直覺手術 (ISRG) 2024 Q3 法說會逐字稿

Thank you, everyone, for standing by, and welcome to the Intuitive third-quarter 2024 earnings release. (Operator Instructions)

感謝大家的支持，歡迎閱讀 Intuitive 2024 年第三季財報。（操作員指示）

I will now turn the conference over to your host, Brandon Lamm within Investor Relations for Intuitive. Please go ahead.

現在，我將會議交給主持人、Intuitive 投資者關係部門的 Brandon Lamm。請繼續。

Good afternoon, and welcome to Intuitive third-quarter earnings conference call. With me today, we have Gary Guthart, our CEO; Dave Rosa, our President; and Jamie Samath, our CFO.

下午好，歡迎參加 Intuitive 第三季財報電話會議。今天和我一起的有我們的執行長 Gary Guthart、我們的總裁 Dave Rosa 和我們的財務長 Jamie Samath。

Before we begin, I would like to let you know that Brian Kane has moved on to pursue his next opportunity. We appreciate his contributions over the past nine years and wish him well in his next endeavor. A search for his replacement is in progress.

在我們開始之前，我想讓你們知道，布萊恩凱恩 (Brian Kane) 已經離開去尋找下一個機會。我們感謝他過去九年來的貢獻，並祝福他在接下來的工作中一切順利。目前正在尋找他的繼任者。

Moving on, 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 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.

接下來，我想告訴您，今天電話會議上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提交給美國證券交易委員會的文件中進行了詳細描述，包括我們截至 2023 年 12 月 31 日的財政年度的最新 10-K 表格以及後續文件。您可以透過我們的網站或美國證券交易委員會 (SEC) 網站查閱我們向 SEC 提交的文件。提醒投資者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，您可以在我們網站 intuitive.com 的「投資者關係」頁面下的「活動」部分中收聽本次電話會議的音訊重播。今天的新聞稿和補充財務數據表已發佈到我們的網站。

Today's format will consist of providing you with highlights of our third quarter results, as described in our press release announced earlier today, followed by a question-and-answer session. Gary will introduce the call and provide a business overview. Dave will present the quarter's business operational and clinical highlights. Jamie will provide a review of our financial results and procedure highlights. Then, I will provide our updated financial outlook for 2024. And finally, we will host a question-and-answer session.

今天的會議形式將包括向您介紹我們第三季業績的亮點，正如我們今天早些時候發布的新聞稿中所述，然後進行問答環節。加里將介紹此次電話會議並提供業務概述。戴夫將介紹本季的業務運作和臨床亮點。傑米將回顧我們的財務業績和程序亮點。然後，我將提供我們 2024 年的最新財務展望。最後，我們將舉辦問答環節。

With that, I'll turn it over to Gary.

說完這些，我就把麥克風交給蓋瑞。

Thank you for joining us today. Q3 of 2024 was a good quarter forms, with healthy procedure growth, solid capital placements, and strong operational execution in a dynamic global environment. I'll kick off by providing a perspective on our platforms and our regions.

感謝您今天加入我們。2024 年第三季表現良好，在動態的全球環境中，流程成長健康，資本配置穩健，營運執行強勁。我將首先介紹我們的平台和地區。

Starting with our multi-port system, we now have an installed base of roughly 9,300 globally. Our five-year procedure compound annual growth rate in multiport has been 17%, with approximately 16 million total patients treated using da Vinci multiple platforms, of which approximately $10 million were in the past five years. Manufacturing, logistics, and service capability has increased over the past several years, helping ensure availability for our customers while managing margins.

從我們的多埠系統開始，我們目前在全球擁有約 9,300 個安裝基數。我們在多端口領域的五年複合年增長率為 17%，共有約 1600 萬名患者使用達文西多平台進行治療，其中約 1000 萬美元是在過去五年內實現的。過去幾年來，製造、物流和服務能力不斷提高，有助於確保為客戶提供可用性，同時管理利潤。

System stability taken across our multi-port product lines has been outstanding, setting the standard for dependability. We launched our fifth generation multi-port system in March this year, and have installed 188 today with over 12,000 procedures completed using da Vinci 5 and roughly six months.

我們的多埠產品線的系統穩定性非常出色，為可靠性樹立了標準。我們在今年 3 月推出了第五代多孔系統，目前已安裝了 188 台，使用 da Vinci 5 在大約六個月的時間內完成了超過 12,000 個程序。

da Vinci 5 is bringing outstanding improvements for surgeons care teams and hospitals, in addition to the first-of-their-kind features that we think will improve patient outcomes. We're moving towards our broad launch and are well into the process of securing additional global regulatory clearances for da Vinci 5, which you'll hear about later in the call.

除了我們認為將改善患者治療結果的首創功能外，達文西 5 還為外科醫生護理團隊和醫院帶來了卓越的改進。我們正在向廣泛發布邁進，並且正在為達文西 5 爭取額外的全球監管許可，您將在稍後的電話會議中聽到有關信息。

Turning to our endoluminal system, we launched Ion in Q3 of 2019. Today, the Ion install bases 736, of which 722 are in the United States. Physicians have completed more than 150,000 lung biopsies using Ion to date. Each one of which uses machine learning created anatomically segmented long model based on a patient-specific anatomy, personalized digital intervention for every case.

談到我們的腔內系統，我們在 2019 年第三季推出了 Ion。目前，Ion 安裝基地有 736 個，其中 722 個位於美國。迄今為止，醫生已使用 Ion 完成了超過 150,000 例肺部活檢。每個模型都使用機器學習根據患者特定的解剖結構創建解剖分段的長模型，並針對每種情況進行個性化的數位幹預。

Our five-year compound annual growth rate for Ion procedures has been 205%. There are over 100 peer-reviewed articles assessing Ion. Overall safety and accuracy data has been outstanding.

我們的 Ion 程式五年複合年增長率為 205%。有超過 100 篇同儕審查文章對 Ion 進行評估。整體安全性和準確性數據非常出色。

Over the past year, we are focused on excellence in product quality, product availability, and customer experience. We have updated Ion with significant feature and software upgrades five times since its launch and have made dozens of improvements to our catheters and vision programs. Over the next two years, we will expand our efforts to place systems beyond the United States to continue system and software innovation, to increase utilization in existing US accounts, and in continued pursuit of additional indication.

在過去的一年裡，我們專注於產品品質、產品可用性和客戶體驗的卓越。自 Ion 推出以來，我們已對其進行了五次重大功能和軟體升級，並對我們的導管和視覺程序進行了數十項改進。在接下來的兩年裡，我們將擴大努力，將系統部署到美國以外，繼續進行系統和軟體創新，提高現有美國帳戶的使用率，並繼續尋求額外的指示。

We launched da Vinci SP in Q3 of 2018, and the installed base now stands at 243. SP procedures have been growing at a five-year category of 55%, with 67,000 total procedures completed to date. We've seen strong SP performance in Korea, encouraging early growth in Europe and Japan, and have increased our cadence of regulatory activity globally to broaden its applicability. The SP clinical evidence base stands at over 500 peer-reviewed journal articles.

我們於 2018 年第三季推出了 da Vinci SP，目前安裝基數已達 243。SP 程序五年內成長率為 55%，迄今已完成 67,000 例程序。我們看到 SP 在韓國表現強勁，並推動了歐洲和日本的早期成長，同時我們在全球範圍內加快了監管活動的節奏，以擴大其適用性。SP 臨床證據庫包含超過 500 篇同行評審期刊文章。

SP has found stronger uptake outside the United States. Its clinical indications in Europe, Japan, Korea, and now Taiwan, are broader than the US. Our SP team is focused on extending our instrument lineup, including stapling and advanced energy on increasing indications in the US, on enabling proctoring networks and global markets, and on next-generation SP system innovation.

SP 在美國以外的地區受到越來越廣泛的歡迎。其在歐洲、日本、韓國以及現在的台灣的臨床適應症比美國更廣泛。我們的 SP 團隊致力於擴展我們的儀器陣容，包括在美國增加適應症的裝訂和先進能源、支援監考網路和全球市場以及下一代 SP 系統創新。

In our digital efforts, nearly 3,000 da Vinci virtual reality simulators are in the install base, and surgeons complete approximately 15,000 hours of training on simulators per quarter. Our active surgeon users for My Intuitive app now exceed 14,000. Intuitive Hub is enabled in approximately 2,000 operating rooms. We outperformed our analytics program, Custom Hospital Analytics, over 4,000 times and at a run rate of 700 per quarter.

在我們的數位化工作中，安裝了近 3,000 台達文西虛擬實境模擬器，外科醫生每季在模擬器上完成約 15,000 小時的培訓。My Intuitive 應用程式的活躍外科醫生用戶現已超過 14,000 名。大約 2,000 個手術室都啟用了 Intuitive Hub。我們的分析程式 Custom Hospital Analytics 的表現超出預期 4,000 倍以上，運行率為每季 700 次。

Our digital team is focused on three enabling digital pillars: digital tools that improve outcomes in the OR and interventional suite, tools that help create better care teams faster, and tools that drive efficiencies and lower total cost of ownership, all while pursuing outstanding capabilities and cybersecurity and data privacy. Dave will touch on our digital progress shortly.

我們的數位團隊專注於三大數位支柱：改善手術室和介入套件結果的數位工具、有助於更快地創建更好的護理團隊的工具以及提高效率和降低總體擁有成本的工具，同時追求卓越的功能以及網路安全和數據隱私。戴夫很快就會談到我們的數位化進展。

Regionally, we have been investing to build a balanced country and regional teams that allow us to serve customers globally with high-quality interactions. These include commercial activity, payer engagement, R&D, logistics, and production capabilities in region. This has been a multi-year effort that has increased customer satisfied action and strengthen our global capability.

在區域方面，我們一直在投資建立均衡的國家和地區團隊，以便我們能夠透過高品質的互動為全球客戶提供服務。這些包括商業活動、付款人參與、研發、物流和區域生產能力。這是一項多年的努力，旨在提高客戶滿意度並增強我們的全球能力。

Our five-year compound annual growth rate for procedures in the Europe region has been 21%. In the Asia region our five-year procedure CAGR has been 25%. And other markets outside the US has been 18%. Reimbursement coverage for robot-assisted surgery has been obtained or expanded for dozens of procedures and many of the countries we serve. That said, we're still relatively early in our opportunity to localize our capabilities to serve more patients around the world.

我們在歐洲地區的五年複合年增長率為 21%。在亞洲地區，我們五年的複合年增長率為 25%。而美國以外的其他市場則為18%。我們服務的許多國家/地區的數十種機器人輔助手術已獲得或擴大了報銷範圍。話雖如此，我們仍處於相對較早的階段，可以利用本地化能力為全球更多患者提供服務。

Overall, our teams have been strengthening our ability to serve our customers globally at industrial scale, expanding the applicability of robot-assisted surgery and other interventions by pursuing new platforms, products and services, and obtaining new clinical indications. We've also been strengthening our digital ecosystem to support our customers and our company with high-quality data and insight. The opportunity to improve outcomes for patients and our customers quintuple aim through advanced technology ecosystems like ours, is bigger than ever. And we are focused on disciplined execution to get there.

總體而言，我們的團隊一直在加強我們在全球範圍內以工業規模服務客戶的能力，透過追求新平台、產品和服務以及獲得新的臨床適應症來擴大機器人輔助手術和其他幹預措施的適用性。我們也一直在加強我們的數位生態系統，以便為我們的客戶和公司提供高品質的數據和洞察力。透過像我們這樣的先進技術生態系統，改善患者和客戶的治療結果的機會比以往任何時候都更大。我們專注於嚴格執行以實現這一目標。

And I'll turn the time over to Dave to take you through clinical R&D and operational updates.

接下來我將讓戴夫向您介紹臨床研發和營運更新。

Thank you, Gary. Starting with procedures. da Vinci procedure growth in the quarter was 18%, aided by an additional business day relative to Q3 2023. Growth, again, centered on general surgery in the US, with accretive contributions to the global growth rate from Japan, Germany, France, and the UK. In Asia, we have mixed market conditions, largely consistent with the first half of the year. Jamie will describe these dynamics later in the call.

謝謝你，加里。從程序開始。本季達文西程式成長了 18%，這得益於與 2023 年第三季相比增加的一個工作日。成長再次集中在美國的普通外科手術上，日本、德國、法國和英國對全球成長率做出了貢獻。在亞洲，市場狀況好壞參半，與今年上半年基本一致。傑米將在稍後的通話中描述這些動態。

Turning to capital, we placed 379 da Vinci systems in the quarter, including 110 da Vinci 5 systems and 21 SP systems. We also installed 58 Ion systems in the quarter.

談到資本，我們在本季投放了379套達文西系統，其中包括110套達文西5系統和21套SP系統。我們還在本季安裝了 58 個 Ion 系統。

Capital placements were solid in the US, Japan, India, and our distribution markets; and capital pressure in Europe and China continue. System utilization defined as procedures per installed clinical system per quarter grew 4% globally year over year four our multi-port platforms, 9% for SP, and 11% for Ion.

美國、日本、印度和我們的分銷市場的資本配置穩健；歐洲和中國的資本壓力仍在持續。系統利用率定義為每季度每個安裝的臨床系統的操作程序數，與去年同期相比，我們的多端口平台在全球範圍內增長了 4%，SP 增長了 9%，Ion 增長了 11%。

Turning to our finances, revenue grew 17% in the quarter and spending was within our expectations. Our spending reflects investment in research and development to support the growth of our platforms and digital tools. Expansion of our manufacturing facilities and plan leverage from our enabling functions. Jamie will take you through our financials in greater detail later in the call.

談到我們的財務狀況，本季營收成長了 17%，支出也符合我們的預期。我們的支出反映了對研發的投資，以支持我們的平台和數位工具的成長。擴大我們的製造設施並計劃利用我們的支援功能。傑米將在稍後的電話會議中向您更詳細地介紹我們的財務狀況。

In Q3, we continued our measured rollout of da Vinci 5, placing 110 systems as the launch progresses in line with our plans. We are encouraged by broad use of the platform across specialties, with customers expressing a preference for da Vinci 5. Last month, about 1,200 healthcare professionals gathered at our annual user conference, Intuitive 360, to highlight various aspects of their robotic programs.

在第三季度，我們繼續有計劃地推出達文西 5，並按照計劃部署了 110 個系統。我們對該平台在各個專業領域的廣泛應用感到鼓舞，客戶也表示更喜歡 da Vinci 5。上個月，約有 1,200 名醫療保健專業人士齊聚我們的年度用戶大會 Intuitive 360​​，重點介紹他們的機器人程式的各個方面。

Customers have completed over 12,000 cases with da Vinci 5 and several presented their early case data around efficiency and Force Feedback. A number of customers have reported console time savings when comparing da Vinci 5 to Xi, and we look forward to broader analyses as more data becomes available.

客戶已經使用 da Vinci 5 完成了超過 12,000 個案例，其中幾個案例展示了有關效率和力回饋的早期案例數據。許多客戶報告稱，將 da Vinci 5 與 Xi 進行比較可以節省控制台時間，我們期待隨著更多數據的出現進行更廣泛的分析。

For Force Feedback, Dr. Laila Rashidi from MultiCare Health in Tacoma, a leading voice on gentler surgery and its impact on recovery for her colorectal patients described her results. Even with our focus on managing surgical forces, Dr. Rashidi's initial cases with da Vinci 5 show a further review action in force of about 20%, when Force Feedback is used.

對於力回饋，來自塔科馬 MultiCare Health 的 Laila Rashidi 博士描述了她的結果，她是溫和手術及其對結直腸患者康復影響的領導者。即使我們專注於管理手術力量，拉什迪博士使用達文西 5 進行的初始病例也表明，當使用力回饋時，進一步的審查行動的力量約為 20%。

Force Feedback is a complex technology that we have been pursuing for more than two decades. And it stems from a belief that less force on tissue can lead to improved patient experiences. We also believe Force Feedback may accelerate learning for care teams, and we will continue to study the use of Force Feedback that our customers. We expect more publications over the coming quarters in our teams continue working hard to improved product margin, increased supply of Force Feedback instruments. As we have said before, maturing these insights will take time.

力回饋是一項複雜的技術，我們已經研究了二十多年。它源自於這樣一種信念：對組織施加較小的壓力可以改善患者的體驗。我們也相信力回饋可以加速護理團隊的學習，我們將繼續研究客戶對力回饋的使用。我們預計在未來幾季內，我們的團隊將繼續努力提高產品利潤率，增加力回饋儀器的供應。正如我們之前所說，這些見解的成熟需要時間。

Turning to our digital efforts. We believe that digital innovations on our da Vinci and Ion platforms can extract unique, clinical, and operational insights. Coupled with electronic medical record data, these insights should become a core part of improving outcomes learning inefficiencies in the future. To date, we have data from millions of procedures that enable customers to review operational metrics, such as instruments used, procedure duration, and more.

轉向我們的數位化努力。我們相信，達文西和 Ion 平台上的數位創新可以提取獨特的臨床和操作見解。結合電子病歷數據，這些見解應該成為未來改善成果學習效率低落的核心部分。到目前為止，我們擁有數百萬個程式的數據，使客戶能夠查看操作指標，例如所使用的儀器、程式持續時間等。

In addition, hundreds of thousands of these cases are connected corresponding the identified electronic medical records, enabling certain clinical and operational hypotheses to be tested. Case Insights is our new analytical tool in My Intuitive that will add kinematics, Force Feedback, and video data to physician's post-operative case reports, further enabling analyses to identify a connection between da Vinci system data and clinical or operational outcomes. We are at the early stages of innovative technology we believe will be powerful, but it will require rapid cycles of innovation and take time to build validated datasets.

此外，數十萬個病例與已識別的電子病歷相對應，從而可以檢驗某些臨床和操作假設。Case Insights 是 My Intuitive 中的新分析工具，它將運動學、力回饋和視訊數據添加到醫生的術後病例報告中，進一步透過分析確定達文西系統數據與臨床或操作結果之間的聯繫。我們正處於創新技術的早期階段，我們相信它將會非常強大，但它需要快速的創新週期，並需要時間來建立經過驗證的資料集。

In Q3, we submitted our CE technical file in Europe. Last week, we received clearance for da Vinci 5 in Korea, and are back and forth in the regulatory process in Japan. This quarter, we began shipping our da Vinci 5 broad launch hardware, and completed a software update that addresses aspects of early customer feedback. We are driving toward broad launch midyear of 2025, when we expect to be at scale in our manufacturing operations, and will have released a software update and enabling the integrated hub and simulator along with various digital and imaging features.

第三季度，我們在歐洲提交了CE技術文件。上週，我們在韓國獲得了達文西 5 的批准，目前正處於日本的監管流程中。本季度，我們開始發售達文西 5 廣泛發布硬件，並完成了針對早期客戶反饋方面的軟體更新。我們正努力在 2025 年中期廣泛發布，屆時我們預計製造業務將達到規模化，並將發佈軟體更新並啟用整合集線器和模擬器以及各種數位和成像功能。

Moving to instruments and accessories. In Q3, we obtained 510(k) clearance for 8-millimeter SureForm 30 stapler, expanding our advanced instrument portfolio of SureForm staplers that currently includes 12-millimeter versions of 60-, 45-, and 33-millimeter lengths. 8-millimeter SureForm 30 is primarily used in cases where the decrease diameter enables surgeons to better visualize and access tissue in tight spaces as often seen in thoracic or kidney procedures.

轉向儀器和配件。在第三季度，我們獲得了 8 毫米 SureForm 30 縫合器的 510(k) 許可，擴展了我們先進的 SureForm 縫合器產品組合，目前包括 60 毫米、45 毫米和 33 毫米長度的 12 毫米版本。 8 毫米 SureForm 30 主要用於直徑減小的情況，使外科醫生能夠更好地觀察和接觸狹窄空間內的組織，這在胸部或腎臟手術中很常見。

We are starting our commercial journey in China with Ion, where we placed two systems in soft physicians performing the first cases. We will begin working with a number of medical centers to collect data that will inform our broader commercialization strategy in the country. In Europe, our early launch expanded into Germany and Italy.

我們正透過 Ion 在中國開啟我們的商業之旅，我們在中國為執行首批病例的醫生安裝了兩套系統。我們將開始與一些醫療中心合作收集數據，為我們在該國的更廣泛的商業化策略提供資訊。在歐洲，我們早期的產品擴展到了德國和義大利。

Turning to SP. In the quarter, we received clearance with broad indications in Taiwan, similar to Korea, Japan, and Europe. We also completed a US 510(k) submission for colorectal indication. Commercialization in Europe continues according to plan, and we're encouraged by early customer interest for SP.

轉向 SP。本季度，我們在台灣獲得了廣泛指示的批准，類似於韓國、日本和歐洲。我們也完成了美國 510(k) 結直腸指徵的提交。歐洲的商業化進程正在按計畫繼續進行，早期客戶對 SP 的興趣令我們感到鼓舞。

Now, I'd like to share with you some recently published peer-reviewed literature that we found to be notable. In addition to this specific data highlighted on this call, we encourage you to consider the wide body of evidence detailing these topics in published scientific studies over the years.

現在，我想與大家分享一些我們發現值得注意的最近發表的同行評審文獻。除了本次電話會議中強調的具體數據外，我們還鼓勵您考慮多年來發表的科學研究中詳細介紹這些主題的大量證據。

In August, at the 2024 American Association for Oncology and Interventional Pulmonology Annual Conference, Dr. Bryan Husta from Memorial Sloan Kettering Cancer Center presented results from the CONFIRM study. CONFIRM is a prospective multicenter study evaluating outcomes from the integrated Ion endoluminal system and mobile cone beam CT in the biopsy of pulmonary nodules less than 2 centimeters in size.

8月，在2024年美國腫瘤和介入肺病學會年會上，紀念斯隆凱特琳癌症中心的Bryan Husta博士介紹了CONFIRM研究的結果。CONFIRM 是一項前瞻性多中心研究，旨在評估整合離子腔內系統和移動錐形束 CT 對小於 2 公分的肺結節進行活檢的結果。

155 patients from six centers throughout the US were enrolled. With a median nodules size of 14 millimeters, the integrated platform enabled to tool in nodule rate of 99.4%, with a diagnostic yield of 90% and zero pneumothorax observed. Subgroup analysis demonstrated consistent results across all centers, with high diagnostic yields observed regardless of nodule size, location, or presence of CT bronchus sign.

來自美國六個中心的 155 名患者參加了研究。整合平台的結節中位數為 14 毫米，結節入選率為 99.4%，診斷率為 90%，且未觀察到氣胸。亞組分析顯示所有中心的結果一致，無論結節大小、位置或是否有 CT 支氣管徵象，均能觀察到較高的診斷率。

The presented conclusion noted, quote, integrated shape sensing robotic-assisted bronchoscopy and mobile cone-beam CT demonstrated a higher diagnostic yield and excel the safety for small complex modules, with reproducible results across physicians and institutions. These results suggested that integrated platform may be able to compete with the transthoracic biopsy approach and small nodules, close quote.

提出的結論指出，整合形狀感知機器人輔助支氣管鏡檢查和移動錐形束 CT 表現出更高的診斷產量，並且對於小型複雜模組而言具有更高的安全性，並且在醫生和機構之間具有可重複的結果。這些結果表明，綜合平台可能能夠與經胸活檢方法和小結節競爭，接近引文。

Earlier this year, Dr. Maegawa from the Department of Surgery at Emory University in Atlanta, Georgia, published in the journal surgery. The study comparing robotic and laparoscopic cholecystectomy procedures for benign indications performed in 2022. Using the American College of Surgeons' National Surgical Quality Improvement Program database, over 59,000 patients were included in this study, with over 53,000 in the laparoscopic arm in approximately 5,500 in the robotic-assisted arm.

今年早些時候，喬治亞州亞特蘭大埃默里大學外科系的 Maegawa 博士在《外科》雜誌上發表了一篇論文。該研究比較了 2022 年進行的針對良性適應症的機器人和腹腔鏡膽囊切除術。使用美國外科醫師學會的國家外科品質改進計畫資料庫，超過 59,000 名患者參與了這項研究，其中超過 53,000 名患者接受腹腔鏡手術，約 5,500 名患者接受機器人輔助手術。

Through a multi-variable logistic regression analysis, which controlled for confounding factors, patients undergoing a robotic-assisted cholecystectomy at an 18% lower chance of experiencing a serious complication, as well as a 56% lower chance of a conversion to open, and 24% lower risk of requiring hospitalization for more than 24 hours.

透過控制混雜因素的多變量邏輯迴歸分析，接受機器人輔助膽囊切除術的患者發生嚴重併發症的可能性降低 18%，轉為開腹手術的可能性降低 56%，需要住院超過 24 小時的風險降低 24%。

The authors also looked at elective cholecystectomies only that reported a 46% lower chance of conversion to open, 59% lower chance of reoperation, and 30% lower odds of a hospitalization of over 24 hours associated with robotic-assisted cholecystectomies.

作者也研究了選擇性膽囊切除術，結果顯示，與機器人輔助膽囊切除術相比，轉為開腹手術的可能性降低了 46%，再次手術的可能性降低了 59%，住院時間超過 24 小時的可能性降低了 30%。

The authors concluded, quote, using a large and recent National Surgical database, this study showed that overall, robotic cholecystectomies were independently associated with a lower risk of serious complications, lower rate of conversions to open, and lower risk of hospitalization greater than 24 hours when compared to laparoscopy. These findings suggest that the adoption of new technologies might enhance the safety of minimally invasive surgery in selected cases, close quote.

作者總結道，使用大型最新國家外科資料庫，這項研究表明，總體而言，與腹腔鏡手術相比，機器人膽囊切除術與嚴重併發症風險較低、轉為開腹手術率較低以及住院時間超過 24 小時的風險較低獨立相關。這些發現表明，採用新技術可能會提高特定情況下微創手術的安全性，結束引用。

In closing, we are committed to our 2024 priorities, supporting our measured launch of da Vinci 5 and our other new platforms by region; supporting surgeons' adoption of focused procedures continuing to improve product quality and margins; and finally, improving productivity in those functions that benefit from a global scale.

最後，我們致力於實現 2024 年的優先事項，支持按地區分步推出達文西 5 和其他新平台；支持外科醫生採用有針對性的程序，繼續提高產品品質和利潤率；最後，提高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 and procedure highlights in greater detail.

現在我將時間交給 Jamie，他將向您更詳細地介紹我們的財務狀況和程序亮點。

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.我將以非 GAAP 或備考方式描述我們業績的亮點，並將在稍後的準備好的發言中總結我們的 GAAP 業績。我們的備考結果和 GAAP 結果之間的對帳已發佈在我們的網站上。

Core metrics continued to be strong in Q3, but da Vinci procedure growth of 18%, installed base growth of da Vinci systems of 15%, and overall da Vinci system utilization up 3%.

第三季核心指標持續保持強勁，但達文西程式成長了 18%，達文西系統安裝基數成長了 15%，達文西系統整體利用率成長了 3%。

Procedure growth in Q3 benefited from a higher number of business days compared to the year ago perio. On a day-adjusted basis, Q3 procedure growth was 17%. US procedures grew 16%, driven by growth in benign general surgery.

與去年同期相比，第三季的流程成長得益於更多的工作日。以日調整後計算，第三季的程式成長率為 17%。受良性普通外科手術增長的推動，美國外科手術數量增加了 16%。

On a day-adjusted basis, bariatric procedures in the US declined in the mid-single-digit range, similar to last quarter. OUS procedures grew 24%, reflecting strong growth in general surgery, gynecology, and thoracic procedures.

以天數調整後的數據來看，美國的減重手術數量下降了中等個位數，與上一季類似。OUS 手術量增加了 24%，反映了一般外科、婦科和胸腔外科手術的強勁成長。

Within our OUS markets, growth was strong in the UK and India, and solid in Japan, Germany, France, and Italy. Procedure growth in South Korea improved from the prior quarter, but was still below longer-term historical trends given the ongoing precision strike. In China, procedure growth was below the corporate average, given recent system placement trends reflecting several market dynamics that we have previously described and domestic robotic competition.

在我們的美國以外市場中，英國和印度的成長強勁，日本、德國、法國和義大利的成長穩健。韓國的手術量成長較上一季有所改善，但考慮到持續的精確打擊，仍低於長期歷史趨勢。在中國，鑑於最近的系統部署趨勢反映了我們之前描述的幾個市場動態和國內機器人競爭，程式成長低於企業平均值。

With respect to capital performance, we placed 379 systems in the third quarter, compared with 312 systems in Q3 of last year. In the US, we placed 219 systems in quarter three, compared to 159 systems placed in Q3 of last year. US system placements in the quarter included 110 da Vinci 5 placements. As supply of da Vinci 5 increases and we move into broad launch mid-next year, we expect the placements in the US will progressively shift toward trade-ins.

就資本表現而言，我們在第三季投放了 379 個系統，而去年第三季投放了 312 個系統。在美國，我們在第三季安裝了 219 個系統，而去年第三季則安裝了 159 個系統。本季美國系統安裝量包括 110 個達文西 5 安裝量。隨著達文西 5 供應量的增加以及我們將在明年年中廣泛推出該產品，我們預計美國的銷售管道將逐步轉向以舊換新。

Outside the US, we placed 160 systems in quarter three compared with 153 systems last year. Excluding trading transactions, net new system placements in OUS markets increased 28% year over year. Q3 system placements included 65 into Europe, 39 into Japan, and 14 into China, compared with 60 into Europe, 32 into Japan, and 10 into China in quarter three of last year. Placements in Europe continued to be challenged by ongoing government budget pressures impacting health care capital spending.

在美國以外，我們在第三季安裝了 160 個系統，而去年安裝了 153 個系統。不包括交易，OUS 市場的淨新系統安裝量較去年同期成長 28%。第三季系統部署包括歐洲 65 個、日本 39 個和中國 14 個，而去年第三季系統部署包括歐洲 60 個、日本 32 個和中國 10 個。由於政府預算壓力持續影響醫療資本支出，歐洲的佈局繼續面臨挑戰。

Third-quarter revenue was $2 billion, an increase of 17% from last year driven by da Vinci procedure growth, expansion of the da Vinci installed base and growth in our Ion business.

第三季營收為 20 億美元，較去年同期成長 17%，主要得益於達文西手術的成長、達文西安裝基數的擴大以及 Ion 業務的成長。

On a constant currency basis, revenue growth was also 17%. Additional revenue statistics and trends are as follows: leasing represented 58% of Q3 placements, higher than recent periods, reflecting relative capital strength in the US where a much greater proportion of our customers prefer to lease systems. Q3 system average selling prices were $1.51 million, as compared to $1.4 million last year. Higher year-over-year system ASPs reflected a higher mix of da Vinci 5 and a lower mix of trade-ins.

以固定匯率計算，收入成長率也達到了 17%。其他收入統計數據和趨勢如下：租賃佔第三季度投放的 58%，高於近期水平，反映了美國的相對資本實力，在美國，我們有更多的客戶傾向於租賃系統。第三季系統平均售價為 151 萬美元，去年為 140 萬美元。系統平均售價年增率反映了達文西 5 的混合比例較高以及以舊換新的混合比例較低。

We recognized $24 million of lease buyout revenue in quarter three compared with $28 million last quarter and $17 million last year. da Vinci instrument and accessory revenue per procedure was approximately $1,800, flat to the prior quarter and lower than last year's $1,830. The year-over-year decline in I&A per procedure was primarily driven by a lower mix of bariatric procedures and a higher mix of procedures in markets served by distributors.

我們在第三季實現了 2,400 萬美元的租賃買斷收入，而上一季為 2,800 萬美元，去年為 1,700 萬美元。達文西儀器和配件每台手術的收入約為 1,800 美元，與上一季持平，低於去年的 1,830 美元。每項手術的 I&A 年比下降主要是由於減肥手術組合減少以及分銷商服務市場手術組合增加所致。

Turning to our Ion platform. Procedures grew 73% to approximately 25,000 procedures in the third quarter. In Q3, we placed 58 Ion systems compared to 55% last year and 74% last quarter. As a reminder, first half Ion placements reflected a catch-up of backlog as supply of catheters and vision probes improved.

轉向我們的 Ion 平台。第三季手術量增加了 73%，達到約 25,000 例。第三季度，我們安裝了 58 個 Ion 系統，而去年同期為 55%，上一季為 74%。需要提醒的是，由於導管和視覺探頭的供應改善，上半年 Ion 的投放量反映了積壓訂單的追趕。

Q3 Ion system placements included three placements in Europe and our first two placements in China. The installed base of Ion systems increased 50% year over year to 736 systems, of which 296 are under operating lease arrangements.

Q3 Ion 系統部署包括歐洲的三個部署和中國的前兩個部署。Ion 系統的安裝基數較去年同期成長 50%，達到 736 個系統，其中 296 個採用營業租賃安排。

Third-quarter SP procedure growth was 70% with strong multi-specialty growth in Korea, strong growth in the US, and early stage growth in Japan and Europe. 21 of the systems placed in the quarter were SP systems, of which 15 placements were in OUS markets. The SP installed base grew 54% from the year-ago quarter to 243 systems.

第三季 SP 程式成長了 70%，其中韓國的多專業成長強勁，美國成長強勁，日本和歐洲處於早期成長階段。本季安裝的系統中有 21 個是 SP 系統，其中 15 個位於 OUS 市場。SP 安裝基數較去年同期成長 54%，達到 243 個系統。

Moving on to the rest of the P&L. Pro forma gross margin for the third quarter of 2024 was 69.1% compared with 68.8% for the third quarter of 2023 and 70% last quarter. The year-over-year improvement in pro forma gross margin primarily reflects leverage to fixed overhead, lower component costs, and lower logistics costs partially offset by higher inventory reserves.

繼續討論損益表的其餘部分。2024 年第三季的預測毛利率為 69.1%，而 2023 年第三季為 68.8%，上一季為 70%。毛利率預計的同比增長主要反映了固定間接費用的槓桿作用、零件成本的降低以及物流成本的降低，但庫存儲備的增加部分抵消了這一影響。

During the quarter, we opened our new system manufacturing facility at our East Coast hub in Peachtree Corners, Georgia, commencing production of X and Xi systems at that site. We also opened our new global capability center in Bangalore, India, where we are co-locating our local commercial and training teams and the global center for IT and other shared service resources.

本季度，我們在喬治亞州桃樹角的東海岸中心開設了新的系統製造工廠，並開始在該工廠生產 X 和 Xi 系統。我們也在印度班加羅爾開設了新的全球能力中心，將我們的本地商業和培訓團隊以及全球 IT 和其他共享服務資源中心集中於此。

As a reminder, given recent and ongoing capital investments, we expect a significant increase in depreciation expense in 2025 as we bring online additional facilities. Third quarter pro forma operating expenses increased 13% compared with last year, driven by higher head count, increased legal expenses, and higher customer-facing activities.

提醒一下，鑑於近期和正在進行的資本投資，我們預計隨著我們上線更多設施，2025 年的折舊費用將大幅增加。第三季預計營業費用較去年同期增加 13%，原因是員工人數增加、法律費用增加以及面對客戶的活動增加。

Consistent with the last couple of years, we have held pro forma R&D expenses of roughly 11% of revenue, given our prioritization of investments in innovation that drive the quintuple aim and our growth. SG&A expenses continue to leverage, as we benefit from prior investments that allow us to scale efficiently with growth.

與過去幾年的情況一致，考慮到我們優先投資於推動五倍目標和成長的創新，我們將研發費用保持在營收的約 11% 左右。銷售、一般及行政費用繼續發揮槓桿作用，因為我們受益於先前的投資，這些投資使我們能夠隨著成長而有效地擴大規模。

During the quarter, we added approximately 670 employees, of which just over half were in our high-volume INA manufacturing facility in Mexicali to support procedure growth.

本季度，我們增加了約 670 名員工，其中超過一半的員工在墨西卡利的大批量 INA 製造工廠工作，以支持流程成長。

On a year-to-date basis, through Q3 2024, pro forma operating margin was 36% of revenue, an increase of 184 basis points compared to the same period in 2023, driven by higher gross margin and leverage of SG&A expenses as a result of revenue growth and higher operating margins on a year-to-date basis pro forma EPS increased 25% from the prior year.

截至 2024 年第三季度，年初至今的預計營業利潤率的 36%，與 2023 年同期相比增加了 184 個基點，這得益於收入增長導致的毛利率和銷售、一般和行政費用槓桿率上升以及年初至今的營業利潤率上升，預計每股收益比上年增長了 25%。

Pro forma other income was $94.6 million for Q3, higher than $79.4 million in the prior quarter primarily due to higher interest income. Given the interest rate environment, we expect the average interest yield on our cash and investments will decline going into 2025. Our pro forma effective tax rate for the third quarter was 20.5%, reflecting discrete benefits of approximately $12 million, primarily relating to the expiration of statutory limitations for certain tax reserves and an adjustment to our deferred tax assets.

第三季預測其他收入為 9,460 萬美元，高於上一季的 7,940 萬美元，主要原因是利息收入增加。鑑於利率環境，我們預計到 2025 年我們的現金和投資的平均利息收益率將會下降。我們第三季的預測有效稅率為 20.5%，反映了約 1,200 萬美元的單獨收益，主要與某些稅收儲備的法定限製到期以及對我們的遞延所得稅資產的調整有關。

Third quarter 2024 pro forma net income was $669 million or $1.84 per share compared with $524 million or $1.46 per share for the third quarter of last year.

2024 年第三季預計淨收入為 6.69 億美元，即每股 1.84 美元，去年第三季為 5.24 億美元，每股 1.46 美元。

I will now summarize our GAAP results. GAAP net income was $565 million or $1.56 per share for the third quarter of 2024 compared with GAAP net income of $416 million or $1.16 per share for the third quarter of 2023. 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.

我現在將總結我們的 GAAP 結果。2024 年第三季 GAAP 淨收入為 5.65 億美元，即每股 1.56 美元，而 2023 年第三季 GAAP 淨收入為 4.16 億美元，即每股 1.16 美元。我們的網站概述並量化了備考淨收入和 GAAP 淨收入之間的調整，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的損益相關的超額稅收優惠。

We ended Q3 with cash and investments of $8.3 billion, higher than the $7.7 billion we ended last quarter. The sequential increase in cash and investments reflected cash generated from operating activities, partially offset by capital expenditures of $248 million.

第三季末，我們的現金和投資總額為 83 億美元，高於上一季末的 77 億美元。現金和投資的環比增長反映了經營活動產生的現金，但被 2.48 億美元的資本支出部分抵消。

And with that, I would like to turn it over to Brandon to discuss our updated outlook.

接下來，我想讓布蘭登來討論我們最新的展望。

Thank you, Jamie. I will now turn to our financial outlook for 2021. Starting with procedures. On our last call, we forecasted full year 2024 procedure growth within a range of 15.5% and 17%. We are now raising the low end from 15.5% and to 16%, and expect full-year 2024 procedure growth within a range of 16% and 17%.

謝謝你，傑米。現在我將談談我們對 2021 年的財務展望。從程序開始。在我們上次電話會議中，我們預測 2024 年全年的程序成長率將在 15.5% 至 17% 之間。我們現在將低端從 15.5% 提高到 16%，並預計 2024 年全年程序成長率將在 16% 至 17% 的範圍內。

The low end of the range assumes further softening in bariatric procedures, along with increasing headwinds in Asia from physician strikes in Korea and from delayed tenders in domestic robotic systems in China impacting capital placements and therefore, procedure growth. At the high end of the range, we assume bariatric stabilizes at current quarter growth rates, and headwinds in Korea and China do not get worse. The range does not reflect significant impact to elective procedures as a result of IV shortages or other hurricane-related impacts.

該範圍的低端假設減重手術進一步疲軟，同時亞洲因韓國醫生罷工和中國國內機器人系統招標延遲而面臨的阻力不斷加大，從而影響資本配置，進而影響手術成長。在該範圍的高端，我們假設減肥手術在當前季度的成長率上保持穩定，並且韓國和中國的逆風不會變得更糟。此範圍並未反映出靜脈注射短缺或其他颶風相關影響對選擇性手術造成的重大影響。

Turning to gross profit. We continue to expect pro forma gross profit margin to be within a range of 68.5% and 69% of net revenue. Our actual gross profit margin will vary quarter-to-quarter depending largely on product, regional and trade-in mix and the impact of new product introductions.

轉向毛利。我們繼續預計毛利率預計將在淨收入的 68.5% 至 69% 之間。我們的實質毛利率將逐季變化，主要取決於產品、地區和以舊換新組合以及新產品推出的影響。

Turning to operating expenses. On our last call, we forecasted full year 2024 pro forma operating expense growth to be within a range of 10% and 13%. We are now lowering the high end of our estimate and expect full-year 2024 pro forma operating expense growth to be within a range of 10% and 12%.

談到營運費用。在我們上次電話會議上，我們預測 2024 年全年預計營業費用成長率將在 10% 至 13% 之間。我們現在降低了估計的高端，並預計 2024 年全年預計營業費用成長將在 10% 至 12% 的範圍內。

We expect noncash stock compensation expense to range between $670 million and $690 million in 2024. We are increasing our estimate for other income, which is comprised mostly of interest income to total between $325 million and $345 million in 2024.

我們預計 2024 年非現金股票薪酬支出將在 6.7 億美元至 6.9 億美元之間。我們提高了其他收入的估計，其中主要包括利息收入，到 2024 年總額將達到 3.25 億美元至 3.45 億美元之間。

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, we expect the pro forma income tax rate for 2024 to be within a range of 22% and 23% of pretax income.

關於資本支出，我們繼續估計在 10 億美元至 12 億美元之間，主要用於計劃中的設施建設活動。關於所得稅，我們預計 2024 年的預計所得稅率將在稅前收入的 22% 至 23% 之間。

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

我們的準備評論到此結束。我們現在開始回答你們的問題。

(Operator Instructions) Travis Steed, Bank of America.

（操作員指示）美國銀行特拉維斯·斯蒂德 (Travis Steed)。

Sure. Maybe just a little more on thinking about the dV5 ramp between now and the mid-2025 broad launch. Do you expect to make any more upgrades or ad software? And I'd love to dig in a little bit on the customer actions to some of the contribution margin benefits, contribution margin benefits of dV5 kind of on the early data and the hospital CFOs are resonating with some of that fairly profitable data with dV5?

當然。也許只是稍微多考慮一下從現在到 2025 年中期廣泛推出的 dV5 坡道。您是否希望進行更多升級或廣告軟體？我很想深入了解客戶對一些貢獻邊際效益的行為，dV5 的貢獻邊際效益在早期數據上的表現，以及醫院財務長對 dV5 的一些相當有利可圖的數據的共鳴？

Hey, Travis, this is Dave. I will answer some of your questions around kind of where are we going from here to broad launch. So in terms of software updates, we'll continue to make them as they're scheduled in our plans. And you'll see those come out on a semi routine basis.

嘿，崔維斯，我是戴夫。我將回答你們的一些問題，例如從現在到廣泛推出，我們要去哪裡。因此，就軟體更新而言，我們將繼續按照計劃進行更新。你會發現這些情況會以半例行的方式出現。

We have to get to broad launch. As described in my comments, we have a release that will enable some of that hardware and some additional software features in that broad launch time frame.

我們必須進行廣泛推廣。正如我在評論中所描述的，我們有一個版本，它將在廣泛的發佈時間範圍內啟用一些硬體和一些額外的軟體功能。

For the supply side of dV5, we expect that to increase modestly quarter over quarter as we get into next year and into broad launch. On the contribution margin side, maybe, Jamie --?

對於 dV5 的供應方面，我們預計隨著明年的到來和廣泛推出，供應量將逐季度小幅增長。在貢獻邊際方面，也許，傑米--？

Yeah. I'd just say that, obviously, there was a publication in one of the executive publications that we assisted with. It was illustrative in terms of the contribution margin gains that an institution might get given what we're seeing with respect to efficiency.

是的。我只是想說，顯然，在我們協助出版的行政出版物中有一篇出版物。從效率角度來看，這可以說明一個機構可能獲得的貢獻利潤收益。

We have a number of early surgeons that are KOLs that have sophistication in terms of use of da Vinci that are reporting improvements in console time, and that allows for both efficiency in a given procedure and perhaps the opportunity to have higher throughput on the platform. And I think that's part of the conversation with administration.

我們有許多早期的外科醫生，他們是達文西使用方面的 KOL，他們報告了控制台時間的改進，這不僅提高了特定程式的效率，還可能有機會在平台上實現更高的吞吐量。我認為這是與政府對話的一部分。

I'd say that's early, and I think we look to collect evidence and validation as we get into the broad launch, but early feedback from a number of our surgeons has been focused on the efficiency gains they've seen.

我想說這還為時過早，而且我認為我們會在廣泛推出時收集證據和驗證，但我們許多外科醫生的早期反饋都集中在他們所看到的效率提升上。

Larry Biegelsen, Wells Fargo.

富國銀行的拉里·比格爾森。

Thanks for taking the questions. One on international for me, one on procedures, if I may. The Korean approval, I think, came earlier than people expected. Do you have supply to launch that right away?

感謝您回答這些問題。如果可以的話，對我來說一個是關於國際的，一個是關於程序的。我認為韓國的批准比人們預期的要早。您有供應來立即啟動它嗎？

And just what's the update on Japan timing? I heard the back and forth in the prepared remarks. And how long are you expecting the review process in Europe to take? And I have one follow-up.

日本的最新時間是怎麼樣的？我聽到了準備好的發言稿中的反覆發言。您預計歐洲的審查過程需要多長時間？我還有一個後續問題。

Yes, thanks. We do have supply to be able to support Korea demand. And so that is true. We have not outlined timing in Japan. So we remain in that back and forth.

是的，謝謝。我們確實有供應來滿足韓國的需求。事實確實如此。我們尚未確定日本的具體時間。所以我們仍然處於這種來回的狀態。

And then with respect to CE Mark in Europe, no different from last quarter where we expect that near the end of next year 2025

然後就歐洲的 CE 標誌而言，與上一季沒有什麼不同，我們預計明年年底（2025 年）

Got it. That's helpful. And for Dave or Gary, we've heard you and key opinion leaders recently started talking about new procedures such as appendectomy, foregut, hepatobiliary, and emergent procedures. Could you please tell us where you are in addressing these from a clinical, regulatory, and commercial standpoint? And how would you size some of these new procedures? Thanks.

知道了。這很有幫助。對於戴夫或加里，我們聽到您和關鍵意見領袖最近開始談論闌尾切除術、前腸、肝膽和緊急手術等新手術。您能否從臨床、監管和商業的角度告訴我們您如何解決這些問題？您如何衡量這些新程式的規模？謝謝。

Yeah. With respect to foregut and HPB, we've actually been in those procedures in the US for some time. They've been growing nicely for us. Currently, the growth rates for them are accretive to the US average. They are both relatively small categories, and that's probably why they haven't gone a lot of the air time in terms of our commentary.

是的。關於前腸和 HPB，我們實際上已經在美國開展這些程序一段時間了。它們在我們看來一直都生長得很好。目前，它們的成長率已達到美國平均。它們都是相對較小的類別，這可能是為什麼它們在我們的評論中沒有佔據太多播出時間的原因。

Appendectomy is much earlier for us. It's quite a small procedure. It is also accretive growth. I think what you're seeing with appendectomy is as surgeons have adopted Xi over time as they've expanded their kind of taking a practice approach to general surgery.

闌尾切除術對我們來說早很多。這是一個相當小的過程。這也是一種增值性成長。我認為，您在闌尾切除術中看到的是，隨著時間的推移，外科醫生已經採用了 Xi，因為他們已經將這種實踐方法擴展到了普通外科手術。

What you see is that then gets extended into the emergent care settings, acute care settings, and they start to use Xi more routinely. We have done some clinical work on appendectomy. We do have an indication with the FDA in the U.S. and appendectomy, that's a small procedure for us, and obviously, it's concentrated in emergent savings.

您所看到的是，隨後它擴展到緊急護理環境、急性護理環境，並且他們開始更常規地使用 Xi。我們做了一些闌尾切除術的臨床工作。我們確實獲得了美國 FDA 的批准，闌尾切除術對我們來說是一個小手術，顯然，它集中在緊急儲蓄上。

Robbie Marcus, JPMorgan.

摩根大通的羅比·馬庫斯。

Congrats on a great quarter. Two for me, might both be for Jamie, I'll let you decide. Maybe first, the margins were once again really impressive, both gross margin and operating margin. Really, the question is how much more room do you feel like there is to go? We're just starting to see da Vinci 5 flow through. And I know there is definitely some depreciation benefit flowing through this year that probably wanes into next year. And we're coming off a very heavy investment period.

恭喜本季取得優異成績。兩個給我，兩個可能都給傑米，我讓你決定。也許首先，利潤率再次令人印象深刻，包括毛利率和營業利益率。確實，問題是您覺得還有多少空間可以去？我們剛開始看到達文西 5 的進展。我知道今年肯定會有一些折舊收益，但這些收益可能會在明年逐漸減少。我們剛結束一段投資非常緊張的時期。

So I guess the question is, as we move forward, how should we think about the margin progression as you have these new products flowing through and the mix starts to evolve?

所以我想問題是，隨著我們不斷前進，當這些新產品不斷湧現並且產品組合開始演變時，我們應該如何考慮利潤率的成長？

Yeah. Maybe just some framing first. I think we've consistently said we look to have margins that are kind of top tier with respect to our med tech peers. We've also said that we don't have a management expectation to have op margins above 40%. I know they were -- had that level back pre-COVID, but we don't have a management objective to be back at that level. And that's just us balancing the rate of investment with what we think is the right level of profitability.

是的。也許只是先做一些框架。我認為我們一直表示，我們希望獲得比醫療技術同行更高的利潤率。我們也表示，管理階層並不期望營業利潤率超過 40%。我知道他們——在 COVID 之前就已經恢復到那個水平，但我們沒有回到那個水平的管理目標。這只是我們在投資率和我們認為的適當獲利水準之間進行平衡。

We were 37% of margin this quarter, 36% year to date. What I would expect is, for 2025 on the gross margin front, just given the significant incremental depreciation that we've described, you should expect gross margins to be a little lower next year as we start to take on board that incremental depreciation expense.

本季我們的利潤率為 37%，年初至今的利潤率為 36%。我預計，就 2025 年的毛利率而言，考慮到我們所描述的大幅增量折舊，隨著我們開始考慮增量折舊費用，您應該預計明年的毛利率會略低一些。

And you'll have a period, as those new facilities come online, where, in fact, we're period expensing that depreciation because you're early in the phase of ramping production in those facilities versus capitalizing them into inventory. I think what we've said in the midterm is we have the opportunity, we think, on gross margin to get back to 70%. That's our aspiration.

隨著這些新設施投入使用，您將有一段時期，事實上，我們正​​在將折舊計入期間費用，因為您正處於這些設施產量提升的早期階段，而不是將其資本化為庫存。我認為我們在中期所說的是，我們有機會將毛利率恢復到 70%。這就是我們的願望。

But if you think about where we are right now, year to date, 36%, we don't have a management objective to be above 40% is a relatively narrow range over the midterm to improve. The question of what we do on that midterm will also be balanced by how much we invest in R&D, which is going to be a function of the opportunities that we see.

但如果你想想我們現在的狀況，年初至今，我們的管理目標是 36% 以上，而中期改善的範圍相對較窄。我們在中期選舉中做什麼的問題也將取決於我們在研發上投入多少，這將取決於我們看到的機會。

Great. Appreciate that. And then as a follow-up, as we move into next year and you talked about expect more of the trade-ins coming from da Vinci 5 as you move into full launch. There's an opportunity, obviously, to repurpose and resell some of the refurbished is that you get traded in. Just maybe speak to the opportunity there, how we should think about that? And any immediate plans you can talk about? Thanks a lot.

偉大的。非常感謝。然後作為後續，隨著我們進入明年，您談到隨著全面推出，預計會有更多來自達文西 5 的以舊換新。顯然，有機會重新利用和轉售一些翻新產品，只要你進行交易即可。也許只是談論那裡的機會，我們該如何看待它？能談談近期有什麼計畫嗎？多謝。

Yeah. So you should expect us to as the trading cycle occurs, which, by the way, we think will be progressive and will occur over multiple of years, as Xi come back, we will, as we've done in the past, refurbished those, that does allow for segmentation that could be site of care segmentation, for example, in the US and segmentation in markets internationally that are more cost sensitive. We haven't worked through exactly how -- what those plans will be, but you could expect within that framing, that's kind of what we'll do with respect to refurbished excise.

是的。因此，您應該期望我們隨著交易週期的發生而發生，順便說一句，我們認為這將是漸進的並且將持續數年，隨著習近平的回歸，我們將像過去一樣，對它們進行翻新，這確實允許進行細分，例如在美國進行護理細分，以及在對成本更敏感的國際市場進行細分。我們還沒有具體研究這些計劃將會是怎樣的，但你可以在這個框架內預期，這就是我們在翻新消費稅方面將要做的事情。

David Roman, Goldman Sachs.

高盛的戴維·羅曼。

Thank you and good afternoon, everybody. Maybe we can start on Ion. I think if you look in a variety of public forums, there's been a considerable amount of promotional activity, both in the US and Europe, as you've launched in new markets. Maybe you could help us think about where we are in the Ion launch and adoption curve in each of the target geographies and how we should think about growth in that segment on a go-forward basis? And then I have one P&L follow-up.

謝謝大家，下午好。也許我們可以從 Ion 開始。我認為，如果你查看各種公共論壇，你會發現隨著你們進軍新市場，美國和歐洲都出現了大量的促銷活動。也許您可以幫助我們思考我們在每個目標地區的 Ion 發布和採用曲線中所處的位置，以及我們應該如何展望該領域的未來成長？然後我有一個損益跟進。

Sure, I'll take that one. David, it's Gary. In the US, I think Ion is progressing well in its first indication, biopsy of suspicious lung nodules. We think it's crossed the chasm. It should be in double-digit prevalence in terms of total biopsy use.

當然，我會選擇這個。大衛，我是加里。在美國，我認為 Ion 在其首個適應症——可疑肺結節活檢方面進展順利。我們認為它已經跨越了鴻溝。就總切片使用率而言，其盛行率應達到兩位數。

So I think there, the focus is a little bit less now on the earliest customers. I think the early customers have done great. We're pretty deeply penetrated into those sites of care, and the focus there will be on high utilization, high customer satisfaction, some innovation, and pursuit of additional indications inside the lung using the Ion platform.

所以我認為，現在對最早的客戶關注度已經降低。我認為早期的客戶做得很好。我們已經深入滲透到這些護理站點，重點將放在高利用率、高客戶滿意度、一些創新以及使用 Ion 平台尋求肺部內部的更多適應症。

We're much earlier in our journey outside of the United States. So early experiences so far in Europe first started in the UK. They're building some momentum off an early base and then early, early steps into Germany; likewise, early steps into China. So it's a little bit of a two-phased approach here in the US strong move toward high utilization, high satisfaction moving out of the first concentrated set of customers.

我們走出美國之旅才剛開始。因此，迄今為止，歐洲的早期經驗首先始於英國。他們正在利用早期基礎積聚一些勢頭，然後儘早進入德國市場；同樣，也儘早進入中國市場。因此，在美國，這有點像是兩階段的方法，先從第一批集中的客戶開始，大力走向高利用率、高滿意度。

And in OUS, it's really initiating the journey in different

在 OUS，它真正開啟了不同旅程

That's super helpful. And then maybe just a follow-up on the P&L. One of the things that was notable this quarter and has been the past couple is the increased percentage of systems being placed under usage agreements. I think it's gone from about 12% earlier this year to about 15% now.

這非常有幫助。然後也許只是對損益表進行跟進。本季度以及過去幾季值得注意的事情之一是，採用使用協議的系統比例增加。我認為它已經從今年早些時候的約 12% 上升到現在的約 15%。

Can you help us think about the trajectory of that contribution to the placement model and what that means for the P&L?

您能否幫助我們思考一下這種貢獻對投放模式的影響軌跡以及對損益表意味著什麼？

Well, so those arrangements are a subset of operating leases. And obviously, those arrangements are where the customer pays for system and service as they use the system. Those arrangements with the customers have an expectation of what the procedures will be done per year that's reflected in the arrangement.

那麼，這些安排就是經營租賃的子集。顯然，這些安排是客戶在使用系統時支付系統和服務的費用。與客戶達成的這些安排對每年將要完成的程序有一個預期，這反映在安排中。

And so then at target economics, you should think of it as similar to a regular offering, at least it's a fixed payment arrangement and operating leases in general are slightly accretive to purchase because of the embedded interest rate in there. Of course, the difference for the usage-based arrangement is then you have the risk of what is the actual usage by the customer in those uses-based arrangements.

那麼，從目標經濟學的角度來看，你應該把它看作類似於定期發行，至少它是一種固定付款安排，而且由於其中嵌入的利率，經營租賃一般會略微增加購買量。當然，基於使用情況的安排的不同之處在於，您需要承擔客戶在這些基於使用情況的安排中實際使用情況的風險。

We have a distribution, as you would expect in terms of what the usage rates are and we engage with the customers regularly with respect to what their business plans are, particularly when they're not at the target.

正如您所期望的那樣，我們有一個分佈，就使用率而言，我們會定期與客戶溝通，了解他們的業務計劃，特別是當他們沒有達到目標時。

In terms of trajectory, obviously, you've seen it grow. It is popular with customers. It is a way to both access additional capacity without having to consume capital budgets, and it does lower the risk for the customer in terms of taking a new system relative to how well that's going to be utilized.

從軌跡來看，顯然你已經看到它在成長。深受顧客歡迎。這是一種無需消耗資本預算即可獲取額外容量的方法，而且它確實降低了客戶採用新系統的風險（相對於新系統的利用率而言）。

We have provisions and protections in those arrangements for us and for the customer, and we look at those routinely. I would expect it to continue to grow, but it's relatively highly penetrated in the US. And so that the rate of growth will likely moderate. In the international markets, we're at a much earlier stage. So I think that's too early to call in terms of how that might grow.

這些安排為我們自己和客戶提供了規定和保護，我們會定期審查這些規定和保護。我預計它會繼續增長，但它在美國的滲透率相對較高。因此成長率可能會放緩。在國際市場上，我們還處於早期階段。因此我認為現在判斷其發展速度還為時過早。

Rick Wise, Stifel.

瑞克懷斯，Stifel。

Gary, Dave everybody, we continue to have a lot of conversations with surgeons who are interested or potentially interested in da Vinci 5. And I'm not saying this is an accurate sample, but just it's our sample. I get to see some of the larger hospitals, the academic centers that they're more waiting, they're waiting for dual console availability.

加里、戴夫各位，我們繼續與對達文西 5 感興趣或可能感興趣的外科醫生進行大量交談。我並不是說這是一個準確的樣本，而只是我們的樣本。我看到一些較大的醫院、學術中心正在等待，他們正在等待雙控制台的可用性。

And they're saying to me, as our smaller hospitals that you're more focused right now on, I'll call it, mid- to smaller institutions, non-academic. They're making decisions faster.

他們對我說，你們現在更關注的小型醫院，我稱之為中型到小型機構，非學術性。他們做出決策的速度更快。

They're less dependent on dual console. Is that right? Is that what's going on? And I wonder what -- a couple of things, whether procedure growth implications are affected positively or negative by that. And when dual console is more available middle of next year when you're full launch, I assume do we see an acceleration in sort of multisystem, bigger hospital decision making?

他們對雙控制台的依賴程度較低。是嗎？真是這樣嗎？我想知道——有幾件事，程式成長的影響是否會受到正面或負面的影響。當雙控制台在明年年中全面推出時，我認為我們是否會看到多系統、更大的醫院決策加速？

Dave, I'll let you speak to just dual console availability and what's going on there, and then we can speak a little bit to what the trends are will answer the question.

戴夫，我讓你談談雙控制台的可用性以及那裡發生的事情，然後我們可以稍微談談趨勢是什麼，以回答這個問題。

Hey, Rick, and you said it. So in this as we're ramping our supply capabilities, dual console is being prioritized with incremental single system deals. And so as we build our capacity, we will start producing additional consoles for dual system placements.

嘿，里克，你說得對。因此，隨著我們不斷提升供應能力，雙控制台將優先考慮增量單系統交易。因此，隨著我們產能的提升，我們將開始生產更多用於雙系統放置的控制台。

In terms of prioritization and whether being prioritized, I think our team is working with a broad set of customers and to understand what their needs are. And if da Vinci 5 is the right system to meet their needs for their program. And I don't have a lot of information about how that may differ between smaller customers as you put it or in academics or larger institutions.

在優先排序和是否被優先排序方面，我認為我們的團隊正在與廣泛的客戶合作並了解他們的需求。以及 da Vinci 5 是否是能夠滿足他們程序需求的正確系統。而我對於這在較小客戶與學術界或較大機構之間有何區別沒有太多的資訊。

I wouldn't anticipate a significant forecast model change one way or another. I think as we go to broad launch and the pipe opens up, we will seek to serve all those customers. I don't think it inflects procedure growth rate one way or another because of dual console and large versus small. I suspect that's a hard analysis to do. And if you do it, I suspect the differences will be relatively small relative to what we expect.

無論如何，我都不會預期預測模型會發生重大變化。我認為，隨著我們廣泛推出並打開管道，我們將努力為所有客戶提供服務。我不認為它會因為雙控制台和大型與小型而以某種方式影響程式成長率。我認為這是一個很難進行的分析。如果你這樣做了，我認為差異相對於我們預期的來說會相對較小。

Got it, sir. And a quick follow-up, if I could, on Hub. I think it was exciting to hear our in over 2,000 ORs, just help us think through the early experience there and maybe the implications for both da Vinci 5 and again, procedures. Thank you.

明白了，先生。如果可以的話，我對 Hub 進行了快速跟進。我認為聽到我們在 2,000 多個手術室中的經歷是令人興奮的，這有助於我們思考那裡的早期經驗以及對達文西 5 和程序的影響。謝謝。

Yes. So Hub as it exists today, and that includes our generation four compatibility, as well as those that are linked to Gen 5. What does it do? It's a strong data recorder and media management device A lot of those early installs are on-premise implementations versus the cloud. Customers enjoy for their ability to track their data and to assess post-op performance, which has been great.

是的。因此，Hub 目前就已存在，其中包括我們的第四代相容性，以及與第五代相關的兼容性。它起什麼作用？它是一款強大的數據記錄器和媒體管理設備，許多早期安裝都是在本地實施，而不是在雲端。客戶很享受追蹤數據和評估術後表現的能力，這非常棒。

Over time, as we move forward and move toward cloud implementations and other things, I think that it provides them a lot of leverage. There's a lot that we like about it. I think the core capability is really good. There are some things we want to work on.

隨著時間的推移，隨著我們不斷前進並走向雲端實施和其他事物，我認為這為他們提供了很大的槓桿作用。我們非常喜歡它。我認為核心能力確實很好。有些事情我們想繼續努力。

I think refinement, workflow, making those things really easy integration in dV5 is going to be great. We're really excited about it. I think it matters.

我認為改進、工作流程以及使這些東西在 dV5 中真正輕鬆整合將會很棒。我們對此感到非常興奮。我認為這很重要。

So far, so good. I think we're at the beginning of the Hub journey, both in terms of penetration and in terms of future content not the end of it. And I'm proud of the progress the team is making.

到目前為止，一切都很好。我認為我們正處於 Hub 旅程的開始階段，無論是從滲透率還是未來內容來看，而不是結束。我為團隊所取得的進步感到自豪。

Adam Maeder, Piper Sandler.

亞當梅德、派珀桑德勒。

Hi, good afternoon. Congrats on the quarter and thank you for taking the questions. I wanted to ask for some additional color around the capital environment and how you're thinking about hospital budgets and appetite for larger piece of the capital heading into the end of the year in 2025?

嗨，下午好。恭喜本季取得的成績，感謝您回答問題。我想詢問一些有關資本環境的額外信息，以及您如何看待醫院預算以及到 2025 年底對更大部分資本的需求？

And I heard the commentary around Europe and China, it sounds like there's continued pressure there. Just curious, is that kind of status quo versus the first half of the year? Is it getting worse? And kind of how do you expect that to evolve going forward? And then I have a follow-up. Thanks.

我聽到了有關歐洲和中國的評論，聽起來那裡的壓力持續存在。只是好奇，與上半年相比，現狀是這樣嗎？情況變得更糟了嗎？您預計未來將如何發展？然後我有一個後續問題。謝謝。

Thanks. Jamie, why don't you take the broad answer, and then I'll touch on China at the end.

謝謝。傑米，你為什麼不先回答一個廣義的問題，然後我最後再談中國的問題。

Yes. I think I'd characterize US is relatively stable, albeit with a lot of interest in da Vinci 5. I think that's kind of raised the profile again in interest in robotics to some extent. But I'd characterize the overall capital environment is relatively stable.

是的。我認為美國相對穩定，儘管人們對達文西 5 很感興趣。我認為這在某種程度上再次提高了人們對機器人技術的興趣。但我認為整體資本環境相對穩定。

In Europe, what you're seeing particularly in countries like the UK and Germany is pressure on capital spending in the health care space, again, related to government budget pressures that exist there.

在歐洲，尤其是在英國和德國等國家，你會看到醫療保健領域的資本支出面臨壓力，這也與地方政府的預算壓力有關。

And I think that's been similar for the last quarter or so. In the case of Europe, we have some government-related events that come in the next couple of quarters, but too early to predict how that might play out in terms of the changes in the capital dynamics.

我認為上個季度的情況也類似。就歐洲而言，未來幾季將會出現一些與政府相關的事件，但預測這些事件對資本動態變化的影響還為時過早。

Yeah. Just turning to China. There's clearly broad stress across the health care market in total in China, there's kind of a rebaselining there in some of the value-based pricing that has gone through as well as some of the price caps that have gone through in our end of the market.

是的。轉向中國。顯然，中國整個醫療保健市場都面臨著廣泛的壓力，一些基於價值的定價以及我們市場中的一些價格上限正在重新調整。

So I think that pressure is still there. I think it will be there for some quarters. I don't think that resolves quickly.

所以我認為壓力仍然存在。我認為它會存在一段時間。我認為這個問題不會很快解決。

There's also, in our universe, the entry of some domestic competitors that tend to get provincial preferences, the province in which they're headquartered tends to have a preference for them as they launch. And so you see that kind of show up as popcorn as it goes around. I think that will persist for a little while, too. So for us, I think it's not a surprise given the year we've had.

在我們的世界中，還有一些國內競爭對手的進入往往會獲得省級優惠，他們總部所在的省份往往會在他們推出產品時對他們有優惠。因此，當它四處傳播時，您會看到這種現象像爆米花一樣出現。我認為這種情況還會持續一段時間。因此，對我們來說，考慮到我們過去一年所取得的成績，我認為這並不令人意外。

I think, ultimately, these things will wash through how long it takes for it to walk through and stabilizes as yet on them.

我認為，最終，這些事情將通過它需要多長時間才能走完並穩定下來來洗刷掉。

Brandon Vazquez, William Blair.

布蘭登·巴斯克斯、威廉·布萊爾。

Thanks for taking the question. You have a good amount of da Vinci 5 systems out there. I was just curious if you could compare and contrast. Are there any kind of unique insights that you have in that da Vinci 5 installed base, whether it's what types of procedures they're doing or utilization within those accounts are those systems relative to the rest of the Xi base?

感謝您回答這個問題。你們那裡有大量的達文西 5 系統。我只是好奇你是否可以進行比較和對比。您對達文西 5 安裝基礎有什麼獨特的見解嗎？無論是他們正在執行什麼類型的程序，還是在這些帳戶中使用哪些系統，這些系統與 Xi 基礎的其他部分相比如何？

And then maybe just one quick follow-up, I'll throw here now. Can you talk a little bit -- it sounds like innovation on a go-forward basis is really going to be coming a lot from software. Can you kind of compare and contrast the innovation cycle the speed at which you can launch new features on the software side versus what has historically been, I would guess, a little bit of a longer cycle in hardware? Thank you.

然後也許只需要一個快速的後續問題，我現在就在這裡提出。您能否稍微談談——聽起來未來的創新確實很大程度上將來自軟體。您能否比較一下創新週期，即軟體方面推出新功能的速度與歷史上硬體方面推出新功能的周期（我猜想會稍微長一些）？謝謝。

Yeah. So I may try to hit both of those -- on the da Vinci 5 side and the comparison to Xi, one of the things that we're pleased with is it is being used across a broad set of procedures. And so customers with the limited supply are really using them to their fullest.

是的。因此，我可能會嘗試同時滿足這兩個方面——就達文西 5 而言，與 Xi 相比，我們感到高興的事情之一是它被廣泛應用於一系列程式中。因此，供應有限的客戶確實可以充分利用它們。

With respect to how do you compare da Vinci 5 utilization to Xi, it's really too soon to say. The installed base isn't big enough with a long enough history yet to give us a good data set to make those comparisons.

至於如何比較達文西 5 與 Xi 的使用率，現在說還太早。安裝基礎還不夠大，歷史也不夠長，無法為我們提供進行這些比較的良好資料集。

On the software side, there's kind of two buckets that we operate in there are sets of software and products that are nonmedical device. And those are able to have more rapid cycles of innovation and our ability to roll it out to the field. And then there is a second set that our 510(k) or governed by regulatory processes around the globe. And those will generally follow a longer cadence, probably still a bit quicker than you would see in major hardware changes and things like that.

在軟體方面，我們經營兩種業務：軟體和非醫療設備產品。這些能夠加快創新週期，並提高我們將其推廣到實際應用的能力。然後還有第二組，即我們的 510(k) 或受全球監管流程的管轄。這些通常會遵循更長的節奏，可能比你在主要硬體變化和類似的事情中看到的要快一點。

And so on the average, likely we'll see software upgrades and updates happen on a more -- on a higher cadence, but it kind of depends on which bucket they fall into.

因此，平均而言，我們可能會看到軟體升級和更新以更快的節奏進行，但這有點取決於它們屬於哪個類別。

I might challenge the assumption a little bit. I think there's still some hardware we want to do. I don't think hardware is going away. I think that's going to continue and dV5 has some opportunities for that, too. and we'll do the software that you just described.

我可能會對這個假設提出一點質疑。我認為我們還想做一些硬體。我不認為硬體會消失。我認為這種情況將會持續下去，dV5 也有一些機會。我們將開發您剛才描述的軟體。

I think it's great, but we get a chance to do both. Operator, we'll take one more questioner, and then we'll close.

我認為這很棒，但我們有機會同時做這兩件事。接線員，我們再回答一位提問者的問題，然後就結束。

Matt Miksic, Barclays.

巴克萊銀行的馬特‧米克西克 (Matt Miksic)。

Matt Miksic, squeezing in. Hey. Maybe just a big picture kind of a follow-on question. I get some version of this question often from investors, talking about growth drivers, opportunities in procedure growth.

馬特米克西克 (Matt Miksic) 擠了進來。嘿。也許只是一個總體性的後續問題。我經常從投資者那裡聽到這個問題的一些版本，談論成長動力、程式成長中的機會。

And so maybe if you're looking at the US market and the rate that you're growing now, obviously, where penetration is and where it could go over time, do you expect maybe in the next couple of years or three years to be driven more by driving deeper into existing procedures and categories? Or do you see any sort of new large segments, important segments that you expect to help drive that growth would you say the mix looks like or any color you'd be able to add would be super helpful? Thanks.

因此，如果您關注美國市場及其現在的成長速度，顯然，滲透率在哪裡以及隨著時間的推移它會如何發展，您是否預計在未來幾年或三年內，透過深入現有程序和類別，會有更多的推動力？或者您看到任何類型的新的大型細分市場、重要的細分市場，您期望它們有助於推動這種增長，您認為這種組合是什麼樣子的，或者您能夠添加的任何顏色都會非常有幫助？謝謝。

Yeah. Thank you, Matt. It's a great question. I look at. I think in the US, we're -- I won't give you the exact split, but I think it's a balanced perspective. Clearly, we have approaching the back half of some curves and some procedures where it's really about depth. What do the folks who have not yet participated or are participating fully, what do they need from us to keep going and to serve the patients that way.

是的。謝謝你，馬特。這是一個很好的問題。我看一下。我認為在美國，我們——我不會給你確切的劃分，但我認為這是一個平衡的觀點。顯然，我們已經接近一些曲線和一些程序的後半部分，這些曲線和程序實際上與深度有關。那些尚未參與或已經充分參與的人們需要我們做些什麼來繼續為患者服務。

There's still opportunity there. In some ways, there's plenty of opportunity. At the same time, as you start getting to the back half, you want to make sure you're looking for, we want to make sure we're looking for new opportunities and opportunities to serve a different set of patients that we haven't engaged before, and you're starting to see us do that, whether it's in new indications for Ion or SP.

那裡仍有機會。從某些方面來說，機會還是很多的。同時，當你開始進入後半部分時，你要確保你正在尋找，我們要確保我們正在尋找新的機會和機會來服務於我們以前沒有接觸過的不同患者群體，你開始看到我們這樣做，無論是 Ion 還是 SP 的新適應症。

And we think actually in multiport, there's some opportunity and new indication also, although they'll tend to be more niche markets than really big ones. Over time, over the coming quarters, we'll tell you more about that as those opportunities mature.

我們認為，實際上在多端口領域也存在一些機會和新跡象，儘管它們往往是利基市場，而不是真正的大市場。隨著時間的推移，在接下來的幾個季度裡，隨著這些機會的成熟，我們會告訴你更多相關資訊。

So thank you, that was our last question. In closing, we believe there's a substantial and durable opportunity to fundamentally improve surgery and acute intervention. Our teams continue to work closely with hospitals, physicians and care teams in pursuit of what our customers have termed the quintupling, better, more predictable patient outcomes, better experiences for patients, better experiences for their care teams that are access to great care, and ultimately, a lower total cost of care.

謝謝，這是我們的最後一個問題。最後，我們相信，從根本上改善手術和急性幹預存在巨大而持久的機會。我們的團隊繼續與醫院、醫生和護理團隊密切合作，追求我們的客戶所說的五倍、更好、更可預測的患者結果、更好的患者體驗、更好的護理團隊體驗，從而獲得優質的護理，並最終降低護理總成本。

We believe value creation in surgery and acute care is foundationally human. It flows from respect for and understanding of patients and care teams, their needs, and 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，外科手術和急性護理中的價值創造以人為本。它源於對患者和護理團隊、他們的需求以及他們的環境的尊重和理解。在 Intuitive，我們設想未來的照護將侵入性更小、品質更高，可以更早發現疾病並快速治療，以便患者能夠重新回到最重要的狀態。

Thank you, again, for your support on this extraordinary journey. We look forward to talking with you again in three months.

再次感謝您在這次非凡旅程中給予的支持。我們期待三個月後再次與您交談。

And ladies and gentlemen, that does conclude your conference. We do thank you for joining. You may now disconnect.

女士們、先生們，你們的會議到此結束。我們非常感謝您的加入。您現在可以斷開連線。