直覺手術 (ISRG) 2020 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Q2 2020 Earnings Release. (Operator Instructions) As a reminder, this conference is being recorded.

女士們、先生們，感謝你們的耐心等待，歡迎參加 Intuitive 2020 年第二季財報發表會。（操作說明）提醒各位，本次會議正在錄音。

Now I'd like to turn the call over to Senior Director of Finance, Investor Relations for Intuitive Surgical, Calvin Darling. Please go ahead.

現在，我想把電話交給直覺外科公司（Intuitive Surgical）的高級財務總監兼投資者關係主管卡爾文·達林（Calvin Darling）。請繼續。

Thank you. Good afternoon, and welcome to Intuitive's Second Quarter Earnings Conference Call. With me today, we have Gary Guthart, our CEO; Marshall Mohr, our Chief Financial Officer; and Philip Kim, whom I'm pleased to introduce, our Head of Investor Relations. As for me, while passing the lead over to Phil, I plan to continue on in a support role with our Investor Relations team.

謝謝。下午好，歡迎參加 Intuitive 第二季財報電話會議。今天和我在一起的有：我們的執行長 Gary Guthart；我們的財務長 Marshall Mohr；以及我很高興向大家介紹的投資者關係主管 Philip Kim。至於我，在將領導工作移交給菲爾的同時，我計劃繼續在投資者關係團隊中擔任支援角色。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are described in detail in our Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 7, 2020, and Form 10-Q filed on April 17, 2020. Our SEC filings can be found through our website or at the SEC's website. Investors are cautioned not to place undue reliance on such forward-looking statements.

在開始之前，我想告知各位，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於存在某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定性已在我們的證券交易委員會文件中進行了詳細描述，包括我們最近於 2020 年 2 月 7 日提交的 10-K 表格和於 2020 年 4 月 17 日提交的 10-Q 表格。您可以透過我們的網站或美國證券交易委員會的網站找到我們向該委員會提交的文件。投資者應注意，不要過度依賴此類前瞻性陳述。

Please note that this conference call will be available for audio replay on our website at intuitive.com, on the Latest Events section under our Investor Relations page. Today's press release and supplementary financial data tables have been posted to our website. In addition, this quarter, we have also posted a chart illustrating 2020 weekly da Vinci procedure trends, which is intended to provide additional perspective in detail regarding the impact of COVID-19 on our business.

請注意，本次電話會議的音訊回放可在我們的網站intuitable.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。此外，本季度我們還發布了一張圖表，展示了 2020 年每週達文西手術趨勢，旨在更詳細地提供有關 COVID-19 對我們業務影響的更多視角。

Today's format will consist of providing you with highlights of our second 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 Philip will discuss procedure details. And finally, we will host a question-and-answer session.

今天的會議形式將包括：首先向您介紹我們今天早些時候發布的新聞稿中所述的第二季度業績亮點，然後進行問答環節。Gary 將介紹本季的業務和營運亮點。馬歇爾將對我們的財務表現進行回顧，然後菲利普將討論程序細節。最後，我們將舉行問答環節。

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. On this call, we'll describe our experience in the quarter, the actions we are taking and our priorities going forward. Our focus now and in the past is the safety and well-being of patients, care teams, our communities and our employees.

感謝您今天蒞臨。在本次電話會議上，我們將介紹本季我們所取得的成果、我們正在採取的行動以及我們未來的工作重點。我們現在和過去一樣，關注的重點是病人、照護團隊、社區和員工的安全和福祉。

Turning first to global procedures. We ended Q2 2020 down 19% compared with Q2 2019. The underlying driver for this decline has been the growth of COVID-19 in the communities that our customers serve. While we saw procedure declines in all categories, urology and thoracic procedures were relatively resilient, while gynecology experienced the greatest decline. Rates of recovery from lowest by procedure type were more uniform. We've seen hospitals with adequate supplies of staff, PPE and physical resources return to above 90% of pre-COVID procedure run rates over a few months period. Recovery above this number is dependent upon the intensity of COVID in the region, patient's comfort to return to the hospital, availability of testing and patient outreach.

首先來看全局流程。2020年第二季末，我們比2019年第二季下降了19%。導致這一下滑的根本原因是 COVID-19 在我們的客戶所服務的社區中蔓延。雖然所有類別的手術量都有所下降，但泌尿外科和胸腔外科手術相對保持穩定，而婦科手術的下降幅度最大。按手術類型劃分的最低恢復率則較為一致。我們看到，在人員、個人防護裝備和物質資源充足的情況下，醫院的手術量在幾個月內恢復到新冠疫情前90%以上的水平。康復人數超過此數字取決於該地區 COVID 的嚴重程度、患者返回醫院的意願、檢測的可用性和患者聯絡情況。

As we stand here in July, we see the continued growth of COVID in some regions, both domestically and internationally, making future predictions on hospital capacity for surgery difficult. Philip will take you through some examples of regional differences in procedure trends later in the call.

截至7月，我們看到新冠疫情在國內和國際上一些地區持續蔓延，這使得未來對醫院手術能力的預測變得困難。稍後，Philip 會帶你了解一些關於程式趨勢的區域差異的例子。

With regard to capital placements, we installed 178 new systems in Q2 2020. This compares to 273 installs in Q2 2019 and 237 installs in Q1 2020. The new installs in Q2 2020 represent a clinical installed base growth of 9% after accounting for trade-ins. While these numbers are lower than prior year and prior quarter, frankly, they are greater than our expectation coming into the second quarter due to strong performance in Asia and some larger IDN placements in the U.S.

在資本配置方面，我們在 2020 年第二季安裝了 178 個新系統。相比之下，2019 年第二季安裝了 273 次，2020 年第一季安裝了 237 次。2020 年第二季的新安裝量，在計入以舊換新後，臨床安裝基礎成長了 9%。雖然這些數字低於去年同期和上一季度，但坦白說，由於亞洲市場的強勁表現以及美國一些規模較大的 IDN 部署，這些數字高於我們進入第二季度時的預期。

That said, we know the correlation between system utilization in the form of procedure demand and capital availability at hospitals is a strong one. Hospitals will seek to absorb existing capacity before installing new capital. So on average globally, we expect a challenging near to midterm environment for future capital placements as COVID-19 wears on and hospital expenditures remain constrained. Because COVID is impacting locales differently, we see significant variability in procedure growth and new system placement interest by region. Marshall will take you through capital placement trends and risks later in the call.

也就是說，我們知道，醫院的程序需求與資金可用性之間的系統利用率之間存在著強烈的相關性。醫院會優先考慮消化現有醫療資源，然後再投入新的資金。因此，在全球範圍內，我們預計在中短期內，隨著 COVID-19 疫情持續蔓延和醫院支出持續受限，未來的資本配置環境將充滿挑戰。由於 COVID 對不同地區的影響不同，我們看到不同地區的手術量成長和新系統植入興趣有顯著差異。馬歇爾將在稍後的電話會議中向您介紹資本配置趨勢和風險。

Stepping back and evaluating hospital approaches to surgery during this period, we see some principles that are being applied broadly. During local, rapid growth of COVID in a hospital catchment area, their initial response is to align and train their workforce, stabilize their PPE and testing capability, and if ICU resources are scarce, defer surgeries that can be delayed with a managed risk to the patient. As staff, material and ICU resources free up, either by diverting patients to alternative sites of care or within the 4 walls of the hospital, program directors triage patients in need of surgery and ramp back up, the sites become less impacted. We have observed that outreach, education and diagnostic business and procedures come back.

回顧這段時期醫院的手術方法，我們發現了一些被廣泛應用的原則。在醫院服務區域內新冠疫情快速蔓延期間，醫院的初步應對措施是調整和培訓員工隊伍，穩定個人防護裝備和檢測能力，如果重症監護室資源短缺，則推遲那些可以推遲且對患者風險可控的手術。隨著人員、物資和重症監護室資源的釋放（無論是透過將病人轉移到其他護理場所或在醫院內進行治療），計畫主管對需要手術的病人進行分診並逐步恢復，各場所受到的影響就會減少。我們觀察到，外展、教育和診斷業務及流程正在恢復。

The surge of COVID in communities that represent our core markets, either from initial spread or secondary growth, is occurring now. Add to the significant anecdotal evidence of delayed diagnostic visits for non-COVID illness, and we expect that the recovery tail of surgery will be a long one, likely to last many quarters. The ultimate timing and shape of recovery remains uncertain. The drivers of a sustained recovery in surgery will likely vary regionally and may be predicated on the extent and duration of COVID outbreaks, the availability of human, material and physical resources to concurrently treat both COVID and other disease, patient comfort in returning to care centers for diagnostics and treatment and, finally, the relative health of the broader economy and hospital finances.

目前，代表我們核心市場的社區正面臨 COVID 疫情的激增，無論是最初的傳播還是二次增長。再加上大量非新冠​​肺炎疾病診斷就診延遲的軼事證據，我們預計手術後的恢復期將會很長，可能會持續好幾個季度。復甦的最終時間和形式仍不確定。外科手術持續復甦的驅動因素可能因地區而異，並可能取決於 COVID 疫情的程度和持續時間、同時治療 COVID 和其他疾病的人力、物力和物理資源的可用性、患者返回護理中心進行診斷和治療的舒適度，以及最終，整體經濟和醫院財務狀況的相對健康狀況。

At Intuitive, we're focused on those activities and priorities within our control. They are as follows: first, we're focused on the health and well-being of our customers, our employees and our communities. As COVID has ramped in our communities, we instituted employee health and safety protocols and have been tracking our performance and refining our methods. We are also working with our foundation and others to produce and donate PPE for customers in the communities in which we work and live, having delivered to date over 1 million pieces of PPE; second, we focused on inventory and supply chain management. So far, product availability has been strong, thanks to the relentless work of our supply chain teams and our partners; third, we implemented our customer financial relief program in the quarter. The timeliness and the design of the program has been well-received by our customers; fourth, we continue to invest in our high-priority programs, recognizing that high-quality MIS is likely more important in the coming years post-COVID, not less so, if we're evaluating those activities that should be accelerated in the incurrent environment and for which demand is likely to be durable post-COVID; finally, we're constraining spend where we believe it is suboptimal in the current environment.

在 Intuitive，我們專注於我們可控範圍內的活動和優先事項。具體來說：首先，我們關注客戶、員工和社區的健康和福祉。隨著 COVID-19 在我們社區的蔓延，我們制定了員工健康和安全規程，並一直在追蹤我們的績效和改善我們的方法。我們也與基金會和其他機構合作，為我們工作和生活所在社區的客戶生產和捐贈個人防護裝備，迄今已交付超過 100 萬件個人防護裝備；其次，我們專注於庫存和供應鏈管理。到目前為止，產品供應情況良好，這要歸功於我們的供應鏈團隊和合作夥伴的不懈努力；第三，我們在本季實施了客戶財務援助計畫。第四，我們客戶的回饋表明，該項目的及時性和設計都非常出色；第五，我們繼續投資於高優先級項目，因為我們認識到，在後疫情時代，高品質的管理資訊系統（MIS）的重要性可能會更高，而不是更低。如果我們評估哪些活動應該在當前環境下加速推進，以及哪些活動的需求在後疫情時代可能會持續存在，那麼高品質的MIS的重要性就會更高；最後，我們會限制在我們認為當前環境下支出不足的領域的支出。

Turning to instruments, beginning Q4 this year, we plan to introduce an updated set of select EndoWrist instruments for use with da Vinci X and Xi that will enable increased use beyond the current 10 years life span, part of our extended use program. Extended use will vary from 2 to 8 additional uses per instrument and is the result of continuous and significant investment in the design and production of our instrument technologies that have resulted in improved quality and durability. In addition, we'll concurrently lower the price of some other instruments that are most commonly used in lower acuity procedures.

說到器械方面，從今年第四季開始，我們計劃推出一套更新的精選 EndoWrist 器械，用於達文西 X 和 Xi 手術系統，這將使器械的使用壽命超過目前的 10 年，這是我們延長使用期限計畫的一部分。延長使用期限為每台儀器額外使用 2 至 8 次，這是由於我們對儀器技術的設計和生產進行了持續的大量投資，從而提高了品質和耐用性。此外，我們也將同時降低一些常用於低風險手術的其他儀器的價格。

We are dedicated to support our customers' pursuit of the quadruple aim, defined as better patient outcomes, better patient experiences, better care team experiences and lower total cost to treat per patient episode. The long-term opportunity for our products and services is substantial, both in high acuity complex procedures and in shorter duration lower acuity cases, where customers are understandably more cost sensitive. Some EndoWrist instruments are used in every procedure, so our extended use program helps all customers and, in particular, those performing lower acuity cases, which are among the fastest-growing procedures. As the program rolls out, I&A cost for customers performing lower acuity procedures will be highly competitive with non-robotic MIS approaches.

我們致力於支持客戶追求四重目標，即更好的患者療效、更好的患者體驗、更好的護理團隊體驗以及更低的每次患者治療總成本。我們的產品和服務具有巨大的長期發展機遇，無論是在高風險的複雜手術中，還是在持續時間較短、風險較低的病例中（客戶對成本的敏感度顯然更高），都存在著巨大的發展機會。有些 EndoWrist 器械在每項手術中都會用到，因此我們的延長使用計劃可以幫助所有客戶，特別是那些進行病情較輕手術的客戶，而病情較輕的手術是增長最快的手術之一。隨著該計劃的推出，對於進行低難度手術的客戶而言，I&A 成本將與非機器人微創手術方法相比具有強大的競爭力。

I have described our commitment to a virtuous cycle of value adjustment for our customers, driving volume increases, allowing us to invest in design and manufacturing at scale and giving us the opportunity to share these savings with our customers to allow them to use our products more broadly. This program is another step in this journey. Our extended use program has been years in the making, and its timing is fortuitous relative to COVID. We are pleased to bring it to our customers now. The program will negatively impact our near term revenue, but not substantially impact our gross margin for affected instruments. It is the right decision for our customers and, therefore, for Intuitive long term. Marshall will take you through financial implications of this program later in the call.

我已經闡述了我們致力於為客戶創造良性循環價值調整的承諾，這將推動銷售成長，使我們能夠大規模投資於設計和製造，並讓我們有機會與客戶分享這些節省下來的成本，使他們能夠更廣泛地使用我們的產品。這個項目是這段旅程中的又一步。我們的延期使用計畫籌備多年，它的推出時機恰逢新冠疫情爆發。我們很高興現在能將它帶給我們的客戶。該計劃將對我們的近期收入產生負面影響，但不會對受影響儀器的毛利率產生實質影響。對於我們的客戶而言，這是一個正確的決定，因此，從長遠來看，這對 Intuitive 來說也是正確的決定。馬歇爾稍後會在通話中詳細介紹該計劃的財務影響。

Turning to advanced instruments. Our da Vinci energy platform, which includes our next-generation energy instrument and system, SynchroSeal and E-100, have made surprisingly good commercial progress in the second quarter in spite of current environmental challenges, a testament to customer reception to its speed and precision. We also initiated our first commercial cases for E-100 and SynchroSeal in Japan in the quarter. And lastly, our 45-millimeter SureForm stapler launched in Europe in the second quarter.

轉而使用更先進的儀器。儘管面臨當前的環境挑戰，我們的達文西能量平台（包括我們的下一代能量儀器和系統 SynchroSeal 和 E-100）在第二季度取得了令人驚訝的良好商業進展，這證明了客戶對其速度和精度的認可。本季度，我們也在日本啟動了 E-100 和 SynchroSeal 的首批商業案例。最後，我們的 45 毫米 SureForm 訂書機於第二季在歐洲上市。

Turning to other programs of interest. Our Ion program continues to march forward in the face of COVID headwinds. Three systems were placed in the quarter, and our clinical trial is progressing. Design and manufacturing teams continue to make progress on incorporating learnings to allow us to drive towards wider distribution in the future. While our progress in our PRECISE trial for Ion has been slowed, we're seeing a return to cases as our clinical trial partners come free.

轉向其他有興趣的節目。儘管面臨新冠疫情帶來的不利影響，我們的離子計畫仍在持續進行中。該季度安裝了三套系統，我們的臨床試驗正在進行中。設計和製造團隊不斷取得進展，將經驗融入產品中，以便我們未來能夠實現更廣泛的分銷。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恢復正常，我們看到病例數量正在回升。

For our SP program, our teams continue to support our early customers. Average monthly utilization for SP in Korea continues to exceed that of Xi, a strong positive that speaks to early interest in the platform by surgeons and their patients. In addition to our learning from Korea, we are working with regulatory agencies regarding expansion of indications. The regulatory environment in the U.S. and EU has become more complex for new systems over time, made more challenging by diversion of resources at hospitals and at regulators to fight COVID, which impacts clinical trials and regulatory reviews. We'll update progress on additional indications for SP as we have greater clarity.

對於我們的SP計劃，我們的團隊將繼續為早期客戶提供支援。SP 在韓國的平均每月使用率持續超過 Xi，這是一個強烈的積極信號，表明外科醫生及其患者對該平台表現出了早期興趣。除了向韓國學習之外，我們還在與監管機構合作，探討擴大適應症範圍的問題。隨著時間的推移，美國和歐盟的新系統監管環境變得越來越複雜，醫院和監管機構將資源轉移到對抗新冠疫情上，這給臨床試驗和監管審查帶來了更大的挑戰。我們將根據情況，在對 SP 的其他適應症有更清晰的了解後，及時更新進展。

In our intelligence and analytics programs, our teams are performing well, and we are leveraging our prior investments in cloud computing, training technologies and analytics prowess. We have focused on our integration of cloud technologies with InTouch to accelerate access to remote proctoring in certain regions. We had already moved to a network subscription model for our simulation technology platform called SimNow, which is helping us decrease travel for surgeons for some elements of surgical training. Use of our hospital analytics programs is accelerating, even through the turbulence of 2020, helping hospitals and us in planning for system use in dynamic times like these.

在我們的情報和分析專案中，我們的團隊表現出色，我們正在利用先前在雲端運算、培訓技術和分析能力方面的投資。我們專注於將雲端技術與 InTouch 結合，以加速某些地區遠距監考的普及。我們先前已將名為 SimNow 的模擬技術平台轉向網路訂閱模式，這有助於減少外科醫生在某些外科培訓環節的出行。即使在 2020 年的動盪時期，我們的醫院分析程序的使用也在加速增長，這有助於醫院和我們規劃在這樣動態的時期中使用系統。

Before concluding my prepared remarks, let's step back. We cannot yet see the end of the COVID-19 pandemic. When the lessons from this event are absorbed, I believe high-quality, minimally invasive care will be more important to the future, not less so. A balanced approach to improving the quadruple aim remains our North Star. Our priorities for the next few quarters are 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, different customers are at different stages in this period and we'll support them according to their needs; third, advancing our priority programs, instruments, accessories, endoscopy systems and intelligence programs; and finally, disciplined spend management during a period of change.

在結束我準備好的發言之前，讓我們先回顧一下。我們目前還看不到新冠肺炎疫情何時結束。我相信，當我們吸取了這次事件的教訓之後，高品質、微創的醫療照護在未來會變得更加重要，而不是不那麼重要。採取平衡的方法來提高四重目標仍然是我們的指路明燈。未來幾個季度，我們的工作重點如下：第一，在確保供應鏈穩定的同時，繼續在客戶、員工和社區安全方面保持強勁勢頭；第二，繼續根據客戶的具體情況提供支持，不同的客戶處於不同的階段，我們將根據他們的需求提供支持；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；最後支出，在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 will describe the highlights of our performance on a non-GAAP or pro forma basis. I will also summarize our GAAP performance later in my prepared remarks. A reconciliation between our pro forma and GAAP results is posted on our website.

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

Key business metrics for the second quarter were as follows: second quarter 2020 procedures decreased approximately 19% compared with the second quarter of 2019 and decreased approximately 22% compared with last quarter; second quarter system placements of 178 systems decreased 35% compared with 273 systems last year and decreased 25% compared with 237 systems last quarter; we expanded our installed base of da Vinci systems over last year by 9% to approximately 5,764 systems. This growth rate compares with 11% last quarter and 13% last year; utilization of clinical systems in the field, measured by procedures per system, declined approximately 27% compared with last year and declined 23% compared with last quarter.

第二季的關鍵業務指標如下：2020 年第二季手術量較 2019 年第二季下降約 19%，較上季下降約 22%；第二季系統安裝量為 178 套，較去年同期的 273 套下降 35%，文西較上季的 237 套下降 25%；達文這一增長率與上季度的 11% 和去年的 13% 相比有所下降；臨床系統在現場的使用率（以每個系統的手術量衡量）與去年相比下降了約 27%，與上季度相比下降了 23%。

Let me walk through the impact of COVID-19 pandemic on procedures and system placements and how it varied by market. The impact of COVID-19 varied significantly among geographies. To assist in your understanding of this dynamic, we have posted a graph showing U.S., China, Japan and Germany procedures in the Investor Relations portion of our website. In that graph, we compare procedures to the average of the first 2 complete weeks of the first quarter, which we have characterized as pre-COVID-19 level. In the U.S., procedure volumes started the second quarter at around 30% of pre-COVID-19 level and grew by the middle of June to nearly the level measured in the first 2 weeks of the first quarter. However, with the resurgence of COVID-19 regionally in the U.S. and related deferrals of elective surgeries, procedures began to decline in the last weeks of the quarter. We expect to see da Vinci surgeries decline further in July as the pandemic continues to spread and hospitals dedicate human and physical resources to the treatment of COVID-19 and away from other procedures.

讓我來詳細介紹 COVID-19 疫情對手術流程和系統部署的影響，以及這種影響在不同市場之間的差異。新冠疫情對不同地區的影響差異顯著。為了幫助您了解這一動態，我們在網站的投資者關係部分發布了一張圖表，展示了美國、中國、日本和德國的程序。在該圖中，我們將各項流程與第一季前兩週的平均流程進行比較，我們將該平均流程定義為 COVID-19 疫情前的水平。在美國，第二季初的手術量約為新冠疫情前水準的 30%，到 6 月中旬已成長到接近第一季前兩週的水準。然而，隨著 COVID-19 在美國部分地區捲土重來，以及相關的擇期手術推遲，手術量在本季度的最後幾週開始下降。我們預計，隨著疫情持續蔓延，醫院將人力和物力資源投入到新冠肺炎的治療中，而將精力從其他手術轉移到達芬奇手術，7 月份達文西手術量將進一步下降。

Second quarter procedures in China, Japan and Korea grew well year-over-year as COVID had a lower impact on these markets. In Europe, the impact of COVID varied widely with Germany experiencing year-over-year single-digit growth, while France, U.K. and Italy experienced large declines. Capital sales in the U.S. and Europe reflected lower procedures and delayed capital spending, while hospitals revisit their capital budgets given the impacts of COVID-19. On the other hand, capital sales in several of our Asia direct markets, including China, Japan and Korea, were better than anticipated. System placements will likely continue to be pressured by hospital spending, reflecting the impact of COVID-19 and the result into economic pressures. Also, as system utilization declined by 27% year-over-year, hospitals have excess capacity that they will likely seek to fill before purchasing additional systems.

由於新冠疫情對中國、日本和韓國市場的影響較小，這些國家第二季的手術量較去年同期成長良好。在歐洲，新冠疫情的影響差異很大，德國的經濟年增率為個位數，而法國、英國和義大利的經濟則大幅下滑。美國和歐洲的資本銷售反映了手術量減少和資本支出延遲，同時，鑑於 COVID-19 的影響，醫院正在重新審視其資本預算。另一方面，我們在包括中國、日本和韓國在內的幾個亞洲直接市場的資本銷售情況好於預期。系統佈局可能會繼續受到醫院支出的壓力，這反映了 COVID-19 的影響以及由此帶來的經濟壓力。此外，由於系統利用率比去年同期下降了 27%，醫院出現了過剩容量，他們可能會在購買更多系統之前先想辦法填滿這些過剩容量。

The extent and duration of COVID-19 and subsequent resurgences in the U.S. and other parts of the world is uncertain. The time and extent to which da Vinci procedures may recover will vary by market. However, as we believe surgery is durable and that the long-term worldwide opportunity for robotic-assisted interventions remain significant.

COVID-19 疫情的規模和持續時間，以及隨後在美國和世界其他地區的疫情反彈情況，目前尚不確定。達文西手術的恢復時間和程度會因市場而異。然而，我們相信手術是持久的，機器人輔助手術在全球範圍內的長期發展前景依然十分廣闊。

Additional revenue statistics and trends are as follows: Second quarter revenue was $852 million, representing a 22% decrease from last year and a 23% decrease from last quarter; under the previously announced customer relief program, we are providing service credits to customers related to lower use of their systems during the second and third quarters as hospital treat COVID-19 patients. Revenue reflects $59 million of service credits granted to customers in the second quarter. As procedures in the U.S. and Europe recovered more quickly in the second quarter, the credits issued were less than expected. We are now anticipating the total cost of the customer relief program will be in the range of $80 million to $110 million. Second quarter placements included 21 into China, representing a greater proportion of total placements relative to the prior year and prior quarter. As leasing is prohibited in China and most systems are placed within greenfield hospitals, the worldwide percent of leasing and trade-ins has declined. Leasing represented 29% of current quarter placements compared with 32% last quarter. Trade-ins represented 40% of current quarter placements compared with 57% last quarter. We would anticipate in an environment of COVID-19, as economic pressures increase, more customers will seek leasing or alternative financing arrangements than reflected in historical run rates. Trade-in activity can fluctuate and be difficult to predict.

其他收入統計數據和趨勢如下：第二季度收入為 8.52 億美元，比去年同期下降 22%，比上一季下降 23%；根據先前宣布的客戶救濟計劃，由於醫院在第二季度和第三季度治療 COVID-19 患者，客戶的系統使用率降低，我們將向客戶提供服務抵扣。營收反映了第二季向客戶提供的 5,900 萬美元服務抵扣額。由於美國和歐洲的醫療程序在第二季恢復得更快，因此發放的信貸額低於預期。我們現在預計客戶救濟計畫的總成本將在 8,000 萬美元至 1.1 億美元之間。第二季安置的人員中有 21 人被安置到中國，與去年同期和上一季相比，佔總安置人數的比例更高。由於中國禁止租賃，而且大多數系統都安裝在新建醫院中，因此全球租賃和以舊換新的比例有所下降。本季租賃業務佔總業務量的 29%，而上季這一比例為 32%。本季以舊換新車輛佔新車交車量的 40%，而上季這一比例為 57%。我們預計，在新冠疫情的環境下，隨著經濟壓力的增加，尋求租賃或其他融資安排的客戶數量將比歷史運作率所反映的要多。以舊換新活動可能會出現波動，難以預測。

We recognized $9 million of lease buyout revenue in the second quarter compared with $12 million last quarter and $27 million last year. Lease buyout revenue has varied significantly quarter-to-quarter and will likely continue to do so.

第二季我們確認了 900 萬美元的租賃買斷收入，而上一季為 1,200 萬美元，去年同期為 2,700 萬美元。租賃買斷收入季度間波動較大，而且這種情況可能會持續下去。

Instrument and accessory revenue per procedure declined to approximately $1,900 per procedure compared with just over $2,000 per procedure in the first quarter of 2020, reflecting hospital usage of existing inventory as procedures declined. We expect instrument and accessory revenue per procedure to fluctuate as hospitals adjust inventories to reflect changes in procedure volumes.

由於手術量下降，醫院對現有庫存的使用量增加，導致每台手術的器械和配件收入下降到每台手術約 1,900 美元，而 2020 年第一季每台手術的收入略高於 2,000 美元。我們預計，隨著醫院調整庫存以反映手術量的變化，每次手術的器械和配件收入將會波動。

Earlier today, we announced our extended use program, under which, in October, we will launch selected X and Xi instruments possessing 12 to 18 uses compared with our existing 10-use instruments. These extended use instruments represent our higher volume instruments, excluding stapler, monopolar and advanced energy instruments and are used in a broad set of procedures. The announcement is posted on our website. Our ability to introduce instruments with extended uses as the result of significant investments in quality and manufacturing processes over a long period of time. The extended use instruments will generally be priced higher than our 10-life instruments, reflecting the instruments -- the investments we have made, but the cost per use will be lower for our customers. In addition, and simultaneously, we will lower the price of certain instruments used commonly in lower acuity procedures and/or lower reimbursement procedures like cholecystectomies, ingle hernias and benign hysterectomies in the U.S. Combined with the savings associated with extended use instruments, the result into instrument and accessory costs for these procedures will be competitive with non-robotic MIS approaches.

今天早些時候，我們宣布了我們的擴展使用計劃，根據該計劃，我們將在 10 月份推出部分 X 和 Xi 儀器，這些儀器的使用次數將達到 12 到 18 次，而我們​​現有的儀器的使用次數為 10 次。這些擴展使用器械代表了我們銷量較大的器械，不包括縫合器、單極器械和高級能量器械，可用於多種手術。公告已發佈在我們的網站上。由於我們長期以來對品質和製造流程進行了大量投資，我們有能力推出用途更廣泛的儀器。延長使用壽命的儀器價格通常會高於我們的 10 年壽命儀器，這反映了儀器本身的價值——我們投入的資金，但對於我們的客戶來說，每次使用的成本會更低。此外，同時，我們將降低美國膽囊切除術、單疝氣和良性子宮切除術等低風險手術和/或報銷較低的手術中常用的一些器械的價格。加上延長使用器械帶來的成本節約，這些手術的器械和配件成本將與非機器人微創手術方法相比具有競爭力。

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 and 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 be dependent upon procedure volumes, instrument usage, mix, and whether cost elasticity will enable greater penetration into available markets.

總體而言，延長器械使用壽命和降低器械價格將導致 Intuitive 每次手術的 I&A 收入降低。例如，如果 2019 年全年都提供擴展使用器械並實施較低的器械定價，那麼 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 I&A 費用將降低 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、產品組合，以及成本彈性是否能夠使企業更深入地滲透到現有市場。

Five of the systems placed in the second quarter were SP systems, reflecting both our measured rollout of SP and the impact of COVID-19. Our rollout of 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. COVID-19 has delayed the ability to perform a clinical trial associated with an SP colorectal procedure.

第二季部署的系統中有 5 個是 SP 系統，這不僅反映了我們對 SP 的穩定推廣，也反映了 COVID-19 的影響。我們將繼續穩定地推進 SP 手術系統的推廣，將系統交付給經驗豐富的達文西用戶，同時探索其他適應症並優化供應鏈中的培訓途徑。COVID-19 疫情延誤了與 SP 大腸直腸手術相關的臨床試驗的進行。

We placed 3 Ion systems in the quarter. Ion system placements were also 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.

本季我們安裝了3套離子系統。離子治療系統的安裝也受到了新冠疫情的影響。離子系統植入程序及相關資訊不計入我們的系統及程序總數。我們將繼續衡量 Ion 的推廣情況，同時優化供應鏈中的訓練路徑。

The completion of the PRECISE study is delayed due to COVID-19, and we cannot predict when the PRECISE study -- the PRECISE clinical study will be completed.

由於 COVID-19 的影響，PRECISE 研究的完成被推遲，我們無法預測 PRECISE 研究（PRECISE 臨床研究）何時完成。

Outside the U.S., we placed 72 systems in the second quarter compared with 80 in the second quarter of 2019 and 55 systems last quarter. Current quarter system placements included 18 into Europe, 18 into Japan and 21 into China, compared with 30 into Europe, 24 into Japan and 8 into China in the second quarter of 2019.

在美國以外，我們第二季安裝了 72 套系統，而 2019 年第二季安裝了 80 套，上一季安裝了 55 套。本季系統部署包括歐洲 18 個、日本 18 個和中國 21 個，而 2019 年第二季則有 30 個部署在歐洲、24 個部署在日本和 8 個部署在中國。

Moving on to gross margin and operating expenses. Pro forma gross margin for the second quarter of 2020 was 62.4% compared with 71.3% for the second quarter of 2019 and 69.7% last quarter. The decrease compared with the second quarter of 2019 and last quarter primarily reflects period costs associated with abnormally low production, the customer relief program and higher excess and obsolete inventory charges, partially offset by higher system ASPs, reflecting a favorable geographic mix. Second quarter inventory charges were approximately $27 million, primarily reflecting last generation system, vision and instrument products, which, as a result of decreased demand, we are now able to fulfill customer needs with newer, more capable products. 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.

接下來分析毛利率和營運費用。2020 年第二季的備考毛利率為 62.4%，而 2019 年第二季為 71.3%，上一季為 69.7%。與 2019 年第二季和上一季相比，下降主要反映了與異常低產量、客戶救濟計劃以及更高的過剩和過時庫存費用相關的期間成本，部分被更高的系統平均售價所抵消，這反映了有利的地域組合。第二季庫存費用約為 2700 萬美元，主要反映了上一代系統、視覺和儀器產品，由於需求下降，我們現在能夠用更新、更強大的產品來滿足客戶的需求。受新冠疫情影響，收入面臨壓力，生產水平可能低於正常水平，這可能導致勞動成本上升、管理費用吸收不足以及產品利潤率下降。

Pro forma operating expenses increased 3% compared with the second quarter of 2019 and decreased 11% compared with last quarter. Spending in the second quarter reflected curtailment costs associated with the impact of COVID-19, particularly training, marketing events and travel and related expenses, partially offset by costs associated with employee relief programs and other direct costs of COVID-19.

預計營運費用較 2019 年第二季成長 3%，較上一季下降 11%。第二季的支出反映了受 COVID-19 影響而導致的削減成本，特別是培訓、行銷活動以及差旅和相關費用，部分被員工救濟計劃的相關成本和 COVID-19 的其他直接成本所抵消。

Spending during this period of the pandemic will be as follows: we will work to ensure our employees' safety and well-being, including investing in PP&E and employee programs; we will continue to support our customers; we will continue to invest in innovation focused on the quadruple aim; we will invest in manufacturing in our supply chain to ensure supply for our customers; we will ensure that we are prepared for periods when the spread of COVID-19 is contained. Certain costs will be lower as the underlying activities are restricted by COVID-19, including travel and related expenses, clinical trials, surgeon training and marketing events; we will eliminate spending that is ineffective due to COVID-19, like surgeon and hospital events; we will reduce the hiring of volume-related roles like sales reps and manufacturing employees as appropriate.

在疫情期間，我們的支出將如下：我們將努力確保員工的安全和福祉，包括投資於固定資產和員工計劃；我們將繼續支持我們的客戶；我們將繼續投資於以四重目標為中心的創新；我們將投資於供應鏈中的製造，以確保對客戶的供應；我們將確保為 COVID-19 疫情得到控制的時期做好準備。由於 COVID-19 疫情限制了相關活動，某些成本將會降低，包括差旅及相關費用、臨床試驗、外科醫生培訓和市場推廣活動；我們將取消因 COVID-19 疫情而無效的支出，例如外科醫生和醫院活動；我們將酌情減少與業務量相關的崗位招聘，例如銷售代表和生產員工。

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. Our pro forma effective tax rate for the second quarter was 36.9% compared with our expectations of 20% to 21%, reflecting a $37 million or $0.31 per diluted share charge associated with the conclusion of a tax case between an independent third-party and the IRS related to charging foreign subsidiaries for share-based compensation. Our actual tax rate will fluctuate with changes in geographic mix of income, changes in taxation made by local authorities and with the impact of onetime items. Our second quarter 2020 pro forma net income was $132 million or $1.11 per share compared with $388 million or $3.25 per share for the second quarter of 2019 and $323 million or $2.69 per share last quarter.

我們仍然相信，我們擁有獨特的機會，可以擴大電腦輔助手術和急診幹預在全球範圍內的益處，我們將繼續對該業務進行長期投資。第二季的備考有效稅率為 36.9%，高於我們預期的 20% 至 21%，這反映了與獨立第三方和美國國稅局之間關於向外國子公司收取股權激勵費用的稅務案件的結案相關的 3700 萬美元或每股攤薄收益 0.31 美元的費用。我們的實際稅率會隨著收入地域組成的變化、地方政府稅收政策的變化以及一次性項目的影響而波動。2020 年第二季度，我們的備考淨收入為 1.32 億美元，即每股 1.11 美元，而 2019 年第二季度為 3.88 億美元，即每股 3.25 美元，上一季為 3.23 億美元，即每股 2.69 美元。

I will now summarize our GAAP results. GAAP net income was $68 million or $0.57 per share for the second quarter of 2020 compared with GAAP net income of $318 million or $2.67 per share for the second quarter of 2019 and GAAP net income of $314 million or $2.62 per share for the last quarter. The adjustments between pro forma and GAAP net income are outlined and quantified on our website and include excess tax benefits associated with employee stock awards, employee stock-based compensation and IP charges, amortization of intangibles and acquisition-related items and legal settlements.

現在我將總結一下我們的GAAP業績。2020 年第二季 GAAP 淨利為 6,800 萬美元，即每股 0.57 美元；而 2019 年第二季 GAAP 淨利為 3.18 億美元，即每股 2.67 美元；上一季 GAAP 淨利潤為 3.14 億美元，即每股 2.62 美元。我們的網站上列出了備考淨收入與 GAAP 淨收入之間的調整，並進行了量化，其中包括與員工股票獎勵、員工股票薪酬和知識產權費用相關的超額稅收優惠、無形資產攤銷、收購相關項目和法律和解。

We ended the quarter with cash and investments of $6.1 billion compared with $5.9 billion at March 31, 2020. Cash generated from operations was partially offset by investments in working capital and our infrastructure. We did not repurchase any shares in the quarter.

截至本季末，我們的現金和投資為 61 億美元，而 2020 年 3 月 31 日為 59 億美元。經營活動產生的現金流量部分被營運資金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 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 secure supply chain and build appropriate levels of inventory to ensure customer supply, particularly as procedures resume; we will invest in securing our customers; we will continue our market -- our open market repurchase program consistent with our prior practice.

我們目前對資本部署的想法如下：我們認識到新冠疫情給客戶帶來的困難，我們將與客戶合作，減輕達文西手術系統使用率下降帶來的負擔，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，以確保客戶的供應，尤其是在手術恢復後；我們將投資於保障客戶的安全性；

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

接下來，我將把發言權交給菲利普，他將回顧我們的手術過程。

Thank you, Marshall. Our overall second quarter procedure decrease was approximately 19% compared to growth of 17% during the second quarter of 2019 and 10% last quarter. Our Q2 procedure decrease was driven by a 24% decrease in U.S. procedures and a 7% decrease in OUS markets. On a worldwide basis, procedures in the quarter troughed in April and continued to recover throughout the quarter. Although worldwide procedure run rates trended closer to pre-COVID levels in June, we caution investors from assuming this trend continues, given the dynamics discussed earlier in the call.

謝謝你，馬歇爾。與 2019 年第二季 17% 的成長和上一季 10% 的成長相比，我們第二季的整體手術量下降了約 19%。第二季手術量下降主要是因為美國手術量下降了 24%，以及美國境外市場手術量下降了 7%。從全球範圍來看，該季度手術量在 4 月跌至谷底，並在整個季度持續復甦。儘管 6 月全球手術量趨於接近新冠疫情前的水平，但鑑於先前電話會議中討論的動態，我們提醒投資者不要假設這種趨勢會持續下去。

In the U.S., procedure run rates also trended closer to pre-COVID levels in June. However, future procedure performance may fluctuate as customers in states like Texas, Florida and California encounter increased COVID cases. From a procedure standpoint, during the end of Q2, we saw a broad recovery in most procedures, including procedures that had the biggest decline at the end of Q1, such as bariatrics, hernia and benign gynecology.

在美國，6 月的手術量也逐漸接近新冠疫情前的水準。然而，隨著德州、佛羅裡達州和加州等地的客戶遭遇新冠病例增加，未來的手術效果可能會出現波動。從手術流程的角度來看，在第二季末，我們看到大多數手術都出現了廣泛的復甦，包括在第一季末下降幅度最大的手術，例如減重手術、疝氣手術和良性婦科疾病手術。

Within the U.S., there were geographic differences between states that were hit harder by COVID and those that were not. For example, during the quarter, Florida recovered to pre-COVID levels on a run rate basis, while New York did not. State-specific containment strategies impacted procedure growth, and the timing of COVID outbreaks will play a role in driving geographic differences.

在美國國內，受新冠疫情影響嚴重的州與受疫情影響較小的州之間存在地域差異。例如，本季佛羅裡達州的經濟活動以運行率計算已恢復到新冠疫情前的水平，而紐約州則沒有。各州的具體防治策略影響了手術量的成長，而 COVID 疫情爆發的時間將對地域差異產生影響。

Outside of the U.S., procedure growth in Asia was strong. As shown in the chart on our Investor Relations website, China performance was strong, but we would caution investors not to use China as a proxy for a global recovery. Japan growth remained strong at over 30% in Q2, and South Korea also grew in the quarter. Western Europe saw broad declines, with the exception of Germany, which continued to grow in Q2, albeit at a slower rate. We provide these data points to inform investors of the procedure dynamics in the second quarter. Given the uncertain scope and duration of the COVID pandemic and uncertain timing of global recovery and economic normalization, we continue to believe that Q2 procedure results aren't indicative of forward trends.

除美國以外，亞洲地區的手術量增長強勁。正如我們在投資者關係網站上的圖表所示，中國經濟表現強勁，但我們提醒投資者不要將中國經濟作為全球經濟復甦的代表。日本第二季經濟成長依然強勁，超過 30%，韓國本季也實現了成長。西歐經濟普遍下滑，只有德國例外，德國在第二季持續成長，儘管成長放緩。我們提供這些數據點，是為了讓投資人了解第二季的流程動態。鑑於 COVID-19 疫情的範圍和持續時間尚不確定，全球經濟復甦和正常化的時間也尚不確定，我們仍然認為第二季的手術結果並不能預示未來的趨勢。

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

我們的發言稿到此結束。現在開始回答各位的問題。

(Operator Instructions) And first question will come from the line of David Lewis with Morgan Stanley.

（操作員說明）第一個問題將來自摩根士丹利的戴維·劉易斯。

Can you hear me okay?

你聽得清楚我說話嗎？

Hi, David. Yes.

你好，大衛。是的。

Oh, great. A little choppy there. So a couple of quick questions for me, Gary, for you. Obviously, the focus of the call is going to be on the extended instruments program. So maybe 1 for you, Gary, which is, look, in most technology industries where you democratize technology, sort of lower price to drive the TAM, I'm sure you've extensively studied your customer elasticity, and so Marshall talked about a 7% drop in I&A revenue. Can you just give us any sense of a framework around how to think about improvement in utilization based on these cost improvements? And then also for you, given your competitors, you've seen J&J and Medtronic time line slip, I think some investors are going to say, why take this kind of move now when the competitive landscape is getting easier? And then I have a quick follow-up for Marshall.

哦，太好了。剛才有點卡頓。加里，我有幾個問題想問你。顯然，此次電話會議的重點將放在擴展工具計畫上。所以，Gary，也許有一點需要你注意，那就是，在大多數科技業，你透過降低價格來擴大技術市場規模，從而實現技術民主化。我相信你已經廣泛研究了客戶彈性，所以 Marshall 談到了 I&A 收入下降 7%。您能否為我們概述一下，基於這些成本改進，如何思考如何提高利用率？此外，考慮到你的競爭對手，例如強生和美敦力，你們的上市時間表都出現了延誤，我認為一些投資者會說，既然競爭環境變得越來越容易，為什麼現在要採取這樣的舉措呢？然後我還有一個問題要問馬歇爾。

Yes. Thank you. I appreciate the question. On the first question of, do we think that it changes the volume of procedures that might be accessed by our technology, the answer to that is yes. I think the real question will be time line. A little bit hard to predict the time line in the near-term just because I think a lot of it will have to do with COVID and recoveries, so that will kind of blur the speed with which it happens. But if you look out over a couple of years, we clearly think that customers want to use our products, they want to use them broadly, broadly in different procedure domains like general surgery, but also broadly regionally. And to the extent that we can help them with economics, we think they have a preference to use our products, and we think that will help, and that's why we did it.

是的。謝謝。感謝您的提問。對於第一個問題，即我們是否認為它改變了我們的技術可以存取的程式數量，答案是肯定的。我認為真正的問題在於時間安排。短期內很難預測時間表，因為我認為這很大程度上與新冠疫情和康復情況有關，所以這會模糊事件發生的速度。但從未來幾年來看，我們清楚地看到，客戶希望使用我們的產品，他們希望廣泛使用，不僅在普通外科等不同的手術領域，而且在區域範圍內廣泛使用。而且，如果我們能在經濟方面幫助他們，我們認為他們會更傾向於使用我們的產品，我們認為這將有所幫助，這就是我們這樣做的原因。

On question 2 on time line, there -- we've been working at it for some time. These changes and manufacturing process improvements have taken years to get right. I think being a little too fancy in the time line doesn't help the company or our customers. We think that it will be appreciated that we've done it. It will be appreciated that we've done it now. And over time, I think we'll look back on it and be happy that we've brought it as expeditiously as we could.

關於時間線上的第二個問題，我們已經為此努力了一段時間。這些變革和製造過程的改進歷經多年才得以實現。我認為在時間安排上過於講究對公司和我們的客戶都沒有好處。我們認為，我們這樣做會得到大家的讚賞。我們現在這麼做，大家會感激的。隨著時間的推移，我想我們會回顧這件事，並慶幸我們以最快的速度完成了這項工作。

Okay. Very helpful. And then Marshall, for you, I appreciate the commentary on 2019 on revenue, and I apologize if I missed it. The 7% or $170-ish million type of revenue impact, can you give us a sense of what the gross margin impact, gross or EBIT impact, maybe gross would be more helpful on 2019? Just trying to get a sense of the gross margin mix shift into '21 on this I&A extended use program change.

好的。很有幫助。還有馬歇爾，我很欣賞你對 2019 年營收的評論，如果我錯過了，我深感抱歉。7%或1.7億美元左右的收入影響，您能否大致說明一下毛利率、毛利或息稅前利潤的影響？或許2019年的毛利數據會更有幫助？我只是想了解一下，在 I&A 擴展使用計劃變更的情況下，2021 年毛利率結構會發生怎樣的變化。

Sure. The margin on the products will be relatively consistent with current margins, so the impact is nominal in terms of 2019. It's a slight down only because you have less instrument and accessory revenue. And from a mix perspective, you wind up with more systems revenue. Systems revenues have lower margins, but the individual margins on the instruments are not that different.

當然。產品的利潤率將與目前的利潤率保持相對一致，因此對 2019 年的影響微乎其微。只是因為樂器和配件收入減少，所以略有下降。從組合角度來看，最終會獲得更多系統收入。系統收入的利潤率較低，但各儀器的利潤率差異不大。

Our next question will be from the line of Tycho Peterson with JPMorgan.

我們的下一個問題將來自摩根大通的泰科·彼得森。

Gary, I'll start with a question on the capital side. If I go back to last quarter, you obviously talked about using the $6 billion on the balance sheet to place more systems. Operating leases did go down. So can you maybe just talk a little bit about that dynamic, what you're hearing from customers, particularly in the U.S. on operating leases? And to Dave's point before, with your competitors delayed a little bit, does that change your appetite at all for pushing operating leases in this current environment?

加里，我先問一個關於資本的問題。回顧上個季度，您顯然談到了利用資產負債表上的 60 億美元來部署更多系統。經營性租賃確實下降了。那麼，您能否談談這種動態，您從客戶那裡聽到了什麼，尤其是在美國，關於經營租賃方面？正如戴夫之前提到的，由於你的競爭對手稍有延誤，這是否會改變你在當前環境下推廣經營租賃的意願？

Yes. So just standing back to capital, it's really variable regionally, so where they are not strongly affected by COVID or they're recovering strongly, then capital rotates forward again. You saw that in China. And there, we feel good about leasing systems or selling systems. In China, they buy them, they don't lease them. But in other markets, where they're interested in leasing, we're happy to do that.

是的。所以，就資本而言，其流動情況因地區而異，因此，在那些未受新冠疫情嚴重影響或正在強勁復甦的地區，資本就會再次向前流動。你在中國就看到了。因此，我們對租賃系統或銷售系統都感到滿意。在中國，他們是購買而不是租賃。但在其他市場，如果他們對租賃感興趣，我們很樂意這樣做。

In regions that are being disrupted by COVID, where the flow of patients is changing because of either delays in elective surgery or delays in diagnostic pipelines, there, they have capacity on the existing installed base. They may want to move those systems, they may want to upgrade them, but in general, we've seen -- and we've seen this in years past, act one as an operator of a hospital was to use your existing capacity before expanding it. And there, I don't think leasing is the major issue. I think the real issue is them getting back to surgery and getting ready. To the extent that they have demand, leasing helps us, so I think it's kind of secondary to recovery from COVID in the U.S. primarily.

在受新冠疫情影響的地區，由於擇期手術延誤或診斷流程延誤，患者流動發生變化，而這些地區現有的醫療設施具備相應的容量。他們可能想要遷移這些系統，也可能想要升級這些系統，但總的來說，我們看到——而且我們在過去幾年裡也看到過——作為醫院運營者的第一要務是先利用現有的容量，然後再進行擴張。而且，我認為租賃並不是主要問題。我認為真正的問題是他們能否重返手術室並做好準備。只要有需求，租賃就能幫助我們，所以我認為它主要還是次要的，而不是美國從新冠疫情中復甦。

And then on the procedure recovery, just thinking about working through the backlog of patients, is there any (inaudible) on more patients going into laparoscopic or open as there is backlog on robotics or even radiation therapy? I'm just curious about how you think about alternatives to robotics given the backlog today.

關於手術恢復，考慮到積壓的病人，是否有（聽不清楚）更多病人會選擇腹腔鏡手術或開腹手術，因為機器人手術甚至放射治療都存在積壓？我很好奇，鑑於目前的積壓工作，您如何看待機器人技術的替代方案。

We get asked that question periodically. I don't see a philosophical shift by heads of perioperative services to try to shift share in response to COVID. In a really hard hit area, if they're doing everything they can and the only thing they have available is something other than MIS, they might go that way. I don't think that's their primary objective of the health system. And very quickly, they want to return to what they believe is offering the patient the best outcome. Looking in the evidence, we don't see any evidence of share shifts at this time. That's not to say there aren't there, it's just that nothing has really come up. And what we do see is as much positive for robotics as anything else.

我們常常被問到這個問題。我沒有看到圍手術期服務負責人為了應對新冠疫情而改變服務份額的概念發生轉變。在受災嚴重的地區，如果他們已經竭盡所能，而唯一可用的措施是 MIS 以外的措施，他們可能會採取那種措施。我不認為那是他們醫療系統的主要目標。很快，他們就想回到他們認為能為患者帶來最佳療效的治療方案。從現有證據來看，目前我們沒有發現任何份額轉移的跡象。這並不是說沒有合適的人選，只是目前還沒有出現合適的人選。我們看到的這些變化，對機器人技術來說，利大於弊。

Our next question will be from Bob Hopkins with Bank of America.

下一個問題來自美國銀行的鮑伯霍普金斯。

Can you hear me okay?

你聽得清楚我說話嗎？

Yes.

是的。

Great. First one for me is I'm just trying to understand hospital systems' ability to kind of manage through this COVID increase in cases that we're seeing here of late. So I'm just curious, as the -- as that increase in the United States in particular have been disruptive to surgical volumes or if things held steady despite the uptick in cases?

偉大的。首先，我想了解醫院系統是否有能力應對最近我們在這裡看到的 COVID 病例激增的情況。所以我很好奇，特別是美國病例的增加是否對外科手術量造成了乾擾，還是儘管病例增加，情況仍然保持穩定？

We've seen it really depends regionally. So I guess what we've seen is variance regionally. In hard hit areas, we'll see the implementation of deferrals. Again, in other places that had kind of round 1 and it is starting to creep back in, they're assuming to manage it concurrently a little bit better. Netting it out, the first few weeks in July looks really wavy. Hard to call a good trend, certainly would not call it a recovery in July in the United States.

我們發現這確實因地區而異。所以我想我們看到的是區域差異。在受災嚴重的地區，我們將看到延期付款的措施實施。再者，在其他一些地方，疫情已經經歷了一輪反彈，現在又開始悄悄地捲土重來，他們正試圖更好地同時應對疫情。總的來說，7 月的前幾週天氣狀況波動很大。很難說這是個好趨勢，當然也不能說美國7月的經濟已經復甦。

Yes. Okay. I was specifically asking about the U.S., but it sounds like your response was related to the U.S., too.

是的。好的。我原本問的是美國的情況，但聽起來你的回答也跟美國有關。

Yes. It's certainly true in the U.S.

是的。在美國，情況的確如此。

Okay. And then the second question I had was just on the capital environment, and I know you just made a comment there earlier. But these results, it's not obvious that there was a big negative impact from COVID on capital. But you made a comment about a challenging environment going forward. I'm wondering how much of that is the need to absorb capacity versus the impact on COVID? I'm just wondering, specifically in the U.S., the willingness to kind of purchase capital in this environment, just would love an update there.

好的。然後我的第二個問題是關於資本環境的，我知道您之前已經就此發表過評論。但從這些結果來看，並不能明顯看出新冠疫情對資本產生了巨大的負面影響。但你曾提到未來將面臨充滿挑戰的環境。我想知道其中有多少是因為需要吸收產能，又有多少是因為新冠疫情的影響？我只是想了解一下，尤其是在美國，在這種環境下人們購買資本的意願如何，很想了解這方面的最新情況。

Sure. So we did see -- as we reach the end of the quarter, we did see additional postponements of purchases. And we did hear from hospitals that they were back to evaluating their budget, thinking about what the ramifications of the cost of COVID treatment were as well as thinking about the longer-term impacts of COVID in terms of a potential recession and impact on their funds. And so I think the quarter was affected, the capital quarter was affected by COVID. And going forward, you're right, there will be, first, we think, the impact of trying to bring back up systems to fuller utilization. 27% is a pretty steep decline, and we would expect that they will seek to fill that before they go out and buy more capital, particularly when they are already strained on the financial side. So I think it's -- we started to see it this quarter, and I think we're going to continue to see pressures on capital spend.

當然。因此，隨著季度末的臨近，我們確實看到採購訂單進一步推遲。我們也從醫院方面了解到，他們正在重新評估預算，思考新冠肺炎治療費用的影響，以及新冠肺炎可能帶來的長期影響，例如經濟衰退及其對資金的影響。所以我認為，本季，尤其是資本季度，受到了新冠疫情的影響。展望未來，你說得對，首先，我們認為，將會產生影響的是努力使恢復系統達到更充分的利用率。27% 的跌幅相當大，我們預計他們會在購買更多資本之前先想辦法彌補這一缺口，尤其是在他們財務方面已經捉襟見肘的情況下。所以我認為——我們從本季開始就看到了這種趨勢，我認為我們將繼續看到資本支出面臨壓力。

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

下一個問題來自富國銀行的 Larry Biegelsen。

One on capital, one on the regulatory environment. Gary, obviously, systems shipped greatly exceeded Street expectations this quarter. Can you talk about any new programs you've introduced to support new placement? We heard you talk this quarter about the loaner program. Are there any commitments associated with that? And are usage-based agreements increasing? And as I said, I had one follow-up on the regulatory environment.

一份關於資本，一份關於監理環境。加里，很明顯，本季系統出貨量大大超出了華爾街的預期。您能否談談您為支持新員工安置而推出的任何新項目？本季我們聽到您談到了貸款計劃。這其中是否涉及任何承諾？按使用量付費的協議是否越來越多？正如我所說，我還有一個關於監管環境的後續問題。

Sure. On that system shift in the quarter, I'll start the answer, and I'll ask Marshall to jump in and provide a little additional color. I think a lot of what we saw in Q2 in the U.S. was around momentum. Capital pipelines are multi-month engagements for our sales teams and for our customers. They have long-term commitments, they're fairly far down the pipeline. And in some cases, I think they know they want to do this long term, and they went ahead and closed. Outside the U.S., we had strength because you're starting to see procedure recoveries, and they're looking to build capacity for additional procedures.

當然。關於本季系統的變化，我將先開始回答，然後我會請馬歇爾插話補充一些細節。我認為我們在美國第二季度看到的許多現像都與成長勢頭有關。對於我們的銷售團隊和客戶而言，資本項目管道都是需要數月才能完成的項目。他們有長期承諾，專案進展相當順利。在某些情況下，我認為他們知道自己想要長期經營，所以就直接關門了。在美國以外，我們實力強勁，因為手術恢復情況開始好轉，他們正在尋求擴大手術能力。

With regard to, was it a particular sales program or the introduction of a loaner program and so on that really drove the number, I would not guide you that way. I don't really think that's true. But Marshall, why don't you step in?

至於究竟是某個特定的銷售計劃還是推出租賃計劃等等真正推動了銷售增長，我不會在這方面給你建議。我並不認為這是真的。但是馬歇爾，為什麼不出手相助呢？

I think you characterized it right. I don't think there was any particular program that drove it, and I think that it really does reflect momentum. Gary alluded to a couple of larger IDN deals getting done. And those were months, if not a year, in the making, and so it takes time to get them closed out. And when you're getting close, even though there's a COVID virus, they went ahead. And we do see strength outside the U.S., particularly in Asia, where COVID has started to recover.

我認為你的描述很準確。我不認為這是由某個特定的項目推動的，我認為這確實反映了發展勢頭。Gary暗示將達成幾項較大的IDN交易。這些項目耗時數月甚至一年才得以完成，因此需要時間才能最終敲定。即使有新冠病毒，他們還是在接近終點時繼續前進。我們也看到了美國以外地區的強勁勢頭，尤其是在亞洲，那裡的 COVID-19 疫情已經開始好轉。

And just for my follow-up, Gary, you talked about changes to the regulatory environment. Obviously, we all heard J&J said -- saying that they're not going to be filing a 510(k) for their robot in the U.S. I mean, what are you seeing, Gary, at the FDA, do you think future robot -- surgical robots will be like de novo 510(k)s, PMAs, I don't -- obviously, don't expect you to speak for J&J, but what can you talk about generally on surgical robots?

加里，我還有一個後續問題，你剛才談到了監管環境的變化。顯然，我們都聽到了強生公司表示他們不會在美國為其機器人申請 510(k) 許可。我的意思是，Gary，你在 FDA 方面看到了什麼？你認為未來的手術機器人會像全新的 510(k) 和 PMA 嗎？我當然不指望你代表強生公司發言，但你對手術機器人有什麼整體看法？

Now over the last few years, we've seen an increase in clinical data requirements and evidence generation per new platform as we come out and we've been talking to you about that over the last several years. With regard to introducing new platforms, us or anybody else, I think the pathway depends on the details of the claims, what's being claimed, what procedures are being done and the details of the predicates being used, and that would guide any of the conversations we would have with FDA or, frankly, our competitors would have. So I really can't call out what direction it will go for everybody. We do see the discussions being pretty rational, and they just have required additional data sets as time goes on. And nothing we've heard from the last couple of weeks of earnings calls has kind of changed our perspective on what we've seen.

近幾年來，隨著新平台的推出，我們看到臨床數據需求和證據產生量都在增加，而過去幾年我們也一直在和大家討論這個問題。關於引入新平台，無論是我們還是其他任何人，我認為途徑取決於聲明的細節，聲明的內容，正在執行的程序以及所使用的前提的細節，這將指導我們與 FDA 或坦率地說，我們的競爭對手之間的任何對話。所以我真的無法預測它對每個人來說會朝著哪個方向發展。我們認為這些討論相當理性，只是隨著時間的推移，他們需要更多的數據集。過去幾週的財報電話會議並沒有改變我們對所見的看法。

Our next question will go to Larry Keusch with Raymond James.

我們的下一個問題將由 Raymond James 公司的 Larry Keusch 回答。

Gary, I'm just curious about how you're able to manage your internal R&D development projects throughout COVID? And I guess really the question is, were you able to keep things going or did you see setbacks as well? I mean I know you talked about the PRECISE trial, I get it, but I'm really thinking sort of your internal development projects.

Gary，我很好奇你是如何在整個新冠疫情期間管理內部研發專案的？所以我想真正的問題是，你是否能夠讓事情繼續發展下去，還是也遇到了挫折？我知道你談到了 PRECISE 試驗，我明白，但我真正想了解的是你們的內部研發專案。

No, I think we've seen both heroic effort on the part of our teams. We are blessed by having a medical office inside the company and surgeons who -- and medical people who work for the company directly. So we implemented protocols that allowed us to stay at the leading edge of where safety protocols ought to be for infectious disease and do our best to be able to keep making work -- making progress. Our engineering teams have been really creative and thoughtful about getting work done.

不，我認為我們已經看到了我們雙方團隊的英勇努力。我們很幸運，公司內部設有醫療辦公室，並且有外科醫生──還有直接為公司工作的醫護人員。因此，我們實施了相關規程，使我們能夠在傳染病安全規程方面保持領先地位，並盡最大努力繼續開展工作——取得進步。我們的工程團隊在完成工作方面展現了極大的創造力和思考能力。

So we have seen some delays, for sure. I wish I would say otherwise, but it's just a reality. That said, I think that the teams have talked pretty hard to keep our programs progressing and to not just accept slips because COVID exists. Where we are -- where those things are a little bit out of our control tend to be on things that are in clinical trials, as you mentioned. There, you're going back and forth between hospital institution on the front lines. They are using -- deploying their resources in ways that are important to them to manage COVID, we fully understand that. So there, sometimes, it's really us in a support mode. Where we can control it, we can control our environment, we can relay out our spaces, our labs and so on, and we can make a little more progress. So we see some slips, but we also see great effort to manage the slips.

所以，我們確實看到了一些延誤。我真希望我說的是另一種情況，但這卻是現實。也就是說，我認為各隊已經進行了非常充分的討論，以確保我們的專案能夠繼續推進，而不是因為新冠疫情的存在而接受任何下滑。正如您所提到的，我們所處的位置——那些我們無法完全控制的事情往往發生在臨床試驗中。在那裡，你要在前線醫院機構之間來回奔波。我們完全理解，他們正在以對他們來說重要的方式部署資源來應對新冠疫情。所以有時候，我們確實是在扮演支持的角色。在我們可以控制的地方，我們可以控制我們的環境，我們可以重新規劃我們的空間、實驗室等等，我們可以取得更大的進展。所以我們看到了一些失誤，但我們也看到了為應對這些失誤所做的巨大努力。

Okay. Terrific. And then the other question is, certainly, there's a sense out there that COVID will sort of accelerate trend that we've already been seeing and then move to some sort of ambulatory surgical setting. Just curious, in the last quarter's call, you sort of mentioned that the Intuitive organization was ready to be helpful in any way and certainly sound like what was implied if robots need to be moved to either ASCs or other care areas that you'd be prepared to do it. Did you actually see any of that occur? And do you think that there is going to be an accelerated trend to move things that you can into non-acute care settings?

好的。了不起。另一個問題是，當然，人們普遍認為 COVID-19 將加速我們已經看到的趨勢，然後轉向某種門診手術環境。我只是好奇，在上個季度的電話會議上，您提到 Intuitive 公司隨時準備好提供任何幫助，聽起來也像是暗示如果需要將機器人轉移到 ASC 或其他護理區域，您也做好了準備。你親眼看過這些事情發生嗎？你認為未來是否會有加速將一些可以轉移到非急性照護環境的措施的趨勢？

I'm going to ask Marshall to answer the first part of that question around, have we seen acceleration in the data sets, I'm going to -- and I'll answer the second part of the question around what do we think might happen going forward. So Marshall, if you would jump in on the -- on what are we seeing so far?

我將請馬歇爾回答這個問題的第一部分，即我們是否在資料集中看到了加速成長的趨勢；我將回答這個問題的第二部分，即我們認為未來可能會發生什麼。那麼馬歇爾，你能不能插一句——說說我們目前為止看到了什麼？

In terms of ASCs, again, ASC is they -- the number of da Vinci-type procedures, procedures that da Vinci addresses in ASCs is actually not all that significant. What you really -- if you're talking about HOPDs or ASCs that are owned by hospital IDNs, then we have a large presence, and we are addressing procedures that are presented there. We haven't seen -- I haven't -- I'm not aware of movements of large patient quantities to ASCs during this period. I think hospitals are struggling to meet all needs in terms of COVID, so -- I don't think I have anything else to add there.

就 ASC 而言，ASC 就是它們——達文西手術中心開展的手術數量，達文西手術中心開展的手術數量實際上並不那麼重要。如果你指的是醫院綜合醫療網絡 (IDN) 擁有的 HOPD 或 ASC，那麼我們確實有很多業務，並且我們正在處理那裡開展的手術。在此期間，我們沒有看到——我沒有——我不知道有大量病人轉移到門診手術中心的情況。我認為醫院在應對新冠疫情方面面臨著巨大的挑戰，所以——我想我沒有什麼要補充的了。

Yes. I'll jump in on my side. I think that surgery in those environments, what actually happens in the operating room is well understood, and robotics and our robotics can play a real role there. What really determines whether something's in an ambulatory setting, hospital-owned outpatient department setting or inside a hospital and booked as the same-day surgery, the differences there are largely driven by reimbursement and reimbursement policy. To the extent that reimbursement policy stays as it is, then I don't think you'll see a huge move of the kind of procedures that Intuitive does into the ASCs. But if reimbursement policy were to change in the future, then we'll change with it and go there. So there's a lot of same-day surgery or outpatient surgery that's done on da Vinci devices. Where they live has a lot to do with the reimbursement.

是的。我會站在我這邊。我認為，在那種環境下進行的手術，也就是手術室裡實際發生的事情，大家都很了解，而機器人技術和我們的機器人技術可以在其中發揮真正的作用。真正決定某項手術是在門診環境、醫院所屬的門診部環境還是在醫院內並預約為當日手術的，其差異主要由報銷和報銷政策驅動。如果報銷政策保持不變，那麼我認為你不會看到像 Intuitive 這樣的醫療程序大量轉移到門診手術中心。但如果未來的報銷政策發生變化，我們也會隨之改變並採用新的報銷方式。因此，許多當天即可完成的手術或門診手術都是使用達文西手術機器人進行的。他們的居住地與報銷情況有很大關係。

So for us, it's -- where does it make sense to be performed logistically, where does it make sense to be performed from a reimbursement perspective, and then do they have the right tools, technologies and training, and I think we can adjust to that over time.

所以對我們來說，關鍵在於——從物流角度來看，在哪裡進行是合理的；從報銷角度來看，在哪裡進行是合理的；以及他們是否擁有合適的工具、技術和培訓。我認為隨著時間的推移，我們可以做出相應的調整。

Next, we'll go to the line of Amit Hazan with Goldman Sachs.

接下來，我們將介紹高盛的 Amit Hazan 的表現。

Just a couple of quick ones. On the da Vinci SP, if I heard your comments right about Korea utilization being higher than Xi, that was a little bit surprising. So I'm just curious if you can give some color behind that and whether that suggests for you that the types of procedures being done on SP are kind of more on the lower acuity side of the spectrum and whether that kind of paved for you how you might be marketing the product here as it evolves?

就簡單問幾個問題。關於達文西SP，如果我沒理解錯你關於韓國利用率高於習近平的評論，那確實有點令人驚訝。所以我很好奇您能否對此做一些解釋，這是否意味著在SP上進行的手術類型更偏向於低風險的領域，以及這是否對您未來如何在這裡推廣產品產生了影響？

Yes. In Korea, the nice thing is that the regulatory clearance allows broad clinical application. As a result, they can do procedures in urology and thoracic and gynecology, in head and neck, and they're also looking at procedures in the breast. There, I think it's less about low acuity, and I think they're really exploring where does a single incision or a natural orifice approach really drive clinical value. The surgeons are, I think, thoughtful and innovative here, and that's exciting to us.

是的。在韓國，好處在於監管部門的批准允許其在臨床上廣泛應用。因此，他們可以進行泌尿、胸腔外科、婦科、頭頸部的手術，他們也正在研究乳房手術。我認為，在那裡，低危險因子並不重要，他們真正探索的是單切口或自然腔道手術方法在哪些方面能夠真正帶來臨床價值。我認為這裡的外科醫生都很有想法，而且很有創新精神，這讓我們感到很興奮。

In the U.S., we need to run trials and get additional data, as we've said before, for colorectal applications and for some of the other things that we have in the pipeline, so that will take us some time. So we look to Korea to say, okay, what does demand look like when not constrained by the regulatory setting. The nice utilization or high throughput sort of tells us 2 things. One is there's a real interest in exploring the hypothesis that this creates better outcomes. We can also look at the data there and start to see where it does indeed. That's exciting. The second thing is it puts the product through the tests of high throughput, high turnaround. These are well-designed in that setting and can they use it as much, and that's been powerful for learning, but also encouraging for us as to the maturity of the product even at this early stage. So that's how we're looking at Korea, and it will help inform our regulatory strategy in other parts of the world.

在美國，我們需要進行試驗並獲取更多數據，正如我們之前所說，用於結直腸應用以及我們正在研發的其他一些產品，因此這將需要一些時間。因此，我們關注韓國，想了解在不受監管環境限制的情況下，需求會是什麼樣子。良好的利用率或高吞吐量大致告訴我們兩件事。一方面，人們確實有興趣探索這種做法是否能帶來更好的結果。我們還可以查看那裡的數據，並開始了解它確實在哪些方面發揮作用。真令人興奮。第二點是，它對產品進行了高吞吐量、高週轉率的測試。這些產品在這種環境下設計得很好，他們可以充分利用它們，這對學習非常有幫助，同時也讓我們對產品即使在早期階段的成熟度感到鼓舞。這就是我們看待韓國的方式，這將有助於我們制定在世界其他地區的監管策略。

And then my follow-up would be on just new doctor training. That was obviously still quite strong for you pre-COVID here in the U.S., and it's obviously been a key element for you of procedure growth looking forward. So just qualitatively, are you able to just give us a sense of the impact on training that you saw in the quarter and how you're thinking about the rest of the year? Just the levels of normal, even like you did for procedure would be super helpful to just get a sense of where you are with being able to train new doctors.

接下來，我的後續研究將集中在新醫生培訓方面。顯然，在新冠疫情爆發前，這在美國仍然是你們的重要業務，而且顯然也一直是你們未來業務成長的關鍵因素。那麼，就定性而言，您能否為我們介紹一下您在本季看到的培訓影響，以及您對今年剩餘時間的計劃有何看法？即使只是像你之前所做的那樣，提供正常水平的數據，對於了解你在培訓新醫生方面的水平也會非常有幫助。

Yes. I'll start, and Marshall, I'll help you -- I'll ask you to jump in and add some color. It's clearly challenged and one of the things that we're working on. First, right upfront, particularly in the United States, doctors are focused on other things. And travel, which some training requires, is strained. So for us, 2 things have been going on. One of them is to see if we can forward deploy our training assets to make travel easier or extremely convenient. Travel by car, for example, rather than by plane, or use of digital tools and cloud technologies to be able to get access to some of the materials that they might use. We're actually encouraged on that front, I think we have some investments we've made over the years that we can leverage to help, and we're seeing the beginnings of that. So I think that side looks good.

是的。我先來，馬歇爾，我來幫你──我請你加入進來，增添一些色彩。這顯然是一個挑戰，也是我們正在努力解決的問題之一。首先，尤其是在美國，醫生關注的重點是其他事情。而有些訓練需要出行，這給雙方都帶來了壓力。所以對我們來說，有兩件事一直在發生。其中一項是看看我們能否將訓練資源前向部署，讓出行更加便利或極為方便。例如，選擇駕車出行而不是搭飛機，或使用數位工具和雲端技術來獲取他們可能使用的一些材料。在這方面，我們確實感到鼓舞。我認為，我們多年來進行的一些投資可以利用這些投資來提供幫助，而我們已經看到了這種幫助的開始。所以我覺得那邊看起來不錯。

That said, training requires demand generation, requires interactions with our sales teams in addition to training once they get going. So it's substantially below prior levels. We're starting to see the beginnings of it coming back, but I'll let Marshall give you a little better color there.

也就是說，培訓需要創造需求，除了在銷售團隊開始工作後進行培訓之外，還需要與他們互動。所以它遠低於之前的水平。我們開始看到它復甦的跡象，但我還是讓馬歇爾來給你更詳細地描述一下。

Yes. It has been below our historical levels. And the importance of it varies depending on the geography as well. So we're in, let's say, in Japan, where you have newer procedures that you're trying to adopt, training becomes a more important element than, let's say, in the United States where people can otherwise be trained in their institutions or that we're talking about mature procedures where proctoring and so forth is more readily available. So I think in the United States, the contribution of new surgeons is much lower than, let's say, in a geography like Japan. And so we did see quite a drop-off in training earlier in the United States because of reluctance to travel and other COVID-related reasons. And as Gary said, we're finding other ways to perform that training, and it could have some impact on us. But again, it's not as big a contributor in the United States as our existing surgeons.

是的。它低於歷史水平。而且它的重要性也因地理位置而異。假設我們身處日本，在那裡，你正在嘗試採用一些新的程序，培訓就變得比在美國更重要，因為在美國，人們可以在自己的機構內接受培訓，或者我們談論的是一些成熟的程序，監考等服務更容易獲得。所以我認為，在美國，新外科醫生的貢獻遠低於像日本這樣的地區。因此，由於不願出遊以及其他與新冠疫情相關的因素，我們早些時候確實看到美國的訓練量大幅下降。正如加里所說，我們正在尋找其他方法來進行這種訓練，這可能會對我們產生一些影響。但話說回來，它在美國所扮演的角色遠不及我們現有的外科醫生。

Next, we will go to the line of Rick Wise with Stifel.

接下來，我們將介紹 Rick Wise 與 Stifel 的合作系列。

I was reflecting again about the delayed J&J program and about, I think you said it, or Marshall said it, Intuitive's unique opportunity to invest. Help us think about this. I have to imagine that in some way, perhaps many ways, Intuitive has been actively aggressively thinking about the challenge preparing for near-term and long-term for the possibility of more competition. That challenge would seem to be meaningfully delayed for the moment. Does this offer you in any way an opportunity to accelerate the pipeline or accelerate spending in some kind of way? Does it -- does this window present an opportunity? It does present you some kind of unique opportunity to invest in. You're going to do something different now than you would have if it has been more imminent?

我再次思考了強生公司延期的項目，以及，我想你或馬歇爾也說過，直覺公司獨特的投資機會。請大家一起思考這個問題。我不得不認為，在某種程度上，也許在許多方面，Intuitive 一直在積極主動地思考如何應對挑戰，為近期和長期可能出現的更多競爭做好準備。這項挑戰目前看來將被顯著推遲。這是否為您提供了以某種方式加快專案進度或加快支出的機會？這是否——這個窗口提供了一個機會？它確實為你提供了一個獨特的投資機會。如果事情迫在眉睫，你現在的做法會和之前有所不同嗎？

Thanks, Rick. For us, we've really focused on being tightly focused on really making measurable improvements to the quad aim, really looking -- forward-looking through the windshield rather than in the side mirrors as to what we think is important. I guess what I'd say is the greatest limitation for us so far has not been opportunity, I think, to do interesting things. There's an enormous amount of opportunity out there to make improvements, and there's enormous technology opportunity. I think the biggest challenge and the great limiting step for us has really been to continue to deploy our programs with excellence, and so that's been a great limiting step on growth. I think that other companies out there are investing in things that make sense that are interesting. I think the vision about where the world might be in 10 or 15 years is not a complicated one, I think it's reasonably shared. And I think what will differentiate Intuitive and other companies is really the ability to deliver these complex technologies at a very high-quality level and then ways that customers can really use to access their resources. So I look around at what's going on outside, and I think they're engaging some of the -- both opportunities that are out there in the world and some of the challenges of doing this well and delivering it. So for us, it's, I guess, I didn't wake up this week and think that the world has changed because of somebody else's conference call.

謝謝你，里克。對我們來說，我們真正專注於對四重目標進行可衡量的改進，真正著眼於——透過擋風玻璃向前看，而不是透過側視鏡看，看看我們認為什麼是重要的。我認為，到目前為止，我們面臨的最大限制並不是機會，而是做有趣事情的機會。有很多改進的機會，也有很多技術的機會。我認為我們面臨的最大挑戰和最大的限制因素在於如何繼續出色地開展我們的項目，而這正是我們發展道路上的一個巨大限制因素。我認為其他公司都在投資一些有意義且有趣的項目。我認為對於未來 10 年或 15 年世界可能的發展方向，人們的看法並不複雜，我認為這種看法也得到了相當程度的認同。我認為真正能將 Intuitive 與其他公司區分開來的，是其以非常高的品質水準交付這些複雜技術的能力，以及客戶真正能夠利用這些技術來存取其資源的方式。所以我環顧四周，看看外面正在發生的事情，我認為他們正在應對一些機遇，以及做好這件事並實現它所面臨的一些挑戰。所以對我們來說，我想，我這週醒來並沒有覺得世界因為別人的一次電話會議而改變了。

Okay. And just a second question for me. On Monday, we presented 100-plus robotic surgeon survey. And of those who said they had wanted to buy eventually, 40% said that they were -- they had made a decision to now postpone. Not a big shock. And you're corroborating that, of course. But how are you thinking -- how would you have us think about that postponed volume? Are you concerned at all that these orders are lost? And could we see a sharp resurgence in capital as normal demand continues, you opened those accounts, new procedures? And on top of that, we see these postponed volume, is that the right way to think about it?

好的。我還有一個問題。週一，我們發布了一項針對 100 多名機器人外科醫生的調查。在那些表示最終想要購買的人中，40%的人表示他們已經決定推遲購買。並不意外。當然，你也證實了這一點。但是，您是怎麼想的——您希望我們如何看待這批延期發行的書籍？您是否擔心這些訂單會遺失？隨著正常需求的持續，以及您開設帳戶、採用新流程等措施，我們是否會看到資本的急劇回升？除此之外，我們也看到這些延期交付量，這樣理解是否正確？

Okay. I think there's 2 drivers of additional capital. One of them is the need for additional capacity driven by surgeon and patient demand for da Vinci procedures. To the extent that, that demand is suppressed because of COVID, fears about COVID or delays in diagnostic pipelines, that will pressure the capital pipeline. That varies regionally. So where COVID is well-managed, we see a knock on the usual types of sales activities where COVID is very intense. Not surprisingly, they were focused on other things. The second thing that can drive capital demand is new features, a product that they want access to because they have older technology. And in that case, if they have the attention span to pursue it and capital or leasing dollars to do something about it, then we can continue to make progress.

好的。我認為吸引額外資金有兩個驅動因素。其中一個原因是外科醫生和患者對達文西手術的需求推動了對額外產能的需求。如果由於新冠疫情、對新冠疫情的擔憂或診斷流程的延誤而導致需求受到抑制，那麼這將給資本流動帶來壓力。這種情況因地區而異。因此，在新冠疫情得到良好控制的地方，我們看到一些常見的銷售活動受到了衝擊；而在新冠疫情非常嚴重的地區，銷售活動則受到了衝擊。不出所料，他們把注意力放在了其他事情上。推動資本需求的第二個因素是新功能，即使用者因擁有較舊的技術而希望獲得的產品功能。在這種情況下，如果他們有足夠的注意力去追求它，並且有足夠的資金或租賃資金來採取行動，那麼我們就可以繼續取得進展。

The prior one, the issue of absorbing existing demand in the field, procedure demand in the field, will be the dominant one, in my opinion, in the next few months. How long that lasts has a lot to do with COVID, and really, none of us know how long that will be. So we'll be ready, we'll react. We are in a strong position from an organization point of view. I think we are able to run the business for the long term, and so we'll do our best in that period, and we'll see it as it plays out.

在我看來，前一個問題，即如何吸收該領域現有的需求，以及該領域的程序需求，將在未來幾個月內佔據主導地位。這種情況會持續多久很大程度上取決於新冠疫情，實際上，我們誰也不知道會持續多久。所以我們會做好準備，我們會做出反應。從組織角度來看，我們處於有利地位。我認為我們有能力長期經營這項業務，所以我們會在那段時間裡盡最大努力，然後看看結果如何。

That was our last question. Thank you. In closing, we continue to believe there's a substantial and durable opportunity to fundamentally improve surgery and acute interventions. Our teams continue to work closely with hospitals, physicians and care teams in pursuit of what our customers have termed the quadruple aim: better, more predictable patient outcomes; better experiences for patients; better experiences for their care teams; and ultimately, a lower total cost to treat 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.

這是我們最後一個問題。謝謝。最後，我們仍然相信，從根本上改善外科手術和急診幹預措施存在著巨大而持久的機會。我們的團隊繼續與醫院、醫生和護理團隊密切合作，追求客戶所稱的四重目標：更好、更可預測的患者治療效果；更好的患者體驗；更好的護理團隊體驗；以及最終降低治療總成本。我們認為，外科手術和急診護理中的價值創造本質上是人性的。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.

感謝您在這段非凡旅程中給予的支持。我們期待三個月後再次與您交談。

Ladies and gentlemen, that will conclude our conference for today. Thank you for your participation and for using the AT&T TeleConference. You may now disconnect.

女士們、先生們，我們今天的會議到此結束。感謝您的參與以及使用 AT&T 電話會議服務。您現在可以斷開連線了。