直覺手術 (ISRG) 2024 Q4 法說會逐字稿

Good day and thank you for standing by. Welcome to the Q4 2024 Intuitive earnings conference call. At this time, all participants are in a listen-only mode. Please be advised that today's conference is being recorded. (Operator Instructions)

美好的一天，感謝您的支持。歡迎參加 2024 年第四季直觀財報電話會議。此時，所有參與者都處於只聽模式。請注意，今天的會議正在錄製中。 （操作員說明）

I would now like to hand the conference over to your speaker today, Brandon Lamm, Investor Relations for Intuitive Surgical.

現在我想將會議交給今天的演講者，Intuitive Surgical 投資者關係部門的布蘭登·拉姆 (Brandon Lamm)。

Good afternoon and welcome to Intuitive's fourth quarter earnings conference call. With me today, we have Gary Guthart, our CEO; Jamie Samath, our CFO; [Daniel Oh, our Senior Medical Officer;] Dave Rosa, our President and regular participant on this call is away from the office this week on a prior business commitment and will not be joining today. Dr. Daniel Oh, Senior Medical Officer and practicing surgeon will join us on this call to describe clinical highlights.

下午好，歡迎參加 Intuitive 第四季財報電話會議。今天和我在一起的還有我們的執行長加里·古特特 (Gary Guthart)； Jamie Samath，我們的財務長； [Daniel Oh，我們的高級醫療官；]Dave Rosa，我們的總裁，也是本次電話會議的定期參與者，由於之前的業務承諾，本週不在辦公室，今天不會參加。資深醫療官員兼執業外科醫生 Daniel Oh 博士將參加本次電話會議，介紹臨床亮點。

We would also like to announce that Dan Connelly will be joining Intuitive as our VP and Head of Investor Relations. Dan has worked at a global investment manager for the last 18 years and has actively followed (technical difficulty) since 2008. We look forward to Dan joining Intuitive in early February.

我們也想宣布 Dan Connelly 將加入 Intuitive 擔任我們的副總裁兼投資者關係主管。 Dan 在過去 18 年裡一直在全球投資經理工作，並自 2008 年以來一直積極關注（技術難度）。

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.

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。

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.

這些風險和不確定性在我們向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。

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

投資者應注意不要過度依賴此類前瞻性陳述。請注意，本次電話會議將在我們網站直覺的投資者關係頁面下的活動部分進行音訊重播。今天的新聞稿和補充財務數據表已發佈到我們的網站上。

Today's format will consist of providing you with highlights of our full year and fourth quarter results as described in our press release announced earlier today, followed by a question-and-answer session.

今天的形式將包括向您提供我們今天早些時候宣布的新聞稿中所述的全年和第四季度業績的重點，然後是問答環節。

Gary will present business and operational highlights. Jamie will provide a review of our financial results and procedure highlights. Dan will present clinical highlights. Then I will provide our financial outlook for 2025 and finally we will host a question-and-answer session.

加里將介紹業務和營運亮點。傑米將對我們的財務業績和程序要點進行審查。丹將介紹臨床要點。然後我將提供 2025 年的財務展望，最後我們將舉辦問答環節。

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

有了這個，我會把它交給加里。

Thank you for joining us today. I'll touch on our performance for the full year 2024 and share our perspective going into 2025. 2024 was a strong year for Intuitive with robust early adoption of our fifth-generation multiport platform, da Vinci 5 and healthy procedure growth in many of our supported indications in countries, resulting in strong financial performance for the year.

感謝您今天加入我們。我將談談我們2024 年全年的業績，並分享我們對2025 年的看法。 ，而我們的許多業務都實現了健康的程序增長。

Adoption of our Ion and da Vinci SP platforms continued with new global clearances and increased utilization. Our teams have been hard at work launching da Vinci 5 and learning from its early experience. We are improving our products across all three of our platforms and helping our customers achieve their programmatic objectives.

隨著新的全球許可和利用率的提高，我們的 Ion 和 da Vinci SP 平台繼續被採用。我們的團隊一直在努力推出達文西 5，並從其早期經驗中學習。我們正在改進所有三個平台上的產品，並幫助我們的客戶實現他們的計劃目標。

We started 2024 focused on four main thrusts. First, we expanded indications and launches of our new platforms by region with a particular focus on our first phase of da Vinci 5 launch. Second, we pursued increased adoption for focused procedures by country through training, commercial activities and market access efforts.

2024 年伊始，我們將重點放在四大重點。首先，我們按地區擴大了新平台的適應症和發布範圍，特別關注達文西 5 第一階段的發布。其次，我們透過培訓、商業活動和市場准入努力，推動各國更多採用重點程序。

Third, we drove quality and gross margin improvements in our global operations. And finally, we focused on increasing our productivity particularly in functions that benefit from industrial scale. Taken together, our team made excellent progress against these objectives.

第三，我們推動了全球業務的品質和毛利率的提高。最後，我們專注於提高生產力，特別是在受益於工業規模的職能方面。總的來說，我們的團隊在實現這些目標方面取得了巨大進展。

Moving to procedures, growth for the full year was 17%. Areas of strength included general surgery in the United States and regional performance in countries including the UK and Ireland, Japan and Germany. Distribution markets including Brazil, Spain and Italy were also strong in the year.

轉向流程，全年成長率為 17%。優勢領域包括美國的普通外科以及英國、愛爾蘭、日本和德國等國家的區域表現。巴西、西班牙和義大利等分銷市場今年也表現強勁。

This week, we announced the acquisition from ab medica of the da Vinci business in Italy, Spain, Portugal and related territories. We're pleased with their performance, and we look forward to welcoming these new staff to our team.

本週，我們宣布從 ab medica 收購義大利、西班牙、葡萄牙及相關地區的達文西業務。我們對他們的表現感到滿意，並期待歡迎這些新員工加入我們的團隊。

In the US, general surgery procedure growth was led by cholecystectomy with [for cuts] and appendectomy procedures rising as well. Thoracic procedure growth was also healthy in the year. Bariatric procedures fell modestly for the full year 2024 given the rise in GLP-1 medications.

在美國，普通外科手術的成長由膽囊切除帶動，[切割]和闌尾切除術也有所增加。今年胸部手術的成長也很健康。鑑於 GLP-1 藥物的增加，2024 年全年減重手術略有下降。

Procedure growth outside the United States continued to diversify beyond urology with nice growth in categories including general surgery and thoracic surgery. Globally, benign indications grew approximately 200 basis points faster in the year than cancer indications.

美國以外的手術成長持續多樣化，超越泌尿外科，一般外科和胸腔外科等類別也出現了良好的成長。在全球範圍內，良性適應症今年的成長速度比癌症適應症快約 200 個基點。

In flexible robotics, Ion procedures showed continued strength with 78% growth for the full year. SP procedure growth accelerated in the year with 72% growth over a full year. A result of healthy growth in Korea, Japan and Europe and solid growth in the US.

在柔性機器人領域，Ion 手術表現出持續的優勢，全年成長 78%。 SP業務成長年內加速，全年成長72%。這是韓國、日本和歐洲健康成長以及美國穩健成長的結果。

On the capital front, we placed 1,430 multiport systems in the full year, 2024 compared with 1,313 multiport systems in 2023. Ion placements for the full year were 271 versus 213 prior year and SP placements were 96 for the full year versus 57 systems in the prior year.

在資本方面，我們在2024 年全年部署了1,430 個多埠系統，而2023 年部署了1,313 個多埠系統。為96 個，而2023 年為57 個系統。

Globally, placements were strong in the United States, helped by the launch of da Vinci 5. Overall, our systems portfolio of da Vinci 5, da Vinci Xi, da Vinci X, da Vinci SP and Ion, combined with our flexible financing options allows our team to meet our customers' varying needs. Jamie will take you through placement dynamics in more detail later in the call.

在全球範圍內，得益於達文西5 的推出，美國的投放量表現強勁。產品組合，再加上我們靈活的融資選項，使得我們的團隊可以滿足客戶的不同需求。 Jamie 將在稍後的電話會議中向您詳細介紹佈局動態。

System utilization remains an important indicator of customer health because it is correlated to patient demand, care team satisfaction and hospital financial health. Multiport utilization grew 3% in the year. SP utilization grew 12% in the year and Ion utilization grew 13%.

系統利用率仍然是客戶健康狀況的重要指標，因為它與患者需求、護理團隊滿意度和醫院財務狀況有關。今年多埠利用率成長了 3%。今年 SP 利用率成長了 12%，Ion 利用率成長了 13%。

Given our different platforms, their procedure mix and sites of care, teasing apart system utilization by customer segment becomes increasingly important going forward. For example, a midsize community hospital lung program systems utilization can differ from a high-volume community hospital general surgery program.

考慮到我們不同的平台、程序組合和護理地點，按客戶群區分系統利用率在未來變得越來越重要。例如，中型社區醫院肺部計畫系統的使用率可能與大容量社區醫院一般外科計畫不同。

As robot assisted surgery moves to the back half of adoption curves in some procedures, utilization growth rates may differ from prior year trends. Our performance supported revenue of $8.4 billion for the year, of which 84% was recurring and representing 17% growth over 2023. Our operating expenses were at the lower end of our spend guidance.

隨著機器人輔助手術在某些手術中進入採用曲線的後半部分，利用率成長率可能與去年的趨勢有所不同。我們的業績支撐了全年 84 億美元的收入，其中 84% 為經常性收入，比 2023 年增長 17%。

Our spending reflects three initiatives. First, we continue to invest in R&D to support innovation and adoption of our platforms and digital tools globally. Second, we're expanding our manufacturing and commercial footprints. And lastly, we have sought to leverage our enabling functions given our increased scale.

我們的支出體現了三項措施。首先，我們繼續投資研發，以支持我們的平台和數位工具在全球的創新和採用。其次，我們正在擴大我們的製造和商業足跡。最後，考慮到規模的擴大，我們尋求利用我們的支援功能。

Our product margins also started to improve in the year as increased shipment volume allowed for better factory utilization as well as leveraging our component, shipment and other logistics costs. Taken together, our net income grew by 29% in 2024 over 2023.

我們的產品利潤率今年也開始提高，因為出貨量的增加提高了工廠利用率，並充分利用了我們的零件、運輸和其他物流成本。總的來說，我們 2024 年的淨利比 2023 年成長了 29%。

Touching briefly on da Vinci 5, our teams have done a nice job in executing a complex launch. We placed 362 da Vinci 5s in the year and over 2,500 surgeons have performed in total over 32,000 procedures on da Vinci 5 in 2024.

簡單介紹一下達文西 5，我們的團隊在執行複雜的發布方面做得很好。我們全年放置了 362 台達文西 5 台，2024 年共有超過 2,500 名外科醫生使用達文西 5 進行了超過 32,000 例手術。

da Vinci 5 has broad clinical indications and over 40 different procedure types have been performed using da Vinci 5 today. We design our systems to allow for routine sequential upgrades to their capability over time. And da Vinci 5 customers will receive hardware and software upgrades going forward, starting this year.

da Vinci 5 具有廣泛的臨床適應症，目前已使用 da Vinci 5 執行了 40 多種不同的手術類型。我們設計的系統允許隨著時間的推移對其功能進行例行的順序升級。從今年開始，達文西 5 客戶將獲得硬體和軟體升級。

This year's upgrades will focus on digital features supported by our 10,000 time increase in computing power. We'll share more details on these features as we bring them to market.

今年的升級將聚焦在由我們的運算能力提升一萬倍所支援的數位功能。當我們將這些功能推向市場時，我們將分享更多有關這些功能的詳細資訊。

As we enter 2025, our company priorities always follows. First, we will focus on the full launch of da Vinci 5, its regional clearances and follow on feature releases. Second, we'll pursue increased adoption for our focused procedures by country through training commercial activities and market access efforts.

進入 2025 年，我們公司的優先事項始終如一。首先，我們將重點放在達文西 5 的全面發布、區域許可以及後續功能發布。其次，我們將透過培訓商業活動和市場准入努力，爭取各國更多採用我們的重點程序。

Third, we'll drive continued progress in building industrial scale, product quality and manufacturing optimization. And finally, we'll focus on excellence and availability of our digital tools.

第三是推動產業規模、產品品質、製造優化持續推進。最後，我們將專注於數位工具的卓越性和可用性。

Jamie, over to you.

傑米，交給你了。

Good afternoon. I will describe the highlights of our performance on a non-GAAP or pro forma basis, and we'll 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.我將描述我們在非 GAAP 或備考基礎上的業績亮點，我們還將在稍後準備的發言中總結我們的 GAAP 業績。我們的預估結果與公認會計準則結果之間的對帳已發佈在我們的網站上。

Q4 and 2024 revenue procedures and system placements are in line with our preliminary press release of January 15. I will briefly review full year 2024 performance before describing our Q4 results in greater detail. 2024 financial performance was strong, da Vinci procedures and total revenue each grew 17% over the prior year.

第四季和 2024 年收入程序和系統佈局與我們 1 月 15 日的初步新聞稿一致。 2024年財務表現強勁，達文西程式和總營收均較上年成長17%。

Pro forma gross margin improved 100 basis points to 69.1% and pro forma SG&A expenses leveraged as compared to 2023. As a result, pro forma operating margin for 2024 improved 310 basis points to 37% and pro forma EPS increased 28%, building off of the 22% increase in 2023.

與2023 年相比，毛利率預計提高了100 個基點，達到69.1%，預計SG&A 費用槓桿化。 ， 2023 年成長 22%。

We placed 362 da Vinci 5 systems in our first year of the limited launch, of which 174 systems were placed in Q4 including our first replacements of da Vinci 5 in Korea.

在限量推出的第一年，我們放置了 362 套達文西 5 系統，其中 174 套系統是在第四季度放置的，包括我們在韓國的第一批達文西 5 替換品。

Turning to Q4, our financial performance was ahead of our expectations, driven by revenue growth of 25% and strength across the rest of the P&L, resulting in pro forma operating margin of 38%. Q4 revenue reflected a couple of favorable dynamics.

談到第四季度，在營收成長 25% 和其他損益表強勁的推動下，我們的財務表現超出了我們的預期，預計營業利潤率為 38%。第四季的收入反映了一些有利的動態。

First, a higher purchase mix of systems as compared to recent periods driven by multisystem deals with certain US IDNs that prefer to purchase and a higher mix of placements through distributors. Second, we saw a higher mix of dual console placements for da Vinci 5 as we increased supply and were able to support more academic customers.

首先，與近期相比，由多系統驅動的系統購買組合更高，涉及某些更喜歡透過經銷商購買的美國 IDN 和更高組合的投放。其次，隨著我們增加供應並能夠支援更多學術客戶，我們看到達文西 5 的雙控制台放置比例更高。

And finally, we saw a higher system ASP resulting from a stronger mix of da Vinci 5 placements. Underlying core metrics were also strong with da Vinci procedure growth of 18%, growth in the installed base of da Vinci systems of 15% and average system utilization growth of 3%.

最後，我們看到了更高的系統平均售價，這是由於達文西 5 佈局的更強組合所帶來的。基本核心指標也很強勁，達文西程式成長了 18%，達文西系統安裝基數成長了 15%，平均係統利用率成長了 3%。

In Q4, US procedures grew 15% driven by growth in benign general surgery including accretive growth in procedures performed after hours for emerging care. Bariatric procedures in the US declined in the low to mid single-digit range similar to last quarter.

第四季度，美國手術量增長了 15%，這得益於良性普外科手術的增長，包括新興護理下班後進行的手術的增長。與上季類似，美國的減重手術下降幅度在低至中個位數範圍內。

Our US procedures grew 25%, driven by relative strength in India, the UK, Italy and Japan. Procedure growth in Korea improved sequentially in part driven by strong SP growth. However, our business there continues to be impacted by precision strikes.

在印度、英國、義大利和日本相對強勢的推動下，我們的美國業務成長了 25%。韓國的手術成長持續改善，部分原因是 SP 強勁成長。然而，我們在那裡的業務繼續受到精確打擊的影響。

Consistent with the last couple of quarters, procedure growth in China was slightly below the corporate average, reflecting a continuation of the dynamics we have described on previous calls. Looking at OUS procedure performance in aggregate, we see strong growth in colorectal, benign general surgery and thoracic categories.

與過去幾個季度一樣，中國的流程成長略低於企業平均水平，反映出我們在先前的電話會議中所描述的動態的延續。從 OUS 手術的整體表現來看，我們看到結直腸、良性普外科和胸部類別的強勁成長。

Reviewing capital performance, we placed 493 systems in the fourth quarter, 19% higher than the 415 systems we placed in the fourth quarter of last year. In the US, we placed 284 systems in Q4, an increase of 75 systems as compared to last year, reflecting several large multisystem placements with a number of IDNs and an increase in the supply of da Vinci 5.

回顧資本表現，我們在第四季投放了 493 個系統，比去年第四季推出的 415 個系統增加了 19%。在美國，我們在第四季度投放了 284 個系統，比去年增加了 75 個系統，反映出多個 IDN 的大型多系統投放以及 da Vinci 5 供應量的增加。

Outside the US, we placed 209 systems in the fourth quarter compared with 206 in the same quarter last year. This quarter, we placed 89 systems in Europe, 43 in Japan and 20 in China compared with 71 in Europe, 70 in Japan and 11 in China in Q4 of last year. Placements in the UK and Germany continue to be impacted by ongoing government budget pressures affecting healthcare capital spending.

在美國以外，我們在第四季度放置了 209 個系統，而去年同期為 206 個。本季度，我們在歐洲部署了89 個系統，在日本部署了43 個系統，在中國部署了20 個系統，而去年第四季度在歐洲部署了71 個系統，在日本部署了70 個系統，在中國部署了11 個系統。英國和德國的安置繼續受到影響醫療資本支出的持續政府預算壓力的影響。

The 89 system placements in Europe included 39 systems into markets served by our distributors as compared to 24 systems last year. In Japan, financial pressures cause some customers to delay capital investment decisions.

在歐洲部署的 89 個系統中，有 39 個系統進入了我們經銷商服務的市場，而去年為 24 個系統。在日本，財務壓力導致一些客戶推遲資本投資決策。

Fourth quarter revenue was $2.41 billion, a 25% increase over last year. On a constant currency basis, revenue growth was 26%. Systems revenue grew 36% year over year driven by a 19% increase in da Vinci system placements, a higher system ASP and the higher purchase mix previously referenced.

第四季營收為24.1億美元，比去年同期成長25%。以固定匯率計算，營收成長 26%。系統營收年增 36%，這得益於達文西系統放置量成長 19%、系統平均售價更高以及先前提到的更高的購買組合。

Additional revenue statistics and trends are as follows. Leasing represented 45% of Q4 placements compared with 58% last quarter, driven by the aforementioned mix of system placements from certain IDNs in the US who prefer to purchase and a higher mix of placements with our distributors.

其他收入統計數據和趨勢如下。租賃佔第四季度投放量的45%，而上一季為58%，這是由於上述美國某些IDN 的系統投放組合（他們更喜歡購買）以及我們的分銷商的更高組合投放量所推動的。

However, as we look forward, we continue to expect that leasing rates will increase over time. Q4 system average selling prices were $1.59 million as compared to $1.42 million last year, driven by a higher mix of da Vinci 5 and a higher dual console mix partially offset by lower pricing in China.

然而，展望未來，我們仍然預期租賃率將隨著時間的推移而上升。第四季系統平均售價為 159 萬美元，而去年為 142 萬美元，這是由於達文西 5 的組合增加和雙控制台組合增加而部分被中國較低的定價所抵消。

We recognized $28 million of lease buyout revenue in the fourth quarter compared with $21 million last year. da Vinci instrument and accessory revenue per procedure was approximately $1,860 compared with approximately $1,800 last year.

我們在第四季確認了 2,800 萬美元的租賃買斷收入，而去年為 2,100 萬美元。達文西儀器和配件每次手術的收入約為 1,860 美元，而去年約為 1,800 美元。

The year over year increase in I&A per procedure reflects, customer buying patterns and a higher mix of SP procedures partially offset by procedure mix in the US given a lower mix of bariatric procedures and a higher mix of cholecystectomy.

每個手術的 I&A 同比增長反映出，客戶購買模式和 SP 手術的較高組合被美國的手術組合部分抵消，因為美國減肥手術的組合較低，而膽囊切除術的組合較高。

Turning to Ion, there were approximately 28,000 Ion procedures performed in the fourth quarter, an increase of 70% as compared to last year. In Q4, we placed 69 Ion systems compared to 44 in Q4 of 2023. As a reminder, supply constraints impacted Ion system placements in the fourth quarter of last year, seven of the 69 systems were placed in OUS markets.

至於 Ion，第四季大約進行了 28,000 例 Ion 手術，比去年增加了 70%。在第四季度，我們放置了69 個Ion 系統，而2023 年第四季為44 個。 。

The installed base of Ion systems increased 51% from last year to 805 systems and average system utilization increased 13% year-over-year. Fourth quarter SP procedure growth continue to accelerate growing 81% driven by Korea and early-stage growth in Europe and Japan where we have clearance for a broad set of indications.

Ion 系統的安裝基數較去年增加 51%，達到 805 個系統，平均係統利用率較去年增加 13%。第四季 SP 程式成長持續加速，成長 81%，這主要得益於韓國以及歐洲和日本的早期成長，我們已經獲得了一系列廣泛的適應症。

We placed 30 SP systems in Q4 and 96 for the year, up from 57 placements in 2023. Fourth quarter placements included seven in Korea, six in Europe and four in Japan. Average system utilization for our SP platform grew 18% in Q4 reflecting in part growth of SP in markets where we have a broad set of indications.

我們在第四季度放置了30 個SP 系統，全年放置了96 個SP 系統，高於2023 年的57 個。日本。第四季度，我們 SP 平台的平均係統利用率成長了 18%，這部分反映了我們擁有廣泛適應症的市場中 SP 的成長。

We have received recent clearances in the US for thoracic and colorectal indications. However, we expect broad commercial efforts for SP in those procedure categories to commence once we obtain FDA clearance for ASP stapler.

我們最近在美國獲得了胸部和大腸適應症的許可。然而，我們預計，一旦我們獲得 FDA 的 ASP 吻合器許可，SP 在這些手術類別中的廣泛商業努力就會開始。

Moving on to the rest of the P&L, pro forma gross margin for the fourth quarter of 2024 was 69.5% compared with 68% for the fourth quarter of 2023. The year-over-year improvement in gross margin reflects fixed overhead leverage given revenue growth, lower inventory reserves and improvements in freight and logistics costs.

看看損益表的其餘部分，2024 年第四季的預期毛利率為 69.5%，而 2023 年第四季為 68%。儲備並改善貨運和物流成本。

In 2024, we executed on our plans to significantly improve product margins for our Ion and SP platforms. While we have made substantial progress, Ion and SP product margins continue to be dilutive and our teams have ongoing programs to deliver further improvement.

2024 年，我們執行了大幅提高 Ion 和 SP 平台產品利潤率的計畫。雖然我們取得了實質進展，但 Ion 和 SP 產品的利潤率仍在不斷下降，我們的團隊正在製定計劃以實現進一步的改進。

With respect to our manufacturing expansion and capital investment plans, in 2025, we anticipate opening new facilities for da Vinci 5 and Ion system manufacturing in California and new endoscope manufacturing facilities in Germany and Bulgaria. As a result, and as we have previously indicated, we expect a significant increase in depreciation expense in 2025.

關於我們的製造擴張和資本投資計劃，我們預計到 2025 年在加州開設新的 da Vinci 5 和 Ion 系統製造工廠，並在德國和保加利亞開設新的內視鏡製造工廠。因此，正如我們之前所指出的，我們預計 2025 年折舊費用將大幅增加。

We will also continue to transfer mature products to facilities in Peachtree Corners, Georgia and Mexicali. Given these activities, we expect elevated inventory levels during 2025. As we complete this cycle of manufacturing expansion that is driven by our strategy to operate at industrial scale, we anticipate lower levels of capital expenditures in 2025 and 2026 as compared to recent periods.

我們也將繼續將成熟的產品轉移到喬治亞州 Peachtree Corners 和墨西卡利的工廠。鑑於這些活動，我們預計 2025 年庫存水準將會上升。

Fourth quarter, pro forma operating expenses increased 9% compared with last year driven by increased headcount, higher variable compensation and increased legal expenses. Fourth quarter 2024 operating expenses included a $45 million contribution to the Intuitive Foundation as compared to a $40 million contribution in Q4 of last year.

第四季度，由於員工數量增加、可變薪酬增加以及法律費用增加，營運費用預計將比去年增加 9%。 2024 年第四季的營運支出包括向直覺基金會捐款 4,500 萬美元，而去年第四季的捐款為 4,000 萬美元。

Looking at operating expenses for the year, we delivered on planned leverage in SG&A which improved by 180 basis points as a percentage of revenue. While we will continue to look for opportunities within SG&A to leverage as we grow, we would highlight that in 2025, we expect increased depreciation expenses given recent capital expenditures and higher legal expenses given ongoing litigation.

從今年的營運支出來看，我們實現了 SG&A 的計畫槓桿率，佔收入的百分比提高了 180 個基點。雖然隨著我們的發展，我們將繼續在SG&A 中尋找利用槓桿的機會，但我們要強調的是，考慮到近期的資本支出和持續訴訟帶來的更高的法律費用，我們預計到2025 年折舊費用將會增加。

Innovation continues to be critical to helping our customers make progress in the quintuple aim and therefore you should expect us to prioritize investments in R&D. Pro forma other income was $87.6 million for Q4 lower than $94.6 million in the prior quarter, primarily driven by FX remeasurement of the balance sheet.

創新對於幫助我們的客戶在五重目標方面取得進展仍然至關重要，因此您應該期望我們優先考慮研發投資。第四季預計其他收入為 8,760 萬美元，低於上一季的 9,460 萬美元，這主要是由於資產負債表的外匯重新計量所致。

Our pro forma effective tax rate for the fourth quarter was 20.5%, a little lower than our expectations reflecting net discrete benefits of $11 million related to statute of limitation expirations and other adjustments to certain tax items. Fourth quarter 2024 pro forma income was $805 million or $2.21 per share compared with $574 million or $1.60 per share for the fourth quarter of last year.

我們第四季的預期有效稅率為 20.5%，略低於我們的預期，反映出與訴訟時效到期和某些稅項其他調整相關的 1,100 萬美元的淨離散收益。 2024 年第四季預計營收為 8.05 億美元，即每股 2.21 美元，去年第四季為 5.74 億美元，即每股 1.60 美元。

I will now summarize our GAAP results. GAAP net income was $686 million or $1.88 per share for the fourth quarter of 2024 compared with GAAP net income of $606 million or $1.69 per share for the fourth quarter of 2023.

現在我將總結我們的 GAAP 結果。 2024 年第四季的 GAAP 淨利潤為 6.86 億美元，即每股 1.88 美元，而 2023 年第四季的 GAAP 淨利潤為 6.06 億美元，即每股 1.69 美元。

As a reminder, fourth quarter 2023 GAAP tax expense reflected onetime benefits of $159 million related to an increase in deferred tax assets associated with a statutory rate increase in Switzerland and receipt of certain tax benefits related to our Swiss operations.

提醒一下，2023 年第四季 GAAP 稅務費用反映了 1.59 億美元的一次性收益，這些收益與瑞士法定稅率上漲相關的遞延稅資產增加以及與我們瑞士業務相關的某些稅收優惠有關。

The adjustments between pro forma and GAAP net income are outlined and quantified on our website. We ended the year with cash and investments of $8.8 billion compared with $8.3 billion at the end of Q3. The sequential increase in cash and investments reflected cash generated from operating activities partially offset by capital expenditures of $312 million.

我們的網站上概述並量化了預計淨利潤和公認會計準則淨利潤之間的調整。截至年底，我們的現金和投資為 88 億美元，而第三季末為 83 億美元。現金和投資的連續成長反映了經營活動產生的現金被 3.12 億美元的資本支出部分抵銷。

With respect to the plans we announced on Tuesday to go direct in Italy, Spain, Portugal and associated territories, the base purchase price is EUR290 million with an earnout of up to an additional EUR31 million based on 2025 procedure volumes.

對於我們週二宣布的在義大利、西班牙、葡萄牙及相關地區直接開展的計劃，基本購買價格為 2.9 億歐元，根據 2025 年的手術量，可額外獲得高達 3,100 萬歐元的收益。

While our primary motivation is to develop closer relationships with customers serving a combined population of approximately 118 million people, we do expect this transaction which we estimate to close in the first half of 2026 to be slightly accretive to pro forma EPS.

雖然我們的主要動機是與為約 1.18 億人口提供服務的客戶建立更密切的關係，但我們確實預計這項預計將於 2026 年上半年完成的交易將略微增加預計每股收益。

Before I turn it over to Dan to discuss clinical highlights, let me address the outlook for pro forma operating margins for 2025. Q4 performance of 38% was above our expectations. Looking ahead to 2025, we anticipate pro forma operating margins in 2025 to be lower than Q4 due to several dynamics.

在我將其交給 Dan 討論臨床亮點之前，讓我先談談 2025 年預計營業利潤率的前景。展望 2025 年，由於多種因素的影響，我們預計 2025 年預計營業利潤率將低於第四季。

First, as previously stated, leasing rates are expected to be higher than Q4 which results in revenue and profits for related system placements to be recorded over multiple years versus in the quarter of placement.

首先，如前所述，租賃率預計將高於第四季度，這導致相關係統放置的收入和利潤將在多年內記錄，而不是在放置季度記錄。

Second, we anticipate significantly higher depreciation expense given recent capital expenditures and finally, we expect a higher mix of da Vinci 5, Ion and SP revenue which carry product margins below the corporate average.

其次，考慮到近期的資本支出，我們預計折舊費用將大幅增加，最後，我們預期達文西 5、Ion 和 SP 收入的組合將更高，這使得產品利潤率低於公司平均水平。

In addition, from a modeling perspective, I would also highlight a couple of additional considerations. First, revenue denominated in non-USD currencies represents approximately 25% of our total revenue. On a revenue weighted basis using current exchange rates, the US dollar is approximately 4% stronger than rates realized in Q4.

此外，從建模的角度來看，我還要強調一些額外的考慮因素。首先，以非美元貨幣計價的收入約占我們總收入的25%。在使用當前匯率的收入加權基礎上，美元比第四季實現的匯率強約 4%。

Second, as we move into broad launch of da Vinci 5 in the middle of the year and customers have the opportunity to upgrade their fleets, we would expect trading credits for an Xi to be significantly higher than recent periods adversely impacting system ASPs.

其次，隨著我們在年中廣泛推出達文西 5，並且客戶有機會升級其機隊，我們預計 Xi 的交易信用將顯著高於最近時期，從而對系統平均售價產生不利影響。

Finally, given the increasing choice customers have as competitors bring robotic systems to the market and seek geographical clearances, we may see capital selling cycles lengthen as customers evaluate alternatives. Brandon will provide our outlook for 2025 later in this call.

最後，考慮到隨著競爭對手將機器人系統推向市場並尋求地理許可，客戶的選擇越來越多，隨著客戶評估替代方案，我們可能會看到資本銷售週期延長。布蘭登將在本次電話會議稍後提供我們對 2025 年的展望。

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

說到這裡，我想把它交給丹。

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

謝謝你，傑米。我想與您分享一些我們認為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之外，我們鼓勵您考慮詳細說明這些主題的廣泛證據並發表多年來的科學研究。

Today, we'll give an update on two recent publications. In the first study, Dr. Rocco Ricciardi and colleagues from the Massachusetts General Hospital in Boston, collaborated with the research team at Intuitive for the Compare study published in the Annals of Surgery.

今天，我們將更新兩篇最新出版品。在第一項研究中，波士頓麻州總醫院的 Rocco Ricciardi 博士及其同事與發表在《外科年鑑》上的 Intuitive for the Compare 研究的研究團隊合作。

This landmark study compared perioperative outcomes of da Vinci robotic assisted surgery to laparoscopic or thoracoscopic surgery as well as to open procedures. This was a meta analysis which analyzes results from previously published evidence over time to obtain an overview of cumulative data.

這項具有里程碑意義的研究將達文西機器人輔助手術與腹腔鏡或胸腔鏡手術以及開放性手術的圍手術期結果進行了比較。這是一項薈萃分析，它分析了先前發布的證據隨時間變化的結果，以獲得累積數據的概述。

In this study, the investigators pull data from randomized controlled trials, perspective comparative cohort studies and large real world evidence database studies from the past 12 years. In order to evaluate whether da Vinci procedures were associated with an improvement in short term patient outcomes across seven commonly performed oncologic procedures from different specialties.

在這項研究中，研究人員從過去 12 年的隨機對照試驗、前瞻性比較隊列研究和大型現實世界證據資料庫研究中提取數據。為了評估不同專業七種常用腫瘤手術中達文西手術是否與短期患者預後的改善有關。

Notably, over 1 million patients were included in each of the da Vinci laparoscopic, thoracoscopic and open patient groups and included data from 22 countries. The authors found that compared to standard minimally invasive surgery, patients undergoing da Vinci procedures had favorable perioperative outcomes.

值得注意的是，達文西腹腔鏡、胸腔鏡和開腹患者組均納入了超過 100 萬名患者，數據來自 22 個國家。作者發現，與標準微創手術相比，接受達文西手術的患者有良好的圍手術期結果。

Specifically, da Vinci patients had a 56% lower chance of conversion to open, 21% lower chance of receiving a blood transfusion and 10% less likelihood to experience a complication within 30 days of the procedure.

具體而言，達文西患者在手術後 30 天內轉為開腹的幾率降低了 56%，接受輸血的幾率降低了 21%，出現併發症的可能性降低了 10%。

In addition, length of stay was significantly shorter with lower 30 day readmission and mortality rates. Similar favorable outcomes were found for da Vinci patients when compared to the open approach with even greater magnitude differences between the two approaches.

此外，住院時間顯著縮短，30 天再入院率和死亡率也降低。與開放式方法相比，達文西患者也發現了類似的有利結果，但兩種方法之間的差異更大。

The authors concluded that this meta-analysis demonstrated multiple benefits for da Vinci procedures when compared to alternative minimally invasive or open approaches. Noting that these results will be helpful to decision makers considering the use of robotics in multi-specialty settings.

作者的結論是，這項薈萃分析證明了與其他微創或開放方法相比，達文西手術具有多種優勢。注意到這些結果將有助於決策者考慮在多專業環境中使用機器人。

In the second study, Dr. Michael Awad from Washington University School of Medicine and other colleagues published in surgical endoscopy at the results of a preclinical study using Intuitive [novel] force feedback technology incorporated in da Vinci 5.

在第二項研究中，華盛頓大學醫學院的 Michael Awad 博士和其他同事在外科內視鏡檢查中發表了使用達文西 5 中採用的直觀[新穎]力回饋技術進行的臨床前研究的結果。

Across 28 surgeons with varying levels of experience, this study evaluated the forces applied to tissue when having force feedback technology on or off during core surgical tests including retraction, dissection and suturing in a tissue model. Results from this study demonstrated a significant reduction in both the average and maximal forces exerted on tissue for all three surgical tasks irrespective of surgeon experience levels.

這項研究涉及 28 名具有不同經驗水平的外科醫生，評估了在組織模型中進行牽開、解剖和縫合等核心手術測試期間，打開或關閉力反饋技術時施加到組織上的力。這項研究的結果表明，無論外科醫生的經驗水平如何，所有三個手術任務中施加在組織上的平均力和最大力均顯著減少。

Notably, when using the highest sensitivity setting, up to a 55% reduction of the maximum force exerted on tissue during suturing was observed. The authors concluded that this study demonstrated that force feedback technology may significantly decrease the forces applied at the tissue level when performing common surgical tests across novice, intermediate and experienced surgeons.

值得注意的是，當使用最高靈敏度設定時，觀察到縫合過程中施加在組織上的最大力最多減少 55%。作者的結論是，這項研究表明，在新手、中級和經驗豐富的外科醫生進行常見手術測試時，力回饋技術可以顯著減少在組織層面上施加的力。

They continue to note, quote, this innovative technology has the potential to enable safer and gentler surgeries resulting in better surgical outcomes for patients undergoing robotic assisted surgery, end quote.

他們繼續指出，引用，這種創新技術有潛力實現更安全、更溫和的手術，從而為接受機器人輔助手術的患者帶來更好的手術結果，引用結束。

To me, the notable finding in this study is that the benefit of force feedback was observed not just in novice surgeons, which one might expect but also in experienced surgeons who had completed at least 200 da Vinci procedures.

對我來說，這項研究的顯著發現是，力回饋的好處不僅在新手外科醫生中觀察到（這一點可能是人們所期望的），而且在已經完成至少200 例達文西手術的經驗在豐富的外科醫生中也觀察到。

Now, I'll turn it over to Brandon.

現在，我將把它交給布蘭登。

Thank you, Dan. I will now turn to our financial outlook for 2025. Starting with procedures. As described in our announcement earlier this month, total 2024 da Vinci procedures grew approximately 17% year-over-year to over 2,680,000 procedures performed worldwide. For 2025, we anticipate full year procedure growth within a range of 13% and 16%.

謝謝你，丹。我現在將談談我們 2025 年的財務展望。正如我們在本月稍早的公告中所述，2024 年達文西手術總數年增約 17%，全球執行的手術數量超過 2,680,000 例。 2025 年，我們預計全年手術成長在 13% 至 16% 範圍內。

The low-end of the range assumes growth in China continues to be impacted by environmental and competitive dynamics, European governments continue to constrain hospital CapEx budgets, limiting the expansion of capacity in the field and bariatric procedure declines continue at rates similar to 2024.

該範圍的低端假設中國的成長繼續受到環境和競爭動態的影響，歐洲政府繼續限制醫院資本支出預算，限制該領域的產能擴張，減肥手術繼續以與 2024 年類似的速度下降。

At the high end, we assume China procedure growth recovers relative to 2024, the CapEx environment improves in Europe and bariatric procedure declines moderate. Q1 and full year 2025 will have approximately one fewer working day than 2024 due to the leap year.

在高端，我們假設中國手術成長相對於 2024 年有所恢復，歐洲的資本支出環境有所改善，減重手術適度下降。由於閏年，2025 年第一季和全年將比 2024 年減少約一個工作天。

Turning the gross profit. In 2024, our pro forma gross profit margin was 69%. In 2025, we expect our pro forma gross profit margin to be within a range of 67% and 68% of net revenue.

扭虧為盈。 2024年，我們的預期毛利率為69%。到 2025 年，我們預計預計毛利率將在淨收入的 67% 至 68% 之間。

The lower estimate of pro forma gross profit margin 2025 reflects significant incremental depreciation as we bring on new facilities, the impact of growth in newer products and the impact of the stronger US dollar. Our actual gross profit margin will vary quarter to quarter depending largely on product, regional and trade in mix and pricing. The range does not include any potential impact of new tariffs on our business which could be material.

預計 2025 年毛利率較低，反映出我們引進新設施、新產品成長的影響以及美元走強的影響，導致大幅貶值。我們的實際毛利率將隨季度而變化，主要取決於產品、區域和貿易的組合和定價。該範圍不包括新關稅對我們業務可能產生的任何潛在影響。

Turning to operating expenses. In 2024, our pro forma operating expenses grew 10%. In 2025, we expect our pro forma operating expense growth to be within a range of 10% and 15%. The growth in operating expenses reflects increased appreciation from new facilities, investments in innovation to drive our growth objectives and an increase in legal expenses.

轉向營運費用。 2024 年，我們的預計營運費用成長了 10%。到 2025 年，我們預計營運費用成長將在 10% 至 15% 之間。營運費用的成長反映了新設施的增值、推動我們成長目標的創新投資以及法律費用的增加。

We expect our non-cash stock compensation expense to range between $760 million and $790 million in 2025. We expect other income which is comprised mostly of interest income to total between $370 million and $400 million in 2025.

我們預計 2025 年非現金股票補償費用將在 7.6 億美元至 7.9 億美元之間。

With regard to capital expenditures, we expect the range to total between $650 million and $800 million primarily for planned facility construction activities. With regard to income tax in 2024, our pro forma income tax rate was 21.4%. As we look forward, we estimate our 2025 pro forma income tax rate to be within a range of 22% and 23% of pretax income.

關於資本支出，我們預計總支出在 6.5 億至 8 億美元之間，主要用於計劃的設施建設活動。關於2024年的所得稅，我們的預計所得稅率為21.4%。展望未來，我們預計 2025 年預計所得稅稅率將在稅前收入的 22% 至 23% 範圍內。

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

我們準備好的評論到此結束。我們現在將開始電話詢問您的問題。

(Operator Instructions) Larry Biegelsen, Wells Fargo.

（操作說明）Larry Biegelsen，富國銀行。

Good afternoon. Thanks for taking the question and congrats on a really strong finish to the year. One for Gary, one for Jamie. So Gary, historically, you said procedures drive placements in the second half of '24.

午安.感謝您提出問題，並祝賀今年取得了非常出色的成績。一份給加里，一份給傑米。加里，從歷史上看，您說過程序會推動 24 年下半年的安置。

US system placements grew over 35%. Utilization was about 2%. Is this a leading indicator of more procedures? Or will we have a digestion period to restore normal utilization? And I have one follow-up.

美國系統投放量成長超過 35%。利用率約為2%。這是更多程式的領先指標嗎？還是會有一個消化期來恢復正常利用？我還有一個後續行動。

I think a couple of things are going on there. One of them is as I said in the prepared remarks, as we get to the back half of some curves, the expectations of some of those programs may be different in terms of utilization as they participate.

我認為那裡發生了一些事情。其中之一是，正如我在準備好的演講中所說，當我們到達某些曲線的後半部分時，其中一些計劃在參與時的利用率方面的預期可能會有所不同。

In other words, not every account is going to be a high-volume account. And I think that's okay. I think the economics can work and I think we can supply them. So some of that is going on. I think the other thing is new capital opportunities, new capital features can pull forward or otherwise have people delay a little bit and then acquire systems that can put a wave or a ripple through utilization.

換句話說，並非每個帳戶都會成為高交易量帳戶。我認為那沒關係。我認為經濟可行，而且我們可以提供它們。所以其中一些正在發生。我認為另一件事是新的資本機會，新的資本特徵可以提前或以其他方式讓人們延遲一點，然後取得可以透過利用產生波浪或漣漪的系統。

And we're just going to have to see if that ripple plays through. So both of those effects are likely going on. It is actually extremely hard analytically to tease them out. I think in the US over time, you're going to see utilization growth rates in multiport start to settle a little bit. I don't think they'll keep galloping. At the same time, I think SP utilization has room to run, and Ion utilization has room to run.

我們只需要看看這種漣漪是否會發揮作用。因此，這兩種影響都可能持續存在。實際上，透過分析來梳理它們是極其困難的。我認為在美國，隨著時間的推移，你會看到多埠的利用率成長率開始穩定下來。我不認為他們會繼續馳騁。同時我認為SP利用率還有運行空間，Ion利用率還有運行空間。

Thanks, Gary. And Jamie, on the Q3 call, you said the gross margin will be a little lower in 2025 versus 2024. I think the 67% to 68% guidance was probably a little bit lower than expected. Can you quantify the drivers from the 69.1% this year in 2024 to the 67% to 68%. And how to think about the path back to your goal of 70%? Thank you.

謝謝，加里。 Jamie，在第三季電話會議上，您表示 2025 年的毛利率將比 2024 年略低。您能否量化一下驅動力從今年的 69.1% 到 2024 年的 67% 至 68%。如何思考回到 70% 目標的路？謝謝。

Yeah. There's really three drivers, Larry. the largest of which is the impact of depreciation expense and associated fixed costs. So there's deleverage in the '24 to '25 comparison, roughly-ish depending on way you have the revenue model for '25. That's about 1 point of the 160 point delta, if you go from '24 actual to a midpoint of '25.

是的。拉里，確實有三個司機。其中最大的是折舊費用和相關固定成本的影響。因此，24 世紀與 25 世紀的比較中存在去槓桿化，大致取決於 25 世紀的收入模式。如果從 '24 實際值到 '25 的中點，這大約是 160 點增量的 1 點。

The other two dynamics roughly equals in terms of impact our product mix with dV5, Ion and SP being a greater proportion of the revenue. They all carry currently margins below the corporate average, so have a dilutive effect from a mix perspective. And then I think what's new from the last call is the impact of FX.

其他兩項動態對我們產品組合的影響大致相當，其中 dV5、Ion 和 SP 在收入中所佔比例較大。目前它們的利潤率都低於企業平均水平，因此從混合角度來看具有稀釋效應。然後我認為上次電話會議的新內容是外匯的影響。

So those three things are the drivers. There are some offsetting cost reductions. The teams are delivering within that kind of gross margin range. I think what we've said with respect to gross margin is over the midterm, we think we can get back beyond 70%. That is going to require us, once we get past this incremental depreciation to leverage over a multiyear period as we grow.

所以這三件事是驅動因素。有一些抵消成本的降低。這些團隊的毛利率在這個範圍內。我認為我們所說的毛​​利率是在中期之後，我們認為我們可以恢復到 70% 以上。一旦我們克服了這種增量折舊，這將要求我們在多年的成長過程中利用槓桿。

We also have as we've said, the work on product margins in Ion and SP. There's still some work to be done there. And then on a more routine basis, our teams have to deliver cost downs.

正如我們所說，我們也在 Ion 和 SP 的產品利潤方面開展了工作。那裡還有一些工作要做。然後，在更常規的基礎上，我們的團隊必須降低成本。

Robbie Marcus, JPMorgan.

羅比馬庫斯，摩根大通。

Okay. Thanks. And I'll echo congratulations on a fantastic fourth quarter. Two from me. First, maybe for Gary, you gave a lot of detail on the call about a midyear full launch and trade in cycle. Would love to just get your qualitative comments around how you're thinking about the mix of da Vinci 5 versus Xi going forward?

好的。謝謝。我也祝賀第四季的出色表現。我的兩個。首先，也許對加里來說，您在電話會議上提供了有關年中全面啟動和交易週期的大量細節。想聽聽您對未來達文西 5 與 Xi 的組合有何看法？

The necessity or the speed of which an upgrade cycle can start? And how you're thinking about Xi versus da Vinci 5 placements in terms of mix going forward outside the US once approval start rolling in? It all has implications for the model. So I'd love to get your thoughts on that.

升級週期啟動的必要性或速度？一旦獲得批准，您如何看待 Xi 與 da Vinci 5 在美國以外地區的混合佈局？這一切都會對模型產生影響。所以我很想聽聽您對此的想法。

I was going to say -- I'll tell you a little bit about, I think, perhaps the environmental aspects of that kind of the wrapping around it, I'll turn it over to Jamie for any modeling implications. I just -- what goes -- two things are driving what we call broad launch. One of them is getting our supply chains up to scale and volume for what we expect.

我想說——我想，我會告訴你一些關於這種包裹的環境方面的信息，我會把它交給傑米，以了解任何建模含義。我只是 - 發生了什麼 - 有兩件事正在推動我們所謂的廣泛發布。其中之一是讓我們的供應鏈達到我們預期的規模和數量。

Demand could be when we start going out and looking at things like trade-ins and also starting to get clearances around the world. So that's exciting. The next one is software updates, and those software updates reflect both feedback from the field and then the integration of some of the technologies in our digital space from Hub to some of the imaging things we can do that start to come out in the first set of launches, which is really great.

當我們開始出去尋找以舊換新之類的東西並開始在世界各地獲得清關時，需求可能就出現了。所以這很令人興奮。下一個是軟體更新，這些軟體更新反映了來自現場的反饋，以及我們數位空間中的一些技術的集成，從 Hub 到我們可以做的一些成像事情，這些事情開始在第一組中出現的發射，這真的很棒。

I think those are digital tools that our customers and surgeons will appreciate and starts giving them a lot of access to data that helps them analyze the performance of themselves and of their programs. How compelling that is we'll determine how fast customers want to upgrade. I think the upgrade cycle comes down to this kind of question of differential value, X and Xi are outstanding machines. They are workhorses. They work really well.

我認為這些是我們的客戶和外科醫生會欣賞的數位工具，並開始為他們提供大量數據存取權限，幫助他們分析自己及其專案的表現。這有多有吸引力，我們將決定客戶想要升級的速度。我認為升級週期歸結為這種差異化價值的問題，X和Xi是出色的機器。他們是主力。他們工作得很好。

We're delighted to support them and support our customers who use them as they found the increasing value in the features and content we bring to da Vinci 5, whether it's analytics or force reflection or ergonomics or better imaging, then that drives the trade-in cycle. The question, and I understand your modeling question well of how fast does it all move and what does that look like? It can be difficult to predict.

我們很高興為他們提供支持，並為使用它們的客戶提供支持，因為他們發現我們為da Vinci 5 帶來的功能和內容的價值不斷增加，無論是分析、力反射、人體工學還是更好的成像，從而推動了貿易-循環中。這個問題，我很理解你的建模問題，即它的移動速度有多快以及它看起來像什麼樣子？這可能很難預測。

Jamie, I'd turn it over to you and let you add your commentary.

傑米，我會把它交給你，讓你加你的評論。

Yeah. While we don't have a specific percentage, the impact of moving to broad launch, the impact of getting additional geographical clearances, obviously then says, directionally over time the proportion of placements that are dV5 generally should increase.

是的。雖然我們沒有具體的百分比，但顯然，隨著時間的推移，轉向廣泛發布的影響，獲得額外地理許可的影響，dV5 的展示位置比例通常應該會增加。

Although, I would recognize that Xi is a capable system. And at some point, we have the opportunity for a refurbished Xi. With respect to trade-ins, you don't really see trade-in start to pick up until you get to broad launch which is the middle of the year, and it's going to be a function of the dynamics that Gary indicated of course.

儘管如此，我還是承認習近平是個有能力的體制。在某些時候，我們有機會迎來一個煥然一新的習近平。至於以舊換新，直到年中廣泛推出之前，你不會真正看到以舊換新開始回升，當然，這將取決於加里指出的動態。

We can look back at what happened on the Xi launch and how those upgrades went, and we have some indication from customers in our pipelines. I think the best that we could say at this point, given it's so early is that any trade-in cycle would be progressive.

我們可以回顧一下 Xi 發佈時發生的事情以及這些升級是如何進行的，並且我們從管道中的客戶那裡得到了一些指示。我認為，鑑於現在還為時過早，我們目前能說的最好的說法是，任何以舊換新周期都將是漸進的。

Final point I'll make, and I think you had asked, Robbie, the question is part of this is, is there an opportunity for depreciated assets like X and Xi which are highly capable. We know how to service, we know how to support or to those open or create other opportunities in other markets that may be more capital price sensitive and the answer to that is yes.

我要說的最後一點，我想你已經問過，羅比，問題的一部分是，像 X 和 Xi 這樣能力很強的折舊資產是否有機會。我們知道如何提供服務，我們知道如何支持或在其他市場上開放或創造其他機會，這些機會可能對資本價格更加敏感，答案是肯定的。

Great. Maybe just one quick follow up. Gary, you always give us a general state of the union on the health of the capital equipment environment around the world. US, OUS, and I'm particularly thinking of China where you had a really strong placement quarter and fourth quarter. So any thoughts there would be great as we head into 2025. Thanks.

偉大的。也許只是一個快速跟進。加里，您總是向我們介紹有關全球資本設備環境健康狀況的整體情況。美國、OUS，我特別想到中國，那裡的安置季度和第四季表現非常強勁。因此，在我們邁入 2025 年之際，任何想法都會很棒。

Yeah. I think Jamie usually does that. Jamie, why don't you take care of that?

是的。我想傑米通常會這樣做。傑米，為什麼不處理一下呢？

I'd first say I don't think we characterized the 20 systems we placed in China in Q4 as strong. Maybe it is on a year-over-year comparison basis. But the environment in China continues to be dynamic and challenging as we've said, impacted by both domestic competition and a set of activities implemented by the government there. So I characterize the environment as relatively consistent and challenging.

我首先要說的是，我認為我們在第四季在中國部署的 20 個系統並不強大。也許這是基於逐年比較的基礎上。但正如我們所說，受國內競爭和政府實施的一系列活動的影響，中國的環境仍然充滿活力和挑戰。因此，我將環境描述為相對一致且具有挑戰性。

In terms of capital overall, I think in the US, it's been strong. Part of that is interest in da Vinci 5 given it's a new product. And you see, to some extent, less sensitivity to capital budgets given just the proportion of placements in the US in particular at least. We've highlighted the challenges in the UK and Germany.

就整體資本而言，我認為在美國，它一直很強大。部分原因是人們對 da Vinci 5 感興趣，因為它是一款新產品。而且你會發現，在某種程度上，至少考慮到美國的安置比例，資本預算的敏感度較低。我們強調了英國和德國面臨的挑戰。

And new for us in Q4 for Japan was some delays because of the profitability in certain customers there. So I'd say we've seen relative strong strength in the US, some mixed dynamics in the OUS markets. We don't really have enough tea leaves to predict how that plays out in '25.

由於日本某些客戶的獲利能力，我們在第四季度在日本的新業務出現了一些延遲。因此，我想說，我們在美國看到了相對強勁的實力，在海外市場則出現了一些複雜的動態。我們確實沒有足夠的茶葉來預測 25 年的情況。

Travis Steed, Bank of America Securities.

特拉維斯·斯蒂德，美國銀行證券公司。

Gary, I wanted to ask a bigger picture question. You're crossing over $1 billion a year in R&D now and even after launching dV5. So maybe help us understand the R&D investment opportunity over the medium term and potentially moving into new green spaces. Is that going to be more through than the luminal platform?

加里，我想問一個更大的問題。現在，即使在推出 dV5 之後，您每年的研發費用也已超過 10 億美元。因此，也許可以幫助我們了解中期的研發投資機會，並可能進入新的綠色空間。這會比 Luminal 平台更通透嗎？

Or are there still chunky categories like cardio that could be minimal to robotics? Or is it more about geographic expansion side of care? Just to giant understand the true opportunity left out there to capture.

或者是否仍然存在像有氧運動這樣對機器人來說可能最小化的大塊類別？或者更多的是關於護理的地理擴張方面？只是為了了解真正的機會，把握機會。

I think it's a mix of all three of the things you just described. I think there are innovations and technologies, some of which are extensions to platforms you know about, some of which are platforms that are years away and you don't know about that I think open new opportunities for us over time. And we're diligent about them. They take a while. They take some investment, and they take (technical difficulty)

我認為這是您剛才描述的所有三件事的混合。我認為存在一些創新和技術，其中一些是您所知道的平台的擴展，其中一些是幾年後您不知道的平台，我認為隨著時間的推移，它們將為我們帶來新的機會。我們對它們很努力。他們需要一段時間。他們需要一些投資，而且他們需要（技術難度）

There are existing platforms that could use additional indications, and those can be geographic in which case, there's the regulatory and clinical work to secure those indications. And so, we spend money on that and go do it. And then there's additional indications that come from things like additional instruments and accessories and imaging capabilities on existing platforms that if we develop them, we can bring to market and open the market for others.

現有的平台可以使用額外的適應症，這些適應症可以是理性的，在這種情況下，需要進行監管和臨床工作來確保這些適應症。所以，我們花錢去做。然後還有來自現有平台上的額外儀器和配件以及成像功能等的額外跡象，如果我們開發它們，我們就可以將其推向市場並為其他人打開市場。

We also spent some money making sure that latecomers to robotics get what they need. It's not just that late comers just need time to simmer and sooner or later, they come find you. They sometimes have different needs, whether those needs or learning needs or economic needs and it takes some work. But we think that work is worth it. And some of the things you see in da Vinci 5 are those types of things.

我們也花了一些錢來確保機器人技術的後來者得到他們需要的東西。這不只是遲到者需要時間醞釀，遲早他們會來找你。他們有時有不同的需求，無論是這些需求、學習需求或經濟需求，這都需要一些努力。但我們認為這項工作是值得的。你在《達文西 5》中看到的一些東西就是這類東西。

So short story is that we see opportunity in all of those buckets. We run a process that tries to balance those opportunities so that we're not totally overexposed to one or the other. And in that sense, we have a multiyear horizon and multi-specialty horizon and it's geographically mixed.

簡而言之，我們在所有這些領域都看到了機會。我們運行一個試圖平衡這些機會的流程，這樣我們就不會完全過度暴露於其中一個或另一個。從這個意義上說，我們擁有多年的視野和多專業的視野，而且在地理上是混合的。

Helpful. Thanks. And then, Jamie, maybe just a shorter-term OpEx question on the 10% to 15% growth, the high and low end, how much of that's R&D versus SG&A? And any color there on how that can shape up and what drives the high and low end?

有幫助。謝謝。然後，Jamie，也許只是一個關於 10% 到 15% 成長、高端和低端的短期營運支出問題，其中研發與 SG&A 的比例是多少？有什麼顏色可以說明如何形成以及驅動高端和低端的因素嗎？

And potentially, since you did mention tariffs. Just kind of curious how to size that or a potential way to mitigate that, if you can? Just wanted to follow up on Larry's margin question. Thank you.

而且有可能，因為你確實提到了關稅。只是有點好奇如何確定其大小或減輕其潛在影響的方法（如果可以的話）？只是想跟進拉里的保證金問題。謝謝。

Yeah. With respect to how R&D and SG&A might grow, I'd characterize it as similar-ish in terms of -- for that 10% to 15%. Obviously, R&D is a priority as we've stated. In SG&A, what you'll see us add reps and commercial folks to support the procedure growth.

是的。關於研發和銷售、一般管理費用如何成長，我將其描述為類似的——10% 到 15%。顯然，正如我們所說，研發是優先事項。在 SG&A 中，您將看到我們新增代表和商務人員來支援流程的發展。

We also have said that there'll be higher legal expenses in SG&A given ongoing litigation and a portion of the CapEx results and depreciation that goes into our SG&A expenses. And so, they'll grow roughly-ish about the same rate.

我們還表示，鑑於正在進行的訴訟以及部分資本支出結果和折舊，SG&A 費用將會更高。因此，它們將以大致相同的速度增長。

In terms of the range of 10% to 15%, most of that is driven by the procedure range, meaning, obviously, to some extent, we'll manage our expenses in accordance with how our business plays out. There are some opportunities for us to invest incrementally in R&D, but we'll do that as we make progress and achieve milestones.

就 10% 到 15% 的範圍而言，大部分是由程序範圍驅動的，這意味著，顯然，在某種程度上，我們將根據我們的業務開展情況來管理我們的費用。我們有一些機會逐步增加研發投資，但當我們取得進展並實現里程碑時，我們就會這樣做。

In terms of tariffs, obviously, we see a lot in the news, we're monitoring those events closely. We are internally evaluating what the impact of any potential tariff might be and therefore, how we might respond. We can say that the significant portion of our instruments are currently manufactured in Mexico.

顯然，就關稅而言，我們在新聞中看到了很多，我們正在密切關注這些事件。我們正在內部評估任何潛在關稅可能產生的影響，以及我們可能如何應對。可以說，我們的儀器很大一部分目前是在墨西哥製造的。

And so, to the extent there are significant tariffs implemented there that could have a material impact for us. And of course, one response then that any company might consider is what would you do with pricing. Nothing that we've decided there. And obviously, we're balancing the needs of our customers and their objectives with the needs of our own business. So stay tuned is what I'd say.

因此，在某種程度上，在那裡實施的高額關稅可能會對我們產生重大影響。當然，任何公司都可能考慮的一個回應是你會如何定價。我們在那裡沒有做出任何決定。顯然，我們正在平衡客戶的需求及其目標與我們自己業務的需求。所以我想說的是，請繼續關注。

Rick Wise, Stifel.

瑞克懷斯，史蒂菲爾。

Thanks. Good afternoon. Gary, in your very thoughtful comments during the JPMorgan conference, I think you talked about new digital features that you should make today again said hardware and software digital feature is coming. I was hoping and if you're not ready to give us truly specifics on all these.

謝謝。午安.加里，在摩​​爾大通會議期間您發表的非常深思熟慮的評論中，我認為您談到了今天應該再次提出的新數位功能，並表示硬體和軟體數位功能即將到來。我希望，如果你還沒有準備好向我們提供所有這些的真正細節。

But maybe help us understand what areas this -- in what way this might enhance da Vinci 5? Will it open up new procedures? Will it be about productivity? Will it enable you to use the da Vinci 5 in a different setting? How does this expand the vision or the possibilities of da Vinci 5 in the near term? And then I'll have a follow-up, if I could.

但也許可以幫助我們了解哪些領域——這可能會以何種方式增強達文西 5？它會開闢新的程式嗎？會與生產力有關嗎？它能讓您在不同的環境下使用達文西 5 嗎？這如何擴展達文西 5 在短期內的願景或可能性？如果可以的話，我會進行後續跟進。

Yeah. In early thinking here, just think of it in three categories. If we can make it easier to get great outcomes for more care teams by giving them tools in the OR, just real-time tools, we think that creates opportunities for them. I think it builds confidence. I think you get better care teams faster that way.

是的。在早期的思考中，只需將其分為三類即可。如果我們能夠透過為更多護理團隊提供手術室中的工具（只是即時工具），讓他們更容易獲得良好的結果，我們認為這會為他們創造機會。我認為這可以建立信心。我認為這樣你可以更快獲得更好的護理團隊。

And this kind of -- does that give you access to new procedures. I think the way to say that is it probably gives you access to more patients. Are they new procedure categories? Not always. But there are patients that become easier for those surgeons and care teams to reach because they're more confident to reach them.

這種——能讓你接觸到新的程式嗎？我認為可以這麼說，它可能會讓你接觸到更多的病人。它們是新的程式類別嗎？並非總是如此。但對於外科醫生和護理團隊來說，有些患者變得更容易接觸到，因為他們更有信心接觸到他們。

So can it help us that way? Yeah. I think it can. I think that's one set of categories. The next one is building confidence in care teams quickly is in everybody's best interest. It's great for the hospital. It gives them faster returns and higher confidence. It's great for the care teams. They build confidence and they get there faster. And I think a lot of our tools can help do that, can help accelerate learning, not just for the surgeon but for others.

那麼它可以這樣幫助我們嗎？是的。我認為可以。我認為這是一組類別。下一步是快速建立護理團隊的信心符合每個人的最佳利益。這對醫院來說太好了。它帶給他們更快的回報和更高的信心。這對護理團隊來說非常棒。他們建立了信心並且更快地實現目標。我認為我們的許多工具可以幫助做到這一點，可以幫助加速學習，不僅對於外科醫生而且對於其他人。

And then finally, I think a lot of these tools allow for value analysis by the customer using their own data in their own hands. And that I think builds confidence also and illuminates opportunity for them and that helps them, and it helps us.

最後，我認為這些工具很多都允許客戶使用自己手中的資料進行價值分析。我認為這也可以建立信心，為他們提供機會，這對他們有幫助，對我們也有幫助。

So for dV5 and the space we're in right now, that's how you have to think about it. One of the neat things that (inaudible) used to say, and he's right is that every time you build a capability and then secure that, you have it, you understand it well. It opens a new door because a surgeon, like Dr. Oh here will take that new capability and start to explore with it.

因此，對於 dV5 和我們現在所處的空間，這就是你必須考慮的方式。過去（聽不清楚）說過的一件很巧妙的事情，他是對的，那就是，每次你建立一種能力，然後確保它，你就擁有了它，你就很好地理解了它。它打開了一扇新的大門，因為像這裡的吳醫生這樣的外科醫生將掌握這種新能力並開始探索它。

Where can it lead me? What can I do next? And I think some of the things that we're working on in dV5, some of the imaging and augmented reality things will start to inspire the next set of surgeons. And with that inspiration comes opportunity.

它能帶我去哪裡？接下來我能做什麼？我認為我們在 dV5 中所做的一些事情，一些成像和擴增實境的事情將開始激勵下一批外科醫生。伴隨著靈感而來的是機會。

Great. And if I could follow-up briefly with Jamie. Jamie, obviously, Ion, SP both had terrific years last year. What accelerates -- what drives the next phase of growth there? And specifically, what level of sales or what has to happen and is it a year or five away? When are these two excellent products no longer a margin drag? Thank you.

偉大的。如果我能簡單地跟傑米跟進一下的話。顯然，Jamie、Ion、SP 去年都度過了輝煌的歲月。是什麼加速了——是什麼推動了下一階段的成長？具體來說，銷售水平是多少，或者必須發生什麼，是一年還是五年之後？這兩款優秀產品何時不再成為獲利拖累？謝謝。

Yeah. In terms of the overall business, what's driving procedures and revenue. If I look at Ion with 28,000 procedures in Q4, you can see that's a run rate of over 100,000 procedures almost entirely in the US. So you're starting to get up the adoption curve in the US for Ion and a significant remaining portion is in transthoracic needle aspiration in terms of the approach versus bronchoscopic approaches in terms of where we've adopted in the early period.

是的。就整體業務而言，是什麼推動了流程和收入。如果我查看 Ion 在第四季度執行的 28,000 個程序，您會發現超過 100,000 個程序的運行率幾乎全部發生在美國。因此，在美國，Ion 的採用曲線已經開始上升，而且就我們早期採用的方法與支氣管鏡方法而言，剩下的很大一部分是經胸針抽吸術。

So what you see based on where you are in the adoption curve in the US for biopsy for Ion is customers will tend to more focus on improvements in utilization. And as you get to that point in the adoption curve, again, biopsy in the US, you just naturally on the S curve start to see procedure growth rates come down. And you've seen that if you look at the last three or four quarters. And so, for our Ion business, kind of next set of focus.

因此，根據美國 Ion 活檢採用曲線的位置，您會發現客戶將傾向於更加關注利用率的提高。當你到達採用曲線上的那個點時，再次，在美國進行活檢，你很自然地在 S 曲線上開始看到手術增長率下降。如果你看看過去三、四個季度，你會發現這一點。因此，對於我們的 Ion 業務來說，這是下一個重點。

Obviously, we've got to finish the US is the markets in which we're launching internationally with the clearance in Europe, Korea and China. And on a longer-term basis, there is the opportunity for Ion as a platform to get into new indications that would be in the lung first, and there's potential for other places in the body down the road.

顯然，我們必須完成美國市場的開發，並在歐洲、韓國和中國獲得許可。從長遠來看，Ion 作為一個平台有機會首先進入肺部的新適應症，並且在未來還有可能進入身體的其他部位。

From a product cost perspective, it is a set of programs that take quite some time. It's the everyday battle in the manufacturing team and there is some engineering work that needs to happen to get to the product cost. And I'd say that's also in the mid-term, consistent with our overall gross margin objectives.

從產品成本的角度來看，這是一套需要相當長的時間的方案。這是製造團隊的日常戰鬥，需要進行一些工程工作才能降低產品成本。我想說這也是中期的，與我們的整體毛利率目標一致。

With respect to SP adoption, again, we've also got international launches there. Europe and Japan, both have broad indications. You see Korea, which we've had in the marketplace for some time, really strong utilization. And so, for SP, it's really as we look to the US is the additional indications.

關於 SP 的採用，我們也在那裡進行了國際發布。歐洲和日本都有廣泛的適應症。您會看到韓國，我們在市場上已經有一段時間了，利用率非常高。因此，對於 SP 來說，我們在美國看到的確實是額外的跡象。

We've got thoracic and colorectal. You have the opportunity to extend that over some period. You see the growth rate accelerating nicely in SP. Margin work in SP is, let's say, not the same level of effort as Ion because we're more leveraged. The social and vision console of common with Xi, but nevertheless work to do. That is also I characterize as something that happens over the midterm.

我們有胸部和結直腸。您有機會將其延長一段時間。您可以看到 SP 的成長率明顯加快。可以說，SP 的保證金工作與 Ion 的努力程度不同，因為我們的槓桿率更高。與習近平共同的社交和視覺控制台，但仍有工作要做。我認為這也是中期發生的事。

David Roman, Goldman Sachs.

大衛羅曼，高盛。

Thank you and good afternoon, everybody. I wanted just to start with a comment you made in the prepared remarks regarding competition and selling cycles. Is this something that you're observing today as you talk to customers outside the US or even in the US? Or are you just calling out a theoretical impact of what might happen as new entrants come to market? And then I have one follow-up.

謝謝大家，大家下午好。我只想從您在準備好的評論中就競爭和銷售週期發表的評論開始。您今天在與美國境外甚至美國境內的客戶交談時是否觀察到了這一點？或者您只是提出新進入者進入市場時可能發生的情況的理論上的影響？然後我有一個後續行動。

We have seen it clearly in China with the increasing number of domestic competitors there. I'd say that in terms of impact of competition to selling cycles in other international markets has been relatively stable. But what you're seeing is an increasing number of competitors get clearances in various markets, including in the US, there are a number of competitors in the US.

我們在中國清楚地看到了這一點，因為那裡的國內競爭對手越來越多。我想說，就競爭對其他國際市場銷售週期的影響而言，相對穩定。但你看到的是越來越多的競爭對手在各個市場獲得許可，包括在美國，在美國有許多競爭對手。

And obviously, there's one larger company that's looking to make a submission in (technical difficulty) so we're just acknowledging that as competition increases, there is the possibility outside of China, the selling cycles could lengthen.

顯然，有一家較大的公司希望提交（技術難度）提交，因此我們只是承認，隨著競爭的加劇，在中國以外的地區，銷售週期可能會延長。

That's helpful. And maybe just a segue on that one. As you think about the opportunity in instruments and accessories, either on a per procedure basis or a total addressable market basis, can you help us think through which parts of the surgical ecosystem you've captured today?

這很有幫助。也許只是那一個的延續。當您考慮器械和配件的機會時，無論是在每個手術的基礎上還是在整個可尋址市場的基礎上，您能否幫助我們思考您今天佔據了外科生態系統的哪些部分？

And maybe give us some sense of where that might be going over time? We understand that's the fourth sensing piece of the launch with dV5 and how that might impact basically an upgraded instrument and corresponding ASP within that INA line.

或許能讓我們了解隨著時間的推移，情況可能會走向何方？我們了解這是隨 dV5 一起推出的第四個感測部件，以及這可能會對 INA 系列中升級的儀器和相應的 ASP 產生怎樣的影響。

But as you look at kind of other parts of the surgical ecosystem that you could capture to further entrench yourself, can you help us understand what those might be and maybe size some of them? And how you think about that when your marketing and strategic planning teams?

但是，當您查看可以捕獲以進一步鞏固自己的外科生態系統的其他部分時，您能否幫助我們了解這些部分可能是什麼以及其中一些的大小？您的行銷和策略規劃團隊如何看待這一點？

Yeah. Maybe I'll start with kind of the principles we use to think about how we can bring additional value to procedures we already participate in and underneath, I think you have a modeling question, and I'll let Jamie take that.

是的。也許我會從我們用來思考如何為我們已經參與和底層的程式帶來額外價值的原則開始，我認為你有一個建模問題，我會讓傑米接受。

On the principal side, we look around and say if there's something going on in the operating room that our customers are currently spending on, they're buying from somebody else. And we think that either we have design capabilities or integration capabilities that would make for that experience to be better for them and value creating. It's either clinically value creating or it's economically value creating.

從主要方面來看，我們環顧四周並說，如果我們的客戶目前正在手術室中購買某些東西，那麼他們是從其他人那裡購買的。我們認為，我們要麼擁有設計能力，要麼擁有整合能力，可以為他們帶來更好的體驗並創造價值。它要么創造臨床價值，要么創造經濟價值。

And we'll seek to do that, sometimes in partnership. You see that he's doing that with the (inaudible) table and sometimes it's something that we'll try to do ourselves take in house, the way we've done some things like the [canal seals] and stapling. So well, we look across it.

我們將尋求做到這一點，有時是透過合作。你看到他正在用（聽不清楚）桌子做這件事，有時我們會嘗試自己在家裡做一些事情，就像我們做一些事情的方式，例如[運河密封]和裝訂。好吧，我們看看它。

If we see a real place that it's true value creation, not just something where it changes the revenue line by doing exactly what somebody else does, we're not very interested in that. But if we think the integration or the design creates a better outcome for the customer either economically or clinically, hopefully both, then we'll step forward and we'll do that. We don't think we're done.

如果我們看到一個真正的地方，它是真正的價值創造，而不僅僅是透過做別人所做的事情來改變收入線的東西，我們對此不太感興趣。但如果我們認為整合或設計在經濟或臨床上為客戶創造了更好的結果，希望兩者兼而有之，那麼我們就會向前邁進，我們會這樣做。我們不認為我們已經完成了。

If you look at da Vinci 5, you saw some things come into da Vinci 5 that were benefited by integration, and we think it's working great. So we look for those things. They take a while. They're not immediate. So our strategy and our product planners are looking for value creation opportunities there, but it doesn't start with how fast can the revenue growth be. It starts with what's the value creation and what could that be.

如果您查看 da Vinci 5，您會發現 da Vinci 5 中的一些功能受益於集成，我們認為它運作良好。所以我們尋找那些東西。他們需要一段時間。它們不是立即發生的。因此，我們的策略和產品規劃人員正在那裡尋找價值創造機會，但並不是從收入成長有多快開始。首先是價值創造是什麼以及可能是什麼。

For sensing instruments, force reflecting are such an example. They're more complex. They have a higher ASP. We think they bring value. We have to demonstrate that value and off we go. Jamie, I think the modeling question is super hard, but I'm going to give you a shot.

對於感測儀器來說，力反射就是這樣的例子。它們更複雜。他們的平均售價更高。我們認為它們帶來了價值。我們必須證明這種價值，然後我們就可以出發了。傑米，我認為建模問題非常困難，但我會給你一個機會。

So I would just say that the two examples I'd reference in terms of where you could, let's say, get greater share of wallet if you can bring value. Our force feedback instruments and insufflation both on da Vinci 5. Force feedback, we don't expect to be a broad supply until the end of '25.

所以我只想說，我引用的兩個例子是，如果你能帶來價值，你可以在哪裡獲得更大的錢包份額。我們的力回饋儀器和充氣裝置都在達文西 5 上。

So the kind of impact that has on I&A per procedure is gated by when we get to broad supply with respect to inflation. So far, the proportion of cases that use that has been pretty high and that can have an impact as da Vinci 5 procedure volumes grow. I would just say if I zoom out in terms of I&A per procedure in total, the larger driver is going to be procedure mix.

因此，每個程序對 I&A 的影響取決於我們何時獲得與通貨膨脹相關的廣泛供應。到目前為止，使用該技術的案例比例相當高，隨著達文西 5 程式量的增長，這可能會產生影響。我只想說，如果我縮小每個程式的 I&A 總數，那麼更大的驅動力將是程式組合。

A greater proportion of where we see growth coming from is in benign procedures. Gary described that in more recent results. But when you think about cholecystectomy and other benign procedures, you'll have a procedure mix dynamic that means that we think, at least over the next couple of years. I&A per procedure drifts down slowly over time.

我們看到增長的大部分來自良性手術。加里在最近的結果中描述了這一點。但是，當您考慮膽囊切除術和其他良性手術時，您將看到手術組合動態，這意味著我們認為，至少在接下來的幾年裡。每個程序的 I&A 隨著時間的推移慢慢下降。

We have time for just one last question.

我們還有時間回答最後一個問題。

Patrick Wood, Morgan Stanley.

派崔克‧伍德，摩根士丹利。

Beautiful. Thank you so much. A bit of a weird conceptual one. I'm just curious about. But if you think of the efficiencies from your installed base senses. So over time, as you're placing more and more systems and in individual areas and regions, the installed base entities going up. Like is there really a margin implication for that from more efficiencies in selling into the customer base, servicing the systems?

美麗的。太感謝了。有點奇怪的概念。我只是好奇。但如果您考慮一下現有客戶群的效率。因此，隨著時間的推移，當您在各個區域和地區放置越來越多的系統時，已安裝的基礎實體就會增加。例如，提高向客戶群銷售和系統服務的效率是否真的會帶來利潤影響？

Can you see that in some areas or regions or markets where you've got a lot of density versus those where you have slightly less scale? I'm just conceptually trying to understand the effect of that over the long term. Thanks.

您是否可以看到，在某些地區或市場中，您的密度較高，而規模稍小？我只是從概念上試著理解其長期影響。謝謝。

Well, generally, the I&A revenue are at higher margins than capital. And so, as you drive utilization growth, then a greater proportion of the revenue over some period comes from the higher profit streams. And so -- well, let me ask Patrick. Is that the essence of your question?

一般來說，I&A 收入的利潤率高於資本。因此，當您推動利用率成長時，一段時間內更大比例的收入來自更高的利潤流。所以——好吧，讓我問派崔克。這是你問題的本質嗎？

It was more around the service and the efficiency of driving into those existing accounts rather than the mix between the two.

它更多地圍繞著服務和驅動現有帳戶的效率，而不是兩者之間的混合。

I'll answer quickly just in light of time. We do get some advantages of scale with geographic density in terms of cost to support an account. So service, service depots, sales support, training support, as that becomes more dense, it does give us some cost advantages to serve them. Is that where you're headed?

我會根據時間很快回答。在支援帳戶的成本方面，我們確實獲得了一些規模優勢和地理密度優勢。因此，服務、服務站、銷售支援、培訓支持，隨著這些變得更加密集，它確實為我們提供了一些成本優勢來為他們提供服務。那是你要去的地方嗎？

That's the way. Thank you so much.

就是這樣。太感謝了。

Thanks so much. 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 quintuple aim, better, more predictable patient outcomes, better experiences for patients that are experiencing for their care teams, that are access to great care and ultimately, a lower total cost of care.

非常感謝。這是我們最後一個問題。最後，我們相信有一個實質和持久的機會從根本上改善手術和急性幹預。我們的團隊繼續與醫院、醫生和護理團隊密切合作，追求客戶所說的五重目標：更好、更可預測的患者治療結果，為護理團隊的患者提供更好的體驗，獲得優質護理最終，降低總護理成本。

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.

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。

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

在 Intuitive，我們設想了一個侵入性更小、效果更好的未來護理，可以更早發現疾病并快速治療，以便患者能夠回到最重要的事情上。感謝您對這段非凡旅程的支持。我們期待三個月後再次與您交談。

Thank you. This concludes the conference. Thank you for your participation. You may now disconnect.

謝謝。會議到此結束。感謝您的參與。您現在可以斷開連線。