直覺手術 (ISRG) 2024 Q1 法說會逐字稿

Thank you, everyone, for standing by, and welcome to the Intuitive Q1 2024 Earnings Release Call. (Operator Instructions) As a reminder, today's call is being recorded.

感謝大家的耐心等待，歡迎參加直覺的 2024 年第一季財報發布電話會議。 （操作員說明）謹此提醒，今天的通話正在錄音。

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

現在我將把電話轉給我們的主持人、Intuitive Surgical 投資者關係主管 Brian King。請繼續。

Good afternoon, and welcome to Intuitive's first 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 第一季財報電話會議。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 annual report on Form 10-K for the fiscal year ended December 31, 2023, and subsequent filings. 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，包括我們截至 2023 年 12 月 31 日的財年的最新 10-K 表格年度報告以及後續文件。我們的 SEC 備案文件可以透過我們的網站或 SEC 網站找到。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 first 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. Then I will discuss procedure and clinical highlights and provide our updated 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第一季業績的亮點，如我們今天早些時候宣布的新聞稿中所述，然後是問答環節。加里將介紹本季的業務和營運亮點。傑米將對我們的財務業績進行審查。然後我將討論程序和臨床要點，並提供我們最新的 2024 年財務展望。

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.

感謝您今天加入我們。

The first quarter of 2024 was a solid one for Intuitive, where core measures of our business remain healthy including solid procedure growth and capital placements. Furthermore, our teams delivered important milestones across several parts of our Intuitive ecosystem, including launching our next-generation multiport platform, da Vinci 5, launching our da Vinci SP platform in Europe and improving our supply constraints for Ion catheters. Some regional challenges existed in the quarter, which we'll describe today. Taken together, we remain enthusiastic about our opportunity and we'll work through near-term pressures by focusing on what we can control.

2024 年第一季對 Intuitive 來說是一個穩健的季度，我們業務的核心指標保持健康，包括穩健的流程成長和資本配置。此外，我們的團隊在Intuitive 生態系統的多個部分實現了重要的里程碑，包括推出我們的下一代多端口平台da Vinci 5、在歐洲推出我們的da Vinci SP 平台以及改善我們對離子導管的供應限制。本季度存在一些區域挑戰，我們今天將對此進行描述。總的來說，我們仍然對我們的機會充滿熱情，我們將透過專注於我們可以控制的事情來應對短期壓力。

Starting first with procedures, we experienced solid growth in the quarter of 16%, compared with a strong Q1 of '23 that was a result of elevated patient volume from the return of patients post pandemic. Q1 of 2024, procedure performance was led by broad growth in general surgery in the United States, and by procedures beyond urology outside the United States. Globally, cholecystectomy, colon resection and foregut procedures led the way. Regional performance included strength in China, Germany and the United Kingdom. In Japan, we saw a moderation of growth in urology as we reach higher levels of penetration and Q1 2023 benefited from the return of patients in backlog. In Korea, growth was lower than our expectation, primarily due to a physician strike in the country, which began in February and has continued.

首先從手術開始，我們在本季實現了 16% 的穩健成長，而 23 年第一季的強勁成長是由於疫情後患者回歸導致患者數量增加的結果。 2024 年第一季度，手術表現主要由美國普通外科手術的廣泛增長以及美國以外泌尿外科手術的廣泛增長帶動。在全球範圍內，膽囊切除術、結腸切除術和前腸手術處於領先地位。地區表現包括中國、德國和英國的實力。在日本，隨著滲透率達到更高水平，我們看到泌尿科成長放緩，並且 2023 年第一季受益於積壓患者的回歸。在韓國，成長低於我們的預期，主要是由於該國從 2 月開始並持續的醫生罷工。

Turning to capital. We placed 313 da Vinci systems in the quarter, of which 289 were multiport systems, compared with 302 multiport systems in Q1 of '23. SP placements were 24 in the quarter versus 10 systems a year ago, and Ion placements for the quarter were 70 versus 55 a year ago. Capital placements were solid in the United States, our global distribution markets and in Germany. Placements in China appear to be impacted by delayed tenders and an apparent increase in provincial preference for domestic robotic competition. We saw some placement weakness in the U.K. as financial pressures in the NHS constrained access to capital.

轉向資本。我們在本季放置了 313 個達文西系統，其中 289 個是多埠系統，而 2023 年第一季放置了 302 個多埠系統。本季 SP 部署量為 24 個，而一年前為 10 個；本季 Ion 部署量為 70 個，去年同期為 55 個。美國、我們的全球分銷市場和德國的資本配置穩健。在中國的佈局似乎受到招標延遲和各省對國內機器人競爭的偏好明顯增加的影響。由於 NHS 的財務壓力限制了資本的獲取，我們在英國看到了一些配售疲軟。

System utilization defined as procedures per installed system per quarter grew 1% globally year-over-year for our multiport platform, lower than last quarter and our historical trend, a result of a strong placement year in 2023 in which the multiport clinical installed base grew 14%, while customers addressed a COVID-related backlog. For our newer platforms, utilization grew 10% for SP and 14% for Ion in the quarter. Utilization is an important indicator of customer health and is a reflection of customers driving value from their systems.

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系統的程式數）在全球範圍內同比增長了1%，低於上一季度和我們的歷史趨勢，這是2023 年多端口臨床安裝基數成長強勁的結果14%，而客戶則解決了與新冠肺炎相關的積壓訂單。對於我們的新平台，本季 SP 利用率成長了 10%，Ion 利用率成長了 14%。利用率是客戶健康狀況的重要指標，也是客戶從其係統中驅動價值的反映。

Turning to our finances. Revenue growth of 11% in the quarter reflects solid procedure performance and capital placements. Average system selling prices declined modestly due to regional and product mix. Product margins were within our expectations, reflecting a higher mix of newer platforms. Operating expenses came in slightly below plan, resulting in pro forma operating profit growth of 18%. Jamie will take you through our finances in greater detail later in the call.

轉向我們的財務。本季營收成長 11%，反映出穩健的流程績效和資本配置。由於區域和產品組合的原因，平均係統售價略有下降。產品利潤率在我們的預期之內，反映出新平台的組合程度較高。營運支出略低於計劃，預計營運利潤將成長 18%。傑米將在稍後的電話會議中向您詳細介紹我們的財務狀況。

In the quarter, we made good progress with our new platforms. In March, we received FDA clearance for our next-generation multiport platform, da Vinci 5. Within the quarter, we placed 8 da Vinci 5 systems and surgeon completed their first cases. As we engage with customers during their activation of da Vinci 5, our customers are noting and appreciating improved precision, improved imaging, improved efficiency for surgeon and staff, improved ergonomics and they are exploring the potential of Force Feedback, where early surgeons are excited to test hypothesis about its procedural, clinical and learning value. Digital analytical capabilities of da Vinci 5 are also drawing positive reviews.

本季度，我們的新平台取得了良好進展。 3 月份，我們的下一代多端口平台 da Vinci 5 獲得 FDA 批准。當我們在啟動達文西5 期間與客戶互動時，我們的客戶注意到並讚賞精度的提高、成像的改進、外科醫生和工作人員效率的提高、人體工學的改進，並且他們正在探索力反饋的潛力，早期外科醫生對此感到興奮檢驗關於其程序、臨床和學習價值的假設。達文西5的數位分析能力也受到好評。

In parallel with customer support, we're working hard to optimize our supply chains and manufacturing capabilities for da Vinci 5 components. We will remain in our measured rollout as we stabilize supply and respond to customer input.

在提供客戶支援的同時，我們正在努力優化達文西 5 組件的供應鏈和製造能力。隨著我們穩定供應並回應客戶的意見，我們將繼續謹慎地推出。

Turning to Ion, our teams have made meaningful progress on resolving supply challenges for our catheter and Ion vision probe, although work still remains to be done. Earlier this month, FDA reviewed our set of design and production changes and cleared an increase in an Ion catheter lives from 5 lives to 8 lives alleviating some supply constraints while improving the economics for us and our customers. Also in March, we received NMPA clearance for Ion in China through a special review process for innovative medical devices. While NMPA clearance is only the first step towards commercialization in China, we believe Ion can play an important role in helping to address the significant burden of lung cancer in the country.

談到 Ion，我們的團隊在解決導管和 Ion 視覺探頭的供應挑戰方面取得了有意義的進展，儘管仍有工作要做。本月早些時候，FDA 審查了我們的一系列設計和生產變更，並批准將離子導管的使用壽命從5 條壽命延長至8 條，緩解了一些供應限制，同時提高了我們和客戶的經濟效益。同樣在 3 月，我們透過創新醫療器材特別審查流程獲得了 NMPA 在中國 Ion 的許可。雖然 NMPA 的批准只是在中國商業化的第一步，但我們相信 Ion 在幫助解決中國肺癌的重大負擔方面可以發揮重要作用。

Turning to SP, we received CE mark in Europe with a broad set of indications in the quarter, and we placed 8 systems. First cases in Europe were performed this April, and we're encouraged by early customer interest for SP.

談到 SP，我們在本季度獲得了歐洲的 CE 標誌，具有廣泛的適應症，我們放置了 8 個系統。今年四月，歐洲完成了第一批案例，早期客戶對 SP 的興趣讓我們深受鼓舞。

In closing, for 2024, our priorities are as follows: first, we'll support the measured launch of da Vinci 5 and our other new platforms by region. Second, we're focused on supporting surgeons' adoption of focused procedures. Third, we're focused on improving our product margins and quality. And finally, we're focused on improving productivity in those functions that benefit from global scale.

最後，2024 年我們的優先事項如下：首先，我們將支援按地區分階段推出達文西 5 和其他新平台。其次，我們致力於支持外科醫師採用針對性手術。第三，我們專注於提高產品利潤和品質。最後，我們專注於提高那些受益於全球規模的職能部門的生產力。

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

現在我將把時間交給傑米，他將帶您更詳細地了解我們的財務狀況。

Good afternoon.

午安.

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.

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。

In Q1, da Vinci procedures grew 16%, the installed base of systems grew 14% to 8,887 systems and average system utilization increased by 2%, lower than recent trends because of the strength in procedure growth and utilization in Q1 of last year that reflected a significant benefit from the treatment of patient backlogs. U.S. procedures grew 14%, driven by broad growth in general surgery. Bariatrics procedure growth in the U.S. continued to moderate and was flat year-over-year. OUS procedures grew 20%, reflecting strong growth in general surgery and thoracic procedures. Brian will provide additional detail on our clinical performance later in the call.

第一季度，達文西程式成長了16%，系統安裝基數成長了14%，達到8,887 個系統，平均係統利用率成長了2%，低於近期趨勢，因為去年第一季程式成長和利用率的強勁反映了從處理積壓的患者中獲益匪淺。在一般外科廣泛成長的推動下，美國手術量增加了 14%。美國的減肥手術成長持續放緩，較去年同期持平。 OUS 手術成長了 20%，反映出一般外科和胸部手術的強勁成長。布萊恩將在稍後的電話會議中提供有關我們臨床表現的更多詳細資訊。

Turning to capital. We placed 313 systems in the first quarter compared to 312 systems in Q1 of last year. Excluding trading transactions, net new system placements grew 16% to 284 systems. In the U.S., we placed 148 systems in Q1, including 8 da Vinci 5 placements compared with 141 systems placed in Q1 of last year. Given constrained supply of da Vinci 5, system placements may be choppy this year as some customers that are interested in da Vinci 5 decide whether to acquire a fourth-generation system with an upgrade drive or wait for adequate supply. Outside the U.S., we placed 165 systems in Q1 compared with 171 systems last year. Current quarter system placements included 84 into Europe, 20 into Japan and 10 into China compared with 101 into Europe, 16 into Japan and 18 into China of Q1 of last year.

轉向資本。我們在第一季推出了 313 個系統，而去年第一季推出了 312 個系統。不包括貿易交易，新系統淨投放量成長了 16%，達到 284 個系統。在美國，我們在第一季投放了 148 個系統，其中包括 8 個達文西 5 投放量，而去年第一季投放了 141 個系統。鑑於達文西 5 的供應有限，今年的系統佈局可能會出現波動，因為一些對達文西 5 感興趣的客戶決定是否購買帶有升級驅動器的第四代系統或等待充足的供應。在美國以外，我們在第一季放置了 165 個系統，而去年則為 171 個系統。當前季度的系統投放量包括歐洲 84 個、日本 20 個和中國 10 個，而去年第一季歐洲 101 個、日本 16 個、中國 18 個。

Placements in the U.K. were below our expectations and lower than Q1 last year because of the reallocation of NHS capital funding to help address industrial actions in the NHS. Placements in China continue to reflect the impact of domestic robotic competition and delayed tenders due to a broader central government focus on systematic governance across sectors, including health care.

由於重新分配 NHS 資本資金以幫助解決 NHS 的罷工行動，英國的安置低於我們的預期，也低於去年第一季。在中國的佈局繼續反映了國內機器人競爭和由於中央政府更廣泛地關注包括醫療保健在內的跨部門系統治理而推遲招標的影響。

First quarter revenue was $1.89 billion, an increase of 11% from last year. On a constant currency basis, revenue growth was 12%. Additional revenue statistics and trends are as follows: Leasing represented 51% of Q1 placements compared with 42% in Q1 of last year. Given customer preference for our usage-based models in the U.S. and the launch of da Vinci 5, we continue to expect the proportion of systems placed under lease arrangements to grow over time.

第一季營收為18.9億美元，較去年成長11%。以固定匯率計算，營收成長 12%。其他收入統計數據和趨勢如下： 租賃佔第一季投放量的 51%，而去年第一季為 42%。鑑於美國客戶對我們基於使用的模型的偏好以及達文西 5 的推出，我們繼續預期租賃安排下的系統比例將隨著時間的推移而增長。

Q1 system average selling prices were $1.39 million as compared to $1.47 million last year. System ASPs were negatively impacted by regional and platform mix and lower pricing in China, partially offset by lower trade-ins. We've recognized $29 million of lease buyout revenue in the first quarter compared with $21 million last quarter and $24 million last year. da Vinci instrument and accessory revenue per procedure was approximately $1,780, flat to last year and down $20 compared to last quarter. The sequential decline in I&A per procedure is primarily a result of procedure mix in the U.S. given strong growth in cholecystectomy and the moderation of growth in bariatrics. We have also seen larger IDNs in the U.S. look for operational efficiencies by reducing inventory.

第一季系統平均售價為 139 萬美元，而去年為 147 萬美元。系統平均售價受到區域和平台組合以及中國定價較低的負面影響，但以舊換新的減少部分抵消了這種影響。我們在第一季確認了 2,900 萬美元的租賃買斷收入，而上季為 2,100 萬美元，去年為 2,400 萬美元。達文西儀器和配件每次手術的收入約為 1,780 美元，與去年持平，比上季度下降 20 美元。每次手術的 I&A 連續下降主要是由於美國膽囊切除術的強勁增長和減肥治療增長的放緩，導致了手術組合的結果。我們還看到美國較大的 IDN 透過減少庫存來提高營運效率。

Turning to Ion. There were approximately 19,500 Ion procedures in the first quarter, an increase of 90% as compared to last year. Since launching the Ion platform in 2019, on a cumulative basis, more than 100,000 procedures have now been performed. In Q1, we placed 70 Ion systems compared to 55 in Q1 of 2023 and 44 last quarter. Q1 results reflected a partial recovery from last quarter as catheter supply improved. Our team continued to work on stabilizing supply of the catheter and the vision probe. Q1 results included 4 Ion system placements in the U.K. following European clearance last year.

轉向離子。第一季約有 19,500 例 Ion 手術，比去年增加了 90%。自2019年推出Ion平台以來，累計已執行超過10萬例手術。在第一季度，我們部署了 70 個 Ion 系統，而 2023 年第一季為 55 個，上季度為 44 個。第一季的業績反映出隨著導管供應的改善，較上季出現部分復甦。我們的團隊繼續致力於穩定導管和視覺探頭的供應。第一季的結果包括繼去年獲得歐洲許可後在英國部署的 4 個 Ion 系統。

The installed base of Ion systems increased 61% year-over-year to 604 systems, of which 244 are under operating lease arrangements. 24 of the systems placed in the quarter were SP systems, including 8 systems in Europe, reflecting clearance early in the quarter. First quarter SP procedure growth was 60% with healthy growth in Korea and the U.S. and early-stage growth in Japan. In the U.S., during the quarter, we completed a 510(k) submission for a thoracic indication, made continued regulatory progress toward a colorectal submission and enrolled additional patients in our IDE for nipple-sparing mastectomy. The SP installed base grew 55% from the year ago quarter to 201 systems.

Ion 系統的安裝量年增 61%，達到 604 套系統，其中 244 套採用營業租賃安排。本季放置的系統中有 24 個是 SP 系統，其中 8 個系統位於歐洲，反映了本季初的清理情況。第一季 SP 程序成長了 60%，其中韓國和美國健康成長，日本處於早期成長。在美國，本季度，我們完成了胸部適應症的 510(k) 提交，在結直腸提交方面持續取得監管進展，並在我們的 IDE 中招募了更多患者進行保留乳頭的乳房切除術。 SP 安裝基數較去年同期成長 55%，達到 201 個系統。

Moving on to the rest of the P&L. Pro forma gross margin for the first quarter of 2024 was 67.6% compared with 67.2% for the first quarter of 2023 and 68% last quarter. The sequential reduction in pro forma gross margin primarily reflects higher fixed costs including depreciation expense for expanded manufacturing capacity and higher costs associated with the launch of da Vinci 5. Our manufacturing and business unit teams made progress in the quarter on activities to improve gross margin over the medium term. This remains an area of key focus for us.

繼續討論損益表的其餘部分。預計 2024 年第一季毛利率為 67.6%，而 2023 年第一季為 67.2%，上季為 68%。預計毛利率的連續下降主要反映了固定成本的增加，包括擴大製造能力的折舊費用以及與達文西5 的推出相關的更高的成本。的活動中取得了進展中期。這仍然是我們重點關注的領域。

First quarter pro forma operating expenses increased 7% compared with last year, slightly lower than expectations due to the timing of certain expenses. Pro forma operating expenses as a percentage of revenue were 140 basis points lower than Q1 last year, reflecting planned leverage in enabling functions, partially offset by increased R&D to fund innovation and future growth. Pro forma other income was $72.5 million for Q1, higher than $67.1 million in the prior quarter, primarily due to higher interest income. Our pro forma effective tax rate for the first quarter was 22.5%, consistent with our expectations. First quarter 2024 pro forma net income was $544 million or $1.50 per share compared with $444 million or $1.23 per share for the first quarter of last year.

第一季預計營運費用較去年增長 7%，由於某些費用發生的時間安排略低於預期。預計營運費用佔收入的百分比比去年第一季低 140 個基點，反映出計畫中的支援功能槓桿，但部分被為創新和未來成長提供資金的研發增加所抵消。第一季預計其他收入為 7,250 萬美元，高於上一季的 6,710 萬美元，主要是由於利息收入增加。我們第一季的預期有效稅率為 22.5%，與我們的預期一致。 2024 年第一季預計淨利潤為 5.44 億美元，即每股 1.50 美元，去年第一季為 4.44 億美元，即每股 1.23 美元。

I will now summarize our GAAP results. GAAP net income was $547 million or $1.51 per share for the first quarter of 2024 compared with GAAP net income of $361 million or $1 per share for the first quarter of 2023. First quarter GAAP tax expense was a benefit of $9 million, reflecting excess tax benefits associated with employee equity plans of $111 million. The adjustments between pro forma and GAAP net income are outlined and quantified on our website and include excess tax benefits associated with employee equity plans, employee stock-based compensation, amortization of intangibles, litigation charges and gains and losses on strategic investments. We ended the quarter with cash and investments of $7.3 billion, flat to the end of last year. The sequential changes in cash included cash generated from operating activities, offset by capital expenditures of $242 million and the net impact of employee equity plans of $46 million.

現在我將總結我們的 GAAP 結果。 2024 年第一季GAAP 淨利為5.47 億美元，即每股1.51 美元，而2023 年第一季GAAP 淨利為3.61 億美元，即每股1 美元。反映了超額稅費與員工股權計畫相關的福利為 1.11 億美元。我們的網站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，其中包括與員工股權計劃、員工股票薪酬、無形資產攤銷、訴訟費用以及戰略投資損益相關的超額稅收優惠。截至本季末，我們的現金和投資為 73 億美元，與去年年底持平。現金連續變化包括經營活動產生的現金，被 2.42 億美元的資本支出和 4,600 萬美元的員工股權計畫淨影響所抵銷。

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.

謝謝你，傑米。

Overall, first quarter procedure growth was 16% year-over-year compared to 26% for the first quarter of 2023 and 21% last quarter. In the U.S., first quarter 2024 procedure growth was 14% year-over-year compared to 26% for the first quarter of 2023 and 17% last quarter. First quarter growth was led by procedures within general surgery, with strength in cholecystectomy, colon resection and foregut procedures. Growth in bariatrics procedures continued to moderate and was flat year-over-year.

總體而言，第一季程式年增 16%，而 2023 年第一季為 26%，上季為 21%。在美國，2024 年第一季手術量年增 14%，而 2023 年第一季為 26%，上一季為 17%。第一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。減重手術的成長持續放緩，比去年同期持平。

Outside of the U.S., first quarter procedure volume grew 20% compared with 28% for the first quarter of 2023 and 29% last quarter. Over 70% of procedure volume growth was led by procedures beyond urology with strength in colon resection, hysterectomy and lung resection procedures.

在美國以外，第一季的手術量增加了 20%，而 2023 年第一季的增幅為 28%，上一季的增幅為 29%。超過 70% 的手術量增長由泌尿科以外的手術帶動，其中結腸切除術、子宮切除術和肺切除術占主導地位。

In Europe, first quarter growth continued to be led by general surgery and gynecology procedure categories. Germany and the U.K. procedure performance led the region with both experiencing strong growth in colon and rectal resection, and hysterectomy procedures. In Asia, growth in the first quarter was led by China, with strong procedure performance in urology and gynecology procedures. Year-over-year procedure growth in the country benefited from a comparison period, where procedures were beginning to recover from COVID during the first quarter of 2023.

在歐洲，第一季的成長繼續由普通外科和婦科手術類別引領。德國和英國的手術表現在該地區處於領先地位，結腸和直腸切除術以及子宮切除手術均出現強勁增長。在亞洲，第一季的成長由中國引領，泌尿科和婦科手術表現強勁。該國手術量的年增長受益於比較期，2023 年第一季手術量開始從新冠疫情中恢復。

In Japan, while we experienced a moderation in growth in urology, overall procedure growth was healthy with strength in general surgery procedures such as colon and rectal resection in gynecology procedures. Effective June 1, 2024, 5 additional procedures will have reimbursement in Japan with 2 existing rectal resection procedures receiving an increase in reimbursement for equivalency to laparoscopic surgery. The opportunity for these procedures is relatively modest, but continues to support the adoption of minimally invasive robotic surgery across a growing set of procedures.

在日本，雖然泌尿外科的成長有所放緩，但普通外科手術（例如婦科手術中的結腸和直腸切除術）的整體手術增長健康且強勁。自 2024 年 6 月 1 日起，日本將新增 5 種手術報銷，其中 2 種現有直腸切除手術的報銷金額將增加，相當於腹腔鏡手術。這些手術的機會相對較小，但繼續支持在越來越多的手術中採用微創機器人手術。

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 first quarter of this year, Dr. Jae Hwan Choi and team from University of South Florida and Tampa, Florida, published a meta-analysis of randomized controlled trials describing outcomes of robotic-assisted abdominopelvic surgery in the journal Surgical Endoscopy. This analysis included a review of 50 publications published through April 2021, included over 4,800 patients from randomized controlled studies and covered a variety of abdominopelvic surgical procedures, including anti-reflux, gastrointestinal, colorectal, urologic, hernia repair and gynecologic procedures. The authors compared robotic-assisted outcomes with those from both open and laparoscopic procedures. When compared to the open approach, robotic-assisted procedures had lower rates of postoperative complications with a 32% lower risk of postoperative complications across all procedures as well as less estimated blood loss with a mean difference of 286.8 milliliters. Furthermore, length of stay was on average 1.7 days shorter for robotic-assisted procedures.

今年第一季度，來自南佛羅裡達大學和佛羅裡達州坦帕市的 Jae Hwan Choi 博士和團隊在《外科內視鏡》雜誌上發表了描述機器人輔助腹盆腔手術結果的隨機對照試驗的薈萃分析。該分析回顧了截至2021 年4 月發表的50 篇出版物，包括來自隨機對照研究的4,800 多名患者，涵蓋了各種腹盆腔外科手術，包括抗逆流、胃腸道、結直腸、泌尿科、疝氣修補和婦科手術。作者將機器人輔助的結果與開放性手術和腹腔鏡手術的結果進行了比較。與開放性手術相比，機器人輔助手術的術後併發症發生率較低，所有手術的術後併發症風險降低了 32%，估計失血量也較少，平均差異為 286.8 毫升。此外，機器人輔助手術的住院時間平均縮短了 1.7 天。

Relative to the laparoscopic approach, rates of conversion to open for the robotic assisted group was approximately half the rate of the laparoscopic approach. Length of stay was also shorter for robotic-assisted procedures. Interestingly, the authors also reported an analysis on the impact of surgeon experience comparing inexperienced versus experienced surgeons and found that the experienced robotic-assisted surgeons had a lower risk of intraoperative complications with significantly less risk in the experienced group as compared with the laparoscopic group as well as a lower risk of conversion to open for the experienced surgeon relative to the laparoscopic group with comparable operative times compared to laparoscopy with experienced surgeons.

相對於腹腔鏡方法，機器人輔助組的轉換為開放率大約是腹腔鏡方法的一半。機器人輔助手術的住院時間也較短。有趣的是，作者還報告了一項關於外科醫生經驗影響的分析，比較了缺乏經驗的外科醫生與經驗豐富的外科醫生，發現經驗豐富的機器人輔助外科醫生髮生術中並發症的風險較低，與腹腔鏡組相比，經驗豐富的組別的風險顯著降低。低，且手術時間相當。

The authors concluded in part that their results suggest robotic surgery may shorten length of stay and rates of conversion to open when compared to laparoscopy with experience mitigating potential differences in operating time, while improving rates of intraoperative complications and conversions to open surgery.

作者得出的部分結論是，他們的結果表明，與腹腔鏡手術相比，機器人手術可能會縮短住院時間和轉開腹手術的比率，並具有減少手術時間潛在差異的經驗，同時提高術中並發症和轉開腹手術的比率。

In March this year, Dr. Nicole Lunardi from the University of Texas Southwestern, along with colleagues from other hospitals and data support from the Intuitive Health Economics and Outcomes Research team, reported outcomes describing the use of robotic technology in emergency general surgery cases. Published in JAMA Surgery, this analysis used the PI and CAI health care database, a database that collects data from over 800 facilities to identify adult patients undergoing urgent or emergent cholecystectomy, colectomy, inguinal and ventral hernia repairs between 2013 and 2021.

今年 3 月，德州大學西南分校的 Nicole Lunardi 博士與其他醫院的同事以及直覺健康經濟學和結果研究團隊的數據支援一起，報告了描述在緊急普通外科手術病例中使用機器人技術的結果。這項分析發表在《JAMA 外科雜誌》上，使用了PI 和CAI 醫療保健資料庫，該資料庫從800 多家機構收集數據，以確定2013 年至2021 年間接受緊急或緊急膽囊切除術、結腸切除術、腹股溝和腹部疝氣修復術的成年患者。

For reference, emergent procedures were described as those required for life-threatening or potentially disabling conditions, while urgent procedures were those where immediate intervention was needed and prioritized as first available. Over 1 million urgent or emergent procedures were identified. During the study period, the use of robotic-assisted surgery for all procedures experienced a 3.5-fold increase in cholecystectomy, a 6-fold increase for colectomy and 38-fold increase in inguinal hernia repairs. Notably, increases in the robotic-assisted approach corresponded to decreases in the open approach for these procedures as well as a decrease in laparoscopy for cholecystectomy and colectomy procedures. Furthermore, a propensity score matched analysis demonstrated a lower risk of conversion to open for the robotic-assisted approach when compared to laparoscopy.

作為參考，緊急程序被描述為危及生命或可能致殘的情況所需的程序，而緊急程序是需要立即乾預並優先考慮的程序。已確定超過 100 萬個緊急程序。在研究期間，所有手術中使用機器人輔助手術的膽囊切除術增加了 3.5 倍，結腸切除術增加了 6 倍，腹股溝疝氣修補術增加了 38 倍。值得注意的是，機器人輔助方法的增加對應於這些手術的開放方法的減少以及膽囊切除術和結腸切除術的腹腔鏡手術的減少。此外，傾向評分配對分析表明，與腹腔鏡檢查相比，機器人輔助手術的轉換風險較低。

Cholecystectomy procedures with a 45% lower risk of conversion, colectomy with a 63% lower risk, inguinal hernia repair with a 79% lower risk and ventral hernia repair with a 70% lower risk of conversion. The authors concluded, "The application of robotic surgery in emergency general surgery has steadily increased in the past decade, which is especially useful in older patients with several comorbidities. As observed in this cohort study, compared with laparoscopic surgery, robotic surgery appears to have resulted in lower rates of conversion to open surgery from 2013 to 2021. Robotic surgery also leads to a shorter or comparable post-operative length of stay in the hospital. Nevertheless, open surgery remains a key component for most emergency general surgery. As robotic surgery continues to increase in emergency general surgery, barriers to implementation need to be addressed and optimized through coordinated efforts across stakeholders."

膽囊切除術的風險降低 45%，結腸切除術的風險降低 63%，腹股溝疝氣修補術的風險降低 79%，腹疝氣修補術的風險降低 70%。作者總結：「機器人手術在急診普外科手術中的應用在過去十年中穩步增加，這對於患有多種合併症的老年患者尤其有用。正如本隊列研究中觀察到的，與腹腔鏡手術相比，機器人手術似乎導致2013 年至2021 年轉為開放式手術的比率降低。 。

I will now turn to our financial outlook for 2024. Starting with procedures. On our last call, we forecasted full year 2024 procedure growth within a range of 13% and 16%. We are now increasing our forecast and expect full year 2024 procedure growth of 14% to 17%. The low end of the range assumes further weakness in bariatric procedures, along with challenges in China from increasing provincial robotic competition and delayed tenders impacting capital placements and therefore, procedure growth. We also assume there is no benefit of patient backlog in the year. At the high end of the range, we assume bariatrics continues at flat to slightly positive growth rates and factors in China don't have a significant impact on our business. In addition, we assume any backlog of patients would decline throughout the year.

我現在將談談我們 2024 年的財務展望。在上次電話會議中，我們預測 2024 年全年手術成長將在 13% 至 16% 的範圍內。我們現在提高了預測，預計 2024 年全年流程將成長 14% 至 17%。該範圍的低端假設減重手術進一步疲軟，同時中國面臨來自省級機器人競爭加劇和招標延遲影響資本配置和手術增長的挑戰。我們也假設今年患者積壓沒有任何好處。在該範圍的高端，我們假設減肥治療繼續保持持平或略為正的成長率，並且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。

Turning to gross profit. We continue to expect our pro forma gross profit margin to be within 67% and 68% of net revenue. Pro forma gross profit margin in 2024 reflects the impact of growth in our newer products, da Vinci 5, Ion and SP 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 trade-in mix and the impact of new product mix.

轉向毛利。我們繼續預計毛利率預計將在淨收入的 67% 和 68% 之間。預計 2024 年毛利率反映了我們新產品 da Vinci 5、Ion 和 SP 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在很大程度上取決於產品、區域和以舊換新組合以及新產品組合的影響，每季都會有所不同。

Turning to operating expenses. We are holding our guidance for pro forma operating expense growth to be between 11% and 15%. We continue to expect our noncash stock compensation expense to range between $680 million to $710 million in 2024. We are holding our guidance for 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。我們將預期營業費用成長指引維持在 11% 至 15% 之間。我們仍預期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。之間。

With regard to capital expenditures, we continue to estimate a range of $1 billion to $1.2 billion, primarily for planned facility construction activities. With regard to income tax, there is no change to our guidance of 2024 pro forma income tax rate to be between 22% and 24% of pretax income. That concludes our prepared comments. We will now open the call to your questions. Thank you.

關於資本支出，我們繼續估計在 10 億至 12 億美元之間，主要用於計劃的設施建設活動。關於所得稅，我們對 2024 年備考所得稅率的指導沒有變化，即稅前收入的 22% 至 24% 之間。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。謝謝。

(Operator Instructions) We will go to the first question at this time, and that's from Robbie Marcus, JPMorgan.

（操作員說明）我們現在將討論第一個問題，該問題來自摩根大通的 Robbie Marcus。

Congrats on a very nice quarter. I was hoping you could touch on what surprised me the most was the procedure volume off a really difficult quarter here, 16%. Could you walk us through your view of what's driving it? Obviously, you gave color on some of the procedures, but it's a really strong number. And what gives you the confidence that it's sustainable with the raised guidance through the rest of the year?

恭喜您度過了一個非常美好的季度。我希望你能談談最令我驚訝的是，這個季度的手術量下降了 16%，這是一個非常困難的季度。您能否向我們介紹一下您對推動這一趨勢的看法？顯然，您對某些程序進行了說明，但這是一個非常強大的數字。是什麼讓您相信在今年剩餘時間內提高的指導意見是可持續的？

Yes, I'm going to turn that first question over to Jamie. Thanks, Marcus. Jamie, why don't you go, and then I'll add a few thoughts thereafter.

是的，我要把第一個問題轉給傑米。謝謝，馬庫斯。傑米，你為什麼不去呢，然後我會補充一些想法。

Yes, where we saw particular strength regionally was in the U.S. and the U.K. in particular. What you also see in OUS markets, as Brian described, is this continuing growth in procedures beyond geology. That first is focused on cancer procedures, colorectal, thoracic, hysterectomy some early-stage growth in benign in our international markets. So the combination of those things, I think, were behind the performance in Q1. And as you kind of look at then the inputs from the teams as we get feedback from our customers, I think then we kind of reflect that in the rest of the year guidance. Obviously, the guidance is only up a point at the low end -- the high end of the range. So it's something we're watching carefully.

是的，我們在區域上看到了特別的優勢，尤其是在美國和英國。正如布萊恩所描述的，您在 OUS 市場中也看到了地質學以外的程序的持續增長。首先是癌症手術、大腸直腸癌、胸部手術、子宮切除術以及我們國際市場上良性腫瘤的一些早期增長。因此，我認為，這些因素的結合推動了第一季的表現。當你看到團隊的投入以及我們從客戶那裡獲得回饋時，我認為我們會在今年剩餘時間的指導中反映這一點。顯然，指引僅在低端（範圍的高端）上升了一個點。所以這是我們正在仔細觀察的事情。

Maybe just as a quick follow-up at the SAGES conference now, and the doctor feedback is phenomenal on da Vinci 5 from our end and the doctors we spoke to. I was hoping you could just give us some early feedback on what you've heard across the field. Doctors' willingness and hospitals' willingness to not just add new systems, but upgrade the fleet and just what you've been hearing.

也許就像現在 SAGES 會議上的快速跟進一樣，我們這邊以及我們採訪過的醫生對達文西 5 的反饋非常好。我希望您能就您在整個領域所聽到的情況向我們提供一些早期回饋。醫生和醫院不僅願意添加新系統，還願意升級車隊以及您所聽到的。

Yes. In terms of early feedback we're hearing, I think what we were hoping for in terms of our design intent, they're appreciating the improvements to precision and imaging to workflow and the team's efforts on human factors design and user interface, strong commentary on ergonomics. And I think Force Feedback is something that is new and will create opportunities to really understand the clinical implications of force application during surgery. I think that will be exciting and powerful over time. I think it's really hard for us sitting where we are today to predict the depth and timing of a replacement cycle. We're excited. I think that folks are excited about what's the potential of the product. That said, Xi is great. Xi has a lot of clinical indications. And we're going to have some supply constraints here as we work through our launch.

是的。就我們聽到的早期反饋而言，我認為我們在設計意圖方面所希望的，他們讚賞工作流程的精度和成像的改進以及團隊在人為因素設計和用戶界面方面的努力，強烈的評論關於人體工程學。我認為力回饋是一種新事物，它將為真正理解手術期間施力的臨床影響創造機會。我認為隨著時間的推移，這將是令人興奮和強大的。我認為我們現在很難預測更換週期的深度和時間。我們很興奮。我認為人們對該產品的潛力感到興奮。這就是說，習近平是偉大的。 Xi有很多臨床適應症。在我們推出產品的過程中，我們將面臨一些供應限制。

Jamie, I don't know if there's anything you'd like to add to that, today?

傑米，我不知道你今天還有什麼要補充的嗎？

No, I think you got it, Gary.

不，我想你明白了，加里。

We'll go to the next line, Larry Biegelsen, Wells Fargo.

我們將轉到下一行，Larry Biegelsen，富國銀行。

I'll echo Robbie's congratulations on a nice quarter here. Just 2 on da Vinci 5 for me. Maybe starting with Gary, the supply constraints. When do you expect those to be resolved? How long into 2025 will the limited launch last? And what will trigger the full launch?

我將回應羅比對本季美好表現的祝賀。對我來說，達文西 5 上只有 2 個。也許從加里開始，供應限制。您預計這些問題什麼時候才能解決？限量發售將持續到 2025 年多久？什麼會觸發全面啟動？

Yes. Thanks, Larry, there's 3 things that are going on for us. One of them is optimizing the supply chain, making sure that we have the quality that we want, that will, for sure, go through all of '24 in some part of the early part of '25. So that's one. The second thing is we want to incorporate feedback from our customers. We want to make sure that we're adjusting the things that we need to adjust to make sure they're highly satisfied. And then the last thing is we have additional feature content and hardware improvements and other things that are planned that our design teams are going to execute on, whether it's software or other updates or some of the things we can do in imaging, that we want to do as we bring it through. So it's kind of a 3-part set of activities. And we think it's pretty well planned out. I wouldn't expect big changes from our plan. And if there are changes in the future, then we'll be sure to talk about them.

是的。謝謝拉里，我們有 3 件事正在發生。其中之一是優化供應鏈，確保我們擁有我們想要的質量，這肯定會貫穿整個 24 年和 25 年初的某些部分。這就是其中之一。第二件事是我們希望吸收客戶的回饋。我們希望確保我們正在調整我們需要調整的事情，以確保他們非常滿意。最後一件事是我們有額外的功能內容和硬體改進以及我們的設計團隊將要執行的其他計劃，無論是軟體或其他更新還是我們可以在成像中做的一些事情，我們希望盡我們所能完成它。所以這是一套由三個部分組成的活動。我們認為這是精心策劃的。我預計我們的計劃不會有重大變化。如果將來有變化，我們一定會討論它們。

That's helpful. And Gary, you haven't been specific about new indications that da Vinci 5 could open, but can you help us understand what the features are of da Vinci 5 that could allow physicians to do new procedures and why?

這很有幫助。蓋瑞，您還沒有具體說明達文西 5 可以打開的新適應症，但是您能否幫助我們了解達文西 5 的哪些功能可以讓醫生進行新的手術，為什麼？

Yes. Our first thought here and bringing the system to the market has been to allow surgeons to go deeper into the existing indications we have already. So the indications for da Vinci 5 largely mirror the Xi -- indications that we had already. But we do think that it will invite new surgeons and care teams into robotic-assisted surgery. I think it allows us to deepen our relationship with that customer base, and we're excited about it. In terms of core capabilities, da Vinci 5 has some really cool things. Better imaging that right now today is better and will get better over time, precision and high performance and tracking performance allows for really subtle and fine surgical motions. And we think that's really powerful, and it's a core capability. Faster workflow opens new opportunities for people too. So we do think there are additional clinical indications we can pursue. We are evaluating them. We have not finalized on everything yet, and likely, they will require conversations with FDA. So we're not prepared at this time to tell you what they might be. But as we get a little closer and work through it, then we'll describe it once we've settled our approach.

是的。我們將系統推向市場的第一個想法是讓外科醫生更深入地了解我們已經掌握的現有適應症。因此，達文西 5 的跡像在很大程度上反映了 Xi——我們已經有的跡象。但我們確實認為它將邀請新的外科醫生和護理團隊參與機器人輔助手術。我認為這使我們能夠加深與客戶群的關係，我們對此感到興奮。在核心功能方面，達文西5有一些非常酷的東西。更好的成像現在更好，並且隨著時間的推移變得更好，精度和高性能以及追蹤性能允許真正微妙和精細的手術運動。我們認為這非常強大，並且是一項核心能力。更快的工作流程也為人們帶來了新的機會。因此，我們確實認為我們可以尋求其他臨床適應症。我們正在評估他們。我們還沒有敲定所有事情，他們很可能需要與 FDA 進行對話。因此，我們目前不準備告訴您它們可能是什麼。但當我們更接近並解決它時，一旦我們確定了我們的方法，我們就會描述它。

And we will go to the next line, Travis Steed, Bank of America.

我們將轉到下一行，Travis Steed，美國銀行。

I wanted to ask a little bit more color on the strong Xi placements and the capital environment even ahead of the dV5 launch. And it sounded like the message changed on system placements in 2023. I think or 2024, I think before it was system placements could be lower in '24 and now it's just choppy. So does that mean there's a chance that system placements are up in 2024?

即使在 dV5 推出之前，我想對強大的 Xi 佈局和資本環境進行更多了解。聽起來系統佈局的資訊在 2023 年發生了變化。那麼這是否意味著 2024 年系統放置量有可能增加？

Jamie, go ahead and take it. Apologies.

傑米，拿走吧。道歉。

Yes. I think the first dynamic is trading given the limited supply in dV5. Those placements will be during the measured launch focused on incremental placements. So not a lot of trade activity coming from dV5. And if you look at what's left in the installed base for our third gen Xi, you've got about 350 systems globally, of which 50 are in the U.S. So we do expect trading volumes to be down quite a bit in '24.

是的。我認為第一個動態是交易，因為 dV5 的供應有限。這些展示位置將在衡量發布期間重點關注增量展示位置。因此，dV5 的貿易活動並不多。如果你看看我們第三代 Xi 的安裝基礎，你會發現全球大約有 350 個系統，其中 50 個在美國。

With respect to overall system placements, I know we made the comments on the last call, but generally, we don't guide system placements. So we'll let you run that through your models, given the update of our procedure guidance, but certainly, we've acknowledged that placements could be choppy, while we're constrained on dV5. In Q1, we didn't really see any customers pushing back on, I don't want an Xi, we want to wait for dV5. But since the launch, which obviously was only in March, we've had our Connect conference. We've had SAGES this week, a significant number of surgeons and executives have now seen dV5 put their hands on it. So we're acknowledging that customers may choose to wait. We don't have enough evidence or indication yet to see which way that will go.

關於整體系統佈局，我知道我們在上次通話中發表了評論，但一般來說，我們不指導系統佈局。因此，考慮到我們的程式指南的更新，我們將讓您在模型中運行該操作，但當然，我們已經承認，當我們受到 dV5 的限制時，展示位置可能會不穩定。在第一季度，我們並沒有真正看到任何客戶反對，我不想要安熙，我們想等待 dV5。但自從發布以來（顯然只是在三月），我們就召開了 Connect 會議。本週我們舉辦了 SAGES，大量外科醫生和高管現在已經親眼目睹了 dV5 的實踐。因此，我們承認客戶可能會選擇等待。我們還沒有足夠的證據或跡象來判斷事情會走向何方。

Great. And, maybe, Gary, if you could spend some time just kind of a bigger picture question on dV5 and the capabilities it brings to training, being able to practice some of the edge cases helping with proctoring. I'm just curious how you see the impact on robotic surgery adoption and driving better outcomes from some of these dV5 training capabilities that's going to roll out? And how long some of this stuff actually is going to take?

偉大的。加里，也許您可以花一些時間來了解 dV5 及其為培訓帶來的功能，能夠練習一些有助於監考的邊緣案例。我只是好奇您如何看待即將推出的一些 dV5 培訓功能對機器人手術採用和推動更好結果的影響？這些東西實際上需要多長時間？

In terms of raw capability, I think that it will help care teams acquire skills more quickly, and it also helps them in the case. You can kind of think of that as context sensitive help. The device is kind of aware of where it is and what it's doing and can share that information with the care team so that as they're doing things, whether it's changing tools or setting it up, it provides real-time help to help guide them through it. And I think that's a really good thing. It just makes it easier to use.

就原始能力而言，我認為這將幫助護理團隊更快地掌握技能，並且對他們在案例中也有幫助。您可以將其視為上下文相關的幫助。該設備在某種程度上知道它在哪裡以及正在做什麼，並且可以與護理團隊共享這些信息，以便在他們做事時，無論是更改工具還是設置它，它都可以提供實時幫助來幫助指導他們通過它。我認為這真的是一件好事。它只是讓它更容易使用。

Our Intuitive hub has integration technologies that start with da Vinci 5, and we'll get better over time as we release software updates and hardware updates. And so that starts to close an analytical loop for our customers from what they're seeing in the case to video review to video analytics to feeding back information to their phones and their laptops and whatever their means are consuming that data is. And so that gives them an analytical loop, which should also help. And we'll also continue to evolve our simulation training in some of our other packages or online learning that will help them as well.

我們的直覺中心擁有從達文西 5 開始的整合技術，隨著時間的推移，隨著我們發佈軟體更新和硬體更新，我們會變得更好。因此，這開始為我們的客戶形成一個完整的分析循環，從他們在案例中看到的內容到視頻審查、視頻分析，再到將信息反饋到他們的手機和筆記型電腦，以及他們使用這些數據的方式。這給了他們一個分析循環，也應該有所幫助。我們也將繼續在其他一些軟體包或線上學習中改進我們的模擬培訓，這也將幫助他們。

So I think all of this is going to take a little bit of time. But I think the design concept, I think our designers did a beautiful job. I think the design concept of integrating these ideas, making it easy for care teams, for surgeons to follow that journey should help us.

所以我認為這一切都需要一些時間。但我認為設計理念，我認為我們的設計師做得很好。我認為整合這些想法的設計理念應該對我們有幫助，讓護理團隊和外科醫生輕鬆遵循這個過程。

The final point I'll make is that in our labs and during our early experience with da Vinci 5, it looks like force reflection helps novice, new to robotics, new to robotics system surgery acquire their skills faster. So it should invite more surgeons in and ease their journey, remains to be proven. It's not done and done, but we think it's encouraging. And so stay tuned. I think keep asking that question. And as the data starts to come out, we'll be pleased to share it with you.

我要說的最後一點是，在我們的實驗室以及我們對達文西 5 的早期體驗中，力反射似乎可以幫助機器人技術新手、機器人系統手術新手更快地掌握技能。因此，它是否應該邀請更多的外科醫生並簡化他們的旅程，還有待證明。雖然還沒完成，但我們認為這是令人鼓舞的。請繼續關注。我想繼續問這個問題。隨著數據開始出現，我們將很高興與您分享。

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

我們將轉到下一行。瑞克懷斯，史蒂菲爾。

Gary, maybe it would be helpful to hear in a little more detail, your thoughts on a couple of points that maybe some of the headwinds, bariatrics flat year-over-year. I wasn't sure completely what I was hearing about trends. Is it getting worse, still is the rate of pressure easing? I appreciate talking about the guidance you talked about a range given the range of outcomes. But I just want to make sure I understood what you're saying.

加里，也許更詳細地聽聽你對一些觀點的看法會有所幫助，這些觀點可能是一些不利因素，減肥治療同比持平。我完全不確定我所聽到的關於趨勢的內容。情況變得更糟，壓力是否仍在緩解？鑑於結果的範圍，我很高興談論您所談到的一系列指導。但我只是想確保我明白你在說什麼。

Yes. Let me share my perspective. Rick, thanks for the question. And then Brian, I'll kick it to you to talk about the range. I think what we can tell you is what we see, and what we've seen is continued deceleration such that it's flat year-over-year. There are a lot of opinions out in the field, and we can all talk to them. I think the reality is nobody really knows yet. We're going to have to live through it together. And as a result, it's going to be dynamic. We do know that bariatric surgery is well tolerated and it's a good option. And we also know that people are interested in pharmaceuticals and that the pharmaceuticals work as long as you take them for a subset of the population and then stop working if you don't. What that means for future surgery, I think there's a range of opinions and I would not hang a lot of confidence on any of them just yet. And that's why we have a range.

是的。讓我分享我的觀點。里克，謝謝你的提問。然後布萊恩，我會請你談談範圍。我認為我們可以告訴你的是我們所看到的，我們所看到的是持續減速，以至於與去年同期持平。現場有很多意見，我們都可以與他們交談。我認為現實是還沒有人真正知道。我們必須一起度過難關。結果，它將是動態的。我們確實知道減肥手術的耐受性良好，並且是一個不錯的選擇。我們也知道，人們對藥物感興趣，只要對一小部分人群服用，藥物就會起作用，如果不服用，藥物就會停止作用。這對未來的手術意味著什麼，我認為有各種各樣的觀點，但我目前還不會對其中任何一個抱有很大的信心。這就是我們有一個系列的原因。

And Brian, perhaps you can just touch on how you see bariatric surgery affecting the range, just reiterate that, if you would.

布萊恩，也許你可以談談減肥手術如何影響範圍，如果你願意的話，請重申。

Sure. And just to reiterate again, the low end of the range assumes that there's further weakness in bariatric procedures, right? So at the low end of the range, further weakness in bariatric procedures. At the high end of the range, we assume that bariatrics continues at flat to slightly positive growth rates. And I think, again, to Gary's point, it will be dynamic, and we're just going to have to see how it plays out throughout the year.

當然。再次重申一下，範圍的低端假設減肥手術還存在進一步的弱點，對吧？因此，在該範圍的低端，減肥手術進一步疲軟。在該範圍的高端，我們假設減重治療繼續保持持平或略為正的成長率。我再次認為，就加里的觀點而言，這將是動態的，我們只需要看看它全年的表現如何。

Okay. Great. And let me turn to some of the new and incremental features you talked about, Gary. I'm sure all of us on the call have been talking to doctors have been hearing a variety of additional features, some quite compelling. Can you give us any flavor -- I mean, first of all, I'd be happy to hear from you what some of them could be. But how quickly, given what you know today, how -- when could we see those features that, again, I would assume would enhance the value? Are we going to see them this year, second half? Or is it more likely that's something for next year as you get the supply chain where you want it to be.

好的。偉大的。加里，讓我談談您談到的一些新的增量功能。我確信我們所有參加電話會議的人都已經與醫生交談過，並且已經聽到了各種附加功能，其中一些非常引人注目。你能給我們一些味道嗎——我的意思是，首先，我很高興聽到你的意見，其中一些可能是什麼。但是，鑑於您今天所了解的情況，我們何時才能看到那些我認為會提高價值的功能？今年下半年我們會見到他們嗎？或者更有可能的是，當你將供應鏈置於你想要的位置時，明年就會發生這種情況。

Yes. I think as we add capabilities in time, we have some imaging things that we want to do. We have some things in terms of software upgrades and analytics power and some things we want to do in terms of integration. That's much more likely to be '25 and later than '24. A lot of '24 will be making sure that we and our suppliers feel great about what we've got and then adapting to any immediate feedback that we see.

是的。我認為，隨著我們及時添加功能，我們有一些想做的成像事情。我們在軟體升級和分析能力方面有一些東西，並且在整合方面我們想做一些事情。這更有可能發生在 25 年及以後，而不是 24 年。 24 世紀的許多人會確保我們和我們的供應商對我們所擁有的東西感到滿意，然後適應我們所看到的任何即時回饋。

And we will go to the next line. Adam Maeder, Piper Sandler.

我們將進入下一行。亞當梅德，派珀桑德勒。

Congrats on the nice quarter. I wanted to start by asking about the Force Feedback instruments. I was hoping, Gary, you could share a little bit more color on the feedback that you're getting from clinicians thus far into launch. And then if I understand correctly, you have 6 Force Feedback instruments that are used across different common procedures. Will you look to expand the portfolio of that technology going forward? And if so, what might that look like? And then I have a follow-up.

恭喜這個美好的季度。我想先詢問力回饋儀器。加里，我希望您能就迄今為止從臨床醫生那裡得到的回饋分享更多的資訊。如果我理解正確的話，您有 6 個力回饋儀器，可用於不同的常見程序。您未來會尋求擴大該技術的產品組合嗎？如果是這樣，那會是什麼樣子？然後我有一個後續行動。

Sure. We're getting a variety of feedback on the instruments themselves. Just a reminder for everyone, they have very sensitive sensors that are built into the distal end -- in the body end of the instruments that are sterilizable and cleanable and they report back contact forces with tissue, which at a sensitive way, which has been a goal for us and for surgery for a long time. So it's a hard technology. We've been really excited to bring it to market.

當然。我們收到了有關儀器本身的各種回饋。只是提醒大家，他們在遠端（可消毒和可清潔的器械的主體端）內置了非常靈敏的傳感器，它們以靈敏的方式報告與組織的接觸力，這已被這是我們和手術長期以來的目標。所以這是一項硬技術。我們非常高興能將其推向市場。

We will hear everything from, hey, I'm getting great results with da Vinci X and Xi today that has very limited version of haptics. It really doesn't have in body sensing. It does have a little something, but it's not -- it's not sensing in a technical sense. And that's true. They're getting great results. So it's a new sense. That said, people are quite interested to explore where it'll take them. And what's interesting is that when you're using a force sensing instrument, it's sensing whether you turn on force reflection into the surgeon's hands or not. So the surgeon can feel it. They can turn it on, or they can turn it off, but still measure so that they have the feeling experience of an X or an Xi.

我們會聽到一切，嘿，我今天用達文西 X 和 Xi 取得了很好的結果，但觸覺版本非常有限。它確實沒有身體感應功能。它確實有一些東西，但它不是——它不是技術意義上的感測。確實如此。他們取得了很好的成果。所以這是一種新的感覺。也就是說，人們非常有興趣探索它將帶他們到哪裡。有趣的是，當你使用力感測儀器時，它會感知你是否打開力道反射到外科醫生的手中。所以外科醫生可以感覺到它。他們可以打開它，也可以關閉它，但仍然進行測量，以便他們有 X 或 Xi 的感覺體驗。

And what they find when they turn it on and off is that the amount of force that they apply during surgery to tissue decreases when force reflection into the hands is on. And so the big question is, what's the clinical value of that? What will be the implications for patient outcomes by procedure and by technique. And that's what they're going to go explore, and we will help them do that exploration. So now we're talking about the future of what could happen. I suspect, I believe, it's a personal opinion. There will be types of procedures and types of patients where having lower force applied to tissue during the surgery is going to be clinically meaningful, and we have to go prove that. So I think it's quite interesting.

當他們打開和關閉它時發現，當力量反射到手上時，他們在手術期間施加到組織的力的大小會減少。所以最大的問題是，它的臨床價值是什麼？程序和技術對患者結果有何影響？這就是他們要探索的內容，我們將幫助他們進行探索。所以現在我們正在談論未來可能發生的事情。我懷疑，我相信，這是個人意見。對於某些類型的手術和類型的患者，在手術期間對組織施加較小的力將具有臨床意義，我們必須證明這一點。所以我認為這很有趣。

The technology is sophisticated. We are with our manufacturing partners, learning how to make these at scale with good yield and robust. It's a worthy endeavor, but it is not easy, and we're going to focus on it and make sure that we get what we want. We want to make sure we have robust and high-yield products. We want to extend their lives to help the economics of our customers and our economics. So that is our first focus.

技術很先進。我們與我們的製造合作夥伴一起學習如何以良好的產量和穩健性大規模生產這些產品。這是一項值得的努力，但並不容易，我們將專注於它並確保我們得到我們想要的。我們希望確保我們擁有穩健且高產量的產品。我們希望延長他們的壽命，以幫助我們客戶的經濟和我們的經濟。這是我們的第一個重點。

As to the 6 instruments, I'm going to look to Jamie as to whether the 6 number is right, I think it is. Certainly, over time, we have the opportunity to extend it to other instruments. But that first set of 6 are the ones that we thought were right. 6 is the right number, Jamie?

至於 6 種樂器，我會向 Jamie 詢問 6 號是否正確，我認為是正確的。當然，隨著時間的推移，我們有機會將其擴展到其他工具。但第一組 6 個是我們認為正確的。 6 是正確的數字嗎，傑米？

It is. And it's a combination of graspers and needle drivers and those instruments are used in very common tasks, dissection, retraction, and suturing.

這是。它是抓緊器和針驅動器的組合，這些儀器用於非常常見的任務，解剖、回縮和縫合。

We'll go to the next line. Andrew Ranieri, Morgan Stanley.

我們將轉到下一行。安德魯·拉涅利，摩根士丹利。

Maybe just on SP for a moment with the indication expansion in Europe. Can you talk about that a bit more, Gary, and I was hearing from a surgeon today that the CRSA conference in November in Rome could be pretty important for just getting broader adoption from European surgeons. But does that inform how you could approach the U.S. market with a broader indication? And then I just had a follow-up.

也許只是在 SP 上停留一段時間，以適應歐洲的適應症擴張。加里，你能再多談談這一點嗎？ 今天我從一位外科醫生那裡得知，11 月在羅馬舉行的 CRSA 會議對於獲得歐洲外科醫生的更廣泛採用可能非常重要。但這是否告訴您如何以更廣泛的適應症進入美國市場？然後我就進行了跟進。

Yes. Yes. I'm actually here in Europe have been for the last couple of weeks talking to SP surgeons here. I think the early uptake and early excitement is quite palpable. Where we've had broad indications, as you know, in Korea and now Japan, we've seen nice uptake in adoption and good study, good clinical study. And I think that the surgeons here are building on that. They're learning from and adapting what they see in the rest of the world and getting excited about it. So I'm encouraged.

是的。是的。事實上，過去幾週我一直在歐洲與這裡的 SP 外科醫生交談。我認為早期的接受和早期的興奮是顯而易見的。如您所知，在韓國和現在的日本，我們已經看到了廣泛的適應症，我們看到了良好的採用和良好的研究、良好的臨床研究。我認為這裡的外科醫生正在以此為基礎。他們正在學習和適應他們在世界其他地方看到的東西，並對此感到興奮。所以我很受鼓舞。

How deep that goes? It's still early days here in Europe. We will see. But we're starting to see fairly long case studies. In things like colorectal surgery coming out of Asia and other places, we have submitted, as Jamie had mentioned, for an additional indication in the United States. We have another one coming. We have IDE trials ongoing. So we have some natural experiments to see what occurs. We know that the experiment in Korea has worked out well. We're in process in Japan and now we're in the early experience for broad indications in Europe. That should help us generate data and accelerate additional indications over time in the U.S. And I have to say, I think, it remains a build for SP, but I'm encouraged by the build.

那有多深？在歐洲，現在還處於早期階段。我們會看到。但我們開始看到相當長的案例研究。正如傑米所提到的，對於來自亞洲和其他地方的結直腸手術之類的事情，我們已經在美國提交了額外的適應症。我們還有另一位來了。我們正在進行 IDE 試驗。所以我們進行了一些自然實驗來看看會發生什麼。我們知道韓國的實驗效果很好。我們正在日本進行試驗，現在我們正處於歐洲廣泛適應症的早期經驗階段。這應該有助於我們產生數據並隨著時間的推移在美國加速更多的跡象。

And maybe this is more for Jamie. But Jamie, could you talk about the commentary about lower pricing in China for the quarter? Just talk about that a little bit more and maybe put that into context on if this is temporary, if it's permanent or more to come and just the overall competitive situation in China would be great.

也許這更適合傑米。但是傑米，您能談談有關本季中國定價較低的評論嗎？多談談這一點，也許可以考慮一下這是暫時的、永久性的還是未來更多的情況，中國的整體競爭情況會很好。

Yes. It's primarily a function of the competitive environment we've described with the domestic robotic players. What we actually have now, given last year, we qualified a domestically manufactured Xi is actually some segmentation between the domestically manufactured product and an imported product. And the domestic product gives us the opportunity to both participate in tenders that require a locally produced system, but also allows us to segment on price. But the primary impact on China pricing is really competition. And you kind of see that theme broadly with other med tech players in terms of the impact of VBP. It doesn't apply in this case, but kind of the macro theme of pricing pressure does.

是的。這主要是我們與國內機器人玩家所描述的競爭環境的函數。我們現在實際上擁有的，去年我們對國產Xi進行了鑑定，實際上是國產產品和進口產品之間的某種細分。國內產品使我們有機會參與需要本地生產系統的招標，同時也使我們能夠進行價格細分。但對中國定價的主要影響實際上是競爭。就 VBP 的影響而言，您可以在其他醫療技術參與者中看到這個主題。它不適用於這種情況，但定價壓力的宏觀主題卻適用。

And we will go to the next line. And that will be Matt Miksic, Barclays.

我們將進入下一行。那就是巴克萊銀行的馬特‧米克西奇。

Congrats on a really strong quarter against tough comps. So a couple of follow-ups, if I could, on a couple of things you mentioned, Gary, in your last answer around Force Feedback and sort of the clinical impacts of optimizing and reducing the force used during surgery, which is kind of buzzing around here at SAGES quite a bit this year in the sessions. And I'm wondering -- I appreciate always the data that you talked about during the prepared remarks and recent clinical data. I'm wondering how far out are we going to see clinical reference like that to studies around the use of Force Feedback versus not? And also maybe efficiency is driven by a lot of the docs you're talking about smoother operating arms and being able to get through cases faster. Is that a year out? Are we 6 months? Are we 2 years out for dV5 research like that?

恭喜我們在艱難的競爭中取得了非常強勁的季度表現。因此，如果可以的話，我會就您在上次關於力反饋的回答中提到的幾件事進行一些後續行動，以及優化和減少手術期間使用的力的臨床影響，這是一種嗡嗡聲今年在SAGES 的會議上有很多次。我想知道 - 我一直很欣賞您在準備好的演講中談到的數據和最近的臨床數據。我想知道我們多久才能看到類似的關於使用力回饋與不使用力回饋的研究的臨床參考？而且也許效率是由您正在談論的許多文件驅動的，這些文件涉及更順暢的操作臂和能夠更快地處理案件。那是一年了嗎？我們6個月了嗎？我們這樣的 dV5 研究需要兩年時間嗎？

Yes. It's a good question. Thank you. This is approximate, not specific, so take it with some error bars. But I think what you're going to see in Force Feedback study is going to be a progression. You'll see narrow series, single institution studies come out first that are kind of directional. They talk about what they're seeing in their own. And then you'll see a little bit -- and that should be the kind of thing that comes out in the next 12 months. And then over the next period after that over the next couple of years, you'll see multiple center trials that are comparing in a little more structured way. So I think you can predict the path of the journey. But I think this is something that you're going to see from narrower input to start to broader input in the next year to prospective studies that start to report over the next year after that. So I think it's a build, but I think it's going to be a powerful build in the end.

是的。這是一個好問題。謝謝。這是近似值，而不是具體值，因此請考慮一些誤差線。但我認為你將在力回饋研究中看到的是一個進步。你會看到狹窄的系列、單一機構的研究首先出現，這些研究是有方向性的。他們談論自己所看到的事。然後你會看到一點——這應該是未來 12 個月內出現的事情。然後在接下來的幾年裡，您會看到多個中心試驗以更結構化的方式進行比較。所以我認為你可以預測旅程的路徑。但我認為，從開始的更窄輸入到明年更廣泛的輸入，再到明年開始報告的前瞻性研究，你都會看到這一點。所以我認為這是一個構建，但我認為它最終將是一個強大的構建。

I think with regard to efficiencies, we're hearing anecdotal reports already that the surgeon autonomy features that are in da Vinci 5, the ability for them to control their own field and to control the equipment, ancillary equipment in the room, has been really positive, and they're reporting efficiencies already. I think real-world evidence is going to be powerful on the efficiency side. And I think that's the kind of thing that people can benchmark their own cases, also our data collection capabilities between Intuitive Hub and the My Intuitive app allow them to measure that very quickly. So I think you'll see the real-world evidence of that build, and it will be in the coming months and quarters, and that will be exciting for us.

我認為就效率而言，我們已經聽到傳聞稱達文西 5 中的外科醫生自主功能，即他們控制自己的領域並控制房間內的設備和輔助設備的能力，確實是非常出色的。 ，他們已經報告了效率。我認為現實世界的證據在效率上將是強而有力的。我認為人們可以對自己的案例進行基準測試，我們的 Intuitive Hub 和 My Intuitive 應用程式之間的資料收集功能也使他們能夠非常快速地進行測量。因此，我認為您將在未來幾個月和幾個季度看到該構建的現實證據，這對我們來說將是令人興奮的。

We'll go the next line. Brandon Vazquez, William Blair.

我們去下一行。布蘭登·巴斯克斯，威廉·布萊爾。

I want to focus on Ion real quick. You had a nice rebound in the quarter there after some supply last quarter. Just curious, you see a little bit of catch-up there or not? And then even as these numbers are getting bigger, you're still putting up some really strong growth. So curious where you're seeing the most growth there, new accounts or existing utilization and how sustainable you think it is?

我想快速關注 Ion。在上個季度出現一些供應之後，本季出現了不錯的反彈。只是好奇，你是否看到了一些追趕的狀況？即使這些數字越來越大，您仍然會實現一些非常強勁的成長。很好奇您在哪裡看到了最大的成長，新帳戶或現有利用率以及您認為它的可持續性如何？

Jamie, why don't you take that one?

傑米，你為什麼不拿那個？

Yes, I'd say it was a partial recovery in the quarter. We haven't completely resolved both catheter supply and the vision probe. We still have a little bit of backlog in terms of number of systems that's pending kind of stabilization of that supply. With respect to where are we placing those systems, it's actually a blend between existing accounts and new accounts. We still have a number of opportunities, what I call greenfield accounts. And so both are a focus for the sales team.

是的，我想說的是本季的部分復甦。我們還沒有完全解決導管供應和視覺探頭的問題。就係統數量而言，我們仍然有一些積壓，有待供應穩定。至於我們將這些系統放置在哪裡，它實際上是現有帳戶和新帳戶之間的混合。我們仍然有很多機會，我稱之為綠地客戶。因此，兩者都是銷售團隊關注的焦點。

Okay. And one quick follow-up maybe on the surgical side. The 1% utilization growth, I appreciate off of a tough comp, and we're kind of normalizing, but I think we kind of -- we usually use utilization growth as an indication for system placements and then it implies a certain procedure growth as well. Just talk to us a little bit about what you kind of think a below historical average utilization growth in the quarter might mean for those key moving pieces in the next couple of quarters?

好的。可能會在手術方面進行快速跟進。 1% 的利用率成長，我很欣賞艱難的競爭，我們正在正常化，但我認為我們通常使用利用率成長作為系統佈局的指標，然後它意味著一定的程式成長，如出色地。請與我們談談您認為本季低於歷史平均利用率成長對未來幾季的那些關鍵變化可能意味著什麼？

I'll start.

我開始吧。

Go ahead, Gary.

繼續吧，加里。

I'll jump in and then Jamie take it. I think that in the prepared remarks, we had said you had a nice capital placement year and we have bolus of post-COVID come back into Q1. I think the uncertainty part of this is really just going to be what the inpatient volumes look like in the next quarters of 2024. In other words, just the patient census as it comes through. But you're right. I think that it's an indicator of capacity. So depending on what that patient census looks like, that will determine the high end and the low end of utilization growth in terms of how many procedures people want to put on those systems.

我會跳進去，然後傑米接手。我認為，在準備好的發言中，我們已經說過你們今年的資本配售很好，而且我們在第一季有大量的新冠疫情后的資金回來。我認為其中的不確定性部分實際上是 2024 年接下來幾季的住院人數。但你是對的。我認為這是能力的指標。因此，根據患者普查的情況，這將決定利用率成長的高端和低端，即人們希望在這些系統上進行多少程序。

Sorry, Jamie, go ahead, you might discuss the modeling there.

抱歉，傑米，繼續吧，你可以在那裡討論建模。

I would just say that if you look at Q1 utilization over an extended period, look at what the CAGR is versus the year-over-year comparison, you see that start to be in a more normal range of 3% to 4%. I do think that in the year ago quarter, you had a number of institutions that actually set themselves up to do sprint with respect to their ability to treat patients. And so I do think that was elevated and at that level of utilization growth of 13%, it wasn't particularly sustainable. So as I look forward to the rest of the year, I'd expect some levels of utilization growth of, let's say, closer to our long-term averages. There's still some patient backlog benefit in the year ago quarters, even in Q2 and Q3. So it's not perfectly matched, but I think there's room for normalization over time.

我只想說，如果你長期觀察第一季的利用率，看看複合年增長率與同比比較，你會發現它開始處於 3% 到 4% 的更正常範圍內。我確實認為，在上一季度，有許多機構實際上已經做好了在治療患者的能力方面進行衝刺的準備。因此，我確實認為這一數字有所上升，而且在 13% 的利用率增長水平上，它並不是特別可持續。因此，當我展望今年剩餘時間時，我預期利用率成長會達到一定水平，比如說，更接近我們的長期平均值。與去年同期相比，即使在第二季度和第三季度，患者積壓仍然有一些好處。所以它並不完美匹配，但我認為隨著時間的推移，還有正常化的空間。

And we will go to the next question from the line of Jayson Bedford, Raymond James.

我們將討論傑森貝德福德、雷蒙詹姆斯提出的下一個問題。

Just maybe Ion in China. Obviously, a large opportunity there. Just a couple of questions, and I apologize if I missed this. But does Ion fall within the existing robotics quota? And then for Ion, you mentioned clearance is the first step. Can you just talk through the other steps to commercialization and associated timing of those steps?

也許 Ion 在中國。顯然，那裡有很大的機會。只是幾個問題，如果我錯過了，我深感抱歉。但 Ion 是否屬於現有機器人配額之內？然後對於 Ion，你提到清除是第一步。您能否談談商業化的其他步驟以及這些步驟的相關時間安排？

Yes, we have some work to put ion at a point where it's actually available to sale -- to sell. So that will take us some time. We're not expecting to have commercialization really until the back half of 2024. And China is a market where, like many cases, when we launch a new product in a market, we do that progressively as we kind of build our infrastructure in terms of training capabilities and engage with customers. So I'd say back half of '24 is when you start to see the potential for Ion placements in China.

是的，我們做了一些工作，讓 ion 真正可以出售。所以這需要我們一些時間。我們預計要到 2024 年下半年才能真正商業化。客戶互動。所以我想說，24 世紀後半段你開始看到 Ion 在中國的潛力。

On the issue of is it competing for the same quota, Jamie?

關於它是否爭奪相同配額的問題，傑米？

Sorry. Yes, our understanding is it's not in the quota given the price.

對不起。是的，我們的理解是，考慮到價格，它不在配額內。

And Jayson, if you have one more follow-up, that will wrap it up for us.

傑森，如果你還有後續的話，我們就可以結束了。

No, that's fine.

不，沒關係。

Okay. That was our last question.

好的。這是我們最後一個問題。

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

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、醫生和護理團隊密切合作，追求客戶所說的「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；最終，降低總護理成本。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具有更少的侵入性和更好的效果，疾病能夠更早被發現並快速治療，以便患者能夠回到最重要的事情上。

Thank you for your support on this extraordinary journey. 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。

And thank you, everyone, for joining today's conference call. That does indeed conclude your conference call. You may now disconnect. Have a good day.

感謝大家參加今天的電話會議。您的電話會議確實結束了。您現在可以斷開連線。祝你有美好的一天。