Financial Data and Key Metrics Changes - Revenue grew 21% year over year to $10.1 billion, with operating margins at 37% reflecting investments in R&D and manufacturing scale [8][16][29] - Proforma EPS increased 22%, marking the third consecutive year of growth above 20% [16] - Free cash flow rose to $2.5 billion, up from $1.3 billion in 2024 [16] Business Line Data and Key Metrics Changes - Total procedures grew 19%, with da Vinci procedures increasing 17% and Ion procedures growing 51% [5][16] - Single-port procedures grew 87%, while multi-port procedures increased 17% [5][11] - In Q4, da Vinci procedures in the U.S. increased 15% to over 2 million, while international procedures grew 23% [6][19] Market Data and Key Metrics Changes - U.S. procedures increased 16%, with da Vinci procedures growing 15% and Ion procedures growing 41% [17] - Internationally, da Vinci procedures grew 21%, with notable growth in Canada, India, Korea, and various European markets [20][21] - Japan's procedure growth was lower than expected due to capital placement challenges, with potential reimbursement changes anticipated in 2026 [21] Company Strategy and Development Direction - The company focuses on four strategic priorities: launching da Vinci 5, increasing adoption of focused procedures, building industrial scale, and enhancing digital tools [4][13] - Plans to expand into ambulatory surgery centers (ASCs) and enhance training and support for customers [19][56] - Continued investment in market access activities and local evidence generation to meet clinical and economic objectives [6][7] Management's Comments on Operating Environment and Future Outlook - Management believes the company is in the early stages of advancing minimally invasive care, with significant growth opportunities ahead [4][78] - Anticipated da Vinci procedure growth for 2026 is projected between 13%-15%, driven by general surgery and international procedures [36] - Expected gross profit margin for 2026 is projected to be between 67% and 68% of net revenue, with various factors impacting this guidance [37] Other Important Information - The company placed 1,721 da Vinci systems in 2025, including 870 da Vinci 5 systems [7][23] - The installed base of da Vinci systems increased by 12% to over 11,100 systems, with average system utilization rising by 4% [17][26] - The company plans to introduce additional products and features for da Vinci 5 in 2026 [10] Q&A Session Summary Question: FDA approvals for cardiac non-force feedback instruments - Management discussed the importance of supporting cardiac surgery and the foundational work being done, including training pathways and developing cardiac-specific instrumentation [41][42][44] Question: Advanced imaging features in the robotic ecosystem - Management explained that advanced imaging capabilities are being developed, which will add revenue streams and improve surgical outcomes [48][49] Question: ASC opportunity and key procedures - Management highlighted the growing ASC opportunity, focusing on high-quality clinical outcomes and the need for repeatable procedures [53][55] Question: Gross margin and operating expenses assumptions - Management provided insights into the dynamics affecting gross margin, including higher trade-ins and the mix of da Vinci 5 systems [64][66] Question: Competition in China - Management acknowledged increased competition in China but expressed confidence in their ability to compete effectively with local robotic companies [68][70]

Financial Data and Key Metrics Changes - Revenue grew 21% year over year to $10.1 billion, with operating margins at 37% reflecting investments in R&D and manufacturing scale [7][15][27] - Proforma EPS increased 22%, marking the third consecutive year of growth above 20% [15] - Free cash flow rose to $2.5 billion from $1.3 billion in 2024, driven by increased profitability and lower capital expenditures [15] Business Line Data and Key Metrics Changes - Total procedures grew 19%, with da Vinci procedures increasing 17% and Ion procedures growing 51% [5][14] - In Q4, da Vinci procedures grew 18%, with general surgery in the U.S. and broad-based growth in international markets driving this increase [15][17] - The installed base of da Vinci systems increased by 12% to over 11,100 systems, while average system utilization rose by 4% [16] Market Data and Key Metrics Changes - U.S. da Vinci procedures increased 15% to over 2 million, while international procedures grew by 23% to over 1.1 million [5][19] - Growth rates were 21% in Europe, 24% in Asia, and 27% in the rest of the world [5] - In Q4, total procedures outside the U.S. grew 22%, with notable increases in Canada, India, Korea, and distributor markets [19] Company Strategy and Development Direction - The company focuses on four strategic priorities: launching da Vinci 5, increasing adoption of focused procedures, building industrial scale and product quality, and enhancing digital tools [4][5] - Plans to expand the da Vinci XIR system and related economic programs to increase access to da Vinci surgery internationally and in U.S. ambulatory surgery centers [7][11] - Continued investment in market access activities and local evidence generation to meet clinical and economic objectives [6] Management's Comments on Operating Environment and Future Outlook - Management believes the company is in the early stages of advancing minimally invasive care, with significant long-term opportunities ahead [4][5] - Anticipated full-year da Vinci procedure growth for 2026 is projected to be between 13%-15%, driven by general surgery in the U.S. and international procedures [32] - The company expects gross profit margins to be within a range of 67%-68% of net revenue for 2026, with potential impacts from tariffs and product mix [33] Other Important Information - The company received FDA clearance for several cardiac procedures on da Vinci 5, with plans for a measured rollout to support training and adoption [8][36] - The My Intuitive Plus digital subscription package is expected to enhance customer engagement and provide additional revenue streams starting in 2026 [55] Q&A Session Summary Question: About FDA approvals for cardiac non-force feedback instruments - Management discussed ongoing support for cardiac surgery and the importance of training pathways and developing specific instrumentation for cardiac procedures [36][37] Question: Expanding footprint in ASCs - Management highlighted the growing opportunity in ASCs for lower acuity procedures and the need for high-quality clinical outcomes and operational infrastructure [41][42] Question: Gross margin and operating expenses assumptions - Management explained the dynamics affecting gross margin, including higher trade-ins and the mix of da Vinci 5 systems, while also addressing operating expense growth expectations [46][47] Question: Position in China and competition - Management acknowledged increased competition in China but expressed confidence in their ability to compete effectively with local robotic companies [49][50]

Core Viewpoint - Intuitive Surgical exceeded Wall Street expectations for fourth-quarter profit and revenue, driven by increasing demand for its surgical robots utilized in minimally invasive procedures [1] Company Summary - Intuitive Surgical reported a strong performance in the fourth quarter, surpassing analysts' profit and revenue forecasts [1] - The growth in demand for surgical robots indicates a positive trend in the adoption of minimally invasive surgical techniques [1] Industry Summary - The surgical robotics market is experiencing growth, reflecting a broader trend towards minimally invasive procedures in the healthcare industry [1] - Increased demand for advanced surgical technologies suggests a favorable environment for companies operating in the surgical robotics sector [1]

Core Insights - Intuitive Surgical (ISRG) and Medtronic (MDT) represent contrasting strategies in the MedTech sector, with ISRG focusing on robotic-assisted surgery and MDT being a diversified medical technology conglomerate [1] Company Overview Intuitive Surgical (ISRG) - ISRG is a leader in robotic-assisted surgery, primarily centered around the da Vinci and Ion platforms, allowing for coordinated product development and commercialization [4] - The company has a competitive advantage through surgeon training, workflow integration, and data-driven feedback, leading to increased utilization of its platforms [5] - Approximately 85% of ISRG's revenues are derived from recurring sources, with a 19% growth in procedures translating directly into revenue expansion [6] - Recent pro forma operating margins are near 39%, supported by scale and high utilization, with strong free cash flow generation enabling sustained reinvestment in R&D and manufacturing [8] - The strategy emphasizes expanding minimally invasive surgery and leveraging data and digital insights, reinforcing a coherent long-term roadmap [9] Medtronic (MDT) - MDT faces macroeconomic headwinds affecting procedural volumes, particularly in elective surgeries, with recovery lagging in certain categories [11] - The company anticipates a $185 million cost-of-goods-sold headwind due to U.S.–China tariffs, impacting gross margins despite mitigation efforts [12] - A shift in U.S. distributor buying patterns has negatively affected the Surgical segment, although growth in LigaSure Advanced Energy products and emerging markets has partially offset this impact [13] Financial Performance - In the past six months, ISRG shares gained 3.2%, while MDT shares increased by 7.6% [2] - ISRG trades at a forward price-to-earnings multiple of 54.4, compared to MDT's 16.4, indicating a higher valuation for ISRG despite its strong growth prospects [16] Investment Outlook - ISRG is viewed as a superior long-term investment due to its focused strategy, high-margin recurring revenue model, and strong cash flow generation [17] - MDT, while a strong player in MedTech, faces challenges from diversification and uneven segment recovery, which dilute its strategic momentum in robotics [18] - Despite ISRG's higher valuation, its robust growth makes it a more compelling investment opportunity compared to MDT, which has a lower Zacks Rank [19]

Market Overview - U.S. equity markets ended the fourth quarter positively, with the S&P 500 and Nasdaq 100 rising 2.4% and 2.6% respectively, while the Dow Jones Industrial Average led with a 3.6% return [2] - The Russell 1000 Growth Index lagged, increasing only 1.1% as investors shifted from high-growth technology stocks to more defensive sectors [2] - The quarter was marked by significant volatility, influenced by a 43-day government shutdown that affected market transparency and risk appetite [2] Economic and Monetary Policy - Approximately 83% of S&P 500 companies reported positive earnings surprises, indicating a broadening economic recovery beyond the "Magnificent Seven" [4] - The Federal Reserve implemented two 25-basis point cuts, bringing the federal funds rate to a range of 3.50% to 3.75% by year-end, and concluded its quantitative tightening program [4] - The Fed's balance sheet expanded by approximately $100 billion to $6.6 trillion, reflecting a shift from "abundant" to "ample" bank reserves [4] Sector Performance - Ithaka's portfolio underperformed the Russell 1000 Growth Index by 700 basis points, with stock selection detracting 740 basis points from relative performance [6] - Positive relative returns were generated in the Materials and Processing sector, while Technology and Consumer Discretionary sectors were significant sources of underperformance [7] - Weakness in Technology was attributed to fears of AI disintermediating software stocks, while Consumer Discretionary faced pressures from consumer spending concerns [7] Top Contributors and Detractors - Top contributors included Intuitive Surgical (26.6% return), Advanced Micro Devices (32.4%), and Alphabet (28.9%), driven by strong earnings and positive investor sentiment [9][10][12] - Major detractors were ServiceNow (-16.8%), Netflix (-21.8%), and Veeva Systems (-25.1%), with concerns over AI impacts and unexpected financial disclosures affecting stock performance [9][15][16] Investment Strategy and Outlook - Ithaka initiated three new positions and eliminated four during the quarter, with a trailing 12-month turnover of 22.1% [17] - The investment approach focuses on long-term wealth creation through concentrated positions in high-quality companies with strong management and favorable market conditions [4][19] - The narrative around AI is shifting towards tangible productivity gains, suggesting that the economic opportunities from AI will continue to expand [18]

Core Viewpoint - Intuitive Surgical, Inc. (ISRG) is expected to report strong fourth-quarter 2025 earnings, with preliminary results indicating significant growth in procedures and revenues, although pricing pressures and tariffs may impact margins [2][3][10]. Financial Performance - The Zacks Consensus Estimate for ISRG's fourth-quarter sales is $2.87 billion, with earnings per share (EPS) estimated at $2.25 [2]. - Preliminary fourth-quarter revenues are projected at approximately $2.87 billion, reflecting a 19% increase year-over-year [3]. - ISRG has maintained stable EPS estimates of $8.65 for 2025 and $9.61 for 2026 over the past month [2]. Growth Metrics - The company reported an 18% growth in procedures globally, with a 4% increase in average da Vinci system utilization [3][10]. - A total of 532 da Vinci surgical systems were placed in the fourth quarter, including 303 da Vinci 5 systems, contributing to strong demand [3][12]. Segment Performance - The Instruments & Accessories (I&A) segment saw a 17% revenue growth in the fourth quarter, supported by the increase in procedures, although pricing pressure was noted [8][10]. - The Systems segment benefited from strong demand for da Vinci 5, with average selling prices (ASPs) for da Vinci systems reaching at least $1.6 million [12]. Competitive Landscape - Intuitive Surgical's close peers, Thermo Fisher Scientific and Boston Scientific, are also set to announce their quarterly results, with ISRG having outperformed them in terms of earnings surprises in recent quarters [4][5]. Valuation Insights - ISRG is currently trading at a forward 12-month P/E of 55.21X, which is above the industry average of 30.02X, indicating a premium valuation despite a decrease from a five-year high [19]. - The company's high valuation reflects its growth prospects, although it is currently rated with a Value score of D, indicating concerns about its valuation level [19]. Future Outlook - The company is expected to sustain strong top-line performance through 2026, driven by da Vinci procedure growth and the adoption of the Ion platform [21]. - However, ongoing challenges in pricing, particularly in China and for ambulatory surgery centers in the U.S., may temper growth [9][22]. - Geopolitical tensions and tariff issues could also pose risks to global performance, although domestic revenues are somewhat insulated due to key manufacturing operations in the U.S. and Mexico [23].

Core Viewpoint - Intuitive Surgical, Inc. is expected to report strong quarterly results, with potential for upward revisions in estimates due to previous performance, despite increasing competition from companies like Medtronic and Johnson & Johnson [1][2]. Group 1: Company Performance - Intuitive Surgical designs and manufactures robotic systems for minimally invasive surgical procedures, with its Da Vinci surgical machine being a key product [2]. - The company experienced a significant quarter previously, leading to bullish sentiment from analysts, indicating that the upcoming results may exceed current expectations [1][2]. Group 2: Market Sentiment - Jim Cramer highlighted Intuitive Surgical as a standout performer in the stock market, contrasting its recent resurgence with a prior decline in popularity due to lower utilization rates of its surgical systems [2]. - There is a cautionary note regarding potential pullbacks in stock price following strong performance, as high expectations can lead to corrections [2].

Core Insights - The article highlights a valuation disconnect between Insulet Corporation (PODD) and Intuitive Surgical (ISRG), suggesting that investing in PODD may be more advantageous than ISRG due to its lower Price to Operating Income (P/OpInc) ratio despite higher revenue and operating income growth [2][4]. Group 1: Valuation and Performance - PODD has a lower valuation (P/OpInc) compared to Intuitive Surgical stock [4]. - PODD exhibits higher revenue and operating income growth than Intuitive Surgical [4]. - The current discrepancy in stock prices may indicate that Intuitive Surgical could be overpriced relative to its competitors if its underperformance continues [6]. Group 2: Investment Strategy - A strategic allocation and diversification approach can help investors remain invested despite stock volatility [2]. - Trefis portfolio strategies consider multiple perspectives for investment analysis, aiming to minimize stock-specific risk while providing upside exposure [6][7]. - The Trefis High Quality Portfolio has outperformed its benchmark, which includes the S&P 500, Russell, and S&P midcap index [7].

Group 1: Eli Lilly - Eli Lilly became the first healthcare company to join the trillion-dollar club, driven by its leadership in the weight-loss market and the success of its drug tirzepatide, which became the world's best-selling compound last year [3][6] - The company is expected to receive approval for Orforglipron, an oral medication for diabetes and weight loss, which will further enhance its market position [4] - Eli Lilly's innovative culture and strong financial results make it an excellent buy-and-hold option, with potential for significant revenue growth from its weight-loss portfolio [7] Group 2: AbbVie - AbbVie has a diverse product portfolio with key growth drivers in its immunology segment, particularly with drugs like Skyrizi and Rinvoq, and has successfully managed the loss of patent exclusivity for Humira [8][10] - The company is recognized as a dividend growth powerhouse, being part of the Dividend Kings group, which has raised payouts for at least 50 consecutive years, making it a strong long-term investment [11] - AbbVie is actively working on a vast pipeline to address upcoming patent expirations, ensuring a steady flow of new products [10] Group 3: Intuitive Surgical - Intuitive Surgical is a leader in robotic-assisted surgery systems, particularly known for its da Vinci system, which has a competitive advantage due to high switching costs for hospitals [12][13] - The company continues to expand its installed base and benefits from increasing procedure volumes, which are crucial for revenue growth [15] - Long-term growth is supported by demographic trends such as the aging population, positioning Intuitive Surgical for competitive returns [16]

Core Insights - Intuitive Surgical's (ISRG) third-quarter 2025 commentary emphasizes that da Vinci 5 is a significant upgrade, featuring a powerful digital backbone with approximately 10,000 times greater compute power than previous generations, facilitating extensive surgical data collection and processing [1][10] Digital Strategy - The integrated Hub is central to the strategy, designed to capture and transmit large volumes of intraoperative video data, combined with kinematic, force, and electronic medical record (EMR) data, creating a multimodal dataset for centralized analysis and insights delivery [2][10] - The software updates for da Vinci 5 include features like Force Gauge, Focus Mode, in-console video replay, and 3D model manipulation, aimed at enhancing surgeon awareness and real-time decision-making during procedures [3] Future Outlook - Intuitive Surgical is positioning its digital roadmap towards AI-driven intraoperative guidance and "augmented dexterity," believing that AI applied to aggregated surgical datasets can optimize outcomes, efficiency, and economics [4] - The company is potentially evolving from a robotics leader to a surgical data intelligence company, with the capability to monetize insights alongside instruments and systems in the long term [5] Industry Trends - Several medical device manufacturers, including GE HealthCare and Boston Scientific, are integrating AI to enhance device efficiency and output [6] - Boston Scientific is focusing on AI as a core differentiator in its electrophysiology and mapping ecosystem, with specific products like the OPAL HDx mapping system and Cortex AI algorithm [7][8] - GE HealthCare is embedding AI into its "precision care" strategy, enhancing imaging hardware, cloud software, and digital workflows, with strong uptake of AI-enabled products [9][11] Financial Performance - ISRG shares have increased by 3.6% over the past six months, compared to a 12.2% increase in the industry [12] - The company trades at a forward price-to-earnings ratio of 55.23, above the industry average but lower than its five-year median of 71.51, with a Value Score of D [13] - The Zacks Consensus Estimate for ISRG's 2026 earnings indicates an 11.1% rise from the previous year [14]