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- **Record Revenue Growth**: Q3 2025 revenue of $2.5 billion (+23% YoY) driven by 19% da Vinci and 52% Ion procedure growth.
- **da Vinci 5 Dominance**: 240 systems placed globally, with 18 of top 20 U.S. health systems now standardized to dV5.
- **International Expansion**: First systems in Japan and Europe, SP procedures up 91% with Korea leading adoption.
- **Force Feedback Innovation**: Early data shows 20% reduction in surgical force, with clinical outcome studies underway.
- **Gross Margin Resilience**: 68% gross margin despite tariffs, supported by da Vinci 5 and Ion mix.
- **Challenges Ahead**: China market constrained by competition, bariatrics down 6+ quarters, and U.S. Medicare noise impacting elective procedures.

**【CEO Summary Section】**
- **Revenue Growth**: Q3 2025 revenue reached $2.5 billion, a 23% year-over-year increase, driven by 19% growth in da Vinci procedures and 52% growth in Ion procedures.
- **da Vinci 5 Adoption**: Placed 240 da Vinci 5 systems globally, with 12 in OUS markets. U.S. IDNs now have at least 1 da Vinci 5 in 18 of the top 20 health systems.
- **International Expansion**: First systems placed in Japan and Europe, with positive early feedback. SP procedures grew 91%, led by Korea and international markets.
- **Force Feedback Technology**: Early data shows reduced force application during thoracic procedures, with studies underway to assess clinical outcomes.

**【CFO Financial Commentary】**
- **Financial Performance**: Pro forma EPS of $2.40, up 30% YoY. Gross margin of 68% reflected higher da Vinci 5 and Ion revenue mix, offset by tariffs and facility costs.
- **Capital Spending**: $590 million in systems revenue, 33% growth, with 54% of da Vinci placements under lease agreements. Recurring revenue accounted for 85% of total.
- **Operational Efficiency**: Trade-in transactions increased 245% YoY, driven by U.S. upgrades to da Vinci 5. Lease buyout revenue declined 28% due to delayed buyouts.

**【Clinical Highlights】**
- **Ion Performance**: Ion procedures reached 38,000, with a 52% increase in U.S. utilization and quadrupling in OUS markets. FDA-cleared workflow improvements enhance biopsy accuracy.
- **SP Platform**: 91% procedure growth, led by Korea and early adoption in Europe. FDA clearances for SP stapler and Sensitive Firefly expand versatility.
- **Force Feedback Studies**: Ohio State University study showed 20% reduction in peak force application, supporting gentler surgery. European Respiratory Society data highlights Ion's role in early lung cancer diagnosis.

**【Financial Outlook Update】**
- **Procedure Growth**: Updated da Vinci procedure guidance to 17-17.5% YoY, up from 15.5-17%. Gross margin expected at 67-67.5% for 2025, reflecting tariff impacts and cost reductions.
- **Expense Management**: Operating expenses to grow 11-13% YoY, driven by headcount and R&D. Tax rate estimated at 21-22% due to U.S. tax reforms.

**【Q&A Highlights】**
- **Sustainability of Growth**: U.S. da Vinci utilization up 2% QoQ, driven by da Vinci 5 adoption. OUS growth benefited from 1% holiday timing adjustment.
- **Refurbished Xi Systems**: 20 units sold to date, targeting cost-sensitive sites and ASCs. Commercial teams see segmentation opportunities across customer segments.
- **China Challenges**: Competitive tendering and reimbursement pressures persist. Europe and Japan show early interest in da Vinci 5, but regulatory approvals lag.
- **Bariatrics Drag**: Domestic bariatric procedures down high single digits for 6+ quarters, impacting 3% of da Vinci volume. Surgeon feedback indicates no near-term recovery.
- **Hub Evolution**: Video data collection and AI integration progressing, with potential for intraoperative guidance and outcome optimization in future iterations.

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