Procept Biorobotics Corp (PRCT) 2022 Q4 法說會逐字稿

Good afternoon, and welcome to the PROCEPT BioRobotics Fourth Quarter Earnings Conference Call. (Operator Instructions) As a reminder, this call is being recorded for replay purposes.

下午好，歡迎來到 PROCEPT BioRobotics 第四季度收益電話會議。 （操作員說明）作為提醒，正在錄製此通話以供重播。

I would now like to turn the call over to Matt Bacso, Vice President, Investor Relations, for a few introductory comments.

我現在想把電話轉給投資者關係副總裁 Matt Bacso，請他發表一些介紹性評論。

Thank you. Good afternoon and thank you for joining PROCEPT BioRobotics Fourth Quarter 2022 earnings conference call. Presenting on today's call are Reza Zadno, Chief Executive Officer; and Kevin Waters, Chief Financial Officer.

謝謝。下午好，感謝您參加 PROCEPT BioRobotics 2022 年第四季度收益電話會議。出席今天電話會議的有首席執行官 Reza Zadno；以及首席財務官 Kevin Waters。

Before we begin, I'd like to remind listeners that statements made on this conference call that relate to future plans, events or performance are forward-looking statements as defined under the Private Securities Litigation Reform Act of 1995. While these forward-looking statements are based on management's current expectations and beliefs, statements are subject to several risks, uncertainties and assumptions and other factors that could cause results to differ materially from the expectations expressed on this conference call. These risks and uncertainties are disclosed in more detail in PROCEPT BioRobotics filings with the Securities and Exchange Commission, all of which are available online at www.sec.gov.

在我們開始之前，我想提醒聽眾，在本次電話會議上做出的與未來計劃、事件或業績相關的聲明是 1995 年《私人證券訴訟改革法案》所定義的前瞻性聲明。雖然這些前瞻性聲明基於管理層當前的預期和信念，聲明受多種風險、不確定性和假設以及其他因素的影響，這些因素可能導致結果與本次電話會議上表達的預期存在重大差異。這些風險和不確定性在 PROCEPT BioRobotics 提交給美國證券交易委員會的文件中有更詳細的披露，所有這些文件都可以在 www.sec.gov 上在線獲取。

Listeners are cautioned not to place undue reliance on these forward-looking statements, which speak only as of today's date, February 28, 2023, except as required by law, PROCEPT BioRobotics undertakes no obligation to update or revise any forward-looking statements to reflect new information, circumstances or unanticipated events that may arise.

告誡聽眾不要過分依賴這些前瞻性陳述，這些陳述僅在今天即 2023 年 2 月 28 日生效，除非法律要求，PROCEPT BioRobotics 不承擔更新或修改任何前瞻性陳述的義務以反映可能出現的新信息、情況或意外事件。

With that, I'd like to turn the call over to Reza.

有了這個，我想把電話轉給 Reza。

Good afternoon and thank you for joining us. For today's call, I will provide opening comments and a business update followed by Kevin, who will provide additional detail regarding our financial performance and initial 2023 guidance before opening the call to Q&A.

下午好，感謝您加入我們。在今天的電話會議上，我將提供開場評論和業務更新，隨后凱文將提供有關我們財務業績和 2023 年初步指導的更多詳細信息，然後再開始問答電話會議。

Starting with our quarterly revenue results, we are pleased to report another strong quarter, where our customers and patients continue to realize the significant clinical benefits of Aquablation therapy. Total revenue for the fourth quarter of 2022 was $23.8 million, representing growth of 135% compared to the fourth quarter of 2021. On a full year basis, total revenue for 2022 was $75 million, representing growth of 118% for the full year 2021.

從我們的季度收入結果開始，我們很高興地報告另一個強勁的季度，我們的客戶和患者繼續意識到 Aquablation 療法的顯著臨床益處。 2022 年第四季度總收入為 2380 萬美元，較 2021 年第四季度增長 135%。按全年計算，2022 年總收入為 7500 萬美元，較 2021 年全年增長 118%。

As I look back on 2022, I'm extremely proud of our commercial accomplishments, having increased average monthly utilization by approximately 50% despite more than doubling our U.S. installed base. Given the strong underlying demand for Aquablation therapy, we were able to deliver average utilization of approximately 6 handpieces per account per month in 2022. Our initial 2022 guidance assume utilization of approximately 4 handpieces pieces per month. Due to this rate of adoption and support for Aquablation therapy, I'm more confident than ever in our company's future.

回顧 2022 年，我為我們的商業成就感到非常自豪，儘管我們在美國的安裝基數增加了一倍多，但平均每月利用率提高了約 50%。鑑於對 Aquablation 療法的強勁潛在需求，我們能夠在 2022 年實現每個賬戶每月平均使用約 6 個手機。我們最初的 2022 年指導假設每月使用約 4 個手機。由於 Aquablation 療法的採用率和支持率，我對我們公司的未來比以往任何時候都更有信心。

As we enter 2023, we believe there are several positive factors, which will allow us to continue to execute against our strategic growth plans. More importantly, we believe these underlying fundamentals reflect the business that is laying the foundation to become the BPA surgical standard of care.

隨著我們進入 2023 年，我們相信有幾個積極因素將使我們能夠繼續執行我們的戰略增長計劃。更重要的是，我們相信這些基本面反映了正在為成為 BPA 手術護理標準奠定基礎的業務。

Starting with the current urology market, we are very fortunate to operate in a market, where the #1 reason men see urologist are symptoms associated with PPA. Given an increasing aging population along with the millions of men, who currently forego treatment, we believe underlying market growth will be attractive for many years to come. We also believe urology patient volume at the accounts continue to grow nicely and are above pre-COVID levels. In fact, most urologists have indicated to us that in addition to normal patient activity, a large number of men who have postponed surgery due to the pandemic are now scheduling surgical procedures.

從目前的泌尿科市場開始，我們很幸運能夠在這樣一個市場開展業務，在這個市場上，男性看泌尿科醫生的第一大原因是與 PPA 相關的症狀。鑑於人口老齡化以及目前放棄治療的數百萬男性的增加，我們相信潛在的市場增長在未來許多年將具有吸引力。我們還認為，賬戶中的泌尿科患者數量繼續良好增長，並且高於 COVID 前的水平。事實上，大多數泌尿科醫生向我們表示，除了正常的患者活動外，大量因大流行而推遲手術的男性現在正在安排手術程序。

Turning to our commercial organization, as mentioned on previous earnings calls, our plan was to further expand our field-based commercial team in the fourth quarter of 2022, which consists of capital sales reps, Aquablation reps and clinical support specialists. Speaking specifically about our capital sales personnel, we ended 2022 with approximately 30 capital sales reps, which is a 50% increase from the third quarter of 2022. It is important to remember the productivity curve for capital reps is approximately 6 months. Over the 6-month period, they will be responsible for building out their respective pipelines. Thus, we do not expect the capital risk added in the fourth quarter of 2022 to start meaningfully contributing to U.S. system sales until the second half of 2023, which is factored into our 2023 guidance.

談到我們的商業組織，正如之前的財報電話會議所述，我們的計劃是在 2022 年第四季度進一步擴大我們的現場商業團隊，該團隊由資本銷售代表、Aquablation 代表和臨床支持專家組成。具體說到我們的資本銷售人員，到 2022 年底，我們擁有大約 30 名資本銷售代表，比 2022 年第三季度增加了 50%。重要的是要記住資本代表的生產率曲線約為 6 個月。在 6 個月的時間裡，他們將負責建設各自的管道。因此，我們預計 2022 年第四季度增加的資本風險要到 2023 年下半年才會開始對美國系統銷售做出有意義的貢獻，這已納入我們的 2023 年指導方針。

Given our strong commercial momentum, excellent real-world clinical outcome and robust pipeline, we plan to continue field-based hiring in 2023 to further penetrate the market and expand our sales footprint beyond what we currently have today. Our goal in 2023 will be for Aquablation reps to continue identifying, training and educating new surgeons at existing and new accounts, while expanding our clinical support staff to facilitate case coverage across our installed base. As it pertains to hospital capital spending, we remain positioned for continued adoption around our AquaBeam Robotic Systems sales due to a multitude of positive factors around our technology and our early-stage of market penetration.

鑑於我們強勁的商業勢頭、出色的現實世界臨床結果和強大的管道，我們計劃在 2023 年繼續進行現場招聘，以進一步滲透市場並擴大我們目前的銷售足跡。我們在 2023 年的目標是讓 Aquablation 代表繼續在現有和新客戶中識別、培訓和教育新外科醫生，同時擴大我們的臨床支持人員，以促進病例覆蓋我們的現有客戶群。由於涉及醫院資本支出，由於圍繞我們的技術和早期市場滲透的眾多積極因素，我們仍然定位於繼續採用我們的 AquaBeam 機器人系統銷售。

With a growing and increasing educated patient population, hospitals are motivated to invest in cutting-edge technologies to ensure they stay competitive and not lose patients to other area hospitals. We believe our AquaBeam Robotic Systems allows hospitals to operate cutting-edge technology in the BPH surgical space. We exited the fourth quarter of 2022 with an installed base of 167 systems in the U.S. We estimate approximately 2,700 total hospitals in the U.S. are performing in PPA surgeries, of which 860 are high-volume targets, averaging over 200 BPH procedures per year. Given this large market, we are still very early in our adoption curve with a long runway in front of us.

隨著受過良好教育的患者人數不斷增加，醫院有動力投資尖端技術，以確保他們保持競爭力並且不會將患者流失到其他地區的醫院。我們相信我們的 AquaBeam 機器人系統可以讓醫院在 BPH 手術領域使用尖端技術。截至 2022 年第四季度，我們在美國安裝了 167 個系統。我們估計美國大約有 2,700 家醫院在進行 PPA 手術，其中 860 家是大容量目標，平均每年超過 200 例 BPH 手術。鑑於這個巨大的市場，我們仍然處於採用曲線的早期階段，前面還有很長的路要走。

In terms of our pipeline, the number of opportunities continue to grow meaningfully. When compared to the end of Q4 2022, we exited February with approximately 30% more opportunities, which have cleared this stage where we have signed a high level of confidence to close. Our 2023 guidance is informed by what we are seeing in our pipeline, how opportunities progress, what customers are telling us and overall close rate.

就我們的管道而言，機會的數量繼續有意義地增長。與 2022 年第四季度末相比，我們在 2 月結束時獲得了大約 30% 的機會，這已經清除了這個階段，我們已經簽署了高度自信的關閉。我們的 2023 年指南基於我們在管道中看到的內容、機會如何進展、客戶告訴我們的內容以及整體成交率。

Next, I want to touch on our progress securing IDN contracts in 2022. Exiting 2022, we have signed contracts with numerous IDNs, which will allow for our sales team to operate in an expedited and more predictable manner. The importance of these contracts is meaningful to our ability to penetrate the U.S. market, one of the most time consuming phases of selling capital equipment involved establishing a legal contract. The strategic benefit of working with IDN is that the corporate entity has agreed to a standardized legal contract across its hospital network. We anticipate having the majority of IDNs in the U.S. under contract by the end of 2023, which we believe will contribute meaningfully to our future revenue, which provides increased visibility in our pipeline.

接下來，我想談談我們在 2022 年獲得 IDN 合同的進展情況。到 2022 年結束時，我們已經與眾多 IDN 簽訂了合同，這將使我們的銷售團隊能夠以更快、更可預測的方式運作。這些合同的重要性對我們打入美國市場的能力意義重大，這是銷售資本設備最耗時的階段之一，涉及建立合法合同。與 IDN 合作的戰略優勢在於，公司實體已同意在其醫院網絡中籤訂標準化的法律合同。我們預計到 2023 年底，美國的大部分 IDN 都將簽訂合同，我們相信這將對我們未來的收入做出有意義的貢獻，從而提高我們管道的知名度。

Turning to increased surgeon and patient interest, as we have communicated to investors over the last 12 months, our primary focus is for Aquablation therapy to become the standard of care for BPH surgery. And to achieve this goal, we have prioritized surgeon engagement and training. Given our robust training and education program in addition to being in most procedures, our clinical support team has demonstrated its value to surgeons and hospital staff. Our consistent presence in the operating room provides surgeons with more confidence to standardize their practice to treat all ranges of prostate sizes and shapes. Due to the consistent and predictable outcomes, our surgeon customers are realizing peer-to-peer communication has increased meaningfully, resulting in active surgeon growth of 140% compared to 2021 levels.

轉向增加外科醫生和患者的興趣，正如我們在過去 12 個月中與投資者溝通的那樣，我們的主要重點是讓 Aquablation 療法成為 BPH 手術的護理標準。為了實現這一目標，我們優先考慮外科醫生的參與和培訓。鑑於我們強大的培訓和教育計劃，除了在大多數程序中，我們的臨床支持團隊已經證明了它對外科醫生和醫院工作人員的價值。我們在手術室的一貫存在使外科醫生更有信心標準化他們的做法，以治療所有範圍的前列腺大小和形狀。由於一致且可預測的結果，我們的外科醫生客戶意識到點對點交流已經有意義地增加，導致活躍的外科醫生與 2021 年的水平相比增長了 140%。

Another metric we track very closely is our Net Promoter Score, which measures customer experience and brand loyalty. As of December 2022, we surveyed our Net Promoter Score, and it was an impressive 92. We believe our Net Promoter Score is a direct reflection of our commitment to partnering with urologists, while also providing a high-quality product that delivers superior clinical outcomes. As it relates to specific Aquablation patient interest, we have also seen a meaningful uptick in online search activity. This is particularly noteworthy since direct-to-patient advertising has been predominantly driven by hospitals up to this point.

我們密切跟踪的另一個指標是我們的淨推薦值，它衡量客戶體驗和品牌忠誠度。截至 2022 年 12 月，我們調查了我們的淨推薦值，這是一個令人印象深刻的 92。我們相信我們的淨推薦值直接反映了我們與泌尿科醫生合作的承諾，同時也提供了可提供卓越臨床結果的高質量產品.由於它與特定 Aquablation 患者的興趣相關，我們還看到在線搜索活動顯著增加。這一點尤其值得注意，因為到目前為止，直接面向患者的廣告主要由醫院推動。

Our current strategy will continue to be focused on surgeon engagement and awareness. However, we believe patients actively representing Aquablation therapy and following through to see a surgeon is another positive indicator for our expanding product awareness and presence in the marketplace.

我們目前的戰略將繼續專注於外科醫生的參與和意識。然而，我們相信患者積極代表 Aquablation 療法並堅持看外科醫生是我們擴大產品知名度和市場影響力的另一個積極指標。

Next, I want to touch on reimbursement and increased private pay coverage. In aggregate, we estimate private payers and Medicare provide Aquablation coverage for a significant percentage of our target patient population. While a few payers have yet to issue a positive coverage policy, given our low penetration rate in the market and the fact that roughly 50% of BPH patients are covered under Medicare, our growth over the next few years should not be limited by additional private pay coverage. Additionally, in the fourth quarter of 2022, CMS finalized its 2023 hospital outpatient prospective payment system. The Level 6 APC code for our procedure will provide the hospitals approximately $8,558 for each Aquablation procedure, which is a slight increase over the 2022 rate.

接下來，我想談一談報銷和增加的私人支付範圍。總的來說，我們估計私人支付者和醫療保險為我們目標患者群體的很大一部分提供了 Aquablation 覆蓋。雖然一些付款人尚未發布積極的覆蓋政策，但鑑於我們在市場上的滲透率較低以及大約 50% 的 BPH 患者都在 Medicare 的覆蓋範圍內，我們未來幾年的增長不應受到額外私人支付保險。此外，在 2022 年第四季度，CMS 完成了其 2023 年醫院門診預期支付系統。我們程序的 6 級 APC 代碼將為醫院提供大約 8,558 美元的每次 Aquablation 程序，這比 2022 年的費率略有增加。

Lastly, with respect to international market development activities, in early February, Aquablation therapy received a medtech innovation briefing from the National Institute of Health and Care Excellence or NICE, for BPH in the United Kingdom. NICE has recognized that Aquablation therapy is effective for the removal of prostate tissue for people with PPH. Clinical experts set the technologies innovative compared to the standard of care and offers additional benefits such as increased ability to preserve quality of life.

最後，關於國際市場開發活動，2 月初，Aquablation Therapy 收到了英國國家健康與護理卓越研究所 (NICE) 為 BPH 提供的醫療技術創新簡報。 NICE 已經認識到 Aquablation 療法可有效去除 PPH 患者的前列腺組織。與護理標準相比，臨床專家將技術創新，並提供額外的好處，例如提高保持生活質量的能力。

Clinical experts associated with the review stated that the technology has the potential to replace TURP and will challenge Holmium Laser Enucleation of the prostate for larger prostates. While our presence in the U.K. is small today, given this updated guidance from NICE, we believe the U.K. could be an attractive market for PROCEPT in the future.

與審查相關的臨床專家表示，該技術有可能取代 TURP，並將挑戰前列腺钬激光去核術治療較大的前列腺。雖然我們今天在英國的影響力很小，但鑑於 NICE 的這一更新指南，我們相信英國未來可能成為 PROCEPT 的一個有吸引力的市場。

In summary, we are pleased with our 2022 performance and believe the tailwinds I highlighted will continue to allow us to execute our strategic growth plan of penetrating BPH hospitals, increasing utilization by treating their full range of prostate sizes and shapes and expanding private payer coverage. Given this positive momentum, we believe Aquablation therapy will truly revolutionize the treatment of BPH.

總而言之，我們對我們 2022 年的表現感到滿意，並相信我強調的順風將繼續使我們能夠執行我們的戰略增長計劃，即滲透 BPH 醫院，通過治療各種前列腺大小和形狀來提高利用率，並擴大私人付款人的覆蓋範圍。鑑於這種積極勢頭，我們相信 Aquablation 療法將真正徹底改變 BPH 的治療。

With that, I will turn the call over to Kevin.

有了這個，我會把電話轉給凱文。

Thanks, Reza. Total revenue for the fourth quarter of 2022 was $23.8 million, representing growth of 135% compared to the fourth quarter of 2021. U.S. revenue for the quarter was $21.8 million, representing growth of 149% compared to the prior year period. In the fourth quarter, we sold 28 AquaBeam Robotic Systems generating total U.S. system revenue of $10.4 million, representing system revenue growth of 109% compared to the fourth quarter of 2021.

謝謝，禮薩。 2022 年第四季度總收入為 2380 萬美元，比 2021 年第四季度增長 135%。本季度美國收入為 2180 萬美元，比去年同期增長 149%。第四季度，我們售出了 28 套 AquaBeam 機器人系統，在美國產生的系統總收入為 1040 萬美元，與 2021 年第四季度相比，系統收入增長了 109%。

U.S. handpiece and consumable revenue for Q4 was $10.4 million, representing growth of approximately 202% compared to the fourth quarter of 2021. Handpiece growth was driven by an increase in the installed base of AquaBeam Robotic Systems, which has grown 114% from the fourth quarter of 2021. Additionally, we have seen an increase in utilization from our installed base as measured by handpieces sold per account.

第四季度美國手機和耗材收入為 1040 萬美元，與 2021 年第四季度相比增長了約 202%。手機的增長是由 AquaBeam 機器人系統安裝基數的增加推動的，該系統比第四季度增長了 114% 2021 年。此外，我們還發現，根據每個客戶銷售的手機數量來衡量，我們安裝基礎的利用率有所提高。

Utilization per account increased approximately 23% compared to the fourth quarter of 2021. Utilization outperformance in the fourth quarter was a direct reflection of strong commercial execution and surgeons taking the next step to adopt Aquablation therapy as their treatment of choice for resective procedures. We view utilization as the true leading indicator of overall market adoption long-term.

與 2021 年第四季度相比，每個賬戶的利用率增加了約 23%。第四季度的出色利用率直接反映了強大的商業執行力和外科醫生採取下一步行動將 Aquablation 療法作為切除手術的首選治療方法。我們將利用率視為長期整體市場採用率的真正領先指標。

We shipped approximately 2,960 handpieces in the U.S. in the fourth quarter, representing unit growth of 145% during the fourth quarter of 2021 with average selling prices of approximately $3,140. International revenue for the fourth quarter was $2 million, representing growth of approximately 44%.

第四季度，我們在美國售出了約 2,960 台手機，2021 年第四季度單位銷量增長了 145%，平均售價約為 3,140 美元。第四季度國際收入為 200 萬美元，增長約 44%。

Gross margin for the fourth quarter of 2022 was 45%. Gross margin in the fourth quarter was negatively impacted by approximately $700,000 of inventory write-offs. The inventory write-offs were related to a lower manufacturing yield on certain components in the disposable handpiece. This issue was identified early in the fourth quarter of 2022 and resolved in the first quarter of 2023.

2022 年第四季度的毛利率為 45%。第四季度的毛利率受到大約 700,000 美元的庫存註銷的負面影響。庫存註銷與一次性手機中某些組件的製造產量較低有關。該問題於 2022 年第四季度初被發現，並於 2023 年第一季度得到解決。

While gross margins in 2022 sequentially declined throughout the year, it is important to point out that this is a direct function of manufacturing overhead expenses growing faster than revenue, along with the onetime charges noted in our fourth quarter, not an increase in standard material cost per unit. Given our favorable standard margin profile of both our robot and handpiece, we have increased confidence to absorb overhead expenses in 2023 and start showing gross margin expansion in the second half of 2023.

雖然 2022 年的毛利率全年連續下降，但必須指出，這是製造間接費用增長快於收入的直接結果，以及我們第四季度提到的一次性費用，而不是標準材料成本的增加每單位。鑑於我們的機器人和手機的標準利潤率狀況良好，我們更有信心在 2023 年吸收間接費用，並在 2023 年下半年開始顯示毛利率增長。

Lastly, on margins, we continue to make nice progress with regards to our move to San Jose, California, which will increase our footprint by 4x to 160,000 square feet. As stated previously, we expect to move into our new San Jose location by the third quarter of 2023.

最後，在利潤率方面，我們在遷往加利福尼亞州聖何塞方面繼續取得良好進展，這將使我們的佔地面積增加 4 倍，達到 160,000 平方英尺。如前所述，我們預計將在 2023 年第三季度搬遷到新的聖何塞辦公地點。

Moving down the income statement, total operating expenses in the fourth quarter of 2022 were $35.7 million compared to $21.3 million in the same period of the prior year and $32.3 million in the third quarter of 2022. The increase is driven by increased sales and marketing expenses, primarily to expand the commercial organization, increased variable compensation expenses and increased research and development and general and administrative expenses.

從損益表向下看，2022 年第四季度的總運營費用為 3570 萬美元，上年同期為 2130 萬美元，2022 年第三季度為 3230 萬美元。增加的原因是銷售和營銷費用增加，主要是為了擴大商業組織，增加可變補償費用，增加研發和一般及行政費用。

Total interest and other expense in the quarter was $3.1 million. As a reminder, we entered into a new 5-year $52 million loan agreement in October 2022. As part of this refinancing, we recognized loan extinguishment charges of $3.3 million in the fourth quarter of 2022. Given the lower interest rate associated with this new loan, we estimate quarterly interest expense of approximately $800,000 to $900,000 in 2023.

本季度的利息和其他費用總額為 310 萬美元。提醒一下，我們於 2022 年 10 月簽訂了一項新的 5 年期 5200 萬美元的貸款協議。作為此次再融資的一部分，我們在 2022 年第四季度確認了 330 萬美元的貸款清償費用。鑑於與此新協議相關的利率較低貸款，我們估計 2023 年的季度利息支出約為 800,000 美元至 900,000 美元。

Net loss was $28.2 million for the fourth quarter of 2022 compared to $18.3 million in the same period of the prior year. Adjusted EBITDA was a loss of $21.7 million compared to a loss of $14.7 million in the fourth quarter of 2021. Our cash and cash equivalents balance as of December 31 was $221.8 million (sic) [$221.9 million]. We believe our strong balance sheet will provide the liquidity and capital resources needed to support and grow our current business.

2022 年第四季度淨虧損為 2820 萬美元，上年同期為 1830 萬美元。調整後的 EBITDA 虧損 2170 萬美元，而 2021 年第四季度虧損 1470 萬美元。截至 12 月 31 日，我們的現金和現金等價物餘額為 2.218 億美元（原文如此）[2.219 億美元]。我們相信我們強大的資產負債表將提供支持和發展我們當前業務所需的流動性和資本資源。

Moving to our 2023 financial guidance, we expect full year 2023 total revenue to be approximately $125 million, representing growth of approximately 67% compared to 2022. Our capital pipeline remains robust and growing, and we are excited to continue penetrating the U.S. market at an unprecedented rate for robotic surgery. As Reza mentioned in his comments, we had a 50% increase in our capital reps by the end of 2022. Therefore, we expect our new capital reps to become fully productive in the second half of 2023. We also expect U.S. average selling prices to be approximately $375,000.

轉向我們的 2023 年財務指引，我們預計 2023 年全年總收入約為 1.25 億美元，與 2022 年相比增長約 67%。我們的資本渠道保持強勁並在增長，我們很高興能繼續滲透美國市場機器人手術前所未有的速度。正如 Reza 在他的評論中提到的那樣，到 2022 年底，我們的資本代表增加了 50%。因此，我們預計我們的新資本代表將在 2023 年下半年全面投入生產。我們還預計美國的平均售價將達到約為 375,000 美元。

Regarding handpieces sold in the U.S., we expect full year monthly utilization to be approximately 6% across our average installed base for 2023. Additionally, we expect handpiece average selling price to be approximately $3,100 and for other consumables revenue to be approximately $5 million. Lastly, we expect full year international revenue to be approximately $9 million, representing growth of approximately 24% compared to 2022.

關於在美國銷售的手機，我們預計到 2023 年我們平均安裝基數的全年月度利用率約為 6%。此外，我們預計手機平均售價約為 3,100 美元，其他消耗品收入約為 500 萬美元。最後，我們預計全年國際收入約為 900 萬美元，與 2022 年相比增長約 24%。

Moving down the income statement, we expect full year 2023 gross margins to be approximately 53%. Based on my previous comments and given the current rate of overhead absorption, we expect Q1 and Q2 gross margins to be in the high 40% to low 50% range. Additionally, we forecast full year 2023 operating expenses to be approximately $163 million. This increase in operating expense is associated with strategic investments in R&D, commercial team expansion and underlying general and administrative costs to support the business and put us in a favorable position to execute on our long-term growth plan.

向下移動損益表，我們預計 2023 年全年毛利率約為 53%。根據我之前的評論並考慮到目前的間接費用吸收率，我們預計第一季度和第二季度的毛利率將在 40% 至 50% 的高位範圍內。此外，我們預測 2023 年全年運營費用約為 1.63 億美元。運營費用的增加與研發戰略投資、商業團隊擴張以及支持業務的基本一般和行政成本有關，並使我們處於執行長期增長計劃的有利位置。

Lastly, we expect full year 2023 adjusted EBITDA to be approximately negative $70.5 million. At this point, I'd like to turn the call back to Reza for closing comments.

最後，我們預計 2023 年全年調整後的 EBITDA 約為負 7050 萬美元。在這一點上，我想把電話轉回 Reza 以徵求意見。

Thanks, Kevin. In closing, I want to thank our employees, customers and shareholders for all their support to help us along our journey to becoming the standard of care for these patients. We will continue to leverage our commercial and clinical investments to execute on our long-term strategy.

謝謝，凱文。最後，我要感謝我們的員工、客戶和股東的所有支持，幫助我們在成為這些患者護理標準的過程中提供幫助。我們將繼續利用我們的商業和臨床投資來執行我們的長期戰略。

Have a great day, and I look forward to meeting many of you at the upcoming investor conferences. At this point, we will take questions. Operator?

祝你有美好的一天，我期待在即將舉行的投資者會議上見到你們中的許多人。在這一點上，我們將接受提問。操作員？

(Operator Instructions) The first question will come from Joshua Jennings of Cowen.

（操作員說明）第一個問題將來自 Cowen 的 Joshua Jennings。

Congratulations to the strong finish to the year. I was hoping to start with the beginning of this year, 2023, just get a better understanding of, one, just the capital spending environment, different med device companies are being impacted in various ways. I wanted to hear about the PROCEPT experience in early 2023. And then anything you can share on just kind of the cadence of quarterly revenue and assuming that we should see some sequential progression. But is there any seasonality that we should be thinking about as your revenue bases blossom in 2022 in the 4Q, 1Q transition?

祝賀您以強勁的成績結束了這一年。我希望從今年年初，即 2023 年開始，更好地了解資本支出環境，不同的醫療設備公司正以各種方式受到影響。我想听聽 2023 年初的 PROCEPT 體驗。然後你可以分享任何關於季度收入節奏的信息，並假設我們應該看到一些連續的進展。但是，隨著您的收入基礎在 2022 年第四季度、第一季度的過渡中蓬勃發展，我們是否應該考慮任何季節性因素？

Josh, this is Reza. Thanks for the question. Before I get into answering the question, I wanted to provide some high-level commentary, what our enthusiasm starting 2023. Recently, I participated in our global sales meeting and met our newly hired sales rep, very enthusiastic, and we also are seeing pipeline growing and our interest in the surgeon using our product is ever increasing. Probably, with respect to capital environment, we are not seeing anything from a macro level has not changed. We are not seeing any slowdown of the capital going to 2023. I'm going to let Kevin to provide more color on this.

喬什，這是禮薩。謝謝你的問題。在開始回答這個問題之前，我想提供一些高級評論，我們從 2023 年開始的熱情是多少。最近，我參加了我們的全球銷售會議，見到了我們新聘請的銷售代表，非常熱情，我們也看到了管道不斷增長，我們對使用我們產品的外科醫生的興趣也在不斷增加。大概，就資本環境而言，我們從宏觀層面上看沒有任何變化。到 2023 年，我們沒有看到首都有任何放緩。我將讓凱文對此提供更多的顏色。

So just some specificity around the capital to your question, when we look at the full year, our total revenue guidance of $125 million, if you parse out the utilization metrics that we provided, you'll back into around 140 U.S. system sales in 2023 for the full year, which would suggest we're going to continue to see the momentum and the pipeline coming to fruition that Reza went through in his prepared remarks.

因此，關於你的問題的一些具體細節，當我們回顧全年時，我們的總收入指導為 1.25 億美元，如果你分析我們提供的利用率指標，你將在 2023 年回到大約 140 個美國系統銷售額全年，這表明我們將繼續看到 Reza 在他準備好的發言中經歷的勢頭和管道取得成果。

Specifically to the first quarter, which was part of your question, given where we're currently at today, we do expect Q1 U.S. system sales to be somewhere in the range of 25 to 30. This guidance would imply a very similar distribution of unit sales in 2023 as compared to 2022. If you go back and look at last year, about 45% of all of our capital sales were in the first half of the year and 55% were in the back half. And we think that's a very normal cadence perhaps that addresses some of the seasonality that you mentioned in your comments, which would be typical of Q1 in a capital environment.

具體到第一季度，這是你問題的一部分，鑑於我們目前所處的位置，我們確實預計第一季度美國系統銷售額將在 25 到 30 之間。該指導意味著單位分佈非常相似與 2022 年相比，2023 年的銷售額。如果回顧去年，我們所有資本銷售中約有 45% 發生在上半年，55% 發生在下半年。我們認為這是一個非常正常的節奏，也許可以解決您在評論中提到的一些季節性，這在資本環境中是典型的第一季度。

And just to summarize on the capital side, we continue to have a high degree of confidence to achieve our growth targets. Reza mentioned just the expansion of our pipeline with the high-quality opportunities, and this is our expanded field-based capital team give us a lot of conviction around the capital number that I just provided.

總結一下資本方面，我們繼續對實現我們的增長目標充滿信心。 Reza 剛剛提到了我們的管道擴張與高質量的機會，這是我們擴大的現場資本團隊讓我們對我剛剛提供的資本數量充滿信心。

One follow-up, I think I heard, Reza, you mentioned that you anticipate having contracts with the majority of major IDNs in the U.S. by the end of 2023. I just want to make sure I heard that correctly for one and then two, if it was, (inaudible) correctly. Can you just talk about where the starting point is entering 2023? I know you've had a couple of announcements, a couple of major wins with IDNs, but how big of an opportunity is that? And maybe just thinking about the growth contribution from these IDN contracts, if I did hear you correctly?

一個後續行動，我想我聽到了，Reza，你提到你預計到 2023 年底與美國大多數主要 IDN 簽訂合同。我只是想確保我聽到一個和兩個正確，如果是，（聽不清）正確。能不能簡單說說進入2023年的起點在哪裡？我知道你們已經發布了一些公告，在 IDN 方面取得了一些重大勝利，但這是一個多大的機會？如果我沒聽錯的話，也許只是考慮這些 IDN 合同對增長的貢獻？

Yes. Thanks, Josh. This is Kevin. I'll take that. And just specific to IDN, as Reza mentioned, we do think that this represents a significant opportunity. We signed contracts with several. I would characterize it with a few to go in 2023 and a few of the larger ones. And how that translates to how we're thinking about capital and how that's factored into our guidance. We do assume that IDNs purchased capital in 2023. So that is in our guidance, but we are not assuming any large multisystem type of orders in any given quarter. We do think this could happen, but we're not factoring that into our guidance at this time.

是的。謝謝，喬希。這是凱文。我會接受的。就 IDN 而言，正如 Reza 提到的，我們確實認為這是一個重要的機會。我們與幾個人簽訂了合同。我會用一些在 2023 年進行的項目和一些較大的項目來描述它。以及這如何轉化為我們對資本的看法以及如何將其納入我們的指導方針。我們確實假設 IDN 在 2023 年購買了資本。這在我們的指導中，但我們不假設任何特定季度都有任何大型多系統類型的訂單。我們確實認為這可能會發生，但我們目前並未將其納入我們的指導方針。

(Operator Instructions) The next question is coming from Craig Bijou of Bank of America.

（操作員說明）下一個問題來自美國銀行的 Craig Bijou。

Congrats on an impressive '22. I know you get this question a lot, but -- so I apologize for asking again, but I wanted to see if you could provide a little bit more color on the utilization trends. How should we think about the utilization ramp once you do get a system place? And has that ramp changed, if you look from -- if you look at systems placed in more recent quarters versus the earlier quarters?

恭喜你取得令人印象深刻的 '22。我知道你經常收到這個問題，但是 - 我很抱歉再次提出這個問題，但我想看看你是否可以提供更多有關利用率趨勢的信息。一旦您獲得系統名額，我們應該如何考慮利用率提升？如果你看一下 - 如果你看看最近幾個季度與較早幾個季度放置的系統，那麼這個斜坡是否發生了變化？

Yes. Thanks, Craig. This is Reza. We are very pleased to utilize it across all the installed base. As you recall, last year, we entered the year, our goal was 4 per account per month. We finished 6, despite many new accounts that we open. And that is because surgeons are using it on all broad size range and more surgeons on the account start using the system. And they are standardizing the procedure. It takes about 3 quarters to get to 6. And so despite even, for example, going to 2023, we are adding, let's call 140 accounts, we are going from 160 roughly to 300 accounts, and we are main-- our goal is to maintain that at 6. So that is -- we are very excited that our current accounts continue increasing. So getting to 6 roughly about 3 quarters, if that's your question.

是的。謝謝，克雷格。這是禮薩。我們很高興在所有已安裝的基礎上使用它。您還記得，去年，我們進入了這一年，我們的目標是每個帳戶每月 4 個。儘管我們開設了許多新帳戶，但我們完成了 6 個。那是因為外科醫生在所有廣泛的尺寸範圍內使用它，並且該帳戶上的更多外科醫生開始使用該系統。他們正在標準化程序。大約需要 3 個季度才能達到 6 個。因此，即使到 2023 年，我們仍在增加，讓我們稱之為 140 個賬戶，我們將從大約 160 個賬戶增加到 300 個賬戶，我們的主要目標是將其維持在 6。也就是說 - 我們對我們的經常賬戶繼續增加感到非常興奮。如果這是你的問題，那麼大約在 3 個季度內達到 6。

That's helpful. And maybe just a follow-up on that, are systems placed now? Is it a faster utilization ramp than maybe what you saw in earlier placements?

這很有幫助。也許只是對此的後續行動，現在是否放置了系統？它是否比您在之前的展示位置中看到的利用率更快？

It's highly variable, Craig. This is Kevin. Given we're so early in our commercial trajectory. What I will say is that we're definitely seeing in new accounts a greater number of surgeon interest at each of those accounts. So if I go back kind of 1 or 2 years ago, we'd identify a surgeon champion and perhaps maybe that might be the only surgeon performing Aquablation in the hospital, whereas today, we're seeing when we're placing a system much more surgeon interest and more surgeons performing Aquablation. I think, again, it's highly variable, but directionally, we are seeing higher utilization initially than we were a year or 2 ago.

這是高度可變的，克雷格。這是凱文。鑑於我們處於商業軌道的早期階段。我要說的是，我們肯定會在新賬戶中看到每個賬戶都有更多的外科醫生興趣。因此，如果我回到大約 1 或 2 年前，我們會確定一位外科醫生冠軍，也許這可能是唯一在醫院進行水消融的外科醫生，而今天，我們看到我們何時將系統放置得太多更多的外科醫生興趣和更多的外科醫生進行 Aquablation。我再次認為，它變化很大，但從方向上講，我們最初看到的利用率比一兩年前更高。

Got it. That's helpful. And then if I can ask on the capital reps and the large number of hires. Just a little bit more on the strategy there, are those going into new greenfield opportunities, geographies that you're not in currently? Or is it to handle some demand in existing geographic locations? And then just if you guys could remind us of the rep productivity and kind of what do you expect at maximum rep productivity for the capital reps?

知道了。這很有幫助。然後我是否可以詢問資本代表和大量僱員。就那裡的戰略再多說一點，那些正在進入新的綠地機會，你目前不在的地區嗎？還是為了處理現有地理位置的一些需求？然後，如果你們能提醒我們代表生產力以及您對資本代表的最大代表生產力的期望是什麼？

Yes. Thanks, Craig. So last year, we were about 20 capital reps and they produced about 100 systems. So productivity was about 45 systems. It takes about 6 months for a capital rep to get to that level of productivity. The 10 capital rep that we added in the back half of the fourth quarter become -- they get to that level in the second half of 2023. And these new reps that we have added will be in new territory, we are expanding territories in large cities like Minneapolis, Seattle, all the new Charlotte. So these are the -- where they are going.

是的。謝謝，克雷格。所以去年，我們有大約 20 名資本代表，他們生產了大約 100 個系統。所以生產力大約是 45 個系統。資本代表需要大約 6 個月的時間才能達到這種生產力水平。我們在第四季度後半段增加的 10 名資本代表成為 - 他們在 2023 年下半年達到這個水平。我們增加的這些新代表將在新的領域，我們正在擴大領土像明尼阿波利斯、西雅圖和新夏洛特這樣的城市。所以這些就是他們要去的地方。

And just -- and Craig, that's a primary reason that the capital forecast is split 45% in the first half and 55% in the back half of the year. The majority of those new hires that Reza referenced, they are going into greenfield territories, where we didn't either -- did not have a presence or we didn't have a highly focused presence. And we think that productivity is really going to start to come through in the back half of '23.

只是 - 克雷格，這是資本預測在上半年分裂 45% 和下半年分裂 55% 的主要原因。 Reza 提到的大多數新員工，他們都進入了綠地，而我們也沒有——沒有存在，或者我們沒有高度集中的存在。而且我們認為生產力真的會在 23 世紀下半年開始出現。

(Operator Instructions) Next question will be coming from Chris Pasquale of Nephron.

（操作員說明）下一個問題將來自 Nephron 的 Chris Pasquale。

I wanted to follow-up on the sales force. I appreciate the detail on the capital side. Can you tell us where you exited the year in terms of Aquablation sales reps? And then as we think about '23, what are you targeting in terms of growth for your overall rep headcount by the end of the year?

我想跟進銷售人員。我很欣賞資本方面的細節。你能告訴我們你在 Aquablation 銷售代表方面退出了這一年嗎？然後，當我們考慮 23 年時，您的目標是到年底實現整體代表人數的增長？

Yes. So we made very -- so we have a sales force that consists of 3 types of -- Reza and myself spend a lot of time going through the capital reps. So we also have Aquablation reps who are responsible for driving utilization, and we also have a clinical sales team, which is responsible for surgeon training and case coverage. We didn't provide specific numbers, but you can assume that the person increase in those buckets was very comparable to the person increase with robotic reps. So that's the absolute number. In terms of cadence and timing, that is something we're going to continue to evaluate throughout the year. Our operating expense guidance does allow us to make investments in the commercial team throughout the year. So what we have today isn't what we expect to end the year, but we do expect to add and that's encompassed in our guidance.

是的。所以我們非常 - 所以我們有一支由 3 種類型組成的銷售隊伍 - Reza 和我自己花了很多時間與資本代表打交道。因此，我們也有負責推動利用率的 Aquablation 代表，我們還有一個臨床銷售團隊，負責外科醫生培訓和病例報導。我們沒有提供具體數字，但您可以假設這些桶中的人員增加與機器人代表的人員增加非常相似。這就是絕對數字。就節奏和時機而言，這是我們將在全年繼續評估的內容。我們的運營費用指南確實允許我們全年對商業團隊進行投資。因此，我們今天所擁有的不是我們期望在今年年底達到的，但我們確實希望增加，這包含在我們的指導中。

Okay. And then the handpiece ASP has been climbing pretty steadily over the past 5 or 6 quarters now. You're assuming it levels out here in '23. Is there any reason you couldn't continue to take price incrementally higher given the favorable economics for the hospital?

好的。然後，在過去的 5 或 6 個季度中，手機 ASP 一直在穩步攀升。你假設它在 23 年達到水平。鑑於醫院有利的經濟狀況，您是否有任何理由不能繼續逐步提高價格？

Yes. So today, the last few quarters have actually been fairly stable kind of in that $3,000 to $3,100 range, and that's what we guided to in '23. I think in the short-term, that's the price that we'd be looking to charge customers. We feel that's where there's a win on both sides for both the hospital and for the company. And I don't expect us to take price up on the handpiece in the near-term.

是的。所以今天，過去幾個季度實際上在 3,000 美元到 3,100 美元的範圍內相當穩定，這就是我們在 23 年的指導方針。我認為在短期內，這就是我們希望向客戶收取的價格。我們認為這對醫院和公司來說都是雙贏的地方。而且我不希望我們在短期內提高手機的價格。

(Operator Instructions) The next question will be coming from Richard Newitter of Truist.

（操作員說明）下一個問題將來自 Truist 的 Richard Newitter。

I'll echo my congrats on the strong finish to the year. Just going back to your comment, rather than 30% more opportunities are, I guess, at a high confidence or in a high confidence cohort within your pipeline or your funnel. I'm curious with the IDN or greater percentage of IDN contracts in place. I'm just trying to trying to max those 2 things together to get a sense quantitatively if possible, like how much more visibility you have into the year ahead guide that you're providing today compared to when you provided your guidance at the beginning of last year? Maybe what percentage of your funnel would you have characterized this high confidence at that point in time? And I'm also just curious, with the IDNs and more kind of established contracting there, does that just mean that the conversion rate and the capital sales cycle of those high confidence accounts gets shortened? Help me think through some of those items.

我將對今年的強勢結束表示祝賀。回到你的評論，而不是 30% 更多的機會，我猜，在你的管道或渠道中的高信心或高信心人群中。我對 IDN 或更大比例的 IDN 合同感到好奇。我只是想盡量將這兩件事放在一起，以便在可能的情況下獲得定量的感覺，比如與你在開始時提供指導時相比，你對今天提供的來年指導的可見性有多大去年？也許在那個時間點，您的漏斗中有多少百分比具有這種高信心？而且我也很好奇，有了 IDN 和更多類型的既定合同，這是否意味著那些高可信度帳戶的轉換率和資本銷售週期會縮短？幫助我考慮其中的一些項目。

This is Kevin. I'll take your question. And the short answer is, we have much greater visibility and predictability into our funnel today than we did a year ago, really just due to the fact that we have another year of commercial experience and history to lean on. So we have a higher degree of visibility today. But specifically to the pipeline and the metrics that we provided, that increase in the pipeline of 30%. It's important to note that, that is measured by as we call it internally deals that have reached Stage 1, where we've already identified a surgeon champion within that account, and we have a high degree of confidence that, that deal will close. That metric does not include every deal in the funnel. So the metric we're providing is the metric that we think has a high degree of certainty to close and we have a high degree of visibility into that deal, which is the primary reason to your question that we feel very comfortable with our full year capital guide, albeit timing could be variable, as you know, in the capital world. So that's on visibility.

這是凱文。我會回答你的問題。簡短的回答是，與一年前相比，我們今天對漏斗的可見性和可預測性要高得多，這真的只是因為我們還有一年的商業經驗和歷史可以依靠。所以我們今天有更高的知名度。但具體到管道和我們提供的指標，管道增加了 30%。重要的是要注意，這是通過我們稱之為已達到第一階段的內部交易來衡量的，我們已經在該賬戶中確定了一位外科醫生冠軍，並且我們高度相信該交易將完成。該指標不包括漏斗中的每筆交易。因此，我們提供的指標是我們認為具有高度確定性的指標，我們對該交易有高度的可見性，這是我們對全年感到非常滿意的問題的主要原因資本指南，雖然時間可能是可變的，正如你所知，在資本世界。這就是可見性。

To your question on IDNs, right now, that's really a license to hunt for us. You would assume should shorten that sales funnel from the 3 to 6-month period, but we're still very early in that IDN journey and are kind of still evaluating any differences there. But the drafting of a legal contract definitely takes time and having an IDN contract in place shorten that time.

對於你關於國際化域名 (IDN) 的問題，現在，這實際上是對我們進行搜索的許可。您可能會認為應該將銷售漏斗從 3 個月縮短到 6 個月，但我們在 IDN 旅程中仍處於早期階段，並且仍在評估那裡的任何差異。但起草一份法律合同肯定需要時間，而製定一份 IDN 合同可以縮短這一時間。

Okay. That was really helpful. Maybe turning to the handpiece and the guidance on utilization, so you're guiding to, I guess, an average of 6 per system per month -- per year -- I'm sorry, 6 per system per month. That's virtually no growth year-over-year. You guided to 4 at the beginning of last year, you delivered 6. I guess why -- how should I think about that? You've been growing your utilization in the teens for several quarters now. I'm just curious, is that just conservatism? Is there anything that's happened? Is it just a lot of large numbers at install base is getting bigger and that's the way to think about it? Or does that potentially leave room for overage if things continue to develop as they have been over the last few quarters?

好的。這真的很有幫助。也許轉向機頭和使用指南，所以我猜你指導的是平均每個系統每月 6 個 - 每年 - 對不起，每個系統每月 6 個。這幾乎沒有同比增長。你在去年年初指導了 4 個，你交付了 6 個。我猜為什麼——我應該如何考慮？幾個季度以來，您一直在提高青少年的利用率。我只是好奇，這只是保守主義嗎？有什麼事情發生了嗎？是否只是安裝基礎上的大量數字越來越大，這就是思考它的方式？或者，如果事情繼續像過去幾個季度那樣發展，這是否有可能為超支留下空間？

Thanks for the question. Good question. We had the installed base stayed the same. Yes, that's a good comment. But as I mentioned last year, we increased the installed base. And this year, we are going to add another, let's call it, 140. So going from 160 to 300, we're maintaining that utilization means, current accounts have to use more than 6 in order to average to stay at 6. We are adding -- we are going again from 160 to 300 new accounts, maintaining utilization at 6, and it takes about 3 quarters for new accounts to reach that level. So we are very happy with that level of utilization, particularly where we are installing so many new accounts.

謝謝你的問題。好問題。我們的安裝基礎保持不變。是的，這是一個很好的評論。但正如我去年提到的，我們增加了安裝基數。今年，我們將增加另一個，我們稱之為 140。所以從 160 到 300，我們保持這種利用率意味著，經常賬戶必須使用超過 6 才能平均保持在 6。我們正在添加——我們將再次從 160 個新帳戶增加到 300 個新帳戶，將利用率保持在 6，新帳戶需要大約 3 個季度才能達到該水平。因此，我們對這種利用率水平感到非常滿意，尤其是在我們安裝如此多新帳戶的情況下。

(Operator Instructions) And our next question is coming from Neil Chatterji of B. Riley.

（操作員說明）我們的下一個問題來自 B. Riley 的 Neil Chatterji。

I think a lot of might have been asked, but maybe on -- I think earlier, you mentioned kind of an uptick in patient-driven demand activity. Just kind of curious, any more color there on expectations for that to be a growing driver? And do you intend to launch any DTC campaigns over time?

我想可能會問很多問題，但也許是——我想早些時候，你提到了患者驅動的需求活動有所上升。只是有點好奇，是否還有更多關於它成為增長驅動力的預期顏色？您是否打算隨著時間的推移發起任何 DTC 活動？

So yes, we are seeing that through the hits on the website, but we are not planning to run a direct-to-consumer campaign. Whatever -- when we have new accounts, we provide material update to reach out to their patients, but we do not currently do the direct-to-consumer advertising. It is through the accounts.

所以是的，我們通過網站上的點擊率看到了這一點，但我們不打算開展直接面向消費者的活動。不管怎樣——當我們有新客戶時，我們會提供材料更新以接觸他們的患者，但我們目前不做直接面向消費者的廣告。它是通過帳戶。

This is Kevin. I think it's important to remember, our initial commercial strategy is to cannibalize an existing large and growing market. We're not trying to move patients to a different site of service. The patients at these hospitals are already there, the #1 reason men go see a urologist and there's no shortage of patients to treat. There's just been a lack of viable alternatives to treat those patients. And therefore, I don't think we have the same kind of DTC comparable that perhaps some other technologies may have to embark on to early in our commercialization.

這是凱文。我認為重要的是要記住，我們最初的商業戰略是蠶食現有的龐大且不斷增長的市場。我們不會試圖將患者轉移到不同的服務地點。這些醫院的病人已經在那裡，這是男人去看泌尿科醫生的第一個原因，而且不乏需要治療的病人。只是缺乏可行的替代方法來治療這些患者。因此，我認為我們沒有同類的 DTC 可比，也許其他一些技術可能必須在我們的商業化早期著手進行。

Great. And then secondly, maybe just anything we should anticipate hearing in relation to occupation at the upcoming AUA conference this spring or any specific KOL events to raise awareness?

偉大的。其次，也許我們應該期待在今年春天即將舉行的 AUA 會議或任何特定的 KOL 活動中聽到與職業相關的任何內容以提高認識？

Yes. So there will be some presentations, but the most important is the order to 5-year data will be presented. And AUA, we are excited about that -- that is what will be presented along other presentations.

是的。所以會有一些介紹，但最重要的是將介紹 5 年數據的順序。而 AUA，我們對此感到很興奮——這將與其他演示文稿一起介紹。

We're also going to have an IR event, again, at AUA, where we'll have surgeon speakers along with the management team that we're going to give an announcement out shortly, but we're going to do that again this year at AUA as well.

我們還將在 AUA 再次舉辦 IR 活動，屆時我們將與管理團隊一起邀請外科醫生演講，我們將很快發佈公告，但我們將再次這樣做也是在 AUA 的一年。

(Operator Instructions) Our next question will be coming from Nathan Treybeck of Wells Fargo.

（操作員說明）我們的下一個問題將來自富國銀行的 Nathan Treybeck。

I just wanted to understand the status of your PPP, was set to expire in December of '22, but it looks like it has been extended by year. Can you comment there?

我只是想了解您的 PPP 的狀態，原定於 2022 年 12 月到期，但看起來它已經延長了一年。你能在那裡發表評論嗎？

Yes, thanks for the question. So the transitional pass-through, we -- it was for 2 years and it has increased by 1 more year. It brings some incremental benefit to some accounts, but it's not in a meaningful manner that would change much -- some accounts will benefit. Definitely, we are excited about it, but it's not -- it doesn't affect every account. It doesn't have any negative impact. It's just positive for some accounts. The good news is the APC Level 6 stayed at the level, in fact, increased a little bit over 2022.

是的，謝謝你的提問。所以過渡傳遞，我們 - 持續了 2 年，並且又增加了 1 年。它為某些帳戶帶來了一些增量收益，但不會以有意義的方式改變太多——某些帳戶會受益。當然，我們對此感到很興奮，但事實並非如此——它不會影響每個賬戶。它沒有任何負面影響。這對某些帳戶來說只是積極的。好消息是 APC Level 6 保持在這個水平，實際上比 2022 年有所增加。

Specific to guidance, Nate, we basically, our sales effort has always assumed transitional pass-through is going away. So even with the extension, it didn't change our thinking about the year in 2023. As Reza mentioned, there may be a marginal benefit for some accounts. But in general, our commercial team has been communicating to customers since the beginning of '22 that this was going away. So we're not in a position, where people are buying our system or increasing utilization because of PPP. It was nice to have when we had very limited coverage when we had Medicare only, for example. But given where we're at right now with private payer coverage, given the APC Level 6 that Reza referenced, this really wasn't a commercial driver for us moving forward.

具體到指導，內特，我們基本上，我們的銷售工作一直假設過渡傳遞正在消失。因此，即使延期，也沒有改變我們對 2023 年的想法。正如 Reza 提到的，某些客戶可能會獲得邊際收益。但總的來說，自 22 年初以來，我們的商業團隊一直在與客戶溝通這將消失。因此，我們無法讓人們購買我們的系統或因為 PPP 而提高利用率。例如，當我們只有醫療保險時，我們的覆蓋範圍非常有限，這真是太好了。但考慮到我們現在所處的私人支付覆蓋範圍，考慮到 Reza 提到的 APC 6 級，這真的不是我們前進的商業驅動力。

Okay. And can you comment on any changes you've seen in recent trends around the prostate sizes that are being addressed by Aquablation? I mean have you seen procedures kind of move down into -- in the smaller end of the prostate spectrum in the last 6 months or so?

好的。您能否評論一下您在 Aquablation 解決的前列腺大小的近期趨勢中看到的任何變化？我的意思是，在過去 6 個月左右的時間裡，您是否看到過一些程序進入了前列腺範圍較小的一端？

So we have been monitoring this for the last 2 years roughly, and the majority of the cases are below 100 gram, but the top of the bell curve is between 60 and 80 gram. So what that shows is surgeons are using this now on all prostate side. The histogram that we are seeing represents the histogram of prostates are patients with BPH, they're using it on all prospects right now.

所以我們在過去 2 年裡一直在粗略地監測這一點，大多數情況下都在 100 克以下，但鍾形曲線的頂部在 60 到 80 克之間。所以這表明外科醫生現在正在所有前列腺側使用它。我們看到的直方圖代表前列腺增生患者的直方圖，他們現在正在所有潛在客戶中使用它。

Okay. If I could just sneak one more in. Just around the gross margins. So I understand the first half is going to be impacted by the inventory issue. But I believe previously, you indicated you were comfortable exiting the year at 55% in Q4. Is that still the case? And how should we think about progression through the year?

好的。如果我能再偷偷進去一點就好了。就在毛利率附近。所以我知道上半年將受到庫存問題的影響。但我相信之前，你表示你很樂意在第四季度以 55% 的比例退出今年。現在還是這樣嗎？我們應該如何考慮這一年的進展？

Yes. So progression through the year, Q1 and Q2 will be in the high-40s and low-50s. And then we would expect, as you implied, that we would be in the mid-50% range in the back half of the year, which on a blended basis, would get us to 53%. And it's important to note that we just need to grow into the investments that we made in 2022, and we're not expanding the operations team in the same manner this year. And you're really going to start to see the leverage of that team in the back half of the year as revenue increases.

是的。因此，今年的進展，第一季度和第二季度將處於 40 多歲和 50 多歲的低位。然後我們預計，正如您暗示的那樣，我們將在今年下半年處於 50% 的中間範圍內，在混合的基礎上，這將使我們達到 53%。重要的是要注意，我們只需要在 2022 年進行的投資中成長，而今年我們不會以同樣的方式擴大運營團隊。隨著收入的增加，你真的會在今年下半年開始看到該團隊的影響力。

(Operator Instructions) And the next question is coming from Matthew Mishan of KeyBanc.

（操作員說明）下一個問題來自 KeyBanc 的 Matthew Mishan。

Just on R&D, it was a noticeable step-up in 3Q and 4Q sequentially on the R&D dollars. Just can you comment a little bit about where you're spending and kind of where the dollars are going incrementally?

就研發而言，第三季度和第四季度的研發費用明顯增加。你能評論一下你在哪裡消費以及美元的增量嗎？

Yes. Thanks for the question, Matt. So we did see an R&D sequential increase of $2 million in Q4. And a few reasons for that. Just philosophically, as a robotic company, we're always going to be highly focused on innovation, and we made investments across the board in R&D in Q4. This was in people. It was in products. It was in processes. And specific to products, we're not going to talk about future platform type of R&D. We are always working to maintain our clinical advantage from a technology standpoint. So rest assured, we are working on things like that. But in the near-term, we're definitely focused on items that make our robotic system simpler to use, improving workflow, improving the overall design of the system, and that's where we're spending those dollars. And to your observation, you should view our Q4 R&D OpEx as more reflective of the quarterly run rate as we head into 2023. So our $163 million revenue guide, that would assume that R&D maintains that Q4 run rate of around $10 million for all of '23 as well.

是的。謝謝你的問題，馬特。所以我們確實看到第四季度的研發連續增加了 200 萬美元。以及一些原因。從哲學上講，作為一家機器人公司，我們將始終高度關注創新，並且我們在第四季度對研發進行了全面投資。這是在人身上。它在產品中。它在過程中。具體到產品，我們不打算談論未來的平台類型的研發。我們一直致力於從技術角度保持我們的臨床優勢。所以請放心，我們正在處理類似的事情。但在短期內，我們肯定會專注於使我們的機器人系統更易於使用的項目，改進工作流程，改進系統的整體設計，這就是我們花這些錢的地方。根據您的觀察，您應該將我們的第四季度研發運營支出視為更能反映我們進入 2023 年時的季度運行率。因此，我們的 1.63 億美元收入指南假設研發在所有的季度中保持大約 1000 萬美元的第四季度運行率'23 也是如此。

Okay. I think that's great. And then just on the increase in your level of capital with sales force. I think, previously, you guys were talking about a gradual lift in kind of placements. I think you wanted to maintain a certain level of outcome as you place these devices. Are you comfortable that now that you've hired more people that you have the right training in place where over the next like 6 to 9 months as they ramp and you do start (technical difficulty) in a more accelerated fashion that you're going to get the same outcomes that you've been getting with the device over the last 18 months?

好的。我認為那很好。然後就是增加銷售人員的資本水平。我想，以前，你們在談論逐步提升安置。我認為您希望在放置這些設備時保持一定程度的結果。現在你僱用了更多的人，你是否感到舒服，你有適當的培訓，在接下來的 6 到 9 個月裡，隨著他們的增加，你確實以更快的速度開始（技術難度）獲得與您在過去 18 個月中使用該設備獲得的相同結果？

Yes, it's a great observation. And look, while we continue to recruit and hire experienced medtech capital reps, and that's our focus, and we're really happy with the people we're getting. We definitely know that training and education is what leads to success in the field and ultimately, clinical outcomes. So we're hiring on the capital front and being very cognizant of that. But at the same time, remember, we're also hiring a comparable number of clinical support staff and specialists to make sure that our physicians and our patients continue to have the outcomes that they deserve and that what we've seen over the last year. So we're highly cognizant of growing fast, but growing responsibly and not sacrificing patient outcomes. Think about it every day.

是的，這是一個很好的觀察。看，在我們繼續招聘和聘用經驗豐富的醫療技術資本代表的同時，這是我們的重點，我們對我們得到的人感到非常滿意。我們絕對知道，培訓和教育是導致該領域取得成功並最終取得臨床成果的因素。所以我們在資本方面進行招聘，並且非常清楚這一點。但與此同時，請記住，我們還聘請了相當數量的臨床支持人員和專家，以確保我們的醫生和患者繼續獲得他們應得的結果以及我們在過去一年中看到的結果.因此，我們高度認識到快速增長，但要負責任地增長，而不是犧牲患者的治療效果。每天想想。

And that was also reflected in the Net Promoter Score that we showed the support we are giving to our customers. 92 is, we believe, is a very impressive number.

這也反映在我們向客戶提供支持的淨推薦值中。我們認為，92 是一個非常可觀的數字。

(Operator Instructions) Our next question will be coming from Ryan Zimmerman of BTIG.

（操作員說明）我們的下一個問題將來自 BTIG 的 Ryan Zimmerman。

All right. I want to ask about system sales a little bit. Kevin, you gave some commentary, I think, for first quarter to be in the range of 25% to 30%. And as we think about kind of the incremental sites of care within the system, are you seeing multiple sites share systems? Just asking because our own diligence suggests we're a bit surprised that, that system number isn't marginally higher for the first quarter? And then as part of that question, at what utilization level would you think a site of care can support a second system?

好的。我想問一下系統銷售。凱文，你發表了一些評論，我認為，第一季度將在 25% 到 30% 的範圍內。當我們考慮系統內的增量護理站點時，您是否看到多個站點共享系統？只是問，因為我們自己的努力表明我們有點驚訝，第一季度的系統數量沒有略微增加？然後作為該問題的一部分，您認為護理場所可以支持第二個系統的利用率水平是多少？

So just to address the absolute number first, I think a few things there is, the sales rep productivity and our expanded field-based capital team really doesn't start to contribute to the number to the back half of the year. That's point 1. Point 2 is the split of capital sales in the first half and the second half of 45%-55%, while Q1, we gave a fairly wide range, we think that split is reflective of what we did last year as well. So there's really no change in whether it's the capital environment or how folks kind of view our system. And in fact, if you look at our first quarter growth, it is actually 70%-plus growth in the first quarter compared to the prior year. So we're really pleased, even with our first quarter growth, albeit on a range of capital sales of $25 million to $30 million. To your last question about multi-systems within a hospital, we don't view that as a main driver of our business in the near-term. Although I will say, we are starting to hear from some customers that potentially would be interested in the second system, but it's not a main driver in the near-term. If you look at an average high-volume hospital, they do about 17 BPH procedures a month on average. And if you look at the supportability of our system within a hospital, the ease of use, you really don't see a need for a second system in the near-term.

所以首先要解決絕對數字，我認為有幾件事，銷售代表生產力和我們擴大的現場資本團隊真的沒有開始為今年下半年的數字做出貢獻。那是第 1 點。第 2 點是上半年和下半年 45%-55% 的資本銷售分配，而第一季度，我們給出了相當廣泛的範圍，我們認為這種分配反映了我們去年所做的出色地。因此，無論是資本環境還是人們對我們系統的看法，都沒有任何變化。事實上，如果你看一下我們第一季度的增長，第一季度與去年同期相比實際上增長了 70% 以上。所以我們真的很高興，即使我們第一季度的增長，儘管資本銷售範圍在 2500 萬到 3000 萬美元之間。關於你關於醫院內多系統的最後一個問題，我們認為這不是我們近期業務的主要驅動力。雖然我會說，我們開始聽到一些客戶可能對第二個系統感興趣，但它不是近期的主要驅動力。如果您觀察一家普通的大容量醫院，他們平均每月進行大約 17 次 BPH 手術。而且，如果您查看我們系統在醫院內的可支持性和易用性，您確實認為短期內不需要第二個系統。

We have not factored over time may happen. But right now, we are not factoring that in.

我們沒有考慮到隨著時間的推移可能會發生。但現在，我們沒有考慮到這一點。

Okay. That's very helpful. And then the second question is also around systems for me just because a lot has been asked tonight. But as you think about the 140 or so systems for '23, how would you -- like where would you characterize those going in? Are those purely -- and this is in conjunction with the expansion of capital reps, are those purely high-volume resection hospitals that you're going to target for those 140? Or should we think you're targeting beyond, say, that high volume that 860 target that you've put out there?

好的。這很有幫助。然後第二個問題對我來說也是關於系統的，因為今晚已經問了很多。但是當你想到 23 年的 140 個左右的系統時，你會如何 - 你會在哪裡描述那些進入的系統？那些純粹 - 這與資本代表的擴張相結合，是那些純粹的高容量切除醫院，你打算為這 140 家醫院定位嗎？或者我們是否應該認為您的目標是超越您已經推出的 860 目標的高容量？

So our initial target is 860 high-volume hospitals. With that said, we have seen success in medium and low volume accounts. And in fact, of that installed base at the end of December '22 of 167, 20% to 30% of those are actually in low and medium volume hospitals, and that's been a nice surprise to the upside. And just to provide some further metrics there. If you look at the pipeline, right now that pipeline is comprised of about 80% high-volume hospitals and about 20% low and medium volume hospitals. So definitely focus on high volume, but we're seeing nice interest from the low and medium volume hospitals as well that are perhaps looking to expand their offering.

所以我們最初的目標是 860 家大容量醫院。話雖如此，我們已經看到了中低交易量賬戶的成功。事實上，在 167 年 12 月 22 日結束時安裝的基數中，有 20% 到 30% 實際上是在中低容量醫院，這是一個很好的驚喜。只是為了提供一些進一步的指標。如果你看看管道，現在管道由大約 80% 的大容量醫院和大約 20% 的中小容量醫院組成。所以肯定會專注於高容量，但我們也看到中低容量醫院的興趣很大，他們可能正在尋求擴大他們的服務範圍。

Thank you. That concludes today's Q&A session. I would like to pass the call back to Reza Zadno, CEO of close remarks. Go ahead, sir.

謝謝。今天的問答環節到此結束。我想將電話轉回給 CEO Reza Zadno，結束語。來吧，先生。

Thank you. Thanks, everyone, for joining our call today. I hope to see many of you in the upcoming conferences. Have a nice day.

謝謝。感謝大家今天加入我們的電話會議。我希望在即將舉行的會議上見到你們中的許多人。祝你今天過得愉快。

Thank you all for joining today's conference call. You may disconnect, and everyone, have a great evening. Goodbye.

感謝大家參加今天的電話會議。您可能會斷開連接，祝大家度過一個愉快的夜晚。再見。