直覺手術 (ISRG) 2022 Q1 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Intuitive Q1 2022 Earnings Release. (Operator Instructions) And as a reminder, your conference is being recorded.

女士們、先生們，感謝您的耐心等待，歡迎參加 Intuitive 2022 年第一季財報發布會。 （操作說明）提醒您，本次會議正在錄製中。

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

現在我將會議交給主持人、投資人關係主管布萊恩金先生。請開始吧。

Good afternoon and welcome to Intuitive's first quarter earnings conference call. With me today, we have Gary Guthart, our CEO; and Jamie Samath, CFO.

下午好，歡迎參加Intuitive第一季財報電話會議。今天與我一同出席的有我們的執行長Gary Guthart和財務長Jamie Samath。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are described in detail in our Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 3, 2022. Our SEC filings can be found through our website or at the SEC's website. Investors are cautioned not to place undue reliance on such forward-looking statements.

在會議開始之前，我想告知各位，今天電話會議中提及的評論可能包含前瞻性陳述。由於某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定性已在提交給美國證券交易委員會（SEC）的文件中詳細描述，包括我們於2022年2月3日提交的最新10-K表格。您可以透過我們的網站或SEC網站查閱我們的SEC文件。投資者請勿過度依賴此類前瞻性陳述。

Please note that this conference call will be available for audio replay on our website at intuitive.com on the Events section under our Investor Relations page. Today's press release and supplementary financial data tables have been posted to our website.

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

Today's format will consist of providing you with highlights of our first quarter results as described in our press release announced earlier today, followed by a question-and-answer session. Gary will present the quarter's business and operational highlights. Jamie will provide a review of our financial results, then I will discuss procedure and clinical highlights and provide our updated financial outlook for 2022. And finally, we will host a question-and-answer session.

今天的會議形式如下：首先，我們將重點介紹今天早些時候發布的新聞稿中概述的第一季業績；隨後進行問答環節。 Gary 將介紹本季的業務和營運亮點；Jamie 將回顧我們的財務表現；之後，我將討論流程和臨床方面的亮點，並提供我們最新的 2022 年財務展望；最後，我們將進行問答環節。

With that, I will turn it over to Gary.

接下來，我將把麥克風交給蓋瑞。

Thank you for joining us today.

感謝您今天蒞臨。

In the first quarter, procedure demand for our products was healthy, recovering where COVID receded. Drivers of procedure performance included general surgery in the U.S. and non-urology procedures outside of the U.S., which are our areas of focus. Regardless of the healthy procedure demand, we were challenged by environmental stresses, including regional waves of COVID, staffing pressure at hospitals, component and raw material availability and logistic delays. While it's difficult to forecast how long these headwinds will persist, our teams are working hard to meet the challenge.

第一季度，隨著新冠疫情的消退，我們產品的手術需求呈現健康復甦態勢。推動手術量成長的主要因素包括美國境內的普通外科手術以及美國境外的非泌尿外科手術，這些也是我們重點關注的領域。儘管手術需求良好，但我們仍面臨許多環境壓力，包括區域性新冠疫情的反覆爆發、醫院人員短缺、零件和原材料供應以及物流延誤。雖然難以預測這些不利因素將持續多久，但我們的團隊正在努力應對挑戰。

In the quarter, da Vinci procedures grew 19% compared to the first quarter 2021. The use of da Vinci in general surgery in the United States grew nicely, led by bariatric procedures, cholecystectomy, hernia repair and rectal surgery. Lobectomy growth was also healthy. Outside the United States, the U.K., China, Japan, Germany and Italy grew above our quarterly average growth rate, but I will note that some countries saw the beginnings of COVID slowdowns later in the quarter, in particular China and Korea.

本季度，達文西手術量較2021年第一季成長19%。在美國，達文西手術在一般外科手術的應用成長良好，主要體現在減重手術、膽囊切除、疝氣修補術和直腸手術。肺葉切除術的成長也較為穩健。除美國外，英國、中國、日本、德國和義大利的成長率均高於季度平均水平，但需要指出的是，部分國家在本季後期開始出現新冠疫情導致的經濟成長放緩，尤其是中國和韓國。

International use of da Vinci is diversifying beyond urology in several countries with growth in oncologic procedures in thoracic surgery, gynecology and general surgery. In Japan, MHLW increased reimbursement for robotically assisted gastrectomy and added another 8 procedures to reimbursement coverage in April, bringing the total number of covered da Vinci procedure types to over 25 in Japan. In our flexible robotics program, Ion procedures grew approximately 350% in Q1 compared with Q1 2021, reflecting continued strength in adoption and utilization of the platform.

在多個國家，達文西手術系統的應用範圍已從泌尿外科擴展到其他領域，例如胸腔外科、婦科和一般外科的腫瘤手術。在日本，厚生勞動省於4月提高了機器人輔助胃切除術的報銷比例，並新增了8種手術納入報銷範圍，使日本達文西手術系統報銷的手術類型總數超過25種。在我們靈活的機器人手術計畫中，Ion手術量在今年第一季較2021年第一季成長了約350%，反映出該平台的應用和普及程度持續強勁。

Turning to capital. Our team installed 311 da Vinci systems in the quarter compared with 298 systems in Q1 2021, bringing our total clinical installed base to 6,920 da Vinci systems. Placements varied by region with the U.K. standing out with a strong placement quarter. Capital placements have been historically lumpy and after several quarters of capital strength, we're seeing some near-term softening of our capital placement pipeline in the U.S. Contributing factors may include a pull-forward of Q1 2022 demand into Q4 2021 due to customer budget utilization at year-end, a reduction in the number of third-generation da Vinci systems available for trade-ins and an overall tightening of hospital finances.

再來看資本方面。本季我們的團隊安裝了311台達文西手術系統，而2021年第一季為298台，使我們的臨床安裝總量達到6920台。不同地區的安裝情況有所不同，其中英國的安裝量表現突出。資本安裝歷來波動較大，在經歷了幾個季度的強勁增長後，我們看到美國地區的資本安裝項目短期內有所放緩。造成這種情況的原因可能包括：由於客戶在年底預算用盡，導致2022年第一季的需求提前至2021年第四季；可供以舊換新的第三代達文西手術系統數量減少；以及醫院整體財務狀況趨緊。

With a 3-year CAGR in procedures of 15% from Q1 of '19 to Q1 of '22 and installed base growth of 11% over the same period, utilization of installed systems continue to climb through the pandemic and in the first quarter. This is increasing the value derived from the existing installed base for our customers and for us. Over the midterm, capital demand in mature robotic-assisted surgery segments is a function of procedure demand moderated by utilization growth. Jamie will give regional capital trends and Brian will give a more detailed procedure review later in the call.

從2019年第一季到2022年第一季度，手術量三年複合年增長率（CAGR）為15%，同期裝置容量成長11%，在疫情期間以及第一季度，已安裝系統的利用率持續攀升。這提高了我們和客戶從現有裝置容量中獲得的價值。中期來看，成熟的機器人輔助手術領域的資本需求取決於手術量需求，並受到使用率成長的調節。 Jamie將在電話會議稍後介紹區域資本趨勢，Brian將對手術量進行更詳細的分析。

As we exit the first quarter, we continue to invest in global expansion, innovation initiatives and our business infrastructure. Our spending in the quarter was roughly in line with our target. In instruments and accessories, we received Chinese NMPA clearance for our 45-millimeter and 60-millimeter SureForm staplers, our Vessel Sealer Extend and our Endoscope Plus. These products support the utility of our Xi systems for several procedures, particularly general and thoracic surgeries.

第一季即將結束，我們持續加大對全球擴張、創新措施和業務基礎設施的投資。本季支出基本符合預期目標。在器械及配件方面，我們的45毫米和60毫米SureForm吻合器、Vessel Sealer Extend血管封閉器以及Endoscope Plus內視鏡獲得了中國國家藥品監督管理局（NMPA）的批准。這些產品有助於提升我們Xi系統在多種手術中的應用，尤其是在一般外科和胸腔外科手術中。

Turning to Ion. We submitted our EU medical device regulation application for the platform to allow the entry of Ion into Europe. Our teams are also building production capacity and making improvements to customer workflow, planning software and reprocessing efficiency.

接下來是Ion平台。我們已向歐盟提交了該平台的醫療器材法規申請，以使其能夠進入歐洲市場。我們的團隊也正在積極提升產能，並改善客戶工作流程、規劃軟體和再處理效率。

In digital products, the My Intuitive app community tripled year-over-year. It is now available in the U.S., Japan, Germany, France, United Kingdom and Ireland and Switzerland with launches set for Italy, Spain and India in Q2. Building on our Orpheus technology, our teams in Israel and the U.S. have created Intuitive Hub, a unified hardware and software solution for the operating room. Intuitive Hub enables OR teams to capture, edit and share video clips from clinical procedures and collaborate virtually using existing workflows and Intuitive systems.

在數位產品方面，My Intuitive 應用社群年增三倍。該應用程式目前已在美國、日本、德國、法國、英國、愛爾蘭和瑞士上線，並計劃於第二季在義大利、西班牙和印度推出。基於我們的 Orpheus 技術，我們在以色列和美國的團隊開發了 Intuitive Hub，這是一款針對手術室的軟硬體一體化解決方案。 Intuitive Hub 讓手術室團隊能夠捕獲、編輯和共享臨床手術的影片片段，並利用現有工作流程和 Intuitive 系統進行虛擬協作。

In the quarter, we launched an upgraded interface to da Vinci systems that allows for automated video capture with integrated procedure annotation for key events, creating convenient video storage and review for da Vinci cases. Customer feedback for this integration has been encouraging. Across the installed base, the number of procedures in which Intuitive Hub was used grew approximately 60% year-over-year.

本季度，我們推出了升級版的達文西手術系統介面，該介面支援自動視訊擷取，並整合了關鍵事件的手術註釋功能，從而為達文西手術病例提供便利的視訊儲存和回顧。客戶對此整合的回饋令人鼓舞。在所有已安裝的系統中，使用 Intuitive Hub 的手術數量年增約 60%。

To our goal of adding Iris anatomical models, we're in conversations with FDA on how best to characterize some of its core AI technology, which will require a resubmission of our 510(k) for the next set of segmented organ models. Finally, the installed base of our virtual reality training simulator, SimNow, grew 33% in the quarter compared with a year ago.

為了實現添加虹膜解剖模型的目標，我們正在與FDA討論如何更好地描述其核心人工智慧技術，這將需要我們重新提交下一批分割器官模型的510(k)申請。最後，我們的虛擬實境訓練模擬器Sim​​Now的安裝量在本季年增了33%。

For our single port program, da Vinci SP, we began the launch of our next-generation SP endoscope, which includes our Firefly Fluorescence Imaging technology and has 65% longer life. We also launched our next-generation core SP instruments that can apply higher forces during surgery and are more durable. Feedback on both has been encouraging.

針對我們的單孔手術系統達文西SP，我們開始推出新一代SP內視鏡，該內視鏡採用了螢火蟲螢光成像技術，使用壽命延長了65%。同時，我們也推出了新一代SP核心器械，這些器械在手術過程中能夠施加更大的力，並且更加耐用。目前，兩款產品的回饋都令人鼓舞。

In Japan, we submitted our da Vinci SP for clearance to PMDA seeking broad indications. We continue to pursue additional indications for SP in the U.S., which is important for broader adoption, with an ongoing IDE trial in colorectal surgery and an approved IDE for thoracic surgery. COVID and some site-specific delays have slowed our progress in our colorectal trial. We're working hard to expand the number of participating sites to accelerate its completion.

在日本，我們已向日本藥品和醫療器材管理局 (PMDA) 提交了達文西SP手術系統的上市申請，尋求更廣泛的適應症。我們正持續在美國推進SP系統的其他適應症申請，這對於其更廣泛的應用至關重要。目前，我們正在進行一項針對結直腸手術的IDE臨床試驗，並已獲批准一項針對胸腔外科手術的IDE臨床試驗。新冠疫情以及部分研究中心的具體延誤延緩了我們結直腸手術臨床試驗的進展。我們正努力擴大參與中心的數量，以加快試驗的完成。

Stepping back, for 2022, our top priority is to support, supply and train our customers as they navigate a challenging environment. We are also focused on helping general surgeons in the United States adopt our technologies and diversifying our business outside the United States beyond urology and in executing on our new platforms and digital tools.

展望2022年，我們的首要任務是支援、供應和培訓客戶，幫助他們應對充滿挑戰的環境。同時，我們也致力於幫助美國普通外科醫生採用我們的技術，並將業務拓展到美國以外的泌尿外科領域，並積極推進新平台和數位化工具的開發和應用。

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

現在我將時間交給傑米·薩馬斯，他將更詳細地為大家講解財務方面的問題。

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

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

Overall, Q1 results reflected approximately 19% procedure growth as compared to the first quarter of 2021 and system placements of 311 systems, resulting in an expansion of the installed base of da Vinci systems of approximately 13%. As a result of our procedure and capital performance, Q1 revenue increased by 15% year-over-year.

總體而言，第一季業績反映出手術量較 2021 年第一季成長約 19%，系統安裝量為 311 套，使得達文西系統的裝機量擴大了約 13%。由於手術量和資本支出的良好表現，第一季營收年增 15%。

Key business metrics for the first quarter of 2022 were as follows. Within the 19% procedure growth, procedures in the U.S. increased 16% and OUS procedures grew by 25%. Procedures in the U.S. were impacted in January by the significant number of hospitalizations related to the Omicron variant. As rates of COVID-related hospitalizations declined in February and March, da Vinci procedures recovered quickly. On a 3-year compound annual growth rate basis, first quarter procedures grew approximately 15%.

2022年第一季的關鍵業務指標如下。在19%的手術量成長中，美國手術量成長16%，美國境外手術量成長25%。 1月份，由於大量與Omicron手術系統相關的住院病例，美國手術量受到影響。隨著2月和3月新冠肺炎相關住院率的下降，達文西手術量迅速恢復。以三年複合年增長率計算，第一季手術量成長約15%。

First quarter system placements of 311 increased 4% from the 298 systems placed last year. The number of systems placed in conjunction with a trade-in of an older generation system declined by 18% from the first quarter of 2021. That decline was entirely driven by the U.S. Utilization of clinical systems in the field, measured by procedures per system, increased approximately 6% compared to last year. Using a 3-year CAGR, first quarter utilization grew 4%.

第一季系統安裝量為311套，較去年同期的298套成長4%。與舊系統置換同時安裝的系統數量較2021年第一季下降18%，此降幅完全由美國市場造成。臨床系統在現場的使用率（以每套系統完成的手術量衡量）較去年同期成長約6%。以三年複合年增長率計算，第一季使用率成長4%。

During the quarter, the supply chain environment continued to be challenging and remains dynamic. In Q1, we continued to experience constraints in our ability to meet customer demand. And as a result, on-time delivery performance to our customers was lower than we have experienced so far during the pandemic.

本季，供應鏈環境仍充滿挑戰且瞬息萬變。第一季度，我們滿足客戶需求的能力持續受到限制。因此，我們按時交付客戶的表現低於疫情期間迄今為止的水平。

In Europe, recently, we have experienced some geographically limited delays in fulfilling orders for some da Vinci instruments and accessories. These delays were due to a combination of the global supply chain and logistics issues, including our freight forwarder's unanticipated shutdown of its computer system. While these constraints did not have a material impact to our Q1 financial results, risks associated with potential disruption to our manufacturing operations and our ability to supply certain products to our customers remain significant. During the quarter, we also experienced higher logistics costs and manufacturing inefficiencies that impacted our gross margin.

近期，我們在歐洲部分地區出現了一些達文西手術器械及配件訂單交付延遲的情況。這些延遲是由於全球供應鏈和物流問題造成的，其中包括我們的貨運代理的電腦系統意外宕機。雖然這些限制並未對我們第一季的財務業績產生實質影響，但可能中斷生產營運以及影響我們向客戶供應特定產品的風險仍然顯著。此外，本季我們也面臨物流成本上升和生產效率低下的問題，這些問題也影響了我們的毛利率。

U.S. procedure growth of 16% over Q1 of 2021 reflected continued relative strength in bariatrics, cholecystectomy and hernia repair. In Europe, we experienced strong growth in the U.K., reflecting in part the significant adverse impact of COVID in Q1 of 2021. Procedure growth in the U.K. also reflected strong early-stage growth in hysterectomy, colorectal and thoracic procedures. Procedure growth in Germany and Italy was also strong, while procedure growth in France was adversely impacted by COVID-mitigation measures in the first part of the quarter.

美國手術量較2021年第一季成長16%，主要得益於減重手術、膽囊切除術和疝氣修補術的持續強勁成長。歐洲方面，英國手術量成長強勁，部分原因是受2021年第一季新冠疫情的顯著負面影響。英國手術量的成長也體現在子宮切除術、結直腸手術和胸腔外科手術的早期強勁增長。德國和義大利的手術量成長同樣強勁，而法國的手術量成長則受到第一季前半段新冠疫情防治措施的不利影響。

Overall procedure growth in Asia was solid with growth across a broad set of procedure categories. Q1 procedures in China and Korea were slightly lower than our expectations given the impact of the Omicron variant later in the quarter. Procedure growth in Japan was strong, reflecting some recovery in urologic procedures and strong growth in rectal, hysterectomy and thoracic, key procedures that were granted da Vinci reimbursement in April of 2020.

亞洲整體手術量成長穩健，涵蓋多種手術類別。受歐米伽隆手術系統（Omicron）變體在第一季後期上市的影響，中國和韓國第一季的手術量略低於預期。日本的手術量增長強勁，反映出泌尿外科手術有所復甦，以及直腸手術、子宮切除術和胸腔外科手術（這些關鍵手術於2020年4月獲得達文西手術系統的醫保報銷）的強勁增長。

The impact of the Delta variant in Q3 of last year and the impact of the Omicron variant in this past quarter highlight the continued risk of future COVID waves and the associated significant risks to the number of da Vinci procedures that may be performed. Brian will provide additional procedure commentary later in this call.

去年第三季Delta變體的影響以及本季​​Omicron變體的影響凸顯了未來新冠疫情再次爆發的風險，以及由此對達文西手術數量可能造成的重大影響。 Brian將在本次電話會議稍後提供更多關於手術方面的評論。

As Gary indicated, during the quarter, we experienced a softening in our U.S. capital pipeline, which we expect to impact system placements in the near term. In the U.S., we placed 186 systems in the first quarter, lower than 190 in Q1 of 2021, reflecting a decline of 28 systems associated with trade-in transactions, partially offset by increased placements to greenfield customers. The remaining installed base of Si systems in the U.S. is approximately 268 systems.

正如Gary所指出的，本季我們在美國的業務拓展有所放緩，預計這將對短期內的系統部署產生影響。在美國，我們第一季共部署了186套系統，低於2021年第一季的190套，這主要歸因於以舊換新交易導致的28套系統減少，但部分被新增新客戶安裝量的增加所抵銷。目前，Si系統在美國的剩餘裝置量約為268套。

Outside the U.S., we placed 125 systems in the first quarter compared with 108 in the first quarter of 2021. Current quota system placements included 78 into Europe, 19 into Japan and 9 into China compared with 59 into Europe, 8 into Japan and 23 into China in the first quarter of 2021. We placed 30 systems in the U.K. in Q1 driven in part by the timing of government budget cycles. We do not expect to place similar levels of systems in the remainder of 2022 in the U.K.

除美國以外，我們在第一季部署了125套系統，而2021年第一季為108套。目前，配額系統部署包括歐洲78套、日本19套和中國9套，而2021年第一季分別為歐洲59套、日本8套和中國23套。我們在第一季於英國部署了30套系統，部分原因是受政府預算週期的影響。我們預計2022年剩餘時間在英國的系統部署量不會達到類似水準。

Capital performance in Japan was driven primarily by greenfield accounts and some existing customers adding capacity in anticipation of the 8 additional procedure reimbursements taking effect on April 1. System placements in China were moderately impacted by longer logistic cycle times as a result of lockdowns in response to increased COVID cases. As of the end of Q1 2022, there were 55 systems remaining under the current quota in China, which may also be available to competitors that have received local regulatory clearance.

日本的資本績效主要得益於新建案以及部分現有客戶為迎接4月1日生效的8項新增手術報銷政策而增加的產能。受新冠疫情封鎖措施的影響，中國地區的系統部署受到物流週期延長的一定程度影響。截至2022年第一季末，中國現有配額下還剩55套系統，這些配額也可能提供給已獲得當地監管部門核准的競爭對手。

Globally, trade-in transactions represented 35% of placements in the quarter compared to 38% for the full year of 2021 and 48% for the full year 2020. Given the lower number of older-generation systems in the field, we expect the volume of trade-ins to be significantly lower in 2022 as compared to 2021.

從全球來看，本季以舊換新交易佔總交易量的35%，而2021年全年為38%，2020年全年為48%。鑑於目前市場上老一代系統的數量較少，我們預計2022年的以舊換新交易量將比2021年大幅下降。

Hospitals continue to experience financial and operational pressures as a result of staffing shortages, the supply chain environment and resulting inflation. Since the start of the pandemic in 2020, the impact of COVID has placed a significant burden on hospitals. The financial pressures our customers have faced have been partially mitigated by government funding, such as the approximately $178 billion of CARES Act and other relief made available to hospitals in the U.S.

由於人員短缺、供應鏈環境以及由此引發的通貨膨脹，醫院持續面臨財務和營運壓力。自2020年疫情爆發以來，新冠疫情的影響給醫院帶來了沉重負擔。政府資金，例如《新冠病毒援助、救濟和經濟安全法案》（CARES Act）提供的約1780億美元資金以及其他向美國醫院提供的援助，在一定程度上緩解了我們客戶面臨的財務壓力。

The rising interest rate environment increases debt servicing costs and may make access to new debt more challenging. To the extent that hospitals continue to face financial pressures, reductions in government funding and higher interest rates, hospital capital spending may be adversely impacted. In addition, as competition progresses in various markets, we will likely experience longer selling cycles and price pressure.

利率上升會增加償債成本，並可能使獲得新債務更加困難。如果醫院持續面臨財務壓力、政府撥款減少和利率上升，醫院的資本支出可能會受到不利影響。此外，隨著各市場競爭加劇，我們可能會面臨更長的銷售週期和價格壓力。

Additional revenue statistics and trends are as follows. Total first quarter revenue was $1.49 billion, an increase of 15% from last year. Leasing represented 35% of Q1 placements compared with 37% last year, last quarter rather. The slightly lower first quarter lease mix primarily reflected the mix of customers who prefer to purchase systems. While leasing will fluctuate from quarter-to-quarter, we continue to expect that the proportion of placements under operating leases will increase over time.

其他收入統計數據和趨勢如下。第一季總營收為14.9億美元，較去年同期成長15%。租賃佔第一季設備部署量的35%，而去年同期為37%。第一季租賃佔比略低，主要反映了部分顧客傾向購買系統。儘管租賃業務會隨季度波動，但我們仍然預計，隨著時間的推移，經營租賃比例將會上升。

First quarter system average selling prices were $1.54 million, higher than the $1.45 million last quarter. The sequential increase was primarily driven by a lower mix of bulk buy transactions with large customers and a favorable product mix, in particular a higher proportion of Xi dual system placements in the quarter.

第一季系統平均售價為154萬美元，高於上一季的145萬美元。環比成長的主要原因是與大客戶的大量採購交易佔比下降以及產品組合的優化，特別是本季Xi雙系統安裝比例的提高。

We recognized $16 million of lease buyout revenue in Q1 compared with $26 million last quarter and $19 million last year. Lease buyout revenue has varied significantly quarter-to-quarter and will likely continue to do so.

第一季我們確認了1,600萬美元的租賃買斷收入，而上一季為2,600萬美元，去年同期為1,900萬美元。租賃買斷收入季度間波動較大，而且這種情況可能會持續下去。

Instrument and accessory revenue per procedure was approximately $1,870 per procedure compared with $1,940 per procedure in the fourth quarter of 2021 and down 4% from the $1,950 realized in the first quarter of last year. The year-over-year decrease primarily reflects the benefit of stocking orders in Q1 of 2021 associated with the launch of our extended use instruments program in the U.S. and Europe and an unfavorable FX impact from the stronger U.S. dollar. The sequential decline primarily reflects lower stocking orders associated with lower system placements, hospital ordering patterns and a small unfavorable impact from FX.

每台手術的器械及配件收入約為 1,870 美元，而 2021 年第四季為 1,940 美元，較去年第一季的 1,950 美元下降 4%。年比下降主要反映了 2021 年第一季因在美國和歐洲推出延用器材項目而帶來的庫存訂單成長，以及美元走強帶來的不利匯率影響。環比下降主要反映了由於系統安裝量減少、醫院訂購模式變化以及匯率波動帶來的輕微不利影響，導致庫存訂單減少。

We placed 34 Ion systems in the quarter as compared to 14 Ion placements in the first quarter of last year. The installed base of Ion systems is now 163 systems, of which 70 are under operating lease arrangements. First quarter Ion procedures of just over 3,900 are up over 4x compared to the first quarter of 2021. Seven of the systems placed in the first quarter were SP systems, including 3 systems placed at customers in Korea. Our installed base of SP systems is now 106.

本季我們安裝了34套離子系統，而去年同期為14套。目前離子系統的裝機量為163套，其中70套為租賃經營。第一季離子手術量略高於3900例，較2021年第一季成長超過4倍。第一季安裝的系統中，有7套為SP系統，其中3套安裝在韓國的客戶處。目前SP系統的裝機量為106套。

First quarter SP procedures grew approximately 36% year-over-year with approximately 50% growth in transoral procedures, a small but high-value segment. Growth of the SP platform will continue to be gated by additional clinical indications and clearances in markets beyond the U.S. and Korea.

第一季SP手術量年增約36%，其中經口手術成長約50%，儘管該細分市場規模較小，但價值很高。 SP平台的成長將繼續受到美國和韓國以外市場更多臨床適應症和批准的限制。

Moving on to gross margin and operating expenses. Pro forma gross margin for the first quarter of 2022 was 69.8% compared with 71.8% for the first quarter 2021 and 70.1% last quarter. Pro forma gross margin was lower than last quarter, primarily as a result of higher logistics costs and increased fixed costs relative to revenue as we invest in our infrastructure and manufacturing capacity to serve our long-term needs. While net inventory grew approximately $66 million quarter-over-quarter, there are still a number of components and products that are below our targeted levels.

接下來是毛利率和營運費用。 2022年第一季的備考毛利率為69.8%，低於2021年第一季的71.8%和上一季的70.1%。備考毛利率低於上一季度，主要原因是物流成本上升以及固定成本佔收入的比例增加，因為我們投資於基礎設施和生產能力以滿足長期需求。雖然淨庫存季增約6​​,600萬美元，但仍有一些零件和產品的庫存低於我們的目標水準。

Pro forma operating expenses increased 26% compared with the first quarter of 2021. The increase in first quarter operating expenses from a year ago reflected an increase in headcount, increased variable compensation and higher customer-facing costs, customer training, travel costs and marketing programs. As of the end of Q1, we had just over 10,500 employees, an increase of 26% from the first quarter of 2021 or an increase of 20% on a 3-year CAGR basis. Of the approximately 2,100 employees we have added over the last year, approximately 900 are manufacturing employees.

與2021年第一季相比，備考營運費用成長了26%。第一季營運費用較上年同期成長主要反映了員工人數增加、可變薪酬增加以及面向客戶的成本上升，包括客戶培訓、差旅費用和行銷項目支出。截至第一季末，我們擁有超過10,500名員工，較2021年第一季成長26%，或以三年複合年增長率計算成長20%。在過去一年新增的約2,100名員工中，約有900名是生產製造部門的員工。

Capital expenditures in Q1 were $95 million, primarily comprised of infrastructure investments to expand our facilities footprint, increase manufacturing capacity and automation of certain production lines.

第一季資本支出為 9,500 萬美元，主要包括基礎設施投資，用於擴大我們的設施規模、提高製造能力以及實現某些生產線的自動化。

Our pro forma effective tax rate for the first quarter was 23.3%, slightly above our expectations primarily due to certain discrete tax items. Our pro forma tax rate was above the 22.2% for 2021, primarily due to a previous change in U.S. tax law that became effective on January 1, 2022. Our first quarter 2022 pro forma net income was $413 million or $1.13 per share compared with $427 million or $1.17 per share for the first quarter of 2021.

我們第一季的備考實際稅率為23.3%，略高於預期，主要原因是某些特殊稅務項目。我們的備考稅率高於2021年的22.2%，主要原因是美國稅法先前的一項變更已於2022年1月1日生效。我們2022年第一季的備考淨利為4.13億美元，即每股1.13美元，而2021年第一季為4.27億美元，即每股1.17美元。

I will now summarize our GAAP results. GAAP net income was $366 million or $1 per share for the first quarter of 2022 compared with GAAP net income of $426 million or $1.17 per share for the first quarter of 2021. The adjustments between pro forma and GAAP net income are outlined and quantified on our website and include excess tax benefits associated with employee stock awards, employee stock-based compensation, amortization of intangibles and gains and losses on strategic investments.

現在我將總結我們的GAAP業績。 2022年第一季GAAP淨利為3.66億美元，即每股1美元，而2021年第一季GAAP淨利為4.26億美元，即每股1.17美元。備考淨利潤與GAAP淨利潤之間的調整項已在我們的網站上列出並量化，其中包括與員工股票獎勵、員工股票期權激勵、無形資產攤銷以及戰​​略投資損益相關的超額稅收優惠。

We ended the quarter with cash and investments of $8.4 billion compared with $8.6 billion as of December 31, 2021. The sequential reduction in cash and investments in the first quarter primarily reflected share repurchases, capital expenditures and unrealized losses on interest-bearing investments classified as available for sale, partially offset by cash from operating activities and proceeds from employee stock plans. During the quarter, we repurchased 398,000 shares at an average price of $268 per share for a total expenditure of $107 million.

本季末，我們的現金及投資餘額為84億美元，而截至2021年12月31日為86億美元。第一季現金及投資餘額較上季減少，主要反映了股票回購、資本支出以及歸類為可供出售的計息投資的未實現損失，部分被經營活動產生的現金流量和員工持股計畫所得款項所抵銷。本季度，我們以每股268美元的平均價格回購了39.8萬股股票，總支出為1.07億美元。

And with that, I would like to turn it over to Brian, who will discuss clinical highlights and provide our updated outlook for 2022.

接下來，我將把發言權交給布萊恩，他將討論臨床亮點並提供我們最新的 2022 年展望。

Thank you, Jamie.

謝謝你，傑米。

Our overall first quarter 2022 procedure growth was 19% compared to 16% for the first quarter of 2021. The 3-year compound annual growth rate was 15% between the first quarter of 2019 and first quarter of 2022. First quarter 2022 procedure growth benefited by 140 basis points from 1 additional workday in the quarter.

2022年第一季度，我們的整體手術量增加了19%，而2021年第一季為16%。 2019年第一季至2022年第一季的三年複合年增長率為15%。 2022年第一季手術量成長受惠於該季度多出的一個工作日，增幅為140個基點。

In the U.S., first quarter 2022 procedure growth was 16% year-over-year compared to 14% for the first quarter of 2021 and 16% last quarter. On a 3-year compound annual growth basis, U.S. procedure growth was 13%. In the U.S., first quarter growth was again driven by growth in procedures within general surgery. Bariatrics, cholecystectomy and hernia repair were the largest contributors to procedure growth, while growth in foregut and rectal resection were also strong contributors.

2022年第一季，美國手術量年增16%，高於2021年第一季的14%和上一季的16%。過去三年的複合年增長率為13%。在美國，第一季的成長再次主要由一般外科手術量的成長所推動。其中，減重手術、膽囊切除術和疝氣修補術是手術量增加的主要貢獻者，而上消化道切除術和直腸切除術的成長也貢獻顯著。

Outside of the U.S., first quarter procedure volume grew approximately 25% compared with 23% for the first quarter of 2021 and 28% last quarter. On a 3-year compound annual growth basis, procedure growth was 20%. In Europe, we experienced strong growth in the U.K., Italy and Germany, partially reflecting the disruption caused by COVID in the first quarter of 2021. In the U.K., procedure growth was strong in general surgery and gynecology categories, supported by early-stage growth in hysterectomy, colorectal and thoracic procedures. Procedure growth in Germany and Italy was also driven by procedures outside of urology with growth driven by colorectal, hysterectomy and thoracic procedures.

除美國以外，第一季手術量成長約25%，高於2021年第一季的23%和上一季的28%。以三年複合年增長率計算，手術量成長率為20%。在歐洲，英國、義大利和德國的手術量均實現了強勁成長，部分原因是2021年第一季新冠疫情造成的衝擊。在英國，一般外科和婦科手術量成長強勁，這主要得益於子宮切除術、大腸直腸手術和胸腔外科手術的早期成長。德國和義大利的手術量增長也主要由泌尿外科以外的手術推動，其中結直腸手術、子宮切除術和胸腔外科手術的增長尤為顯著。

Capital placements were also strong in the U.K. with the placement of 30 systems, the highest number of systems placed in the U.K. in a single quarter, driven in part by government funding and the trade-ins of older-generation systems. In Japan, growth in general surgery, gynecology and thoracic continued to be strong with robust growth specifically in benign hysterectomy, gastrectomy and lobectomy. In addition, urologic procedures, specifically prostatectomy and partial nephrectomy, both experienced solid double-digit growth, reflecting a recovery when compared to the prior year, which was constrained by COVID.

英國的資本配置情況也十分強勁，共配置了30套系統，創下英國單季配置系統數量的最高紀錄，部分原因是政府撥款和舊系統以舊換新。在日本，一般外科、婦科和胸腔外科的成長動能依然強勁，其中良性子宮切除術、胃切除術和肺葉切除術的成長尤為顯著。此外，泌尿外科手術，特別是前列腺切除術和部分腎切除術，均實現了兩位數的穩健增長，與上一年受新冠疫情影響的情況相比，已有所復甦。

In China and Korea, first quarter procedure growth was solid but slightly below expectations as we saw a resurgence in March of COVID infections, regional lockdowns and hospitalizations, which negatively impacted procedure volumes. In China, growth in urology was solid, in particular with growth in prostatectomy, nephrectomy and partial nephrectomy. We continue to see broad-based growth in general surgery, thoracic and gynecology as well. As we enter the second quarter this year, we are seeing the negative impact on procedure volume as a result of continued regional lockdowns.

在中國和韓國，第一季手術量成長穩健，但略低於預期，原因是3月份新冠感染病例再次激增，導致各地實施封鎖措施和住院人數上升，對手術量造成了負面影響。在中國，泌尿科手術量成長強勁，尤其是攝護腺切除術、腎臟切除術和部分腎切除術。一般外科、胸腔外科和婦科手術量也持續維持全面成長。進入今年第二季度，由於持續的地區封鎖措施，手術量受到負面影響。

Now turning to Ion, our robotic-assisted endoluminal platform focused today on minimally invasive lung biopsy procedures. First quarter 2022 Ion procedures totaled just over 3,900 in Q1 2022, an approximately 350% increase over the prior year and 34% over the prior quarter. Ion system placements were also strong, ending Q1 '22 with 163 installed systems, growing approximately 225% over the prior year.

現在我們來談談Ion，這是我們的機器人輔助腔內手術平台，今天主要專注於微創肺活檢手術。 2022年第一季，Ion手術總量略高於3,900例，較上年同期成長約350%，較上一季成長34%。 Ion系統的安裝量也表現強勁，截至2022年第一季末，已安裝163套系統，較上年同期成長約225%。

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

現在我們來談談業務的臨床方面。每個季度，我們都會在這些電話會議上重點介紹一些我們認為值得關注的近期發表的研究。然而，為了更全面地了解現有證據，我們鼓勵所有利害關係人仔細審查多年來發表的大量科學研究的詳細資訊。

During the quarter, Dr. Paresh Shah, along with colleagues from the Robert I. Grossman School of Medicine at New York University and in collaboration with Intuitive, published a real-world body of evidence assessing open conversion rates during minimally invasive surgery using laparoscopic/thoracoscopic or da Vinci robotic surgery across 10 common procedures for benign or malignant conditions. Utilizing the Premier Healthcare Database, this study included over 275,000 adult patients who, between January 2013 and September 2015, underwent a minimally invasive procedure, including hysterectomy, sigmoidectomy, right colectomy, ventral or inguinal hernia repair, partial nephrectomy, lobectomy or low anterior resection.

本季度，帕雷什·沙阿博士與紐約大學羅伯特·I·格羅斯曼醫學院的同事以及Intuitive公司合作，發表了一項基於真實世界數據的研究，評估了在10種常見良性或惡性疾病的手術中，使用腹腔鏡/胸腔鏡或達文西機器人手術進行微創手術時，轉為開放手術的轉化率。研究利用Premier醫療保健資料庫，納入了2013年1月至2015年9月期間接受微創手術的27.5萬多名成年患者，這些手術包括子宮切除術、乙狀結腸切除術、右半結腸切除術、腹壁或腹股溝疝氣修補術、部分腎切除術、腎葉切除術或低位前切除術。

Overall, a 5% conversion to open rate for the MIS approach was observed across all procedures with a range of 1% to 24%. Converted to open patients were associated with a 1.8-day longer length of stay, 1.7x greater risk of readmission within 30 days of the procedure and a significantly higher in-hospital or perioperative 30-day total cost, adding approximately $2,900 to the in-hospital cost and $3,400 to the total 30-day cost. The researchers also compared differences in conversions between the laparoscopic/thoracoscopic and da Vinci cohorts. After performing propensity score matching, conversion rates for da Vinci procedures were significantly lower than LAP or VATS across all procedures. The volume-weighted conversion rate for da Vinci was approximately 2.8%, corresponding to a total relative conversion reduction for all study procedures of 58.5% compared to the laparoscopic or the thoracoscopic procedures.

整體而言，所有微創手術（MIS）手術的轉開腹率約為5%，範圍在1%至24%之間。轉開腹手術的病患住院時間延長1.8天，術後30天內再入院風險增加1.7倍，住院或圍手術期30天總費用顯著升高，住院費用增加約2,900美元，30天總費用增加約3,400美元。研究人員也比較了腹腔鏡/胸腔鏡手術組和達文西機器人手術組的轉開腹率差異。經傾向評分配對後，達文西機器人手術的轉開腹率在所有手術中均顯著低於腹腔鏡手術（LAP）或胸腔鏡輔助手術（VATS）。達文西機器人手術的加權轉開腹率約為2.8%，與腹腔鏡手術或胸腔鏡手術相比，所有研究手術的轉開腹率整體相對降低了58.5%。

The researchers concluded in part, "From the standpoint of population health or a hospital system, these high-level data indicated that a cumulative effect of conversions can be a significant burden. And that reduction of conversion has major benefits and leads to increased value for the patient, the hospital and society at large. The use of robotic-assisted surgery is associated with a significant decrease in the conversion rate for all 10 operations studied, and a multidisciplinary robotic program encompassing several specialties could result in significantly decreased conversion rates with an improved ability to deliver successful minimally invasive surgery to its patients."

研究人員得出部分結論：「從人口健康或醫院系統的角度來看，這些高水平數據表明，手術轉換的累積效應可能造成重大負擔。而降低手術轉換率則具有重大益處，並能為患者、醫院乃至整個社會帶來更多價值。在所有研究的10種手術中，機器人輔助手術的使用均與手術轉換率的顯著相關機器人；在所有研究的10種手術中，機器人輔助手術的使用均與手術轉換率的顯著相關機器人；

I will now turn to our financial outlook for 2022, starting with procedures. On our last call, we forecast full year 2022 procedure growth within a range of 11% to 15%. We are now increasing our forecast and expect full year 2022 procedure growth of 12% to 16%. This range continues to reflect the uncertainty associated with the course of the pandemic. The low end of the range assumes ongoing COVID and staffing pressure at hospitals and assume some continued choppiness with COVID throughout the year. At the high end of the range, we assume COVID-19-related hospitalizations around the world decline throughout the remainder of 2022, and there are no additional significant impacts from further resurgences. As noted last quarter, the range does not reflect significant supply chain disruptions.

接下來，我將談談我們對2022年的財務展望，首先是手術量。在上一次電話會議上，我們預測2022年全年手術量成長率介於11%至15%之間。現在，我們上調了預測，預計2022年全年手術量成長率將達到12%至16%。這一預測範圍仍反映了疫情發展帶來的不確定性。預測範圍的下限假設新冠疫情將持續，醫院人員配備壓力將持續存在，並且全年疫情波動將持續。預測範圍的上限則假設2022年剩餘時間內全球新冠肺炎相關住院人數將持續下降，且不會出現疫情反彈帶來的其他重大影響。如同上個季度所述，此預測範圍並未反映供應鏈可能出現的重大中斷。

The steep increase in infections and subsequent recovery in the quarter from the Omicron variant in the U.S. and the trend in procedure volumes we have seen exiting the quarter in China highlight the risk to the number of procedures that may be performed. In the second quarter of 2022, our year-over-year procedure growth rate will likely be lower than recent quarters as Q2 2021 results reflected a strong recovery in procedures as COVID began to subside.

美國奧密克戎變異株感染病例的急劇增加以及隨後的恢復，以及我們觀察到的中國本季末手術量的變化趨勢，都凸顯了手術量可能面臨的風險。由於2021年第二季的數據反映了隨著新冠疫情開始消退，手術量強勁復甦，因此2022年第二季我們同比手術量成長率可能低於近幾季。

Turning to gross profit. On our last call, we forecast our 2022 full year pro forma gross profit margin to be within 69.5% and 70.5%. We are now slightly expanding the range of our pro forma gross profit margin to be within 69% and 70.5% of net revenue. The lower end of the range was updated to reflect the impact on input costs related to supply chain, inflation and some impact from a stronger U.S. dollar. Our actual gross profit margin will vary quarter-to-quarter depending largely on product, regional and trade-in mix and the impact of new product introductions.

接下來談談毛利。在上一次電話會議上，我們預測2022年全年備考毛利率將在69.5%至70.5%之間。現在，我們將備考毛利率的預測範圍略微擴大至淨收入的69%至70.5%。下限的調整是為了反映供應鏈相關投入成本、通貨膨脹以及美元走強所帶來的影響。我們的實際毛利率將因產品、地區和以舊換新組合以及新產品上市的影響而逐季波動。

With respect to operating expenses, on our last call, we forecast pro forma operating expense growth to be between 21% and 27%. We are refining our estimate and now expect our full year pro forma operating expense growth to be between 23% and 27%. We continue to expect our noncash stock compensation expense to range between $510 million and $550 million in 2022. We expect other income, which is comprised mostly of interest income, to total between $50 million and $60 million in 2022.

關於營運費用，在上次電話會議上，我們預測備考營運費用成長率將在21%至27%之間。我們正在調整預測，目前預計全年備考營運費用成長率將在23%至27%之間。我們仍預期2022年非現金股權激勵費用將介於5.1億美元至5.5億美元之間。我們預計2022年其他收入（主要包括利息收入）總額將在5,000萬美元至6,000萬美元之間。

On last quarter's call, we forecast 2022 capital expenditures within a range of $700 million to $1 billion. We are now refining estimated capital expenditures for 2022 to be in the range of $700 million to $900 million based primarily on the current timing of planned facility construction activities. With regard to income tax, we continue to estimate our 2022 pro forma tax rate to be between 22% and 24% of pretax income.

在上季財報電話會議上，我們預測2022年資本支出將在7億至10億美元之間。目前，我們正在根據已規劃的設施建設活動的進度，將2022年資本支出預估調整至7億至9億美元之間。關於所得稅，我們繼續預期2022年備考稅率為稅前利潤的22%至24%。

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

我們的發言到此結束。現在開始接受各位提問。

(Operator Instructions) And our first question is from the line of Amit Hazan.

（操作說明）我們的第一個問題來自 Amit Hazan 的提問。

Maybe I'll ask my first question on your comments on the U.S. systems side and the capital spending environment. Would just love to have more color on that. And obviously, we're focused on the same numbers that you mentioned, which is just the greenfield unit placements. And if we kind of look back just as context of what we have just over the past 4 or 5 years, those tend to increase by about 10% a year, and it is pretty choppy year-to-year. Just using that as a proxy, how much help can you give us on whether that's a good kind of target for this year for the nontrade-ins in the U.S.? And then just color on what you're seeing here in the near kind of just immediate term that you mentioned, it sounded like a lot of risk factors. And I'm wondering if it's risk factors that you're citing or something that you're actually seeing in your customers delaying planned purchases.

我的第一個問題可能想問您關於美國系統方面和資本支出環境的評論。我很想了解更多細節。顯然，我們關注的重點是您提到的那些數據，也就是新建專案的部署量。如果我們回顧過去四、五年，就會發現這些項目通常每年增長約10%，但每年的波動幅度相當大。以此為參考，您能否就今年美國非以舊換新專案的部署量目標給予一些建議？另外，您提到的近期風險因素似乎很多。我想知道您指的是這些風險因素，還是指您的客戶延遲購買計畫的情況。

Yes. Let me take the second question first and then I'll ask Jamie to step in on, a little bit more on the trade-in side. So what we're seeing now where we're at is a little bit less delay of planned purchases, a little bit less what we're signaling, more around Q4 demand looks strong. Q1 in terms of the early parts of the pipeline process and some of the contracting, some of the later parts, we're seeing in the U.S. just a little bit lower volume.

是的。我先回答第二個問題，然後請Jamie補充一些關於以舊換新方面的內容。目前我們看到的情況是，計劃採購的延遲情況有所減少，正如我們之前所預測的，第四季度的需求看起來比較強勁。第一季度，就流程早期階段和一些合約簽訂而言，我們看到美國的一些後期階段的交易量略有下降。

It may clear itself. It may entirely be that this was just a pull-forward of a little bit of demand and some budget flushing as hospitals got ready for the retirement of some of the government support for COVID. But it's not clear. We don't know yet. We know for sure that we're getting toward the end of the Si trade-in cycle in the United States. So that will soften some of the U.S. capital. And then there's forecasted additional pressures on hospitals and finances. The short answer to that is, we're going to have to see. We'll see if those come to fruition or not. So that's a little bit of where that lays out. With regard to kind of what does the trade-in ratio look like, let me turn it to you, Jamie.

情況或許會自行好轉。也可能完全是因為醫院提前釋放了一些需求，同時也是為了因應政府部分新冠疫情援助資金的到期而進行的預算清理。但目前尚不明朗。我們還不得而知。我們確切知道的是，美國的舊藥置換週期即將結束。這將緩解部分美國資本的壓力。此外，預計醫院和財務狀況還將面臨額外的壓力。簡而言之，我們拭目以待。看看這些預測是否會成真。以上就是目前的情況。至於舊藥置換率的具體情況，我把這個問題交給你，傑米。

Yes. If I just look back at last year, 2021, there's about 500-ish trade-ins done globally. Of that, about 80% were transactions in the U.S. So you can just kind of get a sense of the degree to which the U.S. has driven the trade-in cycle. As I said in my prepared remarks, as of the end of Q1, there's about 268 Sis left in the U.S. in the installed base. And so you can kind of use those 2 data points to do some estimate of how that will play out over time.

是的。回顧去年，也就是2021年，全球約完成了500筆以舊換新交易。其中約80%的交易發生在美國。由此可見，美國在以舊換新周期中扮演了多麼重要的角色。正如我在準備的發言稿中提到的，截至第一季末，美國在售的S1車型大約還有268輛。因此，我們可以利用這兩個數據點來預測未來一段時間內的發展趨勢。

As you start to get towards kind of the end of the tail of remaining Sis, they probably last for a little longer than kind of the average when you're at the middle of the distribution. But that's what I'd say with respect to trade-ins.

當你開始接近剩餘 Sis 數量的尾端時，它們的壽命可能會比分佈中部的平均壽命稍長。但這就是我對以舊換新面向的看法。

I think, Amit, you had a question on greenfields. The way I would think about it in the U.S. is you kind of have your procedure estimates that you can take from our range. You can apply the usual model with respect to utilization. That gives you some sense of how the installed base might expand. And so you can kind of do that calculation. That obviously is a mix of greenfields and incrementals. And I would just reflect in that model then what is the potential risk from what we highlighted with respect to the softening U.S. capital pipeline that we saw in Q1.

阿米特，我想你之前問過關於新建案的問題。就美國的情況而言，我會這樣想：你可以先根據我們的估算範圍，應用一些常規的使用率模型。這樣就能大致了解已安裝項目的規模可能會如何成長。然後你就可以進行一些計算了。這顯然包括新建項目和新增項目。我會在這個模型中反映出，我們在第一季看到的美國資本項目供應疲軟所帶來的潛在風險是什麼。

Just a capping remark on that. Final thought is the core driver in a mature multiport market segment in a country like the United States, the core driver is procedure demand. And we feel like procedure demand is healthy. It's healthy in our target areas. Our major focus is making sure that we can supply the customer with what they need in a way that's high quality and timely. So it's really managing the supply chain. If that goes well and we are successful in closing those gaps, I think capital demand will work itself out. It will play through because it ultimately in those markets is driven by core procedure demand.

最後補充一點。我認為，在像美國這樣成熟的多口岸市場中，核心驅動力就是流程需求。我們認為流程需求目前狀況良好，尤其是在我們的目標區域。我們的主要目標是確保能夠以高品質、及時的方式為客戶提供所需產品和服務。因此，關鍵在於供應鏈管理。如果供應鏈管理順利，而我們成功彌補了這些缺口，我認為資本需求本身會得到解決。最終，資本需求會被有效控制，因為在這些市場，核心流程需求才是驅動力。

And the second question, I always hate to ask this question, but I feel like investors want me to at this point in time, just get you to reflect on this. We always believe, as you stated, that you're working on at least one, if not 2, new platforms. We know you have that in the background. We see your R&D spend. That's obvious to everyone. I think the big question is always about timing. And for us, what we wanted to ask is, is this a situation at this point in time where technology just needs more time to incubate, whether maybe what we're seeing is more something that's related to FDA and the process that you go through and how that's evolved. How much color can you give us on just the process for getting new technology to market and where you are?

第二個問題，我總是很不願意問，但我覺得投資人現在可能想聽我談談這個問題，希望您能認真思考。正如您所說，我們一直相信您至少在研發一個，甚至兩個新平台。我們知道您一直在進行這方面的工作，也看到了您的研發投入，這一點顯而易見。我認為關鍵問題始終在於時機。我們想問的是，目前的情況是否只是技術需要更多時間來孵化，還是說我們現在看到的更多是與FDA審批流程以及您經歷的流程和發展歷程相關的問題？您能否詳細介紹一下新技術上市的流程以及您目前的進展？

Yes. It's a good question. What I'd say here is a couple. One is, as the technologies have matured and the installed base has gotten bigger, we've made an intentional decision to invest a lot in upgrading the capabilities of Gen 4 platforms that are out there. So the first thing has been that the Xi that somebody purchases today is more capable than the Xi that they had when it was first launched, and we keep doing that.

是的，這是一個很好的問題。我想從兩方面來談談我的看法。首先，隨著科技的成熟與用戶基數的擴大，我們有意加大投入，提升現有第四代平台的效能。因此，用戶今天購買的Xi處理器比他們最初購買的Xi處理器效能更強，而且我們會持續改進。

In part, that's easier, those kind of incremental adds to a platform architecture that's pretty mature are easier for the customer base to absorb. And they also compound utilization. They allow them to get more utility out of the capital they have. They get higher throughput through it, and they do more procedures with it. And in Gen 4, we're not done with that. We have continued to do it, whether it's instruments and accessories or endoscopy or software. And we have some things up our sleeves for that, too.

部分原因在於，這種對相當成熟的平台架構進行增量式擴展的方式更容易被客戶接受。而且，這些擴展也能提高設備利用率，讓客戶更有效地利用現有資金，獲得更高的吞吐量，並進行更多手術。在第四代產品中，我們並未止步於此。我們一直在持續推進，無論是儀器和配件、內視鏡或軟體。而且，我們在這方面也還有一些計畫。

So that was intentional. We were doing more kind of structural changes early on in that product and we have intentionally moved some things into more incremental changes on Gen 4. We do think that there are bigger structural changes that will make sense. We are working on them. They are interesting. I think they have long-term implications for the surgical market segments we participate in. I'm excited about them. Some of those things are around technology development. Some of them are around manufacturing and supply chain development, and some of them are around clinical pathways and regulatory pathways. So all of those things play out.

所以這是我們有意為之。我們在產品早期階段就進行了一些結構性變革，而第四代產品中，我們有意將一些內容改為漸進式改進。我們認為，未來還會有一些更重大的結構性變革，這些變革將會更加合理。我們正在著手進行這些變革。它們很有意思，我認為它們會對我們所參與的外科手術市場領域產生長遠影響。我對此感到非常興奮。其中一些變革涉及技術研發，一些涉及生產製造和供應鏈發展，還有一些涉及臨床路徑和監管路徑。所有這些因素都會相互影響。

I will reinforce what you said. We work on incremental changes. We work on structural changes. And we work kind of multiple generations ahead. And that remains true. We continue to do that. Timing-wise, sometimes a little bit hard to predict perfectly based on both supply chain readiness and how FDA thinks about those things. For us, I want to make sure that every time we make a step that the customers value it, that it's done with them in mind rather than with us in mind. And we continue to have that philosophy and we'll pursue it.

我會重申您剛才所說的。我們致力於漸進式變革，也致力於結構性變革，而我們的工作著眼於未來世代的發展。這一點始終不變，我們會繼續這樣做。至於時機，有時很難準確預測，這取決於供應鏈的準備以及FDA對此的看法。對我們而言，我希望確保我們採取的每一步都能真正惠及客戶，確保我們始終以客戶為中心，而不是以我們自身為中心。我們將繼續秉持這項理念，並為此努力不懈。

The next question is from Rick Wise from Stifel.

下一個問題來自 Stifel 公司的 Rick Wise。

Maybe we could talk about, you could expand on your comments on Ion. Just a couple of things you said that I'd be curious to hear more about. Submitted for EU approval, maybe you could give us a little more color on the timing of the opportunity and I'm wondering whether it impacts '22. But maybe you could also talk a little bit about what you've been kind enough to describe in the recent past as sort of an inflection point for Ion. Maybe broadly speaking, what's the feedback you're getting from how the device is using? And maybe talk a little bit about what's next. I mean, it seems more like an execution kind of story at this point.

或許我們可以聊聊，您可以詳細說說您對 Ion 的看法。您剛才提到的幾點我很想了解更多。 Ion 已經提交歐盟審批，能否詳細介紹審批的時間節點？我想知道這是否會影響到 2022 年的計劃。另外，您能否也談談您之前提到的 Ion 的一個轉折點？從整體來看，您從使用者回饋中了解到這款裝置有哪些使用情況？能否也談談下一步的計劃？我的意思是，目前看來，這更像是執行層面的問題。

Thanks, Rick. On submission for Europe, we just submitted our dossier. Europe has changed over the framing of their medical device regulation. They call it EU MDR. It's relatively new for the world. As a result, projecting exact timing to get those clearances is a little different relative to historical norms. We don't anticipate it completing in 2022. It's a little bit of, what's the odds game, but we think it's several quarters to finish mostly because it's new for the regulators and it's new for us.

謝謝，里克。關於歐洲的審批，我們剛剛提交了申請資料。歐洲的醫療器材法規架構已經改變，他們稱之為歐盟醫療器材法規（EU MDR）。這對世界來說還比較新。因此，與以往相比，獲得這些批准的確切時間預測會略有不同。我們預計無法在2022年完成。這有點像是在玩機率遊戲，但我們認為需要幾個季度才能完成，主要是因為這對監管機構和我們來說都是新的。

On the point of how is Ion going, it's being driven right now on the single indication of biopsy and bronchoscopy. I think it's driving well because it meets a need. I think alternate technologies, manual and robotic, are less capable. And we see a lot of peer-to-peer word of mouth that is driving interest, and that's backed by data like the PRECIsE trial. So that's been helpful for us.

關於Ion系統的發展情況，目前它主要針對活檢和支氣管鏡檢查這一單一適應症。我認為它發展得很好，因為它滿足了實際需求。我認為其他技術，無論是手動或機器人輔助，都無法完全滿足需求。我們看到許多口碑傳播推動了人們對它的興趣，而PRECIsE試驗等數據也支持了這種興趣。所以這對我們很有幫助。

A lot of our focus here has been developing our manufacturing capacity, continuously improving the product in terms of usability, quality, robustness and efficacy. And the teams are doing a great job and working extremely hard to do all of those things, make sure that we can maintain supply and improve. I'm just delighted with what they're up to. They are both increasing capacity and improving robustness and quality simultaneously. So that's been wonderful, and I think we have room.

我們目前的工作重點是提升產能，並不斷改進產品的易用性、品質、耐用性和功效。團隊的工作非常出色，他們為此付出了巨大的努力，確保我們能夠維持供應並持續改進。我對他們的工作成果感到非常滿意。他們正在同步提升產能、耐用性和品質。這真是太棒了，而且我認為我們還有提升的空間。

We're seeing the combination of Ion bronchoscopic evaluation combined with robotic surgery thereafter. Sometimes people do it on the same day. And that has seen some real value for patients. It's not every part of the patient population, but there are some patients for whom that's a good solution. And we see a lot of excitement. So the tie-through of Ion diagnostics with follow-through treatment is creating patient value. It's shortening the time to definitive answers and then a surgery if a surgery is indicated. So that's been great.

我們看到，Ion支氣管鏡檢查與後續的機器人手術相結合的治療模式正在興起。有時，患者甚至能在同一天完成這兩項治療。這種模式確實為患者帶來了實質的好處。雖然並非所有患者都適合這種治療方式，但對於某些患者來說，這確實是一個很好的解決方案。我們看到了很多正面的回饋。因此，Ion診斷與後續治療的結合正在為患者創造價值。它縮短了獲得明確診斷結果的時間，並在必要時加快了手術。這真是太棒了。

We think Ion as a platform has multiple future indications that it can provide, of clinical value that it can bring, and we are pursuing them assertively in various places. We are not yet publicly describing what those things are, in part because we have some technology to develop, in part there's some regulatory pathways and it's a competitive space. And so we're working down those elements. As we get a little closer, have a little bit better visibility into which ones, when, then we'll be sure to share.

我們認為Ion平台未來有多種適應症，能夠帶來臨床價值，我們正在積極地在各個領域推進這些適應症的開發。目前我們尚未公開具體內容，部分原因是我們需要開發一些技術，部分原因是涉及一些監管途徑，而且這是一個競爭激烈的領域。因此，我們正在逐步完善這些要素。一旦我們更接近目標，對具體方向和時間有更清晰的了解，我們一定會及時分享。

Got you. Procedure demand, as you clearly stated, it was healthy this quarter. It feels like it's likely to continue. So hopefully, as hopefully COVID headwinds settle back a little bit around the world, Intuitive always used to talk about the, let's see if I can say this correctly, Gary, the percentage of utilization for average utilization for da Vinci systems. And I'm sort of making this up from memory, but it used to be like when you got to 60% or 65% of da Vinci capacity, it would start to drive new discussions about new systems. Forgetting the specifics of my question, where do you feel like you are with the current installed base utilization? And is that a consideration that we should reflect on as we think about system placements going forward?

明白了。正如您所說，本季手術需求​​良好，而且感覺這種勢頭可能會持續下去。希望隨著新冠疫情在全球範圍內的影響有所緩解，Intuitive 公司過去總是會提到，嗯，我猜 Gary，達文西手術系統的平均利用率百分比。我憑記憶大概是這麼說的，但以前當達文西手術系統的產能利用率達到 60% 或 65% 時，就會開始討論添置新系統。暫且不談我的問題，您覺得目前已安裝系統的使用率如何？當我們考慮未來系統部署時，這是否是需要考慮的因素？

There's absolutely a relationship between procedure growth and demand and increased utilization on capital, right? And it's inversely related. If you have lower utilization, you sell more capital to do the same number of procedures. We have believed and have pursued assertively that while higher utilization decreases the number of systems that we sell, it increases the utility, the economic value derived by our customers to get higher throughput. And so we put programs in, both in terms of design and workflow as well as consulting services to help them get higher utilization. We've been doing that for years.

手術量成長、需求增加以及資本利用率提高之間確實存在關聯，對吧？而且是反比關係。如果利用率較低，就需要銷售更多資本來完成相同數量的手術。我們一直堅信並積極推行這個理念：雖然更高的利用率會減少我們銷售的系統數量，但它能提高效用，也就是客戶透過更高的吞吐量所獲得的經濟價值。因此，我們在設計和工作流程以及諮詢服務方面都推出了相應的方案，幫助客戶提高使用率。我們多年來一直致力於此。

It's a number that you can move in a sustained way, but it's hard to move quickly. And I'll turn it over to Jamie shortly. He'll talk a little bit about what the trend line and utilization growth has been. But from an intent point of view, we are happy to see increased utilization even if that pressures near-term capital because it creates better ROI conditions for our customers. And from a pure marginal economics point of view, at Intuitive, the marginal economics work out well for us, too. So it's a win-win even though at the top line in placements it may look like pressure.

這是一個可以持續提升的數字，但很難快速提升。我稍後會把麥克風交給Jamie，他會簡單談談趨勢線和使用率成長。但從意圖的角度來看，我們樂意利用率的提升，即使這會對短期資金造成壓力，因為它能為我們的客戶創造更好的投資報酬率。而且從純粹的邊際經濟角度來看，在Intuitive，邊際經濟效益對我們來說也是有利的。所以，儘管從投放量來看，這似乎會帶來壓力，但實際上這是一個雙贏的局面。

So then you had asked the question, kind of what is peak utilization and how do you think about that. I'll also turn that over to Jamie. It has a lot to do with mix and operating conditions in the hospital. It's a little bit less a technology question, a little bit more how they use it. So Jamie, perhaps a little bit on utilization.

所以你剛才問了關於峰值利用率的問題，以及你是如何看待這個問題的。我也把這個問題交給傑米回答。這與醫院的配置和運作條件有很大關係。這與其說是技術問題，不如說是如何使用科技的問題。那麼傑米，我們先來談談利用率吧。

If I just go back to pre-COVID for a second, Rick, if you look at 2019, average system utilization grew by 5% over 2018. If I look at recent times and use the CAGR approach to kind of normalize for COVID, last year, on a 2-year CAGR basis in 2021, utilization grew by 4%. This past quarter on a 3-year CAGR basis, again, back to 2019, grew by 4%. So you can see some relative consistency there.

里克，如果我先回顧一下新冠疫情之前的情況，看看2019年，平均係統利用率比2018年增長了5%。如果我回顧近期數據，並使用複合年均成長率（CAGR）來消除新冠疫情的影響，那麼去年，以2021年的兩年複合年均成長率計算，利用率成長了4%。而上個季度，以2019年的三年複合年均成長率計算，利用率也成長了4%。所以你可以看到，這方面有一定的穩定性。

With respect to looking forward, I think that there is some dependency on the institution, the procedure mix within the institution. General surgery in combination with Xi gives you the opportunity to drive utilization differently than a different procedure mix, particularly given the lower procedure times in some of the benign low-acuity procedures. But it also reflects the number of surgeons that are trained and the commitment of the hospital to drive asset utilization. If you look at the distribution of utilization, today, it's relatively wide. I think there are a number of CFOs in hospitals that on a medium-term basis see opportunities to continue to drive utilization up, and we are supportive of that.

展望未來，我認為這在一定程度上取決於醫療機構及其內部的手術組合。一般外科手術與Xi技術的結合，能夠以不同於其他手術組合的方式來提升資源利用率，尤其是一些病情較輕、風險較低的手術耗時較短。但這同時也反映了受訓外科醫生的數量以及醫院致力於提升資產利用率的決心。從目前的資源利用率分佈來看，其範圍相對較廣。我認為許多醫院的財務長都看到了中期內持續提升資源利用率的機會，我們對此表示支持。

And the next question is from Larry Biegelsen from Wells Fargo.

下一個問題來自富國銀行的拉里·比格爾森。

Just one on China for me and one on inflation and supply constraint. So on China, what have you guys seen so far from the lockdowns? And what are your expectations for the second quarter? Do you think you can still grow year-over-year in China? And related to that, Gary, what's the process and time line for the next quota? You're about to finish this quota. Is it possible the next quota could be larger or eliminated entirely? And I have one follow-up.

我這裡只問一個關於中國的問題，還有一個關於通貨膨脹和供應限制的問題。關於中國，你們目前從封鎖措施中看到了什麼？你們對第二季有什麼預期？你們認為在中國還能達到年成長嗎？另外，Gary，下一個配額的流程和時間表是什麼？你們即將完成目前的配額。下一個配額有可能增加或完全取消嗎？我還有一個後續問題。

I'll turn those both to Jamie.

我會把那兩樣東西都轉交給傑米。

Yes. With respect to what we saw in procedures in Q1, as you saw, the COVID cases rises in places like Shanghai. And as the authorities lock down, and they lock down pretty strictly, we saw procedures impacted in March. That's continued so far into April, although it's obviously early. I think that there's risk in procedures in Q2 relative to what you would expect without COVID and those lockdowns.

是的。如您所見，第一季的手術量有所下降，上海等地的疫情病例激增。隨著當局採取嚴格的封鎖措施，我們看到3月的手術量受到了影響。這種情況一直持續到4月份，雖然現在下結論還為時過早。我認為，與沒有疫情和封鎖措施的情況相比，第二季的手術量有一定的風險。

China is our second-biggest marketplace, but it's still a relatively small proportion of overall procedures. U.S. is still about 70% of global procedures. But certainly, the way things look right now, you have some impact in Q2. What that ends up being really depends on how long the lockdowns last and how long COVID persists in China. I think a separate risk is kind of the impact of logistics and supply chains as we deliver product to China and from a more macro perspective just the port closures and the broader impact that we could see in China given the degree of exports they have just generally across the economy.

中國是我們的第二大市場，但其業務量佔比仍然相對較小。美國仍佔全球業務量的70%左右。但就目前的情況來看，第二季肯定會受到一定影響。最終影響程度取決於封鎖措施持續的時間以及新冠疫情在中國持續的時間。我認為另一個風險是物流和供應鏈受到的影響，因為我們需要向中國交付產品。從更宏觀的角度來看，港口關閉以及考慮到中國整體經濟的出口規模，疫情可能對中國經濟產生更廣泛的影響也不容忽視。

With respect to the China quota, difficult to predict. The last couple of times, the quota has been issued in the third year of the quota period, which would be next year. We don't have great visibility into when that might be. And we don't have, honestly, great visibility into what the number would be. I don't think we are expecting or planning on a situation where we are exempt from a quota. But again, we don't have great insights to how that will play out.

關於中國配額，很難預測。過去幾次，配額都是在配額期間的第三年發放的，也就是明年。我們無法準確預測具體時間。坦白說，我們也無法準確預測配額數量。我認為我們既沒有預期也沒有計劃獲得配額豁免。但同樣，我們無法預知最終結果會如何。

In general, if the quota is responsive to demand, we think demand is high, and the question is how responsive to that demand is the central government quota when they do it. Sorry, Larry, go ahead.

一般來說，如果配額能夠回應需求，我們就認為需求很高，問題在於中央政府在製定配額時，對這種需求的回應程度如何。抱歉了，拉里，你繼續。

No. I'm sorry to interrupt you. Jamie, on inflation and supply constraints, are you able to quantify the impact on the gross margin that you're expecting from inflation? And on supply constraints, how are you addressing this? A lot of companies are buying forward inventory. And what are your expectations for when it gets better? I know you've talked about hand-to-hand combat. You've used that phrase almost on the last few calls.

不，不好意思打斷。傑米，關於通貨膨脹和供應限制，您能否量化一下您預期通貨膨脹對毛利率的影響？關於供應限制，您是如何應對的？很多公司都在提前採購庫存。您對情況好轉後的預期是什麼？我知道您之前提到過「近身肉搏」。您幾乎在最近幾次電話會議中都用到了這個詞。

Yes. I would just maybe ground the impact of inflation a couple of ways. If you look back at history, our gross margin has been in, let's say, the 71%-ish range versus what we just guided, 69% to 70.5%. And there's really 2 drivers in the gap between our history and that range. One are the investments we're making in fixed costs in infrastructure and manufacturing capacity that's being invested effectively for long-term need. So some of that is ahead of when we will need it. But the lead times require that we put that in place ahead of time.

是的。我可能會從幾個方面來解釋通膨的影響。回顧歷史，我們的毛利率通常在71%左右，而我們剛剛給出的預期是69%到70.5%。造成我們歷史資料與預期範圍之間差距的原因主要有兩個。一是我們在基礎設施和生產能力方面的固定成本投資，這些投資有效地滿足了長期需求。因此，其中一些投資是在我們需要之前進行的。但由於交貨週期的原因，我們必須提前做好準備。

The second impact is this impact from the supply chain and inflation in the form of logistics costs, higher component prices, et cetera. I can't give you perfect kind of delineation between the 2. I would say, roughly slightly more of that, the impact of that gap is on the fixed cost side. The remainder is in inflation, supply chain impacts.

第二個影響來自供應鏈和通貨膨脹，具體表現為物流成本上升、零件價格上漲等等。我無法對這兩者進行精確的區分。大致來說，這部分缺口的影響更體現在固定成本方面，其餘部分則反映在通貨膨脹和供應鏈方面。

With respect to how we're managing through the supply chain, there are significant efforts by our operations team just to respond to the whack-a-mole that you described. It's a constant battle of issue resolution. And our #1 goal, as Gary described, is to ensure continuity of supply to customers. So that's where our efforts and focus is.

關於我們如何管理供應鏈，我們的營運團隊投入了大量精力來應對您所描述的「打地鼠」式問題。我們一直在與各種問題作鬥爭。正如Gary所說，我們的首要目標是確保對客戶的持續供應。因此，這就是我們努力和關注的重點。

As the supply chain environment rebalances in whatever point that is in the future, certainly, we will kind of refocus our operations teams to focus on cost reductions, getting our manufacturing efficiencies back to our targets. But that's going to really be a question of when will that be. On the inventory side, you saw us actually increase inventories. I referenced in my prepared remarks almost $70 million sequentially. The mix of that, though, is clearly not perfect. We're replenishing inventory where we can if and as supply lasts. But we have an imbalance currently.

隨著供應鏈環境在未來某個時間點重新平衡，我們肯定會調整營運團隊的工作重心，致力於降低成本，使生產效率恢復到目標水準。但這究竟何時實現，還有待觀察。庫存方面，你們也看到了，我們實際上增加了庫存。我在先前的發言稿中提到，庫存比上季增加了近7,000萬美元。然而，目前的庫存結構顯然並不理想。我們會根據供應情況，盡可能補充庫存。但目前我們的庫存確實存在不平衡。

Certainly, if you look at the medium to long term, we're going to look carefully at what levels of inventory we want to hold as one risk mitigation. I think the other thing we'll look at is how do we make ourselves less dependent on sole suppliers.

當然，從中長期來看，我們會仔細研究庫存水平，以此作為降低風險的措施之一。我認為我們還要考慮的另一件事是如何降低對單一供應商的依賴。

Just a tiny bit of color on that capping sentence. The current situation, it's a little bit hard to predict the future because there's enough moving parts that determining what or forecasting exactly how it will move is probably difficult at this moment. Currently, the number of parts that are under stress has decreased, but the intensity of the stress around a few parts has increased. So the number of things that are a challenge is narrowing, but the ones that remain are more stubborn. And Jamie, your point of, we use various tools, whether it's buying ahead, buying safety stock or redundancy in the supply chain, we'll use any and all of those if we can to help mitigate the risk.

關於最後那句話，我再補充一點。目前的情況比較複雜，未來很難預測，因為變數太多，現在很難確定具體走向或預測其發展趨勢。目前，面臨壓力的環節數量減少，但少數環節的壓力強度卻增加。因此，挑戰的環節數量正在減少，但剩下的環節卻更加棘手。傑米，你說得對，我們會使用各種工具，無論是提前採購、購買安全庫存還是在供應鏈中增加冗餘，只要能降低風險，我們都會盡力而為。

Our next question is from Drew Ranieri from Morgan Stanley.

下一個問題來自摩根士丹利的德魯·拉涅利。

Gary, just for you. I mean, I think Intuitive has like 2,200 U.S. hospital customers. That's more my guess than, I think, what you've ever laid out. But can you maybe talk about what it takes to get the remaining 4,000 hospitals really off the sidelines and using robotics? Just maybe how are you thinking about that in the U.S.? I mean, do you necessarily have to go everywhere? Are there really kind of still opportunities to get into the high-volume surgery centers, hospitals given some of the commentary about the trade-in cycle dynamics and your push for some higher utilization of the systems?

加里，這個問題是專門問你的。我的意思是，我覺得Intuitive在美國大概有2,200家醫院客戶。這只是我的猜測，而不是你之前公佈的具體數字。可以談談如何才能讓剩下的4000家醫院真正開始使用機器人手術嗎？你在美國是如何看待這個問題的？我的意思是，真的需要面面俱到嗎？考慮到先前關於設備更換週期動態的評論，以及你一直致力於提高系統利用率，現在是否還有機會打入那些手術量大的中心醫院？

I won't speak to the quantitative approach. And perhaps, Jamie, you have a perspective. But just to give you a little bit of a qualitative view, many of the hospitals out there that are greenfields, while they may not have one of our programs today are part of an integrated delivery network that somewhere in the system they have our products and knowledge. The way we work with that is collaboratively with IDN leadership. As they start to understand what the value of the programs are, they will start to move within their own system our products into locations they care about. And so we've seen a really nice move and collaborative expansion with our customer base into those spaces.

我不打算談量化方法。傑米，或許你有自己的看法。但就定性方面而言，許多新建醫院雖然目前可能還沒有採用我們的項目，但它們都隸屬於整合醫療服務網絡（IDN），也就是說，在他們系統的某個環節，已經應用了我們的產品和知識。我們與IDN領導層合作的方式是共同協作。隨著他們逐漸了解這些項目的價值，他們會開始在自己的系統內，將我們的產品推廣到他們重視的領域。因此，我們看到了與客戶群在這些領域進行的非常成功的合作和擴展。

Increasingly, we have conversations about moving into different sites of care, especially as benign general surgery procedures and some other procedures that are benign and often done in smaller ambulatory environments become more prevalent in our workspace, we see that improving over time. So we think we can follow our customers where they want to go.

我們越來越多地討論將服務地點轉移到不同的醫療機構，尤其是在良性普通外科手術以及其他一些通常在小型門診環境中進行的良性手術在我們工作場所越來越普遍的情況下，我們看到這種情況會隨著時間的推移而改善。因此，我們相信我們可以跟隨客戶的意願，滿足他們的需求。

There is the concentrating effect of robotics and capital investment. It is capital investment. When that happens, it does concentrate regionally those patients and procedures into centers of excellence. We think that's good for our customer to get higher utilization. We think it's good for surgical outcomes because they get more practice. So I think it's a combination of the 2. I don't think we just look at it and think we have to go to where every patient is today. We do think consolidation helps and works, but it will expand from where it is in this moment. Jamie, I don't know if you want to add anything to that.

機器人技術和資本投資確實會產生集中效應。這是資本投資。當這種情況發生時，患者和手術就會在區域內集中到一些卓越中心。我們認為這對我們的客戶來說是好事，可以提高資源利用率。我們認為這對手術效果也有好處，因為他們能獲得更多實務機會。所以我認為這是兩者的結合。我們不會僅僅著眼於滿足所有患者的需求。我們確實認為整合是有益的，而且行之有效，但它會從目前的規模擴展到更大的範圍。傑米，我不知道你是否還有什麼要補充的。

The only thing I would say is the remaining greenfields tend to be, this is not always the case, but tend to be more in the rural setting, smaller number of beds. So what I think we've seen over the last 3, 4 quarters, as Gary described, is actually increases in the number of placements of greenfield accounts. These are hospitals, as Gary said, that are within existing IDNs. And that's largely a function of the success and experience those IDNs have had with benign procedures, particularly in general surgery, which tend to be a higher mix in these rural hospitals. And so they see the opportunity for effective robotics programs in that setting, whereas before maybe there was more skepticism or the financial picture was more challenging. We'll do that carefully and in conjunction with our IDN partners, and it has to be one that makes economic sense for us and for the customer.

我唯一想說的是，剩餘的新建項目往往（雖然並非總是如此）位於鄉村地區，床位數量較少。正如Gary所描述的，過去三、四個季度我們看到的是新項目數量的增加。這些醫院，正如Gary所說，都隸屬於現有的整合醫療網絡（IDN）。這很大程度上得益於這些IDN在進行良性手術方面累積的成功經驗，尤其是在普通外科手術方面，而普通外科手術在這些鄉村醫院中的比例往往更高。因此，他們看到了在這種環境下開展高效機器人手術專案的機會，而此前可能存在更多疑慮，或者財務狀況更具挑戰性。我們將與我們的IDN合作夥伴謹慎合作，確保專案對我們和客戶都具有經濟意義。

On the ASC side, we have a relatively small but growing installed base. Our procedure growth at ASCs in the U.S. is accretive, but that's probably because the number of systems that we have at hospitals or ASCs is relatively low. Those ASCs generally are ASCs affiliated in some way with our IDNs. That kind of gives us greater confidence in those accounts.

在門診手術中心（ASC）方面，我們的裝機量雖然相對較小，但正在成長。我們在美國門診手術中心的業務量成長顯著，但這可能是因為我們在醫院或門診手術中心部署的系統數量相對較少。這些門診手術中心通常與我們的整合醫療網絡（IDN）有某種形式的合作關係。這讓我們對這些客戶更有信心。

Drew, I'll give you a fast follow-up here at the end.

德魯，最後我再給你一個簡短的後續說明。

All right. Just on Japan, you talked about adding 8 more procedures, you're getting reimbursement for 8 more procedures. Can you maybe just put that in context of how you expect that ramp to maybe look like versus the prior wave of reimbursed procedures in Japan?

好的。就日本的情況而言，您提到新增了8項手術，並且獲得了這8項手術的報銷。您能否解釋一下，您預計這8項手術的報銷規模與先前在日本獲得報銷的手術數量相比會有什麼變化？

Drew, this is Brian. I guess I would say, really, the opportunity for adoption on those 8 newly reimbursed procedures, it's a bit difficult, I'd say, to estimate at this time, right? I mean, if you were to take procedures like colon resection as an example, it's highly penetrated by LAP today. So I think adoption of da Vinci will actually be dependent on, say, demonstrating clinical and economic benefits, which I think is going to take some time. And I think it's going to take some time to develop our training and proctoring capabilities and really to establish key opinion leaders. So I think it's just going to take some time. It's really hard to estimate how quickly da Vinci will adopt locally.

德魯，我是布萊恩。我想說，就這8項新納入健保報銷範圍的手術而言，其普及率目前很難估計，對吧？我的意思是，以大腸切除術為例，目前腹腔鏡手術的普及率很高。所以我認為達文西手術系統的普及實際上取決於能否證明其臨床和經濟效益，而這需要一些時間。此外，我認為我們需要時間來發展培訓和指導能力，並真正建立關鍵意見領袖。所以，我認為這需要時間。很難估計達文西手術系統在本地的普及速度。

A little color on that. I think over the midterm we're really excited about it. Over the near term, it takes more. Thank you, Drew. That was our last question.

再補充一點。我覺得中期選舉前我們都非常興奮。但短期內，還需要更多努力。謝謝你，德魯。這是我們的最後一個問題。

In closing, we continue to believe there's a substantial and durable opportunity to fundamentally improve surgery and acute interventions. Our teams continue to work closely with hospitals, physicians and care teams in pursuit of what our customers have termed the Quadruple Aim: better, more predictable patient outcomes; better experiences for patients; better experiences for their care teams; and ultimately a lower total cost to treat.

最後，我們仍然堅信，在從根本上改善外科手術和急診幹預方面存在著巨大且持久的機會。我們的團隊將繼續與醫院、醫生和護理團隊緊密合作，追求客戶所稱的「四重目標」：更佳、更可預測的患者治療效果；更佳的患者體驗；更佳的護理團隊體驗；以及最終更低的治療總成本。

We believe value creation in surgery and acute care is foundationally human. It flows from respect for and understanding of patients and 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，外科手術和急診的價值創造根植於人性。它源自於對患者及其照護團隊、他們的需求以及他們所處環境的尊重和理解。在Intuitive，我們展望未來，希望醫療照護更加微創、更有高效，能夠更早發現疾病並迅速治療，讓患者盡快回歸最重要的生活。

Thank you for your support on this extraordinary journey. We look forward to talking with you again in 3 months. This concludes the call.

感謝您在這段非凡旅程中的支持。我們期待三個月後再次與您通話。通話到此結束。

Thank you. And ladies and gentlemen, that does conclude our conference for today. Thank you for your participation and for using AT&T TeleConference Service. You may now disconnect.

謝謝大家。女士們、先生們，今天的會議到此結束。感謝您的參與以及使用AT&T電話會議服務。您現在可以斷開連線了。