直覺手術 (ISRG) 2023 Q3 法說會逐字稿

Thank you, everyone, for standing by. Welcome to the Intuitive Surgical Q3 2023 Earnings Release. (Operator Instructions)

感謝各位的耐心等待。歡迎收看 Intuitive Surgical 2023 年第三季財報發表會。 （操作說明）

I will now turn the conference over to your host, Head of Investor Relations, Intuitive Surgical, Brian King. Please go ahead.

現在我將會議交給主持人，直覺外科公司投資人關係主管布萊恩金。請開始吧。

Good afternoon, and welcome to Intuitive's Third Quarter Earnings Conference Call. With me today, we have Gary Guthart, our CEO; Jamie Samath, our CFO; and Dr. Myriam Curet, our Chief Medical Officer.

下午好，歡迎參加Intuitive第三季財報電話會議。今天與我一同出席的有：執行長Gary Guthart；財務長Jamie Samath；以及首席醫療官Myriam Curet博士。

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 10, 2023, and Form 10-Q filed on July 24, 2023.

在會議開始之前，我想告知各位，今天電話會議中提及的評論可能包含前瞻性陳述。由於某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定性已在提交給美國證券交易委員會的文件中詳細描述，包括我們於2023年2月10日提交的最新10-K表格和於2023年7月24日提交的10-Q表格。

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.

投資者可透過本公司網站或美國證券交易委員會（SEC）網站查閱本公司提交的文件。請投資人注意，不應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 Events section under our Investor Relations page. Today's press release and supplementary financial data tables have been posted to our website.

請注意，本次電話會議的音訊回放可在我們網站intuitive.com的「投資者關係」頁面下的「活動」欄位中找到。今天的新聞稿和補充財務數據表已發佈在我們的網站上。

Today's format will consist of providing you with highlights of our third quarter results, as described in our press release announced earlier today, followed by a question-and-answer session. Gary will present the quarter's business and operational highlights, Jamie will provide a review of our financial results, Myriam will present clinical highlights, and I will discuss procedure details and provide our updated financial outlook for 2023. And finally, we will host a question-and-answer session.

今天的會議形式如下：首先，我們將重點介紹我們今天早些時候發布的新聞稿中概述的第三季度業績；隨後進行問答環節。 Gary 將介紹本季度的業務和營運亮點；Jamie 將回顧我們的財務表現；Myriam 將介紹臨床方面的亮點；我將討論手術流程詳情並提供我們更新後的 2023 年財務展望。最後，我們將進行問答環節。

With that, I will turn it over to Gary.

接下來，我將把麥克風交給蓋瑞。

Thank you for joining us today. In this third quarter, we saw a strong growth in procedures performed by our customers, solid new system placements and healthy growth in utilization amid market conditions that remain largely consistent with Q2.

感謝您今天蒞臨本次活動。第三季度，我們看到客戶的手術量強勁成長，新系統安裝量穩健，且在市場環境與第二季度基本保持一致的情況下，系統利用率也實現了健康成長。

Our new platforms continue to gain ground with Ion installs and procedure growth continuing, SP installs and procedure growth modestly accelerating and healthy growth in customer use of our digital tools.

我們的新平台持續取得進展，Ion 安裝量和流程成長持續，SP 安裝量和流程成長略有加速，客戶對我們數位工具的使用也實現了健康成長。

Turning first to procedures. da Vinci procedure growth in the quarter was 19%. Areas of strength included general surgery for benign conditions, particularly in the United States and broad regional growth with Germany, Japan, the U.K. and India standouts. China procedure growth was in line with our global average in the quarter. U.S. dermal surgery procedure growth was led by cholecystectomy and colon resection.

首先來看手術量。本季達文西手術量成長了19%。表現強勁的領域包括良性疾病的普通外科手術，尤其是在美國，以及德國、日本、英國和印度等地區的廣泛成長。中國市場的手術量成長與本季全球平均水平持平。美國皮膚外科手術量的成長主要由膽囊切除術和結腸切除術所推動。

Ion procedures showed continued strength with 125% growth in the quarter. SP procedure growth accelerated with 54% global growth in the quarter driven by strength in the United States.

離子導入手術持續強勁成長，本季成長125%。 SP手術成長加速，全球本季成長54%，主要得益於美國市場的強勁表現。

On the capital front, we placed 312 systems in Q3 compared with 305 systems in Q3 of last year. Our clinical installed base now stands 8,127 multiport da Vinci systems, 490 Ion systems and 158 single-port da Vinci systems.

在資本投入方面，我們第三季安裝了312套系統，而去年同期為305套。目前，我們的臨床裝置量為：多端口達文西手術系統8127套，Ion手術系統490套，單端口達文西手術系統158套。

Overall, our capital placement trends reflect demand for additional capacity in multiport, continued greenfield interest in our Ion system and a modest acceleration for placements of SP. The proportion of leases for new capital placements accelerated in the quarter with the U.S. using the highest leasing rates. We think the acceleration in leasing reflects the convenience of our leasing program and the maturity of our Generation 4 multiport systems.

總體而言，我們的資本配置趨勢反映了對多埠系統新增產能的需求、市場對我們離子交換系統新建專案的持續興趣以及SP系統配置的適度加速。本季新資本配置的租賃比例上升，其中美國地區的租賃費率最高。我們認為，租賃比例的加速反映了我們租賃方案的便利性以及我們第四代多埠系統的成熟度。

While leasing reduces in-quarter revenue relative to capital purchase, total economics are healthy for our customer and for us. Leasing allows our customers to build clinical capacity when and where they need it and provides predefined pathways for our new technology as it enters the market.

雖然租賃方式相對於資本購買會降低當季收入，但從整體經濟效益來看，對我們的客戶和我們本身都是有利的。租賃方式使我們的客戶能夠根據自身需求隨時隨地建立臨床能力，並為我們的新技術進入市場提供預先設定的路徑。

The growth rate in system utilization, defined as procedures per installed system per quarter was 6%, down from 9% last quarter while still above historical growth rates.

系統利用率（定義為每季每套已安裝系統的手術量）成長率為 6%，低於上一季的 9%，但仍高於歷史成長率。

Strong procedure growth and increased proportion of use in benign indications shortens average procedure times and needs of scheduling. Higher utilization increases our customers' return on invested capital and is economically healthy for us.

手術量強勁成長以及良性適應症使用比例的提高，縮短了平均手術時間，減少了預約安排的需求。更高的利用率提高了客戶的投資報酬率，也為我們帶來了良好的經濟效益。

Turning to our finances. Our revenue grew 12% in the quarter and our operating expenses were within our spend guidance. Our spending reflects continued investments in research and development to support the growth of our platforms and digital tools, expansion of our manufacturing and commercial footprints and capital amortization.

接下來談談我們的財務狀況。本季我們的營收成長了12%，營運支出符合預期。我們的支出主要體現在對研發的持續投入，以支持我們平台和數位化工具的成長、擴大生產和商業版圖以及資本攤銷等方面。

Looking at the broader picture, our fourth-generation da Vinci platform is operating at global scale and embedded in a robust ecosystem of instruments, accessories, training and services. Customer acceptance of our Ion platform is strong. Acceptance of our da Vinci SP is accelerating with new indications in the pipeline, and our digital tools are building momentum through their early stages.

從更宏觀的角度來看，我們的第四代達文西手術平台已在全球範圍內投入運營，並融入由儀器、配件、培訓和服務組成的強大生態系統中。客戶對我們Ion平台的接受度很高。隨著新適應症的不斷湧現，達文西SP的市場接受度正在加速提升，而我們的數位化工具也正處於早期發展階段，勢頭強勁。

We welcome Dr. Myriam Curet, Intuitive's Chief Medical Officer to this call, and she will take us through our clinical perspective and some of the work we're doing to expand indications.

我們歡迎 Intuitive 的首席醫療官 Myriam Curet 博士參加本次電話會議，她將向我們介紹我們的臨床觀點以及我們為擴大適應症所做的一些工作。

Our operations teams did a fantastic job supporting our customers through the supply chain shocks of the past several years. This unavoidable effort diverted resources away from product cost reduction and as supply chain stresses ease, we're now pivoting our attention to once again lowering our product costs.

在過去幾年供應鏈遭受衝擊的情況下，我們的營運團隊出色地完成了支援客戶的工作。這項不可避免的工作分散了我們用來降低產品成本的資源。隨著供應鏈壓力的緩解，我們現在正重新調整工作重心，再次致力於降低產品成本。

Areas of opportunity include our Ion program, our SP accessories portfolio and our multiport accessories in advanced instrument lines. Given the timing of facilities completion, manufacturing efficiency improvements for new products and other complex projects, we expect variability in gross margin over the coming quarters as we work through these programs.

機會領域包括我們的離子項目、SP配件產品組合以及先進儀器系列中的多端口配件。鑑於設施竣工時間、新產品生產效率提升以及其他複雜項目，我們預計未來幾季毛利率將出現波動，因為我們需要推進這些項目。

Turning to our digital offerings, customer use of our digital tools and channels is growing nicely. Our SimNow surgical simulators are installed at the majority of our customer sites and subscription renewal rates are outstanding. Routine use of My Intuitive app by over 10,000 da Vinci surgeons grew by 140% year-over-year and is receiving strong Net Promoter Scores that continue improving over time.

再來看我們的數位化產品，客戶對我們數位化工具和通路的使用情況正在穩定成長。我們的SimNow手術模擬器已安裝在大多數客戶現場，訂閱續訂率非常出色。超過1萬名達文西手術醫師日常使用My Intuitive應用程式的比例年增140%，且淨推薦值（NPS）表現優異，且持續提升。

Our Intuitive Hub media management and telepresence system installations grew 58% in the quarter, and Hub captured surgical cases grew 61%.

本季度，我們的直覺中心媒體管理和遠端呈現系統安裝量增加了 58%，中心捕獲的手術病例增加了 61%。

In closing, core demand is healthy. We're focused on in our ecosystem internationally and driving our product cost down, particularly for our newer platforms. We are dogged in pursuit of significant long-term opportunity to improve the quadruple aim using our integrated ecosystem powered by analytics, and we are pacing our investments to catalyze that opportunity.

總之，核心需求保持健康。我們正專注於國際生態系統建設，並努力降低產品成本，尤其是在我們的新平台上。我們堅定不移地尋求重大的長期機遇，利用由分析驅動的整合生態系統來提升四重目標，並正在調整投資節奏以加速實現這一機會。

I'll now turn the time over to Jamie, who will take you through our finances in greater detail.

現在我將時間交給傑米，他將更詳細地向大家介紹我們的財務狀況。

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.我會先介紹我們依照非GAAP準則或備考財務報表編製的績效重點。稍後，我也會在我的發言稿中概述我們按GAAP準則編制的業績。我們網站上已公佈備考財務報表與GAAP財務報表的調節表。

Core metrics continue to be healthy in Q3, with global procedure growth of 19% and an increase in the installed base of da Vinci systems of 13% and an increase in average system utilization of 6%. Our key financial indicators were also healthy. Third quarter recurring revenue grew 21%. Pro forma operating margin was 36%, and pro forma earnings per share increased 23% over last year.

第三季核心指標持續維持良好勢頭，全球手術量成長19%，達文西手術系統裝機量成長13%，平均係統利用率成長6%。關鍵財務指標同樣表現良好。第三季經常性收入成長21%。調整後營業利益率為36%，調整後每股盈餘較上年同期成長23%。

Procedures in the U.S. grew 17%, reflecting a lower benefit from patient backlogs as compared to the first half of 2023.

美國手術量增加了 17%，反映出與 2023 年上半年相比，病患積壓帶來的效益降低。

Last quarter, we highlighted that our growth rate in bariatric's procedures in the U.S. had slowed given patient interest in weight loss drugs. In Q3, we continued to see double-digit growth albeit at a modestly lower growth rate as compared to Q2. Bariatric's procedures represent between 4% and 5% of total global procedures.

上個季度，我們曾指出，由於患者對減重藥物的需求增加，我們在美國進行的減重手術成長速度有所放緩。第三季度，我們持續保持兩位數成長，但成長速度較第二季度略有下降。減重手術佔全球手術總量的4%至5%。

Based on third-party data, we believe we continue to gain market share in the bariatric surgical segment.

根據第三方數據，我們相信我們在減重手術領域將繼續擴大市場份額。

OUS procedures grew 24% with relative strength in India, Germany, the U.K. and Japan. Procedure growth in China was consistent with our expectations, lower than last quarter due to a strong base period given the recovery from COVID-related lockdowns in the year ago quarter.

海外手術量成長了24%，其中印度、德國、英國和日本的成長尤為強勁。中國的手術量成長符合預期，但由於去年同期受新冠疫情封鎖措施的影響，基數較高，因此低於上一季。

Consistent with recent trends, growth in non-neurology procedures outside of the United States was accretive, growing at approximately 31%. Within the larger cancer categories, our fastest-growing OUS procedure is colon resection, a high-value procedure led by adoption in Japan, Germany and the U.K.

與近期趨勢一致，美國以外地區的非神經外科手術成長呈上升趨勢，成長率約 31%。在癌症大類中，我們成長最快的美國境外手術是大腸切除術，這是一項高價值手術，主要得益於日本、德國和英國的普及。

With respect to capital performance, we placed 312 systems in the third quarter as compared to 305 systems last year. As a reminder, system placements in Q3 of last year benefit from a delay in the shipment of approximately 15 systems from June into July as a result of supply chain challenges we encountered in June of last year.

就資本績效而言，我們第三季共安裝了312套系統，而去年同期為305套。需要說明的是，去年第三季的系統安裝量得益於約15套系統從6月延遲到7月交付，這是由於去年6月我們遇到了供應鏈的挑戰。

Late in Q3, we started to see delays in tender processes in China, primarily as a result of anticorruption efforts by the central government, resulting in lower system placements in China in Q3. We expect tender delays to continue to impact system placements in China in Q4.

第三季末，我們開始看到中國招標流程出現延誤，這主要是由於中央政府的反腐敗行動所致，導致第三季中國系統上線數量下降。我們預計招標延誤將在第四季持續影響中國系統上線數量。

Q3 revenue was $1.7 billion, an increase of 12% year-over-year. Q3 revenue growth was driven by procedure growth, partially offset by an 11% decline in systems revenue due to the significant increase in the mix of operating lease arrangements.

第三季營收為17億美元，年增12%。營收成長主要得益於手術量的成長，但部分被系統收入下降11%所抵消，後者是由於經營租賃安排佔比大幅增加所致。

On a constant currency basis, third quarter revenue growth was also 12%. Given recent movements in exchange rates, at current rates, the U.S. dollar is approximately 3% stronger on a revenue-weighted basis as compared to the average rates realized in Q3. Revenue denominated in non-USD currencies represent approximately 24% of total revenue.

以固定匯率計算，第三季營收成長12%。鑑於近期匯率波動，以當前匯率計算，美元兌營收加權平均匯率較第三季平均匯率上漲約3%。以非美元貨幣計價的營收約佔總營收的24%。

Additional revenue statistics and trends are as follows: in the U.S., we placed 159 systems in the third quarter compared to 175 systems placed last year. Outside the U.S., we placed 153 systems in Q3 compared with 130 systems last year. Current quarter system placements included 60 into Europe, 32 into Japan and 10 into China compared with 54 into Europe, 32 into Japan and 15 into China in Q3 of last year.

其他營收統計數據和趨勢如下：在美國，第三季我們安裝了159套系統，而去年同期為175套。在美國以外地區，第三季我們安裝了153套系統，而去年同期為130套。本季安裝的系統包括歐洲60套、日本32套和中國10套，去年同期分別為歐洲54套、日本32套和中國15套。

62 of the 312 systems placed in Q3 were trading transactions compared to 71 trading transactions in the third quarter of last year. As of the end of Q3, there are approximately 440 SIs remaining in the installed base, of which 85 are in the U.S.

在第三季安裝的312套系統中，有62套用於交易，去年同期為71套。截至第三季末，已安裝的系統整合商（SI）數量約為440家，其中85家位於美國。

Operating leases represented 52% of third quarter placements compared with 37% last year. In the U.S., 70% of system placements in Q3 were under operating lease arrangements compared to 48% last year. Of the 163 operating lease placements in the quarter, 93 were usage-based arrangements, an increase compared to 54% last year, reflecting customer preferences, particularly in the U.S.

第三季度，經營租賃佔總部署量的52%，去年同期為37%。在美國，第三季70%的系統部署採用經營租賃方式，去年同期為48%。本季163個經營租賃項目中，有93個為按使用量計費的租賃安排，高於去年同期的54%，這反映了客戶的偏好，尤其是在美國。

While leasing may fluctuate from quarter-to-quarter, we continue to expect that the proportion of placements under operating leases will increase over time.

儘管租賃情況可能每季都會有所波動，但我們仍然預計，隨著時間的推移，經營租賃的比例將會增加。

Q3 system average selling prices were $1.4 million as compared to $1.39 million last quarter from $1.5 million last year. The year-over-year decrease in system ASPs was primarily driven by lower pricing and geographical mix. We recognized $17 million of lease buyout revenue in the third quarter compared with $12 million last quarter and $17 million in Q3 of 2022.

第三季系統平均售價為140萬美元，低於上季的139萬美元和去年同期的150萬美元。系統平均售價較去年同期下降的主要原因是價格下調和地理分佈變化。第三季我們確認了1700萬美元的租賃買斷收入，高於上季的1200萬美元和2022年第三季的1700萬美元。

da Vinci instrument and accessory revenue per procedure of approximately $1,830, compared with approximately $1,840 last quarter and $1,800 last year. On a sequential basis, lower I&A per procedure reflected the impact of customer ordering patterns, partially offset by a full quarter impact from the I&A price increase that went into effect halfway through last quarter.

達文西手術器械及配件的單次手術收入約為 1,830 美元，而上季度約為 1,840 美元，去年同期約為 1,800 美元。環比來看，單次手術器械及配件收入的下降反映了客戶訂購模式的變化，但部分被上季度中期生效的器械及配件價格上漲帶來的整季度影響所抵消。

Turning to our Ion platform. In Q3, we placed 55 Ion systems as compared to 50 in Q3 of 2022. Third quarter Ion procedures of approximately 14,500 increased 125% as compared to last year. 16 of the systems placed in the third quarter were SP systems, 12 into the U.S. and 4 into Korea. SP procedures grew by 54%, and average system utilization growth continued to accelerate growing 21% compared to Q3 of last year.

接下來談談我們的Io平台。第三季度，我們安裝了55套Ion系統，而2022年第三季為50套。第三季Ion手術量約14,500例，較去年同期成長125%。第三季安裝的系統中，有16套為SP系統，其中12套在美國，4套在韓國。 SP手術量成長了54%，系統平均利用率的成長速度持續加快，較去年同期成長21%。

Moving on to the rest of the P&L. Pro forma gross margin for the third quarter was 68.8% compared with 68.5% last quarter and 69.8% last year. As a reminder, pro forma gross margin in Q3 of last year included a onetime benefit of approximately 50 basis points related to the favorable conclusion of certain indirect tax matters.

接下來來看損益表的其他部分。第三季的備考毛利率為68.8%，高於上一季的68.5%和去年同期的69.8%。需要說明的是，去年第三季的備考毛利率包含了一筆約50個基點的一次性收益，該收益與某些間接稅事項的有利結果有關。

The remaining year-over-year difference in pro forma gross margin is primarily due to a higher mix of the Ion revenue, which currently carries significantly lower margins as compared to the da Vinci business and lower system ASP, partially offset by the I&A price increase.

剩餘的同比毛利率差異主要是由於 Ion 收入佔比更高，而 Ion 收入目前的利潤率遠低於達文西手術業務，且係統平均售價也較低，這部分被 I&A 價格上漲所抵消。

Inventory increased to approximately 180 days in Q3, higher than historical averages, driven by 2 factors: first, we have modestly increased our inventory targets given supply chain stresses over the last couple of years; and secondly, given significant capital investments we are making in manufacturing facilities and capacity, we are building bridge inventory to facilitate an elevated number of line transfers to new locations. As a result, we expect higher levels of inventory relative to historical norms into 2025.

第三季庫存週轉天數增至約180天，高於歷史平均水平，主要受兩方面因素影響：首先，鑑於過去幾年供應鏈面臨的壓力，我們小幅提高了庫存目標；其次，由於我們對生產設施和產能進行了大量資本投資，我們正在建立過渡庫存，以支持更多生產線轉移到新的生產地點。因此，我們預計到2025年，庫存水準將高於歷史平均值。

Third quarter pro forma operating expenses increased 8% year-over-year, driven primarily by higher headcount-related costs.

第三季備考營運費用年增 8%，主要原因是與人員編制相關的成本增加。

During the quarter, our head count increased by 489 employees, of which approximately 275 were for our manufacturing operations in support of revenue growth. SG&A expenses as a percentage of revenue were lower by 100 basis points as compared to Q3 of last year and largely reflected planned leverage in our enabling functions.

本季度，我們員工總數增加了489人，其中約275人負責生產運營，以支持營收成長。銷售、管理及行政費用佔營收的比例較去年同期下降了100個基點，這主要反映了我們各項職能部門的預期槓桿效應。

Pro forma other income in Q3 was $58 million compared to $42 million last quarter and $7 million last year. Other income primarily consists of interest income and the increase as compared to last quarter was driven by higher interest rates and higher average cash and investment balances. Pro forma other income in Q3 of last year also reflected higher than typical foreign exchange losses resulting from remeasurement of the balance sheet as a result of the strengthening U.S. dollar.

第三季其他營收（按備考數據）為5,800萬美元，高於上季的4,200萬美元和去年同期的700萬美元。其他收入主要包括利息收入，較上季成長主要得益於利率上升以及平均現金和投資餘額增加。去年第三季其他收入（按備考數據）也反映了由於美元走強導致資產負債表重新計量而產生的高於往常水準的外匯損失。

Capital expenditures in Q3 were $256 million, primarily comprised of infrastructure investments to expand our facilities footprint and increase manufacturing capacity. Our pro forma effective tax rate for the third quarter was 22.5%, consistent with our expectations.

第三季資本支出為2.56億美元，主要用於基礎建設投資，以擴大生產設施規模並提高產能。第三季備考有效稅率為22.5%，與預期相符。

Third quarter pro forma net income was $524 million or $1.46 per share compared with $429 million or $1.19 per share for Q3 of last year.

第三季以備考計算的淨利為 5.24 億美元，即每股 1.46 美元，去年同期為 4.29 億美元，即每股 1.19 美元。

I will now summarize our GAAP results. GAAP net income was $416 million or $1.16 per share for the third quarter of 2023 compared with GAAP net income of $324 million or $0.90 per share for the third quarter of 2022. 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, amortization of intangibles and gains and losses on strategic investments.

現在我將總結我們的GAAP業績。 2023年第三季GAAP淨利為4.16億美元，即每股1.16美元，而2022年第三季GAAP淨利為3.24億美元，即每股0.90美元。備考淨利潤與GAAP淨利潤之間的調整項已在我們的網站上列出並量化，其中包括與員工股票獎勵、員工股票期權激勵、無形資產攤銷以及戰​​略投資損益相關的超額稅收優惠。

We ended the quarter with cash and investments of $7.5 billion compared with $7.1 billion last quarter. The sequential increase in cash and investments reflected cash from operating activities and proceeds from employee stock exercises partially offset by capital expenditures.

本季末，我們持有的現金及投資為75億美元，高於上季的71億美元。現金及投資的環比成長主要反映了經營活動產生的現金流量和員工股票行權所得，但部分被資本支出所抵銷。

And with that, I would like to turn it over to Myriam, who will discuss clinical highlights.

接下來，我將把發言權交給 Myriam，她將介紹臨床的亮點。

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

謝謝。現在我們來談談我們業務的臨床方面。每個季度，我們都會在這些電話會議上重點介紹一些我們認為值得關注的研究。但是，為了更全面地了解現有證據，我們鼓勵所有利益相關者仔細查閱多年來發表的大量科學研究的詳細資訊。

In addition to relaying the results of one of these studies, I'd like to start by describing the status of some important Intuitive research projects underway that support our company's belief in the potential value of da Vinci systems specifically our single-port system for procedures requiring refined access to tight or difficult to reach anatomical areas.

除了介紹其中一項研究的結果外，我還想先介紹一下 Intuitive 公司正在進行的一些重要研究項目的現狀，這些項目支持我們公司對達文西系統潛在價值的信念，特別是我們的單孔系統，該系統適用於需要精細進入狹窄或難以到達的解剖區域的手術。

In June 2021, Intuitive launched an FDA-approved clinical study focused on complex colorectal procedures, such as low anterior resection or right colectomy, performed using the SP platform. Currently, enrollment is complete with 60 patients across 9 sites in the U.S. and Korea.

2021年6月，Intuitive公司啟動了一項FDA批准的臨床研究，該研究專注於使用SP平台進行複雜的結直腸手術，例如低位前切除術或右半結腸切除術。目前，研究已完成入組，在美國和韓國的9個研究中心共招募了60名患者。

Another FDA-approved trials for rapid procedures in pulmonary lobectomy and thymectomy performed using SP completed enrollment in June of this year with 32 subjects enrolled across 6 centers in the U.S.

另一項 FDA 批准的、使用 SP 進行肺葉切除術和胸腺切除術快速手術的試驗於今年 6 月完成招募，共有 32 名受試者在美國 6 個中心入組。

We believe that Intuitive single-port technology will enable thoracic surgeons to perform uniportal lobectomy, something that may be difficult using a VATS approach. Intuitive intent to submit data from these 2 studies to the FDA after the patient follow-up outlined in the study plan and the data analysis has been completed.

我們相信，Intuitive 的單孔技術將使胸腔外科醫生能夠進行單孔肺葉切除術，而這在使用胸腔鏡輔助手術（VATS）時可能難以實現。 Intuitive 計劃在完成研究方案中規定的患者追蹤和數據分析後，將這兩項研究的數據提交給 FDA。

Now I'll turn to a notable study published in the Annals of Surgery this past August. This study was not sponsored by Intuitive. Dr. Yogita Patel of McMaster University in Canada published early results from the RAVAL trial in a manuscript titled Robotic Lobectomy is cost effective and provides comparable health utility scores to video-assisted lobectomy.

現在，我想談談今年八月發表在《外科年鑑》（Annals of Surgery）上的一項重要研究。這項研究並非由Intuitive公司贊助。加拿大麥克馬斯特大學的Yogita Patel博士在一篇題為《機器人肺葉切除術具有成本效益，且其健康效用評分與視頻輔助肺葉切除術相當》的論文中，發表了RAVAL試驗的早期結果。

This study describes results from a multicenter, multinational, blinded, randomized controlled study comparing the da Vinci and VATS approach to pulmonary lobectomy. It analyzed 164 subjects, 81 in new robotic-assisted group and 82 in the VATS group. And all robotic-assisted lobectomies were performed with a da Vinci multiport platform.

本研究描述了一項多中心、多國參與、盲法、隨機對照研究的結果，該研究比較了達文西機器人輔助肺葉切除術和胸腔鏡輔助肺葉切除術（VATS）。研究分析了164位受試者，其中81例為機器人輔助組，82例為VATS組。所有機器人輔助肺葉切除術均使用達文西多孔平台完成。

Notably, the health utility score was significantly higher in the da Vinci arm at 7 weeks and 12 weeks post procedure, which suggests the quality of life for patients who underwent a da Vinci lobectomy was better than for patients undergoing the VATS procedure.

值得注意的是，達文西組在術後 7 週和 12 週的健康效用評分明顯高於胸腔鏡手術組，這表明接受達文西肺葉切除術的患者的生活品質優於接受胸腔鏡手術的患者。

Interestingly, and related to quality of life outcomes, the authors analyzed the incremental cost-effective ratio or ICER for the robotic group relative to VATS and reported the robotic group was associated with a gain of approximately $11,000 per quality adjusted life year.

有趣的是，與生活品質結果相關的是，作者分析了機器人組相對於 VATS 的增量成本效益比 (ICER)，並報告說機器人組每品質調整生命年可獲得約 11,000 美元的收益。

In addition, the median number of lymph nodes examined and sampled were significantly higher in the da Vinci Group.

此外，達文西組的淋巴結檢查和取樣數量中位數明顯高於對照組。

To summarize, the authors conclude that, "Early results from the RAVAL trials suggest that robotic pulmonary lobectomy is a cost-effective intervention, which is associated with comparable patient-reported health utility scores when compared to VATS lobectomy."

綜上所述，作者得出結論：“RAVAL 試驗的早期結果表明，機器人肺葉切除術是一種具有成本效益的干預措施，與 VATS 肺葉切除術相比，其患者報告的健康效用評分相當。”

And with that, I would like to turn it over to Brian who will discuss additional procedure highlights and provide our updated outlook for 2024.

接下來，我將把發言權交給布萊恩，他將討論其他流程要點，並提供我們對 2024 年的最新展望。

Thank you, Myriam. Our overall third quarter procedure growth was 19% year-over-year compared to 20% for the third quarter of 2022 and 22% last quarter. In the U.S., third quarter 2023 procedure growth was 17% year-over-year compared to 18% for the third quarter of 2022 and 19% last quarter. Q3 growth was led by procedure strength within general surgery, with particular strength in cholecystectomy and colon resection.

謝謝Myriam。我們第三季的整體手術量年增19%，而2022年第三季為20%，上季為22%。在美國，2023年第三季的手術量年增17%，而2022年第三季為18%，上季為19%。第三季的成長主要得益於一般外科手術的強勁表現，尤其是膽囊切除術和結腸切除術。

Outside of the U.S., third quarter procedure volume grew 24% compared with 24% for the third quarter of 2022 and 28% last quarter. OUS growth was led by procedures beyond urology, which now make up approximately 50% of total OUS procedures.

除美國以外，第三季手術量年增24%，與2022年第三季的24%和上一季的28%相比均有所成長。美國以外地區的成長主要由泌尿外科以外的手術推動，這些手術目前約占美國以外地區手術總量的50%。

General surgery growth was strong, primarily in colorectal procedures followed by growth in gynecology procedures. Growth in urology continued to be healthy, led by kidney procedures, along with continued double-digit growth in prostatectomy.

一般外科手術成長強勁，主要以大腸直腸手術為主，婦科手術成長也較為顯著。泌尿外科手術持續保持健康成長，腎臟手術是主要成長動力，前列腺切除術也持續維持兩位數成長。

In Europe, we experienced strong growth in Germany, the U.K. and Spain. In each of the regions noted, procedure growth was led by general surgery, primarily from colorectal procedures and specifically in Germany and the U.K., hysterectomy procedures also contributed to strong growth.

在歐洲，我們在德國、英國和西班牙都實現了強勁成長。在上述各個地區，手術量的成長主要由普通外科手術推動，尤其是結直腸手術；在德國和英國，子宮切除術也為強勁成長做出了貢獻。

In Asia, growth was led by Japan. More than half of the incremental procedure growth in the country was led by strong growth in general surgery procedures, consisting largely of colorectal and gastrectomy procedures. In China, procedure growth was consistent with our expectations for the quarter.

在亞洲，日本引領了成長。該國新增手術量超過一半是由普通外科手術的強勁增長帶動的，其中主要包括結直腸手術和胃切除術。在中國，手術量成長符合我們對該季度的預期。

Growth was driven primarily in neurology, notably by prostatectomy and kidney procedures.

增長主要由神經科推動，特別是前列腺切除術和腎臟手術。

In India, while in the early stage of adoption, saw strong growth in general surgery procedures, namely cholecystectomy and hernia repair and growth in gynecology procedures.

在印度，雖然仍處於早期採用階段，但普通外科手術（特別是膽囊切除術和疝氣修補術）以及婦科手術都出現了強勁增長。

I will now turn to our financial outlook for 2023. Starting with procedures. On our last call, we forecasted full year 2023 procedure growth within a range of 20% to 22%. We are now raising the low end from 20% to 21% and expect full year 2023 procedure growth of 21% to 22%. The low end of the range reflects uncertainty around the duration of elevated procedure volumes with patients returning to health care, a continued slowing of bariatric growth rates in the U.S. and macroeconomic challenges that could impact hospitals and patient spending.

接下來，我將談談我們對2023年的財務展望。首先是手術量。在上一次電話會議上，我們預測2023年全年手術量成長率介於20%至22%之間。現在，我們將下限從20%上調至21%，預計2023年全年手術量成長率為21%至22%。下限反映了以下幾個方面的不確定性：患者重返醫療機構後，手術量持續增長的不確定性；美國減重手術成長率持續放緩；以及可能影響醫院和患者支出的宏觀經濟挑戰。

At the high end of the range, we assume macroeconomic challenges do not have a significant impact on hospital procedure volumes, and bariatric growth rates in the U.S. continue at the rate we experienced in Q3. The range does not reflect significant material supply chain disruptions or hospital capacity constraints.

在預測區間的高端，我們假設宏觀經濟挑戰不會對醫院手術量產生重大影響，並且美國減重手術的成長率將繼續保持第三季的速度。此預測區間並未反映重大的原料供應鏈中斷或醫院容量限制。

Turning to gross profit. On our last call, we forecast our 2023 full year pro forma gross profit margin to be within 68% and 69%. We are now refining our estimate of pro forma gross profit margin to be within 68% and 68.5%. Our actual gross profit margin will vary quarter-to-quarter depending largely on product, regional and trade-in mix and the impact of new product introductions.

接下來談談毛利。在上一次電話會議上，我們預測2023年全年備考毛利率將在68%至69%之間。現在，我們將備考毛利率的預測值修正為68%至68.5%。實際毛利率將因產品、地區和以舊換新組合以及新產品上市的影響而逐季波動。

With respect to operating expenses, on our last call, we forecast pro forma operating expense growth to be between 12% and 15%. We are adjusting our estimate and now expect our full year pro forma operating expense growth to be between 12% and 14%. We are also refining our estimate for noncash stock compensation expense to range between $600 million to $610 million in 2023, lowering the range from our previous estimates of $600 million to $620 million.

關於營運費用，在上次電話會議上，我們預測備考營運費用成長率將在12%至15%之間。我們正在調整這項預測，目前預計全年備考營運費用成長率將在12%至14%之間。此外，我們也將2023年非現金股權激勵費用的預測範圍下調至6億美元至6.1億美元，低於先前預測的6億美元至6.2億美元。

We are increasing our estimate for other income, which is comprised mostly of interest income, to total between $190 million and $200 million in 2023, an increase from our previous estimate of $160 million and $180 million. The increase primarily reflects the rise in interest rates.

我們將其他收入（主要包括利息收入）的預期值上調至2023年1.9億美元至2億美元，高於先前預期的1.6億美元至1.8億美元。此次上調主要反映了利率的上升。

With regard to capital expenditures, we are narrowing our estimate to range between $900 million to $1 billion, primarily for planned facility construction activities. With regard to income tax, we are also refining our estimate for the 2023 pro forma tax rate to be between 22% and 23% of pretax income, reducing the previous estimate of the upper end of the range from 24% to 23%.

關於資本支出，我們將預估範圍縮小至9億至10億美元，主要用於計畫中的設施建設活動。關於所得稅，我們也調整了2023年預計稅率，預計稅率為稅前利潤的22%至23%，將先前預估的稅率上限從24%下調至23%。

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

我們的發言到此結束。現在開始接受各位提問。

(Operator Instructions) We go to the first question from the line of Robbie Marcus, JPMorgan.

（操作員指示）我們來回答摩根大通的羅比·馬庫斯提出的第一個問題。

Congrats on good quarter. Maybe to start, it's hard to escape it. GLP-1 is becoming a very big topic in med tech. And your -- it's impacting bariatric surgery here. It doesn't seem to be impacting anything else, particularly in the pipeline. But just wondering your thoughts overall, could GLP-1s ultimately be a positive as more people try weight loss surgery and come in the funnel? And any other impacts good or bad that you foresee on business?

恭喜本季業績出色。或許一開始很難避開它。 GLP-1 正成為醫療科技領域的熱門話題。而且——它正在影響減肥手術。它似乎對其他領域，特別是研發管線，沒有產生影響。但我想了解您的整體看法：隨著越來越多的人嘗試減肥手術並進入治療流程，GLP-1 最終是否會帶來正面影響？您還預見到它對業務的其他任何正面或負面影響嗎？

Thanks, Robbie. I'm going to ask Dr. Curet as a bariatric surgeon to go ahead and weigh in on that first part of your question, and we'll talk about the broader implications after that.

謝謝，羅比。我會請庫雷特醫生這位減肥外科醫生先就你問題的第一部分發表意見，之後我們再討論更廣泛的影響。

I think you are correct. I think in the short term, we will see patients who are considering or are in the pipeline for bariatric surgery going to try the drug. However, given compliance issues, costs, side effects, we expect that many of them will not stay on the drug for longer than a year or 2. And at that time, we'll consider bariatric surgery. So I think overall, we'll see an increased interest in bariatric surgery, but that will get delayed in the short term.

我認為您說得對。短期內，我們會看到一些正在考慮或已經預約減肥手術的患者嘗試這種藥物。但是，考慮到依從性問題、費用以及副作用，我們預計他們中的許多人服用這種藥物的時間不會超過一到兩年。到那時，我們會考慮減重手術。所以我認為總體而言，人們對減重手術的興趣會增加，但這在短期內會被推遲。

Robbie, any follow-up you wanted on GLP-1s?

羅比，你對GLP-1還有什麼後續問題嗎？

No, I had a financial question for Jamie, if that's okay, after.

不，我還有一個關於財務方面的問題想問傑米，可以嗎？稍後再問。

Please.

請。

Jamie, it looks like the fourth quarter gross margin is ticking down a bit, and you're talking about the increased depreciation cost and some of these new investments here. I was wondering if you could size the amount, and I'm really looking for how to think about into next year with depreciation, so we could get our gross margin set based on whatever expansion or contraction we're all forecasting.

傑米，看起來第四季的毛利率略有下降，你提到了增加的折舊成本和一些新的投資。我想請你估算一下具體金額，我真的很想知道明年折舊方面的情況，這樣我們才能根據大家預測的經濟擴張或收縮情況來設定毛利率。

Yes. For Q4, you're not really seeing significant depreciation and expense reflected in the range that we provided. That's really more next year as some of the manufacturing capacity in facilities come online.

是的。就第四季而言，我們提供的預測範圍內並沒有反映出明顯的折舊和費用。這種情況要到明年才會出現，因為部分工廠的產能將會陸續投產。

What you're seeing in Q4 really is a little bit of FX given how the rates have moved, a little bit of slower progress in some of the line transfers and product cost reduction plans that we have, that's not a large delay. It's just slightly slower than we had planned. And then there's some mix dynamics reflected in Q4. They now to be relatively small, but those are the dynamics as to why gross margin range for the year is at the midpoint, slightly lower than what we had previously.

第四季業績下滑主要是由於匯率波動、部分產品線轉移和成本削減計劃進度略有放緩，但這並非大幅延誤，只是比我們預期的稍慢一些。此外，第四季也反映了一些產品組合的變化。雖然這些變化幅度相對較小，但正是這些因素導致全年毛利率區間處於中位數，略低於先前的預期。

With respect to how '24 is shaping up, what I would just say is, as Gary said in his prepared remarks, we'll see some variability in gross margin over the next several quarters is the depreciation expense and the ongoing efforts to improve our product costs, particularly on the Ion side. And frankly, there are some accumulated inefficiencies just in our global manufacturing operations. They built up over COVID and because of the supply chain issues that we encountered that we're addressing. And a number of those will take time for us to resolve.

關於2024年的業績展望，正如Gary在事先準備好的發言稿中所說，未來幾個季度毛利率可能會出現一些波動，這主要是由於折舊費用以及我們持續努力降低產品成本（尤其是在Ion產品方面）所致。坦白說，我們全球製造營運中也存在一些效率低下的問題。這些問題是在新冠疫情期間以及我們遇到的供應鏈問題（我們正在努力解決）中累積的。其中一些問題需要時間才能徹底解決。

So I'd say let us give you '24 guidance for gross margin when we get to January because I think we still have to work through those plans.

所以我認為，等到明年一月我們再給 2024 年毛利率的預期，因為我覺得我們還需要完善這些計畫。

We'll go to the next line, Travis Steed, Bank of America.

接下來我們採訪下一位，特拉維斯·斯蒂德，美國銀行。

I guess to follow up on that. I know on the prepared remarks, it sounds like Gary said, manufacturing improvements for new products and other complex projects. So just curious if you could elaborate on some of those new products and complex projects and what those are that's impacting the gross margin.

我想就此繼續探討。我知道在事先準備好的演講稿中，Gary 提到了新產品和其他複雜項目的製造流程改進。所以我想請您詳細說明這些新產品和複雜項目，以及它們對毛利率的影響。

Yes. On the product side, we have real work to do on Ion. Ion is well accepted by the customer base, growing quickly. We need to iterate and drive manufacturability and manufacturing costs on Ion. So that was mainly what I was referring to.

是的。在產品方面，我們確實還有很多工作要做，尤其是在 Ion 上。 Ion 目前已經獲得了客戶群的認可，並且成長迅速。我們需要不斷迭代，提升 Ion 的可製造性並降低製造成本。這主要是我之前提到的。

Some of the accessories in the SP line are real opportunities. We want to be assertive there. So on the product side, that's most of what the reference is.

SP系列中的一些配件確實蘊藏著巨大的商機。我們希望在這個領域佔據主導地位。因此，在產品方面，這便是我們主要關注的重點。

Just one other element. We are in-sourcing a high-volume accessory on the multiport side as part of in-sourcing that there's some differential automation in the line there. And so ramping that, there's some work to get that to be at our targets.

還有一點要說明。我們正在將多端口介面上的一個大批量配件的生產納入內部流程，作為內部流程的一部分，該生產線上有一些差異化自動化。因此，為了提高產能，我們需要做一些工作才能達到我們的目標。

Great. Helpful. And coming into this year, on the procedures, some of the swing factors were China, staffing pressures and COVID. And I imagine like going into '24, there's bariatrics in China, some of the swing factors. Maybe you could just talk about some of the swing factors on 2024 procedures, pluses and minuses and do you think China and bariatrics are still going to be growing and adding to the growth in procedures in '24?

太好了，很有幫助。就今年的手術量而言，一些影響因素包括中國市場、人員壓力和新冠疫情。我想到了2024年，中國的減重手術也會有一些影響因素。您能否談談2024年手術量的一些影響因素，包括利弊，以及您認為中國市場和減重手術在2024年是否還會持續成長，並推動手術量的成長？

Travis, this is Brian. I guess thinking of 2024, nothing really to share at this point. Clearly, I think when we get into January, we'll be able to give you a bit more insight. But I guess I'll just leave it at that for now.

崔維斯，我是布萊恩。關於2024年，目前還沒有什麼可以透露的。當然，我想到了明年一月，我們就能提供更多資訊了。不過，現在就先說到這裡吧。

Let me just pick up 2 topics you hit. On the China side, I think the procedure demand side remains robust. I think there's some government policy activity that's putting a little bit of a chill in the market. Some of that is economics, so price caps and value-based pricing and some of it is in any corruption probe that is giving hospitals some pause moving forward with other new programs.

我只想談談你提到的兩個面向。就中國而言，我認為手術需求依然強烈。但我認為一些政府政策措施為市場帶來了一絲寒意。部分原因是經濟因素，例如價格上限和基於價值的定價；部分原因是任何反腐敗調查都讓醫院在推進其他新項目時有所顧慮。

We'll see. I think the China side is likely to -- some pressure on the China side is likely to persist for several quarters.

我們拭目以待。我認為中方可能會面臨一些壓力，這種壓力可能會持續幾個季度。

On the bariatric side, I think we'll find a new normal in the next few quarters. It's hard to predict exactly when that will happen. We'll see that play out in the marketplace.

就減重手術而言，我認為未來幾季我們會找到新的常態。但很難準確預測何時會實現。我們將拭目以待市場表現。

We go to next line, Larry Biegelsen, Wells Fargo.

接下來是拉里·比格爾森，富國銀行。

Gary, your usage-based leasing program has gotten some scale. Can you talk about the utilization rates on those systems relative to the average? And any other themes you could share?

Gary，你的以使用量租賃專案已經取得了一定的規模。你能談談這些系統的利用率相對於平均值的情況嗎？還有其他想分享的嗎？

Sure. I will turn to Jamie here on kind of utilization rates. So why don't you kick that off?

當然。關於利用率的問題，我會請傑米來解答。那你先開始吧？

Yes. There's 2 ways to look at it, Larry, what is the absolute utilization rate compared to a regular leasing compared to a purchase arrangement. They are very similar. Actually, the tightness on the mean between those 3 structures is very tight.

是的。拉里，有兩種看待這個問題的方式：一是與一般租賃相比，二是與購買安排相比，絕對利用率是多少？它們非常接近。實際上，這三種安排的平均使用率非常接近。

Within those arrangements, you generally have a target procedure level that reflects success of the program for the customer and the economic objectives that we have. And if you accumulate again, the portfolio they run at slightly above the targeted procedure levels that we have embedded in the contracts. So they have run very well so far, and it's one of the reasons why we and the customer have expanded those so quickly in recent times.

在這些安排中，通常會設定一個目標手術量，以反映專案對客戶的成​​功程度以及我們設定的經濟目標。總的來說，他們的手術量略高於我們合約中設定的目標手術量。因此，到目前為止，他們的手術量運作得非常好，這也是我們和客戶近期迅速擴大手術量的原因之一。

That's helpful. And leasing in the U.S., where do you see that going? I mean, it was almost -- it was over 70 this quarter and last quarter. Have we plateaued? Or does that continue to go higher?

這很有幫助。那麼，您認為美國的租賃市場會如何發展？我的意思是，上個季度和上個季度都幾乎超過了70%。現在市場是否已經趨於平穩？還是會繼續漲？

On a global basis, we expect the proportion of placements that are leased to continue to find. U.S. is pretty high, as you pointed out, Larry, 70% this quarter, 78% last quarter. There will be some larger IDNs that just routinely prefer to purchase just because of how that affects the metrics that are important to them. But even in the U.S., I think there's some room for that to continue to creep up a little bit, obviously, running out of room. We found a number of U.S. customers have really appreciate that as a way to manage through what are totally managed capital budgets.

在全球範圍內，我們預期租賃部署的比例將持續上升。正如您所指出的，Larry，美國的租賃部署比例相當高，本季為70%，上季為78%。一些規模較大的整合交付網路（IDN）出於自身利益考慮，通常會選擇購買部署，因為這會影響到對他們至關重要的指標。但即使在美國，我認為租賃部署的比例仍有進步空間，畢竟市場空間有限。我們發現，許多美國客戶非常欣賞這種方式，認為它有助於他們更好地管理完全受控的資本預算。

Next, we have Brandon Vazquez, William Blair.

接下來是布蘭登·瓦茲奎茲和威廉·布萊爾。

Maybe my first one, I wanted to talk a little bit about general surgery, that's obviously been a nice growth path for you here in the U.S. My understanding is it's a little less penetrated international. What do you think needs to happen in the international markets to kind of get on that steep part of the adoption curve for general surgery as well? Are they kind of seeing time lines and catalysts in the U.S?

我的第一個問題，我想談談普通外科，這顯然是您在美國發展得非常順利的領域。據我了解，它在國際上的滲透率相對較低。您認為國際市場需要哪些變化，才能讓一般外科也像在美國一樣快速發展？他們是否看到了美國市場正在經歷的類似時間表和催化劑？

Sure. Thank you for the question. On -- one way to think about it is that general surgery comprises both procedures that are done where cancer is the underlying cause and others that are benign indication.

當然。謝謝你的提問。關於這一點－你可以這樣理解：一般外科手術既包括因癌症引起的治療手術，也包括因良性疾病引起的治療手術。

On the cancer as an underlying cause, we're seeing nice early growth in several OUS markets. So there, I think that's healthy, and we're enthused. I think reimbursements are generally in place in many of the places that we are operating. I think that's what good in clinical data coming out has been supportive.

就癌症作為潛在病因而言，我們在幾個美國境外市場看到了良好的早期成長。我認為這是健康的，我們也為此感到振奮。我認為在我們開展業務的許多地區，醫保報銷機制已經基本到位。我認為，臨床數據的良好表現也為此提供了支持。

I think that as you think about benign indications, we're seeing some of the beginnings of benign indications in some markets, there may be reimbursement work or education of insurers that has to be done for those to progress further. So in that setting, we'll have additional work to do as it plays out.

我認為，在考慮良性適應症時，我們已經在一些市場看到了良性適應症的雛形，但要讓這些適應症進一步發展，可能還需要在報銷方面開展工作，或者對保險公司進行相關教育。因此，在這種情況下，我們還需要隨著事態發展進行更多工作。

Great. And then maybe last one for me as a follow-up, I think last quarter, you guys were talking a little bit about launching, I believe it was called Case Insights, kind of the software AI platform. Any kind of updates on that end? How are things going so far? And maybe what's in the future for that program?

好的。最後一個問題，作為後續跟進，我記得上個季度你們提到要推出一個叫做「案例洞察」（Case Insights）的軟體人工智慧平台。請問這方面有什麼最新進展嗎？目前進展如何？未來這個計畫有什麼計畫？

Yes. Thank you for the reference. So Case Insights is our machine learning AI program that looks at surgical science. We have our first installs and first cases going. We had talked about it with you last quarter. So far, early feedback, and it's super early. We're really in the early innings here is very good. Case Insights builds on some prior research that we had done with academic centers on something that we have described as a computational observer. So we have some pretty good scientific underpinnings for it.

是的，謝謝您的推薦。 Case Insights 是我們基於機器學習的人工智慧程序，用於分析外科手術科學。我們已經完成了首次安裝並開始處理首批病例。上個季度我們曾與您討論過這個項目。到目前為止，初步回饋非常好，當然，現在還處於非常早期的階段。 Case Insights 是基於我們先前與學術中心合作進行的一些研究，我們將其描述為「計算觀察器」。因此，它擁有相當紮實的科學基礎。

We expect over time that, that program will feed insights into different parts of the hospital's analytic system from giving specific guidance to learning surgeons and care teams about where they might improve their technique and skills to giving suggestions to programmatics about efficiency and total cost management, to giving other insights for the company about how to improve procedures in the OR.

我們預計，隨著時間的推移，該程序將為醫院分析系統的不同部分提供見解，從為學習外科醫生和護理團隊提供關於他們可以在哪些方面改進技術和技能的具體指導，到為程序部門提供關於效率和總成本管理的建議，再到為公司提供關於如何改進手術室流程的其他見解。

So we think it's a long-term set of investments around really the science of surgery. We remain extremely excited about it. While we do have some revenue for it, we don't expect it to be a serious revenue driver. We think it is an ecosystem complementor. And we look forward to describing it more to you as time goes on.

所以我們認為這是一系列圍繞外科手術科學的長期投資。我們對此仍然感到非常興奮。雖然目前我們已經從中獲得了一些收入，但我們並不指望它成為主要的收入來源。我們認為它是一個生態系統補充。隨著時間的推移，我們期待向您詳細介紹它。

We'll go next to Matt Miksic, Barclays.

接下來我們來採訪巴克萊銀行的馬特‧米克西奇。

So I had one question on -- follow-up on kind of the bariatric trends and one on sort of the system leasing effect on pricing. So bariatric, if you could maybe talk about -- you mentioned the global percentage of procedures that bariatric represents maybe just the growth trajectory of that business in the second quarter and the third quarter and whether that's something you expect to grow at a similar trajectory or bottom out given your comments on folks getting on the drug or getting off saying a year or 2 to kind of suggest maybe a longer path to stabilization in that business line within. And then I'll just follow up briefly with the question on ASPs, if I could.

我有一個問題，是關於減肥手術趨勢的後續問題，還有一個問題是關於系統租賃對價格的影響。關於減肥手術，您能否談談——您提到了減肥手術在全球手術中所佔的比例，以及該業務在第二季度和第三季度的增長軌跡，並說明您是否預計該業務會保持類似的增長軌跡，或者考慮到您之前提到患者服用或停用藥物需要一到兩年時間，這是否意味著該業務線可能需要更長的時間才能穩定下來？最後，如果可以的話，我再簡單問一下關於平均售價（ASP）的問題。

Yes. Jamie, you might speak to kind of what the size or percentage of that business is for us and a little bit of the acceleration or deceleration trend.

是的。傑米，您能否談談這項業務在我們公司所佔的規模或比例，以及其加速或減速的趨勢？

Yes. And I want to make sure I got it right, Matt. So come back to me if I have the wrong questions. But our total bariatric business represents about 4% to 5% of global procedures. What you saw in Q2 was in the U.S., which is where the majority of our bariatric procedure volumes are, in the U.S., the growth rate declined to about the U.S. average and then what we saw in Q3 was it modestly decline a little further in Q3. Were those your questions?

是的。馬特，我想確保我理解正確。如果我問錯了，請隨時告訴我。我們所有的減重手術業務約佔全球手術量的4%到5%。您在第二季度看到的是美國的情況，也就是我們減肥手術量最大的地區。在美國，成長率下降到與美國平均水平大致相同的水平，然後在第三季度，成長率略有下降。這些就是您的問題嗎？

Yes. No, that's very helpful. And then I guess, just your expectation -- you framed out in terms of your guidance, but I mean, is this -- I mentioned it just because one of the other competitors actually saw a decline, I guess, in laparoscopic bariatric or some (inaudible) open in the third quarter, single-digit decline, but it doesn't seem like you're in that zone, right? You're still at or slightly below your average growth rate in the U.S. Is that -- am I hearing you answer correctly?

是的。不，這很有幫助。然後我想，關於您的預期——您在業績指引中已經提到過——我的意思是，我之所以提到這一點，是因為其他競爭對手在第三季度似乎出現了腹腔鏡減肥手術或其他（聽不清）手術方面的下滑，個位數的降幅，但您似乎沒有遇到這種情況，對嗎？您在美國的平均成長率仍然維持在或略低於平均水平。我理解的對嗎？

Well, if you take our procedure growth in bariatrics relative to market, we're taking share and have been for some time. So the fact that we had double-digit growth in Q3 relative to another company that had a decline, that's just a reflection in part of the fact that we are taking share in bariatrics and continue to do so even though there's an impact to overall bariatric surgery because of GLP-1s.

嗯，如果以我們減肥手術業務相對於市場的成長情況來看，我們正在不斷擴大市場份額，而且這種情況已經持續了一段時間。因此，我們在第三季度實現了兩位數的成長，而另一家公司卻出現了下滑，這在一定程度上反映了我們正在不斷擴大減肥手術的市場份額，並且即使GLP-1類藥物對整體減肥手術產生了一定影響，我們仍然能夠繼續擴大市場份額。

Got it. That's very helpful. And then the other -- just ASP, I understand the system ASP you give is not -- does not -- as your U.S. leasing goes up, as I understand it, those leased systems in the U.S. are not included in that ASP calculation. So if you could maybe just speak to -- I don't know, the way in which the increased leases have affected ASP or whether this is straight up year-over-year decline that suggested in sort of the overall numbers that you provide, if that's a clear question.

明白了，這很有幫助。另外，關於平均售價（ASP），我理解您提供的系統ASP並沒有－據我了解，隨著美國租賃業務的成長，這些在美國租賃的系統並沒有計入ASP的計算中。所以，您能否解釋一下——我不知道，租賃業務的成長是如何影響ASP的，或者這是否像您提供的整體數據所顯示的那樣，是同比下降？如果我的問題表達清楚了的話。

So everything you described is correct. Generally, although there can be exceptions for mix effect, generally U.S. system ASPs when purchased are accretive to the global average. So in effect, as leasing has grown significantly in the U.S., that in and of itself has an adverse effect for calculated system ASP.

所以您描述的內容完全正確。一般來說，雖然混合效應可能會有例外，但美國系統的平均售價（ASP）在購買時通常會提升全球平均水準。因此，實際上，隨著租賃在美國的顯著成長，這本身會對計算出的系統平均售價產生不利影響。

The other thing that you see then with now a greater proportion of systems used to calculate that system ASP being international FX can have an effect if you look on a 2-year horizon. So for example, the exchange rate in Japan based on how the U.S. dollar has strengthened, there's a 30% to 40% impact over a 2-year basis on system ASP in Japan as translated. So there is a geographical effect.

此外，由於現在用於計算系統平均售價（ASP）的系統中，國際外匯交易所佔比例越來越高，如果從兩年的時間跨度來看，這可能會產生影響。例如，美元走強導致日本匯率波動，兩年內，日本的系統平均售價（ASP）會受到30%到40%的影響。因此，這確實存在地域性影響。

And if you look at a long enough horizon, there's an FX effect in what we described in Q3 was in terms of the year-over-year decline in ASP, also a dynamic relative to pricing and that's really just as we expand our existing customers who are looking for a third, fourth, fifth system, those tend to be slightly lower ASPs than you've seen previously when they were greenfield accounts.

如果從足夠長的時間跨度來看，我們在第三季度描述的ASP同比下降中存在外匯影響，這也是定價的動態變化，這實際上就是隨著我們現有客戶尋求第三、第四、第五個系統，這些系統的平均售價往往比以前作為全新賬戶時略低。

I would say that in China, we do see some competitive dynamics with respect to pricing just given the number of lower local players. And so there's been some competitive effect on system ASPs in China specifically. We don't really see that in other markets to this point.

我認為，在中國，由於本地小型企業數量眾多，我們確實看到了定價方面的一些競爭動態。因此，這種競爭對中國市場的系統平均售價（ASP）產生了一定的影響。到目前為止，我們在其他市場還沒有看到這種情況。

And we'll go to the next line. Jayson Bedford, Raymond James.

接下來是下一位。傑森貝德福德，雷蒙德詹姆斯。

Gary, I think you've expressed your views on the role of bariatric surgery in a GLP world. I'm just wondering if these views have changed in any way over the last quarter or 2? I know it's not a lot of time, but the adoption of this class of drugs is obviously ramping quickly. And then just as kind of a related follow-up, getting back to Robbie's question on the potential impact of GLPs beyond bariatrics. Do you expect an impact from some of your other procedure categories as GLPs get adopted?

加里，我想你已經表達了你對減重手術在GLP（良好實驗室規範）體系下的作用的看法。我只是想知道，在過去的一、兩個季度裡，你的看法是否有所改變？我知道時間不長，但這類藥物的應用顯然正在迅速成長。另外，還有一個相關的後續問題，回到羅比關於GLP在減重手術之外的潛在影響的問題。隨著GLP的普及，你認為其他一些手術類別也會受到影響嗎？

On the first one, I think Myriam described it well. Our position on GLP-1s as it relates to bariatric surgery, I think she hit it well at the start of the call, no reason to reiterate it here.

關於第一個問題，我認為Myriam已經解釋得很清楚了。至於我們對GLP-1在減肥手術中的應用立場，我認為她在電話會議開始時已經闡述得很清楚了，這裡就不贅述了。

On the issue of potential impact beyond bariatrics, there may be some, although I think as you think through the analysis, I think it will be modest.

至於減重手術以外的潛在影響，可能會有一些，但我認為，經過分析，這種影響會比較有限。

And here's how we think about it. If you look at obesity and diabetes is risk factors in other domains and other diseases for which surgery is performed, they are sometimes positive correlated risk factors for that disease. In some weird cases, they are negative in cases that it's actually protective against disease. So it's not entirely obvious.

我們是這樣看待這個問題的。如果你觀察肥胖和糖尿病在其他領域以及其他需要手術治療的疾病中的風險因素，你會發現它們有時是這些疾病的正相關風險因素。但在某些特殊情況下，它們反而會起到保護作用，對某些疾病產生負面影響。所以，情況並非總是顯而易見的。

In most of the diseases that we treat as we look at it, it is not the dominant risk factor. So as we look out and think about what could it be like in our TAM, we can kind of do a back of the envelope analysis. It is really early. I don't think anybody knows the exact number. What I can say is that it's not the dominant risk factor in most things that we look at. And we have a very large unpenetrated TAM. I think that we're still in the early innings of what we're trying to work on. So if these drugs are highly effective at avoiding other types of diseases, we will cheer. I still think we have a lot of upside opportunity to pursue.

在我們研究的大多數疾病中，它並非主要風險因素。因此，當我們展望未來，思考它在潛在市場規模（TAM）中可能扮演的角色時，我們可以進行一些粗略的分析。目前還處於非常早期的階段。我認為沒有人知道確切的數字。但我可以肯定的是，在我們研究的大多數疾病中，它並非主要風險因素。而且，我們還有非常大的未開發潛在市場規模。我認為我們目前的研究仍處於早期階段。因此，如果這些藥物在預防其他類型疾病方面非常有效，我們將感到欣喜。我仍然認為我們有很多潛在的成長機會可以挖掘。

And we'll go to next line. Ryan Zimmerman, BTIG.

接下來我們請下一位發言者。瑞恩·齊默曼，BTIG。

I think you spoke about some of the new indications in SP. If I'm not mistaken, I think there's a 30-day follow-up on the thoracic trial. But I'm curious if you could expand maybe when complex colorectal and thoracic cases potentially could become growth drivers for SP adoption and when you expect those -- not just those trials to wrap up, but potentially clearances in the U.S. with that?

我想您剛才提到了SP的一些新適應症。如果我沒記錯的話，胸部臨床試驗還有30天的追蹤期。但我很好奇，您能否進一步闡述一下，複雜的結直腸和胸部病例何時可能成為SP應用增長的驅動因素，以及您預計這些病例——不僅僅是臨床試驗——何時能夠完成，以及何時可能在美國獲得批准？

Sure. Myriam, I think you're best to answer.

當然可以。米里亞姆，我覺得你最適合回答這個問題。

Yes. So we are hoping to submit everything in the foreseeable future. After that, as you know, there's at least a 90-day turnaround for the IDEs and then -- excuse me, for the clearances. And then after that, we will have to put training together and the launches together. So I can't really give you a time line for when that would be, but we know what the work is that needs to be done, and we are starting and moving forward on that.

是的。我們希望在不久的將來提交所有資料。之後，如您所知，IDE至少需要90天的審批時間，然後——抱歉，是安全許可審批。之後，我們還要安排訓練和發射事宜。所以我無法給出具體的時間表，但我們知道需要完成哪些工作，並且正在著手推進。

Our biggest steps are get the data arranged, get it into the FDA and work with them to get clearances. And then as Myriam says, we'll go through a staged commercialization. So you can expect submissions in the first half of '24 and then response thereafter.

我們最重要的步驟是整理數據，提交給FDA，與他們合作獲得批准。然後，正如Myriam所說，我們將分階段進行商業化。因此，您可以預期在2024年上半年提交申請，之後會收到回覆。

One of the other things, and I don't know if it's direct to you, Gary or Jamie, but you did talk about an opportunity to lower product costs as supply chain stresses ease and I know there were some comments earlier about '24 gross margins. But stepping aside from that, can you quantify the opportunity potentially for what that looks like? Have you gotten your arms around -- I know Marshall has been kind of shepherd in these processes. But at what point can you give the Street more color on what that opportunity looks like to drive gross margin gains?

還有一件事，我不知道這個問題是直接問你，Gary 還是 Jamie，你們之前提到隨著供應鏈壓力的緩解，產品成本有望降低。我知道之前也提到過 2024 年的毛利率。但拋開這些不談，你們能否量化一下這個潛在機會的具體情況？你們是否已經掌握了相關資訊——我知道 Marshall 在這些過程中扮演著引導者的角色。但你們什麼時候才能向華爾街更詳細說明這個機會如何真正推動毛利率的成長呢？

We have very well detailed plans for each of the areas that we're focused on. The teams have the capability and skill. It's going to take some time. I think the best way I would answer the question is we see a path over time probably in the midterm to get back above 70% gross margin.

我們針對每個重點領域都制定了非常詳細的計畫。團隊具備相應的能力和技能。但這需要一些時間。我認為回答這個問題的最佳方式是，我們看到了一條逐步恢復毛利率至70%以上的路徑，可能在中期就能實現。

We go to next line. Anthony Petrone, Mizuho Group.

我們進入下一位發言者。安東尼‧佩特羅內，瑞穗集團。

Maybe one on China and one on pricing on instruments. When we think about the quota size that National Health Commission in China put out, its new quota is 559 systems. Just wondering on anticorruption, could that shift that number over time whether it be that just fewer capital dollars going to projects or just from a timing element because things are getting elongated.

或許可以寫一篇關於中國的文章，一篇關於儀器定價的文章。讓我們來看看中國國家衛生健康委員會公佈的配額，新的配額是559套系統。我在想，反腐敗措施會不會隨著時間的推移影響到這個數字，例如專案資金減少，或者只是因為專案週期延長導致時間上的變化。

And then the pricing question would be on instruments and accessories. The company put a 5% price increase in their first one in 14 years. Chairman Powell came out and said, look, inflation is going to be persistent and elevated for quite some time. If inflation stays high, could another 5% price increase beyond the table for 2024?

接下來就是定價問題了，主要集中在樂器和配件。該公司14年來首次漲價5%。鮑威爾董事長公開表示，通貨膨脹將在相當長的一段時間內持續高漲。如果通貨膨脹居高不下，2024年是否可能再漲價5%？

With regard to the capital side in China, I'll jump into that. I think demand for our systems and for the procedures they support in China, raw demand is really high. So it's really being limited or titrated by policy. I don't see -- I haven't heard anything that says people want to go back and revisit or lower the quota, I think that would be resisted by customers who are looking for purchases.

關於中國的資金方面，我來說說。我認為，中國對我們系統及其所支援流程的需求，也就是絕對需求，非常高。所以，這種需求其實是受到政策的限製或調控的。我沒有聽說——或者說，我沒有聽說有人想要重新審視或降低配額，我認為這樣做會遭到那些正在尋找購買管道的客戶反對。

So I think it's more around delay and a kind of a timing thing. How long it is hard to predict, but months, not weeks.

所以我認為這更多的是延遲和時間安排的問題。具體會持續多久很難預測，但肯定是幾個月，而不是幾週。

On the pricing side, I'll speak to a general principle rather than projecting '24. What we try to do is a couple of things. One is be an outstanding manufacturer, really get high quality at low cost and make sure that we can invest in manufacturing prowess to do that. I think that's really powerful for us, gives us enormous flexibility to meet the customers' needs, kind of where they are.

關於定價方面，我更傾向於談談一個總體原則，而不是預測2024年的情況。我們努力做到兩點。一是成為一家卓越的製造商，真正做到以低成本提供高品質的產品，並確保我們能夠投資於製造能力的提升來實現這一目標。我認為這對我們來說非常重要，它賦予我們極大的靈活性，能夠滿足客戶的各種需求。

With regard to pricing, we look at a couple of things, certainly price to us, cost to us, but also price elasticity, what the customer can do and achieve and that varies by market. And I think we've become increasingly sensitive to and sophisticated at understanding pricing.

關於定價，我們會考慮幾個因素，當然包括我們的價格和成本，但價格彈性，也就是客戶能夠負擔的價格和所能達到的效果，而這因市場而異。我認為我們對定價的理解和掌握已經越來越敏銳和成熟。

So raw material pricing and core inflation to us is an input to our pricing. That's why we took price up this last year but it's not the only thing, and you shouldn't expect us to be purely algorithmic tracking inflation on its own.

因此，原物料價格和核心通膨是我們定​​價的考量因素。這就是我們去年漲價的原因，但這並非唯一因素，您也不應該指望我們完全依靠演算法來追蹤通膨。

And we'll go to the line of Michael Polark of Wolfe Research.

接下來，我們將採訪 Wolfe Research 的 Michael Polark。

I have big picture one modeling long term. There's an investor presentation out earlier this year and it -- Intuitive identified 6 million procedures globally for multi and single port for which you currently have line of sight. And on that same slide, identified that there's 20 million soft tissue surgery procedures overall. And if I look at where you're today, you're approaching 40% of that 6 million. And so my question is the delta between the 20 and the 6 to 14 kind of -- how do you expand the 6 towards the 20? And what are the major unlocks that you expect over the next 3 to 5 years that will move the 6 towards the 20 and kind of your feel for the pace of addressing more of the global procedure pie?

我有一個著眼於長遠發展的宏觀模型。今年早些時候，我們發布了一份投資人報告，其中提到，Intuitive公司指出，目前全球有600萬例多孔和單孔手術需求，你們目前已對這些手術有所了解。同一張投影片也指出，全球軟組織手術總量為2,000萬例。如果看看你們目前的進展，你們已經接近這600萬例中的40%。所以我的問題是，你們要如何將這600萬例提升到2000萬例？你們預計未來3到5年內有哪些重大突破能夠推動你們將這600萬例提升到2000萬例？你們對拓展全球手術市場的速度有何看法？

Yes, it's a good question. I think the general tools that we use to get from 6 to 20 are kind of 3 buckets. Some of them are clearances in new markets. So making sure that a market we can address has access to the technologies that we already have. So when you think about something like Ion, for example, Ion is not yet available in all the markets in which we operate as it operates that it starts to open what we can do. That's kind of one bucket.

是的，這是一個很好的問題。我認為我們用來實現從 6 到 20 倍增長的通用工具大致可以分為三類。其中一類是開拓新市場。也就是說，要確保我們能夠進入的市場能夠獲得我們現有的技術。例如，像 Ion 這樣的技術，雖然它在我們經營的所有市場中尚未普及，但它的出現確實拓展了我們的業務範圍。這算是其中一類工具。

New indications are another one that some of the work that Myriam described earlier. That starts to open a new opportunity for us as we broaden the applicability of our platforms to new types of surgery and intervention.

新的適應症是Myriam之前提到的一些研究成果之一。隨著我們將平台的應用範圍擴展到新型手術和介入治療領域，這為我們開闢了新的機會。

The third bucket or another bucket is reimbursement. There are places where we think additional data is required to get insurers to engage a little bit differently and open the market.

第三個面向是報銷。我們認為，在某些領域，需要更多的數據才能促使保險公司以不同的方式參與進來，從而開放市場。

And then lastly, there are new products and technologies that we're working on that we are not yet described that we think allow us to provide new solutions that are competitive in the marketplace.

最後，我們正在研發一些新產品和新技術，目前尚未公開，但我們認為這些產品和技術能夠為市場提供具有競爭力的新解決方案。

Each of those operates on a little bit different time line. So it's not -- I can't give you a simple synopsis of how fast each one runs. Some of them take a lot of years, some reimbursement things or long lead. A product development can be long lead. Other types of access can happen more quickly. But that's a set of plans that we lay out. We're pretty disciplined about laying out what we want to do over time over a multiyear time horizon. And that's how we start to open that market.

這些項目的運作時間略有不同。所以，我無法簡單地概括每個專案的進度。有些專案需要數年時間，例如報銷流程或較長的準備期。產品開發可能需要很長時間。其他類型的准入則可能更快。但這些都是我們所製定的計畫。我們非常注重規劃未來幾年的發展方向。這就是我們開拓市場的方式。

That was our last question. 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 of care.

這是我們的最後一個問題。最後，我們仍然相信，在從根本上改善外科手術和急診介入方面，存在著巨大且持久的機會。我們的團隊將繼續與醫院、醫生和護理團隊緊密合作，追求客戶所說的「四重目標」：更佳、更可預測的患者治療效果，更佳的患者體驗，更佳的護理團隊體驗，以及最終更低的醫療總成本。

We believe value creation in surgery and acute care is foundationally human. It flows from respect for and understanding of patients and their teams, their needs and their environment.

我們相信，外科手術和急診的價值創造本質上是人文關懷。它源自於對患者及其團隊、他們的需求以及他們所處環境的尊重和理解。

At Intuitive, we envision the future of care that is less invasive and profoundly better where diseases are identified earlier and treated quickly so patients can get back to what matters most.

在 Intuitive，我們展望未來，希望醫療照護更加微創、效果顯著，能夠更早發現疾病並迅速治療，讓患者能夠重返最重要的生活。

Thank you, everyone. And that does conclude your conference. We do thank you for joining. You may now disconnect. Have a good day.

謝謝大家。本次會議到此結束。感謝各位的參與。現在可以斷開連線了。祝您今天愉快。