A：In China, the adoption of da Vinci systems faced challenges due to low tender activity and competition resulting in policy-driven pricing pressure. In Japan, procedure growth was below historical levels despite sequential improvement, which the company attributes to fewer system placements.

A：The da Vinci 5 systems have been placed globally with encouraging customer adoption and feedback. These systems are contributing to increased clinical throughput and expanded access to da Vinci surgery.

A：The force feedback instruments received FDA 510(k) clearance for an additional 15 uses, with a combined total of 25 cleared uses for the instruments. This clearance supports broader availability throughout the year.

A：The digital ecosystem is advancing innovation by investing in data and digital infrastructure, enabling better understanding of surgical procedures through real-world data, and providing insights into clinical contexts. This aids in developing capabilities for digital and AI integration.

A：Intuitive Plus is playing an expanding role in training and program support with growing adoption of telepresence capabilities that facilitate proctoring, mentoring, and collaboration across surgeons and sites.

A：The Singapore platform is contributing to growth with procedures increasing year over year, driven by expansion in Korea, the US, and select international markets. It will incorporate features of the da Vinci 5 ecosystem, including current and future digital and AI capabilities.

A：The progress with Ion systems includes results that help physicians improve lung cancer patient survival and clinical publications reinforcing the earlier identification of malignancy. The teams are also making progress on rapid on-site tissue evaluation technology and integrating endobronchial ultrasound for streamlined detection to diagnosis processes.

A：The company priorities for 2026 remain unchanged, focusing on global expansion of platforms, digital feature releases, and ecosystem enhancements; increased adoption for focused procedures; building industrial scale, enhancing product quality, and achieving manufacturing optimization; and advancing innovation to reach more patients in current and new disease states.

A：Dr. Jamie Wong has been promoted to Chief Medical Officer at Intuitive.

A：The cyber incident did not disrupt Intuitive's business or manufacturing operations, nor did it affect their products. It also did not have a significant impact on their first-quarter financial results.

A：In the quarter, total procedures grew 16%, with 16% growth in Davinci procedures and 39% growth in Ion procedures. Quarter-on-quarter revenue increased 23% to $2.77 billion, with recurring revenue also higher by 23% to $2.4 billion, accounting for 86% of total revenue.

A：In the US, total procedures increased 15%, with strong growth in cholecystectomy and appendectomy procedures. Globally, total procedures grew 20%, with strong results in India, Canada, the UK, Korea, Taiwan, and solid growth in distributor markets like Italy and Germany.

A：In China, procedure growth was below the corporate average due to lower tenders and competitive pricing pressures. In Japan, procedure growth was also below the corporate average, reflecting lower capital placements. The Japanese Ministry of Health, Labor and Welfare introduced incremental reimbursements for hospitals exceeding certain procedure volumes and for new robotic procedures, but the company remains cautious given the financial position of public hospitals.

A：The Intuitive Sp platform had strong performance, with a 23% increase in total revenue to $1.7 billion, and the new Sp stapler was launched broadly in the US. Notable system placements included 431 Davinci systems, a 17% increase from the previous year, with 34 Sp systems placed in Q1, driven by increased US and Taiwan placements. For the Ion platform, 88 systems were placed in Q1.

A：Davinci leasing revenue increased 28%, driven by a 14% expansion of the installed base under operating lease arrangements and a script increase in lease revenue per system due to a higher mix of five systems and higher utilization for usage-based arrangements.

A：The non GAAP gross margin for the quarter was 67.8%, up from 66.4% in Q1 of the prior year. The year-over-year improvement resulted from product cost reductions and fixed overhead leverage, partially offset by the impact of tariffs.

A：The GAAP net income for the quarter was $822 million, or $2.28 per share, compared to $698 million, or $1.92 per share, in the prior year quarter.

A：The company plans to drive innovation-led revenue performance through the continued development of highly differentiated products, accretive pricing, higher levels of integration, and incremental trading volumes. It also aims to leverage existing and planned AI and digital capabilities, as well as increase the value of its Ion platform in the lung through pursuing a staging indication and integrating AI-based rose technology.

A：The study by Dr. Sebastian Fernandez Busey and colleagues, published in Mayo Clinic Proceedings, showed that the diagnostic yield for peripheral pulmonary lesions biopsied using shape sensing robotic-assisted bronchoscopy was 79% with a sensitivity of malignancy at 85%. The procedure also enabled concurrent endobronchial ultrasound lymph node staging in 74% of patients, reducing the risk of repeated interventions and facilitating lung cancer diagnosis. The authors concluded that shape sensing robotic-assisted bronchoscopy consistently demonstrates an optimal diagnostic yield and is preferable over CT guided thoracic biopsy.

A：The updated forecast for full year 2026 Davinci procedure growth is within a range of 13% to 15.5%, an increase from the previous forecast.

A：The updated non GAAP gross profit margin forecast considers an additional 120 basis points impact from tariffs, higher input costs in areas such as freight and semiconductor memory, faster growth of newer products in Davinci and ion, modest incremental depreciation from recent facility expansion, and the impact from higher Davinci system upgrades. Cost reductions and the impact from recent stock repurchase activities are also factors considered.

A：Intuitive expects AI to contribute to improved care, reduced variation, enhanced patient experiences, and lower total costs. AI is also anticipated to provide advanced access for patients globally.

A：Initially, AI will show up in the form of operational guidance and assistance to hospital robotic programs to increase efficiencies and understand costs. It will also help in learning for surgeons and care teams.

A：Intuitive's differentiation in the AI ecosystem is supported by its installed base of systems, including about 100 Davinci 5 systems and the 3 million procedures done annually. They also leverage unique data sets and advantages like edge and cloud compute, as well as proprietary training algorithms.

A：Oil prices and their derivative impacts are expected to have a small, relatively insignificant effect on gross margins, based on the current knowledge. The macro impacts have been accounted for in the gross margin guidance and are closely being watched along with potential supply constraints.

A：Rose and Ebus are known technologies with a more short-term timeline. They are expected to bring significant differentiated value to the lung cancer diagnosis, detection, and diagnosis journey. Updates on this will be provided as the timeline progresses.

A：Intuitive has not yet sized the appendectomy opportunity and is still working internally to determine the right approach. Early clinical outcomes suggest better results with da Vinci for appendectomies, but this needs to be validated in larger clinical studies. In Japan, mhlw has added reimbursement for 7 procedures, with one of the largest being bilateral.

A：Intuitive's approach to innovation-led revenue growth involves leveraging new technologies like AI and differentiated products. The company aims to provide meaningful insights and value to customers, which is anticipated to drive revenue growth faster than the growth in procedures. While specific quantitative comparisons were not provided, the company indicates that innovation will have a significant impact on revenue growth going forward.

A：Revenue growth and procedure growth are influenced by the deployment of R&D to areas where the company can achieve differentiation and make a meaningful difference for customers, aligning with the quintuple aim. This strategy includes accretive or incremental pricing based on differentiation and cost savings. The company also considers the economic cost sensitivity of certain procedures and geographies and aims to share cost savings with customers. The dynamic mix of these factors contributes to the overall revenue and procedure growth within the business.

A：Utilization growth is a critical factor in driving placement and future revenue. However, it's difficult to quantify how much more growth there is in terms of utilization and procedure volume. Intuitive is strategically aligned with customers aiming to increase robotic throughput as it benefits economically and supports their long-term success. Markets like Japan and some European and US markets have room to improve utilization. The transition of the entire install base in the US to higher utilization levels is expected to drive growth, but the timeline and impact are uncertain.

A：Intuitive Surgical faces competition from various sources, including big surgical competitors, companies in China, and Europe. Intuitive aims to meet customer needs at the right price point by focusing on the value customers receive from establishing a robotic program and treating patients with minimally invasive robotic procedures. Intuitive's portfolio offers a range of features and economics suitable for different customer segments, including refurbished systems that provide a complete suite of capabilities with attractive economics. This differentiation is intended to support conversations with customers and ensure that they consider the full range of outcomes and value that Intuitive's systems can provide.

A：The significant difference in procedure growth internationally was likely due to customer ordering patterns, which can be lumpy and lead to orders being placed in a quarter for several future quarters. Additionally, the company experienced benefits from capital placements, including stocking orders that positively impacted Q1. Foreign Exchange (FX) also contributed to the difference in procedure growth rates internationally.

A：The planned additions to the company's ecosystem include further development of collaboration capabilities and tele-serials, which are considered a subset of use cases that will be incorporated into the platform in the future.

A：The current platform is performing well, evidenced by rapid adoption and thousands of use cases per month. It is anticipated that enhancements such as tele-serials will be integrated into the platform, and the company expects these to be a subset of use cases that will continue to demonstrate value to customers.

A：New areas of surgery being explored include minimally invasive cardiac surgery and percutaneous transcatheter approaches. The company is investing in capabilities like the Da Vinci Xi and focusing on training to enable surgeons to treat patients with minimally invasive approaches to these diseases.

A：Opportunities for the adoption of the company's technology include additional clearances for procedures and new instrumentation. In the short term, the focus is on the opportunities that differentiate from other procedures and are already within the cleared indications. Long-term, opportunities like Nipple-Sparing Mastectomy are in an early stage of development, and the company believes there is a potential for the technology to expand the overall addressable procedure market.

A：The strategy to ensure competitiveness includes deep investment in local teams, product expansion, appropriate pricing, and articulating the value of the company's offerings to customers and government agencies. The company tailors programs and pricing to each market while ensuring value realization. They also have strategic plans for each market, with direct engagement in suitable markets and potential localized manufacturing. International ambitions include expanding with distributors into new markets.