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.

女士們，先生們，感謝您的支持，歡迎來到 Intuitive Q2 2020 收益發布。

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

（操作員說明）作為提醒，本次會議正在錄製中。

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

現在，我想將電話轉給 Intuitive Surgical 投資者關係高級財務總監 Calvin Darling。

Please go ahead.

請繼續。

Thank you.

謝謝你。

Good afternoon, and welcome to Intuitive's Second Quarter Earnings Conference Call.

下午好，歡迎參加 Intuitive 的第二季度收益電話會議。

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.

今天和我在一起的是我們的首席執行官 Gary Guthart；我們的首席財務官 Marshall Mohr；我很高興向他介紹我們的投資者關係主管 Philip Kim。

As for me, while passing the lead over to Phil, I plan to continue on in a support role with our Investor Relations team.

至於我，在將領導權交給菲爾的同時，我計劃繼續在我們的投資者關係團隊中擔任支持角色。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements.

在開始之前，我想通知您，今天電話會議中提到的評論可能被視為包含前瞻性陳述。

Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties.

由於某些風險和不確定性，實際結果可能與明示或暗示的結果大不相同。

These risks and uncertainties are described in detail in our Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 7, 2020, and Form 10-Q filed on April 17, 2020.

這些風險和不確定性在我們提交給證券交易委員會的文件中進行了詳細描述，包括我們最近於 2020 年 2 月 7 日提交的 10-K 表格和 2020 年 4 月 17 日提交的 10-Q 表格。

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

我們的 SEC 文件可以通過我們的網站或 SEC 的網站找到。

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

告誡投資者不要過分依賴此類前瞻性陳述。

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

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

Today's press release and supplementary financial data tables have been posted to our website.

今天的新聞稿和補充財務數據表已發佈到我們的網站。

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.

此外，本季度，我們還發布了一張圖表，說明了 2020 年每周達芬奇程序趨勢，旨在詳細提供有關 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.

今天的形式將包括為您提供我們今天早些時候宣布的新聞稿中所述的第二季度業績的亮點，然後是問答環節。

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

Gary 將介紹本季度的業務和運營亮點。

Marshall will provide a review of our financial results, then Philip will discuss procedure details.

Marshall 將對我們的財務結果進行審查，然後 Philip 將討論程序細節。

And finally, we will host a question-and-answer session.

最後，我們將舉辦問答環節。

With that, I will turn it over to Gary.

有了這個，我會把它交給加里。

Thank you for joining us today.

感謝您今天加入我們。

On this call, we'll describe our experience in the quarter, the actions we are taking and our priorities going forward.

在這次電話會議上，我們將描述我們在本季度的經歷、我們正在採取的行動以及我們未來的優先事項。

Our focus now and in the past is the safety and well-being of patients, care teams, our communities and our employees.

我們現在和過去的重點是患者、護理團隊、社區和員工的安全和福祉。

Turning first to global procedures.

首先轉向全局程序。

We ended Q2 2020 down 19% compared with Q2 2019.

與 2019 年第二季度相比，我們在 2020 年第二季度末下降了 19%。

The underlying driver for this decline has been the growth of COVID-19 in the communities that our customers serve.

這種下降的根本驅動因素是我們客戶服務的社區中 COVID-19 的增長。

While we saw procedure declines in all categories, urology and thoracic procedures were relatively resilient, while gynecology experienced the greatest decline.

雖然我們看到所有類別的手術都出現下降，但泌尿科和胸科手術相對有彈性，而婦科的下降幅度最大。

Rates of recovery from lowest by procedure type were more uniform.

按程序類型從最低恢復率更加一致。

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.

我們已經看到，擁有充足員工、個人防護裝備和物質資源的醫院在幾個月內恢復到 COVID 前手術運行率的 90% 以上。

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.

恢復到這個數字以上取決於該地區 COVID 的強度、患者返回醫院的舒適度、檢測的可用性和患者外展。

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.

當我們在 7 月站在這裡時，我們看到 COVID 在國內和國際一些地區的持續增長，使得未來對醫院手術能力的預測變得困難。

Philip will take you through some examples of regional differences in procedure trends later in the call.

菲利普將在電話會議的稍後部分向您介紹程序趨勢的區域差異的一些示例。

With regard to capital placements, we installed 178 new systems in Q2 2020.

在資本配置方面，我們在 2020 年第二季度安裝了 178 個新系統。

This compares to 273 installs in Q2 2019 and 237 installs in Q1 2020.

相比之下，2019 年第二季度安裝了 273 次，2020 年第一季度安裝了 237 次。

The new installs in Q2 2020 represent a clinical installed base growth of 9% after accounting for trade-ins.

考慮到以舊換新後，2020 年第二季度的新安裝量代表臨床安裝基數增長了 9%。

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.

雖然這些數字低於去年和上一季度，但坦率地說，由於亞洲的強勁表現和美國的一些更大的 IDN 安置，它們高於我們進入第二季度的預期。

That said, we know the correlation between system utilization in the form of procedure demand and capital availability at hospitals is a strong one.

也就是說，我們知道以程序需求形式的系統利用率與醫院的資本可用性之間的相關性很強。

Hospitals will seek to absorb existing capacity before installing new capital.

醫院將在安裝新資本之前尋求吸收現有容量。

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.

因此，在全球範圍內，我們預計隨著 COVID-19 的流行和醫院支出仍然受到限制，未來資本配置的近期中期環境將面臨挑戰。

Because COVID is impacting locales differently, we see significant variability in procedure growth and new system placement interest by region.

由於 COVID 對地區的影響不同，我們看到不同地區的程序增長和新系統放置興趣存在顯著差異。

Marshall will take you through capital placement trends and risks later in the call.

Marshall 將在電話會議稍後帶您了解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.

在此期間退後一步並評估醫院的手術方法，我們看到一些被廣泛應用的原則。

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.

在醫院服務區內 COVID 在當地快速增長期間，他們的初步反應是調整和培訓他們的勞動力，穩定他們的 PPE 和測試能力，如果 ICU 資源稀缺，則將可能因風險可控而延遲的手術推遲到病人。

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.

隨著工作人員、物資和 ICU 資源的釋放，無論是通過將患者轉移到替代護理地點還是在醫院的 4 道牆內，項目主管都會對需要手術的患者進行分類並重新投入使用，這些地點受到的影響變得更小。

We have observed that outreach, education and diagnostic business and procedures come back.

我們觀察到外展、教育和診斷業務和程序又回來了。

The surge of COVID in communities that represent our core markets, either from initial spread or secondary growth, is occurring now.

代表我們核心市場的社區中的 COVID 激增，無論是從最初的傳播還是二次增長，現在正在發生。

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.

再加上非 COVID 疾病診斷就診延遲的重要軼事證據，我們預計手術的恢復期將很長，可能會持續很多個季度。

The ultimate timing and shape of recovery remains uncertain.

復甦的最終時機和形式仍不確定。

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.

手術持續恢復的驅動因素可能因地區而異，並且可能取決於 COVID 爆發的程度和持續時間、同時治療 COVID 和其他疾病的人力、物質和物理資源的可用性、患者返回護理中心的舒適度診斷和治療，最後是更廣泛的經濟和醫院財務的相對健康狀況。

At Intuitive, we're focused on those activities and priorities within our control.

在 Intuitive，我們專注於我們控制範圍內的那些活動和優先事項。

They are as follows: first, we're focused on the health and well-being of our customers, our employees and our communities.

它們如下：首先，我們關注客戶、員工和社區的健康和福祉。

As COVID has ramped in our communities, we instituted employee health and safety protocols and have been tracking our performance and refining our methods.

隨著 COVID 在我們的社區中蔓延，我們制定了員工健康和安全協議，並一直在跟踪我們的績效並改進我們的方法。

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.

我們還與我們的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 PPE，迄今為止已交付超過 100 萬件 PPE；其次，我們專注於庫存和供應鏈管理。

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.

到目前為止，由於我們的供應鏈團隊和合作夥伴的不懈努力，產品的可用性一直很強勁；第三，我們在本季度實施了客戶財務救濟計劃。

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.

方案的及時性和設計得到了客戶的一致好評；第四，我們繼續投資於我們的高優先級項目，認識到高質量的 MIS 在 COVID 後的未來幾年中可能會更加重要，而不是更重要，如果我們正在評估那些在當前環境中應該加速的活動以及在 COVID 之後的需求可能會持續存在；最後，我們將支出限制在我們認為在當前環境下不理想的地方。

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.

談到儀器，從今年第四季度開始，我們計劃推出一套更新的精選 EndoWrist 儀器，與 da Vinci X 和 Xi 一起使用，這將能夠在當前 10 年的使用壽命之後增加使用，這是我們擴展使用計劃的一部分。

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.

每台儀器的延長使用次數從 2 次到 8 次不等，這是對我們儀器技術的設計和生產進行持續和重大投資的結果，從而提高了質量和耐用性。

In addition, we'll concurrently lower the price of some other instruments that are most commonly used in lower acuity procedures.

此外，我們還將同時降低其他一些最常用於低敏度手術的儀器的價格。

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.

我們致力於支持我們的客戶追求四重目標，即更好的患者結果、更好的患者體驗、更好的護理團隊體驗和更低的每次患者治療總成本。

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.

我們的產品和服務的長期機會是巨大的，無論是在高敏度複雜程序中，還是在較短持續時間的低敏度病例中，客戶對成本更加敏感，這是可以理解的。

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.

一些 EndoWrist 儀器用於每個程序，因此我們的擴展使用計劃可以幫助所有客戶，特別是那些執行較低敏銳度病例的客戶，這是增長最快的程序之一。

As the program rolls out, I&A cost for customers performing lower acuity procedures will be highly competitive with non-robotic MIS approaches.

隨著該計劃的推出，執行較低敏銳度程序的客戶的 I&A 成本將與非機器人 MIS 方法相比具有高度競爭力。

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.

我已經描述了我們對客戶價值調整良性循環的承諾，推動銷量增長，使我們能夠大規模投資設計和製造，並讓我們有機會與客戶分享這些節省，讓他們更多地使用我們的產品寬廣地。

This program is another step in this journey.

該計劃是這一旅程的又一步。

Our extended use program has been years in the making, and its timing is fortuitous relative to COVID.

我們的擴展使用計劃已經醞釀多年，相對於 COVID，它的時機是偶然的。

We are pleased to bring it to our customers now.

我們很高興現在將它帶給我們的客戶。

The program will negatively impact our near term revenue, but not substantially impact our gross margin for affected instruments.

該計劃將對我們的近期收入產生負面影響，但不會對受影響工具的毛利率產生重大影響。

It is the right decision for our customers and, therefore, for Intuitive long term.

這對我們的客戶而言是正確的決定，因此對於 Intuitive 的長期而言也是如此。

Marshall will take you through financial implications of this program later in the call.

Marshall 將在稍後的電話會議中向您介紹該計劃的財務影響。

Turning to advanced instruments.

轉向高級儀器。

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.

我們的達芬奇能源平台，包括我們的下一代能源儀器和系統 SynchroSeal 和 E-100，儘管當前面臨環境挑戰，但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接受度.

We also initiated our first commercial cases for E-100 and SynchroSeal in Japan in the quarter.

本季度，我們還在日本啟動了 E-100 和 SynchroSeal 的首個商業案例。

And lastly, our 45-millimeter SureForm stapler launched in Europe in the second quarter.

最後，我們的 45 毫米 SureForm 訂書機於第二季度在歐洲推出。

Turning to other programs of interest.

轉向其他感興趣的程序。

Our Ion program continues to march forward in the face of COVID headwinds.

面對 COVID 逆風，我們的 Ion 計劃繼續前進。

Three systems were placed in the quarter, and our clinical trial is progressing.

本季度放置了三個系統，我們的臨床試驗正在進行中。

Design and manufacturing teams continue to make progress on incorporating learnings to allow us to drive towards wider distribution in the future.

設計和製造團隊繼續在整合學習方面取得進展，以使我們能夠在未來推動更廣泛的分銷。

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.

雖然我們在 Ion 的 PRECISE 試驗中的進展已經放緩，但隨著我們的臨床試驗合作夥伴的自由，我們看到了病例的回歸。

For our SP program, our teams continue to support our early customers.

對於我們的 SP 計劃，我們的團隊繼續支持我們的早期客戶。

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.

韓國 SP 的平均每月使用率繼續超過 Xi，這是一個強烈的積極因素，表明外科醫生及其患者對該平台的早期興趣。

In addition to our learning from Korea, we are working with regulatory agencies regarding expansion of indications.

除了向韓國學習外，我們還在與監管機構合作擴大適應症。

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.

隨著時間的推移，美國和歐盟的監管環境對於新系統而言變得更加複雜，醫院和監管機構為了抗擊 COVID 而轉移了資源，這使得其更具挑戰性，這會影響臨床試驗和監管審查。

We'll update progress on additional indications for SP as we have greater clarity.

隨著我們更加清晰，我們將更新有關 SP 的其他適應症的進展。

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.

在我們的情報和分析計劃中，我們的團隊表現良好，我們正在利用我們之前在雲計算、培訓技術和分析能力方面的投資。

We have focused on our integration of cloud technologies with InTouch to accelerate access to remote proctoring in certain regions.

我們專注於將雲技術與 InTouch 集成，以加快在某些地區對遠程監考的訪問。

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.

我們已經為我們的模擬技術平台 SimNow 遷移到網絡訂閱模式，這有助於我們減少外科醫生在外科培訓的某些方面的差旅。

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.

即使在 2020 年的動盪中，我們醫院分析程序的使用也在加速，這有助於醫院和我們在這樣的動態時期規劃系統使用。

Before concluding my prepared remarks, let's step back.

在結束我準備好的評論之前，讓我們退後一步。

We cannot yet see the end of the COVID-19 pandemic.

我們還看不到 COVID-19 大流行的結束。

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.

當吸取這次事件的教訓時，我相信高質量的微創護理對未來將更加重要，而不是更重要。

A balanced approach to improving the quadruple aim remains our North Star.

改進四重目標的平衡方法仍然是我們的北極星。

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.

我們未來幾個季度的優先事項如下：首先，在確保供應鏈穩定的同時，在客戶、員工和社區安全方面繼續保持強勁表現；第二，持續支持我們的客戶，適應他們的具體情況，不同的客戶在這個時期處於不同的階段，我們會根據他們的需求來支持他們；第三，推進我們的優先項目、儀器、配件、內窺鏡系統和智能項目；最後，在變革時期進行有紀律的支出管理。

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

我現在將把電話轉給馬歇爾，他將帶您更詳細地了解財務問題。

Good afternoon.

下午好。

I will describe the highlights of our performance on a non-GAAP or pro forma basis.

我將在非公認會計原則或備考基礎上描述我們表現的亮點。

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

稍後我還將在準備好的評論中總結我們的 GAAP 表現。

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

我們的備考結果和公認會計原則結果之間的對賬發佈在我們的網站上。

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.

第二季度的主要業務指標如下： 2020 年第二季度程序與 2019 年第二季度相比減少了約 19%，與上一季度相比減少了約 22%；第二季度 178 個系統的系統佈局與去年的 273 個系統相比減少了 35%，與上一季度的 237 個系統相比減少了 25%；與去年相比，我們將達芬奇系統的安裝基礎擴大了 9%，達到約 5,764 個系統。

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.

這一增長率與上一季度的 11% 和去年的 13% 相比；以每個系統的程序衡量，該領域臨床系統的利用率與去年相比下降了約 27%，與上一季度相比下降了 23%。

Let me walk through the impact of COVID-19 pandemic on procedures and system placements and how it varied by market.

讓我來看看 COVID-19 大流行對程序和系統佈局的影響，以及它如何因市場而異。

The impact of COVID-19 varied significantly among geographies.

COVID-19 的影響因地區而異。

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.

為了幫助您了解這一動態，我們在我們網站的投資者關係部分發布了一張圖表，顯示了美國、中國、日本和德國的程序。

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.

在該圖中，我們將程序與第一季度前 2 個完整週的平均值進行了比較，我們將其定性為 COVID-19 之前的水平。

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.

在美國，第二季度開始的手術量約為 COVID-19 之前水平的 30%，到 6 月中旬增長到接近第一季度前兩週的水平。

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.

然而，隨著 COVID-19 在美國地區的死灰復燃以及相關擇期手術的推遲，手術在本季度的最後幾週開始下降。

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.

隨著大流行繼續蔓延，醫院將人力和物力資源投入到 COVID-19 的治療中，而不是其他程序，我們預計 7 月份達芬奇手術的數量將進一步下降。

Second quarter procedures in China, Japan and Korea grew well year-over-year as COVID had a lower impact on these markets.

由於 COVID 對這些市場的影響較小，中國、日本和韓國的第二季度程序同比增長良好。

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.

在歐洲，COVID 的影響差異很大，德國經歷了同比個位數的增長，而法國、英國和意大利則經歷了大幅下降。

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.

美國和歐洲的資本銷售反映了較低的程序和延遲的資本支出，而鑑於 COVID-19 的影響，醫院重新審視其資本預算。

On the other hand, capital sales in several of our Asia direct markets, including China, Japan and Korea, were better than anticipated.

另一方面，我們在中國、日本和韓國等幾個亞洲直接市場的資本銷售情況好於預期。

System placements will likely continue to be pressured by hospital spending, reflecting the impact of COVID-19 and the result into economic pressures.

系統安置可能會繼續受到醫院支出的壓力，這反映了 COVID-19 的影響以及由此產生的經濟壓力。

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.

此外，由於系統利用率同比下降 27%，醫院的產能過剩，他們可能會在購買額外系統之前尋求填補這些產能。

The extent and duration of COVID-19 and subsequent resurgences in the U.S. and other parts of the world is uncertain.

COVID-19 的範圍和持續時間以及隨後在美國和世界其他地區的死灰復燃尚不確定。

The time and extent to which da Vinci procedures may recover will vary by market.

達芬奇程序可能恢復的時間和程度因市場而異。

However, as we believe surgery is durable and that the long-term worldwide opportunity for robotic-assisted interventions remain significant.

然而，我們相信手術是持久的，並且機器人輔助干預在全球範圍內的長期機會仍然很大。

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.

其他收入統計和趨勢如下： 第二季度收入為 8.52 億美元，比去年下降 22%，比上一季度下降 23%；根據先前宣布的客戶救濟計劃，我們將在第二和第三季度為醫院治療 COVID-19 患者時向客戶提供與其係統使用率降低相關的服務積分。

Revenue reflects $59 million of service credits granted to customers in the second quarter.

收入反映了第二季度授予客戶的 5900 萬美元服務信用。

As procedures in the U.S. and Europe recovered more quickly in the second quarter, the credits issued were less than expected.

由於美國和歐洲的程序在第二季度恢復得更快，發放的信用額度低於預期。

We are now anticipating the total cost of the customer relief program will be in the range of $80 million to $110 million.

我們現在預計客戶救濟計劃的總成本將在 8000 萬美元到 1.1 億美元之間。

Second quarter placements included 21 into China, representing a greater proportion of total placements relative to the prior year and prior quarter.

第二季度有 21 人進入中國，與去年和上一季度相比，佔總安置的比例更大。

As leasing is prohibited in China and most systems are placed within greenfield hospitals, the worldwide percent of leasing and trade-ins has declined.

由於中國禁止租賃並且大多數係統都安裝在新建醫院內，全球租賃和以舊換新的百分比已經下降。

Leasing represented 29% of current quarter placements compared with 32% last quarter.

租賃佔當前季度安置的 29%，而上一季度為 32%。

Trade-ins represented 40% of current quarter placements compared with 57% last quarter.

以舊換新佔當前季度安置的 40%，而上一季度為 57%。

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.

我們預計，在 COVID-19 的環境中，隨著經濟壓力的增加，與歷史運行率所反映的相比，更多的客戶將尋求租賃或替代融資安排。

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

以舊換新活動可能會波動且難以預測。

We recognized $9 million of lease buyout revenue in the second quarter compared with $12 million last quarter and $27 million last year.

我們在第二季度確認了 900 萬美元的租賃收購收入，而上一季度為 1200 萬美元，去年為 2700 萬美元。

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

租賃收購收入在每個季度之間變化很大，並且可能會繼續如此。

Instrument and accessory revenue per procedure 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.

與 2020 年第一季度的 2,000 多美元相比，每次手術的器械和附件收入下降至每次手術約 1,900 美元，這反映了隨著手術減少，醫院對現有庫存的使用。

We expect instrument and accessory revenue per procedure to fluctuate as hospitals adjust inventories to reflect changes in procedure volumes.

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出現波動。

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.

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 月推出具有 12 至 18 次使用的選定 X 和 Xi 儀器，而我們現有的 10 次使用儀器。

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.

這些擴展使用儀器代表了我們的高容量儀器，不包括訂書機、單極和高級能量儀器，並用於廣泛的程序。

The announcement is posted on our website.

該公告發佈在我們的網站上。

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.

由於長期對質量和製造工藝進行了大量投資，我們能夠引入具有擴展用途的儀器。

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.

延長使用儀器的價格通常會高於我們的 10 壽命儀器，這反映了儀器——我們所做的投資，但對於我們的客戶而言，每次使用的成本會更低。

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.

此外，同時，我們將降低在美國低敏度程序和/或低報銷程序（如膽囊切除術、疝氣和良性子宮切除術）中常用的某些器械的價格。結合與延長使用器械相關的節省，結果這些程序的儀器和附件成本將與非機器人 MIS 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.

總體而言，延長使用儀器和降低儀器定價將導致 Intuitive 的每個程序的 I&A 收入降低。

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.

例如，如果延長使用儀器可用並且 2019 年全年儀器定價較低，則 2019 年的收入將比報告的少 1.5 億美元至 1.7 億美元，每個程序的 I&A 將降低 7%。

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.

這些行動對未來收入的影響將取決於手術量、儀器使用、組合以及成本彈性是否能夠更大程度地滲透到可用市場。

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.

第二季度放置的五個系統是 SP 系統，反映了我們對 SP 的測量推出和 COVID-19 的影響。

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.

我們將繼續衡量我們推出的 SP 手術系統，將系統交到經驗豐富的達芬奇用戶手中，同時我們尋求更多適應症並優化我們供應鏈中的培訓途徑。

COVID-19 has delayed the ability to perform a clinical trial associated with an SP colorectal procedure.

COVID-19 推遲了進行與 SP 結直腸手術相關的臨床試驗的能力。

We placed 3 Ion systems in the quarter.

我們在本季度放置了 3 個 Ion 系統。

Ion system placements were also impacted by COVID-19.

離子系統的佈置也受到 COVID-19 的影響。

Ion system placements procedures and related information is excluded from our overall systems and procedure counts.

離子系統放置程序和相關信息不包括在我們的整體系統和程序計數中。

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

在我們優化供應鏈中的培訓途徑的同時，我們將繼續衡量我們推出的 Ion。

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，PRECISE 研究的完成被推遲，我們無法預測 PRECISE 研究何時完成——PRECISE 臨床研究將完成。

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.

在美國以外，我們在第二季度放置了 72 個系統，而 2019 年第二季度為 80 個，上一季度為 55 個。

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.

當前季度系統安置包括 18 個進入歐洲、18 個進入日本和 21 個進入中國，而 2019 年第二季度有 30 個進入歐洲、24 個進入日本和 8 個進入中國。

Moving on to gross margin and operating expenses.

繼續討論毛利率和運營費用。

Pro forma gross margin for the second quarter of 2020 was 62.4% compared with 71.3% for the second quarter of 2019 and 69.7% last quarter.

2020 年第二季度的備考毛利率為 62.4%，而 2019 年第二季度為 71.3%，上一季度為 69.7%。

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.

與 2019 年第二季度和上一季度相比，這一下降主要反映了與異常低產量、客戶救濟計劃以及較高的過剩和過時庫存費用相關的期間成本，部分被較高的系統 ASP 所抵消，反映了有利的地理組合。

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.

第二季度庫存費用約為 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，我們現在能夠通過更新、更強大的產品滿足客戶的需求。

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.

由於 COVID-19 給收入帶來壓力，生產水平可能低於正常水平，這可能導致勞動力成本上升、間接費用吸收不足和產品利潤率下降。

Pro forma operating expenses increased 3% compared with the second quarter of 2019 and decreased 11% compared with last quarter.

與 2019 年第二季度相比，備考運營費用增加了 3%，與上一季度相比下降了 11%。

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.

第二季度的支出反映了與 COVID-19 影響相關的削減成本，特別是培訓、營銷活動和差旅及相關費用，部分被與員工救濟計劃相關的成本和 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.

在大流行期間的支出將如下：我們將努力確保員工的安全和福祉，包括投資於 PP&E 和員工計劃；我們將繼續支持我們的客戶；我們將繼續投資於專注於四重目標的創新；我們將投資於我們供應鏈的製造，以確保為我們的客戶提供供應；我們將確保我們為遏制 COVID-19 傳播的時期做好準備。

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.

由於基礎活動受到 COVID-19 的限制，某些成本將會降低，包括差旅和相關費用、臨床試驗、外科醫生培訓和營銷活動；我們將消除因 COVID-19 而無效的支出，例如外科醫生和醫院活動；我們將酌情減少銷售代表和製造員工等與數量相關的職位的招聘。

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.

我們仍然相信，我們有一個獨特的機會來擴大全球計算機輔助手術和急性干預的好處，我們將繼續長期投資於該業務。

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.

我們第二季度的備考有效稅率為 36.9%，而我們的預期為 20% 至 21%，這反映了與獨立第三方與IRS 涉及向外國子公司收取股權補償費用。

Our actual tax rate will fluctuate with changes in geographic mix of income, changes in taxation made by local authorities and with the impact of onetime items.

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

Our 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 2020 年第二季度的備考淨收入為 1.32 億美元或每股 1.11 美元，而 2019 年第二季度為 3.88 億美元或每股 3.25 美元，上一季度為 3.23 億美元或每股 2.69 美元。

I will now summarize our GAAP results.

我現在將總結我們的 GAAP 結果。

GAAP net income was $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.

2020 年第二季度 GAAP 淨收入為 6800 萬美元或每股 0.57 美元，而 2019 年第二季度 GAAP 淨收入為 3.18 億美元或每股 2.67 美元，上一季度 GAAP 淨收入為 3.14 億美元或每股 2.62 美元。

The adjustments between pro forma and GAAP net income are outlined and quantified on our website and include excess tax benefits associated with employee stock awards, employee stock-based compensation and IP charges, amortization of intangibles and acquisition-related items and legal settlements.

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

We ended the quarter with cash and investments of $6.1 billion compared with $5.9 billion at March 31, 2020.

截至本季度末，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。

Cash generated from operations was partially offset by investments in working capital and our infrastructure.

營運產生的現金部分被營運資金和基礎設施的投資所抵消。

We did not repurchase any shares in the quarter.

我們在本季度沒有回購任何股票。

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 COVID 給客戶帶來的困難，我們將與客戶一起減輕達芬奇利用率較低的負擔，包括為客戶提供更靈活的融資；我們將確保安全的供應鏈並建立適當水平的庫存以確保客戶供應，尤其是在程序恢復時；我們將投資於保護我們的客戶；我們將繼續我們的市場——我們的公開市場回購計劃與我們之前的做法一致。

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

有了這個，我想把它交給菲利普，他將檢查我們的程序性能。

Thank you, Marshall.

謝謝你，馬歇爾。

Our overall second quarter procedure decrease was approximately 19% compared to growth of 17% during the second quarter of 2019 and 10% last quarter.

與 2019 年第二季度的 17% 和上一季度的 10% 的增長相比，我們第二季度的整體程序減少了約 19%。

Our Q2 procedure decrease was driven by a 24% decrease in U.S. procedures and a 7% decrease in OUS markets.

我們第二季度程序減少的原因是美國程序減少 24% 和 OUS 市場減少 7%。

On a worldwide basis, procedures in the quarter troughed in April and continued to recover throughout the quarter.

在全球範圍內，本季度的程序在 4 月達到低谷，並在整個季度繼續恢復。

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.

儘管 6 月份全球程序運行率趨於接近 COVID 之前的水平，但鑑於電話會議早些時候討論的動態，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.

在美國，6 月份的程序運行率也趨於接近 COVID 之前的水平。

However, future procedure performance may fluctuate as customers in states like Texas, Florida and California encounter increased COVID cases.

但是，隨著德克薩斯州、佛羅里達州和加利福尼亞州等州的客戶遇到更多 COVID 病例，未來的程序性能可能會出現波動。

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.

從手術的角度來看，在第二季度末，我們看到大多數手術都出現了廣泛的恢復，包括第一季度末下降幅度最大的手術，例如減肥、疝氣和良性婦科。

Within the U.S., there were geographic differences between states that were hit harder by COVID and those that were not.

在美國，受 COVID 打擊較重的州與未受災的州之間存在地理差異。

For example, during the quarter, Florida recovered to pre-COVID levels on a run rate basis, while New York did not.

例如，在本季度，佛羅里達州在運行率的基礎上恢復到 COVID 之前的水平，而紐約則沒有。

State-specific containment strategies impacted procedure growth, and the timing of COVID outbreaks will play a role in driving geographic differences.

特定州的遏制策略影響了程序的增長，而 COVID 爆發的時間將在推動地理差異方面發揮作用。

Outside of the U.S., procedure growth in Asia was strong.

在美國以外，亞洲的程序增長強勁。

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.

正如我們投資者關係網站上的圖表所示，中國表現強勁，但我們提醒投資者不要將中國作為全球復甦的代表。

Japan growth remained strong at over 30% in Q2, and South Korea also grew in the quarter.

日本在第二季度保持強勁增長，超過 30%，韓國在該季度也有所增長。

Western Europe saw broad declines, with the exception of Germany, which continued to grow in Q2, albeit at a slower rate.

西歐出現普遍下滑，但德國除外，德國在第二季度繼續增長，儘管增速放緩。

We provide these data points to inform investors of the procedure dynamics in the second quarter.

我們提供這些數據點是為了讓投資者了解第二季度的程序動態。

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.

鑑於 COVID 大流行的範圍和持續時間不確定，以及全球復甦和經濟正常化的時間不確定，我們仍然認為第二季度的程序結果並不代表未來趨勢。

That concludes our prepared remarks.

我們準備好的發言到此結束。

We will now open the call to your questions.

我們現在將打開您的問題的電話。

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

（操作員說明）第一個問題來自摩根士丹利的 David Lewis。

Can you hear me okay?

你能聽到我的聲音嗎？

Hi, David.

嗨，大衛。

Yes.

是的。

Oh, great.

哦，太好了。

A little choppy there.

那裡有點波濤洶湧。

So a couple of quick questions for me, Gary, for you.

加里，給你幾個簡單的問題。

Obviously, the focus of the call is going to be on the extended instruments program.

顯然，這次通話的重點將放在擴展儀器程序上。

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.

所以也許 1 適合你，加里，也就是說，在大多數技術行業中，你使技術民主化，以更低的價格來推動 TAM，我相信你已經廣泛研究了你的客戶彈性，所以馬歇爾談到了一個I&A 收入下降 7%。

Can you just give us any sense of a framework around how to think about improvement in utilization based on these cost improvements?

您能否就如何根據這些成本改進來考慮提高利用率的框架給我們一些概念？

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?

然後對你來說，考慮到你的競爭對手，你已經看到強生和美敦力的時間線下滑，我想一些投資者會說，當競爭格局變得更加容易時，為什麼現在採取這種舉措？

And then I have a quick follow-up for Marshall.

然後我有一個馬歇爾的快速跟進。

Yes.

是的。

Thank you.

謝謝你。

I appreciate the question.

我很欣賞這個問題。

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.

關於第一個問題，我們是否認為它會改變我們的技術可能訪問的程序量，答案是肯定的。

I think the real question will be time line.

我認為真正的問題將是時間線。

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.

有點難以預測近期的時間線，因為我認為其中很多都與 COVID 和恢復有關，所以這會模糊它發生的速度。

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.

但如果你仔細觀察幾年，我們清楚地認為客戶想要使用我們的產品，他們想要廣泛地使用它們，廣泛地用於不同的程序領域，如普通外科，但也廣泛地用於區域。

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.

在我們可以在經濟上幫助他們的範圍內，我們認為他們傾向於使用我們的產品，我們認為這會有所幫助，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.

關於時間線的問題 2，我們已經研究了一段時間。

These changes and manufacturing process improvements have taken years to get right.

這些變化和製造過程的改進需要數年時間才能正確完成。

I think being a little too fancy in the time line doesn't help the company or our customers.

我認為在時間線上過於花哨對公司或我們的客戶沒有幫助。

We think that it will be appreciated that we've done it.

我們認為我們已經做到了這一點，我們將不勝感激。

It will be appreciated that we've done it now.

我們現在已經做到了，我們將不勝感激。

And over time, I think we'll look back on it and be happy that we've brought it as expeditiously as we could.

隨著時間的推移，我認為我們會回顧它並為我們盡可能迅速地帶來它而感到高興。

Okay.

好的。

Very helpful.

非常有幫助。

And then Marshall, for you, I appreciate the commentary on 2019 on revenue, and I apologize if I missed it.

然後馬歇爾，對你來說，我很欣賞關於 2019 年收入的評論，如果我錯過了，我深表歉意。

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?

7% 或 1.7 億美元的收入影響，您能否讓我們了解毛利率的影響、毛利率或息稅前利潤的影響，也許毛利率對 2019 年更有幫助？

Just trying to get a sense of the gross margin mix shift into '21 on this I&A extended use program change.

只是想了解一下這個 I&A 擴展使用程序更改的毛利率組合轉變為 21 年。

Sure.

當然。

The margin on the products will be relatively consistent with current margins, so the impact is nominal in terms of 2019.

產品上的毛利會和現在的毛利比較一致，所以2019年的影響是名義上的。

It's a slight down only because you have less instrument and accessory revenue.

只是因為您的儀器和配件收入較少，因此略有下降。

And from a mix perspective, you wind up with more systems revenue.

從混合的角度來看，您最終會獲得更多的系統收入。

Systems revenues have lower margins, but the individual margins on the instruments are not that different.

系統收入的利潤率較低，但工具的個別利潤率並沒有太大差異。

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 Tycho Peterson。

Gary, I'll start with a question on the capital side.

加里，我將從首都方面的問題開始。

If I go back to last quarter, you obviously talked about using the $6 billion on the balance sheet to place more systems.

如果我回到上個季度，您顯然談到了使用資產負債表上的 60 億美元來放置更多系統。

Operating leases did go down.

經營租賃確實下降了。

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?

所以你能不能談談這種動態，你從客戶那裡聽到的，特別是在美國的經營租賃？

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?

就戴夫之前的觀點而言，由於您的競爭對手有所延遲，這是否會改變您在當前環境下推動經營租賃的興趣？

Yes.

是的。

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.

所以只是回到資本，它確實在地區上是可變的，所以在他們沒有受到 COVID 的強烈影響或者他們正在強勁復甦的地方，資本就會再次向前旋轉。

You saw that in China.

你在中國看到了。

And there, we feel good about leasing systems or selling systems.

在那裡，我們對租賃系統或銷售系統感覺良好。

In China, they buy them, they don't lease them.

在中國，他們購買它們，而不是出租它們。

But in other markets, where they're interested in leasing, we're happy to do that.

但在他們對租賃感興趣的其他市場，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.

在受 COVID 干擾的地區，由於選擇性手術的延遲或診斷管道的延遲，患者的流動正在發生變化，在那裡，他們在現有的安裝基礎上有能力。

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.

他們可能想要移動這些系統，他們可能想要升級它們，但總的來說，我們已經看到 - 我們在過去幾年已經看到了，作為醫院的運營商，之前使用你現有的能力擴展它。

And there, I don't think leasing is the major issue.

在那裡，我不認為租賃是主要問題。

I think the real issue is them getting back to surgery and getting ready.

我認為真正的問題是他們重返手術室並做好準備。

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.

在他們有需求的情況下，租賃對我們有幫助，所以我認為這主要是在美國從 COVID 中復甦之後。

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?

然後在程序恢復方面，只是考慮解決患者的積壓問題，是否有更多的患者（聽不清）進入腹腔鏡或開放，因為機器人技術甚至放射治療的積壓？

I'm just curious about how you think about alternatives to robotics given the backlog today.

鑑於今天的積壓，我只是好奇你如何看待機器人技術的替代品。

We get asked that question periodically.

我們會定期被問到這個問題。

I don't see a philosophical shift by heads of perioperative services to try to shift share in response to COVID.

我沒有看到圍手術期服務負責人的哲學轉變，試圖轉移份額以應對 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.

在一個真正受災嚴重的地區，如果他們正在盡其所能，而他們唯一可用的東西是 MIS 以外的東西，他們可能會走那條路。

I don't think that's their primary objective of the health system.

我不認為這是他們衛生系統的主要目標。

And very quickly, they want to return to what they believe is offering the patient the best outcome.

很快，他們想要回到他們認為為患者提供最佳結果的方式。

Looking in the evidence, we don't see any evidence of share shifts at this time.

從證據來看，我們目前沒有看到任何股票轉移的證據。

That's not to say there aren't there, it's just that nothing has really come up.

這並不是說不存在，只是沒有真正出現。

And what we do see is as much positive for robotics as anything else.

我們所看到的對機器人技術和其他任何事物一樣積極。

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

我們的下一個問題將來自美國銀行的 Bob Hopkins。

Can you hear me okay?

你能聽到我的聲音嗎？

Yes.

是的。

Great.

偉大的。

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.

對我來說，第一個是我只是想了解醫院系統在我們最近在這裡看到的病例中通過這種 COVID 增加進行管理的能力。

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?

所以我只是好奇，因為 - 特別是美國的增長對手術量造成了破壞，或者儘管病例增加，情況是否保持穩定？

We've seen it really depends regionally.

我們已經看到它確實取決於地區。

So I guess what we've seen is variance regionally.

所以我想我們看到的是地區差異。

In hard hit areas, we'll see the implementation of deferrals.

在重災區，我們將看到延期的實施。

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.

同樣，在其他有第 1 輪的地方並且它開始重新出現，他們假設同時管理它會更好一點。

Netting it out, the first few weeks in July looks really wavy.

算起來，七月的前幾週看起來真的很不穩定。

Hard to call a good trend, certainly would not call it a recovery in July in the United States.

很難稱其為好趨勢，當然也不會稱其為美國 7 月份的複蘇。

Yes.

是的。

Okay.

好的。

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

我是專門問美國的，但聽起來你的回答也與美國有關。

Yes.

是的。

It's certainly true in the U.S.

在美國確實是這樣。

Okay.

好的。

And then the second question I had was just on the capital environment, and I know you just made a comment there earlier.

然後我的第二個問題是關於資本環境的，我知道你剛才在那裡發表了評論。

But these results, it's not obvious that there was a big negative impact from COVID on capital.

但從這些結果來看，COVID對資本的負面影響並不明顯。

But you made a comment about a challenging environment going forward.

但你對未來充滿挑戰的環境發表了評論。

I'm wondering how much of that is the need to absorb capacity versus the impact on COVID?

我想知道吸收容量的需求與對 COVID 的影響有多少？

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.

我只是想知道，特別是在美國，在這種環境下購買資本的意願，只是想在那裡更新一下。

Sure.

當然。

So we did see -- as we reach the end of the quarter, we did see additional postponements of purchases.

所以我們確實看到了——當我們到達本季度末時，我們確實看到了額外的採購延期。

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.

我們確實從醫院那裡聽說他們正在重新評估他們的預算，考慮 COVID 治療成本的後果，以及考慮 COVID 在潛在衰退和對其資金的影響方面的長期影響.

And so I think the quarter was affected, the capital quarter was affected by COVID.

所以我認為這個季度受到了影響，資本季度受到了 COVID 的影響。

And going forward, you're right, there will be, first, we think, the impact of trying to bring back up systems to fuller utilization.

展望未來，您是對的，首先，我們認為，嘗試使系統恢復到更充分的利用率會產生影響。

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.

27% 是一個相當大的跌幅，我們預計他們會在出去購買更多資本之前尋求填補這一點，特別是當他們已經在財務方面感到緊張時。

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.

所以我認為這是 - 我們本季度開始看到它，我認為我們將繼續看到資本支出的壓力。

Our next question will be 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。

One on capital, one on the regulatory environment.

一是資本，一是監管環境。

Gary, obviously, systems shipped greatly exceeded Street expectations this quarter.

顯然，Gary 本季度的系統出貨量大大超出了華爾街的預期。

Can you talk about any new programs you've introduced to support new placement?

您能談談您為支持新安置而引入的任何新計劃嗎？

We heard you talk this quarter about the loaner program.

我們聽到您在本季度談到了貸款人計劃。

Are there any commitments associated with that?

是否有任何與此相關的承諾？

And are usage-based agreements increasing?

基於使用的協議是否在增加？

And as I said, I had one follow-up on the regulatory environment.

正如我所說，我對監管環境進行了一次跟進。

Sure.

當然。

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.

在本季度的系統轉變中，我將開始回答，我會請馬歇爾加入並提供一些額外的顏色。

I think a lot of what we saw in Q2 in the U.S. was around momentum.

我認為我們在第二季度在美國看到的很多情況都與勢頭有關。

Capital pipelines are multi-month engagements for our sales teams and for our customers.

對於我們的銷售團隊和我們的客戶來說，資本管道是數月的約定。

They have long-term commitments, they're fairly far down the pipeline.

他們有長期的承諾，他們離計劃還很遠。

And in some cases, I think they know they want to do this long term, and they went ahead and closed.

在某些情況下，我認為他們知道他們想長期這樣做，他們繼續前進並關閉。

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.

在美國以外，我們有實力，因為您開始看到程序恢復，他們正在尋求建立額外程序的能力。

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.

至於，是一個特定的銷售計劃還是貸款計劃的引入等等真正推動了這個數字，我不會那樣指導你。

I don't really think that's true.

我真的不認為那是真的。

But Marshall, why don't you step in?

但是馬歇爾，你為什麼不介入呢？

I think you characterized it right.

我認為你的描述是對的。

I don't think there was any particular program that drove it, and I think that it really does reflect momentum.

我不認為有任何特定的程序推動了它，而且我認為它確實反映了勢頭。

Gary alluded to a couple of larger IDN deals getting done.

Gary 提到完成了幾項大型 IDN 交易。

And those were months, if not a year, in the making, and so it takes time to get them closed out.

那是幾個月，如果不是一年，正在醞釀中，因此需要時間才能將它們關閉。

And when you're getting close, even though there's a COVID virus, they went ahead.

當你接近時，即使有 COVID 病毒，他們也會繼續前進。

And we do see strength outside the U.S., particularly in Asia, where COVID has started to recover.

我們確實看到了美國以外的實力，特別是在 COVID 開始復甦的亞洲。

And just for my follow-up, Gary, you talked about changes to the regulatory environment.

就我的後續行動而言，加里，你談到了監管環境的變化。

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?

顯然，我們都聽強生說過——說他們不會在美國為他們的機器人申請 510(k) 我的意思是，你在 FDA 看到了什麼，加里，你認為未來的機器人—— - 手術機器人將像 de novo 510(k)s，PMA，我不 - 顯然，不要指望你代表強生，但你能一般談論手術機器人嗎？

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.

現在在過去幾年中，隨著我們的推出，我們看到每個新平台的臨床數據需求和證據生成有所增加，並且在過去幾年中我們一直在與您討論這一點。

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.

關於引入新平台，我們或其他任何人，我認為路徑取決於聲明的細節、聲明的內容、正在執行的程序以及使用的謂詞的細節，這將指導任何對話我們會與 FDA 合作，或者坦率地說，我們的競爭對手也會這樣做。

So I really can't call out what direction it will go for everybody.

所以我真的無法說出每個人的發展方向。

We do see the discussions being pretty rational, and they just have required additional data sets as time goes on.

我們確實看到討論非常合理，隨著時間的推移，他們只是需要額外的數據集。

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.

我們從過去幾週的財報電話會議中聽到的任何消息都沒有改變我們對所見所聞的看法。

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

我們的下一個問題將與 Raymond James 一起向 Larry Keusch 提問。

Gary, I'm just curious about how you're able to manage your internal R&D development projects throughout COVID?

加里，我只是好奇您如何能夠在整個 COVID 期間管理您的內部研發開發項目？

And I guess really the question is, were you able to keep things going or did you see setbacks as well?

我想真正的問題是，您是否能夠讓事情繼續進行，或者您是否也看到了挫折？

I mean I know you talked about the PRECISE trial, I get it, but I'm really thinking sort of your internal development projects.

我的意思是我知道你談到了 PRECISE 試驗，我明白了，但我真的在考慮你的內部開發項目。

No, I think we've seen both heroic effort on the part of our teams.

不，我認為我們已經看到了我們團隊的英勇努力。

We are blessed by having a medical office inside the company and surgeons who -- and medical people who work for the company directly.

我們很幸運在公司內部有一個醫療辦公室和外科醫生——以及直接為公司工作的醫務人員。

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.

因此，我們實施了協議，使我們能夠保持在傳染病安全協議應有的領先地位，並儘最大努力能夠繼續工作——取得進展。

Our engineering teams have been really creative and thoughtful about getting work done.

我們的工程團隊在完成工作方面非常有創意和深思熟慮。

So we have seen some delays, for sure.

所以我們確實看到了一些延誤。

I wish I would say otherwise, but it's just a reality.

我希望我不這麼說，但這只是現實。

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.

也就是說，我認為團隊已經非常努力地討論了我們的計劃，而不是僅僅因為 COVID 的存在而接受失誤。

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.

正如你所提到的，我們在哪裡 - 這些事情有點超出我們的控制往往是臨床試驗中的事情。

There, you're going back and forth between hospital institution on the front lines.

在那裡，你在前線的醫院機構之間來回穿梭。

They are using -- deploying their resources in ways that are important to them to manage COVID, we fully understand that.

他們正在使用——以對他們來說很重要的方式部署他們的資源來管理 COVID，我們完全理解這一點。

So there, sometimes, it's really us in a support mode.

所以，有時，我們真的處於支持模式。

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.

在我們可以控制它的地方，我們可以控制我們的環境，我們可以對我們的空間、我們的實驗室等進行中繼，我們可以取得更大的進步。

So we see some slips, but we also see great effort to manage the slips.

所以我們看到了一些失誤，但我們也看到了管理這些失誤的巨大努力。

Okay.

好的。

Terrific.

了不起。

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.

然後另一個問題是，當然，有一種感覺，即 COVID 將加速我們已經看到的趨勢，然後轉移到某種門診手術環境。

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.

只是好奇，在上個季度的電話會議中，您提到 Intuitive 組織已準備好以任何方式提供幫助，並且如果機器人需要被轉移到 ASC 或您將成為的其他護理區域，這聽起來肯定是暗示的準備去做。

Did you actually see any of that occur?

你真的看到發生了這些嗎？

And do you think that there is going to be an accelerated trend to move things that you can into non-acute care settings?

您是否認為將有加速的趨勢將您可以使用的東西轉移到非急性護理環境中？

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.

我要請馬歇爾回答這個問題的第一部分，我們是否看到數據集的加速，我會 - 我將回答問題的第二部分，我們認為可能會發生什麼發生在前進。

So Marshall, if you would jump in on the -- on what are we seeing so far?

那麼馬歇爾，如果你願意加入我們到目前為止所看到的內容嗎？

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.

就 ASC 而言，ASC 是它們——達芬奇類型程序的數量，達芬奇在 ASC 中處理的程序實際上並不那麼重要。

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.

您的真實情況- 如果您談論的是醫院IDN 擁有的HOPD 或ASC，那麼我們的存在很大，我們正在處理那裡提出的程序。

We haven't seen -- I haven't -- I'm not aware of movements of large patient quantities to ASCs during this period.

我們沒有看到——我沒有——我不知道在此期間有大量患者轉移到 ASC。

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.

我認為醫院正在努力滿足 COVID 方面的所有需求，所以——我認為我沒有其他要補充的地方。

Yes.

是的。

I'll jump in on my side.

我會站在我這邊。

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.

我認為在這些環境中進行手術，在手術室中實際發生的事情是很好理解的，機器人技術和我們的機器人技術可以在那裡發揮真正的作用。

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.

真正決定某物是在門診、醫院擁有的門診部還是在醫院內並預定為當日手術的因素，其中的差異主要是由報銷和報銷政策驅動的。

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.

如果報銷政策保持原樣，那麼我認為您不會看到 Intuitive 在 ASC 中所做的那種程序的巨大轉變。

But if reimbursement policy were to change in the future, then we'll change with it and go there.

但是，如果將來報銷政策發生變化，那麼我們將隨之改變並去那裡。

So there's a lot of same-day surgery or outpatient surgery that's done on da Vinci devices.

所以有很多在達芬奇設備上完成的當日手術或門診手術。

Where they live has a lot to do with the reimbursement.

他們住的地方與報銷有很大關係。

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，這是 - 後勤執行的意義在哪裡，從報銷的角度來看執行的意義在哪裡，然後他們是否擁有正確的工具、技術和培訓，我認為我們可以適應隨著時間的推移。

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

接下來，我們將與高盛一起前往 Amit Hazan。

Just a couple of quick ones.

只是幾個快速的。

On the da Vinci SP, if I heard your comments right about Korea utilization being higher than Xi, that was a little bit surprising.

在達芬奇 SP 上，如果我聽到你關於韓國利用率高於習近平的評論是正確的，那有點令人驚訝。

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?

所以我只是好奇你是否可以在這背後給出一些顏色，這是否對你表明在 SP 上進行的手術類型更多的是在光譜的低敏銳度方面，以及這是否為你鋪平瞭如何隨著產品的發展，您可能會在這裡推銷產品？

Yes.

是的。

In Korea, the nice thing is that the regulatory clearance allows broad clinical application.

在韓國，好消息是監管許可允許廣泛的臨床應用。

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.

因此，他們可以在泌尿科、胸科和婦科、頭部和頸部進行手術，而且他們也在研究乳房手術。

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.

在那裡，我認為這與低敏銳度無關，我認為他們真正在探索單切口或自然孔道方法真正推動臨床價值的地方。

The surgeons are, I think, thoughtful and innovative here, and that's exciting to us.

我認為，這裡的外科醫生是深思熟慮和創新的，這對我們來說是令人興奮的。

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.

正如我們之前所說，在美國，我們需要進行試驗並獲得更多數據，用於結直腸應用和我們正在籌備的其他一些事情，所以這需要一些時間。

So we look to Korea to say, okay, what does demand look like when not constrained by the regulatory setting.

所以我們期待韓國說，好吧，當不受監管環境的限制時，需求會是什麼樣子。

The nice utilization or high throughput sort of tells us 2 things.

良好的利用率或高吞吐量告訴我們兩件事。

One is there's a real interest in exploring the hypothesis that this creates better outcomes.

一個是人們真正感興趣的是探索這樣的假設，即這會產生更好的結果。

We can also look at the data there and start to see where it does indeed.

我們還可以查看那裡的數據並開始了解它確實在哪裡。

That's exciting.

真令人興奮。

The second thing is it puts the product through the tests of high throughput, high turnaround.

第二件事是它使產品通過了高吞吐量、高周轉的測試。

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.

這些都是在那種環境下精心設計的，他們可以盡可能多地使用它，這對學習很有幫助，而且即使在這個早期階段，產品的成熟度也對我們來說是鼓舞人心的。

So that's how we're looking at Korea, and it will help inform our regulatory strategy in other parts of the world.

這就是我們看待韓國的方式，這將有助於為我們在世界其他地區的監管戰略提供信息。

And then my follow-up would be on just new doctor training.

然後我的跟進將是新的醫生培訓。

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.

對於您在美國的 COVID 之前的情況來說，這顯然仍然相當強大，而且這顯然是您向前看程序增長的關鍵因素。

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?

因此，就定性而言，您能否讓我們了解您在本季度看到的對培訓的影響以及您對今年剩餘時間的看法？

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.

只是正常水平，甚至就像你在手術過程中所做的那樣，對於了解你在哪裡能夠培訓新醫生非常有幫助。

Yes.

是的。

I'll start, and Marshall, I'll help you -- I'll ask you to jump in and add some color.

我會開始，馬歇爾，我會幫助你——我會請你加入並添加一些顏色。

It's clearly challenged and one of the things that we're working on.

這顯然面臨挑戰，也是我們正在努力的事情之一。

First, right upfront, particularly in the United States, doctors are focused on other things.

首先，在前期，尤其是在美國，醫生專注於其他事情。

And travel, which some training requires, is strained.

一些培訓需要的旅行也很緊張。

So for us, 2 things have been going on.

所以對我們來說，有兩件事正在發生。

One of them is to see if we can forward deploy our training assets to make travel easier or extremely convenient.

其中之一是看看我們是否可以向前部署我們的培訓資產，以使旅行更容易或極其方便。

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.

例如，開車而不是乘飛機旅行，或者使用數字工具和雲技術來訪問他們可能使用的一些材料。

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.

我們實際上在這方面受到鼓勵，我認為我們多年來進行了一些投資，我們可以利用這些投資來提供幫助，我們正在看到它的開始。

So I think that side looks good.

所以我覺得那一面看起來不錯。

That said, training requires demand generation, requires interactions with our sales teams in addition to training once they get going.

也就是說，培訓需要產生需求，除了培訓之外，還需要與我們的銷售團隊進行互動。

So it's substantially below prior levels.

所以它大大低於之前的水平。

We're starting to see the beginnings of it coming back, but I'll let Marshall give you a little better color there.

我們開始看到它的開始回歸，但我會讓 Marshall 給你一個更好的顏色。

Yes.

是的。

It has been below our historical levels.

它一直低於我們的歷史水平。

And the importance of it varies depending on the geography as well.

它的重要性也因地理位置而異。

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.

因此，比方說，在日本，您嘗試採用更新的程序，因此培訓成為比在美國更重要的因素，在美國，人們可以在他們的機構或我們談論的是成熟的程序，其中更容易獲得監考等。

So I think in the United States, the contribution of new surgeons is much lower than, let's say, in a geography like Japan.

所以我認為在美國，新外科醫生的貢獻遠低於日本這樣的地區。

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.

因此，由於不願旅行和其他與 COVID 相關的原因，我們確實看到美國早些時候的培訓數量大幅下降。

And as Gary said, we're finding other ways to perform that training, and it could have some impact on us.

正如加里所說，我們正在尋找其他方法來進行培訓，這可能會對我們產生一些影響。

But again, it's not as big a contributor in the United States as our existing surgeons.

但同樣，它在美國的貢獻並不像我們現有的外科醫生那麼大。

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

接下來，我們將與 Stifel 一起前往 Rick Wise 的路線。

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.

我再次反思了延遲的強生計劃，我想你說過，或者馬歇爾說過，Intuitive 獨特的投資機會。

Help us think about this.

幫助我們思考這個問題。

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.

我不得不想像，在某些方面，或許在很多方面，Intuitive 一直在積極積極地思考挑戰，為近期和長期的挑戰做準備，以應對更多競爭的可能性。

That challenge would seem to be meaningfully delayed for the moment.

目前，這一挑戰似乎被有意義地推遲了。

Does this offer you in any way an opportunity to accelerate the pipeline or accelerate spending in some kind of way?

這是否以任何方式為您提供了加速管道或以某種方式加速支出的機會？

Does it -- does this window present an opportunity?

它——這個窗口是否提供了機會？

It does present you some kind of unique opportunity to invest in.

它確實為您提供了某種獨特的投資機會。

You're going to do something different now than you would have if it has been more imminent?

如果它已經迫在眉睫，你現在會做一些不同的事情嗎？

Thanks, Rick.

謝謝，瑞克。

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.

對我們來說，我們真正專注於真正對四邊形目標進行可衡量的改進，真正地向前看——通過擋風玻璃而不是後視鏡看我們認為重要的東西。

I guess what I'd say is the greatest limitation for us so far has not been opportunity, I think, to do interesting things.

我想我要說的是迄今為止對我們來說最大的限制不是機會，我認為，做有趣的事情。

There's an enormous amount of opportunity out there to make improvements, and there's enormous technology opportunity.

有大量的機會進行改進，還有巨大的技術機會。

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.

我認為對我們來說最大的挑戰和最大的限制步驟確實是繼續以卓越的方式部署我們的程序，因此這是限制增長的一個很大的步驟。

I think that other companies out there are investing in things that make sense that are interesting.

我認為其他公司正在投資有意義且有趣的事物。

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.

我認為關於 10 年或 15 年後世界可能會是什麼樣子的願景並不復雜，我認為它是合理共享的。

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.

我認為將 Intuitive 和其他公司區分開來的真正原因在於能夠以非常高質量的水平交付這些複雜的技術，然後是客戶可以真正用來訪問其資源的方式。

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.

所以我環顧四周，我認為他們正在參與其中的一些 - 既有世界上存在的機會，也有一些做好這件事並實現它的挑戰。

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.

所以對我們來說，我想，這週我沒有醒來並認為世界已經因為別人的電話會議而改變了。

Okay.

好的。

And just a second question for me.

對我來說還有第二個問題。

On Monday, we presented 100-plus robotic surgeon survey.

週一，我們展示了 100 多名機器人外科醫生調查。

And of those who said they had wanted to buy eventually, 40% said that they were -- they had made a decision to now postpone.

在那些說他們最終想購買的人中，40% 的人說他們是——他們已經決定現在推遲購買。

Not a big shock.

不是很大的震驚。

And you're corroborating that, of course.

當然，你正在證實這一點。

But how are you thinking -- how would you have us think about that postponed volume?

但是你是怎麼想的——你會讓我們怎麼想那本被推遲的書？

Are you concerned at all that these orders are lost?

您是否擔心這些訂單會丟失？

And could we see a sharp resurgence in capital as normal demand continues, you opened those accounts, new procedures?

隨著正常需求的繼續，我們是否會看到資本的急劇復甦，您開設了這些賬戶，新的程序？

And on top of that, we see these postponed volume, is that the right way to think about it?

最重要的是，我們看到這些推遲的交易量，這是正確的思考方式嗎？

Okay.

好的。

I think there's 2 drivers of additional capital.

我認為有兩個額外資本的驅動因素。

One of them is the need for additional capacity driven by surgeon and patient demand for da Vinci procedures.

其中之一是外科醫生和患者對達芬奇手術的需求需要額外的容量。

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.

在某種程度上，由於 COVID、對 COVID 的擔憂或診斷管道的延遲，這種需求受到抑制，這將給資本管道帶來壓力。

That varies regionally.

這因地區而異。

So where COVID is well-managed, we see a knock on the usual types of sales activities where COVID is very intense.

因此，在 COVID 管理良好的情況下，我們會看到 COVID 非常激烈的通常類型的銷售活動受到衝擊。

Not surprisingly, they were focused on other things.

毫不奇怪，他們專注於其他事情。

The second thing that can drive capital demand is new features, a product that they want access to because they have older technology.

可以推動資本需求的第二件事是新功能，這是他們想要使用的產品，因為他們擁有較舊的技術。

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.

在這種情況下，如果他們有足夠的注意力去追求它，並且有資本或租賃資金來做點什麼，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.

前一個問題，吸收該領域的現有需求，該領域的程序需求，在我看來，將是未來幾個月的主導問題。

How long that lasts has a lot to do with COVID, and really, none of us know how long that will be.

持續多長時間與 COVID 有很大關係，實際上，我們都不知道會持續多久。

So we'll be ready, we'll react.

所以我們會做好準備，我們會做出反應。

We are in a strong position from an organization point of view.

從組織的角度來看，我們處於有利地位。

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.

我認為我們能夠長期經營這項業務，因此我們會在那段時間內盡最大努力，我們會看到它的發展。

That was our last question.

那是我們的最後一個問題。

Thank you.

謝謝你。

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

最後，我們仍然相信，從根本上改善手術和急性干預是一個巨大而持久的機會。

Our teams continue to work closely with hospitals, physicians and care teams in pursuit of what our customers have termed the quadruple aim: better, more predictable patient outcomes; better experiences for patients; better experiences for their care teams; and ultimately, a lower total cost to treat of care.

我們的團隊繼續與醫院、醫生和護理團隊密切合作，以追求我們的客戶所說的四重目標：更好、更可預測的患者結果；為患者提供更好的體驗；為他們的護理團隊提供更好的體驗；並最終降低治療護理的總成本。

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

我們相信，手術和急症護理的價值創造從根本上說是人性化的。

It flows from respect for and understanding of patients and care teams, their needs and their environment.

它源於對患者和護理團隊、他們的需求和環境的尊重和理解。

Thank you for your support on this extraordinary journey.

感謝您對這次非凡旅程的支持。

We look forward to talking with you again in 3 months.

我們期待在 3 個月後再次與您交談。

Ladies and gentlemen, that will conclude our conference for today.

女士們，先生們，今天的會議到此結束。

Thank you for your participation and for using the AT&T TeleConference.

感謝您的參與和使用 AT&T 電話會議。

You may now disconnect.

您現在可以斷開連接。