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，感謝您的耐心等待，歡迎參加 Intuitive 2020 年第三季財報發表會。 （操作說明）提醒您，本次電話會議正在錄音。 （操作說明）

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，我謹將會議交給我們的第一位發言人，投資者關係主管Philip Kim。請開始吧。

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，歡迎參加Intuitive第三季財報電話會議。今天與我一起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 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。由於某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定性已在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7月23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 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三季度業績；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 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.

感謝您今天蒞臨本次會議。第三季業績斐然，達文西手術量在持續適應客戶需求的同時，也恢復了成長。由於疫情影響的差異，各地區的實際業績表現不一。公司內部營運表現強勁，團隊展現出高度的專注與勤奮。

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.

首先來看全球手術量。 2020年第三季手術量較2019年第三季成長7%。各國手術量成長差異顯著，我們設有直屬銷售團隊的大多數國家的手術量均已恢復成長。美國的成長率為個位數中段，而中國的成長尤為強勁。按臨床類別分析當前全球季度手術量與2019年第三季度的對比情況，普通外科手術復甦最快，實現了兩位數增長；婦科手術實現了個位數中段增長；泌尿外科手術則實現了適度增長。

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，我們看到客戶的使用率不斷提高，這表明外科醫生和醫院正在繼續致力於微創手術。

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.

達文西手術系統能夠提供高品質、微創的治療，使更多患者能夠儘早出院，並降低加護病房（ICU）的資源需求，這在新冠疫情時代尤其重要。目前，醫院在收治新冠患者和非新冠患者時面臨兩大挑戰。首先，一些原定於春夏季進行的手術被推遲，現在又重新入院接受治療。其次，大腸鏡檢查和PSA檢測等診斷程序被推遲，目前可能尚未恢復到疫情前的水平。診斷就診的延遲會延緩疾病的發現，就像2012年前列腺癌篩檢的變化一樣，導致大量晚期患者滯留。由於這些延遲手術的患者現在重新入院，加上診斷就診的延遲導致疾病識別延遲，這種相互制約的局面使得未來幾季的醫院患者數量難以預測。

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，診斷的全面恢復符合每個人的利益，我們預計手術量將在中期內恢復到疫情前的水平。

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.

Philip 將在稍後的電話會議中為您介紹手術流程趨勢。鑑於疫情導致手術量放緩，我們預計第三季資本需求將會下降。本季度，我們安裝了 195 套新系統。相比之下，2019 年第三季安裝了 275 套，2020 年第二季安裝了 178 套。扣除以舊換新設備後，第三季末的安裝基數年增了 8%。我們知道，系統利用率（以手術需求衡量）與醫院新增資本容量的需求之間存在著強烈的相關性。許多醫院會優先考慮消化現有容量，然後再購買新的設備。

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.

在達文西手術系統較為普及的地區，醫院可能會延後引進新系統，直到使用率恢復正常。整體而言，隨著新冠疫情持續蔓延，醫院財務狀況依然緊張，我們預計未來中短期內，全球範圍內的資本投入仍將面臨挑戰。由於新冠疫情對各地的影響不盡相同，我們預期各地區的手術量成長和新系統引進計畫將有顯著差異。馬歇爾將在稍後的電話會議中詳細介紹資本投入的趨勢和風險。

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，我們專注於可控範圍內的活動和優先事項。我們的團隊，無論是在現場、實驗室、工廠，或是在家或辦公室工作，都表現出色。為了因應疫情帶來的挑戰並滿足我們服務對象的需求，我們調整了2020年的工作重點。首先，我們關注患者、客戶、員工和社區的健康與福祉。其次，我們專注於庫存和供應鏈管理。迄今為止，由於供應鏈團隊和合作夥伴的不懈努力，產品供應一直非常充足。第三，我們實施了客戶財務援助計畫和延長使用期限的儀器計畫。這些計劃的及時性和設計都受到了客戶的好評。第四，我們繼續投資於高優先級的研發項目，因為我們認識到，高品質的醫療資訊系統（MIS）在未來幾年將變得更加重要。第五，我們正在加速推動那些有助於我們適應當前環境且在疫情後仍具有持續需求的活動。最後，我們限制了在當前環境下我們認為效率低下的支出。在這些優先事項的指導下，本季我們的營運和財務表現都很好地服務於我們的客戶和公司。

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.

憑藉敏銳的商業和培訓團隊的直覺，我們調整了工作方式，以便更好地滿足客戶的實際需求。多年來，我們的團隊建立了一個強大的網絡，其中包括經驗豐富的現場培訓師、銷售代表、外科醫生指導員以及支援雲端的達文西手術系統。我們的專業教育和商業團隊積極利用這個網絡，實施現場數位化和區域性項目，使客戶互動和培訓項目逐漸恢復到疫情前的水平，這是一項卓越的成就。在公司內部，我們的團隊優先考慮各項工作，並嚴格遵守財務紀律。基於品質和自動化水平的提升以及持續的關注，我們的製造團隊有效地控制了產品成本，從而實現了強勁的毛利率表現。同時，我們也實施了客戶援助計畫和第四代器材的延保使用計畫。

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.

儘管疫情帶來了短期和中期的不確定性，例如醫療保健優先事項的衝突和經濟壓力，但我堅信，從長遠來看，高品質、微創的手術和療法至關重要。為了應對當前和未來醫療保健系統面臨的壓力，支付方、醫院和外科醫生都在尋求能夠改善治療效果、減少院內資源消耗並降低總治療成本的解決方案。換句話說，這些正是我們多年前所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.

我們的團隊展現了卓越的財務紀律，尤其是在疫情期間。未來，我們將加大對創新引擎的投入，以更好地實現我們面向客戶的四重目標，並拓展市場機會。同時，我們將繼續投資於生產品質和效率的良性循環，從而提升產品質量，降低製造成本，並為客戶提供更靈活的定價方案，最終實現銷售成長。

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.

本季度產品營運回顧。我們在內鏡計畫中的先進儀器取得了顯著的臨床和財務表現。客戶對我們的縫合器產品線、血管封閉器和E-100發生器的接受度令人鼓舞。這些產品在其目標臨床手術中的使用率和復購率均表現強勁。儘管2020年受到新冠疫情的影響，但新推出的產品以及我們最新的內視鏡Endoscope Plus的銷售量仍然強勁。正如我們之前所說，成功的臨床手術需要合適的客戶、合適的系統、合適的儀器、合適的影像設備、合適的培訓和合適的支援。隨著我們第四代生態系的日益成熟，客戶在第四代系統中實現了目標手術的高使用率。

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.

我們的離子治療計畫持續推進，本季已安裝11套系統，其中許多位於大型教學機構。離子診斷程序也正恢復顯著成長。早期臨床研究已開始發表，這些研究將離子治療系統與市場上現有的手持式和機器人式設備進行了比較，結果令人鼓舞，印證了我們設計團隊早期做出的架構決策。

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.

儘管我們針對 Ion 的 PRECISE 試驗進展有所放緩，但隨著臨床試驗合作夥伴的退出，我們看到病例數正在回升。最後，我們的團隊將繼續吸取客戶的經驗教訓，並持續改進我們的系統、生產和供應鏈，並努力為更大規模地支援 Ion 提供支援。

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.

接下來談談我們的SP系統。其臨床證據不斷積累，使用該系統的外科醫生也越來越支持它。第三季SP手術量出現了良好的反彈。外科醫生對此系統性能的評價以及它未來可能應用於更多手術類型，都令我倍感鼓舞。在美國，我們正在多個領域尋求擴大臨床適應症，結直腸IDE試驗已準備就緒。我們的系統和首批臨床試驗中心已準備就緒，只待FDA的回饋以及新冠疫情帶來的其他不利因素出現後即可啟動研究。如果一切按計劃進行，我們預計將在今年第四季或2021年第一季迎來首批病例。

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.

我們的雲端模擬、智慧和分析專案也表現出色。今年，我們加快了雲端和遠端技術的部署，遠端病例觀察和網路模擬器的使用量迅速增長。本季度，我們的網路手術模擬器使用次數超過 87,000 次，較去年同期成長近一倍。我們的 Iris 擴增實境專案於去年第四季小範圍推出，並在第三季恢復良好。最後，我們的客戶分析服務在 2020 年得到了醫院的廣泛應用，並且正在穩步擴展。

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.

在我們最終敲定2021年計畫之際，不妨稍作回顧。在包括外科手術在內的急性介入領域，改進的機會巨大，而這注定是一段長達數十年的漫長旅程。 2020年第四季將是Intuitive公司成立25週年暨臨床應用21週年。回顧已取得的成就，展望未來仍需完成的重要工作，我們致力於持續創新，並積極拓展人才隊伍，運用Intuitive公司開創的科學技術，共同改善醫療。

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，我們成立了直覺創投集團（Intuitive Ventures），作為我們未來發展計畫的一部分，其使命是加速醫學前沿領域的機會。直覺創投集團的首期基金規模為1億美元，我們的團隊正與全球各地的創業家合作，並在本季完成了部分專案的投資。我們期待看到他們為解決複雜問題帶來的方案。

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，我們未來幾季的優先事項如下：第一，繼續在保障客戶、員工和社區安全方面保持強勁勢頭，同時確保供應鏈穩定；第二，繼續根據客戶的具體情況提供相應的支持；第三，推進我們的重點項目、儀器、配件、內視鏡系統和智能項目；最後，在此變革時期，嚴格控制支出。

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 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.

午安.我會先介紹我們公司非GAAP（非GAAP）或準備績效的亮點。稍後，我將在準備好的演講稿中概述我們GAAP（GAAP）下的表現。我們網站上已公佈備考業績與GAAP業績的調節表。

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.

第三季的關鍵業務指標如下。 2020年第三季手術量較2019年第三季成長約7%，較上季成長約36%。第三季系統安裝量為195套，較去年同期的275套下降29%，但較上季的178套成長10%。過去一年，我們的達文西手術系統安裝量增加了8%，達到約5,865套。這一成長率低於上季的9%和去年同期的13%。

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.

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

讓我來詳細介紹一下新冠疫情對手術流程和系統部署的影響，以及它如何影響我們的業務。整體而言，本季手術量逐漸恢復，到季末已恢復到疫情前水準的90%左右。然而，不同市場的恢復程度和速度有所不同。在美國，我們觀察到幾個共同的主題。我們見證了多種手術流程的廣泛應用，其中以普通外科手術最為顯著。

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，我們看到減肥手術的數量比去年同期增長顯著。然而，由於患者擔心感染新冠病毒以及疫情在特定地區再次爆發，導致擇期手術受到干擾，從而減少了疾病的診斷和治療，這在一定程度上抵消了減肥手術普及率的提高。前列腺癌的診斷和治療減少最為明顯。

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.

影響美國的因素也影響了我們的海外市場。總而言之，與受新冠疫情影響較大的市場（例如英國和印度）相比，我們在新冠疫情傳播程度較低的市場（例如中國和日本）觀察到了更高的手術量增長。雖然全球手術總量有所改善，但新冠疫情的再次爆發（例如目前在歐洲和美國部分地區出現的情況）可能會對達文西手術產生負面影響。此外，潛在疾病的診斷和治療延誤也可能對達文西手術產生負面影響。 Philip 將在本次電話會議稍後提供更多關於手術量的評論。

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.

儘管第二季資本投入有所增加，但第三季的投入反映了我們上季度討論過的不利因素，包括醫院在購買額外資本之前優先填滿現有系統容量，以及由於新冠疫情的影響，醫院重新審視其資本預算而推遲了資本支出。第三季的利用率比2019年第三季下降了2%，而2020年第二季的利用率比2019年第二季下降了27%。展望未來，我們預期這些不利因素將持續影響資本投入。此外，新冠疫情造成的宏觀經濟環境也可能影響醫院支出。而且，由於我們在各個市場面臨競爭，我們可能會經歷更長的銷售週期和價格壓力。

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.

其他營收統計及趨勢如下：第三季總營收為10.78億美元，較去年同期下降4.5%，較上季成長26%。 2020年第三季營收包含先前公佈的客戶紓困計畫中所發放的2,300萬美元服務抵扣額。該計劃旨在幫助客戶應對疫情期間達文西手術系統的使用量低於疫情前水準的情況，並向其提供服務抵扣額。該客戶紓困計畫現已結束，累計發放的服務抵扣額為8,200萬美元。

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.

本季租賃方式佔總部署量的35%，高於上季的29%。在第二季部署的系統中，來自中國的部署比例較高，而租賃在中國大陸是被禁止的。若排除中國大陸，我們看到市場對租賃模式的需求增加。在新冠疫情和經濟壓力不斷增加的背景下，我們預計未來尋求租賃或其他融資方案的客戶數量將高於歷史平均值。第三季部署的系統中，40%為以舊換新，與上季持平。

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

以舊換新活動可能會出現波動，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.

第三季我們確認了1700萬美元的租賃買斷收入，而上一季為900萬美元，去年同期為2,000萬美元。租賃買斷收入季度間波動較大，且這種情況可能還會持續。每台手術的器械及配件收入略有成長，約1,910美元，而2020年第二季為1,900美元，但低於去年同期的1,980美元。與去年同期相比的下降反映了客戶的購買模式，但部分被先進器械使用量的增加所抵消。

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.

2020年第三季度，我們並未如預期般，在推出可重複使用器械之前出現器械採購量下降的情況。 10月初，我們在美國推出了可重複使用器械。與先前的器械僅可使用10次相比，可重複使用器械的使用次數增加至12至18次。此外，我們也降低了某些常用於低風險手術和/或報銷金額較低的手術的器械的價格。我們計劃在第四季稍後在歐洲推出可重複使用器械，並根據監管要求，在2021年和2022年在其他市場推出。整體而言，可重複使用器械和降低器械價格將導致Intuitive公司每次手術的器械及附件（I&A）收入下降。例如，如果可重複使用器械在2019年全年都以較低的器械價格供應，則2019年的收入將比報告的少1.5億美元至1.7億美元，每次手術的器械及附件（I&A）收入將降低7%。這些措施對未來收入的影響將取決於手術量、器械使用情況和組合，以及成本彈性是否能夠使企業更深入地滲透到現有市場。

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.

從第四季開始，隨著延長使用壽命器械的引入，我們預計I&A收入和單次手術收入將低於預期。第三季安裝的系統中有6套是SP系統，這不僅反映了我們對SP系統的穩定推廣，也反映了新冠疫情的持續影響。目前，我們已安裝58套SP系統，其中8套在韓國，50套在美國。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。

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.

如同Gary所述，我們預計將於2021年第一季啟動與大腸直腸臨床試驗相關的首批病例。本季我們安裝了11組Ion系統，使總安裝量達到32套。 Ion系統的安裝也持續受到COVID-19疫情的影響。 Ion系統的安裝、手術及相關資訊不計入我們的系統和手術總數。我們將持續評估Ion系統的推廣情況，同時優化供應鏈中的訓練路徑。

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.

受新冠疫情影響，PRECISE 研究的各項流程完成速度比預期慢。按照目前的流程速度，我們預計 PRECISE 研究將於 2021 年第二季完成。

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.

除美國以外，我們第三季共部署了79套系統，而2019年第三季為90套，上季為72套。本季部署的系統包括歐洲39套、日本15套和中國12套，而2019年第三季則分別為歐洲36套、日本27套和中國10套。

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年期間的154套系統配額擴大至225套。擴大後的125套系統採購期限與原配額相同，即在2020年12月31日前獲得配額的醫院有兩年時間完成招標。我們預計剩餘系統將在兩年期限臨近結束時完成大部分，2020年第四季預計僅有約12套系統投入使用。我們也預計其他公司將在未來一年左右獲得監管部門的批准。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.

接下來是毛利率和營運費用。 2020年第三季的備考毛利率為70.2%，而2019年第三季為72%，上一季為62.4%。 2020年第二季包含因產量異常低迷而導致的較高期間成本、客戶紓困計畫的更大影響以及較高的過剩和過時庫存費用。與2019年第三季相比，毛利率的下降反映了因產量異常低迷和客戶紓困計畫而導致的較高期間成本，但部分被產品組合所抵銷。

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.

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 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.

經核算，第三季營運費用較2019年第三季成長1%，較上季成長約5%。第三季營運費用較2019年第三季成長的主要原因是加大了對產品開發活動的投入，包括資訊學、先進影像技術以及我們的Io和SP平台，同時也加大了對海外市場人員配備和能力建設的投資。部分成長被受新冠疫情直接影響的活動支出減少所抵消，這些活動包括行銷活動、差旅和培訓，以及其他支出減少，這體現了公司內部持續的自律精神。

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.

與上季相比，支出增加了培訓和差旅費用，產品開發領域的支出也有所增加，但部分被其他支出減少所抵消。我們仍然相信，我們擁有獨特的機遇，可以在全球擴大電腦輔助手術和急診介入治療的益處，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.

第三季的預期實際稅率為19.8%，低於我們先前預期的20%至21%。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。

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.

2020 年第三季度，我們的備考淨收入為 3.34 億美元，即每股 2.77 美元，而 2019 年第三季度為 4.09 億美元，即每股 3.43 美元，上一季為 1.32 億美元，即每股 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.

現在我將總結我們的GAAP業績。 2020年第三季GAAP淨利為3.14億美元，合每股2.60美元；而2019年第三季GAAP淨利為3.96億美元，合每股3.33美元；上一季GAAP淨利為6,800萬美元，合每股0.57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。這些調整項目包括與員工股票獎勵、員工股票選擇權和智慧財產權費用相關的超額稅收優惠、無形資產攤提、收購相關項目以及法律和解費用。

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GAAP淨利還包括因收購某些技術而從對非上市公司的投資中獲得的稅前收益6,200萬美元。扣除稅項後，這些收益對每股盈餘的影響為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.

本季末，我們的現金及投資餘額為640萬美元，而2020年6月30日為61億美元。經營活動和股票行使產生的現金部分被營運資本和基礎設施投資所抵銷。本季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.

我們目前對資金部署的考慮順序如下。我們深知新冠疫情造成客戶的困難，並將與客戶攜手合作，減輕達文西手術系統使用率下降的負擔，包括為客戶提供更靈活的融資方案。我們將確保供應鏈安全，並建立適當的庫存水平，以保障客戶的供應。我們將投資員工保障。我們將繼續對業務進行再投資，專注於拓展市場機會或加速產品推廣。我們將繼續實施與以往做法一致的公開市場回購計畫。

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

接下來，我將把發言權交給菲利普，他將介紹手術流程。

Thank you, Marshall. Our overall 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.

謝謝馬歇爾。我們第三季的整體手術量成長了7%，而2019年第三季成長了20%，上一季則下降了19%。第三季手術量的成長主要得益於美國市場7%的成長和美國以外地區9%的成長。美國、一般外科手術和中國是第三季手術量成長的主要驅動力。

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，第三季手術量的成長主要得益於一般外科的強勁表現。疝氣、結腸和減重手術是該季度一般外科手術成長的主要驅動力。減重手術在2020年受到更多關注，部分患者優先考慮減重也可能從中受益，因為肥胖是新冠肺炎的重要風險因素。在中國，隨著新系統按配額投入使用，手術量增長顯著加快，為增量增長提供了額外的容量。中國第三季手術量成長強勁，泌尿科、胸腔外科、一般外科和婦科均實現了全面成長。

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.

就我們在美國較成熟的手術類別而言，第三季婦科手術量年增率低個位數，其中子宮癌切除術量年增中個位數。第三季dVH良性手術量較去年同期成長略有成長。在美國，第三季dVP手術量年減高個位數。我們認為，診斷流程受阻可能是導致dVP手術量下降的原因，因為患者可能在疫情期間推遲了癌症篩檢。在全球範圍內，第三季dVP手術量年減中個位數。我們目前尚無法預測診斷流程何時恢復。

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.

某些新冠病例增加的州，其手術量成長率較低。第二季末，這些州的手術量成長放緩，並在第三季後期逐漸恢復。我們提醒投資者，我們對新冠疫情爆發的預測能力有限，當某些地區新冠病例激增時，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 OUS 手術量成長 9%，而 2019 年第三季成長 23%。第三季 OUS 成長主要得益於泌尿外科、胸腔外科、一般外科和婦科的持續成長。

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（直接靜脈注射）增速放緩，手術量增速較第二季下降。整體而言，隨著各國從新冠疫情中復甦，歐洲手術量在第三季溫和成長。第三季度，德國、法國和義大利的年成長貢獻顯著，而英國則出現下滑。然而，我們提醒各位，由於新冠疫情在不同國家出現反复，手術量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.

值得注意的是，我們沒有相關指導，而且由於新冠疫情可能再次爆發、患者接受手術的意願以及診斷流程受限等原因，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。

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，由田納西大學諾克斯維爾分校的梅麗莎·拉平斯卡博士領導撰寫的一篇文章發表在《外科內視鏡雜誌》上。

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%.

本研究基於真實世界證據，利用腹部核心健康品質協作組織的數據，對非複雜性腹壁疝氣修補術進行了迄今為止規模最大的匹配病例係列分析。研究比較了1230例接受機器人輔助或腹腔鏡非複雜性腹壁疝氣修補術的患者。在傾向評分配對分析中（每組615例患者），機器人輔助手術組的平均住院時間縮短了2天，中轉開腹率降低了1%以上，30天內門診復診率降低了6%，需要治療的手術部位併發症或感染發生率降低了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.

德州大學MD安德森癌症中心的Ravi Rajaram、David Rice和Eduardo Bruera醫生在《胸心血管外科雜誌》上發表了一篇文章，該文章利用肺葉切除術的權威醫院數據庫，提供了一項基於真實世界證據的分析結果。這項研究納入了2013年1月1日至2015年9月30日期間因原發性肺癌接受擇期肺葉切除術的患者，旨在比較機器人輔助肺葉切除術、開放手術和胸腔鏡輔助手術後住院期間的阿片類藥物使用情況。在傾向評分配對分析中，每個隊列均納入超過2000名受試者，結果顯示，與接受開放性手術或胸腔鏡輔助手術的患者相比，機器人輔助肺葉切除術患者從術後第一天到出院期間，使用的總阿片類藥物劑量和平均每日劑量（以嗎啡等效日劑量中位數評估）均較低。在同一時期，兩項比較均顯示，與接受機器人輔助手術的患者相比，接受開放式肺葉切除術和胸腔鏡輔助肺葉切除術（VATS）的患者使用阿片類藥物的可能性更高；與開放式手術相比，機器人輔助手術的患者使用阿片類藥物的比例減少了7.6%；與VATS2%，機器人輔助手術的患者使用阿片類藥物的比例減少了2.2%。作者在這項針對肺癌肺葉切除術患者的研究中得出結論：與VATS或肺葉切除術相比，採用機器人輔助手術可減少術後住院期間阿片類藥物的使用。

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

這包括我們事先準備好的演講稿。現在我們將開放提問環節。

(Operator Instructions)

（操作說明）

Our first question today comes from Tycho Peterson with JPMorgan.

今天我們收到的第一個問題來自摩根大通的泰科彼得森。

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?

我先從流程說起。截至六月底，你們的成長率是8%。顯然，正如您所提到的，第二波疫情以及一些診斷方面的不利因素帶來了許多波動。您能否談談本季的線性成長情況？七月、八月和九月的業績如何？十月上半月的情況如何？您認為診斷上的不利因素何時會逆轉？您認為這可能會如何發展？

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.

馬歇爾，不如你先就線性度問題談談你的看法？我們再簡單聊聊－我來談談診斷流程方面。

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。正如我們上次通話所述，本季初的經濟情勢相對於六月中旬而言較為低迷。此後，經濟情勢在本季緩慢復甦。當然，由於各地區情況不盡相同，經濟走勢難免有所波動，但總體而言，經濟在本季度穩步回升，並在第三季末可能達到了高峰。

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，我認為醫療服務提供者普遍認識到，這些流程停滯不前對任何人都沒有好處。我認為目前正在努力推進這些流程。話雖如此，至於這些流程的恢復速度以及患者前來就診的舒適度，我認為我們都需要拭目以待。所以我們會持續關注並追蹤進展。通路調查顯示，相關人員正在努力。至於流程何時能夠最終完成，我認為目前還沒有人能夠準確預測。

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，Gary，關於上個季度的一些進展，例如延期使用工具和價格調整，您能否分享一些與客戶溝通的軼事，說說他們對增量使用的看法？您剛才提到了延期使用工具的監管障礙，我想這應該比較容易解決。您能否也談談這方面？

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。從客戶回饋來看，我們看到了正面的迴響。不同的市場區隔群體，無論是人們希望使用我們的設備（達文西手術系統）進行哪些類型的手術，或是不同的地區，都存在差異。這些地區的報銷和支付機制也各不相同。在那些壓力較大的地區，我們看到了非常積極的參與和回饋。我們會隨著時間的推移繼續觀察。我認為，在早期擴展使用階段，新冠疫情將是一個複雜的影響因素。早期的驅動因素可能很簡單，例如人們如何同時治療新冠和非新冠患者，但我們認為，隨著時間的推移，這對我們來說將非常有利，而且分析其潛在價值並不難。

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.

就監管途徑而言，我們認為監管方面不存在真正的障礙。我認為驗證方面還有一些工作要做。除此之外，我認為一切都在掌控之中。因此，我認為在延長使用期限的醫療器材的監管審批方面不會遇到什麼壓力。

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。最後一個問題是關於中國的。您在關於配額的評論中提到，明年可能會有競爭性系統獲得批准。能談談中國的競爭環境嗎？您是否看到有更多平台湧現？

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.

對許多人來說，中國有不少商業集團正在研發各種類型的系統，無論他們是想與多端口的達文西手術系統、單端口系統還是離子型系統競爭。我們看到市場對這些系統都表現出了興趣。最終，它們將通過監管審批流程，進入市場。我們看到中國市場需求旺盛。我認為，配額的增加反映了客戶的興趣，而這些需求正在逐步通過國家審批流程，以獲得額外的批准。因此，我們感覺自身在競爭中處於有利地位。我們認為中國存在一個真正的市場，但目前受到配額制度的限制。我們預計，看到市場價值後，其他企業也會進入這個市場。我們已經調整了團隊，確保我們能夠比其他企業更好地滿足客戶的需求。

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

接下來，我們來聽聽摩根士丹利的戴維‧劉易斯提出的問題。

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.

加里，我這裡就幾個問題。很明顯，整個季度的手術流程趨勢已經趨於正常，這一點你和強生都看到了。你提到了各種因素，例如積壓病例的減少、醫院容量的提升以及診斷水平的提高。那麼，未來緩慢而穩定地改善，但速度會更溫和，這種預期是否合理？我們從強生公司得到的資訊大致是如此。我想請你對此發表一下看法。所以，我們會看到改善，但這種改善在未來將會更加循序漸進。

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.

我不敢妄下斷言，因為我無法預知新冠疫情的未來走向和壓力。但我可以肯定的是，醫院目前應對各種並發需求的能力有所提升。我認為他們已經制定了完善的應對方案，並且擁有了早期所缺乏的資源和個人防護裝備等物資。這讓我們感到欣慰，除非出現大規模的患者湧入，否則他們應該能夠應對不同規模的患者需求。

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.

未來會如何發展——抱歉，產能才是關鍵。他們顯然希望進行微創手術，而且是高品質的微創手術，並且對我們的產品感興趣，這讓我感到安心。至於天氣變化和新冠疫情的影響，我認為Intuitive很難直接預測。

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。但聽起來，在一切正常的情況下，系統似乎持續改進。當然，你無法控制外在因素。

I think that's fair.

我覺得很公平。

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，非常公平。關於延長使用時間，我有兩個問題。馬歇爾，我好像聽到你說過，如果我聽錯了請見諒，客戶在第三季的購買模式並沒有改變。我只是好奇你認為這是為什麼？顯然，你是否更有信心第四季情況會有所改變？還有，加里，如果我說延長使用時間會帶來一到兩方面的影響，例如吸引更多普通外科醫生和更多類型的手術，或者刺激對第四代平台的需求，你認為近期內更大的驅動因素是什麼？

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?

所以我們在七月宣布了這項計劃，其初衷是希望醫院能夠利用該計劃來管理庫存水準。他們有自己的做法。我無法回答他們之前的採購模式是怎麼樣的。我認為，就未來而言，將會有一個徹底的轉變。你不會再看到醫院同時採購這兩種產品，我們也不會提供這兩種產品的組合。我們基本上會將其全部切換到長效醫療器材。所以，就像我在稿子裡說的那樣，這將對第四季度產生影響，但我認為從醫院的經濟角度來看，這將是積極的，而這正是該計劃的初衷，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.

接下來談談我們認為它將帶來的改變。首先，我們認為外科醫生有興趣廣泛使用我們的產品，尤其是在傳統上採用腹腔鏡進行的手術中。公司成立初期，我們的產品主要取代了傳統開放性手術。在開放性手術盛行、手動微創手術難度極高的地區，我們的產品提供了一種微創手術的選擇。然而，在一般外科領域，我們也看到了這種趨勢——我們客戶群的一項調查顯示，達文西機器人手術通常採用腹腔鏡進行。

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.

這其中是有原因的。這套系統符合人體工學，能夠讓使用者舒適且反覆地處理更複雜的案例。因此，我們看到了這方面的真實需求。隨著規模的擴大，隨著我們多年來對儀器品質和製程的改進，以及我們不斷進行的設計調整，我們能夠讓那些希望更廣泛地使用它的人更容易、更經濟地實現這一目標。所以我們認為，從長遠來看，這將刺激這方面的更多需求，更準確地說，它將降低門檻。我認為客戶想要使用這套系統，而這降低了他們使用這套系統的門檻。

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，我認為有很多充分的理由促使客戶升級——例如，如果他們目前使用的是第三代或第二代系統，可以選擇升級到第四代系統（Xi 或 X），或者升級到 S 或 Si 系統。延長使用壽命的儀器只是其中一個優點。所以我認為升級有助於解決這個問題。但如果非要權衡的話，我認為前者（指延長使用壽命的儀器）的吸引力更大。延長使用壽命的儀器、新一代影像技術、新一代先進儀器、新一代縫合技術和血管密封技術，這些都是從 Si 系統升級到第四代系統的絕佳理由。

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拉里·比格爾森。

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.

關於復甦方面也有類似的問題，但這次是從系統層面來說。 Gary，你覺得未來幾季狀況會如何發展？有沒有什麼與醫院溝通的案例可以分享？本季的使用率下降幅度小於上季。我還有一個後續問題。

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.

我對與各醫院就係統及其機器人手術專案進行的溝通進度比較滿意。我認為他們的態度非常理性。他們認為高品質、微創手術在未來至關重要。他們現在掌握了大量數據（其中許多數據由我們提供），可以用來了解和評估其專案的績效。他們可以觀察並思考：如果患者術後恢復情況有所改善，這是否對他們有幫助？總的來說，他們認為這確實有幫助。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，我認為他們都在努力規劃2021年的財務狀況。有些公司對財務狀況的可見度較高，有些則不然。所以我認為他們可能會採取循序漸進的方式，而我們也確實看到了這種趨勢。我對長遠發展並不感到悲觀。我認為，分析能力與對低波動性、高品質幹預措施價值的認識相結合，將會帶來非常強大的優勢。因此，短期內很難預測。正如馬歇爾所說，我們預計會面臨壓力。我認為馬歇爾說得對。話雖如此，從長遠來看，隨著手術的恢復，資金將變得至關重要。我們將不斷創新產品，從而推動升級週期。

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幾乎只專注於有機種植，早期投資智慧財產權並圍繞智慧財產權開發產品，而不是收購擁有商業產品的公司或整合分銷管道。您預計未來幾年這種情況會改變嗎？這也是您宣布成立Intuitive Ventures的部分原因？

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。我認為我們對自身的創新能力充滿興趣和自豪，我希望它能繼續成為我們的支柱，並融入我們的基因。隨著我們的發展，以及市場（尤其是醫療市場）開始真正認識到機器人輔助手術和電腦輔助手術的潛力，我認為許多新的途徑正在湧現，這為我們提供了機會。我們並非「非我發明」的文化。我們對外部的優秀人才持開放態度。我們開展了許多活動和持續的合作。這些活動和合作可能會隨著時間的推移而擴大規模。我們可能會繼續進行這些活動。總的來說，我更傾向於儘早引入新技術。另一方面，如果某個技術很有意思，我們也會持開放態度。我認為，創投基金和我們的未來發展計畫正在建立一個有趣的生態系統。許多技術分支能夠對醫學產生重大影響。我們希望促進這種發展。

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

接下來，我們來聽聽高盛的 Amit Hazan 提出的問題。

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?

我想嘗試從新技術和研發管線的角度來談談。或許可以從研發的角度再談一次。我覺得你過去在這方面回答得最得心應手。所以，就從這個角度來問吧。顯然，儘管面臨壓力，研發支出在過去幾季仍在持續成長。您能否談談研發支出中最大的幾個類別，以及目前最關注的領域？還有，您是如何分配這些研發支出的呢？

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.

好的，我先開始，然後請馬歇爾再詳細說說比較分析。我們通常從三個方面來考慮這個問題。首先，我們可以投資哪些項目，這些投資能夠帶來實質的改變，不是2%的改變，而是更大的改變。這些項目會引起我們的關注，並引導我們進行一系列投資。這是第一點。

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.

我們正在尋找新的方法，以減少對健康組織的損傷，並降低手術的變異性。如您所知，我們一直在努力尋找能夠為外科醫生提供更多資訊並使其更易於理解的方法，無論是先進的成像技術、更高品質的成像技術還是機器學習。所有這些都是為了幫助外科醫生做出決策，減輕他們的負擔，我們在這一領域取得了顯著進展。過去幾個季度，或許幾年以來，我們一直在探討如何促進良性循環：提高產量、提升品質、降低產品製造成本，並將節省下來的成本回饋給客戶，使他們能夠將我們的產品應用到他們想要的領域，我們也看到了這種趨勢正在發生。以上就是我們目前思考的重點。馬歇爾，關於大致的混合方案，就交給你來回答吧。

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。從年度角度來看，正如我在演講稿中提到的，最大的投資領域實際上是數位化能力、人工智慧、機器學習和資訊學。其次是先進成像技術及其相關能力，您也看到了我們推出了新的內視鏡技術，同時也投資其他解剖成像方式。當然，另外兩個領域是離子和SP，我們正在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，關於Iris，我想再補充一點。既然您提到了，我認為它在本季度恢復得很好。我很想更深入地了解你們的部署和實施情況。我的意思是，顯然，在這個領域有很多實力雄厚的公司，你們其實需要與之競爭、合作。您現在如何看待這個領域的發展？在未來一兩年內，我們應該考慮哪些發展方向？

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.

我先簡單介紹一下Iris是什麼。這是一個擴增實境程序，它可以將術前3D模型、核磁共振和CT掃描等通常在患者術前準備流程中已經完成的數據整合起來，讓外科醫生能夠非常輕鬆地即時存取這些數據。首先，在手術前，這些數據可以幫助他們更好地了解手術情況並制定手術計劃；其次，這些數據可以即時顯示在手術控制台上。

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，這其實是個非常簡單的想法。正如你所說，而且說得沒錯，真正難的是把它做好，好好執行。我們在這個領域有一些非常優秀的合作夥伴，可以一起實現這個目標。想想看——我們自己並不去獲取這些圖像。它們是透過其他人的設備取得的。這些公司有動力並且樂於接受各種方案，推動這些技術的發展。我們和他們一直保持著良好的合作關係。我們已經開發了一些非常酷的專有技術。我們擁有一支傑出的科學家和電腦科學家團隊，他們一直在深入研究如何讓擴增實境技術真正發揮作用。快速製作一個原型很容易，但要讓它能夠真正融入手術流程，並且不干擾外科醫生的操作，就很難了。這正是Iris自那時以來一直在努力的方向。

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，如果你仔細想想，這能帶你深入了解人體內部的哪些面向呢？這真的很奇妙。你會對血管系統、實體器官的運作、腫瘤邊界感興趣。外科醫生可以利用這些訊息，思考可能的手術方案，從電腦系統獲得手術建議，並與患者溝通。這些都是非常有益的、有助於展開討論的方式。我認為，相對於市場上其他公司以及大學裡的研究人員而言，我們在這方面相當有優勢。所以，我們的團隊非常出色。

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.

隨著時間的推移，這項技術將如何發展？接下來我們將研究身體的哪些部位？我們已經制定了路線圖，並且正在逐步推進。我們相信外科醫生和醫院會重視這項技術。我們正在 Iris 1.0 中累積證據，這是首次發布，旨在真正確立其價值並製定路線圖。到目前為止，我們已經擁有了許多來自公司內外的熱情支持者。所以，目前一切進展順利。

Our next question comes from Larry Keusch with Raymond James.

下一個問題來自 Raymond James 公司的 Larry Keusch。

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.

好的。您在準備好的評論中提到了一些，但我很好奇，您是如何看待我們目前的流程的？積壓的案件和已經完成的案件狀況如何？目前，我們是如何開始處理積壓案件並著手處理新案件的？或者說，我只是想了解一下您認為積壓案件是如何逐步處理的。

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.

我覺得我們是從三個不同的角度切入的，所以沒什麼特別的見解可以分享。我倒希望自己能有更好的見解。不過，就算有人給了你什麼高見，我也未必會相信。話雖如此，菲爾，既然你已經有了這麼好的思路，如果你有什麼想補充的，請儘管說。

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，在我們準備好的演講稿中，我們已經明確提到，有些患者的治療被推遲了——他們現在正在推遲治療，這顯然對患者不利。所以，正如加里在稿子中提到的，我們已經處理了一些積壓的病例，但仍然有一些患者的治療被推遲，他們的情況仍然需要處理。

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，盡我們所能幫助他們向患者提供保障，確保患者持續接受醫療保健。如果能與其他機構合作簡化這個過程，我們當然樂意。我們也確實獲得了一些這樣的機會。總的來說，我認為這項流程的主要負責人是醫療服務提供者，而我們始終支持他們。之所以難以建立統一的模式，是因為沒有哪個地區、哪家醫院、哪個國家能夠完全遵循單一的模式。因此，我們需要在非常廣泛的範圍內進行整合。

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，太好了。第二個問題是，您剛剛多次提到延長儀器使用期限以及降低複雜度較低的儀器價格所帶來的好處。當然，這些都很有道理。我想大家想了解的一個關鍵點是，您是如何看待價格彈性的？它對潛在市場規模（TAM）又會產生什麼影響？想必，這項分析的部分目的是為了確定儀器的合理價格。所以，我想知道，在您對價格調整後，您現在是如何看待潛在市場規模（TAM）的擴張？還有什麼補充嗎？

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，這個問題問得好。顯然，我們認為不同價位的需求量更大，這取決於人們想要做的手術類型以及不同地區的市場狀況。至於未來一段時間內的潛在市場規模（TAM）是多少，我認為我們目前還無法在這次電話會議上與您分享。但我們相信，隨著時間的推移，尤其是在明年，我們將更清楚地了解實際情況與我們模型預測的差異，屆時我們將開始與您分享更多關於我們模型預測的資訊。

So operator, just one more caller, please.

接線員，請再接一通電話。

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

這個問題將由美國銀行的鮑伯霍普金斯提出。

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.

好的。鑑於時間已晚，我就問一個問題。加里，我好像聽到你說過，你預期各項流程會在中期恢復正常。首先，我沒聽錯吧？其次，我很好奇你對「中期」的定義是什麼。最後，也許也是最重要的一點，我很好奇是什麼讓你如此自信，因為有些人開始認為，這些新冠疫情帶來的問題可能會對醫院的病患診療流程或後勤保障產生一些持久的影響。所以，我想請你詳細解釋一下你對「中期」的看法。

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，有道理。我並沒有設定具體的時間期限。坦白說，我認為正如你在問題中所描述的那樣。我認為，你的問題隱含的意思是，隨著新冠疫情得到控製或得到有效管理，確保人們不會患有未確診的疾病，或者確診的疾病得不到治療，這符合醫療系統和患者的利益。

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.

我認為全球的醫療衛生系統、衛生政策制定者和機構領導者都在努力確保他們能夠更好地服務各自的群體。對我而言，中期目標的定義是，當他們克服了積壓病例和病患流動的難關之後，情況就會好轉。這可能意味著在新冠疫情的背景下進行管理，也可能意味著新冠疫情的影響開始減弱，他們有了更大的應對空間。

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，這種情況可能會以幾種不同的方式發展。只要醫院系統對新冠疫情仍處於被動應對狀態，我認為我們目前還處於短期階段。因此，我會將中期定義為人們不再完全處於被動應對狀態，而是能夠同時管理其他事務的時候。我們看到，在一些新冠疫情仍然存在、疫情沒有失控的國家，他們能夠很好地控制疫情。在這些國家，我們看到外科手術患者的管理也恢復得相當不錯。這種情況正在越來越多的國家出現。這需要多長時間？我真的不知道。而具體的催化劑是什麼？這取決於新冠疫情的管理政策。

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

好的，謝謝你，鮑伯。嗯，這是我們最後一個問題了。

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，我們仍然堅信，在從根本上改善外科手術和急診幹預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，追求客戶所稱的「四重目標」：更佳、更可預測的患者治療效果，更佳的患者體驗，更佳的護理團隊體驗，以及最終更低的醫療總成本。我們認為，外科手術和急診的價值創造根植於人性。它源自於對病人和照護團隊、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 with you again in 3 months. This concludes today's call.

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。今天的通話到此結束。

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，今天的會議到此結束。感謝您使用AT&T電話會議系統參與本次會議。您現在可以斷開連線了。