[ISRG] Intuitive Surgical: Is U.S. da Vinci Procedure Growth Slowing for Good?

Intuitive Surgical (ISRG) develops, manufactures and markets the da Vinci surgical robot and the Ion endoluminal system for minimally invasive lung biopsy[1], and its next earnings call is scheduled for 2026-10-20, when it reports the third quarter of 2026, ending September 30, 2026[2]. The question hanging over that report is da Vinci procedure growth. In the second quarter of 2026, the latest disclosed period, revenue rose 19% to $2.892 billion, da Vinci procedures rose 15% to about 889,000 and da Vinci system placements rose 18% to 468[3]; diluted earnings per share were $2.29 and non-GAAP earnings per share were $2.80[4]. The company gives no quarterly guidance. On the July 16 call management kept its full-year 2026 da Vinci procedure growth range at 13.5% to 15.5% and said results should land near the midpoint, raised its full-year non-GAAP gross margin range to 68% to 69%, and set operating expense growth at 11% to 13%[5]. FXEmpire's page showed on September 19, 2026 that 22 analysts expected third-quarter earnings per share of $2.69 and revenue of $2.96 billion, and the page did not say which accounting basis the earnings figure uses[6].

Three things are worth watching in this report. The first is U.S. da Vinci procedure growth: it slowed to about 12% in the second quarter from 14% a year earlier[7], the company attributed part of that to the expiration of enhanced premium subsidies and called the continuing impact uncertain[8], and the third-quarter reading will help show whether patients are temporarily deferring surgery or the U.S. market is starting to decelerate on its own. The second is the composition of placements: 144 of the 468 second-quarter placements involved trade-ins[9] and 54% were operating leases[10], so how long the upgrade cycle lasts and how much systems revenue leasing pushes into later periods will set the direction of the systems line. The third is gross margin without one-time items: the 70.0% non-GAAP gross margin in the second quarter[11] included $35.9 million of refunds for tariffs paid in prior periods[12], management put the margin excluding that benefit at 68.7%[13], and the third quarter will test whether the margin improvement is dependable.

Company Background and Business Structure

Intuitive Surgical pioneered robotic-assisted minimally invasive surgery, and it has only two product lines, da Vinci and Ion. The da Vinci surgical system is used in general surgery, urology, gynecology, cardiothoracic surgery and head and neck surgery and consists of a surgeon console, a patient-side cart and a high-performance vision system; Ion is a flexible, catheter-based robotic platform whose first cleared indication is minimally invasive lung biopsy[1]. The newest da Vinci generation is da Vinci 5, while the fourth-generation platform has produced the XiR for cost-constrained customers, and management said about 130 XiR systems were installed worldwide as of the second quarter[14]. Customers performed about 3,153,000 da Vinci procedures and about 144,100 Ion procedures in 2025, and the year-end installed base was about 11,106 da Vinci systems and about 995 Ion systems[15].

The company operates in one reportable segment[16], and its revenue falls into three types, about 85% of which is recurring. The first is instruments and accessories: each instrument has a limited life and must be replaced once it is used up, the company discloses that it earns between $900 and $3,700 of instruments and accessories revenue per procedure[17], customers replenish on a regular basis and orders typically ship within one business day[18], and this line brought in $1.735 billion, or 60% of total revenue, in the second quarter of 2026[19]. The second is systems: a da Vinci system sells for between $0.6 million and $3.1 million[17], and customers can either buy it outright or choose a fixed-payment or usage-based operating lease[20]; second-quarter systems revenue was $685 million, or 24% of the total, including $262 million of operating lease revenue[21]. The third is service: da Vinci service contracts carry an annual fee between $95,000 and $225,000[17], and second-quarter service revenue was $472 million, or 16% of the total[22]. Instruments and accessories, service and operating leases together make up recurring revenue, which was $2.469 billion, or 85% of total revenue, in the second quarter[23].

The United States contributes about two-thirds of revenue, and the sales channel is moving from distributors to direct sales. Second-quarter U.S. revenue was $1.933 billion, or 67% of the total, and revenue outside the U.S. was $959 million, or 33%[19]; no country other than the U.S. accounted for 10% of total revenue[16]. The company sells directly in the U.S., most European countries, Japan, South Korea, India and other markets, and operates in China through a joint venture with Fosun Pharma[24]; Intuitive owns 60% of the joint venture and Fosun Pharma owns 40%, and the venture holds a license to manufacture the da Vinci Xi in China[25]. On March 1, 2026 the company paid about $533 million in cash for the da Vinci and Ion distribution businesses in Italy, Spain, Portugal and nearby territories and took those markets direct[26]. On the production side, systems are built in Sunnyvale, California, in Peachtree Corners, Georgia, and at the joint venture's Shanghai plant, and instruments and accessories are made in Sunnyvale and in Mexicali, Mexico; some components come from sole-sourced or single-sourced suppliers, the company buys mostly through purchase orders rather than long-term agreements, and it does not hold large volumes of finished goods[27].

Customer purchasing behavior explains both the seasonality of the business and why cost matters so much. A system is a large capital outlay for a hospital, and placements have historically been heavier in the fourth quarter and lighter in the first; more than half of da Vinci procedures treat benign conditions, which patients can defer, and in the U.S. these procedures also follow the annual deductible reset, running higher in the fourth quarter and lower in the first[18]. Most payors, including Medicare, do not pay providers more for a procedure because a robot was used, so the extra cost falls on the hospital or surgery center[28], which makes cost per procedure the key variable when a customer decides whether to expand its use.

Financial History and Current Position

Intuitive's revenue grew in each of the last three full years, and the recurring share of revenue held steady. Total revenue rose from $7.124 billion in 2023 to $8.352 billion in 2024 and $10.065 billion in 2025[29], a 21% increase in 2025[15]. Over the same period instruments and accessories revenue rose from $4.277 billion to $6.019 billion, and recurring revenue stayed between 83% and 84% of total revenue[30]. Da Vinci procedures grew 18% in 2025 and the company placed 1,721 systems during the year, 870 of them da Vinci 5[15]; U.S. procedures grew about 15% in both 2025 and 2024[31].

The cost of growth in 2025 showed up in gross margin, although cash generation remained ample. Full-year gross margin was 66.0%, down from 67.5% in 2024, while operating income still rose 25% to $2.95 billion; the company repurchased $2.30 billion of stock during the year and ended it with $9.03 billion in cash and investments[32]. The company attributed the decline in product gross margin to new tariffs, higher fixed overhead including depreciation on expanded manufacturing capacity, and the higher cost of da Vinci 5[33]. Operating cash flow was $3.031 billion in 2025, and capital expenditures fell to $540 million from $1.111 billion in 2024[34].

In 2026 revenue has kept growing at roughly 20%, and profit has grown faster than revenue. First-quarter revenue was $2.77 billion, up 23%, and da Vinci procedures grew 16%[35]; second-quarter revenue was $2.892 billion, up 19%, with instruments and accessories at $1.735 billion (up 18%), systems at $685 million (up 19%)[36] and service at $472 million (up 21%)[22]. Second-quarter gross margin was 67.8%, up from 66.3% a year earlier, and operating income rose 31% to $972 million[37], but cost of revenue in the quarter was reduced by $35.9 million of refunds for tariffs paid in prior periods[12]. Second-quarter net income attributable to the company was $818 million and diluted earnings per share were $2.29[38]; on a non-GAAP basis gross margin was 70.0% and operating income was $1.218 billion[11], and earnings per share were $2.80[4].

In the first half of 2026 the company spent its operating cash flow mainly on buybacks and an acquisition, while procedure growth slowed quarter by quarter. First-half operating cash flow was $1.973 billion, capital expenditures were $216 million, share repurchases were $1.444 billion, and the acquisition and related investing activities used about $528 million[39]; cash and investments stood at $8.63 billion at the end of June, about $0.4 billion below the $9.03 billion held at the start of the year[37]. Alongside strong revenue growth, da Vinci procedure growth slowed from 18% in 2025 to 16% in the first quarter of 2026[35] and 15% in the second quarter, and U.S. growth in the second quarter was only 12%[7].

Operating Model

Revenue is the sum of instruments and accessories, systems and service, and procedure volume is the most important driver. Instruments and accessories revenue roughly equals procedure volume times instruments and accessories revenue per procedure: in the second quarter customers performed about 889,000 da Vinci procedures, management disclosed revenue per procedure of about $1,830[40], and consumables for about 47,900 Ion procedures[3] brought the total to $1.735 billion; because orders typically ship within one business day, a change in procedure volume reaches this revenue line almost within the same quarter[18]. Systems revenue depends on the number of placements, the split between outright sales and operating leases, the average selling price and the revenue from leases already in place: in the second quarter the average selling price was about $1.59 million, operating lease revenue was $262 million and lease buyout revenue was $56 million[21]. Service revenue roughly equals the installed base under contract times the annual service fee, and it grew 21% in the second quarter, which the company attributed to a larger installed base producing service revenue and a favorable product mix from da Vinci 5[22]; system sales generally include a five-year service period with the first year included in the selling price[17], so a new placement contributes to service revenue with a lag of about a year.

Operating income equals revenue times gross margin, minus selling, general and administrative expenses and research and development expenses. Second-quarter gross margin was 67.8%, with product gross margin at about 67.9% and service gross margin at about 67.2%, and operating income was $972 million[38]; selling, general and administrative expenses were $618 million, or 21% of revenue[41], and research and development expenses were $371 million, or 13% of revenue[42]. Product cost reductions, fixed overhead leverage and lower logistics costs push gross margin up, while tariffs, rising depreciation and amortization of acquired intangible assets push it down[43], and tariffs recognized in cost of revenue were $20.8 million in the second quarter[12]. Share-based compensation is a large part of expenses, and second-quarter operating income included $213 million of it[37]; interest and other income was $82.7 million in the second quarter, down from $88.7 million a year earlier[38].

Operating cash flow roughly equals net income plus non-cash items such as share-based compensation and depreciation, minus working capital, and the leasing business is the main user of working capital. First-half 2026 net income was $1.649 billion[38] and operating cash flow was $1.973 billion[39]; changes in operating assets and liabilities used $870 million of cash, including a $515 million increase in inventory that counts equipment transferred from inventory to property, plant and equipment, which the company said supports business growth including leasing and guards against supply chain shortages[44]. It follows that the higher the lease share, the more equipment the company funds on behalf of customers and the longer it takes to collect the cash. First-half capital expenditures were $216 million, down from $272 million a year earlier[39], and the $1.111 billion capacity build-out peak of 2024 has passed[34].

The model has several blind spots that readers should keep in mind when they look at the numbers. The company has one reportable segment and does not disclose profit by platform or region or quarterly procedure volume by procedure type, so the separate revenue effects of slower benign procedures, the bariatric decline and Chinese price limits cannot be measured directly. Instruments and accessories revenue per procedure is an average that management gives verbally on the call, and management itself says procedure mix and ordering patterns affect it[40]. A flexible robotic endoscope for gastrointestinal procedures has only just been submitted for FDA 510(k) clearance, and the instrument extended use program does not launch until the first half of 2027[45], so neither has an observable quarterly financial metric yet.

Industry and Competitive Position

The first layer of competition Intuitive faces is not another robot but open surgery, conventional laparoscopy and other therapies. In its annual report the company counts as competitors both the companies whose products are used in open or minimally invasive surgery and those that offer other therapeutic approaches for the same conditions[46]. Weight loss drugs are the clearest example: the annual report acknowledges that these drugs have reduced the number of bariatric procedures and that the long-term impact is difficult to predict[47], U.S. da Vinci bariatric procedures declined in the high single digits in 2025[31], and they declined in the high single digits again in the second quarter of 2026, when they made up about 2% of total da Vinci procedures[8].

The second layer comes from other robot makers, and the pressure is currently most concentrated in China. The companies that the annual report names as having entered the field or stated an intention to enter it include Medtronic, Johnson & Johnson, CMR Surgical, Distalmotion, Medicaroid, Karl Storz, SS Innovations and Noah Medical, along with Chinese makers such as Beijing Surgerii, Harbin Sizhe Rui, Shandong Weigao, Shanghai Microport Medbot and Shenzhen Edge Medical, and the report says competition within China will increase[46]. The company said in its 10-Q that rising domestic competition, together with a healthcare governance campaign launched in July 2023 that has led to some tenders being canceled or delayed without a timeline, contributed to fewer system placements in China in the second quarter of 2026 than it had anticipated[48]. China's National Healthcare Security Administration also issued a unified national pricing framework for robotic-assisted surgery in the second quarter and required all provinces to implement it in the upcoming quarters[49].

The company's documented advantage is scale, but comparable competitor data are not at hand. As of June 30, 2026 the da Vinci installed base was about 11,710 systems, of which 6,615 were in the U.S., 2,325 in Europe, 2,111 in Asia and 659 in the rest of the world; the company estimates that Ion's penetration of U.S. lung biopsy procedures has passed the halfway point, and customers there have begun to shift from adding capacity to raising utilization of existing systems[50]. The company's disclosures contain no installed base, procedure or price data for competitors, so the comparison here can only rest on the company's own scale and its description of the competitive situation, and it cannot show how much share rivals have won, in which markets or at what price.

Core Debates

U.S. da Vinci procedure growth slowed to 12% — is that patients deferring surgery after ACA subsidies expired, or the first sign of maturity in the company's largest market?

This question matters because recurring revenue starts with procedure volume and the United States is the largest part of it. Recurring revenue is 85% of total revenue[23]; the U.S. accounted for about 62% of global da Vinci procedures in the second quarter[7], and U.S. instruments and accessories alone brought in $1.180 billion, about 41% of total company revenue[19], so each 1 percentage point change in U.S. growth moves global procedure growth by about 0.6 percentage points. Second-quarter results came in above market expectations, yet the company did not raise its full-year procedure range, and Investing.com recorded that the shares fell 10.9% the day after the results[51]. The two explanations carry different implications: if the cause is deferral after premium subsidies expired, the deferred procedures will still be performed later and growth will recover; if highly laparoscopic benign procedures have reached a certain level of penetration, the slowdown will persist and the company will need markets outside the U.S. and new procedures to make up for it.

The current evidence supports both explanations, and the company itself has not ruled out either one. U.S. customers performed about 552,000 da Vinci procedures in the second quarter, up about 12% compared with 14% growth a year earlier, and first-half growth was about 13%[7]. The company gave two reasons in its 10-Q: a high-single-digit decline in bariatric procedures, which are about 2% of total procedures, and a "modestly" negative impact from the expiration of enhanced premium subsidies, whose continued extent it called uncertain[8]. Management said on the call that customer feedback shows deferrable procedures growing more slowly than non-deferrable ones, but in the same answer it acknowledged that part of the slowdown reflects law-of-large-numbers effects from the size of the business[52]; the annual report had already warned that a federal law enacted in July 2025 may reduce enrollment in Medicaid and Affordable Care Act marketplace plans[53]. Instruments and accessories revenue per procedure was about $1,830, slightly above $1,800 a year earlier[40], so instruments and accessories revenue still grew 18% in the second quarter[36].

This debate reaches revenue directly through procedure volume, and current disclosure is not enough to separate the two explanations. The transmission runs as follows: premium subsidies expire and patients' out-of-pocket costs rise, some patients defer benign procedures such as gallbladder removal and hernia repair, U.S. procedure growth slows, replenishment of limited-life instruments and accessories falls with it, usage-based lease revenue slows at the same time, and the result is slower growth in instruments and accessories revenue, which is 60% of the total, and in recurring revenue. The company has not disclosed separate growth rates for deferrable and non-deferrable procedures, so outsiders cannot check management's attribution against data. Another unknown is the instrument extended use program due in the first half of 2027: it will lower the cost per procedure for high-volume benign procedures and also reduce instrument revenue per procedure, and management said adoption will build progressively through 2027 and that it will quantify the impact on the next earnings call[52].

The key readings in the third quarter are whether U.S. growth holds at 12% and how the company describes its full-year range. Global procedures grew 15% in the first half, and management guided to a full-year result near the midpoint of the 13.5% to 15.5% range[5]; arithmetic on the company's own figures implies second-half growth of about 14%, which is an arithmetic relationship and not a prediction by anyone. If U.S. growth is at least 12% in the third quarter, the company keeps its full-year range and instruments and accessories revenue keeps growing faster than procedures, the reading of persistent weakness loses force. Conversely, management has itself cautioned that softness could continue if deferred procedures do not return in the second half[54]; U.S. growth of 10% or less, or a lower range, would add weight to the explanation that the market is maturing.

Can 20% procedure growth outside the U.S. hold up against weak Chinese tenders and tight European and Japanese budgets, and keep offsetting the U.S. slowdown?

Markets outside the United States are the other half of whether the full-year procedure guidance can hold. They accounted for about 38% of global da Vinci procedures in the second quarter[7] and 33% of company revenue[16], and the full-year procedure range of 13.5% to 15.5% is in effect a weighted result of 12% to 13% growth in the U.S. and about 20% growth elsewhere. This growth faces constraints entirely different from those in the U.S.: what decides it is not patients' insurance but government budgets, tenders and pricing. The company's response is a tiered product line and direct distribution, the former including the XiR for cost-constrained markets and the 2027 instrument extended use program[45], the latter being the roughly $533 million purchase of the southern European distribution businesses in March[26].

Growth outside the U.S. held at 20% in the second quarter, but it has already stepped down from a year ago, and placements in China have nearly stalled. Da Vinci procedures outside the U.S. grew about 20%, with Europe, Asia and the rest of the world at 20%, 20% and 22%[55], and India, Italy and the United Kingdom were the strongest markets; growth a year earlier was 23%, and the first-half comparison is 20% against 24%[56]. The company placed 201 systems outside the U.S., up from 179 a year earlier[9], and placements in Japan rose to 25 from 15 after reimbursement for additional robotic procedures took effect on June 1[57]; revenue outside the U.S. was $959 million, up 18%[19], and it includes the contribution from consolidating the southern European distribution businesses. In China, the 2023 quota allows the sale of 559 new surgical robots, and the company's cumulative placements under that quota moved only from 166 at the end of March[58] to 169 at the end of June; the company said the price limits implemented so far have not had a material impact because only a small portion of its installed base in China is located in the affected provinces[49].

The transmission chain in this debate is longer than in the U.S., and there is also a reading that favors the company. Regulatory clearances, reimbursement lists and public hospital budgets in each country first determine tenders and placements, procedure growth follows placements, and instruments, accessories and service revenue come after that; domestic competition and the unified pricing framework in China press down on both the number of placements and the instrument price per procedure[48]. The favorable reading is that growth outside the U.S. is spread across many markets, and that 20% growth has held even though Chinese placements have been weak for some time, which suggests China's marginal effect is limited. The unfavorable side is that the company does not disclose China revenue separately, so outsiders cannot size the effect of price limits reaching more provinces; management also said conditions in Europe depend on national budgets and described the outlook for Japan as only "cautiously optimistic"[59].

The three readings to watch next are growth outside the U.S., placements outside the U.S. and the quota increment in China. If procedure growth outside the U.S. holds at 20% in the third quarter, placements keep rising from a year earlier and the recovery in Japanese placements after the reimbursement change continues, this part of the business can still offset the U.S. slowdown. For China, the observation that would falsify the pessimistic reading is that the company still calls the impact immaterial in its 10-Q after more provinces implement the framework, and that the quarterly increase in cumulative quota placements recovers to more than 4 systems. Da Vinci 5 and SP are moving through the green channel approval process for Mainland China[57], and progress there is another observable event; conversely, if growth outside the U.S. falls below 20% and the company points to Chinese pricing or European budgets as the reason, the offsetting logic weakens.

Placements grew 18% almost entirely on da Vinci 5 trade-ins — how long can the upgrade cycle run, and how much systems revenue is the rising lease mix pushing into later periods?

Systems revenue is only 24% of the total, yet it is the most volatile part of quarterly results and the entry point for future recurring revenue. The company placed 468 da Vinci systems in the second quarter, up 18%[3], but 144 of them involved trade-ins, compared with 83 a year earlier[9]; excluding trade-ins the figure is 324, only 4% above 312 a year earlier. In other words, demand for additional capacity was roughly flat, and the high growth came from customers exchanging fourth-generation systems for da Vinci 5. A trade-in does not enlarge the installed base, and its value lies in higher service fees, da Vinci 5 instruments and later software upgrades; at the same time 54% of placements were operating leases[10], which means the company uses its own balance sheet to fund equipment for customers and recognizes revenue period by period instead of at once.

Second-quarter data show that both trade-ins and leasing are accelerating. The company placed 267 systems in the U.S., up from 216 a year earlier[60], and management said the U.S. capital environment is stable, that U.S. placements rose 24% with the increase driven by da Vinci 5 upgrades, and that enrollment concerns tied to premium subsidies have not yet affected capital demand[59]. Da Vinci 5 placements were 246, of which 114 had dual consoles[61]; the average da Vinci selling price excluding leased systems was about $1.59 million, up from about $1.50 million a year earlier[21]. Operating lease placements were 254, or 54% of the total, compared with 193, or 49%, a year earlier, and the increase came mainly from fixed-payment leases (123 against 69), while usage-based leases were 131 against 124[10]. Operating lease revenue was $262 million, up from $214 million a year earlier, of which variable lease revenue was $169 million against $130 million; lease buyout revenue was $56 million, nearly double the $30 million of a year earlier[21].

How placements turn into revenue depends on the split between sales and leases, and how long the upgrade cycle can run has no answer yet. The transmission works like this: capacity demand from procedure growth plus the replacement of fourth-generation systems sets the number of placements in a quarter; the outright sales portion times the average selling price is recognized as systems revenue in that quarter, while the operating lease portion becomes fixed rent and procedure-linked variable rent in later periods; placements also enlarge the installed base and lift service revenue afterwards. The company stated in its 10-Q that second-quarter systems revenue growth was partly offset by the higher proportion of placements under operating leases[36]. The evidence that the upgrade cycle can continue is management's analogy: the Xi upgrade cycle ran over multiple years, and da Vinci 5 should become more attractive as more software updates are added[14]. The opposing evidence comes from the company's own list of factors affecting future placements, one of which is a declining number of older-generation systems available for trade-in[62]; the company also cautions that revenue recognized from usage-based leases could be highly volatile[63].

The third quarter calls for reading total placements, trade-in units and the lease share together. The combination that would falsify the concern that placements depend on trade-ins and cannot last is placement growth no lower than the 12% growth of the installed base, at least 100 trade-ins, and U.S. placements higher than a year earlier. If the lease share keeps rising from 54%, systems revenue growth may trail placement growth, which does not mean weaker demand but does move revenue into later periods. Another item to watch is whether variable lease revenue growth slows along with U.S. procedure growth; management has also cautioned that changes in premium subsidies and Medicaid could raise bad debt at U.S. hospitals and in turn affect future capital demand[54].

A one-time tariff refund lifted second-quarter gross margin to 70% — once it is stripped out, are Intuitive's margins still improving?

Margins were the biggest worry of the past year, and the improvement in 2026 is mixed with a one-time item. The company's gross margin fell from 67.5% to 66.0% in 2025[32]; in 2026 the picture reversed, as the company first raised its full-year non-GAAP gross margin guidance in April from 67% to 68% to a range of 67.5% to 68.5%[64], then raised it again in July to 68% to 69% while narrowing its operating expense growth range from 11% to 14% to a range of 11% to 13%[5], and second-quarter operating income rose 31%, far faster than the 19% revenue growth[37]. The issue is how much of that improvement can last: the 70.0% non-GAAP gross margin in the second quarter included a tariff refund of about $36 million, and it was 68.7% without it[13]. If no further refunds are booked, the third quarter will be the first period that can be observed without that refund.

The available evidence shows gross margin still improving after the refund is removed, but by much less than the headline figure. Second-quarter GAAP gross margin was 67.8%, compared with 66.3% a year earlier[37], and the company attributed the rise in product gross margin to tariff refunds, lower logistics costs and fixed overhead leverage, partly offset by higher intangible asset amortization, with product cost reductions added to the list for the first half[43]. Tariffs recognized in cost of revenue were $20.8 million in the quarter, about 0.7% of revenue, and $48.8 million in the first half[12]; in April the company lowered its estimate of the full-year tariff impact on gross margin from 120 basis points to 100 basis points[64]. On the expense side, second-quarter research and development expenses grew 18%[42] and selling, general and administrative expenses grew 10%[41], the two together were $988.5 million, up about 13%[38], and management said non-GAAP operating expenses also grew 13%[13], which sits at the top of the full-year guidance range.

Gross margin is set by the balance of overhead leverage and cost pressure, and the company's own guidance implies that the second half will not be better. Growth in procedures and placements spreads fixed manufacturing overhead, and product cost reductions and lower logistics costs lift gross margin; tariffs, depreciation on new capacity, acquisition-related amortization and higher freight and semiconductor prices lower it, and gross profit minus research and development and selling, general and administrative expenses gives operating income. The evidence that the improvement can last is that the 68.7% margin excluding the refund is still above 67.9% a year earlier and 67.8% in the first quarter[11], and that system utilization rose 3% from a year earlier[3]. The opposing evidence is that first-half non-GAAP gross margin was 68.9%[11] while the top of the full-year range is only 69%, which leaves almost no room for the second half to exceed the first; the guidance lists offsetting factors such as higher freight and semiconductor costs, new product growth and incremental depreciation[5], and the 10-Q states that depreciation and amortization will keep rising through the remainder of 2026[43].

Third-quarter gross margin and expense growth will answer this question directly. The readings to watch are whether non-GAAP gross margin falls between 68% and 69% and whether it still contains one-time items, whether the company again adjusts its full-year gross margin range and its estimate of the tariff impact, whether operating expense growth stays within 13%, and whether operating income keeps growing faster than revenue. The observations that would weaken the current understanding are input costs rising by more than the company assumed in its guidance, or slower procedure growth lowering utilization and reversing the benefit of fixed cost leverage.

Risks and Falsifiers

Competition and alternative therapies threaten new placements and pricing first. Large device companies such as Medtronic and Johnson & Johnson and several Chinese makers have entered the field of robotic surgery or stated that they will[46], and most payors do not pay extra when a robot is used, which makes hospitals sensitive to cost per procedure[28]. The exposed financial lines are the $685 million of second-quarter systems revenue, the da Vinci average selling price of about $1.59 million[21] and instruments and accessories revenue of about $1,830 per procedure[40]; the company answers cost-constrained customers with the refurbished XiR and the 2027 instrument extended use program, and 20 of the 27 second-quarter placements at U.S. ambulatory surgery centers were XiR systems[45], and both measures pull unit prices down. The observation that would falsify this concern is that the average selling price and instruments and accessories revenue per procedure do not decline from a year earlier and the company does not attribute changes in placements or procedures to competitors.

The risk from a concentrated supply chain falls on instruments and accessories revenue, which is 60% of the total. Systems are built in Sunnyvale, Peachtree Corners and Shanghai, instruments and accessories are made in Sunnyvale and Mexicali, some components depend on sole-sourced or single-sourced suppliers, and the company buys mostly through purchase orders rather than long-term agreements and does not hold large volumes of finished goods[27]. Customers replenish on a regular basis and orders typically ship within one business day[18], so any interruption in the supply of instruments and accessories would hit revenue in the same quarter; inventory, including leased equipment, rose by $515 million in the first half, and one of the reasons the company gave was protection against supply chain shortages[44]. This risk has not materialized if the company reports no shipment delays caused by component shortages or facility inspections and inventory grows roughly in line with revenue.

Continued weakness in deferrable benign procedures in the U.S. is the single risk with the largest revenue effect. The expiration of premium subsidies[8] and a possible decline in Medicaid enrollment[53] could lead more patients to defer or forgo procedures such as gallbladder removal and hernia repair, which are the main source of incremental U.S. volume. The exposed financial line is the $1.180 billion of second-quarter U.S. instruments and accessories revenue, about 41% of total revenue[19]; the U.S. accounts for about 62% of global procedures, so each 2 percentage point decline in U.S. growth lowers global growth by about 1.2 percentage points. Management has already cautioned that softness could continue if deferred procedures do not return in the second half[54]; the observation that would falsify this risk is third-quarter U.S. da Vinci procedure growth of at least 12% with the company keeping its full-year range of 13.5% to 15.5%.

If China's unified pricing framework is implemented in more provinces, procedure volume, instrument prices and placements in China would come under pressure at the same time. Price limits in several provinces since 2022 have already affected local procedure volume and instruments and accessories pricing, and in the second quarter the National Healthcare Security Administration required all provinces to implement pricing within the unified framework in the upcoming quarters; the company has placed only 169 systems in total under the 559-unit 2023 quota[49], and domestic competition and stalled tenders continue[48]. The company does not disclose China revenue separately, and the available reference points are the $959 million of second-quarter revenue outside the U.S., or 33% of the total, and the 2,111 systems in Asia, about 18% of the global installed base[50]. The falsifying condition is that the company still calls the impact immaterial in its 10-Q after more provinces implement the framework and the quarterly increase in cumulative quota placements recovers to more than 4 systems.

The dependence of placement growth on da Vinci 5 trade-ins means placements and systems revenue could fall back together. Trade-ins were 144 units in the second quarter, about 31% of placements, and placements excluding them grew only 4%[9], while the company itself lists a declining number of older-generation systems available for trade-in among the factors affecting future placements[62]. The exposed financial line is systems revenue, 24% of the total; arithmetic on the average selling price of about $1.59 million[21] shows that every 23 fewer outright sales corresponds to about $37 million of systems revenue in a quarter. The falsifying condition is third-quarter placement growth of at least 12%, at least 100 trade-ins and U.S. placements higher than a year earlier.

Changes in tariffs and trade policy are a tail risk because the company's instruments and accessories production is heavily concentrated in Mexico. Tariffs currently recognized in cost of revenue are $20.8 million a quarter[12], and the company puts the full-year impact on gross margin at about 100 basis points[64]; Mexicali is the main production site for instruments and accessories[27], these products are not currently subject to additional U.S. import tariffs because they meet the rules of origin under the United States-Mexico-Canada Agreement, and if that exemption ended the cost effect would be far larger than it is today, with the cost behind the $1.735 billion of second-quarter instruments and accessories revenue exposed. The observation that would falsify this risk is that the company keeps its full-year tariff impact estimate at about 100 basis points and the 10-Q continues to disclose that products made in Mexico are not subject to additional tariffs.

What to Watch Next

• Nature of the U.S. procedure slowdown. The current reading is U.S. da Vinci procedure growth of about 12% in the second quarter and about 13% in the first half[7], against a full-year global range of 13.5% to 15.5%[5]. Watch third-quarter U.S. growth, how the company describes landing near the midpoint, and whether instruments and accessories revenue per procedure stays at about $1,830[40]. Growth of at least 12% with an unchanged range weakens the reading of persistent weakness; growth of 10% or less, or a lower range, supports the maturity explanation.
• Growth outside the U.S. and China. The current reading is procedure growth of about 20%[56], 201 placements[9] and 169 cumulative placements under China's 2023 quota[49]. Watch growth in Asia and Europe, placements in Japan, the rollout of the pricing framework and approvals for da Vinci 5 and SP in China. Growth holding at 20% with the quarterly quota increment back above 4 systems confirms the offset; growth below 20% that the company attributes to China or European budgets weakens it.
• Da Vinci 5 upgrades and lease mix. The current reading is 468 placements including 144 trade-ins[9], a 54% lease share[10] and $169 million of variable lease revenue[21]. Watch whether placements excluding trade-ins grow again and whether systems revenue growth trails placement growth. Placement growth of at least 12%, at least 100 trade-ins and higher U.S. placements confirm durability; all three weakening together falsify it.
• Margins without one-time items. The current reading is a 70.0% non-GAAP gross margin, or 68.7% excluding the refund[13], against a full-year range of 68% to 69%[5]. Watch whether third-quarter gross margin falls inside the range and whether the tariff impact estimate changes again. A margin inside the range, expense growth of no more than 13% and operating income growing faster than revenue confirm the improvement; input costs rising beyond the guidance assumptions weaken it.

Conclusion

Intuitive's business is driven by procedure volume, which feeds the three kinds of recurring revenue, instruments and accessories, service and leases, that together make up 85% of total revenue[23]. The company's financial position in the second quarter was solid: revenue was $2.892 billion, up 19%[3], operating income rose 31%, and the company held $8.63 billion in cash and investments at the end of June[37]. The central unresolved relationship is the one between U.S. procedure growth and the full-year guidance: U.S. growth has slowed to about 12%[7], the full-year range of 13.5% to 15.5%[5] relies on growth of about 20% outside the U.S., the strong placement growth comes mainly from trade-ins, and the high gross margin reading includes a one-time refund.

Only two independent assessments published after the results could be verified, and they share a focus while explaining it from different angles. Maria Ponnezhath of Investing.com recorded in a July 17 report that second-quarter adjusted earnings per share of $2.80 and revenue of $2.89 billion both exceeded the $2.51 and $2.82 billion figures the article cited, yet the shares fell 10.9%; she attributed the decline to full-year procedure growth guidance that disappointed investors and noted that the quarter included a tariff refund benefit of about $28 million after tax, or $0.08 per share, and the article is an earnings brief that does not say where the investor expectations it refers to come from[51]. Zacks Investment Research wrote in a July 28 review of the call that management's tone combined confidence in platform demand with caution about U.S. patient behavior, China pricing pressure and uneven international capital conditions, and that the weakness was concentrated in procedures patients can defer[65]. Both put U.S. procedure volume at the center, which matches the first core debate, and the refund that Investing.com mentions corresponds to the margin debate; the difference is that Zacks largely accepts management's insurance explanation and neither discusses the law-of-large-numbers effect that management also acknowledged nor tests how much trade-ins contributed to placement growth. Both pieces are outside interpretations rather than facts or a vote, and the coverage is thin: neither one tests the two explanations for the U.S. slowdown against independent data.

The combination that would materially strengthen the current understanding is third-quarter U.S. procedure growth of at least 12%, growth outside the U.S. holding at 20%, a maintained or narrowed full-year range, non-GAAP gross margin between 68% and 69% without one-time items, and renewed growth in placements excluding trade-ins. The combination that would materially weaken it is U.S. growth of 10% or less, a lower full-year range or the disappearance of the near-the-midpoint language, fewer trade-ins while the lease share keeps rising, gross margin falling out of the range, or the company starting to describe the impact of Chinese price limits as material. Until those readings arrive, current disclosure cannot settle whether the U.S. slowdown is deferral or maturity.

Sources

[1] ISRG 10-K filed 2026-02-03 · description of the business · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[2] ISRG earnings calendar · 2026-10-20 third quarter 2026 earnings call (calendar last updated 2026-09-19) · 2026-09-19 · earnings calendar

[3] ISRG 10-Q filed 2026-07-21 · second quarter 2026 operational highlights · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[4] ISRG 8-K filed 2026-07-16 · second quarter 2026 earnings release highlights · 2026-07-16 · 8-K · https://www.sec.gov/Archives/edgar/data/0001035267/000103526726000047/q226ex-991earningsrelease.htm

[5] ISRG earnings call 2026-07-16 · 2026 guidance · 2026-07-16 · earnings-call · https://isrg.intuitive.com/events-and-presentations

[6] FXEmpire ISRG earnings estimate (accessed 2026-09-19) · 2026-09-19 · FXEmpire · https://www.fxempire.com/stocks/isrg/earnings

[7] ISRG 10-Q filed 2026-07-21 · da Vinci procedures table · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[8] ISRG 10-Q filed 2026-07-21 · U.S. procedure growth, bariatric decline and ACA subsidies · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[9] ISRG 10-Q filed 2026-07-21 · system placements by region and trade-ins · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[10] ISRG 10-Q filed 2026-07-21 · placements under leasing arrangements · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[11] ISRG 8-K filed 2026-07-16 · GAAP to non-GAAP reconciliation · 2026-07-16 · 8-K · https://www.sec.gov/Archives/edgar/data/0001035267/000103526726000047/q226ex-991earningsrelease.htm

[12] ISRG 10-Q filed 2026-07-21 · tariff costs and IEEPA refunds · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[13] ISRG earnings call 2026-07-16 · tariff refund, non-GAAP margin, expenses and free cash flow · 2026-07-16 · earnings-call · https://isrg.intuitive.com/events-and-presentations

[14] ISRG earnings call 2026-07-16 · Q&A on the da Vinci 5 upgrade cycle and XiR · 2026-07-16 · earnings-call · https://isrg.intuitive.com/events-and-presentations

[15] ISRG 10-K filed 2026-02-03 · 2025 operational and financial highlights · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[16] ISRG 10-Q filed 2026-07-21 · one reportable segment and geographic mix · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[17] ISRG 10-Q filed 2026-07-21 · price ranges for systems, instruments and service · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[18] ISRG 10-K filed 2026-02-03 · replenishment orders and seasonality · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[19] ISRG 10-Q filed 2026-07-21 · revenue by geography and type · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[20] ISRG 10-K filed 2026-02-03 · system leasing model · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[21] ISRG 10-Q filed 2026-07-21 · operating lease revenue, lease buyouts and system ASP · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[22] ISRG 10-Q filed 2026-07-21 · service revenue · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[23] ISRG 10-Q filed 2026-07-21 · recurring revenue table · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[24] ISRG 10-K filed 2026-02-03 · distribution channels and domestic revenue share · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[25] ISRG 10-K filed 2026-02-03 · China joint venture with Fosun Pharma · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[26] ISRG 10-Q filed 2026-07-21 · acquisition of southern European distributors · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[27] ISRG 10-K filed 2026-02-03 · manufacturing footprint and sole-sourced components · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[28] ISRG 10-K filed 2026-02-03 · no separate payment for robotic assistance · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[29] ISRG 10-K filed 2026-02-03 · revenue by geography and type · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[30] ISRG 10-K filed 2026-02-03 · recurring revenue table · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[31] ISRG 10-K filed 2026-02-03 · 2025 procedure growth by geography and bariatric decline · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[32] ISRG 10-K filed 2026-02-03 · 2025 gross margin, operating income, repurchases and cash · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[33] ISRG 10-K filed 2026-02-03 · 2025 product gross margin drivers · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[34] ISRG 10-K filed 2026-02-03 · 2025 operating cash flow and capital expenditures · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[35] ISRG 10-Q filed 2026-04-22 · first quarter 2026 operational highlights · 2026-04-22 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[36] ISRG 10-Q filed 2026-07-21 · second quarter product revenue · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[37] ISRG 10-Q filed 2026-07-21 · second quarter gross margin, operating income, repurchases and cash · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[38] ISRG 10-Q filed 2026-07-21 · condensed income statement · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[39] ISRG 10-Q filed 2026-07-21 · six-month cash flows · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[40] ISRG earnings call 2026-07-16 · instruments and accessories revenue per procedure · 2026-07-16 · earnings-call · https://isrg.intuitive.com/events-and-presentations

[41] ISRG 10-Q filed 2026-07-21 · selling, general and administrative expenses · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[42] ISRG 10-Q filed 2026-07-21 · research and development expenses · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[43] ISRG 10-Q filed 2026-07-21 · product gross margin drivers and depreciation outlook · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[44] ISRG 10-Q filed 2026-07-21 · working capital and inventory for leasing · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[45] ISRG earnings call 2026-07-16 · extended use program and da Vinci XiR · 2026-07-16 · earnings-call · https://isrg.intuitive.com/events-and-presentations

[46] ISRG 10-K filed 2026-02-03 · competitors in robotic-assisted procedures · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[47] ISRG 10-K filed 2026-02-03 · weight loss drugs and bariatric procedures · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[48] ISRG 10-Q filed 2026-07-21 · capital caution and China system demand · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[49] ISRG 10-Q filed 2026-07-21 · China quota and national pricing framework · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[50] ISRG 10-Q filed 2026-07-21 · installed base and Ion demand · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[51] Investing.com 2026-07-17 · Intuitive Surgical falls on weak 2026 procedure growth outlook · 2026-07-17 · Investing.com · https://www.investing.com/news/earnings/intuitive-surgical-falls-on-weak-2026-procedure-growth-outlook-93CH-4797786

[52] ISRG earnings call 2026-07-16 · Q&A on ACA versus maturity · 2026-07-16 · earnings-call · https://isrg.intuitive.com/events-and-presentations

[53] ISRG 10-K filed 2026-02-03 · OBBBA coverage risk · 2026-02-03 · 10-K · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-K&dateb=&owner=include&count=40

[54] ISRG earnings call 2026-07-16 · risks · 2026-07-16 · earnings-call · https://isrg.intuitive.com/events-and-presentations

[55] ISRG earnings call 2026-07-16 · U.S. moderation and regional procedure growth · 2026-07-16 · earnings-call · https://isrg.intuitive.com/events-and-presentations

[56] ISRG 10-Q filed 2026-07-21 · OUS procedure growth · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[57] ISRG earnings call 2026-07-16 · China, Japan and India updates · 2026-07-16 · earnings-call · https://isrg.intuitive.com/events-and-presentations

[58] ISRG 10-Q filed 2026-04-22 · China quota placements as of March 31, 2026 · 2026-04-22 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[59] ISRG earnings call 2026-07-16 · Q&A on the capital environment · 2026-07-16 · earnings-call · https://isrg.intuitive.com/events-and-presentations

[60] ISRG 10-Q filed 2026-07-21 · second quarter system demand by geography · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[61] ISRG earnings call 2026-07-16 · capital placements, leasing share and ASP · 2026-07-16 · earnings-call · https://isrg.intuitive.com/events-and-presentations

[62] ISRG 10-Q filed 2026-07-21 · factors affecting future placements · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[63] ISRG 10-Q filed 2026-07-21 · usage-based lease revenue volatility · 2026-07-21 · 10-Q · https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001035267&type=10-Q&dateb=&owner=include&count=40

[64] ISRG earnings call 2026-04-21 · first-quarter guidance · 2026-04-21 · earnings-call · https://isrg.intuitive.com/events-and-presentations

[65] Zacks Investment Research 2026-07-28 · ISRG Q2 earnings call signals durable demand and U.S. caution · 2026-07-28 · Zacks Investment Research · https://www.theglobeandmail.com/investing/markets/stocks/ISRG/pressreleases/3503885/isrg-q2-earnings-call-signals-durable-demand-us-caution/