Procept Biorobotics Corp (PRCT) 2023 Q2 法說會逐字稿

Good morning, and welcome to PROCEPT BioRobotics Second Quarter 2023 Earnings Conference Call. (Operator Instructions) As a reminder, this call is being recorded for replay purposes. I would now like to turn the call over to Matt Bacso, Vice President, Investor Relations, for a few introductory comments.

早上好，歡迎參加 PROCEPT BioRobotics 2023 年第二季度收益電話會議。 （操作員說明）謹此提醒，此通話正在錄音以供重播之用。現在我想將電話轉給投資者關係副總裁馬特·巴克索（Matt Bacso），請他發表一些介紹性評論。

Good morning, and thank you for joining PROCEPT BioRobotics Second Quarter 2023 Earnings Conference Call. Presenting on today's call are Reza Zadno, Chief Executive Officer; and Kevin Waters, Chief Financial Officer.

早上好，感謝您參加 PROCEPT BioRobotics 2023 年第二季度收益電話會議。出席今天電話會議的有首席執行官 Reza Zadno；和首席財務官凱文沃特斯。

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, these statements are subject to several risks, uncertainties, assumptions and other factors that could cause results to differ materially from the expectations expressed on this conference call. The 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，本次電話會議上所做的與未來計劃、事件或業績相關的陳述屬於 1995 年《私人證券訴訟改革法案》所定義的前瞻性陳述。雖然這些前瞻性陳述這些聲明基於管理層當前的預期和信念，但受到多種風險、不確定性、假設和其他因素的影響，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。 PROCEPT BioRobotics 向美國證券交易委員會提交的文件中更詳細地披露了風險和不確定性，所有這些文件均可在 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, July 27, 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. During the call, we will also reference certain financial measures that are not prepared in accordance with GAAP. More information about how we use these non-GAAP financial measures as well as reconciliations of these measures to their nearest GAAP equivalent are included in our earnings release.

請聽眾不要過分依賴這些前瞻性陳述，這些陳述僅截至今天（2023 年 7 月 27 日）。除法律要求外，PROCEPT BioRobotics 不承擔更新或修改任何前瞻性陳述以反映新情況的義務。可能出現的信息、情況或意外事件。在電話會議期間，我們還將參考某些未按照公認會計準則制定的財務指標。有關我們如何使用這些非 GAAP 財務指標以及這些指標與其最接近的 GAAP 同等指標的調節的更多信息，請參閱我們的收益發布。

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

說到這裡，我想把電話轉給雷扎。

Good morning, 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 updated 2023 guidance before opening the call to Q&A.

早上好，感謝您加入我們。在今天的電話會議中，我將提供開場評論和業務更新，然後由 Kevin 提供有關我們財務業績和更新的 2023 年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 a record quarter where our customers and patients continue to realize the significant clinical benefits Aquablation therapy. Total revenue for the second quarter of 2023 was $33.1 million, representing growth of 98% compared to the second quarter of 2022. Growth in the quarter was driven by strong U.S. system sales and increased utilization from our expanded installed base. We believe the combination of positive long-term clinical data, increased private payer coverage, outstanding real-world patient outcomes and an expanded field-based commercial team continued to drive surgeon interest and adoption of our robotic system. We are also starting to generate stronger international sales momentum led by the United Kingdom following the publication of the NICE Medtech innovation briefing.

從我們的季度收入結果開始。我們很高興地報告一個創紀錄的季度，我們的客戶和患者繼續認識到 Aquablation 療法的顯著臨床益處。 2023 年第二季度的總收入為 3310 萬美元，與 2022 年第二季度相比增長 98%。該季度的增長得益於美國系統銷售的強勁以及我們擴大的安裝基礎的利用率的提高。我們相信，積極的長期臨床數據、增加的私人付款人覆蓋範圍、出色的真實患者治療效果以及擴大的現場商業團隊的結合將繼續推動外科醫生的興趣和對我們機器人系統的採用。在 NICE Medtech 創新簡報發布後，我們也開始產生以英國為首的更強勁的國際銷售勢頭。

In the second quarter, we sold a record 40 robots in the U.S., generating total U.S. system revenue of $14.8 million, representing growth of 74% compared to the prior year. The sequential increase in robotic sales was driven by 2 key factors. First is the growing and expanded capital sales pipeline. Given the timing of how deals progress once we partner with a surgeon champion and how deals are unlikely to fall out of the sales funnel, we have good visibility into our pipeline and confidence to meet our second quarter system sales expectations. Second, as we communicated, a handful of deals we plan to complete in Q1 ultimately closed in the second quarter. It is an important reminder that the first quarter is typically a seasonally slow period for capital equipment, which can meaningfully impact quarter-to-quarter volatility.

第二季度，我們在美國銷售了創紀錄的 40 台機器人，美國系統總收入為 1,480 萬美元，較上年增長 74%。機器人銷量的環比增長由兩個關鍵因素推動。首先是不斷增長和擴大的資本銷售渠道。考慮到我們與外科醫生冠軍合作後交易如何進展的時間，以及交易不太可能脫離銷售漏斗的情況，我們對我們的管道有很好的了解，並且有信心滿足我們第二季度的系統銷售預期。其次，正如我們所傳達的，我們計劃在第一季度完成的一些交易最終在第二季度完成。這是一個重要的提醒，第一季度通常是資本設備的季節性淡季，這可能會對季度間的波動產生重大影響。

In terms of our pipeline, the number of robot placement opportunities continue to grow meaningfully, which has been driven by the addition of new capital reps in greenfield territories. We ended the first quarter of 2023 with approximately 30 capital sales reps, 10 of which were added in the late Q4 2022. With the productivity ramp of 6 to 9 months, we expect the capital reps added in the fourth quarter of 2022 to start contributing to the U.S. system sales in the back half of 2023. Given our system sales outperformance in the first half of the year, our expectations around full year U.S. system sales have slightly increased. However, we still expect approximately 55% of system sales to be in the second half of 2023.

就我們的管道而言，機器人安置機會的數量繼續有意義地增長，這是由於綠地地區新的資本代表的增加所推動的。截至2023 年第一季度末，我們擁有約30 名資本銷售代表，其中10 名是在2022 年第四季度末添加的。隨著6 至9 個月的生產力提升，我們預計2022 年第四季度添加的資本代表將開始做出貢獻2023 年下半年美國系統銷售。鑑於我們上半年的系統銷售表現出色，我們對全年美國系統銷售的預期略有上升。不過，我們仍預計約 55% 的系統銷量將在 2023 年下半年實現。

Next, touching on utilization and surgeon activity. U.S. handpiece and consumable revenue increased 138% compared to the second quarter of 2022. When analyzing our accounts, we are extremely pleased with overall utilization trends. Our U.S. installed base in 6 months has grown 40% compared to the end of 2022, and these new accounts take time to ramp to the levels of existing accounts. We are encouraged by what we are seeing on account specific utilization and believe we now have multiple proof points where Aquablation therapy is viewed as the respective standard of care within a given hospital.

接下來，談談利用率和外科醫生活動。與 2022 年第二季度相比，美國手機和耗材收入增長了 138%。在分析我們的賬戶時，我們對整體利用率趨勢非常滿意。與 2022 年底相比，我們在 6 個月內的美國安裝量增長了 40%，這些新帳戶需要時間才能達到現有帳戶的水平。我們對所看到的具體利用情況感到鼓舞，並相信我們現在有多個證據表明水消融療法被視為特定醫院內各自的護理標準。

The primary drivers of procedure growth continue to be active surgeon growth, which is a combination of new surgeons performing procedures and active surgeon retention rates of approximately 90% for the first 6 months of 2023. We define active surgeon retention as any surgeon who performed a case in both the current and previous quarter. As a company, we benefit greatly from this high level of surgeon retention as our commercial team can focus on training new surgeons.

手術增長的主要驅動力仍然是活躍的外科醫生增長，這是新外科醫生執行手術和2023 年前6 個月約90% 的活躍外科醫生保留率的結合。我們將活躍外科醫生保留率定義為任何執行過手術的外科醫生。本季度和上一季度的情況。作為一家公司，我們從外科醫生的高保留率中受益匪淺，因為我們的商業團隊可以專注於培訓新的外科醫生。

Our revenue guidance, as Kevin will go through shortly, continues to be informed by what we are seeing in our pipeline, how opportunities progress, what customers are telling us, the productivity ramp of new capital reps and overall growth rates. All these indicators continue to trend positive as awareness around Aquablation therapy grows, which gives us confidence in achieving our 2023 growth targets.

正如凱文將很快介紹的那樣，我們的收入指導將繼續根據我們在管道中看到的情況、機會如何進展、客戶告訴我們的內容、新資本代表的生產力提升和總體增長率來提供信息。隨著 Aqu​​ablation 療法意識的增強，所有這些指標繼續呈積極趨勢，這讓我們有信心實現 2023 年的增長目標。

Next, regarding our progress in the quarter with our IDN partners. In the second quarter, we signed a national sales contract with the largest IDN in the U.S. that secures pricing for system placement and handpieces sold to the Nationwide hospital network. Partnering with IDNs continues to be an important initiative as it will allow our sales team to operate in an expedited and more predictable manner as we partner with Aquablation surgeon champions at these hospitals.

接下來，關於我們與 IDN 合作夥伴在本季度取得的進展。第二季度，我們與美國最大的 IDN 簽署了一份全國銷售合同，確保了向全國醫院網絡銷售的系統放置和手機的定價。與 IDN 合作仍然是一項重要舉措，因為當我們與這些醫院的 Aquablation 外科醫生冠軍合作時，這將使我們的銷售團隊能夠以更快、更可預測的方式運作。

Even though we sold record number of systems in Q2, the results did not include any large multisystem orders from strategic IDNs. We believe there is an opportunity in the future for multisystem orders as our sales team continues to expand the pipeline. While there are many hospital networks in the United States, we categorize strategic IDNs as having greater than or equal to 20 hospitals in network. When analyzing the market, we estimate 17 strategic IDNs account for 26% of the 860 high volume BPH hospitals and 29% of the total 2,700 BPH hospitals. Thus, the importance of these IDN relationships is meaningful to our ability to penetrate the U.S. market and provide increased visibility and predictability in our pipeline.

儘管我們在第二季度銷售了創紀錄數量的系統，但結果並不包括來自戰略 IDN 的任何大型多系統訂單。我們相信，隨著我們的銷售團隊不斷擴大產品線，未來多系統訂單會有機會。雖然美國有許多醫院網絡，但我們將戰略 IDN 歸類為網絡中擁有超過或等於 20 家醫院。在分析市場時，我們估計 17 個戰略 IDN 佔 860 家高容量 BPH 醫院的 26%，佔 2,700 家 BPH 醫院總數的 29%。因此，這些 IDN 關係的重要性對於我們滲透美國市場並提高我們的渠道的可見性和可預測性的能力意義重大。

Turning to recent payer coverage updates. In early April, we announced that UnitedHealthcare updated its policy to include Aquablation. This updated policy went into effect on June 1. As the largest commercial payer in the United States with approximately 45 million covered lives, UnitedHealthcare's positive coverage policy will greatly improve accessibility of Aquablation therapy for men suffering from BPH. With the addition of UnitedHealthcare, we now estimate roughly 95% of men in the U.S. have access to Aquablation therapy. Regarding UnitedHealthcare coverage, we are not anticipating any short-term benefit in our Q3 utilization rate. However, we do expect to see a modest benefit of UnitedHealthcare's coverage along with normal seasonality to be a driver of expanded utilization in the fourth quarter.

轉向最近的付款人保險範圍更新。 4 月初，我們宣布 UnitedHealthcare 更新了其政策，將 Aquablation 納入其中。這項更新後的政策於 6 月 1 日生效。作為美國最大的商業支付者，UnitedHealthcare 的積極承保政策將極大地提高患有 BPH 的男性獲得 Aquablation 治療的機會，覆蓋約 4500 萬人。隨著 UnitedHealthcare 的加入，我們現在估計大約 95% 的美國男性可以獲得 Aquablation 治療。關於聯合健康保險的承保範圍，我們預計第三季度的使用率不會出現任何短期效益。然而，我們確實預計聯合醫療保險的覆蓋範圍將帶來適度的好處，加上正常的季節性因素將成為第四季度利用率擴大的推動力。

Additionally, in mid-July, CMS published its 2024 proposed rule for the hospital outpatient prospective payment system. The Level 6 APC code for Aquablation has a proposed payment that would provide the hospital $8,847 for each Aquablation procedure, which is a 3% increase over the 2023 rates. The final rule is estimated to be published in November.

此外，7 月中旬，CMS 發布了 2024 年醫院門診預期支付系統擬議規則。 Aquablation 的 6 級 APC 代碼提議為醫院每次 Aquablation 手術提供 8,847 美元的付款，這比 2023 年的費率增加了 3%。最終規則預計將於 11 月發布。

With respect to international market development activities, we generated $3.2 million of international revenue in the second quarter of 2023, representing growth of 68% compared to the prior year period. This is the second quarter in a row of outperformance by our international business. Growth in the second quarter was driven primarily by strong sales momentum in the United Kingdom. Since the recent positive BPH guidance update earlier this year for Aquablation therapy, our pipeline of large NHS hospitals has grown meaningfully. With respect to market development activities in the U.K., we are very pleased with the initial momentum we have generated. Given the acceleration interest from U.K. surgeons and strong unit economics on handpiece and system average selling prices, we plan to make further investment over the next 12 months in the U.K. to accelerate growth and expand patient awareness.

在國際市場開發活動方面，我們在 2023 年第二季度實現了 320 萬美元的國際收入，較上年同期增長 68%。這是我們的國際業務連續第二個季度表現出色。第二季度的增長主要受到英國強勁銷售勢頭的推動。自從今年早些時候針對 Aquablation 治療的積極 BPH 指南更新以來，我們大型 NHS 醫院的渠道已顯著增長。關於英國的市場開發活動，我們對所產生的初步勢頭感到非常滿意。鑑於英國外科醫生的興趣日益濃厚，以及手機和系統平均售價的強勁單位經濟效益，我們計劃未來 12 個月在英國進行進一步投資，以加速增長並擴大患者意識。

Additionally, in mid-July, we initiated enrollment of our post-market survey in Japan to treat 100 patients with Aquablation therapy. While we do not expect meaningful revenue contribution from Japan in 2023, we view Japan as a very attractive market long term. Like the U.S. and United Kingdom, our strategy is to lead with clinical data to support a more robust and sustainable commercial launch.

此外，7 月中旬，我們開始在日本進行上市後調查，以使用 Aquablation 療法治療 100 名患者。雖然我們預計 2023 年日本不會產生有意義的收入貢獻，但我們認為日本是一個非常有吸引力的長期市場。與美國和英國一樣，我們的戰略是以臨床數據為主導，支持更穩健、更可持續的商業啟動。

In summary, I'm extremely proud of the entire process team and our collective ability to deliver record order. I'm pleased with our year-to-date performance and believe the tailwinds I highlighted will continue to allow us to execute our strategic growth plan of penetrating BPH hospitals and increasing utilization by treating the full range of prostate sizes and shapes. Given this positive momentum, we believe Aquablation therapy will truly revolutionize the treatment of BPH.

總之，我對整個流程團隊以及我們交付創紀錄訂單的集體能力感到非常自豪。我對我們今年迄今為止的表現感到滿意，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 醫院並通過治療各種前列腺尺寸和形狀來提高利用率。鑑於這種積極的勢頭，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.

這樣，我會將電話轉給凱文。

Thanks, Reza. Total revenue for the second quarter of 2023 was $33.1 million, representing growth of 98% compared to the second quarter of 2022. U.S. revenue for the quarter was $29.9 million, representing growth of 102% compared to the prior year period.

謝謝，雷扎。 2023年第二季度總收入為3310萬美元，較2022年第二季度增長98%。該季度美國收入為2990萬美元，較去年同期增長102%。

In the second quarter, we sold a record 40 robotic systems, generating total U.S. system revenue of $14.8 million, an increase of 74% compared to the second quarter of 2022. Our U.S. installed base at the end of the second quarter is now at 233 systems, which is an increase of 104% compared to the second quarter of 2022.

第二季度，我們銷售了創紀錄的40 個機器人系統，美國系統總收入為1,480 萬美元，與2022 年第二季度相比增長了74%。截至第二季度末，我們的美國安裝基數目前為233系統，較 2022 年第二季度增長 104%。

Second quarter system average selling prices were $370,000, which was up 5% compared to the first quarter of 2023 and in line with our expectations. While system average selling prices met our expectations and were increased from the first quarter, we still expect variability around system pricing on a quarterly basis.

第二季度系統平均售價為 37 萬美元，較 2023 年第一季度上漲 5%，符合我們的預期。雖然系統平均售價符合我們的預期，並且較第一季度有所上升，但我們仍然預計系統定價會出現季度性波動。

U.S. handpiece and consumable revenue for the second quarter was $13.6 million, representing growth of 138% compared to the second quarter of 2022. U.S. handpiece revenue growth was driven by an increase in the installed base of robotic systems. Monthly utilization per account increased approximately 9% compared to the second quarter of 2022.

美國第二季度手機和耗材收入為 1360 萬美元，較 2022 年第二季度增長 138%。美國手機收入增長是由機器人系統安裝基數的增加推動的。與 2022 年第二季度相比，每個帳戶的每月利用率增加了約 9%。

U.S. handpiece revenue growth in the second quarter was a reflection of our existing accounts and surgeons taking the next step to adopt Aquablation therapy as their treatment of choice for all resective procedures. We view utilization as a true leading indicator of overall market adoption long term. We shipped 3,904 handpieces in the U.S. in the second quarter, representing unit growth of 124% compared to the second quarter of 2022 with average selling prices of approximately $3,110.

第二季度美國手機收入的增長反映了我們現有的客戶和外科醫生採取下一步行動，採用 Aquablation 療法作為所有切除手術的首選治療方法。我們將利用率視為整體市場長期採用率的真正領先指標。第二季度我們在美國銷售了 3,904 部手機，與 2022 年第二季度相比增長了 124%，平均售價約為 3,110 美元。

International revenue for the second quarter was $3.2 million, representing growth of 68%. As Reza mentioned, international revenue in the quarter was driven primarily by strong performance in the United Kingdom. Gross margin for the second quarter of 2023 was a record 56%, which was ahead of our expectations. Sequential gross margin expansion in the quarter was due to strong execution from our operations team and our ability to absorb overhead expenses along with revenue overachievement. Given our favorable standard margin profile of both our robot and handpiece, we have increased confidence to further absorb overhead expenses and now expect approximately 55% gross margins for full year 2023.

第二季度國際收入為 320 萬美元，增長 68%。正如禮薩提到的，本季度的國際收入主要是由英國的強勁表現推動的。 2023年第二季度毛利率創紀錄的56%，超出了我們的預期。本季度毛利率的連續增長是由於我們運營團隊的強大執行力以及我們吸收管理費用以及收入超額完成的能力。鑑於我們的機器人和手機的標準利潤率良好，我們更有信心進一步吸收管理費用，目前預計 2023 年全年毛利率約為 55%。

Moving down the income statement. Total operating expenses in the second quarter of 2023 were $44.1 million compared to $26.4 million in the same period of the prior year and $40.9 million in the first quarter of 2023. The increase was driven by increased sales and marketing expenses, primarily to expand the commercial organization and variable compensation expense, increased research and development expenses and increased general and administrative expenses.

將損益表向下移動。 2023 年第二季度的總運營費用為4410 萬美元，上年同期為2640 萬美元，2023 年第一季度為4090 萬美元。這一增長是由於銷售和營銷費用增加所致，主要是為了擴大商業規模組織和可變薪酬費用、研發費用增加以及一般和管理費用增加。

Total interest and other income was $340,000 as quarterly interest expense from our $52 million term loan was offset by favorable interest income.

利息和其他收入總額為 340,000 美元，因為我們 5200 萬美元定期貸款的季度利息支出被有利的利息收入所抵消。

Net loss was $25.3 million for the second quarter of 2023 compared to $19.2 million in the same period of the prior year. Adjusted EBITDA was a loss of $19.9 million compared to a loss of $14.6 million in the second quarter of 2022.

2023 年第二季度淨虧損為 2530 萬美元，上年同期淨虧損為 1920 萬美元。調整後 EBITDA 虧損 1,990 萬美元，而 2022 年第二季度虧損 1,460 萬美元。

Our cash and cash equivalents balance as of June 30 was approximately $150 million.

截至 6 月 30 日，我們的現金和現金等價物餘額約為 1.5 億美元。

Moving to our 2023 financial outlook. We are increasing our full year 2023 total revenue guidance to $131 million, representing growth of 75% compared to 2022. We are increasing our revenue guidance based on the following factors. Starting with U.S. systems. We continue to expect approximately 55% of system sales to be in the second half of 2023, which equates to 144 placements for the full year. Given normal seasonality and timing of deals in our pipeline, we expect third quarter system sales to be down relative to the second quarter and for the fourth quarter to be our strongest of the year.

轉向我們的 2023 年財務展望。我們將 2023 年全年總收入指導提高至 1.31 億美元，較 2022 年增長 75%。我們基於以下因素提高收入指導。從美國系統開始。我們仍然預計約 55% 的系統銷量將發生在 2023 年下半年，相當於全年 144 個位置。考慮到正常的季節性和我們管道中交易的時間安排，我們預計第三季度的系統銷售額將低於第二季度，而第四季度將是我們今年最強勁的季度。

Turning to U.S. handpiece revenue. We continue to expect full year utilization to be approximately in the mid-6s as measured by handpieces sold per account per month. Given normal seasonality and an expanding installed base, we expect third quarter monthly utilization to be roughly flat compared to the second quarter and for the fourth quarter to be our strongest utilization quarter of the year. Overall utilization will be impacted by the significant additions to our installed base in the third and fourth quarters, which our guided supplies is to grow by an additional 34% by the end of the year. Additionally, we continue to expect handpiece average selling price to be $3,100 and our other consumables revenue to be $5.9 million.

轉向美國手機收入。我們仍然預計全年利用率約為 6 左右，以每個賬戶每月銷售的手機數量來衡量。考慮到正常的季節性和不斷擴大的安裝基數，我們預計第三季度的月度利用率將與第二季度大致持平，而第四季度將是我們今年利用率最高的季度。整體利用率將受到第三和第四季度安裝基數大幅增加的影響，到年底我們的指導供應量將額外增長 34%。此外，我們仍然預計手機平均售價為 3,100 美元，其他耗材收入為 590 萬美元。

Lastly on revenue, given the strong second quarter and positive momentum, we now expect full year international revenue to be approximately $11.2 million.

最後關於收入，鑑於第二季度的強勁表現和積極勢頭，我們現在預計全年國際收入約為 1120 萬美元。

Moving down the income statement. We now expect full year 2023 gross margins to be approximately 55%, which is a slight increase over our previous guidance of 54%. Additionally, we now forecast full year 2023 operating expenses to be approximately $174 million. This increase in operating expense is associated with strategic investments in R&D, commercial team expansion, and to a lesser extent, increased general and administrative costs to support the business and puts us in a favorable position to execute on our long-term growth plan as we exit 2023. Therefore, given the increase in revenue, improved margin profile and increased operating expenses, we now expect adjusted EBITDA to be a loss of $74.5 million.

將損益表向下移動。我們目前預計 2023 年全年毛利率約為 55%，比我們之前指導的 54% 略有上升。此外，我們現在預測 2023 年全年運營費用約為 1.74 億美元。運營費用的增加與研發戰略投資、商業團隊擴張有關，在較小程度上與支持業務的一般和管理成本增加有關，並使我們處於執行長期增長計劃的有利地位，因為我們退出2023 年。因此，考慮到收入的增加、利潤率的改善和運營費用的增加，我們現在預計調整後的EBITDA 將虧損7,450 萬美元。

At this point, I'd like to turn the call back to Reza for closing comments.

此時，我想將電話轉回給 Reza 以徵求結束意見。

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 BPH. We will continue to leverage our commercial and clinical investments to execute on our long-term strategy. Have a great day, and I look forward to seeing many of you at our upcoming investor conferences. At this point, we will take questions. Operator?

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，幫助我們一路走來成為 BPH 護理標準。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。祝您有美好的一天，我期待在我們即將舉行的投資者會議上見到你們中的許多人。此時，我們將提出問題。操作員？

(Operator Instructions) Our first question comes from the line of Craig Bijou from Bank of America Securities.

（操作員說明）我們的第一個問題來自美國銀行證券公司的 Craig Bijou。

Congrats on a strong quarter. So I wanted to start by asking a few on utilization. And you guys talked about a utilization tick down sequentially, but handpiece growth was very strong on a tougher comp compared to Q1. And you did highlight that the large number of system placements probably impacted that utilization number. So I know you guys track this closely. So can you talk about what you're seeing from cohort utilization? Are you seeing any leveling off of the earlier cohorts? And maybe if you can help us understand how -- quantify or just help us understand how we think about the dilutive effect of a big system placement quarter like what you did.

祝賀季度表現強勁。所以我想首先詢問一些關於利用率的問題。你們談到了利用率連續下降，但與第一季度相比，在更艱難的競爭中手機增長非常強勁。您確實強調，大量的系統佈局可能會影響利用率。所以我知道你們密切關注這一點。那麼您能談談您從隊列利用率中看到的情況嗎？您是否發現早期群體的情況有所趨於平穩？也許您可以幫助我們了解如何量化或只是幫助我們了解我們如何看待像您所做的那樣的大型系統佈局季度的稀釋效應。

Thanks, Craig. So we are very happy with the Q2 results of the utilization and the positive underlying trends that we see. So when we analyze every cohort, definitely we see sequential growth. On the surgeon level, we see active surgeon growth. We see increased new surgeon training, and more importantly, high surgeon retention, as I mentioned in the prepared remarks. All of this results in increased utilization. And that is because of the real-world clinical data standardization of the procedure at the hospital and more importantly, from the CEO and CFO point of view of the hospital, increase efficiency because they can predict the time. So we see sequential growth accounts that we have stayed with us, but as we said, we did about 21%. This was a record robot placement. It was an increase of 21%. That was the headwind. But when we analyze cohorts, they are sequentially increased. I don't know, Kevin, you want to add something to this?

謝謝，克雷格。因此，我們對第二季度的利用率結果以及我們看到的積極的潛在趨勢感到非常滿意。因此，當我們分析每個隊列時，我們肯定會看到連續增長。在外科醫生層面，我們看到外科醫生積極成長。正如我在準備好的發言中提到的那樣，我們看到新的外科醫生培訓有所增加，更重要的是，外科醫生的保留率很高。所有這些都會提高利用率。這是因為醫院手術的真實臨床數據標準化，更重要的是，從醫院首席執行官和首席財務官的角度來看，提高了效率，因為他們可以預測時間。因此，我們看到我們一直保留著連續增長的賬戶，但正如我們所說，我們的增長率約為 21%。這是機器人放置的記錄。增長了 21%。那是逆風。但當我們分析群組時，它們會依次增加。我不知道，凱文，你想對此添加一些內容嗎？

Yes, Craig. Reza's spot on. We do continue to see the earlier cohorts continue to generate sequential increases in utilization. And when you look at those cohorts and think about how that ties into our guide for 2023, you could assume that the accounts that have been with us prior to 2023 are doing well north of the 6.5 per month average that our guide implies. And it allows our guidance for the new accounts in 2023 to be below the average. And that's how it's shaking out. You're correct in observing that having that 21% increase in our installed base is just a natural drag on utilization sequentially, which we've been talking about for a few quarters, but this is really the first quarter where we've seen that occur. But the underlying trends with our accounts hasn't changed. We have a very predictable pathway once an account is installed to increased utilization.

是的，克雷格。雷扎的位置正好。我們確實繼續看到早期的隊列繼續產生利用率的連續增長。當您查看這些群組並思考它們如何與我們的 2023 年指南聯繫起來時，您可以假設 2023 年之前在我們這裡的賬戶的表現遠遠高於我們的指南暗示的每月 6.5 個賬戶。這使得我們對 2023 年新賬戶的指導低於平均水平。這就是它的動搖方式。您的觀察是正確的，我們的安裝基數增加 21% 只是對利用率的自然拖累，我們已經討論了幾個季度，但這確實是我們看到的第一個季度發生。但我們賬戶的基本趨勢並沒有改變。一旦安裝了帳戶，我們就有了一條非常可預測的途徑來提高利用率。

Got it. Very helpful, guys. So coming in -- or after Q1, there were some investor concerns, I would say, on the system pricing given the dip. And Kevin, I appreciate your comments on the variability. You'll have variability on pricing. But it was good to see it back up to 370 level this quarter. So maybe if you can expand on your confidence that you can maintain that pricing. And are you seeing any pricing sensitivity, whether it's in certain accounts or certain regions? I mean, is there anything that you would call out where there could be some increasing price sensitivity?

知道了。非常有幫助，伙計們。因此，在第一季度之後，我想說，鑑於價格下跌，投資者對系統定價產生了一些擔憂。凱文，我很欣賞你對可變性的評論。您的定價會有變化。但很高興看到本季度回到 370 的水平。因此，如果您能夠增強您的信心，您就可以維持該定價。您是否發現任何定價敏感性，無論是在某些帳戶還是某些地區？我的意思是，您是否會指出，價格敏感性可能會增加？

Yes. Look, in my prepared remarks, I did talk about quarter-to-quarter variability around system pricing. While 370 is the average we're guiding to, I do expect that variability quarter-to-quarter and account-to-account. And we have talked a lot about our #1 goal as a company is really to partner with hospitals to drive procedure growth and to grow market share. And you can't do that if you don't have a system. So we do have internal limits to pricing, call them floors and parameters. But we're definitely willing to negotiate, especially if we have a surgeon waiting in the wings to do a lot of procedures. And happy with ASPs rebounding, but again, I would still expect quarter-to-quarter variability. And I don't view that variability as anything other than that.

是的。看，在我準備好的發言中，我確實談到了系統定價的季度變化。雖然 370 是我們指導的平均值，但我確實預計每個季度和每個賬戶都會出現這種變化。我們已經談了很多關於我們作為一家公司的第一目標實際上是與醫院合作以推動手術增長並增加市場份額。如果你沒有系統，你就無法做到這一點。因此，我們確實對定價有內部限制，稱之為下限和參數。但我們絕對願意進行談判，特別是如果我們有一名外科醫生在旁邊等著做很多手術的話。對平均售價的反彈感到高興，但我仍然預計季度與季度之間的變化。除此之外，我不認為這種變化有任何其他意義。

Our next question comes from the line of Joshua Jennings from TD Cowen.

我們的下一個問題來自 TD Cowen 的 Joshua Jennings。

Congrats on the strong quarter. Was hoping to just ask about patient demand. I mean our checks with urologists, although anecdotal, suggest that patient demand is escalating. When I reference patients, I mean patients that are seeking out Aquablation treatment, kind of being savvy and doing their own diligence. But would love to get a kind of broader view from your team, Reza and Kevin, just about what your field is reporting back just in terms of patient demand and how that's driving an uptick in utilization at your core base.

祝賀季度表現強勁。希望只是詢問患者的需求。我的意思是，我們與泌尿科醫師的檢查雖然是軼事，但表明患者的需求正在不斷增加。當我提到患者時，我指的是正在尋求 Aquablation 治療的患者，他們很精明並且自己勤奮。但我很想從你們的團隊、Reza 和 Kevin 那裡獲得更廣泛的觀點，了解你們的領域在患者需求方面所報告的內容，以及這如何推動核心基礎利用率的上升。

Yes. Thanks, Josh. Yes, definitely, we do see the patient demand by the online activities. And the full coverage, or about 95% patient access is also very helpful for patients. Now they have access. The preservation of sexual function is one of the drivers of that. And the predictability and more awareness among patients, and we see this again online activity.

是的。謝謝，喬什。是的，當然，我們確實通過在線活動看到了患者的需求。而且全覆蓋，或者說95%左右的患者訪問對患者來說也是非常有幫助的。現在他們可以訪問了。性功能的保存是其驅動因素之一。患者的可預測性和意識增強，我們再次看到這種在線活動。

Just a follow-up to Reza's other -- I know it wasn't specific to your question, Josh, but just regarding demand, I think the other side of the coin I would say is urologists demand and awareness has definitely increased. And we see that on social media, whether that's LinkedIn or Twitter with new accounts launching on a daily basis. We see that with our peer-to-peer training, which has been very successful. So it's both patient and surgeon awareness and demand that we've definitely seen an increase over the last 12 months.

只是雷扎另一個問題的後續——我知道這並不是針對你的問題，喬什，但就需求而言，我認為硬幣的另一面是泌尿科醫生的需求和意識肯定有所增加。我們在社交媒體上看到了這一點，無論是 LinkedIn 還是 Twitter，每天都會推出新帳戶。我們通過我們的同伴培訓看到了這一點，這是非常成功的。因此，在過去 12 個月裡，患者和外科醫生的意識和需求確實有所增加。

Understood. And just I believe you hired a new executive to lead the marketing effort for Medtronic earlier this year. Any plans or anything you can share just in terms of marketing to both your urologists and patients and how that could pick up as we move through 2023 and 2024? And then just one -- sorry, sneak one more in, just on the commercial team. But I'm sorry if I missed this in the prepared remarks, but just can you give us an update on, I guess, plans for capital rep sales force expansion in 2023, where we should think about that number sitting at the end of this year? And any color you can give on clinical specialists and Aquablation rep hires would be great as well.

明白了。我相信您今年早些時候聘請了一位新高管來領導美敦力的營銷工作。在向泌尿科醫生和患者進行營銷方面，您有什麼計劃或任何事情可以分享嗎？隨著我們進入 2023 年和 2024 年，這種情況會如何發展？然後就只有一個——抱歉，再偷偷進來一個，就在商業團隊裡。但如果我在準備好的發言中錯過了這一點，我很抱歉，但我想，您能否向我們提供有關 2023 年資本代表銷售隊伍擴張計劃的最新信息，我們應該考慮本報告末尾的數字年？您可以為臨床專家和 Aquablation 代表聘用人員提供任何顏色，也都很棒。

Yes. Thanks, Josh. You're correct. Now we have recently hired a marketing executive in our commercial team. He's responsible for both upstream and downstream. And he's focused on the whole gamut. I think he's going to be very complementary to our commercial team. And we're not prepared to go into specific initiatives, but it's definitely a bolster to our team to increase awareness and look at broader strategic items that surround the marketing and commercial team. So we're happy to have him on board. It's been a nice addition.

是的。謝謝，喬什。你是對的。現在，我們最近在我們的商業團隊中聘請了一名營銷主管。他負責上游和下游。他專注於整個領域。我認為他將對我們的商業團隊起到非常好的補充作用。我們不准備採取具體舉措，但這絕對是對我們團隊的一個支持，可以提高我們的團隊意識並關注圍繞營銷和商業團隊的更廣泛的戰略項目。所以我們很高興他加入。這是一個很好的補充。

Specific to capital reps and the capital team, as I said in the prepared remarks, we did increase that capital team from 20 to 30 just recently, 6 months ago. And historically, we have hired 1 or 2 capital rep classes per year. We do that to make sure they're properly trained and give them the proper support. And regarding the remainder of this year, our guidance, our OpEx guidance does allow for us to continue to add more reps to ensure continuity and to make sure we really hit the ground running in 2024.

具體到資本代表和資本團隊，正如我在準備好的發言中所說，就在最近，6個月前，我們確實將資本團隊從20人增加到了30人。從歷史上看，我們每年都會聘請 1 到 2 名資本代表。我們這樣做是為了確保他們接受適當的培訓並為他們提供適當的支持。關於今年剩下的時間，我們的指導、我們的運營支出指導確實允許我們繼續增加更多代表，以確保連續性並確保我們在 2024 年真正起步。

Our next question comes from the line of Matthew Mishan from KeyBanc.

我們的下一個問題來自 KeyBanc 的 Matthew Mishan。

I don't believe you actually gave a 3Q placement number. I think you said you expect it to be down versus 2Q and then the highest level in 4Q. Could you help us like level set for next quarter kind of how much you think it may be down?

我不相信你真的給出了 3Q 的安置號碼。我想你說過你預計它會比第二季度下降，然後在第四季度達到最高水平。您能否幫助我們了解下季度的水平，您認為可能會下降多少？

Yes. I'd say down modestly, to be fair with that. We really look at our forecast as kind of first half, second half as we've been consistent. But modest sequential decrease for Q3 to Q2.

是的。公平地說，我會謙虛地說。我們確實將我們的預測視為上半年和下半年，因為我們一直保持一致。但第三季度至第二季度略有連續下降。

Okay. Excellent. And then just on the profitability. I know it's not really central at this point, but the gross margin's moving higher, the sales number's moving higher. Just curious why the EBITDA loss was moving down a little bit and not a little up.

好的。出色的。然後就是盈利能力。我知道目前這並不是真正的核心，但毛利率正在上升，銷售額也在上升。只是好奇為什麼 EBITDA 損失略有下降而不是上升。

Yes. So we have increased our OpEx guide from $167 million up to $174 million given where we ended Q2, which this would allow for slight sequential increases in OpEx in Q3 and Q4, which is the reason even with increased margins, the EBITDA guide went down slightly. With that said, we do believe these OpEx investments we're making in the second half are primarily in R&D and sales and marketing. We view these as -- these are high-return investments that we believe will allow this business to continue to experience the outsized revenue growth in 2024 as well. And at the same time, even with the increase in OpEx, you pointed out the margin expansion, which we're really happy with.

是的。因此，鑑於第二季度末的情況，我們將運營支出指南從1.67 億美元提高到了1.74 億美元，這將使第三季度和第四季度的運營支出略有連續增長，這就是即使利潤率增加， EBITDA 指南仍略有下降的原因。話雖如此，我們確實相信我們在下半年進行的這些運營支出投資主要用於研發以及銷售和營銷。我們認為這些是高回報投資，我們相信這些投資將使該業務在 2024 年繼續經歷超額收入增長。與此同時，即使運營支出有所增加，您也指出了利潤率的擴張，我們對此感到非常滿意。

We really weren't anticipating mid-50s until exiting 2023. So the fact that we're already there in the second quarter, and by raising our guidance to 55% now implies that we're going to be exiting the year closer to 57% as opposed to 55%. So really nice progress there on margins. And then overall on OpEx, when I look at our revenue growth of 75%, our revised OpEx guidance is now growing at 48%. So while still early in our commercialization of this product, excuse me, we're starting to see some leverage already in the business.

在2023 年退出之前，我們確實沒有預計到50 年代中期。因此，事實上，我們在第二季度就已經達到了這一目標，並且現在將我們的指導提高到55%，這意味著我們將在接近57 年的時候退出% 而不是 55%。所以在利潤率方面取得了非常好的進展。然後，總體而言，在運營支出方面，當我看到我們的收入增長了 75% 時，我們修訂後的運營支出指導現在增長了 48%。因此，抱歉，儘管我們仍處於該產品商業化的早期階段，但我們已經開始看到該業務已經具有一些優勢。

Our next question comes from the line of Richard Newitter from Truist Securities.

我們的下一個問題來自 Truist Securities 的 Richard Newitter。

A couple of questions. Maybe just first on the way you guys sized up your capital funnel. You've provided some color on kind of what's coming into the funnel relative to what's going out. Can you comment a little bit on the extent to which that's expanding the lead generation? And also within the context of a bolus of rep hires that you had at the end of last year, I know you said that you expect them to really be hitting their stride as we move into 3Q and 4Q. So if you could talk about whether they started to contribute faster than expected in the first half, or is that still out in front and how that kind of fits in with the capital funnel changes.

有幾個問題。也許首先是你們評估資本漏斗的方式。您已經對進入漏斗的內容與流出的內容進行了一些說明。您能否評論一下這在多大程度上擴大了潛在客戶的產生？而且，在去年年底大量招聘代表的背景下，我知道您說過，您希望他們在進入第三季度和第四季度時真正取得進展。因此，您是否可以談談他們在上半年的貢獻是否開始快於預期，或者是否仍然領先，以及這種情況如何適應資本漏斗的變化。

Thanks, Rich. Definitely, we were very happy with the Q2 capital is strong. And 2 factors, as I mentioned in the prepared remarks, led to that outcome. We have great visibility on the pipeline, and we have seen growing sales in the pipeline. And the second in the Q2 was some of the capital went from Q1 to Q2, but we continue seeing that, as we have mentioned previously, there are different phases. Once that enters in the Phase I, there is a very high likelihood of that deal to come to fruition. We see that and we see that expand. I don't know, Kevin, you want to add.

謝謝，里奇。當然，我們對第二季度的資本強勁感到非常高興。正如我在準備好的發言中提到的，有兩個因素導致了這一結果。我們對管道有很高的知名度，並且我們看到管道中的銷售額不斷增長。第二季度的第二個是一些資本從第一季度流向第二季度，但我們繼續看到，正如我們之前提到的，存在不同的階段。一旦進入第一階段，該交易很有可能實現。我們看到了這一點，並且看到了這種情況的擴大。我不知道，凱文，你想補充一下。

Yes, it's just -- thanks, Reza. So specifically on the pipeline, I mean, our pipeline, when we looked at it, we gave this number a few quarters ago. But when we looked at our pipeline, which we consider Phase 1, which we have identified a surgeon champion and has a high degree of certainty to close, that pipeline as of June 30 is up about 19% from the end of Q1. So we feel good about the increasing funnel, to answer that question specifically.

是的，只是——謝謝，雷扎。因此，特別是在管道方面，我的意思是，我們的管道，當我們查看它時，我們在幾個季度前給出了這個數字。但當我們審視我們的管道時（我們認為是第一階段），我們已經確定了一位外科醫生冠軍，並且很有可能關閉，截至6 月30 日，該管道比第一季度末增長了約19 %。因此，我們對增加漏斗感到滿意，可以具體回答這個問題。

And around our rep productivity, if you look at our second half guide, it essentially assumes a very comparable level of productivity, giving 30 capital reps as we had in the back half of 2022 with 20 capital reps. So we're definitely starting to see those folks start to produce in Q3 and Q4. But Q4 for us, given normal seasonality and just the capital environment, it's definitely going to be our strongest quarter. And I think will really be the quarter where we have a proof point of these new reps really producing at a meaningful level.

圍繞我們的代表生產力，如果你看一下我們的下半年指南，它基本上假設了非常相似的生產力水平，提供了 30 個資本代表，就像我們在 2022 年下半年有 20 個資本代表一樣。因此，我們肯定會開始看到這些人在第三季度和第四季度開始生產。但對我們來說，考慮到正常的季節性和資本環境，第四季度肯定會是我們最強勁的季度。我認為，我們將在這個季度真正證明這些新代表確實在有意義的水平上做出了貢獻。

That's helpful. Maybe just turning to the profitability, the OpEx guidance increase. With gross margin increasing, even in a quarter where you have a higher capital overage relative to the consumables, I'm just trying to get a sense for whether -- when do you think we would see the profitability start to inflect? It feels like as you increase these investments on the OpEx side, 2024 could be a year where we really start to see consumables as a bigger mix relative to capital. Should we be expecting kind of a steady kind of profit losses, and then all of a sudden, it's going to flip hard to profitability? I'm just trying to think of how we think about when you turn profitable and how fast that can happen when it does.

這很有幫助。也許只是轉向盈利能力，運營支出指導會增加。隨著毛利率的增加，即使在一個季度，相對於消耗品來說，你的資本過剩程度較高，我只是想了解一下，你認為我們什麼時候會看到盈利能力開始出現變化？感覺當你增加運營支出方面的投資時，2024 年我們可能真正開始看到消耗品相對於資本來說是一個更大的組合。我們是否應該期待一種穩定的利潤損失，然後突然間，它會很難扭虧為盈？我只是想想想，當你實現盈利時，我們會如何考慮，以及盈利時能以多快的速度實現。

Yes. I think you're thinking about it the right way. And while we're definitely focused on revenue growth, we do, as a management team, make sure we're responsible and cognizant of where we're spending OpEx dollars, particularly in today's environment. And we do believe when you look at our longer-term model, without talking about specific numbers, Rich, that when you do turn the profitability with this recurring revenue model, with margins we've talked about, we think longer term can get to 70%. It does flip hard, to use your terminology, in terms of profitability. And we're formulating and going through 2024 objectives and plans now, but the management team here is definitely focused on a pathway to profitability and making sure that we can show investors that this business can get there. And I think it's the nature of this business is definitely attractive from a profit standpoint.

是的。我認為你正在以正確的方式思考這個問題。雖然我們絕對專注於收入增長，但作為管理團隊，我們確實要確保我們負責並了解我們的運營支出支出，特別是在當今的環境下。我們確實相信，當你看看我們的長期模型時，不談論具體數字，Rich，當你確實通過這種經常性收入模型改變盈利能力時，按照我們討論過的利潤率，我們認為長期可以達到70 %。用你的術語來說，就盈利能力而言，它確實很難翻轉。我們現在正在製定並實施 2024 年的目標和計劃，但這裡的管理團隊肯定專注於盈利之路，並確保我們可以向投資者展示這項業務可以實現這一目標。我認為從利潤的角度來看，這項業務的本質絕對是有吸引力的。

Our next question comes from the line of Chris Pasquale from Nephron Research.

我們的下一個問題來自 Nephron Research 的 Chris Pasquale。

Congrats on the quarter. Reza, I wanted to circle back to the United coverage expansion. Curious why you don't expect the impact there to show up until the fourth quarter. Could you just remind us what was happening with those patients previously? Was the lack of coverage there a real obstacle, or were they able to get treated, they just had to jump through a bunch of hoops?

恭喜本季度。禮薩，我想回到曼聯的覆蓋範圍擴張。很好奇為什麼你預計影響要到第四季度才會顯現出來。您能否提醒我們之前那些患者發生了什麼？缺乏覆蓋是一個真正的障礙，還是他們能夠得到治療，他們只需要跳過一堆障礙？

Thanks, Chris. So prior to United coverage, if accounts were willing to treat the patient, they had to receive preapproval. And the cases that we're doing, United still would pay about 20% of those cases. The reason -- and as you know, this only became effective June 1. It takes some time for that to become fully functional. That's why Q3, we are not mentioning that a big impact in Q2.

謝謝，克里斯。因此，在美聯航承保之前，如果客戶願意治療患者，則必須獲得預先批准。對於我們正在處理的案件，曼聯仍然會支付大約 20% 的費用。原因是——如您所知，該政策於 6 月 1 日才生效。它需要一些時間才能完全發揮作用。這就是為什麼第三季度我們沒有提到第二季度的巨大影響。

And if you look at our guide, one of the factors in Q4, along with normal seasonality for the expansion and utilization, is we do start to see a very modest, I suggest, benefit in Q4 from United. But at the same time, we do have many different levers to achieve our utilization guidance. And therefore, I wouldn't take these comments as we're relying on a large United bump to achieve guidance, but we are expecting some benefit, and that's why you see expanded utilization in the fourth quarter in particular to get to the full year 6.5% on utilization.

如果你看一下我們的指南，第四季度的因素之一，以及擴張和利用率的正常季節性，我認為我們確實開始看到聯合航空在第四季度帶來的收益非常有限。但與此同時，我們確實有許多不同的槓桿來實現我們的利用指導。因此，我不會接受這些評論，因為我們依靠曼聯的大幅增長來實現指導，但我們預計會帶來一些好處，這就是為什麼您會看到第四季度的利用率擴大，特別是全年的利用率利用率為 6.5%。

Makes sense. And then international has been a nice surprise relative to how we were thinking about at the start of the year. You talked about Japan not really being a 2023 story. Which countries have driven the upside so far this year? And outside of Japan, are there any other new territories that you guys think could be important in 2024?

說得通。相對於我們年初的想法，國際化是一個不錯的驚喜。你談到日本並不是一個 2023 年的故事。今年到目前為止，哪些國家推動了經濟增長？除了日本之外，你們認為 2024 年還有其他重要的新領土嗎？

Yes. So one of the drivers for the international was U.K., as we have mentioned previously, with the report that came with NICE and the coverage. And those are -- U.K. was one of the biggest drivers. The reason Japan, we don't assume the contribution is because we received approval, regulatory approval in Q1 of 2022. We have to do a 100-patient post-market study, and that enrollment started in July. We are happy with that. And that's why we don't anticipate near-term contribution. So internationally, as we have previously said, we are very selective. And we go region by region on large markets and start with market development. And similar to U.S. once we enter, U.K. was the same. We obtained the reimbursement and received support from the NICE in Japan, the same, but we are going to do again with clinical. So we will go very -- we'll have a very targeted approach by various regions. So our initially started with Western Europe and then Japan, and we have the approval in South Korea.

是的。正如我們之前提到的，英國是國際比賽的推動者之一，NICE 的報告和報導也隨之而來。這些是——英國是最大的推動者之一。我們之所以不承擔日本的貢獻，是因為我們在 2022 年第一季度獲得了監管部門的批准。我們必須進行一項 100 名患者的上市後研究，並於 7 月份開始入組。我們對此感到高興。這就是為什麼我們預計短期內不會做出貢獻。因此，正如我們之前所說，在國際上，我們是非常有選擇性的。我們一個地區一個地區地去大市場，從市場開發開始。與美國類似，一旦我們進入，英國也是一樣。我們得到了報銷，得到了日本NICE的支持，同樣的，但是我們要在臨床上再做一次。因此，我們將針對不同地區採取非常有針對性的方法。所以我們首先從西歐開始，然後是日本，我們在韓國得到了批准。

Our next question comes from the line of Ryan Zimmerman from BTIG.

我們的下一個問題來自 BTIG 的 Ryan Zimmerman。

This is Sam on for Ryan. The first one is on system placements. How many systems placed were leased versus sold outright in the quarter? And how should we think about leasing going forward?

這是瑞安的山姆。第一個是系統佈局。本季度放置的系統有多少是租賃的還是直接出售的？我們應該如何考慮未來的租賃？

Yes. So we don't have an internal leasing program that represents a significant portion of our business. All 40 systems that we sold in the quarter were sales to our customers. So no leasing arrangements there. I will point out, though, in the second quarter, we did place a system that we expect to recognize revenue for in the fourth quarter. This system was installed at the customer in the second quarter, and hence, is doing the procedure. So if you look at our installed base exiting Q3, that -- excuse me, exiting Q1 of 192, if you add 40 systems, that would suggest our installed base should be 232. But as noted in my prepared remarks, our installed base is actually 233, and that's just due to the timing of when we'll recognize revenue on the system. But we don't do leasing.

是的。因此，我們沒有代表我們業務很大一部分的內部租賃計劃。我們在本季度銷售的所有 40 套系統均銷售給我們的客戶。所以那裡沒有租賃安排。不過，我要指出的是，在第二季度，我們確實建立了一個系統，預計將在第四季度確認收入。該系統已於第二季度安裝在客戶處，因此正在執行該程序。因此，如果你看看我們退出第三季度的安裝基礎，那麼——對不起，退出第一季度的192 個系統，如果添加40 個系統，那就表明我們的安裝基礎應該是232 個。但正如我準備好的評論中所指出的，我們的安裝基礎是實際上是 233，這只是因為我們在系統上確認收入的時間。但我們不做租賃。

That's helpful. Then you indicated there are 17 IDNs you're targeting. What percentage of systems are placed at IDNs? And how should we think about that going forward for the remainder of the year?

這很有幫助。然後您指出您要定位 17 個 IDN。有多少百分比的系統放置在 IDN 中？我們應該如何考慮今年剩餘時間的情況？

Yes. So we haven't disclosed the exact number of IDNs. What we have said is to date, we have many, I suggest, orders, single orders from IDNs. But what we don't have are these multisystem orders from corporate IDNs as these purchases are really the most difficult to predict. And we haven't had those to date, but we do have numerous single orders with these IDN partners, and we continue to view that as a nice opportunity moving forward in 2023.

是的。所以我們還沒有透露 IDN 的確切數量。我們所說的是，到目前為止，我建議我們有很多訂單，來自 IDN 的單個訂單。但我們沒有來自企業 IDN 的多系統訂單，因為這些採購實際上是最難預測的。迄今為止，我們還沒有收到這些訂單，但我們確實與這些 IDN 合作夥伴簽訂了大量單一訂單，我們仍然認為這是 2023 年前進的一個很好的機會。

Our next question comes from the line of Neil Chatterji from B. Riley.

我們的下一個問題來自 B. Riley 的 Neil Chatterji。

Just curious on the -- I think last quarter, you talked about the low volume centers make up about kind of 30% of the mix for the install. I'm just curious what you saw this quarter in the installs for low volume centers and then how that might be impacting utilization.

只是好奇——我想上個季度，您談到低容量中心約佔安裝組合的 30%。我只是好奇您本季度在低容量中心的安裝中看到了什麼，以及這可能如何影響利用率。

Yes. Thanks, Neil. So the mix hasn't changed. It's in the 20% to 30%. As we had mentioned in the last earnings call, what we are seeing, the utilization and the ramp, low volume and high volume are similar. Again, low volume, as we have said, are not small hospitals. Just historically, they have not been doing many BPH. So the utilization and the ramp were similar, and the mix is the same at this point.

是的。謝謝，尼爾。所以混合沒有改變。是在20%到30%之間。正如我們在上次財報電話會議中提到的，我們所看到的利用率和增長、低交易量和高交易量是相似的。再次強調，正如我們所說，低容量並不是小醫院。從歷史上看，他們並沒有做過很多前列腺增生症治療。因此，利用率和斜坡相似，並且此時的組合是相同的。

Yes. I want to be clear on the sequential utilization was no -- the dynamic of low volume versus high volume hospitals had no bearing on our Q2 utilization amount. It was really the 40 systems that were placed as opposed to any dynamic between low and high volume hospitals.

是的。我想澄清的是，連續利用率不是——低容量醫院與高容量醫院的動態對我們第二季度的利用率沒有影響。實際上是 40 個系統的放置，而不是低容量醫院和高容量醫院之間的任何動態。

Great. Maybe just turning to R&D. Continue to spend there. Just kind of curious if you can update us there in terms of efforts on the R&D pipeline, any planned enhancements on kind of the delivery or speed or imaging, perhaps? Anything that you could share there?

偉大的。也許只是轉向研發。繼續在那裡消費。只是有點好奇您是否可以向我們介紹研發渠道方面的最新情況，或者在交付、速度或成像方面有任何計劃的增強嗎？有什麼可以分享的嗎？

Yes. So we are highly focused, obviously, on innovation, being a robotic company. And the investments in Q1 and Q2, they're across the board. It's people, it's product, it's processes. And not talking specific about future R&D, but you can be assured we're always working to maintain our clinical advantage. It's kind of the bedrock of this company from a technology standpoint. And we're not getting in too much detail in the near term. You can think of things like making our robotic system simpler to use. This is improving workflow, improving overall design. And it's things like that, that we're talking about today, but we're definitely thinking longer term. But I'm not going to provide any details at this time.

是的。因此，作為一家機器人公司，我們顯然高度關注創新。第一季度和第二季度的投資是全面的。是人、是產品、是流程。並沒有具體談論未來的研發，但您可以放心，我們一直在努力保持我們的臨床優勢。從技術角度來看，這是這家公司的基石。我們短期內不會提供太多細節。您可以考慮諸如讓我們的機器人系統更易於使用之類的事情。這正在改善工作流程，改善整體設計。我們今天討論的就是類似的事情，但我們肯定是在考慮更長遠的問題。但我目前不打算提供任何細節。

Our next question comes from the line of Nathan Treybeck from Wells Fargo.

我們的下一個問題來自富國銀行的內森·特雷貝克（Nathan Treybeck）。

Congrats on a great quarter. Just can we go back just to the capital environment. You obviously caught up the placement shortfall from Q1. But at that time, you mentioned IDNs were taking a cautious approach on spending. How has this kind of played out in Q2? And what are you seeing so far in Q3 in terms of the capital environment?

恭喜您度過了一個出色的季度。我們只能回到資本環境。您顯然彌補了第一季度的安置缺口。但當時您提到 IDN 對支出採取謹慎態度。這種情況在第二季度表現如何？到目前為止，您對第三季度的資本環境有何看法？

Yes. So thanks for the question. Definitely, as we have mentioned in Q1 also, yes, hospital P&L pressure. But we are seeing improvement in staffing. And hospitals definitely are prioritizing spend and invest in innovative treatments and those treatments that allow to treat many patients. But in this case, this fits in their strategy of good ROI and allowing to bring more patients because BPH is #1 reason patients go see a urologist. And so from that point of view, we believe this fits in the model, and it allows them to treat more patients and also attract surgeons to -- in their hospital. So that hasn't changed.

是的。謝謝你的提問。當然，正如我們在第一季度提到的，是的，醫院損益壓力。但我們看到人員配備有所改善。醫院肯定會優先考慮對創新療法和那些能夠治療許多患者的療法進行支出和投資。但在這種情況下，這符合他們良好的投資回報率並允許吸引更多患者的策略，因為良性前列腺增生是患者去看泌尿科醫生的第一大原因。因此，從這個角度來看，我們相信這符合該模式，它使他們能夠治療更多的患者，並吸引外科醫生來到他們的醫院。所以這並沒有改變。

Okay. And then to my second question, so AUA, your urologist panel noted they've seen trend of surgeons bypassing drugs and offering Aquablation earlier. Are you seeing significant penetration into the watchful waiters, considering that 20% to 25% of them are under the care of a urologist?

好的。然後是我的第二個問題，AUA，你們的泌尿科醫生小組指出，他們已經看到外科醫生繞過藥物並更早提供 Aquablation 的趨勢​​。考慮到 20% 到 25% 的服務員接受泌尿科醫師的護理，您是否發現他們對警惕的服務員的滲透率顯著提高？

So the data -- I'm sorry, you mentioned 25% of the patients are under the care of a urologist?

那麼數據——抱歉，您提到 25% 的患者接受泌尿科醫生的護理？

Yes.

是的。

Patients are half and half roughly between the -- when they are under medication under the care of urologist and a generalist. So in long term, that may be a driver. But at this point, though, there is a large demand. Patients are already coming to the hospital to get treatment.

患者在泌尿科醫師和全科醫師的護理下接受藥物治療時，病情大致各佔一半。因此，從長遠來看，這可能是一個驅動因素。但目前需求量很大。患者已經來到醫院接受治療。

It's difficult to tell on the numbers, to be honest. I mean, the reality is we're having a lot of traction, a lot of success. But the numbers compared to the overall market are still fairly low in terms of who we're penetrating. We still believe the majority of our patients are converted TURP and GreenLight cases. But you can definitely talk to some of our customers who are treating patients that otherwise would have foregone treatment if Aquablation wasn't an option. So we are seeing that, but it's difficult to parse out at our volumes exactly how -- what percent of those patients are foregoing drugs or are drug dropouts versus -- or candidates for other resective technologies.

老實說，很難通過數字來判斷。我的意思是，現實是我們有很大的吸引力，也取得了很多成功。但就我們的滲透率而言，與整個市場相比，這個數字仍然相當低。我們仍然相信我們的大多數患者已轉為 TURP 和 GreenLight 病例。但您絕對可以與我們的一些正在治療患者的客戶交談，如果不選擇 Aquablation，他們就會放棄治療。所以我們看到了這一點，但很難從我們的數據中準確地分析出這些患者中放棄藥物或放棄藥物的百分比是多少，或者是其他切除技術的候選者。

Our next question comes from the line of Brandon Vazquez from William Blair.

我們的下一個問題來自威廉·布萊爾的布蘭登·巴斯克斯。

First, I just wanted to go back to kind of the utilization. I want to ask kind of the same question, but slightly different. Is there any color you can give us on how dilutive a new system placement can technically be? Maybe what can help there is how -- what does a ramp typically look like in an account? Do they -- like what does the procedure ramp look like so maybe we can tease out what is -- what kind of trends we're seeing in the, quote-unquote, legacy installed base versus new systems?

首先，我只想回到利用率的類型。我想問同樣的問題，但略有不同。您能否告訴我們新系統佈局在技術上的稀釋程度如何？也許可以提供幫助的是——賬戶中的斜坡通常是什麼樣的？它們是否——就像程序升級的樣子，以便我們可以梳理出——我們在舊系統與新系統中看到的趨勢是什麼？

Yes. So again, without getting into specific numbers, I'll try to help you and provide some color, right? And if you look at the accounts that have been with us pre-2023, they are north of our full year guide of 6.5% and continue to trend up every quarter, modestly. And we are seeing sequential increases in that group. But the dilutive effect of new accounts, in any given quarter, there's significant -- in the first quarter, excuse me, they're significantly less than that corporate average. One of the primary reasons being just in capital equipment, it tends to be more heavily weighted towards the second and third month of any quarter. And therefore, we have some accounts where we install a robot, for example, in the second quarter that don't do any procedures, and they don't even launch their account until the subsequent quarter. So that dilutive effect is fairly pronounced. And to model it forward, I would just suggest that you take an average of maybe half of what our normal utilization is for a new account to account for the fact that they're placed mid-quarter.

是的。再說一遍，在不涉及具體數字的情況下，我會盡力幫助您並提供一些顏色，對吧？如果您查看 2023 年之前我們的賬戶，您會發現它們超出了我們 6.5% 的全年指導，並且每個季度都繼續呈小幅上升趨勢。我們看到該群體的數量連續增加。但是，在任何特定季度，新賬戶的稀釋效應都是顯著的——請原諒，在第一季度，它們的稀釋效應明顯低於公司平均水平。主要原因之一是資本設備，它往往在任何季度的第二個月和第三個月占據更大的比重。因此，我們有一些賬戶安裝了機器人，例如在第二季度，他們沒有執行任何程序，他們甚至直到下一個季度才啟動賬戶。因此，稀釋效應相當明顯。為了對其進行建模，我建議您平均使用新帳戶正常利用率的一半，以考慮到它們被放置在季度中期的事實。

Got it. And then in terms of the system pipeline, you guys gave some nice incremental numbers there. I think it was a 19% sequential increase in the pipeline, which is great. Can you remind us again, what's the typical time frame to close on one of these? I imagine that there's kind of a large window, but even kind of knowing that window might be helpful. And the follow-up to that would be, has that time frame changed at all maybe compared to the start of this year, whether it be macro or macro concerns lengthening that or just going deeper into the adoption curve?

知道了。然後就係統管道而言，你們給出了一些不錯的增量數字。我認為管道數量環比增加了 19%，這非常棒。您能否再次提醒我們，完成其中一項任務的典型時間範圍是多長？我想像有一個大窗戶，但即使知道那個窗戶也可能會有所幫助。後續行動是，與今年年初相比，這個時間框架是否發生了變化，無論是宏觀還是宏觀擔憂延長了這一時間，還是只是深入採用曲線？

Yes. So I'll answer your last question first. We haven't seen any lengthening of the pipeline with any type of macro concerns. With that said, the reason why we think about the capital business first half, second half, it is because timing is somewhat unpredictable with these deals. But on average, it could be anywhere -- it's anywhere from 3 to 9 months. But I think we've had an account shorter than 3 months, but that's definitely not the norm. The norm falls in that 3- to 9-month range. That gives us an opportunity to identify the surgeon champion, work with administration and go through all the benefits of the system. And that's been consistent in that range, but inconsistent in terms of giving any further specificity within that range.

是的。所以我先回答你的最後一個問題。我們還沒有看到任何因宏觀問題而導致的管道延長。話雖如此，我們之所以考慮上半年、下半年的資本業務，是因為這些交易的時機有些難以預測。但平均而言，它可能在任何地方——從 3 到 9 個月不等。但我認為我們的帳戶期限還不到 3 個月，但這絕對不是常態。正常情況是在 3 到 9 個月的範圍內。這使我們有機會確定外科醫生冠軍，與行政部門合作並了解該系統的所有好處。這在該範圍內是一致的，但在該範圍內提供任何進一步的特異性方面卻不一致。

Thank you. I would now like to turn the conference back over to Reza Zadno for closing remarks.

謝謝。現在我想將會議轉回禮薩·扎德諾致閉幕詞。

Thank you for attending this earnings call. We are very pleased with our results in Q2, and we hope to see many of you in the upcoming conferences. Have a nice day.

感謝您參加本次財報電話會議。我們對第二季度的結果非常滿意，希望在即將舉行的會議上見到你們。祝你今天過得愉快。

This concludes today's conference call. Thank you for participating. You may now disconnect.

今天的電話會議到此結束。感謝您的參與。您現在可以斷開連接。