Intuitive Surgical Pre-Q4 Analysis: Buy, Hold or Sell ISRG Stock Now?

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].