Intuitive Surgical Inc. 2026 Q3 Earnings Call

You may begin. Good afternoon, and welcome to Intuitive's Q3 2026 earnings conference call.

Joining me today are Dave Rosa, our CEO, Jamie Samath, our CFO, Dr. Jamie Wong, our Chief Medical Officer, and Gary Loeb, our Chief Legal and Compliance Officer. Before we begin, I would like to remind you that comments made on today's call may 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-K filed on February 3rd, 2026, and 10-Q filed on July 21st, 2026. Our SEC filings can be found through our website at intuitive.com or at the SEC's website. Investors are cautioned not to place undue reliance on such forward-looking statements.

This conference call will be available for audio replay on our website in the Events section under our Investor Relations page. We have posted today's press release and supplementary financial data tables to our website. Our format for this afternoon's conference call is as follows. Dave will review our business and operational highlights. Jamie will review our financial results and procedure highlights. Jamie Wong will review clinical highlights. I will review our updated financial outlook for 2026, 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. Q3 was a strong quarter for Intuitive, with broad-based adoption across our multi-port, single port, and Ion platforms. In Q3, total procedures increased 15%, driven by 14% growth in da Vinci procedures and 31% growth in Ion procedures. In the U.S., da Vinci procedure growth was 10%, and outside the U.S., da Vinci procedure growth was 20%. We exited the quarter with more than 13,200 da Vinci and Ion systems installed worldwide. Over time, our customers have adopted, operationalized, and standardized on the da Vinci ecosystem to provide their patients with improved care. That adoption has been driven by our commitment to innovation, robust training, and clinical evidence, and it is apparent in how customers use da Vinci today.

In the quarter, almost 7,000 customers in more than 70 countries performed da Vinci procedures at a rate of over 10,000 procedures per day. On the clinical evidence front, more than 48,000 peer-reviewed publications have evaluated the effectiveness of da Vinci surgery, including the recent Benign COMPARE study, which Jamie Wong will discuss in more detail shortly. As I described last quarter, we continue to see increasing segmentation across our customer base. Needs vary by procedure, site of care, geography, and healthcare system. We have been investing to support the segmentation, and we have positioned Intuitive to serve current and future customers with both our existing technologies and those in development. Meeting those needs also requires that we evolve our commercial approach to tailor how we engage, price, and provide solutions for customers in each segment. In Q3, global customer demand across our da Vinci portfolio remained strong.

da Vinci system placements increased 28% worldwide, with da Vinci 5 and SP accounting for 65% of global placements. Installations of XiR and X more than doubled in the quarter. Customers continue to adopt da Vinci 5 and its growing capabilities, with demand for both capacity expansion and system upgrades. We exited the quarter with more than 2,000 da Vinci 5 systems installed worldwide, used by over 18,000 surgeons since launch. We continue to see strong interest in XiR, both in the U.S. and internationally, where customers are leveraging its familiarity, capabilities, and cost profile to build programs around a focused set of procedures. Our da Vinci single-port platform is playing an increasingly important role for our customers and their patients. Our investments in additional clearances and instrumentation are yielding results as SP procedures expand in the U.S. and internationally.

Adoption of the new SP stapler continues to broaden, and in Q4, we plan to make a U.S. submission for the SP vessel sealer, which we believe is a key enabler for wider adoption of our SP platform. Increasingly, customers that adopt both multi-port and single port describe benefits to their overall da Vinci programs, with SP opening new approaches for the surgeon while existing procedure demand fills their multi-port capacity. In Q3, we finalized a set of pricing actions for a subset of high-volume benign procedures where cost may be a constraint to broader access to da Vinci surgery. We believe these actions, in conjunction with increased availability of XiR, will expand our addressable opportunity and enable da Vinci technology to reach more patients around the world. Jamie will describe the anticipated impact shortly.

Outside the U.S., we are elevating our focus and increasing our investments to help customers establish and expand their da Vinci programs. As of Q3, nearly 4,000 international customers have a da Vinci program, and nearly 25% operate two or more systems. These customers are moving beyond urology and cancer procedures into benign hysterectomy in Germany, colon cystectomy in the U.K. and India, and inguinal hernia repair in Japan. To support this growth, we are continuing to build the foundation of market access country by country through regulatory clearances, reimbursement, training, and clinical and economic validation. da Vinci placements outside the U.S. increased 29% in the quarter, with broad-based global demand. In Europe, Germany led the region with 20 system installations. We also placed systems in more than 20 other European countries, and benign procedures led procedure growth.

In Asia, Japan improved on both system placements and procedure growth for the second consecutive quarter, while India had another strong quarter with 42% procedure growth, surpassing 200,000 cumulative da Vinci procedures. In China, the operating environment remains challenging. To support expected long-term growth in Asia, we recently announced plans for a significant new Ion manufacturing facility in Penang, Malaysia. We expect this facility to begin operations in 2028. Beyond da Vinci, we are investing in Ion outside the U.S. through multi-year, country-by-country work that is foundational to broadening access and shortening the time between detection and treatment of lung cancer. During Q3, we received reimbursement for Ion in Korea, and we expect further reimbursement actions in other geographies in the coming quarters. This quarter, we received several CE marks, including force feedback instrumentation and cardiac procedures on da Vinci 5, as well as transvaginal gynecological procedures on SP.

We now have da Vinci 5 cleared for cardiac procedures in the U.S., Europe, India, Japan, and Korea. During Q3, we received FDA 510(k) clearance on da Vinci 5 for surgeon-initiated tool eject and multi-arm targeting, both of which bring incremental efficiency and surgeon autonomy to procedures. Surgeons have reported that these innovations support extending access to da Vinci surgery beyond traditional workdays and hours. Recently, we submitted a cavitational ultrasonic aspirator instrument for FDA 510(k) clearance for use in liver and pancreas procedures. Last week, we received FDA 510(k) clearance for an integrated version of the da Vinci 5 handheld endoscope. In August, we received FDA 510(k) clearance for our foundational non-commercial next-generation flexible robotic endoscope system for use in the gastrointestinal tract. This program is early in its development, but we are encouraged by our progress and look forward to updating you as we advance.

Adoption of Intuitive Telepresence continues to increase, with surgeons using these sessions to share techniques and to scale training in ways that were not previously practical. Telepresence on da Vinci 5 serves as a foundation for our efforts in telesurgery, where we expect several regulatory clearances in the first half of 2028. Our teams continue to develop additional digital and AI capabilities on da Vinci 5, including a voice-activated user interface and automated fourth-arm control to further enhance efficiency and the user experience. AI-controlled motion in surgery has the potential to improve efficiency and outcomes, but it is early and must earn the confidence of regulators, surgeons, care teams, and patients before we deploy it at scale.

Looking ahead, our objective at Intuitive is to reach more patients with the best care available by combining robotics, human expertise, data, and artificial intelligence so that minimally invasive care becomes more accessible and less variable. The problems we are working to address are significant and specific. Minimally invasive surgery access and adoption remain uneven around the world. Patients wait too long between detection and treatment, and the care a patient receives still varies more than it should, depending on the hospital they enter and the surgeon available that day. Over time, we are focused on significantly advancing the quintuple aim to ensure that the broader patient journey can become more predictable, more connected, and less disruptive to a patient's life.

Before I pass the time to Jamie, today we announced that we have reached an agreement subject to court approval with U.S. customers who participated in the class action lawsuit on third-party remanufacturing of da Vinci instruments and third-party servicing of da Vinci systems. We believe that this no-fault settlement provides certainty for both our customers and Intuitive and maintains our ability to advance the safety, quality, and security of our products. With that, I'll turn the time over to Jamie to take you through our finances in greater detail.