350 hospitals, 690 engagements. I'm just wondering how much more color you can give on that in terms of how much of that is that programmatic variety that you talked about that won't necessarily be monetized versus something that could either improve outcomes or reduce costs and potentially be monetized. Just any color around those early engagements would be helpful.

好的。接下來我想問的是，關於目前為止的數據和數位互動方面的問題。我再次提到您上週關於醫院分析的評論，您提到了350家醫院和690次互動。我想了解一下，您能否更詳細地說明一下，其中有多少是您之前提到的程序化互動（這些互動不一定能變現），又有多少是能夠改善結果或降低成本並有可能變現的互動？任何關於這些早期互動的資訊都將很有幫助。

Yes. Thanks for the question. When we're talking about what we shared with you in the talk at JPMorgan, most of that is programmatic analysis. And it's not so much something that we think is going to be revenue-generating directly. We think that it illuminates the value of our ecosystem and strong da Vinci programs, and that is a benefit to us.

是的，謝謝你的提問。我們在摩根大通的演講中分享的內容，大部分都是程式分析。我們並不認為它能直接帶來收益。我們認為它能凸顯我們生態系統和強大的達文西計畫的價值，這對我們來說才是有益的。

It increases the stick rate. It allows people to see in a verifiable way within their own data sets, the value they're bringing. It gives them action plans to find opportunity for standardization and other kinds of efficiency improvements, so it's of high value to the customer and high value to us.

它提高了用戶黏性。它讓人們能夠以可驗證的方式，在自己的資料集中看到他們所帶來的價值。它為他們提供行動計劃，幫助他們尋找標準化和其他效率提升的機會，因此對客戶和我們都極具價值。

Some of the other things that we've shared with you, for example, Iris, those things are something that we'll collect revenue for. They probably won't become huge revenue arms in and of themselves, but they bring value on a per-case basis, and it's something that we can talk to the customer about in terms of value creation there. They also strengthen the ecosystem.

我們之前分享過的其他一些內容，例如Iris，都是我們可以從中獲得收益的。它們本身可能不會成為巨大的收入來源，但它們確實能為每個案例帶來價值，我們可以就此與客戶探討價值創造方面的問題。此外，它們還能增強生態系。

So I think for shareholders who are asking the question, "Hey, when does informatics and machine learning create a revenue arm of its own?" I'm not sure that's the right question. I think that analytics and informatics power the ecosystem as a whole. We're pretty agnostic as to how we get paid for that. If we get paid for that through increased utilization, wonderful. That works great. We look at the cost to develop those programs and kind of overall their contribution to our financial health. But we don't have to charge for them individually if that's not how a customer wants to pay for it.

所以，對於那些問「資訊學和機器學習什麼時候才能獨立產生收入？」的股東來說，我覺得這個問題問得不太對。我認為分析和資訊學是整個生態系統的動力來源。至於如何從中獲利，我們持開放態度。如果能透過提高使用率來獲得收益，那就太好了。這種方式非常有效。我們會考慮開發這些程序的成本，以及它們對我們整體財務狀況的貢獻。但如果客戶不希望以這種方式付費，我們不必單獨收費。

Let me turn it to you, Marshall, and any color you want to add.

讓我把決定權交給你，馬歇爾，你想添加什麼顏色都可以。

No, I think that's right. I think that we look at it as the opportunity to increase the ecosystem and to expand our base and/or accelerate adoption.

不，我認為你說得對。我認為我們應該把它看作是擴大生態系統、拓展用戶群和/或加速產品普及的機會。

Next, we have the line of David Lewis of Morgan Stanley.

接下來是摩根士丹利的戴維·劉易斯。

Marshall, I appreciate we don't have guidance and I appreciate your commentary on spending levels for '21, but as I'm sure you appreciate without revenue figures, those are kind of hard numbers to put in context. So I was wondering if you could help us out a little bit more. I mean is the right messaging here that OpEx growth in '21 is going to go faster than whatever the sales growth rate is?

馬歇爾，我知道我們目前沒有業績指引，也很感謝你對2021年支出水準的評論，但正如你所知，如果沒有營收數據，這些數字很難準確解讀。所以我想請你再幫我們分析一下。我的意思是，我們是否應該這樣理解：2021年的營運支出成長速度會超過銷售成長率？

Or ask the -- kind of same question a different way. I mean SG&A for the last several years has grown in line with revenue and R&D has grown kind of 2x revenue growth rates. Are those the type of -- any of those parameters, you would kind of give us any visibility and to be super helpful. And then I've got a couple of follow-ups.

或換個方式問類似的問題。我的意思是，過去幾年銷售、管理及行政費用 (SG&A) 的成長與收入基本持平，而研發投入的成長速度大約是營收的兩倍。這些指標是否符合預期？您能否提供一些相關信息，以便我們更好地了解情況？這將對我們非常有幫助。另外，我還有幾個後續問題。

It's a good question, and I am empathetic to the fact that we aren't giving you revenue guidance and so it's hard to put those numbers into context. However, it really does come down to that the impacts of COVID are really pretty unpredictable. And so if COVID wanes quickly, then I think the spend we're talking about might match up better with a revenue increase.

這是一個很好的問題，我也理解我們沒有提供營收預期，所以很難將這些數字放在適當的背景下解讀。然而，關鍵在於新冠疫情的影響確實難以預測。因此，如果疫情迅速消退，那麼我認為我們討論的支出可能會與營收成長更加吻合。

But I got to tell you, the point of my -- the reason I pointed this all out in terms of the increases in expenses that we were able -- this year, we saw a long period where COVID impacted us. And we -- some of the variable expenses I outlined came in pretty low relative to what they historically had been. And those will increase as COVID goes away.

但我必須告訴你們，我之所以指出這些，是因為我們今年經歷了新冠疫情帶來的長期影響，導致一些可變成本（我之前提到的）相對於歷史水平而言相當低。隨著疫情的消退，這些成本將會增加。

But in addition to that, there are other expenses that we will continue to spend. The increase -- there will be increases regardless of what happens to COVID. I think we want to continue to invest in the R&D areas that I mentioned. And we want to -- because we see that there's a real opportunity to continue to expand our marketplace and to expand penetration in the long term. And so we're going to increase those costs. I know I haven't given you what you're looking for, but it's just a very difficult environment to predict revenue and procedures at this point.

但除此之外，我們還有其他一些開支需要繼續投入。無論新冠疫情如何發展，這些開支都會增加。我認為我們希望繼續投資我之前提到的研發領域。我們之所以這麼做，是因為我們看到了拓展市場、長期提高滲透率的真正機會。因此，我們將增加這些方面的投入。我知道我可能沒有提供您想要的信息，但目前的情況確實很難預測收入和業務量。

Okay. And then just maybe 2 quick follow-ups. One easier to answer than the other. Just in terms of volumes. Obviously, fourth quarter was more similar to third quarter. And generally speaking, the message from most corporates last week was that first quarter is going to be at fourth quarter, if not, frankly, a little worse. I just wonder if you could sort of comment on sort of what you're seeing from the procedure environment here in the first quarter?

好的。然後可能還有兩個後續問題。其中一個比較容易回答，就業務量而言。顯然，第四季與第三季更為相似。總的來說，上週大多數公司傳達的訊息是，第一季的情況將與第四季持平，甚至可能更糟。我想請您談談您目前對第一季業務流程環境的看法？

And then just secondarily, on the extended use program, obviously, we saw kind of a bolus on revenue per procedure this particular quarter as hospitals didn't change inventory patterns. Are you seeing any evidence? I know it's hard in COVID that it's driving higher demand, the extended use program driving higher demand. And when would you expect those revenue per procedure numbers to begin to reverse? Is that as early as the first quarter or probably more likely middle part of the year? Sorry for both questions.

其次，關於延長使用計劃，顯然，由於醫院沒有改變庫存模式，我們在本季度看到了單次手術收入的激增。您是否觀察到任何跡象？我知道在新冠疫情期間，延長使用計畫推高了需求，這很難解釋。您預計單次手術收入何時開始回落？最早是第一季度，還是更有可能在年中？抱歉問了兩個問題。

Yes. So your -- the first part of your question was...

是的。所以你的──你問題的第一部分是…

Q1 volume update.

第一季銷售更新。

Yes. Q1 volume. I made the comment that as we went through the quarter, the resurgence became more acute and it had a greater impact on procedures. And so I gave you the California example of where you go from growth in October to reduction in December. That should be an indication of the level of sort of impact they can have.

是的，第一季的數據。我之前提到過，隨著季度的推進，疫情反彈愈演愈烈，對手術量的影響也越來越大。所以我舉了加州的例子，10月份是成長期，12月就出現了下滑。這應該能說明疫情的影響程度。

And then I may -- I also made the comment that we saw the trends at the end of the quarter continue into January. So I think you said that other companies are saying that Q1 could be worse, it could be. But again, we're not going to try to predict exactly where it's going to come out, given the uncertainties around it. But it's clear coming into the quarter, it was at the bottom end of what was going on in Q4.

然後我可能——我也提到過，我們看到季度末的趨勢延續到了1月份。所以，我想您說過其他公司也認為第一季的情況可能會更糟，確實有可能。但鑑於目前有許多不確定因素，我們不會試圖準確預測最終結果。不過很明顯，進入本季時，情況已經比第四季有所改善。

As far as extended use instruments go, we launched it in the U.S. in -- at the beginning of the quarter and in Europe in the middle of the quarter, about 3/4 of our customers are now acquiring extended use instruments. They're starting to be used on procedures. It's really hard for us to predict exactly when we'll start to see the benefits of those extended use instruments in terms of elasticity and -- price elasticity, and it's certainly going to be confounded by COVID.

就延長使用期限的器材而言，我們在本季初在美國推出，並在本季中期在歐洲推出。目前，約四分之三的客戶正在採購延長使用期限的器械，並已開始應用於手術中。我們很難準確預測何時才能看到這些延長使用期限的器材在需求彈性和價格彈性方面的優勢，而且新冠疫情無疑會對此產生影響。

So I think it will take time. I think it's going to take a while before we start to see that. Sometimes you have to point out the benefits to the hospital. You have to sell it a little bit. And I just think we'll be patient about it.

所以我認為這需要時間。我覺得還需要一段時間才能看到效果。有時候你必須指出這對醫院的好處。你必須稍微推銷一下。我想我們會耐心等待的。

Next, we have the line of Bob Hopkins, Bank of America.

接下來是美國銀行的鮑伯霍普金斯。

Gary, I wanted to get your opinion on 2 geographies, if okay. First, on the U.S. Just curious, do you think that perhaps by the second half of this year, there's a chance based on everything you're seeing that we could be close to a normal level of surgical procedure volumes in the U.S. or given what you're seeing on the diagnostic side and the slow vaccine rollout that, that's more likely to be a 2022 event? And then I'd also love to get your opinion on China and the durability of the phenomenal growth you appear to be having here of late?

加里，我想聽聽你對兩個地區的看法，可以嗎？首先是關於美國。我很好奇，根據你目前觀察到的情況，你認為到今年下半年，美國的手術量有可能恢復到正常水平嗎？還是考慮到診斷方面的情況以及疫苗推廣緩慢，這種情況更有可能要到2022年才能實現？另外，我還想聽聽你對中國以及近期中國經濟驚人成長能否持續的看法？

Bob, on the first one, the U.S., I won't predict for you, but let's talk about the puts and the takes, the things that are going to be the push/pull about it. Clearly, hospitals want to get back to treating patients who are non-COVID patients. There's a demand and the desire to do that.

鮑勃，關於美國，我不會替你預測，但我們來談談其中的利弊，以及可能影響疫情發展的各種因素。顯然，醫院都想盡快恢復治療非新冠患者。他們有這樣的需求和願望。

It takes a couple of things. One is that resources get freed up from treating COVID patients to allow them to treat other things, and some of that is ICU resources and a lot of it is staff. So as COVID surges go, so does access to that set of resources. You're tracking and analysis is as good as ours in terms of looking at how well the vaccine is going to go out and what the COVID numbers might be. So I think that's a large part of it.

這需要兩方面因素。首先，需要騰出資源，從治療新冠患者中解放出來，用於治療其他疾病，這一部分是重症監護資源，很大一部分是醫護人員。因此，隨著新冠疫情的加劇，這些資源的取得也會增加。你們的追蹤和分析與我們一樣出色，能夠準確預測疫苗的推廣效果和新冠病例數。所以我認為這是關鍵。

In terms of the diagnostic pipelines, kind of the same thing. I think everybody wants to get patients back in to get diagnosed. There's -- we think a backlog that's been building for surgical patients as the surge happens. And then you have this longer backlog of folks who have been forgoing normal checkups, whether it's colonoscopies or PSA screening or what have you, that will start coming back in. And of course, disease doesn't take a holiday. And as a result, those things will be more advanced when they're caught.

就診斷流程而言，情況也差不多。我認為大家都希望病人能盡快恢復就診。隨著疫情高峰的到來，外科手術患者的積壓情況一直在增加。此外，還有更多人因為疫情而放棄了常規體檢，例如大腸鏡檢查、PSA篩檢等等，這些積壓的病例也會陸續出現。當然，疾病不會放假。因此，當這些疾病被發現時，病情往往已經發展到更嚴重的階段。

We've seen this before. We've been in this movie when we saw changes to PSA testing recommendations. That will again create a backlog, but it will take longer for it to realize and longer for it to process through. I don't think it's going to drive substantive share shifts between treatment modalities. I think it's going to be hard on patients as they go through that. And that will provide a headwind for us in -- certainly, in 2021 and then tailwinds thereafter as those folks are diagnosed and come back into the pipe. So that's kind of where I see the U.S.

我們以前也遇到過這種情況。 PSA檢測建議的變更就是一個例子。這又會造成積壓，但這次需要更長時間才能顯現出來，也需要更長時間才能處理完畢。我認為這不會導致治療方式之間出現實質的份額變化。我認為患者在經歷這個過程時會很艱難。這無疑會在2021年給我們帶來不利影響，但之後隨著這些患者被確診並重新進入治療流程，情況會有所改善。這就是我對美國未來發展的看法。

Moving to China. Long term, we're quite excited. Pretty clearly, Chinese patients are interested in high quality care. Chinese surgeons are quite interested in robotics and in da Vinci, and our partnership with Fosun and the joint venture is going well for us. So in the near term, that feels great. And I think there's a lot of strong underlying interest.

進軍中國市場。從長遠來看，我們非常興奮。很明顯，中國患者對高品質的醫療服務很感興趣。中國外科醫生對機器人手術和達文西手術系統也很感興趣，我們與復星集團的合作以及合資企業進展順利。所以短期來看，這令人振奮。而且我認為，市場對中國市場有著非常濃厚的興趣。

As we've talked about before, the medical marketplace in China is complicated. Right now, systems are under a quota, centrally managed quota. We see changes occurring in the Chinese regulatory environment over time as the FDA implements new policies and processes and we see that there are Chinese companies that are interested in this opportunity and are pushing hard to field competitive systems.

正如我們之前討論過的，中國的醫療市場非常複雜。目前，醫療系統實施配額制，由中央統一管理。隨著美國食品藥物管理局（FDA）實施新的政策和流程，我們看到中國的監管環境正在改變。同時，我們也看到一些中國企業對這項機會很感興趣，並且積極努力推出具有競爭力的醫療系統。

So we are committed long-term to China. I think it's going to be a strong demand market and a bouncy, sometimes turbulent marketplace due to policy changes and some of the central controls that are in place. We'll keep you updated as we get more clarity there.

因此，我們對中國市場有著長期的承諾。我認為，由於政策改變和一些中央管控措施，中國市場需求強勁，但同時也會充滿波動，有時甚至會比較動盪。一旦情況更加明朗，我們會及時向您報告最新進展。

Next, we have the line of Larry Biegelsen, Wells Fargo.

接下來是拉里·比格爾森（Larry Biegelsen）的發言，他是富國銀行（Wells Fargo）的代表。

I'll just ask one multipart question on Ion. I'm just curious to know kind of the -- what comes next year? You talked about the PRECISE data completing enrollment, I think, in the second quarter. Should we assume that we see that data in 2022? Is there any update on Ion in China?

我只想問一個關於Ion的多部分問題。我很好奇——明年會有什麼進展？您提到PRECISE資料將在第二季完成註冊。我們是否可以假設會在2022年看到這些數據？ Ion在中國有什麼最新進展嗎？

And then your competition has talked about indication expansion beyond lung bronchoscopy. Any color you're willing to share there?

而且，你們的競爭對手也談到了將適應症擴展到肺支氣管鏡檢查以外的領域。你們願意透露一些資訊嗎？

And just lastly, adding a therapeutic capability to Ion. So basically, the road map here on Ion, what can we expect maybe going forward here?

最後一點，我們也要為 Ion 添加治療功能。那麼，Ion 的發展路線圖，以及我們未來可能的發展方向，究竟是什麼呢？

All right. Thanks, Larry. Philip, I'm going to turn to you on the PRECISE trial timing, and then I'll take it from there.

好的。謝謝你，拉里。菲利普，接下來我要請你來談談精確的試驗時間安排，然後我再根據你的建議進行下一步。

Yes. We -- with respect to when you might hear some data, it is a fair assumption to expect to hear something in 2022. We haven't been more specific beyond that, Larry.

是的。至於何時能聽到一些數據，我們可以合理預期在2022年聽到一些消息。除此之外，我們沒有給出更具體的消息，拉里。

With regard to future indications, right now, where we're at with Ion, we are -- our commercial teams and our manufacturing operations teams are tightly focused on supplying and performing in the diagnostic bronchoscopy market, our first indication. Clearly, Ion is a platform technology, and we're excited about it.

關於未來的適應症，就目前而言，我們的商業團隊和生產營運團隊正全力以赴地為診斷性支氣管鏡市場（我們的首個適應症）提供產品和服務。顯然，Ion 是一項平台技術，我們對此感到非常興奮。

That said, I'd remind everybody, we are in early innings, all of us. The entire field is in early innings with regard to bronchoscopy. Our clinical results there are outstanding. I think that they are market-leading relative to competitors, any of the competitors. And we want to fulfill that market. We want to satisfy those customers, that means satisfying them in terms of quality and demand and shipments and so on. We think there are longer-term applications beyond bronchoscopy and beyond diagnostics, and we're working on those. We are working on ablation technologies and some other things.

話雖如此，我還是要提醒大家，我們都還處於起步階段。整個支氣管鏡領域都還處於起步階段。我們在支氣管鏡領域的臨床成果非常出色。我認為，相對於任何競爭對手而言，我們的成果都處於市場領先地位。我們希望滿足這個市場的需求。我們希望讓客戶滿意，這意味著在品質、需求、出貨量等方面都讓他們滿意。我們認為，除了支氣管鏡檢查和診斷之外，還有更長遠的應用前景，我們正在努力開發這些應用。我們正在研究消融技術和其他一些技術。

We're not ready to speak publicly about where we might go next for a couple of reasons: one is, we're still in the very earliest innings about making bronchoscopy a reality; and two, for competitive reasons, we're not ready yet to describe what we intend to do next.

基於以下兩個原因，我們目前還不方便公開談論下一步的發展方向：一是，我們仍處於將支氣管鏡檢查變為現實的初期階段；二是，出於競爭原因，我們還不方便透露下一步的計劃。

And China, Gary?

加里，中國呢？

On the China front, we, of course, have the joint venture with Fosun. We are working through pathways for Ion in China. We think there's a market there. I would advise folks that the Chinese regulatory system and CFDA handles Gen 1 products pretty differently than FDA does in the U.S. And as a result, you want to see a little greater maturity in your product line before you go broadly there. So we're working through that with our JV and also with the Chinese regulators. When we have some time lines for you, we will describe them, but we remain active and interested.

在中國市場方面，我們當然與復星集團成立了合資企業。我們正在為Ion在中國的發展尋找途徑。我們認為中國市場潛力巨大。我想提醒大家，中國的監管體系和國家食品藥品監督管理總局（CFDA）對第一代產品的監管方式與美國FDA截然不同。因此，在全面進入中國市場之前，您需要確保產品線更加成熟。目前，我們正與合資企業以及中國監管機構共同推動相關工作。一旦有了具體的時間表，我們會及時公佈，但我們始終保持積極的態度和濃厚的興趣。

Next, we have the line of Tycho Peterson, JPMorgan.

接下來是泰科·彼得森（Tycho Peterson）和摩根大通（JPMorgan）的系列文章。

Gary, you mentioned no kind of shift in treatment modalities. So I assume the deceleration doesn't imply any kind of share loss to laparoscopic. But as we think about coming out of the pandemic, the other side of it is you highlight a remote technology for monitoring, proctoring and analysis. Are there structural changes here, you think, coming out of the pandemic that could drive faster adoption of robotics?

加里，你沒有提到治療方式的任何轉變。所以我認為，這種放緩並不意味著腹腔鏡手術的市佔率有所下降。但當我們展望疫情後的發展時，另一方面，你強調了遠端監測、指導和分析技術的重要性。你認為，疫情後是否存在一些結構性變化，能夠加速機器人手術的普及？

I believe so. Now this is -- the right answer is we'll see. Time will tell. But there are some encouraging anecdotes, and they're anecdotes. One is, I think folks are realizing that a lot can get done without jumping on planes and that's true for surgeons. And one of the things that our teams have done beautifully this year is to more fully digitize and regionalize training. That has been great. So forward deployment of training and greater use of digital tools, that will continue. And I think the acceptance of that is increasing. It's also accelerated remote proctoring, as you said. So I think that has been a positive for us and something that we had, thankfully, made some investments prior to the pandemic.

我相信是這樣。現在的答案是──我們拭目以待。時間會證明一切。但有一些令人鼓舞的軼事，它們畢竟只是軼事。其中之一是，我認為人們正在意識到，很多事情無需乘坐飛機也能完成，這對外科醫生來說尤其如此。我們團隊今年做得非常出色的一件事就是更全面地實現培訓的數位化和區域化。這非常棒。因此，培訓的提前部署和數位工具的更廣泛使用將會繼續下去。我認為人們對這種做法的接受度正在提高。正如您所說，這也加速了遠距監考的發展。所以我認為這對我們來說是一個積極的方面，值得慶幸的是，我們在疫情爆發前就已經在這方面進行了一些投資。

The second part is, I think, that people are seeing changes in resource consumption, days in the hospital, ICU time, patient comforted being housed in hospitals in the pandemic has declined. And I think that will be durable. I think even after COVID rates start to drop, I think folks thinking that sitting around a hospital isn't a great idea. And using ICU resources when you don't have to isn't a great idea.

我認為第二點是，人們已經注意到資源消耗、住院天數、ICU停留時間等方面的變化，疫情期間病患在醫院的舒適度有所下降。而且我認為這種趨勢會持續下去。即使新冠感染率開始下降，人們仍然會認為長時間待在醫院裡並非明智之舉，在沒有必要的情況下佔用ICU資源也並非明智之舉。

And I -- already, I think we see that folks are saying, "Hey, really high-quality minimally invasive surgery done well." And by the way, having the analytics to back that up is going to be appreciated and maybe an accelerant. So I am cautiously optimistic that some of the trends we're seeing in terms of what recovery might be are going to be real positive for Intuitive.

而且，我認為我們已經看到有人說：「嘿，這真是高品質的微創手術，做得非常好。」順便說一句，有數據分析來支持這一點將會受到讚賞，甚至可能起到加速作用。因此，我對我們目前看到的一些關於術後恢復的趨勢持謹慎樂觀的態度，這些趨勢對Intuitive來說將是非常積極的。

Another thing you highlighted at the conference was the regulatory requirements and time lines for the industry keep increasing. I know that's something you've been talking about for a while. But as we think about the road map here for SP, the IDT -- IDE trial for colorectal, have the time lines gotten pushed out further in your view given the regulatory burden? Or it's just kind of in line with what you've been talking about for a while?

您在會議上強調的另一點是，行業監管要求和時間節點不斷增加。我知道您已經談論這個問題一段時間了。但是，考慮到SP的路線圖，以及針對結直腸癌的IDT-IDE試驗，您認為鑑於監管負擔，時間節點是否進一步延長了？或者這與您之前談到的情況基本一致？

Yes. I think we're starting to see the contours of the regulation side in the U.S. stabilize. So it's stabilizing at a requirement level that's greater than it was in year's past, but I don't think it's continuously moving. That's been good.

是的。我認為我們開始看到美國監管方面的輪廓趨於穩定。雖然要求水平高於往年，但我覺得它不會持續變化。這很好。

I think the thing that's challenged some time lines for us and others is COVID. If your clinical trial sites are having to manage COVID as well as whatever your clinical trial is, that can put pressure on you. That's kind of a near-term thing.

我認為對我們和其他一些機構來說，影響專案進度的因素是新冠疫情。如果你的臨床試驗中心既要應對新冠疫情，又要進行臨床試驗，就會帶給你壓力。這算是短期內會遇到的問題。

I think longer term, the question of what does this do if clinical trial requirements and general data requirements in the U.S. and Europe for computer-aided systems and robotics have become greater, what does that imply? And it probably implies a couple of things. One is that systems in the market are likely to stay in the market a little longer because it's just extended time lines for innovation. I think the other thing is that it probably resequences when you see different products where in the world because some health care systems, Korea being notable, are allowing innovative products into their systems a little more quickly and other ones are becoming a little less so.

我認為從長遠來看，如果美國和歐洲對電腦輔助系統和機器人的臨床試驗要求和通用數據要求越來越高，這意味著什麼？這可能意味著兩件事。首先，市場上現有的系統可能會在市場上停留更長時間，因為創新週期延長了。其次，不同地區的產品上市順序可能會有所不同，因為一些醫療系統（例如韓國）會更快地將創新產品引入其係統，而其他系統則相對保守。

So for a company like us, you'll see increased investment in head count and in resources for clinical and regulatory staff, and you'll see a reordering of where we go with new innovations over time. You'll probably see for the industry, platforms sit a little longer, that probably benefits incumbents a little more than it does insurgents.

因此，對於像我們這樣的公司來說，你會看到我們在臨床和監管人員方面的人員和資源投入增加，隨著時間的推移，我們推進創新的方向也會重新調整。你可能會發現，對於整個產業而言，平台需要更長的時間才能成熟，這可能更有利於現有企業而非新興企業。

Great. And then one last one on the extended use rollout. You did Europe recently, U.S. last quarter. Is there a next step to the process? Are you going to do it in Asia? And any reason the elasticity would be different in any of the geographies in your view?

好的。最後一個問題是關於擴展使用推廣的。你們最近在歐洲進行了推廣，上個季度在美國進行了推廣。下一步計劃是什麼？你們會推廣到亞洲嗎？您認為不同地區的推廣彈性會有什麼不同嗎？

Marshall, why don't you take that first?

馬歇爾，為什麼不先拿那個呢？

Sure. The rollout into other parts of the world will depend on the regulatory time lines. As you could imagine, in China, it will take a long time. In some of the other markets, it might be a little bit quicker. I don't have a complete road map of every country. But yes, Asia-Pac is absolutely on our mind, and we'd like to get them out to our direct markets in Asia as soon as possible.

當然。產品推廣到世界其他地區的時間將取決於監管審批的進度。正如您所想，在中國，這需要很長時間。在其他一些市場，速度可能會快一些。我目前還沒有每個國家的完整路線圖。但亞太地區絕對是我們關注的重點，我們希望盡快將產品推向我們在亞洲的直接市場。

As far as the impact on elasticity, we did 2 things in the United States, if you recall. We modified the -- we obviously launched extended use instruments, which lower the cost of care for hospitals. But we also, simultaneous with that, lowered the price of a few select instruments that are used typically in lower benign -- lower acuity procedure -- or benign lower acuity procedures like cholecystectomy, benign hysterectomies and inguinal hernias. And then in totality, then the use that -- if you look at an instrument, set that might be used in cholecystectomies, then the cost is competitive with other minimally invasive approaches.

就彈性而言，如果您還記得的話，我們在美國做了兩件事。我們改進了——顯然，我們推出了可延長使用期限的器械，這降低了醫院的醫療成本。但同時，我們也降低了一些特定器械的價格，這些器械通常用於一些輕微的手術，例如膽囊切除術、良性子宮切除術和腹股溝疝氣修補術。總而言之，如果您看一下膽囊切除術中使用的器械套裝，您會發現其成本與其他微創手術相比具有競爭力。

In each country, we have modified the pricing differently, and we're targeting those procedures that are pressured by reimbursement. So you can't kind of peanut butter spread the comment of what elasticity will do in the United States, will happen in the other countries. But we are targeting specified procedures in each of those countries where reimbursement is stressed, and we believe we provide value. And we'll see. We believe that we'll create some elasticity in each country. It will just vary in terms of magnitude.

在每個國家，我們都對定價策略進行了不同的調整，並且我們專注於那些受報銷壓力影響的醫療項目。因此，你不能簡單地把美國的價格彈性效應照搬到其他國家。但我們針對每個報銷壓力較大的國家，都選擇了特定的醫療項目，我們相信這些項目能夠提供價值。讓我們拭目以待。我們相信，在每個國家，價格彈性都會提升，只是幅度會有所不同。

Okay, next we have the line of Richard Newitter of SVB Leerink.

好的，接下來是SVB Leerink的Richard Newitter的發言。

If I could just start off on the competitive landscape. Gary, any comments you could offer on -- internationally, any competitors that are on the market? And what you're seeing out there relative to kind of what you would have expected? And within the U.S., just in light of some updates from mainly competitor, J&J recently, this fall, provided an update on the feature set. And any thoughts you would care to offer on where they're going to be trying to compete, particularly on kind of ex the robotic arms, et cetera?

如果可以的話，我想先談談競爭格局。 Gary，能否就國際市場上的競爭對手談談你的看法？你觀察到的情況與你的預期相比如何？在美國，考慮到主要競爭對手強生公司最近（今年秋季）更新了產品功能，你認為他們接下來會在哪些領域競爭，尤其是在機械手臂等領域？

Sure. Just on the -- just speaking to the international side, the first thing I'd remind everybody is it's not really a robot-versus-robot question for customers. It's really a robotically-enabled ecosystem that drives outcomes versus a robotically-enabled ecosystem that drives different outcomes. That is -- it's programmatic versus programmatic.

當然。就國際方面而言，我想提醒大家的是，對客戶來說，這並非機器人之間的對立問題。真正的問題在於，一個由機器人驅動的生態系統能夠帶來特定的結果，而另一個由機器人驅動的生態系統卻能帶來不同的結果。也就是說，這是程序化廣告與程序化廣告之間的差異。

So in each of these, when they come out, you kind of look at it and say, "Okay, what's the robot capable of? Do they have instruments any accessories, the imaging systems, the advanced tools that are required, some of those software and analytic capabilities, training capabilities and so on?" And you see a pretty different skill set and capability out of each of these ecosystems. And that's true as well for some of the bigger competitors that are domestic. So that's how we think about it. And I think that's how customers, by and large, will think about it. There will always be some customers who are interested in trialing and seeing what's capable out of something new, so I'd expect that.

所以，當這些產品面世時，你會仔細審視它們，然後問自己：「好的，這款機器人能做什麼？它是否配備了必要的儀器、配件、成像系統、先進工具、軟體和分析功能、訓練功能等等？」你會發現，每個生態系統中的機器人都擁有截然不同的技能和能力。一些國內的大型競爭對手也是如此。這就是我們思考這個問題的方式。我認為，大多數客戶也會這樣想。總是會有一些客戶有興趣試用新產品，看看它的功能，所以我預料到這種情況。

Nothing architecturally that I've seen of any of them, including the most recent announcements, has surprised me. I think we've seen a lot of these ideas. We've trialed personally a lot of them inside the company. And so I think time will tell.

從我目前看到的架構設計來看，包括最近公佈的那些，都沒有什麼讓我感到驚訝的。我覺得我們已經看過太多類似的理念了。我們公司內部也親自測試過很多。所以，時間會證明一切。

We have made the trade-offs we've made for a reason based on evaluation, building product and kind of scientific method. And I think that customers will evaluate those trade-offs over time.

我們做出這些權衡取捨是有原因的，是基於評估、產品開發和某種科學方法。我認為客戶會隨著時間的推移來評估這些權衡取捨。

We've also seen the idea that some of the bigger players want to bundle, that they're going to put all these things together, maybe lower the price of capital and try to throw some other things in and see if they can entice folks. And I think the way I'd ask customers and shareholders to think about it is bundling makes sense if the underlying products are commodities, if everybody is selling 2 ply toilet paper and one brand is not that different than the other, it's all fine. But that's not where we are.

我們也看到一些大型企業想要搞捆綁銷售，他們打算把所有東西打包在一起，或許會降低價格，再加入一些其他的東西，看看能不能吸引顧客。我想讓顧客和股東們這樣想：如果基礎產品是大宗商品，比如大家都賣雙層衛生紙，而且各個品牌之間差別不大，那麼捆綁銷售就說得通。但我們現在的情況並非如此。

Robotic systems and the instrumentation and the imaging systems are not commoditized. And as a result, there'll be strong differences in how they're used and what the outcomes are. And in that regard, I think that's what we'll point our customers to and our sales force to understand as these different things come out.

機器人系統、儀器設備和成像系統並非同質化產品。因此，它們的使用方式和最終效果會存在顯著差異。在這方面，我認為隨著這些不同產品的推出，我們需要引導客戶和銷售團隊了解這一點。

Got it. And if I could just have one more follow-up on the capital environment and the discussions that you're having. As you talk to the institutions as they think of their 2021 budgets, I'm curious, one, are they kind of thinking of a 2-year budgeting process? Or is it any different than the way they've approached their budgeting in the past in the wake of COVID?

明白了。關於資本環境和您正在進行的討論，我還有一個後續問題。在您與各機構討論2021年預算時，我很好奇，首先，他們是否考慮採用兩年預算編制流程？或者，這與他們在新冠疫情後以往的預算編制方式有何不同？

And then maybe two, is the -- what signs are they saying they're going to look for to kind of get back to you to have confidence to go and make the purchase with the uncertainty that still exists?

其次，他們表示會注意哪些跡象，才能讓你有信心在仍存在不確定性的情況下購買？

Marshall, why don't you kick off that answer, and I'll add a little when you're done.

馬歇爾，不如你先開始回答，等你說完我再補充一點。

Yes. I think the first part of your question, what are they doing from a budget perspective? I don't have enough insight to be able to answer the question well. I -- we said that we believe that they'll go through a reset, of course, for 2021. I don't know if they'll have the same level of spending they did. We believe that there is financial pressure on the hospitals -- on a number of the hospitals as a result of COVID. So we -- there's the possibility that 2021 budgets will be less -- will be smaller than they were in 2020, but I don't have great insight to that.

是的。關於您問題的第一部分，即他們從預算角度來看正在做什麼，我了解得不夠深入，無法給出確切的答案。我們說過，我們認為他們肯定會在2021年進行調整。我不知道他們的支出水準是否會和2020年一樣。我們認為，由於新冠疫情的影響，許多醫院都面臨財務壓力。因此，2021年的預算可能會比2020年少，但我對此了解不多。

Yes. I think the thing I would point to that, I think, is kind of a economics question for everybody is just going to be something to look at is they will make their estimates as to how fast folks will return and whether they want to accelerate so that they have capacity available for dealing with the backlog. I think that will differ by hospital groups. So some folks will have the capital capacity to lean in and see this as an opportunity to deepen their exposure or their presence in market. Others will feel conservative, and we'll want to wait and see, so I do not think it's going to be a one size fits all in terms of how they do their financial planning.

是的。我認為我想指出的是，這其實是一個關乎所有人的經濟問題，那就是他們會如何預估患者復工的速度，以及是否希望加快復工步伐，以便有足夠的資源來處理積壓的病例。我認為這會因醫院集團而異。有些醫院集團擁有雄厚的資金實力，會抓住機會，擴大市場佔有率或鞏固自身地位。而有些醫院集團會比較保守，選擇觀望。因此，我認為在財務規劃方面，不會有千篇一律的模式。

That was our last question. So I'll conclude from here. In closing, we continue to believe there is a substantial and durable opportunity to fundamentally improve surgery and acute interventions. Our teams continue to work closely with hospitals, physicians and care teams in pursuit of what our customers have termed the quadruple aim: better and 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 flows from respect for and understanding of patients in care teams, their needs and their environment.

這是我們的最後一個問題。那麼，我就此總結一下。總而言之，我們仍然相信，在從根本上改善外科手術和急診介入方面，存在著巨大且持久的機會。我們的團隊將繼續與醫院、醫生和護理團隊緊密合作，追求客戶所說的「四重目標」：更好、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；以及最終降低總醫療成本。我們認為，外科手術和急診護理的價值創造本質上是人性化的。它源自於護理團隊對病人、他們的需求以及他們所處環境的尊重和理解。

Thank you for your support on this extraordinary journey. We look forward to talking to you again in 3 months.

感謝您在這段非凡旅程中的支持。我們期待三個月後再次與您交流。

And ladies and gentlemen, that does conclude the presentation for this afternoon. Again, we thank you very much for all of your participation and for using our teleconferencing services. You may now disconnect.

女士們、先生們，今天下午的示範到此結束。再次感謝各位的參與和使用我們的遠距會議服務。現在可以斷開連線了。