The speaker, Gary Guthart, introduces himself as the CEO of Intuitive Surgical and discusses the company's mission to improve minimally invasive healthcare using advanced technology. He mentions the company's long history and the large number of procedures and research studies that have been conducted using their products. He also mentions the company's success in placing their hardware platforms and their investment in research.

In the past year, the company has seen growth in their flexible bronchoscopy platform, Ion, and single-port narrow access surgery system, SP. They now have over 9,100 installed systems, with over 8,000 being multiport, over 530 being Ion, and over 170 being single port. The company has faced challenges, such as environmental uncertainty in China and manufacturing challenges with their new platforms. They have also seen a deceleration in bariatric surgery due to the rise of GLP-1s, but are still growing. The company is focused on addressing these challenges and remains optimistic for the future.

The company's flexible bronchoscopy space has been limited by the availability of manufacturing volume for the parts used in each case, specifically the catheter. The company is working hard to resolve this constraint and is making progress in the fourth quarter. They have prioritized countries for Ion and SP system placements and have seen strong procedure growth in the year, with general surgery being the largest category globally. The company has also invested in multi-specialty teams in Europe and Japan, which has resulted in strong performance in those regions.

In the next few years, the company is expecting to see a growth rate of 13-16%, with a focus on trade-ins and incremental placements in their multiport product line. This has led to a 14% increase in their installed base and a 22% increase in procedures. The company has also seen an increase in recurring revenue, which they believe aligns well with their customers' needs. Overall, the company is pleased with their growth and considers it to be a good performance.

The company is experiencing strong growth outside of the United States, particularly in segments outside of urology. The market for their products is estimated to be around 7 million patients annually, but they believe it could potentially grow to 21 million with their current innovation pipeline. They are also seeing growth in their flexible bronchoscopy products, which are used for lung cancer detection. The company is focused on pursuing future opportunities and addressing unmet needs in the market.

Ion has been cleared for use in the United States and Europe, with recent clearances in Korea and ongoing submissions in China. The company's multiport system is gaining traction and is the leading robotic bronchoscopic system in the market. Single access procedures, which have faced regulatory challenges, are also seeing an increase in placements and procedure growth. Ion has completed accrual for colorectal and thoracic IDE studies and has a breast oncology IDE in progress. Recent clearances have been obtained in the US, Korea, and Japan, with an expected European clearance in the first quarter of 2024. The company's system performance is strong and there is a clear unmet need for this technology in the healthcare industry, as identified by top healthcare executives.

The organization is facing challenges with workforce availability, financial constraints, and the rise of behavioral health and addiction issues. Patient safety and quality of outcomes are also a top priority. The organization focuses on helping hospitals with these challenges and has a range of platforms, from established to newer ones, to address them. The adoption process for hospitals usually starts with a pilot program and then expands as evidence of success is seen. The growth rate of integrated delivery networks with multiple da Vinci systems is at 22% and single hospital buildings with multiple ORs are also increasing in number.

The speaker discusses the use of surgical robots and artificial intelligence in the medical field. They mention that Intuitive has been involved in the Internet of Things for surgical robots for 13 years and has been working on AI for 7 years. The speaker believes that AI will be powerful but also messy in the coming decade. They also mention the need for AI to improve patient outcomes, as there is a lot of variability in outcomes and a shortage of well-trained care teams due to aging populations.

The need for better care teams and faster care is driven by financial pressure and demographic issues. The speaker believes that investments should be targeted towards addressing this need. They also mention their company's capabilities in analytics, high-tech products, and workflow consulting. They have built trust with their customers and offer products such as preoperative planning and 3D models for augmented reality in the operating room.

Intuitive is currently in the second generation of its product and is excited about its potential. They offer mixed medium online and hands-on training for surgeons through Intuitive Learning and have also integrated virtual reality training through SimNow. Their app allows surgeons to manage their data and offers intraoperative guidance through Intuitive telepresence. They also have an AI suite called Case Insights that analyzes data from procedures to assess performance. Validation of this technology is ongoing, but early results are promising. This data is also accessible through a customer portal and can be used for hospital analytics.

The company is discussing their integration with hospital electronic medical records and how they provide role-based navigation from portable devices. They use 3D models built from CT or MRI scans for cancer operations and allow surgeons to view and review them with patients before the procedure. They also plan to incorporate machine learning and augmented reality in the future. The Intuitive Hub is a touchscreen computer that is synchronized with their da Vinci system to allow for data handling and synchronization between the surgeon, care team, and algorithms.

The company has developed tools to assist with case assessments and teleproctoring, making it easy for surgeons to access expert help. They are also working on a computational observer called Case Insights, which uses machine learning to determine which surgeons need help and provide real-time insights during surgeries. The company is currently in the early stages of this development.

The use of machine learning and algorithms can help in analyzing data from surgical procedures to determine what factors lead to better outcomes. This data has been previously ignored, but now efforts are being made to gather and curate it for actionable insights. The company also measures its performance through Net Promoter Score, which has consistently been positive.

The speaker discusses the company's success and growth in the past year, attributing it to meeting customer needs, focusing on data, and addressing challenges transparently. They also mention plans for innovation, expansion, and optimizing operations in the future. The interviewer compliments the company's recent performance and asks about their impressive fourth quarter results.

In the fourth quarter, Intuitive Surgical saw an increase in capital placements, particularly in the U.S., Japan, and distributor markets. This was driven by a 22% growth in procedures, with strong Greenfield placements in the U.S. and Japan. OUS performance also saw a 29% growth, with China being a strong contributor due to a soft comparison from the previous year. Other markets such as the U.K., Germany, and Japan also saw good performance.

The company's procedure growth for the year was 22%, with a full year CAGR of 17%. The difference between 17% and 22% is likely due to a backlog of patients. The company's procedure growth for 2024 is expected to be 13% to 16%, with the low end assuming a decline in bariatrics growth and potential delays in China due to anticorruption efforts. The high end of the range takes into account potential backlog carrying over into 2024.

The company assumes that bariatrics will continue to grow at a rate of 16%, with a slight benefit from activities in China. The company is working on a new multiport robot, but the launch will not significantly impact the business due to the high number of leases and the success of the current robot. The company is always working on new developments, but will only bring them to market when they are important enough and the supply chains are ready.

The speaker discusses the importance of having a well-functioning supply chain and gaining approval from global regulators before implementing any new plans. They also mention that they prioritize communicating with their customers before talking to investors. When asked about a new product for 2024, the speaker declines to comment. The other speaker asks about gross margins for 2024, but the first speaker declines to give a specific direction and mentions ongoing efforts to improve product costs and increase manufacturing capacity. This may result in a temporary decline in gross margins due to increased depreciation expenses.

The speaker expects incremental depreciation expenses in 2024, but believes that the company has opportunities for growth through their soft tissue business and Ion platform. They also discuss the number of hospitals with high numbers of robots, and how this creates a competitive advantage for the company. They also mention the importance of competition at the disease state level.

The paragraph discusses the focus of Intuitive Surgical on driving better outcomes and experiences for patients and care teams while reducing costs through their technology. The company aims to demonstrate this through data and believes that their approach sets a high standard for competitors. The impact of AI and big data on the company's economic performance will be small in the short term, but significant in the long term for those who implement it effectively.

The interviewer, Robert Marcus, expresses his regret that there is not enough time to ask all of his remaining questions to the interviewee, Gary Guthart. Guthart thanks Marcus for the interview.

This summary was generated with AI and may contain some inaccuracies.