直覺手術 (ISRG) 2020 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Third Quarter 2020 Earnings Release. (Operator Instructions) As a reminder, today's conference call is being recorded. (Operator Instructions)

女士們，先生們，感謝您的支持，歡迎來到 Intuitive 2020 年第三季度收益發布。 （操作員說明）提醒一下，今天的電話會議正在錄製中。 （操作員說明）

At this time, I'd like to turn the conference over to our first speaker, Head of Investor Relations Philip Kim. Please go ahead.

現在，我想將會議轉交給我們的第一位發言人，投資者關係主管 Philip Kim。請繼續。

Good afternoon, and welcome to Intuitive's Third Quarter Earnings Conference Call. With me today, we have Gary Guthart, our CEO; and Marshall Mohr, our Chief Financial Officer.

下午好，歡迎來到 Intuitive 的第三季度收益電話會議。今天和我一起的是我們的首席執行官 Gary Guthart；和我們的首席財務官 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 and uncertainties. These risks and uncertainties are described in detail in our Securities and Exchange Commission filings, including our most recent 10-K filed on February 7, 2020, and Form 10-Q filed on July 23, 2020. Our SEC filings can be found through our website or at the SEC's website.

在我們開始之前，我想通知您，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於某些風險和不確定性，實際結果可能與明示或暗示的結果存在重大差異。這些風險和不確定性在我們提交給美國證券交易委員會的文件中有詳細描述，包括我們於 2020 年 2 月 7 日提交的最新 10-K 和 2020 年 7 月 23 日提交的 10-Q 表格。我們的 SEC 文件可通過我們的網站找到網站或美國證券交易委員會的網站。

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.

提醒投資者不要過分依賴此類前瞻性陳述。請注意，本次電話會議的音頻重播將在我們網站 intuitive.com 的“投資者關係”頁面下的“最新事件”部分提供。今天的新聞稿和補充財務數據表已發佈到我們的網站上。

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

今天的形式包括為您提供我們今天早些時候發布的新聞稿中描述的第三季度業績的亮點，然後是問答環節。 Gary 將介紹本季度的業務和運營亮點。 Marshall 將對我們的財務業績進行審查。然後我將討論程序和臨床亮點。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. Our third quarter was a productive one with a return to growth in da Vinci procedures amid continuing adaptation to customer needs. In the field, performance varied strongly by region, given differences in pandemic impact. Operational performance inside the company has been strong with remarkable focus and diligence by our teams.

感謝您今天加入我們。我們的第三季度是一個富有成效的季度，在不斷適應客戶需求的過程中，達芬奇程序恢復了增長。在該領域，由於流行病影響的差異，各地區的表現差異很大。公司內部的運營業績一直很強勁，我們的團隊非常專注和勤奮。

Turning first to global procedures. Q3 2020 procedures grew 7% compared with Q3 2019. Procedure growth varied widely by country with growth returning to most of the countries we serve with a direct commercial team. U.S. growth was in the mid-single digits and procedure growth in China stood out as particularly strong. Analyzing current global quarterly procedure performance compared with Q3 2019 by clinical category, general surgery is rebounding most quickly, posting double-digit growth with mid-single-digit growth in gynecology and modest growth in urology.

首先轉向全球程序。與 2019 年第三季度相比，2020 年第三季度的程序增長了 7%。程序的增長因國家/地區而異，我們有直接商業團隊服務的大多數國家都恢復了增長。美國的增長處於中等個位數，中國的程序增長尤其強勁。與 2019 年第三季度相比，按臨床類別分析當前全球季度手術表現，普外科反彈最快，實現兩位數增長，其中婦科增長中等個位數，泌尿外科適度增長。

Overall, we have seen utilization increasing for our customers as their resources become available indicating that surgeons and hospitals are maintaining their commitment to minimally invasive surgery.

總體而言，隨著客戶資源的可用，我們已經看到客戶的利用率有所提高，這表明外科醫生和醫院正在維持對微創手術的承諾。

Da Vinci enables access to high-quality, minimally invasive care, increasing the number of patients who can return home sooner and decreasing the demand on ICU resources, clearly important in the era of COVID-19. Currently, 2 factors are at play at hospitals as hospitals treat both COVID and non-COVID patients. First, there are some deferred cases that were scheduled in the spring and summer that have now come back to the hospital for treatment. Second, diagnostic procedures, such as colonoscopies and PSA tests have been delayed and may not be back to pre-COVID levels now. The delay in diagnostic visits will delay disease detection and like prostate screening changes in 2012 create a reservoir of patients with more advanced disease. This push-pull of those patients who delayed a scheduled surgery coming back into hospitals now and the delay of disease identification due to diagnostic visit postponement makes hospital patient volumes hard to model for the coming quarters.

達芬奇使人們能夠獲得高質量的微創護理，增加可以更快回家的患者數量並減少對 ICU 資源的需求，這在 COVID-19 時代顯然很重要。目前，醫院同時治療 COVID 和非 COVID 患者時，有兩個因素在起作用。首先，有一些原定於春夏兩季延期的病例，現在已經回到醫院接受治療。其次，結腸鏡檢查和 PSA 測試等診斷程序已被推遲，現在可能無法恢復到 COVID 之前的水平。診斷訪問的延遲將延遲疾病檢測，並且像 2012 年的前列腺篩查變化一樣，會產生更多患有更晚期疾病的患者。那些推遲預定手術的患者現在又回到醫院，以及由於診斷就診推遲而導致的疾病鑑定延遲，這使得未來幾個季度的醫院患者數量難以建模。

That said, full diagnostic recovery is in everyone's interest and we expect surgery to return to pre-pandemic levels over the mid-term.

也就是說，完全診斷恢復符合每個人的利益，我們預計手術將在中期恢復到大流行前的水平。

Philip will take you through procedure trends later in the call. Given the slowdown in procedures due to the pandemic, we expected weaker capital demand in the third quarter. For the quarter, we installed 195 new systems. This compares to 275 installs in Q3 2019 and 178 installs in Q2 2020. Year-over-year installed base growth was 8% at the end of Q3 after accounting for trade-ins. We know the correlation between system utilization in the form of procedure demand and the need for new capital capacity at hospitals is strong. Many hospitals will seek to absorb existing capacity before installing new capital.

稍後，Philip 將帶您了解程序趨勢。鑑於大流行導致程序放緩，我們預計第三季度資金需求將減弱。本季度，我們安裝了 195 個新系統。相比之下，2019 年第三季度的安裝量為 275 次，2020 年第二季度的安裝量為 178 次。考慮到以舊換新，第三季度末的安裝基數同比增長 8%。我們知道以程序需求形式出現的系統利用率與醫院對新資本能力的需求之間存在很強的相關性。許多醫院在安裝新資本之前會尋求吸收現有能力。

In regions in which da Vinci systems are more common, hospitals may delay adding new systems until utilization recovers. Average globally, we continue to expect a challenging near- to mid-term environment for future capital placements as COVID-19 wears on and hospital finances remain strained. Because COVID is impacting locales differently, we see significant variability in procedure growth and new system placement pipelines by region. Marshall will take you through capital placement trends and risks later in the call.

在達芬奇系統更為普遍的地區，醫院可能會推遲添加新系統，直到利用率恢復。在全球範圍內平均而言，隨著 COVID-19 的消退和醫院財務仍然緊張，我們繼續預計未來資本配置的中短期環境充滿挑戰。由於 COVID 對地區的影響不同，我們看到不同地區的程序增長和新系統部署管道存在顯著差異。 Marshall 將在稍後的電話會議中帶您了解資本配置趨勢和風險。

At Intuitive, we're focused on those activities and priorities within our control. Our team in the field, in our labs, in our factories and working in homes and offices is performing well. We adapted our priorities for 2020 to meet the challenge of the pandemic and the needs of those we serve. First, we are focused on the health and well-being of patients, customers, our employees and our communities. Second, we're focused on inventory and supply chain management. So far, product availability has been very strong, thanks to the relentless work of our supply chain teams and our partners. Third, we implemented our customer financial relief program and our extended use instruments program. The timeliness and the design of these programs has been well received by our customers. Fourth, we continue to invest in our high-priority development programs, recognizing that high-quality MIS is more important in the coming years, not less so. Fifth, we're accelerating activities that help us adapt to the current environment and for which demand is likely to be durable post-COVID. Finally, we have constrained spend where we believe it is inefficient in the current environment. With these priorities as our guide, our operational and financial performance serve both our customers and our company well in the quarter.

在 Intuitive，我們專注於我們控制範圍內的那些活動和優先事項。我們在現場、實驗室、工廠以及在家中和辦公室工作的團隊表現良好。我們調整了 2020 年的優先事項，以應對大流行病的挑戰和我們所服務人群的需求。首先，我們關注患者、客戶、我們的員工和社區的健康和福祉。其次，我們專注於庫存和供應鏈管理。到目前為止，由於我們的供應鏈團隊和合作夥伴的不懈努力，產品可用性非常好。第三，我們實施了客戶財務救濟計劃和延長使用工具計劃。這些程序的及時性和設計得到了我們客戶的好評。第四，我們繼續投資於我們的高優先級發展計劃，認識到高質量的 MIS 在未來幾年更為重要，而不是更少。第五，我們正在加速幫助我們適應當前環境的活動，而在 COVID 之後，對這些環境的需求可能會持續下去。最後，我們限制了我們認為在當前環境下效率低下的支出。以這些優先事項為指導，我們的運營和財務業績在本季度為我們的客戶和我們的公司提供了良好的服務。

Intuitive commercial and learning teams adjusted their work methods to meet customers where they are, figuratively and literally. Over the years, our teams have built a strong network of capable field trainers, sales reps, surgeon proctors and cloud-enabled da Vinci systems. Our professional education and commercial teams engage this network, implementing on-site digital and regional programs such that customer engagement and training programs are approaching pre-pandemic levels, a remarkable achievement. Across the company, our teams have prioritized their efforts and practiced fiscal discipline. Based on quality and automation improvements and continued attention, our manufacturing teams are managing our product costs well, leading to strong gross margin performance, while we implemented our customer relief program and our extended use program for Generation 4 instruments.

直覺的商業和學習團隊調整了他們的工作方法，以形像地和字面地滿足客戶所在的地方。多年來，我們的團隊已經建立了一個強大的網絡，由有能力的現場培訓師、銷售代表、外科醫生監考人員和支持雲的達芬奇系統組成。我們的專業教育和商業團隊參與該網絡，實施現場數字和區域計劃，使客戶參與和培訓計劃接近大流行前水平，這是一項了不起的成就。在整個公司，我們的團隊已經確定了工作的優先次序並實行了財務紀律。基於質量和自動化改進以及持續關注，我們的製造團隊正在很好地管理我們的產品成本，從而實現強勁的毛利率表現，同時我們實施了客戶救濟計劃和第 4 代儀器的擴展使用計劃。

While the pandemic has created near- and mid-term uncertainty in the form of competing health care priorities and economic stresses, I have high confidence in the need for a high-quality, minimally invasive surgery and therapies in the long term. To deal with the current and future stresses on the health care system, payers, hospitals and surgeons are looking for solutions that improve outcomes, decrease in-hospital resource consumption and lower total cost to treat. In other words, the core pillars of the quadruple aim we had set as our goal many years ago.

雖然大流行病以競爭性醫療保健優先事項和經濟壓力的形式造成了近期和中期的不確定性，但我對長期需要高質量、微創手術和治療充滿信心。為了應對醫療保健系統當前和未來的壓力，付款人、醫院和外科醫生正在尋找能夠改善結果、減少院內資源消耗和降低總治療成本的解決方案。換句話說，我們多年前設定的四重目標的核心支柱。

We have a team that has demonstrated fiscal discipline, particularly in light of the pandemic. Over time, we plan to increase investment in our innovation engines to improve the quadruple aim at our customers and to expand our market opportunity. And we will continue to invest in our virtuous cycle of quality and efficiency gains in production that fuel quality improvement, manufacturing cost reductions and pricing flexibility for our customers that can lead to increased volume.

我們有一個表現出財政紀律的團隊，特別是在大流行的情況下。隨著時間的推移，我們計劃增加對創新引擎的投資，以改進我們對客戶的四重目標並擴大我們的市場機會。我們將繼續投資於我們在生產中提高質量和效率的良性循環，從而為我們的客戶提高質量、降低製造成本和提高定價靈活性，從而增加產量。

Looking at product operations in the quarter. Our advanced instruments in endoscopy programs are producing strong clinical and financial results. Customer adoption of our stapler product line, our vessel sealers and our E-100 Generator has been encouraging. Utilization of these products in their targeted clinical procedures and their reorder rates have been strong. Despite disruptions caused by COVID in 2020, uptake of newly launched products as well as our newest endoscope, Endoscope Plus has also been strong. As we've said in the past, a great clinical procedure takes the customer, the right system, the right instruments, the right imaging, the right training and the right support. As our Generation 4 ecosystem has matured, customers achieve high-utilization rates for our target procedures in Gen 4 accounts.

查看本季度的產品運營。我們在內窺鏡項目中的先進儀器正在產生強大的臨床和財務成果。客戶採用我們的訂書機產品線、我們的容器封口機和我們的 E-100 發電機一直令人鼓舞。這些產品在其目標臨床程序中的使用及其再訂購率一直很高。儘管 2020 年 COVID 造成了中斷，但新推出的產品以及我們最新的內窺鏡 Endoscope Plus 的使用率也很強勁。正如我們過去所說，一個偉大的臨床程序需要客戶、正確的系統、正確的儀器、正確的成像、正確的培訓和正確的支持。隨著我們的第 4 代生態系統的成熟，客戶在第 4 代賬戶中實現了我們目標程序的高利用率。

Our Ion program continues to advance with 11 systems placed in the quarter, many of which are in large teaching institutions. Ion diagnostic procedures are also returning to significant growth. Early clinical studies comparing Ion to existing alternatives in the market, both handheld and robotic, are beginning to be published and are encouraging, supporting the architectural decisions made earlier by our design team.

我們的 Ion 計劃繼續推進，本季度放置了 11 個系統，其中許多在大型教學機構中。離子診斷程序也恢復了顯著增長。將 Ion 與市場上現有替代品（包括手持式和機器人）進行比較的早期臨床研究開始發表並且令人鼓舞，支持我們的設計團隊早些時候做出的架構決策。

While our progress in our PRECISE trial for Ion has been slowed, we are seeing a return to cases as our clinical trial partners come free. Lastly, our team continues to incorporate learnings from customers and improving our system, our manufacturing and our supply chain as we work diligently to support Ion at greater scale.

雖然我們在 Ion 的 PRECISE 試驗中的進展有所放緩，但隨著我們的臨床試驗合作夥伴免費提供，我們正在看到病例的回歸。最後，我們的團隊繼續吸取客戶的經驗教訓，改進我們的系統、我們的製造和我們的供應鏈，因為我們努力工作以更大規模地支持 Ion。

Turning to our SP system. Its clinical evidence continues to mount and advocacy for the system by surgeons who use it is increasing. Procedures on SP rebounded nicely in the third quarter. I'm quite encouraged by the commentary from surgeons on the performance of the system and the potential for it to impact a wider variety of procedures over time. In the United States, we're pursuing expanded clinical indications in a number of areas with our colorectal IDE trials readying initiation. Our system and first clinical case sites are standing by to start the study pending feedback from FDA and barring additional headwinds from COVID-19. If these go to plan, we expect first cases in Q4 of this year or Q1 of 2021.

轉向我們的 SP 系統。它的臨床證據不斷增加，使用它的外科醫生對該系統的支持也在增加。 SP 的程序在第三季度反彈良好。外科醫生對系統性能的評論以及它隨著時間的推移影響更廣泛手術的潛力讓我感到非常鼓舞。在美國，我們正在通過即將啟動的結直腸 IDE 試驗在多個領域尋求擴大臨床適應症。我們的系統和第一個臨床案例站點正準備開始研究，等待 FDA 的反饋，並排除來自 COVID-19 的額外逆風。如果這些按計劃進行，我們預計將在今年第四季度或 2021 年第一季度出現首例病例。

Our cloud simulation, intelligence and analytics programs are also performing well. We've accelerated our cloud and remote technology efforts this year with use of our remote case observations and our network simulators ramping quickly. In the quarter, our network surgical simulators were used over 87,000 times, roughly doubling year-over-year. Our Iris augmented reality program entered limited launch in Q4 of last year and has recovered well in Q3. Lastly, our customer analytics efforts have been well utilized by hospitals in 2020 and are scaling nicely.

我們的雲模擬、情報和分析程序也表現良好。今年，我們通過使用我們的遠程案例觀察和我們的網絡模擬器快速提升，加速了我們的雲和遠程技術工作。本季度，我們的網絡手術模擬器的使用次數超過 87,000 次，同比大約翻了一番。我們的 Iris 增強現實項目於去年第四季度進入有限發布階段，並在第三季度恢復良好。最後，我們的客戶分析工作在 2020 年已被醫院很好地利用，並且正在很好地擴展。

As we finalize our 2021 planning, it's worth reflecting for a moment. The opportunity for improvement in acute interventions, including surgery, is a substantial and decades-long journey. The fourth quarter of 2020 will mark the 25th anniversary of the founding of Intuitive and the 21st year of clinical use. Looking back at what has been achieved and forward to the important work that remains to be done, we are committed both to our organic innovation and to expanding the universe of bright minds who can improve medicine with the types of science and technology Intuitive pioneered.

在我們完成 2021 年計劃時，值得反思一下。改善急性干預措施（包括外科手術）的機會是一個漫長且長達數十年的旅程。 2020年第四季度將迎來Intuitive成立25週年和臨床應用21週年。回顧已取得的成就並展望仍有待完成的重要工作，我們致力於我們的有機創新，並擴大能夠通過 Intuitive 開創的科學和技術類型改進醫學的聰明才智的宇宙。

To that end, we launched our Intuitive Ventures group, a part of our futures initiatives, whose mission is to accelerate opportunities at the frontiers of medicine. Intuitive Ventures group's first fund is $100 million, and our team is engaging globally with entrepreneurs, having funded some in the quarter. We look forward to seeing what solutions they bring to complex problems.

為此，我們推出了 Intuitive Ventures 集團，這是我們未來計劃的一部分，其使命是加速醫學前沿的機會。 Intuitive Ventures 集團的第一筆基金是 1 億美元，我們的團隊正在全球範圍內與企業家合作，並在本季度資助了一些。我們期待看到他們為複雜問題帶來的解決方案。

In closing, our priorities for the next few quarters remain as follows: first, continued strong performance on customer, employee and community safety while ensuring supply chain stability; second, continued support of our customers adapted to their specific conditions will support them according to their needs; third, advancing our priority programs, instruments, accessories, endoscopy systems and intelligence programs; and finally, disciplined spend management during this period of change.

最後，我們未來幾個季度的優先事項如下：首先，在確保供應鏈穩定的同時，在客戶、員工和社區安全方面繼續保持強勁表現；第二，根據客戶的具體情況繼續支持我們的客戶，根據他們的需要提供支持；第三，推進我們的優先項目、儀器、配件、內窺鏡系統和情報項目；最後，在此變革期間嚴格的支出管理。

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

我現在將電話轉給 Marshall，他將帶您更詳細地了解財務問題。

Good afternoon. I would 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.

下午好。我會在非 GAAP 或備考基礎上描述我們業績的亮點。我還將在稍後準備好的評論中總結我們的 GAAP 表現。我們的備考結果與 GAAP 結果之間的對賬已發佈在我們的網站上。

Key business metrics for the third quarter were as follows. Third quarter 2020 procedures increased approximately 7% compared with the third quarter of 2019 and increased approximately 36% compared with last quarter. Third quarter placements of 195 systems decreased 29% compared with 275 systems last year and increased 10% compared with 178 systems last quarter. We expanded our installed base of da Vinci systems over the last year by 8% to approximately 5,865 systems. This growth rate compares with 9% in the last quarter and 13% last year.

第三季度的主要業務指標如下。 2020 年第三季度的程序與 2019 年第三季度相比增加了約 7%，與上一季度相比增加了約 36%。第三季度 195 個系統的安置與去年的 275 個系統相比下降了 29%，與上個季度的 178 個系統相比增加了 10%。去年，我們將達芬奇系統的安裝基礎擴大了 8%，達到約 5,865 個系統。這一增長率與上一季度的 9% 和去年的 13% 形成鮮明對比。

Utilization of clinical systems in the field, measured by procedures per system, declined approximately 2% compared with last year and increased 33% compared with last quarter.

按每個系統的程序衡量，現場臨床系統的使用率與去年相比下降了約 2%，與上一季度相比增長了 33%。

Let me walk you through the impact of COVID-19 pandemic on procedures and system placements and how it impacts our business. Overall, procedures recovered gradually during the quarter to around 90% of pre-COVID levels by the end of the quarter. However, the extent and pace of recovery varied by market. In the U.S., we reflected several underlying themes. We experienced broader adoption across multiple procedures led by general surgery.

讓我向您介紹 COVID-19 大流行對程序和系統佈局的影響，以及它如何影響我們的業務。總體而言，到本季度末，程序在本季度逐漸恢復到 COVID 前水平的 90% 左右。然而，復甦的程度和速度因市場而異。在美國，我們反映了幾個基本主題。我們在以普外科為主導的多個程序中經歷了更廣泛的採用。

For example, we saw a significant year-over-year bariatric procedure growth. Partially offsetting broader adoption is the impact of reduced diagnosis and treatment of conditions given patients' concern over COVID exposure and regional COVID resurgences and regional -- that disrupt elective procedures. The reduction of diagnosis and treatment was most pronounced in prostate cancer.

例如，我們看到減肥手術同比顯著增長。部分抵消了更廣泛採用的影響，因為患者擔心 COVID 暴露和區域 COVID 捲土重來以及區域 - 這會破壞選擇性程序。診斷和治療的減少在前列腺癌中最為明顯。

The dynamics that affected the U.S. also affected our OUS markets. In summary, we saw higher procedure growth in markets where COVID spread is lower, like China and Japan, compared with markets where COVID impact is greater, like the U.K. and India. While total worldwide procedure rates have improved, it is possible that resurgences of COVID-19, like those currently being experienced in parts of Europe and the U.S., could negatively impact da Vinci procedures. In addition, delays in diagnosis and treatment of underlying conditions could also negatively impact da Vinci procedures. Philip will provide additional procedure commentary later in this call.

影響美國的動態也影響了我們的 OUS 市場。總而言之，與 COVID 影響較大的市場（如英國和印度）相比，我們看到在 COVID 傳播較低的市場（如中國和日本）中，程序增長更高。雖然全球總體手術率有所提高，但 COVID-19 的捲土重來可能會對達芬奇手術產生負面影響，就像目前在歐洲和美國部分地區所經歷的那樣。此外，潛在疾病的診斷和治療延誤也可能對達芬奇程序產生負面影響。菲利普稍後將在本次電話會議中提供額外的程序評論。

Although capital placements were higher in the second quarter, third quarter placements reflected headwinds we discussed last quarter, including hospitals filling existing system capacity before purchasing additional capital and delayed capital spending while hospitals revisit their capital budgets given the impacts of COVID-19. Utilization in the third quarter was 2% lower than the third quarter of 2019, while the second quarter 2020 utilization was 27% lower than the second quarter of 2019. Going forward, we expect these same headwinds to impact capital placements. In addition, macroeconomic conditions created by COVID could also impact hospital spending. And as we face competition in various markets, we may experience longer selling cycles and price pressures.

儘管第二季度的資本配售較高，但第三季度的配售反映了我們上一季度討論的逆風，包括醫院在購買額外資本之前填充現有系統容量，以及在考慮到 COVID-19 的影響醫院重新審視其資本預算時推遲資本支出。第三季度的利用率比 2019 年第三季度低 2%，而 2020 年第二季度的利用率比 2019 年第二季度低 27%。展望未來，我們預計這些同樣的逆風將影響資本配置。此外，COVID 造成的宏觀經濟狀況也可能影響醫院支出。當我們面臨各種市場的競爭時，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 third quarter revenue was $1.078 billion, representing a 4.5% decrease from last year and a 26% increase from last quarter. Third quarter 2020 revenue reflects $23 million of service credits issued in relation to the previously announced customer relief program, where we provided service credits to customers as their use of da Vinci systems were lower than pre-COVID volumes. Total service credits issued under the customer relief program, which has now ended, were $82 million.

其他收入統計和趨勢如下： 第三季度總收入為 10.78 億美元，比去年下降 4.5%，比上一季度增長 26%。 2020 年第三季度的收入反映了與先前宣布的客戶救濟計劃相關的 2300 萬美元服務積分，我們向客戶提供了服務積分，因為他們對達芬奇系統的使用低於 COVID 之前的數量。根據現已結束的客戶救濟計劃發放的服務信貸總額為 8200 萬美元。

Leasing represented 35% of current quarter placements compared with 29% last quarter. Second quarter placements included a higher proportion of China placements where leasing is prohibited. Excluding China, we saw increased demand for leasing structures. In an environment of COVID-19 and as economic pressures increase, we anticipate more customers will seek leasing or alternative financing arrangements than reflected in historical run rates. 40% of systems placed in the third quarter involved trade-ins consistent with last quarter.

租賃佔本季度安置的 35%，而上一季度為 29%。第二季度的配售包括較高比例的禁止租賃的中國配售。除中國外，我們看到對租賃結構的需求增加。在 COVID-19 的環境下，隨著經濟壓力的增加，我們預計會有更多的客戶尋求租賃或替代融資安排，而不是歷史運行率所反映的。第三季度放置的系統中有 40% 涉及與上一季度一致的以舊換新。

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

以舊換新活動可能會波動並且難以預測。

We recognized $17 million of lease buyout revenue in the third quarter compared with $9 million last quarter and $20 million last year. Lease buyout revenue has varied significantly quarter-to-quarter and will likely continue to do so. Instrument and accessory revenue per procedure increased slightly to approximately $1,910 per procedure compared with $1,900 per procedure in the second quarter of 2020 and decreased compared with $1,980 realized in the third quarter of last year. The decrease compared to last year reflects customer buying patterns, partially offset by increased advanced instrument usage.

我們在第三季度確認了 1700 萬美元的租賃買斷收入，而上一季度為 900 萬美元，去年為 2000 萬美元。租賃買斷收入的季度變化很大，而且很可能會繼續如此。與 2020 年第二季度的每次手術 1,900 美元相比，每次手術的儀器和配件收入略有增加，達到大約每次手術 1,910 美元，並且與去年第三季度實現的 1,980 美元相比有所下降。與去年相比的減少反映了客戶的購買模式，部分被先進儀器使用的增加所抵消。

In the third quarter of 2020, we did not experience reduced purchases of instruments that we anticipated in advance of the launch of extended use instruments. In early October, we launched our extended use instruments in the U.S. Extended use instruments have 12 to 18 uses compared with our previous 10 use instruments. In addition, we are reducing the price of certain instruments used commonly in lower acuity procedures and/or lower reimbursed procedures. We plan to launch our extended use instruments later in the fourth quarter in Europe and in 2021 and 2022 in other markets depending on regulatory requirements. Overall, extended use instruments and lower instrument pricing will result in lower I&A revenue per procedure to Intuitive. For example, had the extended use instruments been available in the lower instrument pricing been in place for all of 2019, revenue for 2019 would have been $150 million to $170 million less than reported and I&A per procedure would have been 7% lower. The impact of these actions on future revenue will depend on procedure volumes, instrument usage and mix and whether cost elasticity will enable greater penetration into available markets.

在 2020 年第三季度，我們沒有遇到在擴展使用儀器推出之前預期的儀器採購量減少。 10 月初，我們在美國推出了我們的擴展使用儀器。與我們之前的 10 次使用儀器相比，擴展使用儀器有 12 到 18 次使用。此外，我們正在降低通常用於較低敏銳度程序和/或較低報銷程序的某些儀器的價格。我們計劃根據監管要求於第四季度晚些時候在歐洲以及 2021 年和 2022 年在其他市場推出我們的擴展使用儀器。總體而言，延長使用儀器和降低儀器定價將導致 Intuitive 每個程序的 I&A 收入降低。例如，如果擴展使用儀器在 2019 年全年都以較低的儀器定價提供，那麼 2019 年的收入將比報告的收入少 1.5 億至 1.7 億美元，每個程序的 I&A 將減少 7%。這些行動對未來收入的影響將取決於程序量、儀器使用和組合，以及成本彈性是否能夠更大程度地滲透到現有市場。

Beginning in the fourth quarter, with the introduction of extended use instruments, we expect that I&A revenue and revenue per procedure will be lower than it otherwise would have been. 6 of the systems placed in the third quarter were SP systems, reflecting both our measured rollout of SP and the continued impact of COVID-19. Our installed base of SP systems is now 58, 8 in Korea and 50 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.

從第四季度開始，隨著擴展使用工具的推出，我們預計 I&A 收入和每個程序的收入將低於原本的水平。第三季度放置的系統中有 6 個是 SP 系統，反映了我們對 SP 的測量部署和 COVID-19 的持續影響。我們的 SP 系統安裝基數現在為 58 個，其中 8 個在韓國，50 個在美國。我們將繼續衡量 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，同時我們尋求更多適應症並優化培訓我們供應鏈中的路徑。

As Gary outlined, we expect to initiate first cases associated with the colorectal clinical trial by the first quarter of 2021. We placed 11 Ion systems in the quarter, bringing the installed base to 32 systems. Ion system placements also continue to be impacted by COVID-19. Ion system placements, procedures and related information is excluded from our overall systems and procedure counts. Our rollout of Ion will continue to be measured while we optimize training pathways in our supply chain.

正如 Gary 概述的那樣，我們預計到 2021 年第一季度將啟動與結直腸臨床試驗相關的第一例病例。我們在本季度放置了 11 個 Ion 系統，使安裝基數達到 32 個系統。離子系統放置也繼續受到 COVID-19 的影響。離子系統放置、程序和相關信息不包括在我們的整體系統和程序計數中。在我們優化供應鏈中的培訓途徑的同時，我們將繼續衡量 Ion 的推出。

Procedures under the PRECISE study are being completed at a slower pace than anticipated due to COVID-19. Based on the current pace of procedures, we expect the PRECISE study to complete in the second quarter of 2021.

由於 COVID-19，PRECISE 研究下的程序完成速度低於預期。根據目前的程序進度，我們預計 PRECISE 研究將在 2021 年第二季度完成。

Outside the U.S., we placed 79 systems in the third quarter compared with 90 in the third quarter of 2019 and 72 systems last quarter. Current quarter system placements included 39 into Europe, 15 into Japan and 12 into China compared with 36 into Europe, 27 into Japan and 10 into China in the third quarter of 2019.

在美國以外，我們在第三季度放置了 79 個系統，而 2019 年第三季度為 90 個，上季度為 72 個系統。當前季度的系統部署包括 39 個進入歐洲、15 個進入日本和 12 個進入中國，而 2019 年第三季度有 36 個進入歐洲、27 個進入日本和 10 個進入中國。

During the third quarter, MOH in China expanded the previous 154 system quota for the period 2016 through 2020 to 225 systems. The time line for purchasing the 125 systems remaining under the expanded quota is the same as the original quota, which is that hospitals allocated quota by December 31, 2020, have 2 years to complete their tenders. We expect more of the remaining systems to be completed towards the end of the 2-year period and only approximately a dozen systems to be placed in the fourth quarter of 2020. We also anticipate other companies to achieve regulatory approval over the next year or so. If approved, those competitors will share in the remaining quota.

第三季度，中國衛生部將 2016 年至 2020 年期間之前的 154 個系統配額擴大到 225 個系統。擴大配額下剩餘的125個系統採購時間線與原配額相同，即2020年12月31日前分配配額的醫院有2年的時間完成招標。我們預計更多剩餘系統將在 2 年期結束時完成，到 2020 年第四季度將只安裝大約 12 個系統。我們還預計其他公司將在明年左右獲得監管批准.如果獲得批准，這些競爭對手將分享剩餘的配額。

Moving on to gross margin and operating expenses. Pro forma gross margin for the third quarter of 2020 was 70.2% compared with 72% for the third quarter of 2019 and 62.4% last quarter. The second quarter of 2020 included higher period costs associated with abnormally low production, higher impact of the customer relief program and higher excess and obsolete inventory charges. The decrease relative to the third quarter of 2019 reflects higher period costs associated with abnormally low production, the customer relief program, partially offset by product mix.

轉向毛利率和運營費用。 2020 年第三季度的備考毛利率為 70.2%，而 2019 年第三季度為 72%，上一季度為 62.4%。 2020 年第二季度包括與異常低產量相關的更高期間成本、客戶救濟計劃的更大影響以及更高的過剩和過時庫存費用。與 2019 年第三季度相比的下降反映了與異常低產量、客戶救濟計劃相關的期間成本增加，部分被產品組合所抵消。

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 fluctuation in gross margins.

由於收入受到 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、間接費用吸收不足以及產品利潤率下降。此外，產品和客戶組合每季度波動，可能導致毛利率波動。

Pro forma operating expenses increased 1% compared with the third quarter of 2019 and increased around 5% compared with last quarter. The increase in third quarter operating expenses compared with the third quarter of 2019 is driven by higher investments in product development activities, including informatics, advanced imaging and our Ion and SP platforms and investment in headcounts and capabilities in OUS markets. This was partially offset by reduced spending on activities directly impacted by COVID-19, including marketing events, travel and training and reduced spending, reflecting continued discipline throughout the organization.

預計營業費用與 2019 年第三季度相比增長 1%，與上一季度相比增長約 5%。與 2019 年第三季度相比，第三季度運營費用的增加是由於對產品開發活動的投資增加，包括信息學、高級成像以及我們的 Ion 和 SP 平台，以及對 OUS 市場的人員和能力的投資。這部分被 COVID-19 直接影響的活動支出減少所抵消，包括營銷活動、差旅和培訓以及支出減少，反映了整個組織的持續紀律。

Relative to last quarter, spending reflects increases in training and travel, increased spending on product development areas outlined and partially offset by reduced spending. We continue to believe that 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.

與上一季度相比，支出反映了培訓和差旅的增加，概述了產品開發領域支出的增加，部分被支出減少所抵消。我們仍然相信，我們擁有一個獨特的機會，可以在全球範圍內擴大計算機輔助手術和急性干預的好處，我們將繼續對該業務進行長期投資。

Our pro forma effective tax rate for the third quarter was 19.8% compared with our expectations of 20% to 21%. 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.

我們第三季度的備考有效稅率為 19.8%，而我們的預期為 20% 至 21%。我們的實際稅率將隨著收入地域組合的變化、地方當局稅收的變化以及一次性項目的影響而波動。

Our third quarter 2020 pro forma net income was $334 million or $2.77 per share compared with $409 million or $3.43 per share for the third quarter of 2019 and $132 million or $1.11 per share for last quarter.

我們 2020 年第三季度的備考淨收入為 3.34 億美元或每股 2.77 美元，而 2019 年第三季度為 4.09 億美元或每股 3.43 美元，上一季度為 1.32 億美元或每股 1.11 美元。

I will now summarize our GAAP results. GAAP net income was $314 million or $2.60 per share for the third quarter of 2020 compared with GAAP net income of $396 million or $3.33 per share for the third quarter of 2019 and GAAP net income of $68 million or $0.57 per share for last quarter. The adjustments between pro forma and GAAP net income are outlined and quantified on our website. It 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.

我現在將總結我們的 GAAP 結果。 2020 年第三季度 GAAP 淨收入為 3.14 億美元或每股 2.60 美元，而 2019 年第三季度 GAAP 淨收入為 3.96 億美元或每股 3.33 美元，上一季度 GAAP 淨收入為 6800 萬美元或每股 0.57 美元。我們的網站上概述並量化了備考和 GAAP 淨收入之間的調整。它包括與員工股票獎勵、員工股票補償和知識產權費用、無形資產攤銷和收購相關項目以及法律和解相關的超額稅收優惠。

Third quarter of 2020 GAAP net income also included pretax gains of $62 million on our investments in private entities resulting from purchases of certain technologies. The EPS impact of these gains, net of tax, is $0.39 per share.

2020 年第三季度 GAAP 淨收入還包括我們因購買某些技術而對私人實體的投資產生的 6200 萬美元稅前收益。這些收益對 EPS 的影響（扣除稅後）為每股 0.39 美元。

We ended the quarter with cash and investments of $6.4 million compared with 6.1 -- sorry, $6.4 billion compared with $6.1 billion at June 30, 2020. Cash generated from operations and stock exercises was partially offset by investments in working capital and our infrastructure. We did not repurchase any shares in the quarter.

截至本季度末，我們的現金和投資為 640 萬美元，而截至 2020 年 6 月 30 日為 64 億美元，而 6.1 美元為 61 億美元。運營和股票活動產生的現金部分被營運資本和基礎設施投資所抵消。本季度我們沒有回購任何股票。

Our current thoughts on capital deployment are in the following order. We recognize the hardship that COVID-19 places on our customers, and we'll work with customers to ease the burden of lower da Vinci utilization, including providing customers with more flexible financing. We will ensure a secure supply chain and build appropriate levels of inventory to ensure customer supply. We will invest in securing our employees. We will continue to reinvest in the business, focused on expanding our market opportunity or accelerating adoption of our products. We will continue to open market repurchase program consistent with our prior practice.

我們目前對資本配置的想法是按以下順序排列的。我們認識到 COVID-19 給我們的客戶帶來的困難，我們將與客戶合作減輕達芬奇利用率較低的負擔，包括為客戶提供更靈活的融資。我們將確保安全的供應鏈並建立適當的庫存水平以確保客戶供應。我們將投資於保護我們的員工。我們將繼續對該業務進行再投資，專注於擴大我們的市場機會或加速我們產品的採用。我們將繼續按照我們之前的做法進行公開市場回購計劃。

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. Our overall third quarter procedure growth was 7% compared to 20% growth during the third quarter of 2019 and a 19% decline last quarter. Our Q3 procedure growth was driven by 7% growth in the U.S. and 9% growth OUS. U.S., general surgery and China were key drivers of procedure growth in Q3.

謝謝你，馬歇爾。我們第三季度的總體程序增長率為 7%，而 2019 年第三季度增長率為 20%，上一季度下降了 19%。我們第三季度的程序增長是由美國 7% 的增長和美國 9% 的增長推動的。美國、普通外科和中國是第三季度手術增長的主要驅動力。

In the U.S., Q3 procedure growth was largely driven by strength in general surgery. Hernia, coli and bariatric were the largest drivers of growth within general surgery in the quarter. Bariatric procedures have been an increased area of focus in 2020 and may also have benefited from certain patients prioritizing weight loss as obesity is a significant COVID risk factor. In China, procedure growth accelerated meaningfully, as new systems installed under the quota began to provide additional capacity for incremental growth. Q3 China procedure growth was strong with broad-based growth in urology, thoracic, general surgery and gynecology.

在美國，第三季度手術的增長主要是由普外科的實力推動的。疝氣、大腸桿菌和肥胖症是本季度普外科增長的最大驅動力。減肥手術在 2020 年成為關注的重點領域，並且可能還受益於某些優先考慮減肥的患者，因為肥胖是 COVID 的一個重要風險因素。在中國，程序增長顯著加快，因為在配額下安裝的新系統開始為增量增長提供額外的容量。第三季度，中國手術增長強勁，泌尿科、胸科、普通外科和婦科的基礎廣泛。

With respect to our more mature procedure categories in the U.S., Q3 gynecology procedure growth was up low single digits year-over-year with hysterectomy for cancer volumes growing mid-single digits. Q3 dVH benign procedures were up modestly year over. In the U.S., dVP procedures in the third quarter declined high single digits in the quarter compared to a year ago. We believe a constricted diagnostic pipeline may be impacting dVP volumes as patients may be postponing cancer screening procedures during the pandemic. On a worldwide basis, dVP procedures in the third quarter declined mid-single digits compared to a year ago. We do not have visibility as to when the diagnostic pipeline returns.

關於我們在美國更成熟的手術類別，第三季度婦科手術同比增長低個位數，子宮切除術的癌症體積增長中等個位數。 Q3 dVH 良性手術較去年略有上升。在美國，第三季度的 dVP 程序與一年前相比下降了高個位數。我們認為，受限的診斷管道可能會影響 dVP 量，因為患者可能會在大流行期間推遲癌症篩查程序。在全球範圍內，第三季度的 dVP 程序與一年前相比下降了中個位數。我們不知道診斷管道何時返回。

Certain states that saw increased COVID cases had lower growth rates. At the end of Q2, procedure volumes in these states slowed and gradually recovered later in the third quarter. We would caution investors that our visibility of COVID outbreaks is limited and that procedure volumes may fluctuate when certain geographies face an uptick in COVID.

某些 COVID 病例增加的州的增長率較低。在第二季度末，這些州的手術量有所放緩，並在第三季度晚些時候逐漸恢復。我們提醒投資者，我們對 COVID 爆發的可見性有限，並且當某些地區面臨 COVID 上升時，手術量可能會波動。

Third quarter OUS procedure volume grew 9% compared to 23% growth for the third quarter of 2019. Third quarter OUS growth was driven by continued growth in urology, thoracic, general surgery and gynecology.

第三季度 OUS 手術量增長了 9%，而 2019 年第三季度增長了 23%。第三季度 OUS 的增長是由泌尿科、胸科、普通外科和婦科的持續增長推動的。

In Japan, procedure growth moderated versus Q2 due to a slowdown in dVP. Overall, European procedures grew modestly in Q3 as countries recovered from COVID. In Q3, Germany, France and Italy contributed to year-over-year growth, while the U.K. declined. However, we would caution that as COVID surges occur in different countries, procedures can be impacted adversely.

在日本，由於 dVP 放緩，程序增長相對於第二季度放緩。總體而言，隨著各國從 COVID 中恢復過來，歐洲程序在第三季度略有增長。在第三季度，德國、法國和意大利為同比增長做出了貢獻，而英國則有所下降。但是，我們要提醒的是，隨著 COVID 激增在不同國家/地區發生，程序可能會受到不利影響。

It is important to note that we do not have guidance and Q3 trends may not be indicative of future results due to potential COVID surges, patients' willingness to have procedures done and a constricted diagnostic pipeline.

重要的是要注意，由於潛在的 COVID 激增、患者完成手術的意願以及狹窄的診斷管道，我們沒有指導，第三季度的趨勢可能無法預示未來的結果。

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.

現在轉向我們業務的臨床方面。在這些電話會議的每個季度，我們都會重點介紹某些我們認為值得注意的最近發表的研究。然而，為了更全面地了解證據，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。

Early this year, an article led by Dr. Melissa LaPinska from the University of Tennessee, Knoxville, in the journal of Surgical Endoscopy

今年年初，田納西大學諾克斯維爾分校的 Melissa LaPinska 博士在外科內窺鏡雜誌上發表了一篇文章

provided results from one of the largest matched case series analysis for noncomplex ventral hernia repair based on real-world evidence, utilizing the abdominal core health quality collaborative. The study compared 1,230 subjects undergo in either robotic-assisted or laparoscopic noncomplex ventral hernia repair. In a propensity score matched analysis with 615 subjects in each cohort, the robotic-assisted approach had a shorter mean length of stay by 2 days, a lower rate of conversion by over 1%, a lower rate of clinic re-encounters through 30 days by 6% and a lower rate of surgical site occurrences or infections requiring treatments by 2.4%.

根據真實世界的證據，利用腹部核心健康質量協作，提供了非複雜腹疝修復的最大匹配病例係列分析之一的結果。該研究比較了 1,230 名接受機器人輔助或腹腔鏡非複雜腹疝修補術的受試者。在對每個隊列中 615 名受試者進行的傾向評分匹配分析中，機器人輔助方法的平均住院時間縮短了 2 天，轉化率降低了 1% 以上，30 天內的門診再次就診率更低6%，手術部位發生率或需要治療的感染率降低 2.4%。

An article with Doctors Ravi Rajaram, David Rice, Eduardo Bruera from the University of Texas, MD Anderson Cancer Center in the Journal of Thoracic and Cardiovascular Surgery provided results from a real-world evidence analysis using the premier hospital database for lobectomy. This study included patients who underwent an elective lobectomy for primary lung cancer between January 1, 2013, and September 30, 2015, with the objective to compare postoperative inpatient opioid administration after robotic-assisted lobectomy compared to open and video-assisted thoracoscopic surgery approaches. In a propensity score matched analysis with over 2,000 subjects in each cohort, robotic-assisted lobectomy patients used a lower total opioid dose and lower average daily dose assessed through the median morphine equivalent daily dosage compared to patients undergoing either an open or VATS approach from postoperative day 1 until discharge. In both comparisons, over the same period, open lobectomy and VATS patients were more likely to be administered opioids compared to those undergoing a robotic-assisted procedure, 7.6% fewer robotic-assisted patients when compared to open and 2.6% fewer robotic-assisted patients when compared to VATS. The authors concluded in this study of patients with lung cancer undergoing lobectomy, use of a robotic-assisted approach was associated with less opioid administration in the inpatient postoperative period compared to either VATS or lobectomy.

德克薩斯大學醫學博士安德森癌症中心的 Ravi Rajaram 醫生、David Rice 醫生和 Eduardo Bruera 醫生在《胸心血管外科雜誌》上發表的一篇文章提供了使用頂級醫院肺葉切除術數據庫進行真實世界證據分析的結果。本研究納入了在 2013 年 1 月 1 日至 2015 年 9 月 30 日期間接受擇期原發性肺癌肺葉切除術的患者，目的是比較機器人輔助肺葉切除術與開胸和視頻輔助胸腔鏡手術方法術後住院阿片類藥物給藥。在對每個隊列中超過 2,000 名受試者進行的傾向評分匹配分析中，與術後接受開放或 VATS 方法的患者相比，機器人輔助肺葉切除術患者使用較低的阿片類藥物總劑量和較低的平均每日劑量（通過中位嗎啡等效每日劑量評估）第 1 天直到出院。在這兩項比較中，在同一時期內，與接受機器人輔助手術的患者相比，開放式肺葉切除術和 VATS 患者更有可能服用阿片類藥物，機器人輔助患者比開放患者少 7.6%，機器人輔助患者少 2.6%與 VATS 相比。作者在這項針對接受肺葉切除術的肺癌患者的研究中得出結論，與 VATS 或肺葉切除術相比，使用機器人輔助方法與住院術後期間阿片類藥物給藥較少有關。

That includes our prepared remarks. We will now open the call to your questions.

這包括我們準備好的評論。我們現在將打開您的問題的電話。

(Operator Instructions)

（操作員說明）

Our first question today comes from Tycho Peterson with JPMorgan.

我們今天的第一個問題來自摩根大通的第谷彼得森。

I'll start with the procedures here. You were growing 8% exiting June. And obviously, there's a lot of gives and takes on the second wave and some of the diagnostic headwinds as you flagged. But can you maybe just talk on linearity during the quarter? How is July, August and September? And any color on the first half of October? And when do you think the diagnostic headwinds could reverse? How do you think that potentially could play out?

我將從這裡的程序開始。你在六月份增長了 8%。顯然，在第二波浪潮中有很多讓步和接受，以及您標記的一些診斷逆風。但是你能不能在本季度談談線性度？七月、八月和九月怎麼樣？十月上半月有什麼顏色嗎？您認為診斷逆風何時會逆轉？你認為這可能會如何發揮作用？

Marshall, why don't you jump in and speak a little bit to the linearity question? And we'll talk a little bit -- I'll pick up the diagnostic pipeline side.

Marshall，你為什麼不插手談談線性問題？我們會談一談——我會談談診斷管道方面的問題。

Sure. Consistent with our last call, the beginning of the quarter was depressed relative to, let's say, middle of June. It's slowly or gradually came back during the quarter. There's a choppiness, of course, because it varied region by region, but slowly came back in the quarter and probably reached its peak near the end of the third quarter.

當然。與我們上次的電話一致，本季度初相對於 6 月中旬而言是低迷的。它在本季度緩慢或逐漸恢復。當然，有一個波動，因為它因地區而異，但在本季度緩慢回升，並可能在第三季度末達到頂峰。

On the diagnostics side, I think there's a broad recognition by health care providers that it's not in anybody's interest for these pipelines to remain stalled. I think there are efforts to drive them. That said, in terms of how fast they refill and patient comfort to come in and get these things done, I think all of us are going to have to wait and see. So we'll keep watching and tracking it. Channel checks show that people are working on it. How fast it converges, I don't think anybody has a great predictor.

在診斷方面，我認為醫療保健提供者普遍認識到，讓這些管道停滯不前不符合任何人的利益。我認為有人在努力推動他們。就是說，就他們重新填充的速度和患者舒適度來完成這些事情而言，我認為我們所有人都將不得不拭目以待。所以我們會繼續關注和追踪它。頻道檢查顯示人們正在努力。它收斂的速度有多快，我認為沒有人能很好地預測。

And then, Gary, on the -- some of the developments from last quarter, the extended use instruments and the pricing adjustment, any anecdotal color you can provide on your customer conversations on how they're thinking about incremental usage. And that you kind of mentioned the regulatory hurdle for the extended use instruments, I assume that's pretty straightforward. But can you just comment on that as well?

然後，加里，關於 - 上個季度的一些發展，擴展使用工具和定價調整，您可以在客戶對話中提供關於他們如何考慮增量使用的任何軼事色彩。你提到了擴展使用工具的監管障礙，我認為這很簡單。但是你也可以對此發表評論嗎？

Sure. On the customer feedback side, we've seen a positive response. There are different market segments, both in terms of the types of procedures that people are interested in using our device for, da Vinci for and also different regions. And those reimbursement dynamics and payment dynamics differ. In places where that has been greater stress, we've seen really positive engagement and response. We will see as it plays out in time. I think COVID in the early days of extended use will be a confounding factor. The early drivers may be as simple as how folks are treating non-COVID and COVID patients concurrently, but we think as it lays out in time, this is going to be really healthy for us and was not a hard analysis to do to understand the potential value of it.

當然。在客戶反饋方面，我們看到了積極的回應。就人們對使用我們的設備、達芬奇以及不同地區感興趣的程序類型而言，存在不同的細分市場。這些報銷動態和付款動態不同。在壓力更大的地方，我們看到了真正積極的參與和回應。我們會看到它及時播放。我認為 COVID 在擴展使用的早期將是一個混雜因素。早期的驅動因素可能很簡單，就像人們如何同時治療非 COVID 和 COVID 患者一樣，但我們認為，隨著時間的推移，這對我們來說真的很健康，而且不是很難分析來理解它的潛在價值。

In terms of regulatory pathways, we don't see real hurdles on the regulatory side. I think there's work to be done in terms of validations. And otherwise, I think that's all well in hand. So I don't see stresses around regulatory clearances as it relates to extended use instruments.

在監管途徑方面，我們在監管方面沒有看到真正的障礙。我認為在驗證方面還有工作要做。否則，我認為一切都在掌握之中。所以我沒有看到監管許可的壓力，因為它與擴展使用儀器有關。

Okay. And then just last one on China. You mentioned in your comments with regard to the quota that you may see approval from competitive systems next year. Can you just talk on the competitive environment there? Are you seeing more platforms emerge?

好的。最後一個是關於中國的。您在有關配額的評論中提到明年您可能會看到競爭性系統的批准。能談談那裡的競爭環境嗎？你看到更多的平台出現了嗎？

For several folks, there are a handful of commercial groups in China that are working on systems of one variety or another, whether they seek to compete with a multiport da Vinci type system or a single port system or an Ion-type system. We see interest in all those things. Ultimately, they'll make it through the regulatory process and get into the market. We see great demand in China. And the increase in the quota, I think, is a reflection of customer interest working its way through the national processes to get additional approval. So we feel like we're in a strong position competitively. We think that there's a real market there that's really gated and limited by the quota system. And we expect others will enter the market, seeing the value it has. And we've oriented our teams to make sure we're meeting customer needs better than others do.

對於一些人來說，中國有一些商業團體正在研究一種或另一種系統，無論他們是想與多端口達芬奇型系統、單端口系統還是離子型系統競爭。我們看到了對所有這些事情的興趣。最終，他們將通過監管程序進入市場。我們看到中國的巨大需求。我認為，配額的增加反映了客戶通過國家流程獲得額外批准的興趣。所以我們覺得我們在競爭中處於強勢地位。我們認為那裡有一個真正的市場，它確實受到配額系統的限制和限制。我們預計其他人會進入市場，看到它的價值。我們已經調整了我們的團隊，以確保我們比其他人更好地滿足客戶的需求。

Next, we have a question from David Lewis with Morgan Stanley.

接下來，我們有一個來自摩根士丹利的大衛劉易斯的問題。

Just a few here for me, Gary. So it's pretty clear procedure trends normalized across the quarter and you've seen that and J&J saw it as well. You talked about these various forces, exhausting backlog, hospital capacity, improving diagnosis. Is it reasonable to expect slow and steady improvement going forward, but at a more modest rate? That's sort of the message we got from J&J. I'm just wondering if you'd comment on that. So we get improvement, but that improvement is going to be more measured going forward.

給我一些，加里。因此，很明顯整個季度的程序趨勢都正常化了，你已經看到了，強生也看到了。你談到了這些不同的力量，耗盡積壓，醫院容量，提高診斷。期望未來緩慢而穩定地改善，但以更溫和的速度改善是否合理？這就是我們從強生那裡得到的信息。我只是想知道你是否會對此發表評論。所以我們得到了改進，但這種改進將在未來更加衡量。

I hesitate to characterize it just because I don't know what the future holds for COVID outbreaks and strain. What I can say is that hospitals are handling the concurrent needs that they have a little bit better. I think they have protocols that they feel good about. I think they have access to resources and things like PPE that early on, they didn't. That gives us some comfort that barring a massive influx that they can manage both size of patient need.

我猶豫是否要描述它，只是因為我不知道 COVID 爆發和毒株的未來會怎樣。我能說的是，醫院正在處理並發的需求，他們有更好的一點。我認為他們有自己感覺良好的協議。我認為他們很早就可以獲得資源和個人防護裝備之類的東西，但他們沒有。這給了我們一些安慰，除非大量湧入，否則他們可以滿足兩種規模的患者需求。

What that plays out like in the future -- sorry, capacity is better. It's also clear that they want to do minimally invasive surgery and high-quality, minimally invasive surgery and they have an interest in using our products gives me comfort. What the weather does, what the COVID pandemic does, I think, is harder for Intuitive to have direct insight into.

未來的結果——抱歉，容量更好。也很明顯，他們想做微創手術和高質量的微創手術，他們有興趣使用我們的產品讓我感到安慰。我認為，天氣的變化，COVID 大流行的變化，對於 Intuitive 來說更難直接洞察。

Okay. But it sounds like on an apples-to-apples basis, all things being normal, the system continues to improve. Obviously, you're not in control of exogenous factors.

好的。但這聽起來像是在同類基礎上，一切正常，系統在不斷改進。顯然，您無法控制外部因素。

I think that's fair.

我認為這很公平。

Okay. Very fair. Just on extended use. 2 questions for me. Marshall, for you, I thought I heard, I apologize if I misheard. The customers did not change buying patterns in the third quarter. I'm just sort of curious why do you think that was? And are you more confident, obviously, that will change in the fourth quarter? And then, Gary, if I said to you, extended use is going to do 1 or 2 things, it's going to bring more general surgeons and more types of procedures into the mix or it's going to stimulate a significant amount of sort of Gen 4 platform demand, what do you think is sort of the bigger trigger, a bigger factor here near term?

好的。很公平。只是在延長使用。 2個問題給我。馬歇爾，對你來說，我以為我聽到了，如果我聽錯了，我道歉。客戶在第三季度沒有改變購買模式。我只是有點好奇你認為那是為什麼？顯然，您是否更有信心在第四季度發生變化？然後，加里，如果我對你說，延長使用會做一兩件事，它將帶來更多的普通外科醫生和更多類型的程序，或者它將刺激大量的第 4 代平台需求，你認為什麼是更大的觸發因素，是近期更大的因素？

So we announced, in July, the program for the very intent that maybe hospitals might want to take advantage of managing their inventory levels. They do what they do. I can't answer the question as to why their buying patterns where they were. I think that as far as going forward, there will be a hard cutover. You're not going to see hospitals buy a combination of the 2 and we're not offering a combination of the 2. We're basically cutting it over to the extended use instruments. So that will -- like I said in my script, that will have an impact on Q4, but I think it will be positive from a hospital economics perspective, which is the whole intent of the program, right?

因此，我們在 7 月宣布了該計劃，其目的可能是醫院可能希望利用管理其庫存水平的優勢。他們做他們做的事。我無法回答為什麼他們的購買模式在哪裡的問題。我認為就未來而言，將會出現硬切換。您不會看到醫院購買兩者的組合，我們也不會提供兩者的組合。我們基本上將其切換到擴展使用儀器。所以這將 - 就像我在我的腳本中所說的那樣，這將對第四季度產生影響，但我認為從醫院經濟學的角度來看這將是積極的，這是該計劃的全部意圖，對吧？

Turning to the issue of what do we think it's going to catalyze. First, we think that surgeons have an interest in using our products broadly, and in fact, in procedures that have been traditionally done laparoscopically. Early days of the company, it was predominantly a substitution of open surgery. It was a way to allow minimally invasive surgery where open surgery was the norm and MIS by manual means was really difficult. And yet in general surgery, we're seeing a draw -- a poll by our customer base to do with da Vinci procedures that are often done with laparoscopy.

轉向我們認為它將催化什麼的問題。首先，我們認為外科醫生有興趣廣泛使用我們的產品，事實上，在傳統上通過腹腔鏡完成的手術中。公司早期，它主要是替代開放式手術。這是一種允許微創手術的方法，在開放手術是常態的情況下，通過手動方式進行 MIS 非常困難。然而，在普通外科手術中，我們看到了一個平局——我們的客戶群對通常通過腹腔鏡進行的達芬奇手術進行的民意調查。

And there's a reason for that. System is ergonomically sound, it allows more complex cases to be done comfortably and repeatedly. And so we see real demand there. And as a result, we feel like as we've gotten scale, as our instrument quality and processes have improved over the years and we've made design changes, we can make it easier for those who want to use it more broadly to do so economically. So we think it's going to stimulate over the long term more demand on that side and a better way to say it perhaps is it's going to reduce barriers. I think customers want to go there and this reduces barriers to them getting there.

這是有原因的。系統符合人體工程學，可以舒適地重複完成更複雜的病例。所以我們在那裡看到了真正的需求。結果，我們覺得隨著規模的擴大，隨著多年來我們的儀器質量和流程的改進以及我們進行的設計更改，我們可以讓那些想要更廣泛地使用它的人更容易地做這麼經濟。因此，我們認為從長遠來看，這將刺激這方面的更多需求，更好的說法可能是它會減少壁壘。我認為客戶想去那裡，這減少了他們到達那裡的障礙。

With regard to upgrades, I think there are a whole host of good reasons to move -- for a customer to move into a Generation 4 system, Xi or X if they're in a Gen 3 or Gen 2 system and S or Si. And extended use instruments are just one of the advantages there. So I think it helps that problem. But I think that if I had to weigh it to, the former is a strong pull in this. Extended use instruments, next-gen imaging, next-gen advanced instruments, next-gen stapling, vessel sealing, those things are great reasons to upgrade from an Si into Gen 4.

關於升級，我認為有很多很好的理由可以讓客戶遷移到第 4 代系統，如果他們在第 3 代或第 2 代系統以及 S 或 Si 中，則為 Xi 或 X。擴展使用儀器只是其中的優勢之一。所以我認為這有助於解決這個問題。但我認為，如果我必須權衡一下，前者是一個強大的推動力。擴展使用儀器、下一代成像、下一代高級儀器、下一代吻合、血管密封，這些都是從 Si 升級到 Gen 4 的重要理由。

Our next question will come from the line of Larry Biegelsen with Wells Fargo.

我們的下一個問題將來自富國銀行的 Larry Biegelsen。

Similar question on the recovery, but on the system side. Gary, how do you see that playing out over the next few quarters? Any anecdotes you can share about conversations with hospitals? Utilization was down less this quarter than it was last quarter. And I had one follow-up.

關於恢復的類似問題，但在系統方面。加里，你如何看待接下來幾個季度的表現？關於與醫院的對話，您有什麼可以分享的軼事嗎？本季度的利用率低於上一季度。我有一個後續行動。

I've been relatively pleased with the nature of conversations with hospitals around systems and how they view their robotic programs. I think they're being highly rational. I think they view high-quality, minimally invasive surgery is important going forward. They have a lot more data at their fingertips, a lot of it's supplied by us, to understand and measure the performance of their programs. And they can look out and say, okay, as they -- if they get more comfortable with recovery, does this help them? And largely speaking, yes, they view it as a help. So I think that's good.

我對與醫院圍繞系統進行對話的性質以及他們如何看待他們的機器人程序感到比較滿意。我認為他們非常理性。我認為他們認為高質量的微創手術在未來很重要。他們手頭有更多數據，其中很多是我們提供的，用於了解和衡量他們程序的性能。他們可以看看並說，好吧，因為他們——如果他們對恢復感到更舒服，這對他們有幫助嗎？在很大程度上，是的，他們將其視為一種幫助。所以我認為這很好。

Having said that, I think they're trying to plan what their finance is going to look like in 2021. Some of them have reasonable visibility, others have low visibility. And so I think they may pace and we're seeing that pacing. I am not discouraged over the long term. I look out, I think that a combination of analytical prowess and recognizing the value of lower variability, high-quality interventions is quite strong. So it will be hard to predict in the near term. We expect pressure, as Marshall said. I think Marshall is right on it. Having said that, in the long term, as procedures come back, capital will be important. And we keep innovating on our products that catalyzes upgrade cycles.

話雖如此，我認為他們正在努力規劃 2021 年的財務狀況。其中一些具有合理的知名度，而另一些則具有較低的知名度。所以我認為他們可能會加快步伐，我們正在看到這種節奏。從長遠來看，我並不氣餒。我看出來了，我認為分析能力和認識到低可變性、高質量干預的價值的結合是非常強大的。所以短期內很難預測。正如馬歇爾所說，我們預計會有壓力。我認為馬歇爾是對的。話雖如此，從長遠來看，隨著程序的回歸，資本將很重要。我們不斷創新我們的產品，以加快升級週期。

Gary, Intuitive has historically been almost exclusively an organic grower, investing in early in IP and developing products around that rather than buying companies with commercial products or folding in distribution. Do you expect that to change over the next few years? And is that partly why you announced Intuitive Ventures?

Gary，Intuitive 在歷史上幾乎完全是一個有機種植者，早期投資於 IP 並圍繞它開發產品，而不是購買具有商業產品或折疊分銷的公司。您預計這種情況會在未來幾年發生變化嗎？這就是您宣布 Intuitive Ventures 的部分原因嗎？

Yes. I think we have an interest in and pride in our organic innovation capabilities and I expect that to remain a pillar and part of our DNA. As we've grown and as I think the market has started to really appreciate here, I mean, the medical market, really appreciate what robotic-assisted surgery and computer-aided surgery can do, I think that a lot of new avenues open and that provides opportunity for us. We have been -- we're not a not invented here culture. We are open-minded to the very bright people outside. We do a lot of activities and tuck-ins over time. Those may get bigger in time. We may continue to do it. In general, I'd prefer to bring things in earlier rather than later. On the other hand, if something is interesting, we are open-minded to it. The venture fund and our futures initiatives, I think, are really recognizing as an interesting ecosystem out there developing. There's a lot of technology lines that can make a big difference in medicine. And we'd like to facilitate that growth.

是的。我認為我們對我們的有機創新能力感興趣並感到自豪，我希望它仍然是我們 DNA 的支柱和一部分。隨著我們的成長，我認為市場已經開始真正欣賞這裡，我的意思是，醫療市場，真的很欣賞機器人輔助手術和計算機輔助手術可以做什麼，我認為很多新的途徑開闢了這為我們提供了機會。我們一直 - 我們不是這裡發明的文化。我們對外面非常聰明的人持開放態度。隨著時間的推移，我們進行了很多活動和補習。這些可能會及時變大。我們可能會繼續這樣做。總的來說，我寧願早點而不是晚點。另一方面，如果某件事很有趣，我們就會持開放態度。我認為，風險基金和我們的期貨計劃確實被認為是一個正在發展的有趣生態系統。有很多技術路線可以對醫學產生重大影響。我們希望促進這種增長。

Next, we have a question from Amit Hazan with Goldman Sachs.

接下來，我們有一個來自高盛的 Amit Hazan 的問題。

I wanted to kind of try the angle of talking about new technology and pipeline. Maybe try again kind of from an R&D perspective. I think that's where you've been most comfortable answering it in the past. So ask it in that context. Obviously, R&D spending is kind of growing right through these last couple of quarters despite the pressures. Can you just talk to the biggest buckets of R&D spend and your focus or most focused on these days? And how you allocate those buckets within R&D spend?

我想嘗試一下談論新技術和管道的角度。也許從研發的角度再試一次。我認為這是您過去最願意回答的地方。所以在那種情況下問它。顯然，儘管面臨壓力，但在過去幾個季度中，研發支出仍在增長。您能否談談最近最大的研發支出以及您的關注點或最關注的點？您如何在研發支出中分配這些桶？

Yes, I'll start, and I'll ask Marshall to do a little bit more of the comparator. For us, we kind of think about it in 3 categories. One of them is, what are the kinds of things we can invest and that makes a substantive change in outcomes, not a 2% change but a bigger one. And those things get our attention and drive a set of investments. That's one.

是的，我會開始，我會要求 Marshall 做更多的比較器。對於我們來說，我們將其分為 3 個類別來考慮。其中之一是，我們可以投資哪些類型的東西，並使結果發生實質性變化，而不是 2% 的變化，而是更大的變化。這些事情引起了我們的注意並推動了一系列投資。那是一個。

We look out at new ways to get into the body with less damage to healthy tissue and less variability. As you know, we look a lot in ways we can bring more information to the surgeon and to make that information more understandable, whether it's advanced imaging or higher quality imaging or machine learning. All those things are ways to help the decision-making and share the load with surgeons, and we're making substantial progress in that domain. And we've been talking for several quarters now, perhaps several years, about catalyzing a virtuous cycle of driving volume, driving quality, decreasing the cost to make our products and sharing those savings with our customers, which allows them to take our products into places they'd like to go, and we see that happen as well. So those are categorically where we are thinking. Marshall, I'll let you take the kind of rough mix question.

我們尋找新的方法來進入身體，同時減少對健康組織的損害和更少的變異性。如您所知，我們在很多方面都在尋找可以為外科醫生帶來更多信息並使這些信息更易於理解的方法，無論是高級成像還是更高質量的成像或機器學習。所有這些都是幫助決策和與外科醫生分擔負擔的方法，我們正在該領域取得實質性進展。幾個季度以來，也許是幾年，我們一直在談論促進推動產量、推動質量、降低產品製造成本並與客戶分享這些節省的成本的良性循環，這使他們能夠將我們的產品帶入他們想去的地方，我們也看到了這種情況。所以這些絕對是我們正在思考的地方。 Marshall，我會讓你回答那種粗略的混合問題。

Sure. From a year-over-year perspective, as I said in my script, the biggest area of investment really is digital capabilities, AI, machine learning and informatics. Then after that would be advanced imaging and our capabilities there, and you've seen us introduce new scope technologies, but also making investments in other ways to image the anatomy. And then the other 2 areas I'd call out would be Ion and SP, of course, as we bring those products to market.

當然。從年復一年的角度來看，正如我在劇本中所說，最大的投資領域實際上是數字能力、人工智能、機器學習和信息學。然後是高級成像和我們在那裡的能力，你已經看到我們引入了新的範圍技術，但也在其他方面進行投資以對解剖結構進行成像。然後我要提到的另外兩個領域是 Ion 和 SP，當然，因為我們將這些產品推向市場。

So maybe just a related follow-up on Iris. Just given you mentioned I think that it recovered well in the quarter. Would love just a better understanding of where you're deploying it and implementation. I mean, there's obviously some very big players in the space that you have to contend with, practically speaking, and work with and partner with it. How you're seeing that develop now? And what we should be thinking about over the next year or 2 for that evolution?

所以也許只是 Iris 的相關後續行動。鑑於您提到的，我認為它在本季度恢復良好。希望能更好地了解您在何處部署它和實施。我的意思是，在這個領域顯然有一些非常大的參與者，實際上你必須與之抗衡，並與之合作和合作。你現在如何看待這方面的發展？在接下來的一兩年內，我們應該為這種演變考慮什麼？

I would just kind of anchor everybody on what Iris is. This is augmented reality program that takes preoperative 3D models, MR and CT scans, things like that, that are typically already done in the workflow of a workup for a patient and making it really easy for the surgeon to have access to that data real time. First, before the case to help them visualize the case and plan; and second to have it in real-time in the console.

我只想讓每個人都了解 Iris 是什麼。這是一個增強現實程序，它採用術前 3D 模型、MR 和 CT 掃描等類似的東西，這些通常已經在患者檢查的工作流程中完成，並且使外科醫生能夠真正輕鬆地實時訪問這些數據.第一，案前幫助他們形象化案情和計劃；其次是在控制台中實時獲取它。

So it's kind of a really simple idea. And as you say, and rightly say, doing it well, executing it well is the hard part. We have some really good natural collaboration partners in the space to do that with. You think about -- we don't go out and acquire those images ourselves. They're acquired on other people's devices. Those companies are incented and open-minded about how to help those things progress. And we've had good relationships with them. We have done some really cool proprietary things. We have a brilliant team of scientists and computer scientists who have thought hard about how to make that augmented reality work really well. And it's easy to do a quick prototype, and it's hard to do it in such a way that it's additive to the procedure and doesn't get in the way of the surgeon. That's a lot of what has been going on in Iris since then.

所以這是一個非常簡單的想法。正如你所說，正確地說，做好，執行好是困難的部分。我們在該領域有一些非常好的自然合作夥伴可以與之合作。你想一想——我們不會自己出去獲取這些圖像。它們是在其他人的設備上獲取的。這些公司對如何幫助這些事情取得進展持積極和開放的態度。我們與他們建立了良好的關係。我們做了一些非常酷的專有事情。我們擁有一支由科學家和計算機科學家組成的傑出團隊，他們認真思考如何讓增強現實真正發揮作用。做一個快速的原型很容易，很難以一種對手術有附加作用並且不妨礙外科醫生的方式來做。從那時起，Iris 就發生了很多事情。

And then if you think about, well, where can that take you inside the body? It's really neat. You think about you're interested in what the vasculature is up to, you're interested in what solid organs are doing, you're interested in where tumor boundaries are. And surgeons getting access to that, thinking through what approach might be, getting advice from the computing system is how that might work and consulting with patients about it. Those things are really good, facilitated discussions. I think we are quite strong relative to what I see out in the market from others and where people are kind of in universities. So our team is really good.

然後，如果你想一想，那會帶你進入身體的什麼地方？真的很整潔。你想想你對脈管系統的功能感興趣，你對實體器官的功能感興趣，你對腫瘤邊界在哪裡感興趣。外科醫生可以訪問它，思考可能的方法，從計算系統獲得建議是如何工作的，並就此與患者協商。那些東西真的很好，促進了討論。我認為，相對於我在市場上看到的其他人以及人們在大學裡的情況，我們非常強大。所以我們的團隊真的很棒。

How that grows over time, what parts of the body we approach next, we have a road map, we're working through it. We think that surgeons and hospitals will value it. We're developing the evidence in Iris 1.0, this first launch to really build the value and to lay that road map. So far, we have really passionate advocates, both inside and outside the company. So, so far, so good.

它是如何隨著時間的推移而增長的，我們接下來要接觸身體的哪些部位，我們有一個路線圖，我們正在努力完成它。我們認為外科醫生和醫院會重視它。我們正在開發 Iris 1.0 中的證據，這是第一次真正建立價值並製定路線圖的發布。到目前為止，我們在公司內外都有真正熱情的擁護者。所以，到目前為止，一切都很好。

Our next question comes from Larry Keusch with Raymond James.

我們的下一個問題來自 Larry Keusch 和 Raymond James。

Great. Just -- you mentioned some of this in the prepared comments, but just sort of curious sort of how you're thinking about as you look across your procedures, where do we stand with backlog and those that have actually been completed? And at this point, how are we starting to work through that backlog and really into new cases? Or just -- I'm trying to get some sense of how you think that backlog is working its way through.

偉大的。只是 - 你在準備好的評論中提到了其中的一些，但只是有點好奇你在查看你的程序時的想法，我們在積壓和實際完成的工作中處於什麼位置？在這一點上，我們如何開始處理積壓案件並真正處理新案件？或者只是——我正在嘗試了解您認為積壓工作是如何解決的。

I think we're coming at it from 3 different ways, and we have no great insight to share with you. I wish I had better insight. I don't know that if somebody gave you great insight that I would believe it. Having said that, with that as a lovely setup, Phil, if anything you would like to add, please jump in.

我認為我們從 3 種不同的方式來解決這個問題，我們沒有很好的見解可以與您分享。我希望我有更好的洞察力。我不知道如果有人給你很好的洞察力我會相信。話雖如此，作為一個可愛的設置，Phil，如果您想添加任何內容，請加入。

No. I mean it's clear in our prepared comments, we talked about how there are patients that are being deferred -- that are deferring treatment right now, and that's clearly a detriment to the patient. And so we do see -- we have worked through some of the backlog, as Gary alluded to in the script, but there still are patients that are clearly deferring treatment and still are to be worked on.

不，我的意思是在我們準備好的評論中很清楚，我們談到瞭如何推遲治療的患者——他們現在正在推遲治療，這顯然對患者不利。所以我們確實看到了——正如加里在劇本中提到的那樣，我們已經處理了一些積壓的工作，但仍有一些患者明顯推遲了治療，而且仍有待處理。

We're in close contact with our customers to the extent that we can help them provide assurance to patients to make sure that they stay attending to their health care. If we can partner with others to make that easier, we do. And we've had some of those opportunities. Largely, I think this is -- the main owners of this process are the health providers themselves, and we stand in support of them. What makes it so hard to model is that no region, no hospital, no country fits a single pattern. And so you're integrating across a wide spot.

我們與客戶保持密切聯繫，以幫助他們向患者提供保證，確保他們繼續接受醫療保健。如果我們可以與他人合作使這更容易，我們就會這樣做。我們有過一些這樣的機會。在很大程度上，我認為這是——這個過程的主要所有者是醫療服務提供者本身，我們支持他們。建模如此困難的原因在於，沒有哪個地區、沒有醫院、沒有哪個國家適合單一模式。因此，您正在廣泛整合。

Okay. Great. And then just the second question is, again, you talked a lot about sort of the benefits of the extended use of the instruments and the lower pricing of the less complex instruments. And certainly, all that makes sense. I think one part of the equation that people are looking to get some color on is, so how do you look at that price elasticity? And what does that do potentially to the TAM? Presumably, in part, the analysis was done to kind of figure out what the right price for the instruments are. So just wondering if there's anything incremental to add on how you are now thinking about the TAM expansion with sort of the changes that you made to the pricing?

好的。偉大的。然後只是第二個問題，你再次談到了擴展儀器使用的好處和不太複雜的儀器的較低價格。當然，所有這些都是有道理的。我認為人們希望獲得一些顏色的方程式的一部分是，那麼你如何看待價格彈性？這對 TAM 有什麼潛在影響？據推測，部分分析是為了弄清楚這些工具的正確價格是多少。所以只是想知道是否有任何增量可以添加您現在如何考慮 TAM 擴展以及您對定價所做的某種更改？

Yes. Perfectly fair question. Clearly, we think that there's greater demand at different price points, given both the types of procedures that people want to do and given the regions. What that TAM looks like over what period of time, I don't think we're ready to update with you on this call. We do think over time and as we move into next year, we'll have greater visibility in terms of what's actually happening versus what our models are, and we'll start to share with you a little bit more of what our models look like.

是的。完全公平的問題。顯然，考慮到人們想要做的手術類型和地區，我們認為不同價位的需求更大。 TAM 在什麼時間段內是什麼樣子，我認為我們還沒有準備好在這次電話會議上與您更新。隨著時間的推移，我們確實在思考，隨著我們進入明年，我們將更清楚地了解實際發生的事情與我們的模型是什麼，我們將開始與您分享更多我們的模型的外觀.

So operator, just one more caller, please.

接線員，請再接一位來電。

That question will come from Bob Hopkins with Bank of America.

這個問題將來自美國銀行的鮑勃霍普金斯。

Great. I'll just ask one given the lateness of the hour. Gary, I thought I heard you comment that you expect procedures to return to normal sometime in the mid-term. And first, did I hear you correctly? And I'm just curious how you kind of define mid-term. And then lastly and maybe most importantly, I'm just curious what gives you that confidence because there are some people that are beginning to think that maybe some of these COVID issues could have sort of a lasting impact on procedures in terms of patients or logistics within hospitals. So just curious if you could add a little color to your mid-term comment.

偉大的。鑑於時間已晚，我只問一個。加里，我想我聽到你評論說你希望程序在中期的某個時候恢復正常。首先，我沒聽錯嗎？我很好奇你是如何定義中期的。最後，也許也是最重要的一點，我很好奇是什麼給了你這種信心，因為有些人開始認為這些 COVID 問題中的一些可能會對患者或後勤方面的程序產生持久影響醫院內。所以很好奇你是否可以為你的中期評論添加一點色彩。

Yes, fair. I haven't anchored it on a particular time horizon. I think, frankly, it's exactly as you've really outlined in your question. It's -- what's implied in your question is, I think, as COVID is either tamped down or concurrently managed well, it's in the health care system and patient's interest to make sure that people aren't sitting with undiagnosed conditions or suffering with diagnosed conditions that are being untreated.

是的，公平。我沒有將它固定在特定的時間範圍內。我認為，坦率地說，這與您在問題中真正概述的完全一樣。我認為，你的問題暗示的是，由於 COVID 要么被遏制，要么同時得到妥善管理，確保人們不會患有未確診的疾病或患有確診疾病符合醫療保健系統和患者的利益沒有得到治療。

I think health systems globally, health policymakers and leaders of these institutions are trying to make sure they serve their constituencies well. And to me, the definition of mid-term is when they come over the hump of being able to manage that set of backlogs and the flow of patients, that may mean managing it within a COVID context or maybe that COVID impressions start to drop and they have more room.

我認為全球的衛生系統、衛生政策制定者和這些機構的領導人都在努力確保他們為他們的選民提供良好的服務。對我來說，中期的定義是當他們克服能夠管理那組積壓和患者流動的困難時，這可能意味著在 COVID 背景下進行管理，或者 COVID 印像開始下降並且他們有更多的空間。

So you can imagine it plays out in a couple of different ways. So long as hospital systems are fully in reactive mode with regard to COVID, I think we're in the near term. So I'd define mid-term as when folks are not in pure reaction that -- when they can manage things concurrently. And we see that executing well in some countries where COVID exists, it's not growing out of sight, and they can manage that pretty well. And where that happens, we see a return to managing surgical patients pretty well. So it's one that starts to happen in more and more countries. How long does that take? I don't really know. And what exactly the catalysts are? Well, it depends on COVID management policy.

所以你可以想像它以幾種不同的方式發揮作用。只要醫院系統對 COVID 完全處於反應模式，我認為我們就在短期內。所以我將中期定義為當人們不在純粹的反應時——當他們可以同時管理事情時。而且我們看到，在一些存在 COVID 的國家/地區執行得很好，它並沒有消失，而且他們可以很好地管理它。在這種情況發生的地方，我們看到了很好地管理手術患者的回歸。所以它開始在越來越多的國家發生。這需要多長時間？我真的不知道。催化劑到底是什麼？好吧，這取決於 COVID 管理政策。

Okay. Thanks, Bob. Well, that was our last question.

好的。謝謝，鮑勃。嗯，這是我們的最後一個問題。

In closing, we continue to believe there is a substantial and durable opportunity to fundamentally improve surgery and acute interventions. Our teams continue to work closely with hospitals, physicians and care teams in pursuit of what our customers have termed the quadruple aim: better, more predictable patient outcomes, better experiences for patients, better experiences for their care teams and ultimately, a lower total cost of care. We believe value creation in surgery and acute care is foundationally human. It flows from respect for and understanding of patients and care teams, their needs and their environment.

最後，我們仍然相信有大量和持久的機會從根本上改善手術和急性干預措施。我們的團隊繼續與醫院、醫生和護理團隊密切合作，以實現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以及最終更低的總成本照顧。我們相信手術和急症護理的價值創造從根本上講是人性化的。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. We look forward to talking with you again in 3 months. This concludes today's call.

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。今天的電話會議到此結束。

As stated, that does conclude our conference for today. We thank you for your participation for using AT&T teleconferencing. You may now disconnect.

如前所述，我們今天的會議到此結束。感謝您參與使用 AT&T 電話會議。您現在可以斷開連接。