Intuitive Surgical Inc. Wells Fargo 21st Annual Healthcare Conference

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Yeah. Happy to be here.

Yeah. I appreciate the question, and I know there is a lot of focus on the U.S. business right now. Let me zoom out for a second. I would say our focus first is on global procedure growth and on all procedure types, so including Ion. That is how we think about how we do capital allocation, how we incent our sales force. We have significant opportunities to drive the global. U.S. is about 60% of our business, and it has decelerated, as you have described. We said on the Q2 earnings call that there was a modest impact from lower Affordable Care Act subsidies. The way we think about the U.S. business is procedure by procedure. We draw adoption curves for each of them. If I think about that business, you have prostate in the fourth quartile of adoption.

You have cholecystectomy, the largest procedure category in the U.S., in the second quartile. You have appendectomy in the first quartile. We model each procedure on an adoption curve, and it also then ties to how we focus and how we invest, where they are relative to the size of the market. The total U.S. procedure growth then is a summation of each of those procedures and where they are. We think that we have a significant opportunity in the U.S., particularly benign general surgery. We have a couple of procedures that are early and have just been put on the beginning points of adoption in cardiac and nipple-sparing mastectomy. Over time, we think we have the opportunity to add additional procedures to the beginning of the funnel.

The way that we think about the market is a significant and attractive opportunity for us, and we think that we can continue to bring procedures to the beginning of that funnel. Of course, there are some dynamics in the marketplace right now. Affordable Care Act, as I described.

Yeah, I think broadly, just thinking about 2026, expect the growth drivers to be consistent year over year. Jamie mentioned, general surgery and specifically continued growth in after-hours procedures, so chole, hernia repair. In addition to that, obviously, we have some procedures at earlier stage opportunities like Jamie mentioned, cardiac and nipple-sparing mastectomy, as well as significant opportunity remaining in general surgery.

I'd just say, obviously, we don't guide at the regional level. What we did in our last earnings call was provide the guidance range of 13.5% to 15.5%. Again, that's global. We said it's likely to be towards the midpoint of that range. That range does reflect more difficult second half comps compared to the prior year. Obviously, we incorporated our best estimate of the kind of ACA dynamic that we described on the Q2 call. Again, we're focused on the global total and the U.S. component is reflected in that range.

Yeah, I think we described that starting in January of this year on the fourth quarter call as an opportunity over the long run. It's not going to be linear, but think that's a significant opportunity kind of enabled by growth and reconditioned Xi, right? We've had two quarters of that thus far, and I think in Q2, we placed 27 systems into ASCs, which was more than cumulatively over the prior couple of years. 20 of those were XiRs. Certainly supportive of growth in the mid to long term in that side of care.