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]

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 [10][19] - Pro forma EPS increased 22%, marking the third consecutive year of growth above 20% [19] - Free cash flow rose to $2.5 billion, up from $1.3 billion in 2024 [19] Business Line Data and Key Metrics Changes - Total procedures grew 19%, with da Vinci procedures increasing approximately 18% and Ion procedures growing 51% [7][18] - In Q4, da Vinci procedures grew 17%, with the installed base increasing by 12% to over 11,100 systems [20] - Ion platform procedures increased 44%, with the installed base up by 24% to just under 1,000 systems [20] Market Data and Key Metrics Changes - In the U.S., da Vinci procedures increased 15% to over 2 million, while international procedures grew by 23% to over 1.1 million [7] - Growth rates were 21% in Europe, 24% in Asia, and 27% in the rest of the world [7] - Total procedures outside the U.S. accounted for roughly 35% of global procedures [7] 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 [5][16] - The company aims to expand its platforms and digital features while increasing adoption of focused procedures through training and market access efforts [16] 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] - For 2026, the company anticipates da Vinci procedure growth in the range of 13%-15%, driven by general surgery in the U.S. and international procedures [41][42] - The company expects pro forma gross profit margin to be between 67% and 68% of net revenue in 2026 [42] Other Important Information - The company placed 1,721 da Vinci systems in 2025, including 870 da Vinci 5 systems [8] - The installed base of da Vinci systems increased by 12% to just over 11,100 systems, with average system utilization increasing by 4% [20] - The company received FDA clearance for several cardiac procedures on da Vinci 5, indicating a focus on expanding into new disease states [11][52] Q&A Session Summary Question: FDA approvals for cardiac non-force feedback instruments - Management discussed the foundational aspects of supporting cardiac surgery and the importance of training pathways for minimally invasive approaches [48][50] Question: Incorporating advanced imaging features into the robotic ecosystem - Management explained that advanced imaging capabilities are being developed to improve surgical outcomes and will have associated revenue streams [54][55] Question: Expanding footprint in ASCs - Management highlighted the importance of high-quality clinical outcomes and the economic structure needed for ASCs, with a focus on lower acuity procedures [61][62] Question: Utilization and system ASPs in 2026 - Management indicated that while overall da Vinci utilization grew 4%, they are not ready to predict future utilization rates [66] Question: Gross margin and OpEx assumptions - Management outlined various dynamics affecting gross margin, including higher trade-ins and a mix of da Vinci 5 systems [72] Question: Competition in China - Management acknowledged increased competition in China but expressed confidence in their ability to compete effectively [75][76]

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]