Core Insights - Intuitive has achieved a significant milestone with over 20 million patients operated on using da Vinci surgical systems, reflecting the global dedication of surgeons and care teams to improve patient outcomes through minimally invasive technologies [1][2][3] Company Overview - Intuitive, headquartered in Sunnyvale, California, is a leader in minimally invasive care and robotic-assisted surgery, with technologies including the da Vinci surgical system and the Ion endoluminal system [6] - The company envisions a future of care that is less invasive and more effective, focusing on early disease identification and rapid treatment [6] Milestone Achievement - As of the end of 2025, more than 3.1 million da Vinci procedures were performed in the previous year, indicating a growing adoption and access to Intuitive's technology [2] - The achievement is attributed to the commitment of healthcare professionals to provide high-quality care [3] Innovation and Technology - Intuitive's robotic-assisted platforms are designed to enhance clinical outcomes, improve patient experiences, reduce care costs, and expand access to minimally invasive care [4] - The latest da Vinci 5 system offers over 10,000 times the computing power of its predecessor, enhancing patient care capabilities [8] - The Ion platform was utilized for over 140,000 lung biopsies in 2025, aiding in early lung cancer diagnosis [8] Future Focus - The company emphasizes its commitment to future innovations and the potential to impact more patients positively [5]

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]

Core Insights - Intuitive Surgical (ISRG) has developed a comprehensive portfolio focused on minimally invasive care, primarily through its da Vinci robotic surgical systems, which enhance precision and control in complex procedures [1][3] - The company is expanding its offerings with the Ion endoluminal system for early-stage lung cancer diagnosis, diversifying its revenue streams and enhancing its diagnostic capabilities [2] - Intuitive Surgical supports its hardware ecosystem with digital tools and training resources to improve surgeon proficiency and optimize hospital workflows [3] Company Overview - The da Vinci systems include multi-port platforms like Xi and X, as well as the next-generation da Vinci 5, and the single-port da Vinci SP platform for narrow-access procedures [1] - The Ion system is gaining commercial traction, contributing to revenue diversification and expanding ISRG's presence in the diagnostic market [2] - The company has performed over 12 million da Vinci procedures globally and has more than 10,000 systems installed, solidifying its leadership in minimally invasive care [3] Competitive Landscape - Johnson & Johnson (JNJ) is heavily investing in its minimally invasive surgery portfolio through its MedTech division, with products like the VELYS Robotic-Assisted Solution and the Ottava soft-tissue robotic system [4] - Edwards Lifesciences (EW) is a leader in structural heart therapies, particularly with its transcatheter aortic valve replacement (TAVR) solutions, and is expanding into mitral and tricuspid segments [5] Financial Performance - ISRG shares have decreased by 1.9% year-to-date, while the industry has seen an 11% decline [6] - The company trades at a forward price-to-sales ratio of 18.02, which is above the industry average, and carries a Value Score of D [8] - The Zacks Consensus Estimate for ISRG's 2025 earnings suggests a 6.8% year-over-year increase [9] Earnings Estimates - The Zacks Consensus Estimate for the current quarter (6/2025) is $1.92, with estimates for the next quarter (9/2025) at $1.96, and for the current year (12/2025) at $7.84 [10] - Year-over-year growth estimates for the current year and next year are 6.81% and 15.46%, respectively [10]

Financial Data and Key Metrics Changes - First quarter revenue was $2.25 billion, a 19% increase year-over-year, with constant currency growth at 20% [45][46] - Pro forma gross margin for Q1 was 66.4%, down from 67.6% in the previous year, primarily due to higher facility costs and a greater mix of lower-margin products [54] - Pro forma net income for Q1 was $662 million, or $1.81 per share, compared to $541 million, or $1.50 per share, in the same quarter last year [58][59] Business Line Data and Key Metrics Changes - Da Vinci procedure growth was 17%, with a 15% increase in the installed base of Da Vinci systems [38][39] - ION procedures grew 58% to approximately 31,000 in the quarter, with 49 ION systems placed [50][51] - SP procedure growth accelerated to 94%, driven by strong growth in the U.S. and international markets [28][52] Market Data and Key Metrics Changes - U.S. procedures grew 13%, with notable strength in benign general surgery, while OUS procedures grew 24%, driven by markets like India and Korea [40][41] - Capital placements included 367 systems, a 17% increase from the previous year, with 204 systems placed in the U.S. [42][43] - The U.S. capital environment remains strong, while OUS markets face constraints due to government budget limitations [72][74] Company Strategy and Development Direction - The company is focused on the full launch of Da Vinci 5 and increasing adoption of its products through training and market access efforts [29][30] - Plans to optimize production costs and adjust supply chain strategies in response to changing trade policies [10][11] - Continued investment in R&D and innovation to drive long-term growth and improve product quality [57] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the long-term demand for minimally invasive care despite current trade policy uncertainties [11] - The company raised its full-year 2025 procedure growth forecast to a range of 15% to 17% [61] - Management acknowledged potential impacts from tariffs and government budget constraints on capital spending [63][64] Other Important Information - The company opened new manufacturing facilities in California to expand its U.S. manufacturing and R&D footprint [55] - Pro forma operating expenses increased by 12% compared to the previous year, driven by higher headcount and facility-related costs [57] Q&A Session Summary Question: Impact of tariffs on annualized basis - Management indicated that approximately half of the tariff impact is from U.S.-China trade, with the impact expected to increase each quarter [68][69] Question: Capital environment comparison to previous years - Management noted strong customer response to Da Vinci 5 and a relatively strong capital environment in the U.S., while OUS markets face budget constraints [71][72] Question: Inclusion of European reciprocal tariffs in estimates - Management confirmed that the 1.7% estimate includes anticipated European tariffs and emphasized a cautious approach to mitigating tariffs [79][80] Question: Confidence in raising procedure volume forecast - Management cited strong Q1 performance and positive customer feedback as reasons for the early forecast increase [86][87] Question: Drivers of robust OUS growth - Management highlighted strong growth in early-stage markets like India and Taiwan, as well as solid performance in the UK [100][101] Question: After-hours surgery and cardiac surgery growth - Management discussed the importance of after-hours surgery for patient access and the growing interest in cardiac surgery as a viable option for minimally invasive procedures [114][116] Question: Force feedback technology usage and clinical strategy - Management provided insights on the current use of force feedback instruments and the ongoing studies to validate this technology [120][124]

Financial Data and Key Metrics Changes - First quarter revenue was $2.25 billion, a 19% increase year over year, with constant currency growth at 20% [29][30] - Pro forma gross margin for Q1 was 66.4%, down from 67.6% in the same quarter last year, primarily due to higher facility costs and a mix of newer products [34] - Pro forma net income for Q1 was $662 million, or $1.81 per share, compared to $541 million, or $1.50 per share, in the prior year [37] Business Line Data and Key Metrics Changes - Da Vinci procedure growth was 17% in Q1, with significant strength in general surgery in the US and notable performance in India and Korea [9][26] - Capital placements included 367 da Vinci systems, a 17% increase from the previous year, with 147 being da Vinci V systems [10][27] - ION procedures grew 58% to approximately 31,000 in the quarter, with 49 ION systems placed [32] Market Data and Key Metrics Changes - US procedures grew 13%, driven by benign general surgery, while OUS procedures grew 24%, led by India and Korea [26][78] - Procedure growth in China improved from the prior quarter, primarily driven by urologic procedures [26] - The installed base of da Vinci systems grew 15% year over year [25] Company Strategy and Development Direction - The company aims to assure product supply globally and optimize production costs amid dynamic trade policies [7][8] - Focus on the full launch of da Vinci V and increasing adoption of focused procedures through training and market access efforts [19][20] - Commitment to building industrial scale, product quality, and manufacturing optimization [19] Management Comments on Operating Environment and Future Outlook - Management expressed confidence in procedure growth, raising the full-year 2025 procedure growth forecast to 15% to 17% [39] - The impact of tariffs is expected to add approximately 1.7% to cost of sales, with a potential increase in impact as the year progresses [24][41] - Management remains cautious about the capital environment, noting potential constraints in key OUS markets due to government budget limitations [48][80] Other Important Information - The company opened new manufacturing facilities in California to expand its US manufacturing and R&D footprint [35] - The average selling price for da Vinci systems increased to $1.62 million, driven by a higher mix of da Vinci V placements [31] - The company is focused on enhancing its digital tools and computational capabilities to support surgical performance [17] Q&A Session Summary Question: Impact of tariffs on financials - Management indicated that approximately half of the tariff impact is related to US-China trade, with the remainder from imports into the US from other countries [45] Question: Capital environment and customer response - Management noted strong customer response to da Vinci V in the US, with leasing arrangements providing flexibility amid capital constraints [48] Question: OUS growth drivers - Management highlighted strong growth in early-stage markets like India and Taiwan, with ongoing efforts to engage key opinion leaders and surgical societies [80]

Core Insights - The studies published by Intuitive demonstrate that robotic-assisted surgery (RAS) enhances access to minimally invasive care, particularly in underserved areas, leading to improved patient outcomes [1][2][3] Group 1: Study Findings - The first study identifies regions lacking access to high-quality minimally invasive surgery (MIS) due to factors like training availability and hospital infrastructure [3][4] - The second study evaluates the impact of RAS on MIS rates across 408 U.S. hospitals from 2016 to 2022, focusing on 153 hospitals that adopted RAS for common surgeries [5][6] - Hospitals that implemented RAS saw an increase in MIS rates from 60.5% to 65.8%, compared to a smaller increase from 56.1% to 57.0% in non-RAS hospitals [7] Group 2: Barriers and Solutions - Surgeon characteristics accounted for nearly two-thirds of the variation in MIS use, while patient sociodemographic factors contributed nearly 30% [6][8] - RAS offers a shorter learning curve for surgeons, potentially improving MIS adoption and access [6][8] - Telementoring and remote surgical support can extend the reach of experienced surgeons into underserved areas [6] Group 3: Broader Impact - The introduction of RAS has contributed to overall growth in MIS, rather than merely shifting procedures from traditional laparoscopy [8][9] - More than 16 million patients have benefited from minimally invasive care using Intuitive technologies, leading to shorter recovery times and reduced postoperative complications [9]