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Intuitive Surgical is trading higher following another impressive earnings report, marking its third consecutive double-digit EPS beat. Revenue increased 18.8% yr/yr to $2.87 bln, also exceeding expectations. While ISRG does not provide formal revenue or EPS guidance, it expects worldwide da Vinci procedure growth of +13--15% in 2026, moderating from +18% growth in 2025.

• Because ISRG generates revenue from both initial system placements and per-procedure fees, procedure growth remains a key metric. Worldwide procedures (da Vinci + Ion) rose 18% yr/yr in Q4. Da Vinci procedures increased 17% yr/yr, while Ion procedures surged 44% yr/yr, highlighting accelerating adoption of newer platforms.
• ISRG placed 532 da Vinci surgical systems in Q4, up from 493 a year ago. Ion system placements declined to 42 from 69 last year.
• Demand for da Vinci 5 strengthened throughout the year as ISRG scaled manufacturing and expanded availability. In the US, demand was driven by system upgrades and dual-console configurations, reflecting customer interest in standardization, training, and mentoring.
• On the innovation front, ISRG recently received FDA clearance for several cardiac procedures on da Vinci 5 using non-force feedback instruments. Given the complexity of minimally invasive cardiac surgery, the company plans a measured rollout focused on training, education, and adoption, citing strong belief in the benefits of minimally invasive approaches for cardiac patients.
• Looking ahead, ISRG expects 2026 growth drivers to mirror 2025, including US general surgery expansion and international growth beyond urology. The outlook factors in potential headwinds from ACA premium subsidy changes, Medicaid funding, hospital capital constraints in parts of Europe, and shifts in patient behavior.

Briefing.com Analyst Insight:

Intuitive Surgical continues to execute at a high level, pairing strong revenue growth with accelerating procedure volume, which reinforces the durability of its recurring revenue model. While the projected slowdown in da Vinci procedure growth to the mid-teens could raise questions at the margin, the outlook appears reasonable given macro, reimbursement, and hospital capital pressures. Encouraging traction for da Vinci 5, expanding international adoption, and early steps into minimally invasive cardiac surgery provide longer-term growth optionality. Against a backdrop of potential healthcare funding headwinds (ACA, Medicaid cutbacks), investors are likely satisfied with ISRG's 2026 procedure growth outlook and its ability to consistently outperform expectations.