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<p class="p1">As the maker of the pioneering da Vinci surgical systems, which use robotics to make surgery minimally invasive, Intuitive is on the cutting edge of health care. Now the question is whether the Sunnyvale, Calif., company can fend off a growing roster of rivals. The pandemic has temporarily slowed demand for the elective surgeries for which da Vinci systems are used. But the company is looking to make its $2 million surgical robots more affordable in order to extend their reach further in hospitals nationwide. Intuitive’s stock has quadrupled over the past five years.</p>

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Fastest Growing Companies 2020 91 Intuitive

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Intuitive Surgical is a biotechnology company developing tools for minimally invasive, robotics-assisted surgeries. It joined the Fortune 500 list for the first time in 2024. Five years after its 1995 founding, Intuitive introduced its da Vinci robot, a system using a 3D endoscopic camera and small arms operated by a surgeon at a console. According to the company, the da Vinci model has been used in 14 million procedures, including tonsillectomies and hysterectomies. Its da Vinci 5 model gained FDA approval in March 2024.

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Intuitive Surgical (ISRG): Company Profile, Stock Price, News, Rankings

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Intuitive Surgical

intuitive surgical

Hello, everyone, and welcome to the Intuitive Second Quarter twenty twenty five Earnings Release. At this time, all participants are in a listen only mode. After the speakers' presentation, there will be a question and answer session. Please note this event is being recorded. Now it's my pleasure to turn the call over to Dan Connolly, Head of Investor Relations. Please go ahead, sir.

Good afternoon, and welcome to Intuitive's second quarter earnings conference call. With me today, we have Dave Rosa, our CEO and Jamie Samat, our CFO. Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward looking statements. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are described in our Securities and Exchange Commission filings, including our most recent 10 ks filed on 01/31/2025, and Form 10 Q filed on 04/23/2025.

Our SEC filings can be found through our website or at the SEC's website. Investors are cautioned not to place undue reliance on such forward looking statements. Please note that this conference call will be available for audio replay on our website at intuitive.com on the Events section under our Investor Relations page. Today's press release and supplementary financial data tables have been posted to our website. Today's format will consist of providing you with highlights of our second quarter results as described in our press release announced earlier today, followed by a question and answer session.

Dave will review business and operational highlights. Jamie will provide a review of our financial results and procedure highlights. I will review clinical highlights and discuss our updated financial outlook for 2025. And finally, we will host a question and answer session. With that, I will turn it over to Dave.

Good afternoon and thank you for joining us today. Before we proceed, I'd like to take a moment to recognize and thank Gary Goodhart. As you know, after more than fifteen years as Intuitive's CEO, Gary transitioned to Executive Chair of the Board earlier this month. It's been a privilege to work alongside Gary for nearly thirty years. We joined within a month of each other as engineers at what was a tiny California based company in 1996, where a small group of us developed the first da Vinci prototype.

Since then, we have worked together with many extraordinary colleagues to build a company that is today a global enterprise, employing more than 16,000 people, supporting over 11,000 robotic systems across 74 countries, with over 17,000,000 procedures performed. On behalf of the patients, surgeons and care teams we support, our employees and so many other stakeholders, we thank Gary for his leadership at Intuitive and his contributions to advancing minimally invasive care. I am grateful for the strong foundation he's created and honored to serve as Intuitive's next CEO. I'm excited to lead the company forward as we continue to advance the quintuple lane and deliver value for our stakeholders. Moving to the business, our financial metrics were strong in second quarter with solid procedure growth and capital placements despite ongoing macro challenges in certain international markets.

Our teams achieved significant milestones across our ecosystem of products and services while navigating dynamic market conditions globally. Our product operations teams continue to build capacity and deliver for our customers while optimizing production costs within our existing manufacturing and supply chain footprint. Our research and development efforts continue to build momentum in the quarter. Our newest platform, da Vinci V, is in broad launch in The United States and received clearances in Europe and Japan, where we will begin measured launches. We are pleased with customer feedback and adoption of our newer platforms and remain committed to supporting high quality, minimally invasive care with a comprehensive and impactful product portfolio.

Reviewing procedure performance, da Vinci procedure growth in the quarter was 17%. Benign general surgery led US procedure growth with a strong contribution from after hours procedures, while international growth was led by non urology procedures. Regional performance highlights included strength in India, Korea, and distribution markets. Jamie will provide further details on procedure dynamics later in the call. Turning to capital, we placed three ninety five da Vinci systems, including 180 da Vinci V systems and 23 SP systems.

Capital placements were strong in The US, while macro challenges in Japan, China, and Europe continued. We also placed 54 ION systems in the quarter. System utilization, defined as procedures per installed clinical system per quarter, grew 2% year over year for our multiport platforms, and accelerated to 308% for SP and ION respectively. Moving to our finances, revenue growth of 21% reflects solid procedure performance and capital placements and a benefit from higher purchase mix. Product margins and operating expenses were slightly favorable to our expectations.

Turning to our multiport business, da Vinci V has been an important addition to our robotic surgical system portfolio, with more than 100,000 procedures performed to date in what had been a measured US launch. We are pleased to offer da Vinci V broadly in The United States. Commercialization in Europe and Japan will be measured as we work through additional clearances to fully enable the da Vinci V ecosystem. We also added to our advanced energy instrument portfolio with five ten clearance for Vessel Sealer Curved, giving surgeons greater precision in narrow anatomical spaces. Additionally, we received a procedure clearance for tracheobronchoplasty, a surgical treatment for a collapsed trachea and main bronchi during normal breathing.

With respect to our digital ecosystem, customers continue to collect and publish data about force feedback and other aspects of da Vinci V through their use of case insights. Dan will highlight some of this data later in the call. Since launching dual console capability with da Vinci SI in 02/2009, we have developed a range of digital collaboration tools for our customers. We believe these telecollaboration capabilities can advance clinician training, enhance patient care, and optimize care delivery. Intuitive Telepresence, with our latest hub software, will enable customers to use on demand scheduling, connecting easily with a known group of peers, similar to the favorites screen on your phone.

Last week, at the Society of Robotic Surgery Conference, Doctor. Doug Stoddard, Director of Surgery and Robotics at Christus Health, and Doctor. Andrea Pukula, Medical Director of Robotic Surgery at Adventist Health, performed a telesurgery demonstration between Atlanta and Strasbourg on an advanced tissue model using da Vinci V, including force feedback. While the long term opportunity for telesurgery is potentially significant, we recognize that achieving safe, consistent adoption will require robust cybersecurity and privacy infrastructure, new workflows at hospitals, revised medical and legal policies, and appropriate business economics. As with our approach to innovation broadly, our work here is focused on applying our experience and expertise to deliver safe, meaningful, grounded solutions that address real world healthcare challenges.

Turning to SP, procedure growth was strong at 88% year over year, with growth accelerating in Korea. We are still early in our European launch and are pleased with progress to date. Our SP team achieved several milestones, including receiving clearance for our 50 use endoscope, along with five ten clearance for transanal local excision and resection, adding to a suite of transabdominal colorectal procedures. Our priorities for SP in the near term include additional indications in The US, expansion in international markets, enhancing core capability, and improving product costs. Moving to Ion, procedures grew 52% to approximately 35,000 in the quarter.

We recently sold our first systems in Australia and Korea and performed our first commercial procedures. Our priorities for ION in the near term are supporting utilization growth in The US, expansion in international markets, enhancing overall procedure workflow, and improving product costs. Over recent years, we have highlighted our investments in and focus on delivering for our customers across all aspects of our ecosystem at industrial scale. Customers around the globe rely on Intuitive for high quality products and services and rock solid supply continuity to ensure they can serve their patients safely, reliably, and effectively at volumes approaching 3,000,000 patients per year globally. As has been the case throughout our thirty year history, we will continue to innovate across our instrument portfolio, as illustrated by the introduction of our force feedback and extended use instrumentation.

Our work here is guided by a commitment to the quintuple aim, including patient safety, product quality and reliability, and informed by data from millions of procedures. We are aware that third parties have sought to offer products or services to healthcare providers that would modify some of our instruments to extend their use. As customers consider remanufactured instruments from third party suppliers, we expect key areas such as safety, performance, quality, reliability, supply continuity, and pricing will be carefully evaluated and compared. Our strong belief is that high quality instruments with consistent performance, broad operational support, and predictable supply chains provide the greatest value to our customers. In closing, we are committed to our 2025 priorities.

First, focusing on the full launch of da Vinci V, its regional clearances and follow on feature releases. Second, we'll pursue increased adoption for our focused procedures by country through training, commercial activities, and market access efforts. Third, we'll drive continued progress in building industrial scale, product quality, and manufacturing optimization. And finally, we'll focus on excellence and availability of our digital tools. Our core businesses have momentum and our teams are focused on the significant long term opportunity to improve the Quintuple aim through our connected ecosystem.

We are well positioned operationally and financially to execute against our priorities. I'll now turn the time over to Jamie, who will take you through our finances in greater detail.

Good afternoon. I will begin by highlighting our second quarter performance on a non GAAP or pro form a basis, and I will summarize our GAAP results later in my remarks. A reconciliation between our pro form a and GAAP results is available on our website. Our second quarter financial results were strong. Revenue growth was 21%, pro form a operating margin was 39% and pro form a earnings per share increased 23%.

Our underlying core metrics were solid and as follows: da Vinci procedures grew 17% our installed base of da Vinci systems increased 14% to almost 10,500 systems globally, and average system utilization rose by 2%. Taking da Vinci and ION together, total procedure growth was 18%. Strength in Q2 financial results reflected a higher mix of systems purchased by customers as compared to last quarter and last year, and leverage of fixed costs. In The US, da Vinci procedures grew 14%, driven by continued strength in benign general surgery, with notable growth in cholecystectomy and appendectomy, reflecting in part our partnership with customers to support growth in after hours procedures. When considering the environment in The US, we recognize the potential impacts of fiscal policy to Medicaid recipients.

There are approximately 70 to 80,000,000 Americans covered through this program, for which uncertainty remains about whether some patients may lose coverage, how that plays through health systems, and what the ultimate impact might be. At this point, I would highlight the following: First, currently Intuitive's relative penetration is lower for patients covered by Medicaid as compared to all other types of coverage. Second, Medicaid patients tend to be a younger demographic as compared to the overall population. And third, to the extent that intuitive can demonstrate an advantage, clinically and economically, we believe we are in a position of relative strength. Outside The US, da Vinci procedures grew 23%, with strong contributions from India, Korea and distributor markets.

Clinical performance in India has been driven by expansion of the installed base at greenfield accounts, and adoption by surgeons across a broad set of surgical specialties. Strength in Korea procedure growth partly reflected a weaker comparison period, given the impact of physician strikes last year. We also continued to see strong adoption and use of SP in Korea across a broad set of procedures. In China, procedure growth slightly exceeded the global average and continues to reflect the impact of a constrained and a competitive capital environment. Overall, outside The US, we observed robust growth across colorectal, benign general surgery, thoracic, kidney, and HPB procedures.

The breadth of OUS procedure growth reflects our focus in supporting customer adoption beyond urology and is an ongoing opportunity for Intuitive to reach more patients. Turning to capital performance, we placed three ninety five systems in quarter two, a 16% increase from the three forty one systems placed in the same quarter last year. Following our progression into US broad launch of da Vinci V during Q2, we placed 180 da Vinci V systems, bringing the installed base to six eighty nine systems. We saw 83 trade in transactions in Q2, up from 21 a year ago, primarily driven by US customers upgrading to da Vinci V. While there are a number of customers expressing interest in upgrading to da Vinci V, we expect trade ins to occur over multiple years as customers assess its clinical and financial benefits.

In The US, we placed two sixteen systems, up from 149 last year. Outside The US, we placed 179 systems compared to 192 last year. OUS placements included 73 systems in Europe, 15 in Japan, and 13 in China, compared to 71, forty one and fourteen respectively last year. Performance in markets served by distributors has been strong in recent periods. In Q2 we placed 79 systems compared to 70 systems last year.

Recent strength has been driven by growth in Brazil, Eastern Europe and Southeast Asia, reflecting expansion into customers establishing their first robotic programs. Our capital performance outside The US continues to be impacted by ongoing financial and budgetary pressures in Japan, China and Europe. These pressures reflect government budget challenges and uncertainties over the trade environment. During the quarter, NHS England issued its ten year plan to improve healthcare outcomes and associated priorities. We are encouraged to see a commitment to expanding access to robotic surgery as one of the key elements of the plan.

However, we do not expect any positive impact this year from incremental NHS investments in robotics. Total revenue for the quarter was $2,440,000,000 representing 21% growth over the prior year. On a constant currency basis, revenue growth was also 21%. Systems revenue increased 28%, reflecting lower lease rates, increased placements and a higher mix of da Vinci V systems, which drove higher average selling prices. Recurring revenue also grew 21% and accounted for 85% of total revenue.

Leasing represented 49% of Q2 placements, lower than 54% last year, primarily driven by a higher mix of placements with distributors, most of whom do not qualify to lease systems. While leasing rates may vary from quarter to quarter, we continue to expect the trend toward leasing to increase over time, driven primarily by a higher mix of leasing by OUS customers. The average selling price for systems was $1,500,000 compared to $1,440,000 last year, reflecting the increasing mix of da Vinci V systems, partially offset by a higher mix of trade in transactions. Instrument and accessory revenue per procedure was approximately $1,800 relatively consistent with the prior year. On a year over year basis, we saw downward pressure from lower bariatric procedures and higher cholecystectomy procedures, offset by customer ordering patterns, higher SP procedures and da Vinci V specific INA.

Second quarter SP procedures grew 88%, driven by 112% growth in Korea and strong growth in Europe and Japan. We placed 23 SP systems in Q2 compared to 21 systems last year. These included six in The US, six in Korea and five in Taiwan. SP utilization rose 30%, with Korea and Japan continuing with highly efficient, high usage SP programs. Utilization is also steadily increasing in Europe and The US.

We are progressing through the early phase of a measured rollout of our SP stapler, which we believe is a key enabler for SP adoption in colorectal and thoracic procedures. Now turning to Ion. We performed approximately 35,000 Ion procedures in Q2, a 52% increase over the prior year. We placed 54 ION systems, compared to 74 in Q2 of twenty twenty four. Seven of these systems were placed in markets outside The US.

The installed base of ION systems expanded to nine zero five systems, and average system utilization increased 8% from the year ago period. Turning now to the rest of the P and L. Pro form a gross margin for the quarter was 67.9%, down from 70% in Q2 of last year. The year over year decline reflects higher facilities costs, including depreciation related to new manufacturing capacity, a greater mix of lower margin ION and da Vinci V revenue and higher service costs related to da Vinci V. In addition, Q2 results also reflected an impact of approximately 60 basis points from tariffs.

Clearly the trade environment continues to be dynamic. We are currently estimating the impact of tariffs for the year to be approximately 100 basis points, plus or minus 20 basis points, lower than the estimate we provided on last quarter's earnings call, primarily reflecting the reduction of bilateral tariff rates relating to US China trade. Our estimate for the year assumes the following: Imports from China to US bear a tariff rate of 30%. Imports into China of subassemblies and finished goods from The US are subject to a 10% tariff. Imports into The US from all other countries bear a 10% tariff rate, and that imports from Mexico and Canada that comply with USMCA continue to be exempt from tariffs.

As a reminder, we expect the impact of tariffs to increase each quarter this year as tariff expense rolls through inventory into cost of sales. Given the uncertainty surrounding what tariff rates will ultimately be enacted, it is possible future tariff rates could have a significant incremental impact on our cost of sales. During the quarter, we opened a new 187,000 square foot manufacturing facility in Bulgaria with land to expand further as needed. This site will initially be focused on our portfolio of more mature endoscope products. Over time, we expect to further increase our manufacturing footprint in Germany and Mexico, given our mid term needs for additional capacity to support revenue growth and our strategy to operate at industrial scale.

Second quarter pro form a operating expenses increased 9% year over year, driven by higher headcount and increased facility costs including depreciation, partially offset by lower legal expenses. We added approximately 300 employees during the quarter, approximately half of whom were in manufacturing roles in support of customer demand. Pro form a other income was $93,000,000 for the quarter, up from $91,000,000 in the prior quarter, reflecting higher interest income. Our pro form a effective tax rate for Q2 was 22.7%, in line with our expectations. We are at the early stages of evaluating recent US tax reform and at this point we do not anticipate a material impact to our 2025 tax rate.

We are still evaluating potential impacts for 2026. Pro form a net income for the second quarter was $798,000,000 compared with $641,000,000 last year. Pro form a earnings per share increased 23% year over year to $2.19 per share. Now turning to our GAAP results. GAAP net income for the quarter was $658,000,000 or $1.81 per share, compared to $527,000,000 or $1.46 per share in Q2 of last year.

The differences between our pro form a and GAAP results are outlined and quantified on our website. We ended the quarter with $9,500,000,000 in cash and investments, up from $9,100,000,000 last quarter. The sequential increase was driven by operating cash flow, partially offset by stock repurchases of $181,000,000 and $155,000,000 in capital expenditures. During the quarter, we repurchased 350,000 shares at an average price of $518 per share. With that, I'll turn it over to Dan to discuss recent clinical publications and our outlook for 2025.

Thank you, Jamie. Turning to the clinical side for our business, I'd like to share with you data from recent studies that we found notable. In addition to the specific data highlighted on this call, we encourage you to consider the wide body of evidence detailing these topics and published scientific studies over the years. This past June, in the Journal of the American Medical Association, or JAMA, Doctor. Fang from Xianjiang Hospital, Fudan University, on behalf of the investigator team, reported three year results from a randomized trial comparing robotic and laparoscopic surgery for middle and low rectal cancer.

Known as the REAL Study, this study examined local regional recurrence rates with more than five eighty subjects in each of the robotic assisted arm and laparoscopic arm. Recall, secondary short term outcomes from this study were published in The Lancet Gastroenterology and Hematology in November 2022, and described on our earnings call in January 2023. That publication reported robotic assisted surgery resulted in a better oncological quality of resection, less surgical trauma, and better postoperative recovery when compared to the laparoscopic approach. In the current JAMA publication, the primary outcome was the three year local regional recurrence rate, which was defined as any case of cancer recurrence in the pelvic or perineal area at three years after surgery. The authors reported that the robotic assisted group demonstrated a fifty five percent lower risk of local regional recurrence at three years compared to laparoscopy.

The authors concluded, Compared with conventional laparoscopic surgery, robotic surgery significantly improved long term oncological outcomes in patients with middle or low rectal cancer. With additional real world clinical data and modern improved training programs for surgeons, robotic surgery could be the preferred choice for patients with middle or low rectal cancer. With the launch of the da Vinci V platform, we are starting to see evidence emerge that describes the value that new features such as force feedback technology and case insights may bring to minimally invasive surgery. At this month's Society of Robotic Surgery Annual Meeting, Doctor. Leila Rashidi from MultiCare Health System in Tacoma, Washington presented data from her single surgeon experience.

Doctor. Rashidi analyzed relationships between clinical outcomes and objective performance indicators, or OPIs, such as the force measured during surgery using force feedback instruments. To conduct the study, Doctor. Rashidi and colleagues used OPIs generated by Case Insights, an AI enabled solution that combines surgical video with data from the da Vinci platform. Their analysis of 28 low anterior resection cases revealed that certain patient factors and OPIs were associated with the outcomes in these colorectal procedures.

Specifically, higher forces, especially during the dissection phase of surgery, and prior surgery were associated with increased length of stay. The strongest predictor of length of stay was the percent of forced time above 6.5 newtons. Doctor. Rashidi and team concluded in part, quote, This early DV5 experience demonstrates that patient factors and OPIs are associated with clinical outcomes in robotic assisted low anterior resection. Advancements in the technologies integrated with robotic platforms can assist surgeons by identifying factors that predict complications, and aiding the optimization of techniques for specific patients, ultimately supporting safer, gentler, and more precise surgery.

While these results are early, we are encouraged to see results that are consistent with the core hypotheses of the value that force feedback technology and case insights may bring to minimally invasive surgery. We continue to expect clinical evidence to build over the coming quarters and years. I will now turn to our updated financial guidance for 2025, starting with da Vinci procedures. On our last call, we forecast full year 2025 da Vinci procedure growth within a range of 1517%. We are updating our 2025 da Vinci procedure growth guidance to be within a range of 15.517%.

Consistent with last quarter, the low end of the range assumes growth in China is impacted by trade, environmental, and competitive dynamics. Governments in key OUS markets continue to constrain hospital CapEx budgets, which limits the expansion of capacity in the field, and bariatric procedures continue to decline at rates similar to recent trends. The high end of the range assumes China procedure growth improves relative to 2024, the CapEx environment improves in key OUS markets, and bariatric procedure declines moderate. The high end of the range also assumes that da Vinci procedures are not impacted by the current trade environment. Turning to gross profit.

On our last call, we forecast pro form a gross profit margin in 2025 to be within a range of sixty five percent and sixty six point five percent of revenue, which reflected significant incremental depreciation as we bring on new facilities, the contribution from growth in newer products, and the expected impact of tariffs. As Jamie described earlier, we currently expect the recently implemented tariffs globally to increase our 2025 cost of sales by approximately 1% of revenue, plus or minus 20 basis points. As a result, we are updating our estimate for pro form a gross margin to be within a range of 6667% of revenue. In regards to operating expenses, we continue to expect pro form a operating expense growth to be between 1014%, which includes increased depreciation from new facilities and investments to drive our growth objectives. We continue to expect our non cash stock compensation expense to range between $770,000,000 and $790,000,000 We now expect other income, which is comprised mostly of interest income, to total between $370,000,000 and $390,000,000 With regards to capital expenditures, we now estimate a range of $650,000,000 to $725,000,000 primarily for planned facility construction activities.

With regard to income tax, we continue to estimate our 2025 pro form a income tax rate to be between 2223% of pre tax income. That concludes our prepared comments. As we open the line for questions, we ask that you please limit yourself to one or two questions.

Thank Our first question is from Travis Steed with Bank of America Securities. Please proceed.

Hey, thanks for taking the question and congrats. I guess maybe I'll start with a margin question. It was kind of one of the highest margins you've had in a long time, even with the tariff headwind. I don't know how much of this is the new facility coming on in Q1 or what? Just trying to think about how what drove the margin upside this quarter and kind of what's sustainable on the margin side.

Hey, Travis, this is Jamie. Yes, I'd just say we had a strong revenue growth quarter at 21%. Part of that was the increased purchase mix, which obviously the purchase lease mix can vary from quarter to quarter. We did underspend on OpEx just a little bit, that grew 9% year over year. And so part of what fell through then was just the revenue be leveraged through the entire P and L, produced that operating margin result.

I would not characterize that as the new normal, because obviously you've got some benefit from, again, the purchase mix and spending just growing 9%.

Understood. I guess I'll go ahead and get the one reprocessing question out of the way too. I guess the question would be, one, is there any more you could add to what you said in the prepared remarks? Is this something you can kind of do yourself or could you also potentially extend useful life on your own instrumentation as well? Just kind of thinking about like the longer term, how you kind of protect the business.

Yeah, no, hey Travis, it's Dave. I think as I said in my prepared remarks, customers care about the quintuple aim, as they establish robotic programs, they wanna deliver high quality care, great outcomes for their patients. And we know they wanna do it, with the right value too. And so as customers consider remanufactured instruments, from third party providers, it's been my experience that oftentimes hospitals will use value committees to assess these types of, supply chains. Those value committees often consist of a variety of stakeholders from the hospital.

It may be OR leadership, it could be medical personnel, risk management, supply chain, care team folks like surgeons and nurses, and maybe others. And so these value committees have established processes that they look through and assess a whole bunch of variables like we talked about, safety, reliability, performance, continuity of supply, ongoing support, will all be weighed against the expected savings. And so that's where our strong belief is that high quality instruments, the performance that we have demonstrated over time, the operational support that, we engage, through our teams, and a very predictable supply chain will provide the greatest value. As you look forward, I think innovation plays a strong role here. And so you've seen us increase the breadth of our portfolio over time, you've seen us extend instrument uses, introduce force feedback here recently with da Vinci V.

And throughout that entire time, we've worked really hard on instrument reliability and supporting, the safety and performance of robotic surgery of our portfolio. Importantly, from the first use and through the last use. And so we're gonna continue to invest and innovate to differentiate across our portfolio. And that will bring, I think, best in class performance and innovation pursuit of Quintuple Aim. And we're also going to strive to, lower cost and provide the best value for our customers.

And so this journey with remanufactured instruments will have, many phases. And we will innovate in a variety of different ways and, provide the best value for our customers.

Really helpful, thanks Dave. I appreciate the question. Welcome.

Thank you. Our next question is from David Roman with Goldman Sachs. Please proceed. David, your line is open.

Thank you and good afternoon. Appreciate you're taking the question. Maybe Jamie, I could start as a follow-up to your comments regarding some of the policy changes that are evolving. I think on the last quarter call, you had talked you and Gary had talked about the dynamic with the potential for risk around U. S.

Hospital CapEx spending, but at the same time, where Intuitive could be part of the solution. Tonight, you talked about the dynamic around the unfortunate potential loss of coverage for Medicaid patients and what that might do to the business. Can you maybe give us an update on your latest thinking on the capital side and how you're approaching those conversations as you think about aiding hospitals and their objectives to advance patient care? And then I had a follow-up on the, ForeSeeBack study.

Yeah, on Medicaid specifically, I think we would generally say it's too early to make any comments with respect to how US hospitals are responding to that, at least based on our engagements with customers. We recognize that to the extent that hospitals experience lower admissions because patients lose coverage, or they have less reimbursement, then of course that just creates, incremental financial challenges for hospitals that they may need to respond to in terms of how they manage capital budgets or even operational budgets. So we're just acknowledging that and providing that some context with respect to our relative penetration relative to Medicaid. Do think that we have, a growing number of engagements we have with customers, particularly in The US relative to what we call customer hospital analytics, where we can look at their data from a clinical and economic perspective, and oftentimes we see that da Vinci can be actually part of the solution when there's an economic challenge in the form of the things we've talked about, lowering length of stay, lower complication rates, saving precious resources, etcetera. And so we'll look to engage customers if and as that's needed over time.

In terms of the overall capital environment, I'd just say if we look at system placements at March, we'd characterize that as solid performance and in the range of our expectations, but you actually have to double click in terms of the kind of market breakdown of that performance. Placements in The U. S. Grew 45%, reflecting the move into broad launch for da Vinci V in Q2, and strength and interest in da Vinci V. And then we talked about Japan, which was down 26 systems year over year, Europe and China essentially flat, and that's mostly to do with government budget deficits and conserving government spending, including impacts on healthcare.

So I think we feel good about The US and recognize some challenges internationally. In OUS customers, we do have some levers and opportunities. Many of those customers and markets experienced lower levels of utilization, and we have tools, resources and levers to help customers, increase utilization to support procedure growth. We've refined some of our leasing models to more localize them in the past quarter, I think can help with, alleviating the pressures that they face. And of course, we have the launch of da Vinci V now with the clearance in Europe and Japan, and at least we think some early adopters will be responding to that technology.

Finally, I'd say as we are able to drive trade ins in The US, that then gives us the opportunity to add XIR to the portfolio, which can be attractive to OUS customers where they're cost sensitive.

Very helpful. Appreciate all the detail. And maybe just a follow-up on the Force Feedback launch. Can you give us kind of an update on where you are with customer evaluations, as well as capacity expansion and the extent to which that may already be impacting the INA per procedure number and how we should think about the progression of the rollout there?

Yeah, David, maybe I'll take the first part, and I think Jamie will jump in towards the end. Just on the supply of force feedback instruments, we do expect that to be constrained through first quarter of next year. And I'd say more broadly, pleased with adoption thus far. The early feedback's been encouraging, particularly with case insights. I think you heard us describe, you know, we and surgeons, we're building evidence, and continue to, you know, we'll share that over time.

And again, that evidence is mainly looking to demonstrate that force feedback can improve outcomes, and then separately, maybe quicken the learning curve for surgeons adopting robotics, for the first time.

I'm sorry, remind me the second part of your question.

To see the extent to which forced feedback may have impacted, looks like INA outgrew procedure volumes this quarter, whether that's having a positive impact even in its early launch and when we might start to see it sounds like the 2026 is the dynamic with capacity, but when we might start to see a more significant impact from force feedback on that INA per procedure number.

Yeah, in the prepared remarks, it was one of the contributing factors to an upward momentum on INA per procedure, although the smallest component, and the way I characterized it was da Vinci V, INA specific, contributions. That's the combination of force feedback and the tube sets that go along with our integrated insufflator. So one of the smaller factors, and obviously that becomes an opportunity for us to the extent that we can demonstrate value and when we get to full supply.

Thank you. One moment for our next question, please. And it's from Robert Marcus with JPMorgan. Please proceed.

Great. Congratulations on a very nice quarter. And Dave, congratulations as I believe it's your first call as CEO. Two for me. Maybe first, just to kind of pick up a thread in one of David's questions on da Vinci five and productivity.

And I was wondering, I know it's still early in the launch, but you now have a couple of quarters on some of these robots in The U. S. And are you seeing any improvements in productivity? It could obviously be really helpful as we think about the upgrade cycle and the ability to do more procedures, generate more revenue and treat more patients. So first, I'd love to hear what you're seeing in terms of improved productivity on da Vinci V versus Xi. Thanks.

What I would say is, it's one area where we look to build evidence to support the value proposition, and we described to you in the past a number of the anecdotal inputs that we get from surgeons. Some of them have been presented on stage, we've seen some analysis in various publications, but we'd like to get to a state where that is robust evidence and is part of how we engage with the customers, and that will take us some time to build that collateral. I would say that recently average system utilization on da Vinci V surpassed Xi. Obviously we'd like to see that sustain and we'd like to know that that actually is function of then increased efficiency. It could be that the parts of that are just surgeons' interest to try and get on the platform versus the Xi, but that seems consistent from where those lines crossed.

So I think that's an opportunity for us, but we have work to do to get to a level of evidence that's sufficiently robust that we can engage customers that way.

And I just maybe let Dave make any additional comments there.

No, you're right on, Jamie. The DV5, da Vinci V, one of its areas of focus from our design teams was exactly around efficiency. And so you have heard some of the capabilities and features described around head and UI and placements of screens. And so all of those things are contributing and integrating to some of the, efficiency gains that Jamie described.

And we have seen, we are tracking at individual institutions and individual surgeons. And you see on short cases to longer cases, savings that can exceed 20%. And so as more and more data comes to life there, we will start seeing, how that impacts utilization. And I think here, our one goal would be to enable, teams, hospital teams, to add another case during the day. And so, as we continue our journey here with DV5, We look forward to collecting and analyzing and publishing more data.

Great. Maybe a quick follow-up, for you, Jamie. I saw you repurchased shares in the quarter. It's the first time in a while. Just wanted to hear the thought process and your latest thoughts on capital deployment and just how you think about that? Thanks a lot.

Yes. Our capital allocations remain consistent and are probably sound like a broken record. It's first to organically invest in the business and you've seen us do that with R and D and CapEx more recently. Second is we look for smaller tuck in acquisitions where we can find technology that's differentiated or can help us accelerate the business and then, we return capital to shareholders when we have opportunistic, times to do that. And so, what you saw us recognize in the quarter is just the volatility that's in the environment in part because the trade environment, and so we exercise that opportunistically.

We review what we do with capital allocation each quarter with our board, and so we have a relatively formalized process by which we evaluate what we do.

Thank you. Our next question is from Larry Biegelsen with Wells Fargo. Please proceed.

Good afternoon. Thanks for taking the question. Congrats to Dave on the role. Jamie, I think for Jamie, two on systems. I'm going to try to get them both in here.

How should we think about system placements outside The U. S. Going forward, given the recent CE Mark and Japan approval? Is there any reason we wouldn't see system placements start to grow again like we did when you launched DV5 in The U. S?

And secondly, now that the full DV5 launch has started in The U. S, how should we think about the weight of increase in trade ins going forward? And any color on kind of the financial implications of the trade ins? Thanks for taking the questions.

Yeah. With respect to clearance of d v five in Europe and Japan, as our history has been, we're planning for a measured rollout and there's work to do there. We have to obviously build training pathways, proctoring capabilities, and actually engage customers in terms of the relative value of da Vinci V, in particular given its higher price. Of course, you have to wait for clearance before you can directly engage customers in that way. I would say that force feedback instruments for Europe is not yet cleared, and actually we don't expect that before the end of next year.

So there may be some European customers that want to wait for that capability. I would expect that as we've seen in The US, there will be early adopter kinds of companies, customers that will be interested in, getting access to da Vinci V because of the effect of their program and the, desires of their surgeons. But I would consider it to be a measured rollout through the second half as we like to do that the right way with building the infrastructure that drives long term success. With respect to moving into broad launch in The U. S.

In Q2 and the implication for trade ins, yes, we would expect then trade ins to increase given that we have now appropriate levels of supply for those customers that want to upgrade. But as we've said, we think that occurs progressively over multiples of years because, customers are in different places with respect to their programs, the populations they serve, their relative financial priorities in terms of capital budgets and the operational challenges that they face. A number of them will want to evaluate, da Vinci V, and they'll take their time to do it from a clinical efficiency and financial perspective.

Thank you. One moment for our next question, please. And it's from the line of Rick Wise with Stifel. Please proceed.

Good afternoon, Dave. Hi, Jamie. Dave, at the SRS meeting, we heard about the potential for robotics utilization in other spaces beyond current core focuses of the industry like endovascular broadly, AFCs, etcetera. I was just wondering as things evolve and as DB5 rolls out, It's early to say what's next, but how are you thinking about what's next broadly in terms of new locations, new opportunities?

Yeah, hey Rick. You know, you had mentioned ASCs and ambulatory care kind of outpatient environments. And so, you know, that was a focus at SRS. And if I, step back from that and say, what do customers need within an ASC to provide high quality care? A piece of that puzzle is consistent and reliable technology.

And so that surgeons, who come from the main hospital and have some of their practice at an ASC are able to efficiently, do procedures at a volume and with outcomes, that are appropriate. And that's where I'm excited about the technology in our portfolio that we have today. And I like some of the opportunity, as Jamie was talking about trade ins, customers can put the newest technology like DB5 into their, main institutions and focus on some of the inpatient procedures, and then oftentimes take the capital that they already own, be it Xi or X, and move that into ASC environments. And so, one way to help meet customers' needs. But, again, as we're looking at how to solve customers', problems and their goals about quintuple aim, I think increasingly we're seeing some attention around the outpatient environments and ASCs, and feel good about the products that we have there.

Great, and just as a second question, Dave, I'm very conscious that you all have said repeatedly that the da Vinci V will continue to evolve. You've touched on a couple of the aspects. But I was lucky enough to hear, as you know, from your colleague, Iman Jedi, who's leading the DB5 rollout, that with a full launch of the system, broad launch, I think were your words, that there would be additional features, additional software, additional capabilities. And I was hoping you could expand on that and maybe help us understand the implications for adoption, for utilization. And maybe does this help, Jamie, the ASP or margins as the rollout continues? Thank you very much.

Yeah, thanks, Rick. So, you know, of the things about robotic systems as a whole is there are platform technologies. And you start in one place with a product that is launched, at the beginning of last year. And I think you can draw a good analogy to Xi when it was first launched, and then look a decade later at the features and capabilities that were added along the way. And the exact same journey will happen with dB5.

And so, yes, Aman had talked about some of the things that were upcoming. And there are many. One in particular that we've talked about before is, you know, we have the ability to integrate now three d models in a different way than we used to with Xi. And so that is part of the compute, increase in terms of the compute power increase. We're now able to do things graphically and through integration and imaging that we, were not able to do before.

And so, again, with the expectation that these kinds of capabilities will advance one or more aspects of the quintupling, Sometimes outcomes, sometimes the care and patient experiences, or sometimes perhaps cost. And so, I think as we look over the coming quarters and coming years, we'll keep you informed about the features and capabilities and instruments that will continue to be added, to the platform, and, excited about where it's gonna take us.

Rick, we have a roadmap of features to come over time. Some of them are committed and some of them are obviously ideas that we'll explore and make conclusions on. I'd say most of those, features to come, we won't directly charge for, but of course they then enhance the surgeon experience and the overall capability of the system. So in that sense then, for customers that are looking at the price and maybe pausing on whether to make the incremental investment as you increase actually the capability and feature set of the system, then it makes the likelihood of a sale for a customer that was waiting higher. There are some digital capabilities that we're considering charging for and that's going be a function of incremental value and can we demonstrate that to the customer.

I think we've got time for one more question.

Thank you so much. One moment, please. And this question comes from Adam Meeder with Piper Sandler. Please proceed.

Hi, good afternoon. Thank you for squeezing me in and congrats on a nice quarter. I'll keep it to just one question. I did want to ask about the curve vessel sealer, which recently got FDA approval. I've been seeing some buzz on LinkedIn and other sites.

Intuitive Surgical (ISRG) Q2 2025 Earnings Call Transcript

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