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    ISRG
    Earnings call· Mar 2026(Q1 FY26)

    INTUITIVE SURGICAL Q1 FY26 earnings call ISRG

    Apr 21, 2026 Source

    Executive summary

    Intuitive Surgical Q1 FY26 — Strong Procedure and Revenue Growth Driven by da Vinci 5 and SP

    Intuitive Surgical delivered a solid first quarter, marked by robust procedure and revenue growth, fueled by the expanding adoption of its da Vinci 5 and SP platforms. The company is strategically investing in digital innovation and market access efforts globally, navigating persistent headwinds in key international markets like China and Japan, and adapting to evolving procedure trends in the U.S. The focus remains on advancing the Quintuple Aim through product differentiation and ecosystem enhancements.

    Highlights

    5
    • Total procedure growth of 17% year-over-year, with da Vinci procedures up 16% to 847,000 and Ion procedures up 39% to 43,000.

    • Revenue increased 23% to $2.77 billion, with recurring revenue also up 23% to $2.4 billion, accounting for 86% of total revenue.

    • Non-GAAP operating margin was strong at 39%, reflecting significant fixed cost leverage.

    • U.S. da Vinci utilization increased 4%, driven by da Vinci 5 systems showing approximately 11% higher utilization than Xi.

    • SP platform momentum continued with procedure growth of 68% year-over-year, driven by expansion in Korea and the U.S.

    Concerns

    5
    • China market remains challenging with low tender activity, domestic competition, and policy-driven pricing pressure.

    • Japan's procedure growth was below historical levels due to fewer system placements in 2025, despite recent policy developments.

    • U.S. da Vinci bariatrics procedures declined approximately 10%, impacted by the growth in GLP-1 usage.

    • A cyber incident resulted in unauthorized access to some customer and employee data, though it did not disrupt business or significantly impact Q1 financials.

    • Higher input costs for oil and memory prices are expected to have a greater unfavorable impact on gross margin in the remainder of the year.

    Guidance & targets

    6
    CategoryTargetConfidence
    Full-year 2026 da Vinci procedure growth
    13.5% to 15.5%
    high materiality
    High
    Full-year 2026 non-GAAP gross profit margin
    67.5% to 68.5%
    high materiality
    High
    Full-year 2026 non-GAAP operating expense growth
    11% and 14%
    medium materiality
    High
    Full-year 2026 noncash stock compensation expense
    $890 million and $920 million
    low materiality
    High
    Full-year 2026 other income
    $315 million and $335 million
    low materiality
    High
    Full-year 2026 non-GAAP income tax rate
    22% and 23%
    low materiality
    High

    Segment performance

    11
    SegmentRevenueYoYQoQMargin
    U.S. da Vinci Procedures
    Led by strength in general surgery, supported by a 31% increase in after-hours procedures and higher overall utilization.
    14%
    OUS da Vinci Procedures
    Led by continued strength in general surgery and gynecology, with lower growth relative to prior quarters due to challenges in China and Japan.
    Percentage of total da Vinci volume: 38%
    19%
    U.S. Total Procedures
    Reflecting 14% growth in da Vinci procedures and 37% growth in Ion procedures.
    15%
    OUS Total Procedures
    Driven by 19% da Vinci procedure growth, with strong results in India, Canada, U.K., Korea, Taiwan, Italy, and Germany.
    20%
    U.S. Cholecystectomy and Appendectomy Procedures
    Combined growth, driven in part by continued expansion of da Vinci use during after-hours and weekends.
    31%
    U.S. Total Gynecology Procedures
    Investments in clinical support for surgeons performing benign gynecology procedures drove growth.
    10%
    U.S. Non-Hysterectomy Benign Procedures
    Includes sacrocolpopexy, endometriosis, oophorectomy, and myomectomy.
    19%
    U.S. Bariatrics Procedures
    Impacted by the growth in use of GLP-1s.
    -10%
    Europe System Placements
    Compared to 88 systems last year, with relative strength primarily driven by the U.K. (34 systems).
    Systems placed: 117
    33%
    Asia System Placements
    Compared to 52 systems last year, including 13 in Japan and 4 in China.
    Systems placed: 62
    19%
    Rest of World System Placements
    Compared to 23 systems last year.
    Systems placed: 26
    13%

    Operational metrics

    44
    Non-GAAP Net Income
    $901 millionvs $662 million last year
    Q1 2026

    Non-GAAP net income for the first quarter.

    Non-GAAP Earnings Per Share
    $2.50vs $1.81 last year
    Q1 2026

    Non-GAAP earnings per share for the first quarter.

    GAAP Net Income
    $822 millionvs $698 million last year
    Q1 2026

    GAAP net income for the first quarter.

    GAAP Earnings Per Share
    $2.28vs $1.92 last year
    Q1 2026

    GAAP earnings per share for the first quarter.

    Ion Diagnostic Yield Sensitivity of Malignancy
    85%
    July 2019 - August 2024

    Sensitivity of malignancy reported in the Mayo Clinic study using Ion.

    Ion Patients with Concurrent EBUS Lymph Node Staging
    74%
    July 2019 - August 2024

    Percentage of patients in the Mayo Clinic study who had concurrent endobronchial ultrasound lymph node staging with Ion.

    Total Procedures Growth
    17%
    Q1 2026

    Overall procedure growth, including both da Vinci and Ion procedures.

    Total Revenue
    $2.77 billion23% increase
    Q1 2026

    Total revenue for the first quarter.

    Recurring Revenue
    $2.4 billion23% increase
    Q1 2026

    Recurring revenue for the first quarter.

    Constant Currency Revenue Growth
    22%
    Q1 2026

    Revenue growth on a constant currency basis.

    Non-GAAP Operating Margin
    39%
    Q1 2026

    Non-GAAP operating margin for the first quarter, reflecting leverage of fixed costs.

    da Vinci I&A Revenue Per Procedure
    $1,880vs $1,780 last year
    Q1 2026

    Driven by customer ordering patterns, higher mix of SP and da Vinci 5 procedures, and FX, partially offset by lower bariatric and high cholecystectomy procedures.

    da Vinci 5 Installed Base
    almost 1,500
    Q1 2026

    Total installed base of da Vinci 5 systems since launch.

    Surgeons Using da Vinci 5
    almost 13,000
    Q1 2026

    Number of surgeons who have used da Vinci 5 since launch.

    Total da Vinci Systems Placed
    43117% increase from 367 last year
    Q1 2026

    Total da Vinci systems placed in the first quarter.

    da Vinci 5 Systems Placed
    232
    Q1 2026

    da Vinci 5 systems placed in the first quarter.

    SP Systems Placed
    34vs 19 last year
    Q1 2026

    SP systems placed in the first quarter, driven by increased placements in the U.S. and Taiwan.

    XiR Systems Placed
    34
    Q1 2026

    XiR systems placed in the first quarter.

    Ion Systems Placed
    52vs 49 last year
    Q1 2026

    Ion systems placed in the first quarter.

    Refurbished Xi Systems Placed
    34vs 2 last year
    Q1 2026

    Refurbished Xi systems placed in the first quarter, primarily in OUS markets with greater cost sensitivity.

    Trade-in Transactions
    119up from 67 a year ago
    Q1 2026

    Primarily driven by U.S. customers upgrading to da Vinci 5.

    U.S. da Vinci Systems Placed
    226up from 204 last year
    Q1 2026

    Driven by adoption of da Vinci 5.

    Capital Systems Revenue
    $651 million24% growth
    Q1 2026

    Systems revenue for the first quarter.

    Leasing as Percentage of da Vinci Placements
    56%vs 47% last quarter and 54% last year
    Q1 2026

    Driven primarily by customer preference.

    da Vinci Leasing Revenue Growth
    28%
    Q1 2026

    Reflecting a 14% expansion of the installed base under operating lease arrangements and a 12% increase in lease revenue per system.

    Average Selling Price for Purchased da Vinci 5 Systems
    $1.7 millionvs $1.6 million last year
    Q1 2026

    Driven by a higher mix of da Vinci 5 systems and dual-console systems, partially offset by higher trade-ins.

    Lease Buyout Revenue
    $51 millionvs $39 million last quarter and last year
    Q1 2026

    Lease buyout revenue for the first quarter.

    Service Revenue
    $434 million19% increase
    Q1 2026

    Reflecting an increase of the da Vinci installed base of 12% and the Ion installed base of 22%.

    Service Revenue Per da Vinci System Growth
    6%year-over-year
    Q1 2026

    Primarily reflecting a higher mix of da Vinci 5 systems.

    Non-GAAP Gross Margin
    67.8%vs 66.4% last year
    Q1 2026

    Reflects product cost reductions and fixed overhead leverage, partly offset by tariffs.

    Tariff Impact on Gross Margin
    100 bpsvs 120 bps prior estimate
    FY26

    Updated estimate for the impact of tariffs on full-year non-GAAP gross profit margin.

    Non-GAAP Operating Expenses Growth
    10%year-over-year
    Q1 2026

    Driven by higher headcount, increased variable compensation, and higher facility costs, partially offset by lower legal expenses.

    Employees Added
    425
    Q1 2026

    Total employees added during the quarter.

    Non-GAAP Other Income
    $85 millionvs $86 million last quarter
    Q1 2026

    Primarily reflects lower interest income.

    Non-GAAP Effective Tax Rate
    22%
    Q1 2026

    Consistent with expectations.

    Cash and Investments Balance
    $8 billiondown from $9 billion last quarter
    End of Q1 2026

    Driven by stock repurchases, acquisition, and capital expenditures, partially offset by cash from operations and equity activity.

    Stock Repurchases
    $1.1 billion
    Q1 2026

    Amount of stock repurchases during the first quarter.

    Capital Expenditures
    $103 million
    Q1 2026

    Capital expenditures during the first quarter.

    Ion Diagnostic Yield (ATS/ACCP Consensus)
    79%
    July 2019 - August 2024

    Diagnostic yield according to the strict ATS/ACCP Consensus Statement definition in the Mayo Clinic study.

    Ion Pneumothorax Requiring Intervention Rate
    1.4%
    July 2019 - August 2024

    Safety profile metric from the Mayo Clinic study.

    Ion Severe Bleeding Rate
    0.3%
    July 2019 - August 2024

    Safety profile metric from the Mayo Clinic study, defined as Nashville Grade 3 or higher.

    Early-Stage Primary Lung Cancer Diagnosis Increase (Ion Study)
    23 percentage pointsfrom 46% in 2019 to 69% in 2024
    2019 to 2024

    Increase in the rate of early-stage primary lung cancer diagnosis observed in the Mayo Clinic study.

    SP Stapler Usage in U.S. Cases
    almost 40%
    Q1 2026

    Percentage of cases where a stapler was expected to be used, following broad launch in the U.S.

    da Vinci X Systems Sold
    41
    Q1 2026

    Number of da Vinci X systems sold in the quarter.

    Industry KPIs

    9
    MetricValueDetails
    System utilization4%%
    Pricing realized price$1.7 millionUSD
    New product launch ramp
    Procedure volume growth17%%
    FCF conversion leverage guidance67.5% to 68.5%%
    Installed base system placements431systems
    Consumables recurring revenue mix$1.7 billionUSD
    Sales force commercial capacity build425employees
    Pivotal trial clinical evidence milestones79%%

    Product announcements

    2
    ProductTypeDetails
    Force Feedback Instrumentsexpansion
    Single-Port Staplerlaunch

    Deals & partnerships

    1
    Distribution business in Italy, Spain, and Portugalacquisition

    Acquisition of the distribution business in Italy, Spain, and Portugal, which added 230 employees during the quarter.

    Risks & headwinds

    7
    Challenges in China marketOngoing, clarity on new policies not expected until 2027.

    Procedure growth below corporate average, reflecting lower tenders, competitive and pricing pressures.

    Mitigation: Continued investments to improve procedure growth, establish favorable patient charge codes, and support market access activities; active engagement with policymakers.

    Challenges in Japan marketShort term (2026)

    Procedure growth below corporate average, reflecting lower capital placements over the last several quarters.

    Mitigation: Encouraged by recent policy developments (incremental reimbursement for high-volume programs, new procedure reimbursements effective June 2026), but remain cautious given financial position of public hospitals.

    Impact of GLP-1s on U.S. bariatrics proceduresQ1 2026 and ongoing

    da Vinci bariatrics procedures in the U.S. declined approximately 10%.

    Potential impact of changes to ACA premium subsidiesOngoing

    No significant impact on procedure volumes in Q1, but remain cautious.

    Capital pressure in parts of EuropeOngoing

    Related to macroeconomic impact and shifting governmental priorities.

    Higher input costsRemainder of FY26

    Expected greater unfavorable impact from oil and memory prices in the remainder of the year.

    Mitigation: Continuing initiatives to improve gross margins, including fixed overhead leverage, improving product and service margins for da Vinci 5, and additional product cost reductions for SP and Ion.

    Cyber incidentQ1 2026

    Unauthorized access to some customer business and contact information as well as certain Intuitive employee and corporate data. Did not disrupt business or manufacturing operations and did not have a significant impact on Q1 financial results.

    Mitigation: Contained the incident, notified customers, informed appropriate data privacy regulators, and taking additional steps to further strengthen cybersecurity protocols.

    Q&A highlights

    8

    How does Intuitive envision its digital and AI roadmap, and what is the timing for technologies like ROSE and EBUS?

    CEO Dave Rosa detailed a layered AI strategy focused on high-quality data, insights, and consumable delivery to customers, including AI-enabled anatomy identification and future automation. He highlighted the differentiation from Intuitive's installed base and unique data sets. CFO Jamie Samath added that ROSE and EBUS are short-term integrations, not expected this year, but will offer significant differentiated value.

    Our advantage, we believe, lies is in the unique data sets that are available to us today through something like Force Feedback and will be increasingly available to us as we add capability to da Vinci 5.

    asked by Travis Steed · answered by David Rosa

    2 min read6 chapters

    Detailed Narrative

    01

    Digital and AI Ecosystem Development

    Intuitive is building a layered AI strategy, starting with high-quality data from surgeries (video, kinematic, force) and connected electronic medical records. This data is used to generate meaningful insights, which are then delivered to customers in a consumable fashion, such as operational guidance for hospital programs or AI-enabled anatomy identification in the operating room. The company expects to advance towards augmented dexterity and automation, leveraging its installed base of systems, including 1,500 da Vinci 5 systems, and over 3 million annual procedures to strengthen its differentiation.

    02

    Japan Market Policy Developments

    The Japanese Ministry of Health, Labor and Welfare (MHLW) introduced new policies effective June 2026, including incremental reimbursement for hospitals exceeding 200 robotic procedure volumes annually. Additionally, seven new procedures have been granted robotic reimbursement, and rectal resection received premium reimbursement when performed robotically. While these steps are encouraging, management remains cautious about the short-term outlook for the Japanese market due to the financial position of public hospitals.

    03

    SP Platform Expansion and Innovation

    The Single Port (SP) platform continues to gain momentum, with procedures growing 68% year-over-year, driven by expansion in Korea and the U.S. and early adoption in other international markets. The company recently received FDA 510(k) clearance for additional uses of Force Feedback instruments and moved its single-port stapler into broad launch in the U.S., with plans for measured launches in Korea and Europe in Q2. SP is expected to incorporate much of the da Vinci 5 ecosystem, including future digital and AI capabilities, to drive meaningful improvements in patient care.

    04

    Ion Platform Progress and Lung Cancer Focus

    The Ion platform is focused on improving lung cancer patient survival, with recent clinical publications, including a Mayo Clinic study of nearly 2,000 patients, reinforcing its progress. The study demonstrated a 79% diagnostic yield and 85% sensitivity for malignancy, with a low complication rate. Intuitive is also developing rapid on-site tissue evaluation (ROSE) technology and endobronchial ultrasound (EBUS) integration to streamline the detection-to-diagnosis pathway for lung cancer.

    05

    Innovation-Led Revenue Growth Strategy

    Intuitive's strategy emphasizes innovation-led revenue growth, where differentiated products like da Vinci 5 drive revenue growth ahead of procedure growth. This is achieved through accretive pricing, higher integration levels, and incremental trade-in volumes. The company balances this with efforts to reduce product costs and share savings in cost-sensitive markets, creating a mix dynamic that leverages R&D investments to create value for customers and patients.

    06

    International Market Prioritization and Competition

    Intuitive employs a localized approach for its international strategy, investing in regional teams, ensuring product portfolios (including XiR) and ecosystems are cleared, and tailoring economic programs and pricing to market needs. The company aims to articulate and substantiate the value of its robotic programs to customers and government agencies, emphasizing clinical output, system reliability, and comprehensive training and services to compete effectively against new entrants.

    AI-generated summary of the company’s earnings call. Not investment advice.