Intuitive Surgical Q4 Earnings Call Highlights

Core Insights - Intuitive Surgical reported strong growth in da Vinci procedures, with a 15% increase in the U.S. and a 23% increase internationally, driven by clinical demand and improved market access [1][2][3] - The company treated over 3.1 million patients in 2025, bringing the cumulative total to over 20 million since 1997, indicating a robust adoption of minimally invasive care [2][5] - For 2026, the company projects da Vinci procedure growth of 13-15% and a pro forma gross margin of 67-68%, while highlighting potential risks from competition and reimbursement dynamics [4][20][21] Financial Performance - Q4 revenue grew 19% to $2.87 billion, with recurring revenue at 81% of total revenue, and pro forma net income increased to $914 million [5][8][9] - The company ended the year with $9.0 billion in cash, reflecting strong cash flow from operations and stock repurchases totaling $2.3 billion [10][9] - Pro forma operating margin for Q4 was 37%, impacted by tariffs and contributions to the Intuitive Foundation [9][10] Procedure Growth and System Placements - In 2025, the company placed 1,721 da Vinci systems, including 870 da Vinci 5 units, and reported significant growth in multi-port and single-port procedures [5][7][14] - Ion procedures grew 51% in 2025, with cumulative procedures exceeding 325,000 since FDA clearance in 2019 [15] - The installed base for the SP platform rose 39% to 377 systems, driven by demand in Korea and the U.S. [14] Regional Dynamics and Market Strategy - The company is expanding its footprint in ambulatory surgery centers (ASCs) in the U.S., focusing on higher-volume centers to sustain robotic programs [16] - Competitive intensity in China increased, impacting the company's win ratio, while Japan's procedure growth was lower than expected due to capital placement challenges [17][18] - Management is monitoring reimbursement developments in Japan, with updates expected in mid-2026 [18] Digital Tools and Future Outlook - Intuitive is launching a subscription package "My Intuitive Plus" for da Vinci 5, which will transition to a paid renewal option around Q2 2026 [13] - The company anticipates pro forma operating expense growth of 11-15% in 2026, driven by R&D and distributor acquisition expenses [22] - Management will no longer provide specific capital expenditure guidance, expecting capex to normalize [22]