ISRG Stock Gains More than 28% in a Month: Should You Buy, Hold or Sell?

Core Insights - Intuitive Surgical's shares surged 28.5% in the past month due to strong third-quarter performance, showcasing 20% global procedure growth and increased adoption of the da Vinci 5 system [1][8] - Management raised full-year procedure guidance, enhancing investor confidence in sustained momentum [1] Performance Overview - The da Vinci procedures grew by 19% year-over-year, driven by benign general surgery in the U.S. and double-digit growth in gynecology and colorectal procedures internationally [5] - The Ion robotic-assisted bronchoscopy system saw a 52% increase in procedures and a 14% rise in utilization [5] - Approximately 67,000 procedures were performed using the da Vinci 5 system in Q3, up from 50,000 in Q2, indicating strong adoption [6] Growth Drivers - Domestically, benign general surgeries such as cholecystectomy and appendectomy are key growth engines, with after-hours and acute-care surgeries also contributing [9] - Internationally, benign general surgery (up 39%), colorectal (up 28%), hysterectomy (up 27%), and thoracic (up 26%) are leading growth, accounting for about 40% of non-U.S. da Vinci volumes [10] - The Ion platform is gaining clinical validation, showing higher diagnostic yields in lung biopsies compared to conventional methods [11] Future Trends - Management believes utilization growth is still in the early stages of the da Vinci 5 cycle, with hospitals redeploying older systems to expand access [12] - The company aims to drive continued adoption of focused procedures, secure broader regional clearances for da Vinci 5, and enhance surgical precision through digital technologies [13] Financial Estimates - Analysts have revised earnings per share estimates upward, with current estimates at $8.61 for the current fiscal year and $9.55 for the next, indicating year-over-year growth rates of 17.3% and 10.9% respectively [14] Challenges - GLP-1 drugs are negatively impacting bariatric surgery volumes, which fell at a high-single-digit rate in Q3 [16] - Competition in China is intensifying, with delays and budget constraints affecting system placements and pricing [16] - Gross margin contraction is a concern, with pro forma gross margin down 90 basis points year-on-year to 68% [17] Valuation Concerns - Despite recent gains, ISRG shares trade at a forward P/E of 59.47X, significantly higher than the industry average of 30.08X and its peers Stryker and Medtronic [18]