直覺手術 (ISRG) 2023 Q4 法說會逐字稿

Thank you, everyone, for standing by, and welcome to the Intuitive Fourth Quarter 2023 Earnings Call. (Operator Instructions)

感謝大家的耐心等待，歡迎參加直覺的 2023 年第四季財報電話會議。 （操作員說明）

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

現在我將把電話轉給主持人投資人關係主管布萊恩金 (Brian King)。請繼續。

Good afternoon, and welcome to Intuitive's Fourth Quarter Earnings Conference Call. With me today, we have Gary Guthart, our CEO; and Jamie Samath, our CFO.

下午好，歡迎參加 Intuitive 第四季財報電話會議。今天和我在一起的還有我們的執行長加里·古特特 (Gary Guthart)；和我們的財務長 Jamie Samath。

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 October 20, 2023. Our SEC filings can be found through our website or at the SEC's website. Investors are cautioned not to place undue reliance on such forward-looking statements.

在我們開始之前，我想通知您，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定性在我們向美國證券交易委員會提交的文件中進行了詳細描述，包括我們於2023 年2 月10 日提交的最新10-K 表格和於2023 年10 月20 日提交的10- Q 表格。我們向SEC 提交的文件可以透過以下方式找到：我們的網站或 SEC 的網站。投資者應注意不要過度依賴此類前瞻性陳述。

Please note that this conference call will be available for audio replay on our website at intuitive.com on the 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，本次電話會議將在我們網站直覺的投資者關係頁面下的「活動」部分進行音訊重播。今天的新聞稿和補充財務數據表已發佈到我們的網站上。

Today's format will consist of providing you with highlights of our full year and 4 quarter results. As described in our press release announced earlier today, followed by a question-and-answer session. Gary will present business and operational highlights. Jamie will provide a review of our financial results, then I will discuss procedure and clinical highlights and provide our financial outlook for 2024. And finally, we will host a question-and-answer session.

今天的形式將包括向您提供我們全年和第四季度業績的亮點。正如我們今天早些時候宣布的新聞稿中所述，隨後進行了問答環節。加里將介紹業務和營運亮點。 Jamie 將回顧我們的財務業績，然後我將討論程序和臨床亮點，並提供我們 2024 年的財務前景。最後，我們將舉辦問答環節。

And 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. I'll touch on our performance last quarter and for the full year 2023 and share our perspective on 2024. The past year was a good one for Intuitive with use of our platforms growing nicely, hospitals building additional system capacity to support that growth and increased average utilization per system per year for each of our platforms. Our teams have been delivering to meet customer demand, driving quality and availability improvements, running clinical trials and readying new products and services for the market. We'll touch on a few of those efforts on this call.

感謝您今天加入我們。我將談談我們上季和2023 年全年的業績，並分享我們對2024 年的看法。過去的一年對於Intuitive 來說是美好的一年，我們平台的使用增長良好，醫院建立了額外的系統容量來支持這種成長，並增加了我們每個平台每年每個系統的平均利用率。我們的團隊一直致力於滿足客戶需求、推動品質和可用性改進、開展臨床試驗並為市場準備新產品和服務。我們將在這次電話會議上討論其中的一些努力。

Starting first with procedures. Growth for the full year was 22%. Areas of strength included general surgery in the United States, and regional performance in countries, including Germany, France, the U.K. and Ireland, to name a few. In the U.S., general surgery procedure growth was led by cholecystectomy, with foregut procedures rising as well. Colon and hernia procedure growth was also healthy for the year. Bariatric procedures grew year-over-year. However, we saw a continued deceleration of growth throughout 2023, likely the result of the uptake of GLP-1 drugs for obesity.

首先從程序開始。全年成長率為22%。優勢領域包括美國的普通外科，以及德國、法國、英國和愛爾蘭等國的區域表現。在美國，一般外科手術的成長以膽囊切除術為主導，前腸手術也增加。結腸和疝氣手術今年的成長也很健康。減重手術逐年增加。然而，我們看到整個 2023 年成長持續減速，這可能是使用 GLP-1 藥物治療肥胖的結果。

Procedure growth outside the United States diversified beyond urology with nice growth in categories, including gynecology and general surgery. In flexible robotics, Ion procedures showed continued strength with 129% growth for the full year. ASP procedure growth was accretive in the year with 48% growth over full year driven by acceleration in the United States.

美國以外的手術成長多樣化，超越泌尿科，婦科和一般外科等類別成長良好。在柔性機器人領域，Ion 手術表現出持續的優勢，全年成長 129%。在美國加速的推動下，ASP 程序今年成長強勁，全年成長 48%。

On the capital front, we placed 1,313 multiport systems in the full year '23 compared with 1,241 multiport systems in 2022. Ion placements for the year were 213 versus 192 prior year, and SP placements were 57 for the full year versus 23 systems in the prior year. Globally, placements were strong in the United States and Japan in the year.

在資本方面，我們在23 年全年部署了1,313 個多埠系統，而2022 年部署了1,241 個多埠系統。今年Ion 部署量為213 個，上一年為192 個；全年SP 部署量為57 個，而2022 年為23 個系統。去年。從全球來看，今年美國和日本的投放量強勁。

The use of flexible financing arrangements was substantial in the quarter, particularly in the United States, as customers seek to build capacity balance their da Vinci system portfolios to improve access, and lastly, to allow flexibility to upgrade to future systems. Jamie will take you through placement dynamics in more detail later in the call.

本季靈活融資安排的使用量很大，尤其是在美國，因為客戶尋求建立能力平衡其達文西系統投資組合，以改善訪問，最後允許靈活地升級到未來的系統。 Jamie 將在稍後的電話會議中向您詳細介紹佈局動態。

System utilization, defined as procedures per installed clinical system per quarter grew 9% globally year-over-year for our multiport platform, reaching a new high as customers adopt a broad mix of procedures on our systems. Utilization grew 15% for SP in the year, while it grew 6% for Ion over 2022. Utilization is an important indicator of customer health because it is correlated to patient demand, care team satisfaction and hospital financial health. The above performance reported revenue of $7.1 billion for the year, 14% growth over '22.

我們的多端口平台的系統利用率（定義為每季度每個已安裝的臨床系統的程序）在全球範圍內同比增長了9%，隨著客戶在我們的系統上採用廣泛的程序組合，達到了新高。 SP 的利用率在 2022 年增加了 15%，而 Ion 的使用率則增加了 6%。使用率是客戶健康狀況的重要指標，因為它與患者需求、護理團隊滿意度和醫院財務狀況相關。上述業績報告顯示，全年營收為 71 億美元，較 2020 年成長 14%。

Our capital and operating expenses were on the upper end of our spend guidance reflecting continued investments in R&D to support growth of our platforms and digital tools, expansion of our manufacturing and commercial footprints and capital amortization. Product margins were challenged in the full year as a result of higher-than-expected costs, primarily for our newer platforms. Jamie will take you through our financial performance in greater detail later in the call.

我們的資本和營運支出處於支出指導的上限，反映出我們對研發的持續投資，以支持我們的平台和數位工具的成長、擴大我們的製造和商業足跡以及資本攤銷。由於成本高於預期（主要是我們的新平台），全年產品利潤率受到挑戰。傑米將在稍後的電話會議中向您詳細介紹我們的財務表現。

Strength in procedures, growth in the clinical installed base and increased utilization signaled continued belief by our customers that our platforms make a difference in their efforts to pursue the quadruple aim. Better outcomes, better patient experiences, better care team experiences and lower total cost to treat per patient episode.

程式的實力、臨床安裝基礎的成長和利用率的提高表明我們的客戶仍然相信我們的平台在他們追求四重目標的努力中發揮著重要作用。更好的結果、更好的患者體驗、更好的護理團隊體驗以及更低的每次患者治療總成本。

As we look to 2024, I'd like to share with you that we have submitted to FDA our 510(k) application for our next-generation multiport platform, da Vinci 5. Our design priorities for our new platforms are as follows: First, we look for opportunities to bring better minimally invasive care to more patients. Second, we work to improve the performance of our platforms and existing procedures. Third, we seek to improve care team satisfaction through product utility, dependability and usability improvements. And finally, we strive to help lower the total cost to treat per patient episode.

展望 2024 年，我想與您分享的是，我們已向 FDA 提交了下一代多端口平台 da Vinci 5 的 510(k) 申請。我們新平台的設計重點如下： ，我們尋找機會為更多患者帶來更好的微創護理。其次，我們致力於提高平台和現有程序的效能。第三，我們尋求透過產品實用性、可靠性和可用性的改進來提高護理團隊的滿意度。最後，我們努力協助降低每次患者治療的總成本。

Once cleared, we believe da Vinci 5 will make a positive impact on each of these objectives through hundreds of design changes that respond to surgeon and care team inputs and fulfill our design priorities. As just one example, da Vinci 5 possesses 4 orders of magnitude greater processing power than our Generation 4 products. That means 10,000x the processing power to gather data, improve sensing and deliver better digital and analytic performance.

一旦獲得批准，我們相信達文西 5 將透過數百項設計更改對每個目標產生積極影響，這些更改響應外科醫生和護理團隊的輸入並實現我們的設計優先事項。舉一個例子，達文西 5 的處理能力比我們的第 4 代產品高出 4 個數量級。這意味著收集數據、改進感測並提供更好的數字和分析性能的處理能力提高了 10,000 倍。

Given the sophistication of the technologies involved, we plan a phased launch in the first several quarters after clearance, giving us time to mature our supply and manufacturing processes for the new system. da Vinci 5 will join our existing robotic surgical system portfolio alongside multiport systems, X and Xi, and single-port system SP, offering surgeons and hospitals their choice of highly capable, proven solutions from Intuitive.

鑑於所涉及技術的複雜性，我們計劃在許可後的前幾季分階段推出，以便我們有時間成熟新系統的供應和製造流程。達文西 5 將與多端口系統、X 和 Xi 以及單端口系統 SP 一起加入我們現有的機器人手術系統產品組合，為外科醫生和醫院提供來自 Intuitive 的功能強大、經過驗證的解決方案的選擇。

We have been in communication with FDA on da Vinci 5 for the past several quarters and have completed a comprehensive multicenter IDE trial. This trial finished accruing patients in May of 2023, and we submitted for our 510(k) to FDA for da Vinci 5 in August last year. We are currently responding to FDA's questions. The timing of the U.S. launch will depend on the time required to resolve these questions. So far, we believe the questions asked fall within normal expectations for a submission of this type.

過去幾季我們一直在與FDA就da Vinci 5進行溝通，並已經完成了全面的多中心IDE試驗。該試驗於 2023 年 5 月完成了招募患者，我們於去年 8 月向 FDA 提交了達文西 5 的 510(k) 申請。我們目前正在回答 FDA 的問題。美國的發射時間將取決於解決這些問題所需的時間。到目前為止，我們認為所提出的問題符合此類提交的正常預期。

In addition to FDA, we have initiated conversations on da Vinci 5 with regulators in Japan and in Korea, and we'll report our progress towards commercialization in countries outside the United States as we know more. Once FDA cleared, we will communicate features and benefits in greater depth.

除了 FDA 之外，我們還與日本和韓國的監管機構就達文西 5 進行了對話，我們將在了解更多情況後報告我們在美國以外國家的商業化進展。一旦 FDA 批准，我們將更深入地傳達其功能和優點。

We started 2023 focused on increased adoption of our priority procedures in countries through outstanding training, commercial and market access execution. We pursued expanded indications and launches for Ion and SP. We focus on excellence and continuity of supply, product quality and services provision as we emerge from pandemic stresses. And finally, we pursued increased productivity in our functions that benefit from scale. Taken together, our team made good progress against these objectives.

2023 年伊始，我們的重點是透過優秀的培訓、商業和市場准入執行，在各國更多地採用我們的優先程序。我們尋求擴大 Ion 和 SP 的適應症並推出產品。當我們擺脫大流行壓力時，我們專注於供應、產品品質和服務的卓越性和連續性。最後，我們追求透過規模來提高職能部門的生產力。總的來說，我們的團隊在實現這些目標方面取得了良好進展。

As we enter 2024, our company priorities are as follows: First, we'll focus on innovation through expanded indication and launches of our new platforms by region, including our first phase of da Vinci 5 launch once cleared. Second, we'll pursue increased adoption for focused procedures by country through training, commercial activities, and market access efforts. Third, we will drive quality and gross margin improvements. And finally, we continue to focus on increasing our productivity, particularly in functions that benefit from industrial scale.

進入 2024 年，我們公司的優先事項如下：首先，我們將透過按地區擴大新平台的適應範圍和推出來專注於創新，包括一旦清除後推出達文西 5 的第一階段。其次，我們將透過培訓、商業活動和市場准入努力，爭取各國更多採用重點程序。第三，我們將推動品質和毛利率的提高。最後，我們繼續專注於提高生產力，特別是受益於工業規模的功能。

I'll now turn the time over to Jamie.

現在我把時間交給傑米。

Good afternoon. I will describe the highlights of our performance on a non-GAAP or pro forma basis and will also summarize our GAAP performance later in my prepared remarks. A reconciliation between our pro forma and GAAP results is posted on our website.

午安.我將在非 GAAP 或備考基礎上描述我們的業績亮點，並將在稍後的準備好的發言中總結我們的 GAAP 業績。我們的預估結果與公認會計準則結果之間的對帳已發佈在我們的網站上。

Q4 and 2023 revenue procedures and system placements are in line with our preliminary press release of January 9. I will briefly review full year 2023 performance before describing our Q4 results in greater detail. 2023 procedures grew by 22% as compared to last year, or 17% on a 4-year compound annual growth rate basis. As we have discussed on previous calls, 2023 procedure growth was above our longer-term trend, primarily because of the need to address patient backlogs.

第四季和 2023 年收入程序和系統佈局與我們 1 月 9 日的初步新聞稿一致。在更詳細地描述我們第四季度的業績之前，我將簡要回顧一下 2023 年全年業績。 2023 年程序較去年增長 22%，以 4 年複合年增長率計算為 17%。正如我們在之前的電話會議中討論的那樣，2023 年的手術成長高於我們的長期趨勢，主要是因為需要解決患者積壓問題。

During the year, we placed 1,370 systems with customers, an increase of 8% year-over-year. Excluding trading transactions, net new system placements for 2023 grew by 23% over the prior year, with the U.S. up 26%, driven primarily by customer need for additional capacity. Trading volumes declined by 105 systems to a total of 240 trading transactions for the year. Recurring revenue which is correlated to ongoing use of our products represented 83% of total revenue and grew 21% over the prior year. Total revenue of $7.1 billion increased 14% and for the first time, our advanced instrument portfolio of stapler and energy devices exceeded $1 billion in revenue, growing 21% in 2023.

年內，我們向客戶投放了1,370套系統，較去年同期成長8%。不包括貿易交易，2023 年新系統淨投放量比上年增長 23%，其中美國增長 26%，這主要是由客戶對額外容量的需求推動的。全年交易量減少 105 個系統，至 240 筆。與持續使用我們產品相關的經常性收入佔總收入的 83%，比上一年增長 21%。總收入達到 71 億美元，成長 14%，我們的訂書機和能源設備先進儀器產品組合的收入首次超過 10 億美元，到 2023 年成長 21%。

During the year, we repurchased $416 million of our stock or approximately 1.7 million shares at an average price of $241 per share. We have a remaining authorization to repurchase our shares of $1.1 billion. Given these results, pro forma earnings per share for 2023 grew 22% as compared to last year.

年內，我們以每股 241 美元的平均價格回購了價值 4.16 億美元的股票，約 170 萬股。我們還有 11 億美元的剩餘授權可以回購我們的股票。鑑於這些結果，預計 2023 年每股收益將比去年增長 22%。

Turning to Q4. Our core metrics were strong. da Vinci procedures grew 21%. The installed base of systems grew 14% to 8,606 systems, and average system utilization continues to be above long-term trends, increasing by 9% for the full year of 2023. Higher system utilization reflects both a higher mix of shorter duration benign procedures and the need to address patient backlogs.

轉向第四季。我們的核心指標非常強勁。達文西程式成長了21%。系統安裝基數成長了14%，達到8,606 個系統，平均係統利用率繼續高於長期趨勢，2023 年全年增長9%。更高的系統利用率反映了持續時間較短的良性程序和程序的更多組合。需要解決患者積壓問題。

In Q4, U.S. procedures grew 17%, driven by growth in general surgery. Our U.S. procedures grew 29%, driven by strong performance in China, the U.K., Germany and Japan, with notable strength across multiple OUS markets in general surgery which grew 44% in Q4. As a reminder, procedures in China in the fourth quarter of last year were adversely impacted by increasing COVID cases, resulting in negative growth in Q4 of 2022.

第四季度，在普通外科手術成長的推動下，美國手術量增加了 17%。在中國、英國、德國和日本強勁表現的推動下，我們的美國手術成長了 29%，在一般外科領域的多個 OUS 市場表現強勁，第四季度成長了 44%。需要提醒的是，去年第四季中國的醫療程序受到新冠病例增加的不利影響，導致 2022 年第四季出現負成長。

Turning to capital. We placed 415 systems in the fourth quarter, 12% higher than the 369 systems we placed in the fourth quarter of last year. In the U.S. we placed 209 systems in Q4, 28 more than last year, driven by capacity expansion for procedure growth and higher greenfield placements at existing IDN customers. We placed 70 systems in Japan with strength driven by greenfield placements and the customer use of remaining capital budgets. Consistent with last quarter, we have seen delayed tenders and lower system placements in China due to ongoing anticorruption efforts by the government. We expect system placements in China to be at lower levels, at least through the first half of 2024.

轉向資本。我們在第四季投放了 415 個系統，比去年第四季推出的 369 個系統增加了 12%。在美國，我們在第四季度部署了 209 個系統，比去年增加了 28 個，這得益於流程成長的產能擴張以及現有 IDN 客戶的綠地部署量增加。我們在日本部署了 70 個系統，其優勢是由新部署和客戶對剩餘資本預算的使用所驅動。與上季一致，由於政府持續的反腐敗努力，我們發現中國的招標被推遲，系統安裝量減少。我們預計至少到 2024 年上半年，中國的系統佈局將處於較低水準。

Globally, there were 51 trading transactions in the quarter as compared to 110 last year. As of the end of Q4, there were approximately 375 SIs remaining in the installed base, 60 of which were in the U.S.

全球範圍內，本季有 51 筆交易，而去年為 110 筆。截至第四季末，已安裝的 SI 數量約為 375 個，其中 60 個位於美國。

Fourth quarter revenue was $1.93 billion, an increase of 17% from last year. On a constant currency basis, revenue growth was also 17%. Additional revenue statistics and trends are as follows: Leasing represented 48% of Q4 placements compared with 42% last year. The increasing lease mix we have seen over time is primarily driven by customers in the U.S., particularly those who have acquired systems under usage-based arrangements. These arrangements provide customers greater financial flexibility to expand their robotics programs independent of capital budgets. These arrangements also incorporate technology obsolescence protection for next-generation technology.

第四季營收為19.3億美元，較去年成長17%。以固定匯率計算，營收成長也為 17%。其他收入統計數據和趨勢如下： 租賃佔第四季度投放量的 48%，而去年為 42%。隨著時間的推移，我們看到租賃組合的不斷增加主要是由美國客戶推動的，特別是那些根據基於使用情況的安排購買系統的客戶。這些安排為客戶提供了更大的財務靈活性，可以獨立於資本預算來擴展其機器人專案。這些安排還納入了對下一代技術的技術過時保護。

Q4 system average selling prices were $1.42 million as compared to $1.43 million last year. System ASPs were negatively impacted by regional mix, partially offset by lower trade-ins. We recognized $21 million of lease buyout revenue in the fourth quarter compared with $17 million last quarter and last year. da Vinci instrument and accessory revenue per procedure was approximately $1,800 compared with approximately $1,820 last year. The year-over-year decline in I&A per procedure is primarily a result of procedure mix in the U.S. given strong growth in cholecystectomy and lower growth in bariatrics and customer ordering patterns partially offset by the I&A price increase implemented mid-2023.

第四季系統平均售價為 142 萬美元，而去年為 143 萬美元。系統平均售價受到區域組合的負面影響，但以舊換新的下降部分抵消了影響。我們在第四季確認了 2,100 萬美元的租賃買斷收入，而上季和去年的收入為 1,700 萬美元。達文西儀器和配件每次手術的收入約為 1,800 美元，而去年約為 1,820 美元。每個手術的 I&A 同比下降主要是由於美國手術組合的結果，因為膽囊切除術的強勁增長以及減肥治療和客戶訂購模式的較低增長，部分被 2023 年中期實施的 I&A 價格上漲所抵消。

Turning to Ion. There were approximately 16,500 Ion procedures in the fourth quarter, an increase of 108% as compared to last year. In Q4, we placed 44 Ion systems compared to 67 in Q4 of 2022 and 55 last quarter. We experienced supply challenges for our Ion catheter and vision probe and limited Ion system placements during the quarter to ensure customers could effectively launch their programs. There is strong customer demand for Ion, which contributed to backlog growth in the quarter. We are working hard and making progress to resolve these supply challenges.

轉向離子。第四季約有 16,500 例 Ion 手術，較去年增加 108%。在第四季度，我們放置了 44 個 Ion 系統，而 2022 年第四季為 67 個，上季為 55 個。本季度，我們遇到了離子導管和視覺探頭的供應挑戰，以及有限的離子系統佈局，以確保客戶能夠有效地啟動他們的專案。客戶對 Ion 的需求強勁，這推動了本季積壓訂單的成長。我們正在努力工作並取得進展，以解決這些供應挑戰。

The installed base of Ion systems is now 534 systems, of which 214 are under operating lease arrangements.

Ion 系統目前已安裝 534 套系統，其中 214 套採用營業租賃安排。

Our SP platform continued to make progress in 2023. Fourth quarter SP procedure growth accelerated to 58%. We placed 19 systems in Q4 and 57 for the year, up from 23 placements in 2022. Fourth quarter placements included 5 in Korea and 2 in Japan. Average system utilization for our SP platform grew 15% in 2023, reflecting increased usage by U.S. customers. We continue to make progress in expanding the opportunity for SP, including continued work on regulatory submissions in the U.S. for colorectal and thoracic indications and a system submission in China. In January, we received clearance for SP in Europe across a broad procedure set and are planning for a measured rollout as we build local KOLs and establish local proctoring and training capabilities.

我們的SP平台在2023年持續取得進展。第四季SP流程成長加速至58%。我們在第四季度投放了 19 個系統，全年投放了 57 個系統，高於 2022 年的 23 個投放量。第四季的投放量包括 5 個在韓國和 2 個在日本。 2023 年，我們 SP 平台的平均係統利用率成長了 15%，反映出美國客戶使用量的增加。我們在擴大 SP 機會方面繼續取得進展，包括繼續在美國進行結直腸和胸部適應症的監管提交工作，以及在中國進行系統提交工作。一月份，我們在歐洲獲得了廣泛程序集的 SP 許可，並計劃在建立本地 KOL 並建立本地監考和培訓能力的過程中進行有針對性的推廣。

Moving on to the rest of the P&L. Pro forma gross margin for the fourth quarter of 2023 was 68% compared with 68.2% for the fourth quarter of 2022. The year-over-year decline in pro forma gross margin reflects increased inventory reserves and a higher mix of new platform revenue that currently carry dilutive gross margins partially offset by the I&A price increase implemented mid last year.

繼續討論損益表的其餘部分。 2023 年第四季的預計毛利率為 68%，而 2022 年第四季為 68.2%。預計毛利率同比下降反映了庫存儲備的增加以及目前新平台收入組合的增加。去年年中實施的I&A 價格上漲部分抵銷了攤薄毛利率。

With respect to our manufacturing capabilities and capital investment plans, during the quarter, we initiated local Xi System production in China allowing us to participate in tenders that require a domestically produced system. We also completed the transfer of X System production to our East Coast hub near Atlanta, Georgia, and during 2024, we are planning to transfer Xi System production from California to our East Coast hub.

就我們的製造能力和資本投資計劃而言，本季度，我們在中國啟動了本地 Xi System 生產，使我們能夠參與需要國產系統的招標。我們也完成了 X System 生產向喬治亞州亞特蘭大附近的東海岸中心的轉移，並計劃在 2024 年期間將 Xi System 生產從加州轉移到我們的東海岸中心。

Over the next 18 months, we expect to open new manufacturing facilities for da Vinci 5 and Ion system manufacturing in California and to complete line transfers for Ion and SP I&A to our Mexicali facility. We believe these activities will position Intuitive to serve our customers with best-in-class supply availability, product quality and product cost.

在接下來的 18 個月內，我們預計將在加州開設新的 da Vinci 5 和 Ion 系統製造工廠，並完成 Ion 和 SP I&A 生產線向我們墨西卡利工廠的轉移。我們相信這些活動將使 Intuitive 能夠以一流的供應可用性、產品品質和產品成本為我們的客戶提供服務。

Fourth quarter pro forma operating expenses increased 15% compared with last year, driven by increased head count and higher variable compensation. In addition, fourth quarter 2023 operating expenses included a $40 million contribution to the Intuitive Foundation. We did not make a contribution in 2022. Pro forma other income was $67.1 million for Q4, higher than $57.9 million in the prior quarter, primarily due to higher interest income.

受員工數量增加和可變薪酬提高的推動，第四季度預計營運費用將比去年增加 15%。此外，2023 年第四季的營運費用包括向 Intuitive 基金會捐款 4,000 萬美元。我們沒有在 2022 年做出貢獻。第四季度的預計其他收入為 6,710 萬美元，高於上一季的 5,790 萬美元，主要是由於利息收入增加。

Our pro forma effective tax rate for the fourth quarter was 15.9%, lower than prior quarters, primarily because of the release of certain tax reserves associated with the expiration of related statutes and a favorable earnings mix. Fourth quarter 2023 pro forma net income was $574 million or $1.60 per share compared with $439 million or $1.23 per share for the fourth quarter of last year.

我們第四季的預期有效稅率為 15.9%，低於前幾個季度，主要是因為相關法規到期而釋放了某些稅收儲備，以及有利的獲利組合。 2023 年第四季預計淨利為 5.74 億美元，即每股 1.60 美元，去年第四季為 4.39 億美元，即每股 1.23 美元。

I will now summarize our GAAP results. GAAP net income was $606 million or $1.69 per share for the fourth quarter of 2023 compared with GAAP net income of $325 million or $0.91 per share for the fourth quarter of 2022. Fourth quarter GAAP tax expense reflected onetime benefits of $159 million associated with an increase in deferred tax assets associated with the statutory rate increase in Switzerland and receipt of certain tax benefits associated with our Swiss operations.

現在我將總結我們的 GAAP 結果。 2023 年第四季的GAAP 淨利為6.06 億美元，即每股1.69 美元，而2022 年第四季的GAAP 淨利為3.25 億美元，即每股0.91 美元。第四季GAAP 稅費反映出與成長相關的一次性收益1.59 億美元與瑞士法定稅率上漲相關的遞延稅務資產以及與我們的瑞士業務相關的某些稅收優惠。

The adjustments. The adjustments between pro forma and GAAP net income are outlined and quantified on our website. We ended the year with cash investments of $7.3 billion compared with $7.5 billion at the end of Q3. The sequential reduction in cash and investments reflected capital expenditures of $435 million, partially offset by cash generated from operating activities.

調整。我們的網站上概述並量化了預計淨利潤和公認會計準則淨利潤之間的調整。截至年底，我們的現金投資為 73 億美元，而第三季末為 75 億美元。現金和投資的連續減少反映了 4.35 億美元的資本支出，部分被經營活動產生的現金所抵消。

Let me take a moment to address the new multiple system that Gary highlighted and certain assumptions that may impact 2024 modeling. First, since we have not received FDA clearance for da Vinci 5, we cannot provide specificity on launch timing and pricing. Second, once cleared, we are planning a phased launch period over several quarters. Noting that we are at the end of the Si trading cycle and that da Vinci 5 will be in a phased rollout, we expect total trading volumes to be lower in 2024 than the prior year. Given that, and our procedure guidance of 13% to 16% growth, we also expect total system placements for 2024 to be lower than 2023.

讓我花點時間談談加里強調的新多重系統以及可能影響 2024 年建模的某些假設。首先，由於我們尚未獲得 FDA 對 da Vinci 5 的批准，因此我們無法提供具體的上市時間和定價。其次，一旦獲得批准，我們計劃在幾個季度內分階段推出。注意到我們正處於 Si 交易週期的末尾，並且 da Vinci 5 將分階段推出，我們預計 2024 年的總交易量將低於上一年。有鑑於此，以及我們 13% 至 16% 成長的程序指導，我們也預計 2024 年的系統總安置量將低於 2023 年。

As a result of the phased rollout of da Vinci 5, we expect a higher proportion of Gen 4 systems will be leased as customers seek flexibility to upgrade to da Vinci 5 when supply allows. For those customers that prefer to purchase a Gen 4 system, we will offer a future trading right that can be exercised when there is sufficient da Vinci 5 supply. Purchase contracts containing a trading right result in a deferral of a portion of the purchase price negatively impacting systems revenue.

由於達文西 5 的分階段推出，我們預計第四代系統的租賃比例將更高，因為客戶尋求在供應允許時靈活地升級到達文西 5。對於那些喜歡購買 Gen 4 系統的客戶，我們將提供未來交易權，當有足夠的 da Vinci 5 供應時可以行使該權利。包含交易權的購買合約會導致部分購買價格的延期，進而對系統收入產生負面影響。

Finally, consistent with our experience bringing 4 generations of platforms to market, new systems typically start at lower gross margins and rise over a multiyear period as we build volume and optimize design, manufacturing and supply chains. Brian will describe our gross margin guidance in more detail later in the call.

最後，根據我們將第四代平台推向市場的經驗，新系統通常以較低的毛利率開始，並隨著我們擴大產量並優化設計、製造和供應鏈，在多年的時間內不斷上升。布萊恩將在稍後的電話會議中更詳細地描述我們的毛利率指導。

Before I turn it over to Brian to discuss clinical highlights and our outlook for 2024, let me address operating margins. 2023 pro forma operating margin was 34% of revenue compared to 35% in the prior year. We expect operating margins to be under pressure in 2024, given the anticipated launch of da Vinci 5, increased depreciation expense and an adverse mix impact to gross margin from the growth in new platforms.

在我將其交給 Brian 討論臨床亮點和我們對 2024 年的展望之前，讓我先談談營業利潤率。 2023 年預計營業利益率為收入的 34%，而前一年為 35%。鑑於達文西 5 的預期推出、折舊費用增加以及新平台成長對毛利率的不利綜合影響，我們預計 2024 年營業利潤率將面臨壓力。

However, as we look to the medium term, we see opportunity for operating margin expansion based on the following dynamics: One, moving to broad launching da Vinci 5, allowing customers the opportunity to upgrade their existing fleet to the latest technology; two, improving gross margin we aspire to be above the 70% level over time; and three, leveraging those functions that can take advantage of scale as we grow.

然而，展望中期，我們看到基於以下動態的營業利潤率擴張機會：第一，廣泛推出達文西 5，使客戶有機會將其現有機隊升級到最新技術；第二，提高毛利率，我們希望隨著時間的推移能夠達到 70% 以上的水平；第三，利用那些可以隨著我們的成長而發揮規模優勢的功能。

Improvements to gross margin will be driven by the following actions: First, improving the product cost of new platforms, including da Vinci 5; second, growing into and eventually leveraging the incremental fixed costs from new manufacturing facilities; and third, the return of resources that have been deployed to supply continuity given the impact of the pandemic to returning to routine manufacturing and product cost reduction activities. We have the teams and capability to deliver on these efforts over the next several years.

毛利率的提升將透過以下措施來推動：一是提高包括達文西5在內的新平台的產品成本；其次，發展並最終利用新製造設施增加的固定成本；第三，鑑於大流行的影響，已部署用於供應連續性的資源返回到恢復常規製造和降低產品成本活動。我們擁有在未來幾年內實現這些努力的團隊和能力。

And with that, I would like to turn it over to Brian.

說到這裡，我想把它交給布萊恩。

Thank you, Jamie. Overall procedure growth for full year 2023 was 22% year-over-year compared to 18% for the full year of 2022. Overall procedure growth was comprised of 19% growth in the U.S. and 27% growth outside of the U.S. In the U.S., fourth quarter 2023 procedure growth was 17% year-over-year compared to 18% for the fourth quarter of 2022 and 17% last quarter. Fourth quarter growth was led by procedures within general surgery, with strength in cholecystectomy, colon resection and foregut procedures. As Gary noted, bariatric procedures continued to grow year-over-year, but growth moderated into the mid-single digits.

謝謝你，傑米。 2023 年全年的整體手術成長率為 22%，而 2022 年全年的整體手術成長率為 18%。整體手術成長包括美國 19% 的成長和美國以外地區 27% 的成長。2023 年第四季的流程年增17%，而2022 年第四季為18%，上一季為17%。第四季的成長主要由普通外科手術帶動，其中膽囊切除術、結腸切除術和前腸手術表現強勁。正如加里指出的那樣，減肥手術繼續逐年增長，但增長放緩至中個位數。

Looking outside of the U.S., over the years, we have made investments in countries and international markets to support customers and their adoption of da Vinci procedures. Looking back over the past decade, OUS procedures have grown 20% on a compound annual growth basis and have consistently been accretive to total procedure growth. OUS procedures have grown from about 20% of total global procedures to now about 1/3. While market maturity and levels of adoption differ by region and country, broadly, we now see more than half of OUS growth being led by procedures beyond urology, reflecting customers' growing adoption of general surgery, gynecology and thoracic procedures, the results of which I will highlight below.

放眼美國以外的地區，多年來，我們在各國和國際市場進行了投資，以支持客戶及其採用達文西程序。回顧過去十年，OUS 手術的複合年增長率為 20%，並且一直促進總手術的成長。 OUS 程序已從佔全球程序總數的約 20% 增長到目前的約 1/3。雖然市場成熟度和採用水平因地區和國家而異，但總的來說，我們現在看到超過一半的OUS 增長是由泌尿科以外的手術帶動的，反映出客戶越來越多地採用普通外科、婦科和胸部手術，其結果是我將在下面突出顯示。

Focusing on the fourth quarter, OUS procedure volume grew 29% compared with 18% for the fourth quarter of 2022 and 24% last quarter. Growth was led by strength in colon resection followed by growth in hysterectomy and lung resection procedures. Growth in urology continued to be healthy, led by kidney procedures along with continued double-digit growth in prostatectomy.

重點關注第四季度，OUS 手術量成長了 29%，而 2022 年第四季成長了 18%，上一季成長了 24%。結腸切除術的增長帶動了增長，其次是子宮切除術和肺切除術的增長。在腎臟手術和前列腺切除術持續兩位數增長的帶動下，泌尿外科持續健康成長。

In Europe, Fourth quarter growth was led by general surgery and gynecology procedure categories. Germany, the U.K. and France procedure performance led the region. In Germany, we saw strong growth in colon resection and kidney procedures, in the U.K. from growth in hysterectomy and rectal resection and in France from growth in colorectal and lung resection procedures.

在歐洲，第四季度的成長主要由一般外科和婦科手術類別帶動。德國、英國和法國的程序性能在該地區處於領先地位。在德國，我們看到結腸切除術和腎臟手術的強勁增長，在英國，我們看到子宮切除術和直腸切除術的增長，在法國，我們看到結腸直腸切除術和肺切除術的增長。

In Asia, growth in the fourth quarter was led by China, reflecting a benefit from lower procedure volumes in the fourth quarter of 2022 due to COVID.

在亞洲，第四季的成長由中國引領，反映出由於新冠疫情導致 2022 年第四季手術量減少。

In Japan, our third largest market by procedure volume, procedure growth was healthy and led by prostatectomy and colorectal procedures. We placed 70 systems in Japan reflecting the continued adoption of robotic surgery for a growing number of procedures and the availability of remaining capital budgets.

在日本，我們按手術量計算的第三大市場，手術增長健康，並以前列腺切除術和結直腸手術為主導。我們在日本部署了 70 套系統，反映出機器人手術在越來越多的手術中的持續採用以及剩餘資本預算的可用性。

India, while still in the early stage of adoption, saw continued strength in general surgery and gynecology procedures.

印度雖然仍處於採用的早期階段，但在普通外科和婦科手術方面持續強勁。

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

現在轉向我們業務的臨床方面。每個季度，我們都會在這些電話會議中重點介紹一些我們認為值得注意的最近發表的研究。然而，為了更全面地了解證據體系，我們鼓勵所有利害關係人徹底審查多年來發表的科學研究的廣泛細節。

In the fourth quarter, Dr. Nicola de'Angelis from Beaujon University Hospital, along with multiple colleagues from the French Society of Parietal Surgery, Club Hernie, and French Society of Digestive and Visceral Surgery, published a systematic review and meta-analysis describing robotic surgery for inguinal and ventral hernias in surgical endoscopy. In this analysis, authors reviewed publications between September 2014 and July 2022 and published pooled outcomes comparing the robotic-assisted approach for both inguinal and ventral hernia repairs to both laparoscopy and the open approach.

第四季度，博容大學醫院的 Nicola de'Angelis 博士與法國頂葉外科學會、Hernie 俱樂部以及法國消化和內臟外科學會的多位同事一起發表了一篇系統性回顧和統合分析，描述了機器人外科內窺鏡檢查中的腹股溝和腹疝氣手術。在這項分析中，作者回顧了 2014 年 9 月至 2022 年 7 月之間的出版物，並發表了匯總結果，將腹股溝和腹部疝氣修復的機器人輔助方法與腹腔鏡和開放方法進行比較。

With regards to inguinal hernia, when compared to laparoscopy, the robotic-assisted approach was associated with a 46% lower risk of hernia recurrence. Furthermore, subjects undergoing a robotic-assisted approach were associated with a 54% lower rate of opioid use relative to the open approach. For ventral hernia repairs, the robotic-assisted approach had a 49% lower risk of conversion to open and 41% lower risk of intraoperative bowel injuries relative to laparoscopy.

對於腹股溝疝氣，與腹腔鏡手術相比，機器人輔助方法的疝氣復發風險降低了 46%。此外，與開放式方法相比，接受機器人輔助方法的受試者阿片類藥物的使用率降低了 54%。對於腹壁疝氣修補術，與腹腔鏡手術相比，機器人輔助手術的轉開風險降低了 49%，術中腸損傷風險降低了 41%。

When comparing to an open repair for ventral hernias, the robotic-assisted approach was associated with a 3.4-day shorter length of stay, 34% lower risk of 30-day readmissions, 39% lower risk of overall complications, and more specifically, a 53% lower risk of surgical site infections.

與腹部疝氣的開放式修補術相比，機器人輔助方法的住院時間縮短了 3.4 天，30 天再入院的風險降低了 34%，整體併發症的風險降低了 39%，更具體地說，手術部位感染的風險降低53%。

The authors concluded, "the present systematic review and meta-analysis supports the use of robotic surgery for abdominal wall hernia repair. Pooled data analysis show improved outcomes over laparoscopy and open surgery, particularly for ventral hernia repair. Overall, these results based on 64 studies support robotic surgery as a safe, effective and viable alternative to traditional open and laparoscopic surgery for inguinal and ventral hernia repair. And may contribute to dismiss the residual skepticism and increase the interest towards this minimally invasive surgical technique".

作者總結：「目前的系統性回顧和統合分析支持使用機器人手術進行腹壁疝氣修補術。總數據分析顯示，與腹腔鏡手術和開放性手術相比，效果有所改善，特別是腹壁疝氣修補術。總的來說，這些結果是基於64研究支持機器人手術作為腹股溝和腹部疝氣修復的傳統開腹和腹腔鏡手術的安全、有效和可行的替代方案。並可能有助於消除殘留的懷疑並增加對這種微創手術技術的興趣。”

I will now turn to our financial outlook for 2024. Starting with procedures. As described in our announcement earlier this month, total 2023 da Vinci procedures grew approximately 22% year-over-year to over 2,280,000 procedures performed worldwide. For 2024, we anticipate full year procedure growth within a range of 13% and 16%. Our overall procedure guidance range assumes that growth moderates from last year, given the elevated backlog benefit we experienced in 2023.

我現在將談談我們 2024 年的財務展望。從程序開始。正如我們在本月稍早的公告中所述，2023 年達文西手術總數年增約 22%，全球執行的手術數量超過 2,280,000 例。 2024 年，我們預計全年手術成長在 13% 至 16% 範圍內。鑑於我們在 2023 年經歷了積壓效益的增加，我們的整體程序指導範圍假設增長較去年放緩。

The low end of the range assumes a modest decline in bariatric procedures along with challenges in China from increasing competition and anticorruption activities impacting capital placements, and therefore, procedure growth. We also assume there is no impact from patient backlog in the year.

該範圍的低端假設減重手術略有下降，同時中國面臨競爭加劇和反腐敗活動影響資本配置的挑戰，從而影響手術成長。我們也假設今年患者積壓不會產生影響。

At the high end of the range, we assume bariatrics continues at current growth rates, and factors in China do not have a significant impact on our business. In addition, we assume any backlog of patients would decline throughout the year. Finally, we would expect that procedure seasonality will follow normalized historical patterns, resulting in a tough comparison for the first half of 2024, given the strong procedure growth in the first half of last year.

在該範圍的高端，我們假設減肥治療繼續保持目前的成長率，而中國的因素不會對我們的業務產生重大影響。此外，我們假設全年積壓的患者數量將會減少。最後，鑑於去年上半年程序的強勁增長，我們預計程序季節性將遵循正常化的歷史模式，從而導致 2024 年上半年的比較困難。

Turning to gross profit. Our full year 2023 pro forma gross profit margin was 68%. In 2024, we expect our pro forma gross profit margin to be within 67% and 68% of net revenue. The lower estimate of pro forma gross profit margin in 2024 reflects the impact of growth in our newer products, and the impact of capital investments that will come on to support the growth of our business. Our actual gross profit margin will vary quarter-to-quarter depending largely on product, regional and trading mix impact of new product introductions and pricing.

轉向毛利。我們 2023 年全年預估毛利率為 68%。到 2024 年，我們預計預計毛利率將在淨收入的 67% 和 68% 之間。對 2024 年預計毛利率的較低估計反映了我們新產品成長的影響，以及支持我們業務成長的資本投資的影響。我們的實際毛利率將隨季度而變化，很大程度上取決於新產品推出和定價對產品、區域和貿易組合的影響。

Turning to operating expenses. In 2023, our pro forma operating expenses grew 14%. In 2024, we expect pro forma operating expense growth to be between 11% and 15%. The operating expense growth reflects increased depreciation expense as we bring on new facilities and investments to drive our growth objectives. We expect our noncash stock compensation expense to range between $680 million to $710 million in 2024. We expect other income, which is comprised mostly of interest income to total between $290 million and $320 million in 2024.

轉向營運費用。 2023 年，我們的預計營運費用成長了 14%。 2024 年，我們預計營運費用成長將在 11% 至 15% 之間。營運費用的成長反映了折舊費用的增加，因為我們引進了新的設施和投資來推動我們的成長目標。我們預計 2024 年非現金股票補償費用將在 6.8 億美元至 7.1 億美元之間。我們預計 2024 年其他收入（主要由利息收入組成）總額將在 2.9 億美元至 3.2 億美元之間。

With regard to capital expenditures, we expect the range to total between $1 billion to $1.2 billion, primarily for planned facility construction activities. With regard to income tax, in 2023, our pro forma income tax rate was 20.6%. As we look forward, we estimate our 2024 pro forma tax rate to be between 22% and 24% of pretax income.

關於資本支出，我們預計總額在 10 億至 12 億美元之間，主要用於計畫的設施建設活動。關於所得稅，2023年，我們的預計所得稅稅率為20.6%。展望未來，我們預計 2024 年預計稅率將在稅前收入的 22% 至 24% 之間。

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

我們準備好的評論到此結束。我們現在將開始電話詢問您的問題。

(Operator Instructions) Now first question will come from the line of Larry Biegelsen of Wells Fargo. Please go ahead. Sir, your line is open now.

（操作員說明）現在第一個問題將來自富國銀行的 Larry Biegelsen。請繼續。先生，您的線路現已開通。

Can you hear me?

你聽得到我嗎？

Yes, Larry.

是的，拉里。

So you can hear me. Great. Congrats on a nice end to the year here. Thanks for all the color on da Vinci 5. So obviously, a few questions on that. I'd love to start with just, Jamie, maybe a framework for how to think about the financial implications of a new system beyond 2024. Is the Xi launch a good analog from a pacing standpoint? And what are the ramifications of leasing? If a customer on the lease upgrade, will the lease get the ASP lift? We assume you'll have? And what will you do with returned Xi? And I had just one follow-up.

這樣你就能聽到我的聲音。偉大的。恭喜您在這裡度過了美好的一年。感謝達文西 5 上的所有顏色。很明顯，有幾個問題。 Jamie，我想從一個框架開始，也許是一個框架，用於思考 2024 年後新系統的財務影響。從節奏的角度來看，Xi 的發布是否是一個很好的類比？租賃會產生哪些影響？如果顧客進行租賃升級，租賃會獲得平均售價提升嗎？我們假設你會有？習近平回來後你會怎麼做？我只有一次跟進。

Yes. I would say the dynamics are quite different between when we launched Xi in 2014 versus where we are today. And I think the feature sets of da Vinci 5, which we haven't described I think an important context for you all, which we'll do once we have clearance. You look at relative penetration of da Vinci over that period.

是的。我想說，2014 年習主席上台時的動態與今天的情況大不相同。我認為達文西 5 的功能集（我們尚未描述）對你們所有人來說都是重要的背景，一旦我們獲得許可，我們就會這樣做。你可以看看達文西在那個時期的相對滲透率。

The extent to which leasing has changed significantly, our OUS penetration. I think there are a number of factors, Larry, where I would not use the kind of Xi ramp and progression as a reference point for how da Vinci 5 might progress. But I think that I would make any further comments on that once we get through clearance and are able to talk to you about the feature set.

租賃的程度發生了顯著變化，我們的 OUS 滲透率。拉里，我認為有很多因素，我不會使用 Xi 斜坡和進展作為達文西 5 可能如何進展的參考點。但我認為，一旦我們通過許可並能夠與您討論功能集，我會對此發表任何進一步的評論。

There could be any color...

任何顏色都可以...

With respect to the lease. So I think there are a number of dynamics that in the end will motivate a customer to look at a trade even if they have an existing system under lease. If I hold everything else equal and just look at the fact that the asset is leased, I do think there is some benefit to the customer in so far as they can avoid a capital budget barrier to executing an upgrade. But I think you have to look at all of the other dynamics that we're yet to describe.

關於租賃。因此，我認為有許多動力最終會促使客戶考慮交易，即使他們擁有租賃的現有系統。如果我保持其他條件相同，並且只考慮資產是租賃的事實，我確實認為客戶可以獲得一些好處，因為他們可以避免執行升級的資本預算障礙。但我認為你必須看看我們尚未描述的所有其他動態。

Okay. And then I guess on the new system, I'll try by luckier. Just lastly, do you expect the same indications on Xi upon launch? And Gary, is this more about improving outcomes in existing procedures or expanding addressable procedures?

好的。然後我想在新系統上，我會更幸運地嘗試。最後，您是否期望習近平上任後也會出現同樣的跡象？加里，這更多的是關於改善現有程序的結果還是擴大可尋址程序？

Yes. We submitted for a broad indications in the IDE trial, it was a broad indication trial. What that looks like in the end, will come down to how we answer some of the questions that come back and forth. So I'm not telling you what the endpoint is, but I can tell you what our starting point is.

是的。我們在 IDE 試驗中提交了廣泛適應症試驗，這是一項廣泛適應症試驗。最終會是什麼樣子，將取決於我們如何回答一些反覆出現的問題。所以我不會告訴你終點是什麼，但我可以告訴你我們的起點是什麼。

In terms of kind of breadth and depth, we think that it will allow for additional penetration into some of the categories we're in already and maybe an analogy is you could do some general surgery with Si, the earlier system. We had clearances there, but Xi had some product improvements and some really nice forward progress that allowed us for greater penetration depth. So there's opportunity for depth. We think over time, there's opportunity for additional indications. Those are unlikely to occur right out of the gate. And we think that there's some really nice indications to talk about or features to talk about in future calls.

就廣度和深度而言，我們認為它將允許進一步滲透到我們已經所處的某些類別中，也許可以類比一下，您可以使用早期的系統 Si 進行一些普通手術。我們在那裡獲得了許可，但習近平進行了一些產品改進和一些非常好的進展，使我們能夠獲得更大的滲透深度。所以有機會深入。我們認為隨著時間的推移，有機會出現更多的跡象。這些不太可能立即發生。我們認為在未來的電話會議中可以討論一些非常好的跡像或功能。

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

我們將轉到下一行。我們去了美國銀行的特拉維斯·斯蒂德。

Everybody, can you hear me okay?

大家，你們聽得到我說話嗎？

Yes, Travis.

是的，特拉維斯。

Maybe just high level, just like you were talking about da Vinci 5 having hundreds of design changes. When you just think about da Vinci 5 and kind of driving the quad aim, maybe just kind of talk about high level, more what you're trying to solve for with some of the design changes. What's different about da Vinci 5 versus da Vinci 4? And is it possible we could see a system in 2024? Or is it more likely in 2025?

也許只是高水平，就像你所說的達文西 5 有數百個設計更改一樣。當您只考慮達文西 5 和驅動四軸瞄準器時，也許只是談論高水平，更多的是您試圖通過一些設計更改來解決的問題。達文西 5 與達文西 4 有什麼不同？我們有可能在 2024 年看到一個系統嗎？還是2025年更有可能？

I laid out in the script kind of what our design methodology was. I am dying to tell you more about da Vinci 5, but I'll wait for clearance and for the final back and forth with FDA. So we can do that with a little more care. So that's kind of where we are. And that's it. We're excited about it. I think it is substantive. And I think some of the improvements that we can bring are going to be interesting and exciting.

我在腳本中列出了我們的設計方法。我很想告訴你更多關於達文西 5 的信息，但我會等待批准以及​​與 FDA 的最終來回。所以我們可以更加小心地做到這一點。這就是我們現在的處境。就是這樣。我們對此感到興奮。我認為這是實質的。我認為我們可以帶來的一些改進將是有趣且令人興奮的。

We are submitted, and we're in the back and forth with FDA. It is our hope that it is a '24 launch. They ultimately are the arbiters of when we get clearance. But what I'd say, based on past experience with them is that we're in a constructive conversation that we understand. And if that goes the way we want and certainly it's something we'd be excited about in '24. But I can't guarantee it because I don't have the clearance in hand.

我們已經提交了，並且正在與 FDA 進行反覆協商。我們希望它能在 24 年發布。他們最終是我們何時獲得許可的仲裁者。但我想說的是，根據過去與他們的經驗，我們正在進行一場我們理解的建設性對話。如果這按照我們想要的方式進行，那麼我們肯定會在 24 年感到興奮。但我不能保證，因為我手邊沒有許可。

That's helpful. And would you expect some sort of ASP uplift versus da Vinci 4? And maybe also talk about the manufacturing capacity, and how long will it take to get to scale on the manufacturing? And how would that look kind of versus the Xi launch? Can you do hundreds a year or thousands a year, just kind of curious where -- if that's a limiting factor and kind of the availability of these systems going forward.

這很有幫助。您是否期望 ASP 與 da Vinci 4 相比有所提升？也許還可以談談製造能力，以及需要多長時間才能達到製造規模？與習近平的發表會相比，這看起來怎麼樣？你可以每年做數百個或數千個，只是有點好奇在哪裡 - 如果這是這些系統未來可用性的限制因素和某種程度。

Yes, I'll start with just a little bit of color on ASP and then I'll turn it over to Jamie. We won't call any ASP right now. We want to both get through the final clearances. What I will say is there are some differences relative to X, Xi, that make that discussion a little detailed. And it's important for it to be detailed and clear for the customer to understand what they're going to be buying. So we're going to pause that for now.

是的，我將從 ASP 的一點色彩開始，然後將其交給 Jamie。我們現在不會呼叫任何 ASP。我們都希望能夠通過最後的審查。我要說的是，相對於 X、Xi 存在一些差異，這使得討論變得更加詳細。重要的是要詳細、清晰，以便客戶了解他們將要購買的商品。所以我們現在要暫停。

With regard to manufacturing ramp, clearly, we're going to be in a phase launch. I think we'll be supply constrained in the early side of that kind of intentionally as we work through manufacturing process.

顯然，就製造產能而言，我們將分階段啟動。我認為，當我們在製造過程中進行工作時，我們會在早期故意限制供應。

But in terms of pacing of what that might feel like, Jamie, let me turn it over to you.

但就感覺的節奏而言，傑米，讓我把它交給你。

To some extent, it will obviously depend how that progresses both within our 4 walls and with our suppliers. Certainly, is several quarters. I would take several quarters to be something that's beyond the year, but I think you have to watch us make progress here, and we'll keep you updated.

在某種程度上，這顯然取決於我們的 4 堵牆內以及我們與供應商的進展。當然，是幾個季度。我需要幾個季度的時間才能成為超越一年的東西，但我認為您必須看到我們在這裡取得的進展，我們會及時向您通報最新情況。

And we'll go next to the line of Robbie Marcus, JPMorgan.

我們將走到摩根大通的羅比馬庫斯的隊伍旁。

Congrats on a really good quarter. I'm going to push my luck again. Gary, one of the things we talked about 2 weeks ago on stage was big data and the potential to integrate it into your systems. Maybe if we think about just philosophically da Vinci 5. Is this something we'll see a lot more software improvements rather than hardware improvements? I realize you're not giving specific details, but is software and the ability to add future software updates something we can be looking forward to?

恭喜您度過了一個非常好的季度。我又要碰碰運氣了。加里，兩週前我們在台上討論的一件事是大數據以及將其整合到系統中的潛力。也許如果我們只從哲學角度思考達文西 5。我們會看到更多的軟體改進而不是硬體改進嗎？我知道您沒有提供具體細節，但是軟體和添加未來軟體更新的能力是我們可以期待的嗎？

Yes. One of the things we talked about in the script is the increase in computational capability of the system, the rebaselining of that system. And one of the reasons for that is future programmability. Some of the things that we'll be able to bring out of the gate are pretty exciting, but it also gives us the opportunity to build on that base and sequential software releases. So it's a good pull-through, Robbie. The point you make is a good one, and we do want to pull through software capability. It will not just be software that we bring to market, but it's a starting point.

是的。我們在腳本中討論的事情之一是系統運算能力的增加，以及系統的重新基線。原因之一是未來的可程式性。我們將能夠推出的一些東西非常令人興奮，但它也使我們有機會在該基礎和連續軟體版本的基礎上進行構建。所以這是一個很好的突破，羅比。您提出的觀點很好，我們確實希望發揮軟體功能。它不僅是我們推向市場的軟體，也是一個起點。

Just to remind everybody back in the Xi launch period, Xi didn't have everything that we could possibly do with it at first year of launch either. It's something that as we build capability and build skill we can add to over time, and we've done that for years, we will do the same in dV 5 that is a platform upon which we can build for many years to come.

只是提醒大家，在 Xi 啟動期間，Xi 也沒有擁有我們在啟動第一年可以用它做的一切。隨著時間的推移，我們可以不斷增強能力和技能，我們已經這樣做了很多年，我們將在 dV 5 中做同樣的事情，這是一個我們可以在未來許多年中進行構建的平台。

Great. And maybe one for Jamie. OpEx stepping up with the new product launch, you talked about in the midterm, seeing operating margin expansion we're also seeing elevated CapEx this year, as you talked about all the manufacturing plants. Maybe addressing them both. How should we think about where all of these expenses are going, particularly in OpEx this year, R&D versus SG&A? And what types of activities in each? And then is 3 years a good time frame to think about for the midterm when we might see these spending trends moderate?

偉大的。也許是給傑米的。隨著新產品的推出，營運支出不斷增加，您在中期談到了營運利潤率的擴張，正如您談到的所有製造工廠一樣，我們今年也看到了資本支出的增加。也許對他們兩個都說。我們應該如何考慮所有這些費用的去向，特別是今年的營運支出、研發與銷售、一般管理費用？每種活動都有哪些類型？那麼，當我們可能看到這些支出趨勢溫和時，三年是考慮中期的好時間框架嗎？

Yes. Let me take CapEx first. In '23 and '24, the majority of those capital investments are for manufacturing facilities and to add manufacturing capacity in particular to our Mexicali factory. So a significant portion of the depreciation that comes with that will show up in cost of sales, and that's reflected in part in the '24 gross margin guidance. Some of it will show up in OpEx, and that will therefore be reflected in SG&A.

是的。讓我先談談資本支出。在 23 年和 24 年，大部分資本投資用於製造設施和增加製造能力，特別是我們的墨西卡利工廠。因此，隨之而來的折舊的很大一部分將體現在銷售成本中，這部分反映在 24 年毛利率指引中。其中一些將出現在營運支出中，因此將反映在銷售管理費用中。

If I look at the relative growth in R&D and SG&A in '24, I think it's relatively similar. Obviously, innovation in R&D is important to us. But you will have a little bit of an impact in '24 at least for incremental depreciation. We still see opportunity to leverage some of our enabling functions. There are some other functions that also can leverage as we scale and grow, and so we'll look to do that over the next couple of years.

如果我看看 24 年研發和銷售、一般管理費用的相對增長，我認為這是相對相似的。顯然，研發創新對我們來說很重要。但你將在 24 年產生一點影響，至少對於增量折舊而言。我們仍然看到有機會利用我們的一些支援功能。隨著我們的擴展和發展，還有一些其他功能也可以利用，因此我們將在未來幾年內實現這一目標。

With respect to the kind of operating margin expansion opportunity that I described in my prepared remarks. And we said over the medium term, I'd kind of broadly say that's a 3- to 5-year horizon. We have a specific set of actions and plans that we need to execute. Those teams have those as goals. There's some variability, obviously, in terms of how they get executed and there's some interrelationship between set of actions that need to be completed. So there are dynamics there that can impact the speed at which that gets executed. And of course, we have to run our business in the meantime.

關於我在準備好的發言中描述的那種營業利潤率擴張機會。我們說過，從中期來看，我大概會說這是一個 3 到 5 年的期限。我們有一套需要執行的具體行動和計劃。這些團隊將這些作為目標。顯然，它們的執行方式存在一些可變性，並且需要完成的一組操作之間存在一些相互關係。因此，存在可能影響執行速度的動態因素。當然，我們同時也必須經營我們的業務。

And we'll go over to the line of Rick Wise, Stifel.

我們將轉到 Rick Wise 的路線，Stifel。

Everybody, and great to see the Gen 5 announcement. Maybe I'm going to go into a slightly different direction. Maybe we can get some updates and more details, more color on Ion and SP.

大家都很高興看到第五代的發布。也許我會走向一個稍微不同的方向。也許我們可以在 Ion 和 SP 上獲得一些更新、更多細節、更多顏色。

SP, Gary, the strongest quarter ever. I'm just curious your thoughts about '24 and the next couple of years. What's next? How are you -- what are the team priorities for '24?

SP，加里，有史以來最強勁的季度。我只是好奇你對 24 年以及未來幾年的想法。下一步是什麼？你好嗎——24 世紀團隊的首要任務是什麼？

And on the Ion side, maybe more for Jamie, you gave us some good color about demand strong and supply constraints continue. How are you thinking and what are you dialing into your thinking for '24 about resolution of the catheter and the vision probe limitations? When are you hoping that, that gets largely better result?

在 Ion 方面，也許對 Jamie 來說更重要，你給了我們一些關於需求強勁和供應限制持續的良好色彩。您如何看待 24 世紀關於導管解析度和視覺探頭限制的想法？您希望什麼時候能夠獲得更好的結果？

Thanks, Rick. On the SP front, we're pleased with the step forward they took in '23. It was good. We're seeing more focused efforts in our commercial team in the U.S., which has been good. We're excited about its entry into Japan, and we're starting to see a build of activity in Japan, too. So that's been good. We expect to see it in Europe in '24, and that's another nice step. And I think that's a broader set of clinical indications as it was in Korea and Japan. So it gives us a little more freedom to operate, which is great.

謝謝，瑞克。在 SP 方面，我們對他們在 23 年的進步感到高興。這很好。我們看到美國的商業團隊更加專注，這很好。我們對其進入日本感到興奮，我們也開始看到日本的活動不斷增加。所以這很好。我們預計 24 年將在歐洲看到它，這是另一個很好的一步。我認為這是更廣泛的臨床適應症，就像在韓國和日本一樣。所以它給了我們更多的操作自由，這很棒。

In the U.S., we have trials that had finished accrual and have been submitted or will be submitted soon in thoracic and colorectal that will give our U.S. customers more opportunity to use SP in a multiplatform -- multispecialty environment. So I think SP continues to be a nice build. So that looks good. And team has their marching orders and is working down that set of processes. We have a breast oncology trial that's ongoing that we're excited about also that will not make a big impact in '24, but starts to open additional opportunity for narrow access surgery thereafter. So that's kind of where we are in SP, so far, so good.

在美國，我們的胸腔科和結直腸科試驗已經完成應計並已提交或即將提交，這將使我們的美國客戶有更多機會在多平台、多專業環境中使用 SP。所以我認為 SP 仍然是一個不錯的構建。所以看起來不錯。團隊已經有了他們的行進命令，並且正在製定一套流程。我們正在進行一項乳房腫瘤學試驗，我們對此感到興奮，該試驗不會在 24 年產生重大影響，但此後開始為狹窄通道手術提供更多機會。這就是我們在 SP 的情況，到目前為止，一切都很好。

I'll turn it over to Jamie and talk about Ion.

我會把它交給 Jamie 並談論 Ion。

Not ready to be particularly specific yet on when the supply chain challenges are behind us. For catheter, you have 3 dynamics. So we had a specific supply constraint that impacted us. We are, at the same time, transferring a number of catheter lines to Mexicali. And we're doing that as the business is effectively doubling, so you're bringing on new staff, you're having to train them. So that's a real effort that takes some time. And I think there's a little bit of variability in terms of when we get to point where that's behind us. So I'm going to let us have another quarter before we talk about when that's resolved. The teams are making clear progress, but there's work still will be done.

目前還沒有準備好具體說明供應鏈挑戰何時過去。對於導管，有 3 個動力學。因此，我們面臨著影響我們的特定供應限制。同時，我們正在將一些導管線路轉移到墨西卡利。我們這樣做是因為業務實際上翻了一番，所以你要引進新員工，你必須培訓他們。所以這是一項真正的努力，需要一些時間。我認為，當我們到達我們身後的位置時，存在一些可變性。因此，在我們討論何時解決該問題之前，我將再給我們一個季度的時間。團隊正在取得明顯進展，但仍有工作要做。

On the vision probe, I think it's a relatively simple problem for us to address. There isn't a supplier dependency within that particular area. It's really just us being able to execute, again, a line transfer as the business is doubling and the team are making great progress. But stay tuned.

在視覺探針上，我認為這是我們要解決的一個相對簡單的問題。該特定區域內不存在供應商依賴。隨著業務翻倍並且團隊取得巨大進步，實際上只有我們能夠再次執行線路轉移。但請繼續關注。

Got you. And just one follow-up on Gen 5 and what's next. You said, Jamie, and it makes sense that probably in the next couple of quarters or until you launch, customers probably will lean more toward the leases with an upgrade clause. If I understood you.

明白你了。這只是第五代的後續行動以及接下來的內容。你說，傑米，這是有道理的，可能在接下來的幾個季度或在你推出之前，客戶可能會更傾向於帶有升級條款的租賃。如果我理解你的話。

But I was just reflecting on it, should we imagine that, that could accelerate this sort of leasing approach in the near term for Xi, and as people, I guess, preferentially, potentially possibly maybe line up to get Gen 5 and that puts them in a more favorable position. How does that all -- how are all those dynamics work? Is this good? Better for sales that this transition occurs? Or is it going to be more complicated?

但我只是在反思，我們是否應該想像一下，這可能會在短期內加速習近平的這種租賃方式，而作為人們，我想，優先，可能可能會排隊購買第五代，這讓他們處於更有利的地位。這一切是如何運作的？所有這些動態是如何運作的？這個好嗎？這種轉變對銷售來說會更好嗎？還是會變得更複雜？

Well, I think the first effect is we'll see the operating lease proportion of placements increased from where it's been. And again, that's because customers are motivated to have the protection that's in those clauses so that they can upgrade da Vinci 5 when it becomes more broadly available. So that was the first kind of message we wanted to provide in terms of 2024 modeling.

嗯，我認為第一個影響是我們將看到安置中的營業租賃比例比以前增加。再次強調，這是因為客戶有動力獲得這些條款中的保護，以便在 da Vinci 5 更廣泛可用時他們可以升級。這是我們想要在 2024 年建模方面提供的第一個資訊。

In terms of then how that gets upgraded, it's really a function of when does da Vinci 5 launch, which obviously we can't be specific about right now, and there's some things to work through with FDA. And then what's the period of time over which we then go from a constrained or phased launch to a full launch. And so I don't see that particularly as somehow a revenue benefit in '24. I think what we're saying is you'll have more of the placements that are leased, and therefore, that revenue is spread over time.

至於如何升級，這實際上取決於達文西 5 何時發布，顯然我們現在還不能具體說明，並且有一些事情需要與 FDA 合作解決。然後我們從有限或分階段啟動到全面啟動需要多長時間？因此，我不認為這在某種程度上會成為 24 年的收入收益。我認為我們所說的是，您將擁有更多的租賃展示位置，因此，收入會隨著時間的推移而分散。

More likely to be a slight negative than a slight positive. And I think the things we've put in place for customer transparency, the ability to see it, work to mitigate the feeling of having to wait and they'll get a chance to put their hands on it and see it. But I don't see it as an accelerant.

更可能是輕微的負面影響而不是輕微的正面影響。我認為我們為客戶透明度、看到它的能力所採取的措施，可以減輕必須等待的感覺，他們將有機會親自動手並看到它。但我不認為它是一種促進劑。

And we'll go to the line of Adam Maeder, Piper Sandler.

我們將追隨亞當梅德 (Adam Maeder)、派珀桑德勒 (Piper Sandler) 的路線。

Congrats on a great year. I wanted to start on China and ask about the quota that went effective last summer as well as the anticorruption campaign. If I heard the commentary correct -- correctly, it sounds like you expect systems to be impacted -- system placements to be impacted through the first half of 2024. Does that mean there's some optimism that placements could get better in the back half of the year? And just any additional color on what you're seeing in that geography regarding anticorruption campaign would be very appreciated.

恭喜您度過了美好的一年。我想從中國開始，詢問去年夏天生效的配額以及反貪腐運動。如果我聽到的評論是正確的——正確的，聽起來你預計系統會受到影響——系統的佈局將在2024 年上半年受到影響。這是否意味著有一些樂觀情緒認為佈局可能會在2024年下半年變得更好年？如果您在該地區看到的有關反腐敗運動的任何其他信息，我們將非常感激。

Indications so far have been that, that anticorruption effort is a year-long effort which would take us to the middle of '24. And so that's why we indicated that we would expect delayed tenders through the period in which that effort is ongoing. We don't have great visibility, frankly, beyond the first half of '24. And that's why in the prepared remarks, we said at least through the first half of '24.

到目前為止的跡象表明，反腐敗工作是一項為期一年的工作，這將使我們到 24 世紀中期。這就是為什麼我們表示，我們預計在這項努力正在進行期間招標會延遲。坦白說，在 24 年上半年之後，我們的能見度就不高了。這就是為什麼在準備好的發言中，我們說至少要到 24 年上半年。

So yes, if that effort was to be resolved, and if things start to normalize in terms of the pace at which tenders occurred, then you could see some opportunity for that to recover. But we're not in a position where we can predict that at this point.

所以，是的，如果這項工作得到解決，並且如果招標的速度開始正常化，那麼您可能會看到一些恢復的機會。但目前我們還無法預測這一點。

That's helpful color, Jamie. And for the follow-up, I wanted to ask about the procedure growth guidance, the 13% to 16% for this year. Maybe you could flesh that out for a little bit, a little bit by geography, U.S. versus international. How you're thinking about that as well as, I guess, Europe versus Asia specifically. And just any color on quarterly cadence would be appreciated as well.

這是有用的顏色，傑米。至於後續，我想問今年的手術增長指導，即 13% 至 16%。也許你可以透過地理、美國與國際來充實這一點。我猜你是如何看待這個問題的，尤其是歐洲與亞洲。季度節奏中的任何顏色也將受到讚賞。

Let me start with seasonality. And I'm not going to be specific on quarterly cadence, but I do think I tried to emphasize in our prepared remarks that we believe that the first half will be a tougher comp versus last year. And so using that, the comparison from last year and then also thinking about our historical sort of cadence throughout the year, I think you can look at that history and just make an assumption on what that growth rate -- what those growth rates could be by quarter.

讓我從季節性開始。我不會具體說明季度節奏，但我確實認為我試圖在我們準備好的發言中強調，我們相信上半年將比去年更加艱難。因此，利用這一點，與去年進行比較，然後考慮我們全年的歷史節奏，我認為你可以看看這段歷史，並對增長率做出假設——這些增長率可能是多少按季度。

Let's talk about factors in the procedure guidance. So those -- there's really 3 primary factors, right? You have -- we've called out bariatric growth rates, and that's primarily a U.S. factor. We talked a bit about from an OUS perspective, China, and then also backlog in the system. And so the backlog also being primarily a U.S. factor. But could still be broader.

我們來談談程序指導中的因素。那麼，確實有 3 個主要因素，對吧？我們已經提到了肥胖成長率，這主要是美國因素。我們從 OUS 的角度討論了一些中國問題，然後也討論了系統中的積壓問題。因此，積壓也主要是美國因素。但仍然可以更廣泛。

But -- so I'm not going to go into specifics as far as U.S. versus OUS. But I think I'd go back and just really center you on our comments around bariatric growth rates, right? Low end of the range assumes that there's some continued moderation in bariatric procedures and at the high end of the range that it assumes current growth rates. That there's some impact in China at the low end of the range just from the discussion that we had right now an anticorruption and how long that actually persists and then the benefit of backlog and how that will persist throughout the year.

但是——所以我不會詳細討論美國與 OUS 的情況。但我想我會回去並讓您真正關注我們關於肥胖增長率的評論，對吧？該範圍的低端假設減肥手術持續放緩，而該範圍的高端假設當前的增長率。從我們現在進行的反腐敗討論以及這種情況實際持續多久，然後是積壓的好處以及這種情況將如何在全年持續的討論來看，這對中國產生了一些影響。

In soft tissue surgery, I would just say, if you look at '23, the two primary growth drivers that we've called out is general surgery in the U.S., that grew 25% in 2023. And for OUS, beyond urology that grew 35% in '23. And at the core, we think those continue to be growth drivers for the business.

在軟組織手術方面，我只想說，如果你看看23 年，我們指出的兩個主要增長動力是美國的普通外科，到2023 年增長了25%。對於OUS 來說，除了泌尿科之外，成長的還有23 年為 35%。從本質上講，我們認為這些仍然是業務成長的驅動力。

And we'll go to the next line. Go to the line of Drew Ranieri of Morgan Stanley.

我們將轉到下一行。看看摩根士丹利的德魯·拉涅利（Drew Ranieri）的路線。

Gary, just, maybe just broadly on da Vinci 5 and just the TAM that you kind of updated at the conference earlier this month. How are you -- could you maybe just update us maybe on how you're thinking about penetration today in general surgery, where you are with chole, hernia, colorectal bariatrics, just to help us level set because it sounds like this could be another progression in general surgery for the company? And then I had a follow-up.

Gary，只是，也許只是廣泛地介紹了達文西 5，以及您在本月早些時候的會議上更新的 TAM。你好嗎——你能否向我們介紹一下你今天在普通外科中如何看待滲透，你在膽汁、疝氣、結直腸減肥方面的情況，只是為了幫助我們設定水平，因為聽起來這可能是另一個公司一般外科的進展？然後我進行了跟進。

Sure. Jamie, I'll let you take the kind of characterization of where we are in the adoption curves of general surgery, hernia, benign, chole and so on.

當然。傑米，我會讓你描述我們在一般外科、疝氣、良性、膽汁等疾病的採用曲線中所處的位置。

Yes. If you take a look at the U.S., and I'm going to put this in quartiles for a second in terms of where we are in the adoption curve, colorectal we're in the second quartile. Bariatrics, also the second quartile actually cholecystectomy and hernia all in the second quartile in terms of where they are along the adoption curve. And so that obviously gives us some continuing runway to grow, and that's a driver behind the U.S. general surgery growth rates that we've seen.

是的。如果你看美國，我將根據我們在採用曲線中的位置將其放入四分位數，結直腸癌我們處於第二個四分位數。減肥治療，也是第二個四分位，實際上膽囊切除術和疝氣都在第二個四分位，就其沿著採用曲線的位置而言。因此，這顯然為我們提供了一些持續成長的跑道，這是我們所看到的美國普通外科成長率背後的驅動力。

In the international markets, by the way, just in terms of general surgery, for the most part -- in most of the larger markets, we're in the first quarter of adoption. It's early. What we're seeing is growth start to stick and those don't start to be on early growth rates. Particularly in the cancer procedures, colorectal and beyond general surgery in hysterectomy and thoracic.

順便說一句，在國際市場上，就普通外科而言，在大多數較大的市場中，我們正處於採用的第一季。現在還早。我們看到的是成長開始持續，但並沒有開始達到早期成長率。特別是在癌症手術、大腸直腸癌手術以及子宮切除和胸部手術等普通手術。

With regard to dV 5, I won't call out what specific targeting has been. We'll talk about more about dV 5 when we get a chance to talk about clearance. We do think that it's something that can help improve outcomes in multiple places. And we look forward to talking to you about that when we have the opportunity. If you have one follow-up, Drew, I'll take the follow-up. Otherwise, we'll close the call. So Drew, you have one more?

關於 dV 5，我不會透露具體目標是什麼。當我們有機會談論間隙時，我們將詳細討論 dV 5。我們確實認為這可以幫助改善多個地方的結果。我們期待有機會時與您討論這個問題。如果你有後續行動，德魯，我會跟進。否則，我們將結束通話。德魯，你還有一個嗎？

Sure. Yes. Just on da Vinci 5. Can you maybe just talk about how it might be able to improve access to hospitals. I know that you have many IDNs that have added more systems, but do you see that more as an opportunity? Or do you see just maybe better access for even smaller hospitals with having multiport systems in the portfolio?

當然。是的。就達文西 5 而言。您能談談它如何能夠改善就醫的機會嗎？我知道您有許多 IDN 添加了更多系統，但您是否認為這更多是一個機會？或者您認為透過產品組合中的多連接埠系統，即使規模較小的醫院也能獲得更好的存取權限？

Yes. Thank you for the question. We think that having a portfolio of choices makes a ton of sense for hospitals. And this will be a part of that portfolio. We talked about it in the prepared script. I ought to give people choice. Some of that choice will have to do with how they view their practice. Some of it may have to do with what their site of care looks like and feels like. So that gives us some optionality and gives our customers optionality. I think that's really healthy. So thank you, Drew. Appreciate the question.

是的。感謝你的提問。我們認為，擁有多種選擇對醫院來說非常有意義。這將成為該投資組合的一部分。我們在準備好的劇本中談到了這一點。我應該給人們選擇。其中一些選擇與他們如何看待自己的實踐有關。其中一些可能與他們的護理地點的外觀和感覺有關。因此，這給了我們一些選擇權，也給了我們的客戶一些選擇權。我認為這真的很健康。所以謝謝你，德魯。感謝這個問題。

That was our last question. In closing, we continue to believe there is a substantial and durable opportunity to fundamentally improve surgery and acute interventions. Our teams continue to work closely with hospitals, physicians and caregivers 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.

這是我們最後一個問題。最後，我們仍然相信存在大量且持久的機會從根本上改善手術和緊急幹預措施。我們的團隊繼續與醫院、醫生和護理人員密切合作，以實現客戶所說的四重目標。更好、更可預測的患者治療結果、更好的患者體驗、更好的護理團隊體驗，並最終降低總治療成本。

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

我們相信手術和急診護理中的價值創造本質上是人的。它源自於對病人和照護團隊、他們的需求和環境的尊重和理解。在 Intuitive，我們設想未來的護理將是侵入性更小、效果更好的護理，可以更早發現疾病并快速治療，以便患者能夠回到最重要的事情上。

Thank you for your support on this extraordinary journey and we look forward to talking with you again in 3 months.

感謝您對這段非凡旅程的支持，我們期待 3 個月後再次與您交談。

Thank you, everyone, for joining today's conference call. We do thank you for joining. You may now disconnect. Have a good day.

感謝大家參加今天的電話會議。我們非常感謝您的加入。您現在可以斷開連線。祝你有美好的一天。