Intuitive Surgical (NASDAQ:ISRG) outlined what executives called a “strong year” in 2025, driven by multi-specialty procedure growth, increasing adoption of the da Vinci 5 platform, and continued expansion across its da Vinci, single-port (SP), and Ion systems. Management also provided its 2026 procedure growth outlook and discussed factors that could influence demand, including reimbursement dynamics, capital spending pressure in certain regions, and competitive intensity in China.
2025 operating highlights: procedure growth, utilization, and installed base
CEO Dave Rosa said physicians used Intuitive systems to treat more than 3.1 million patients in 2025, bringing the cumulative number of patients treated since 1997 to more than 20 million. He framed the company as still being in the “early stages” of advancing minimally invasive care.
In the U.S., da Vinci procedures grew 15% to more than 2 million, with contributions from general surgery, including after-hours use. Internationally, da Vinci procedures grew 23% to over 1.1 million, with growth of 21% in Europe, 24% in Asia, and 27% in rest-of-world markets. Procedures outside the U.S. represented roughly 35% of global procedures, which management attributed to clinical demand, improved market access, training initiatives, and economics.
System utilization in 2025 rose 3% globally across da Vinci platforms, with multi-port utilization up 3%, SP up 29%, and Ion up 9%.
On system placements, the company placed 1,721 da Vinci systems in 2025, including 870 da Vinci 5 systems, 107 SP systems, and 195 Ion systems. Rosa said demand for da Vinci 5 strengthened as manufacturing scaled and software/product releases added capabilities. Intuitive also began offering refurbished da Vinci Xi systems as part of its strategy and placed 42 da Vinci XIR systems in 2025, which management described as a potential way to expand access internationally and in U.S. ambulatory surgery centers (ASCs).
Q4 results: revenue growth, recurring mix, and operating margin
CFO Jamie Samath reviewed results primarily on a non-GAAP (pro forma) basis. He said Q4 revenue grew 19% to $2.87 billion, with recurring revenue up 20% to $2.3 billion, representing 81% of total revenue. On a constant currency basis, revenue growth was 18%.
Pro forma operating margin was 37% in Q4, which Samath said included a roughly 95-basis-point impact from tariffs and a $70 million contribution to the Intuitive Foundation. Pro forma net income rose to $914 million from $805 million a year earlier, and pro forma EPS increased to $2.53 from $2.21.
On a GAAP basis, Q4 net income was $795 million, or $2.21 per share, compared with $686 million, or $1.88 per share, a year earlier.
Samath said the company ended the year with $9.0 billion in cash and investments, up from $8.4 billion the prior quarter, driven primarily by cash from operations and partially offset by stock repurchases and capital expenditures. He also noted free cash flow of $2.5 billion in 2025, up from $1.3 billion in 2024. Intuitive repurchased $2.3 billion of stock during 2025 at an average price of $478 per share.
Platform updates: da Vinci 5, SP expansion, and Ion utilization focus
Rosa highlighted continued expansion of da Vinci 5, including a second-half launch in Europe, the U.K., and Japan. Intuitive placed 58 da Vinci 5 systems outside the U.S. in 2025, “mostly in Europe,” and said it received positive early adopter feedback.
Rosa also said the FDA cleared several cardiac procedures on da Vinci 5 using non-force feedback instruments, and that the company is planning a “measured rollout” to support training and adoption given the complexity of minimally invasive cardiac surgery. In the Q&A, Samath said about 17,000 cardiac procedures were performed globally in 2025 on SP and Xi, and that when considering where da Vinci 5 is cleared (currently the U.S. and Korea), Intuitive estimates the robotic opportunity at about 160,000 procedures per year, with potential expansion as additional geographies are added.
On digital tools, executives discussed “My Intuitive Plus,” a subscription package offered with da Vinci 5 that includes simulation, telecollaboration/telepresence, and case insights. Samath said the package originally included one year of free use and that a Q2 software update led the company to extend the free period. He said that beginning around Q2 2026, customers will have the opportunity to renew the subscription as a paid offering, with renewal rates and pricing dependent on perceived value. He also said the accounting treatment defers a portion of system revenue into service revenue over time.
For the SP platform, Rosa said procedures grew 87% in 2025, driven by Korea and the U.S., with early growth in Europe, Japan, and Taiwan. The installed base rose 39% to 377 systems. He noted 510(k) clearance in Q4 for additional indications including nipple-sparing mastectomy, inguinal hernia repair, cholecystectomy, and appendectomy, and said the company plans a measured rollout for nipple-sparing mastectomy.
On Ion, Rosa said worldwide procedures grew 51% to just over 144,000 in 2025, and that cumulative procedures since FDA clearance in 2019 exceeded 325,000, with the installed base approaching 1,000 systems. Samath added that in Q4, Ion procedures grew 44% and average system utilization increased 11%. He said lower Ion placements in the U.S. reflected a joint focus with customers on increasing utilization.
Regional dynamics: ASCs, China competition, and Japan reimbursement watch
Management repeatedly pointed to a shift in sites of care in the U.S., from hospitals to hospital outpatient departments and ASCs. Samath said Intuitive is expanding its ASC footprint and expects it to be a multi-year effort, leveraging the XIR system and related economic and acquisition offerings. Rosa said procedures typical of the ASC environment include cholecystectomy, hernia repairs, and benign gynecology, and that the company is initially focusing on higher-volume ASCs that can sustain a robotic program. Samath said about 70% of the ASC procedure opportunity is in ASCs affiliated with existing integrated delivery network (IDN) customers.
In China, executives said competitive intensity increased in Q4, with provincial tenders expressing preferences for local suppliers and lower pricing, which impacted Intuitive’s win ratio in the quarter. Rosa said the company is competing with Xi, manufactured locally, and believes it can compete effectively “at a price point” that works for customers and for Intuitive. Samath added there were about 273 systems left in the current quota and noted that the 2025 tender win ratio was slightly higher than the prior year despite the weaker Q4.
In Japan, Samath said procedure growth was “a little lower than our expectations,” reflecting lower capital placements over several quarters. He noted the Japanese Ministry of Health, Labor, and Welfare was in the final stages of evaluating reimbursement for additional robotic procedures starting in June 2026, with an update expected on the next earnings call.
2026 outlook: procedure growth guidance and margin framework
For 2026, management guided to da Vinci procedure growth of 13% to 15% for the full year. Dan Connally, vice president of investor relations, said the range reflects a number of considerations, including potential impacts from changes to Affordable Care Act premium subsidies and Medicaid funding in the U.S., capital pressure in parts of Europe, China tender volumes and competitive intensity, Japan capital challenges, and new pharmaceutical products for obesity management.
On profitability, Connally said Intuitive expects 2026 pro forma gross margin of 67% to 68% of net revenue. He cited a forecast tariff impact of about 1.2% of net revenue (plus or minus 10 basis points), along with mix effects from da Vinci 5 and Ion, incremental depreciation from facility expansion, and the impact of higher da Vinci system upgrades, partially offset by cost reductions.
The company expects 2026 pro forma operating expense growth of 11% to 15%, driven by higher spending on early-stage R&D programs and incremental expenses related to its distributor acquisition. Intuitive projected non-cash stock compensation expense of $890 million to $920 million, other income of $355 million to $375 million (mostly interest income), and a 2026 pro forma tax rate of 22% to 23%. Management said it will no longer provide specific capital expenditure guidance, citing expectations for capex to return to more normalized levels.
About Intuitive Surgical (NASDAQ:ISRG)
Intuitive Surgical, founded in 1995 and headquartered in Sunnyvale, California, is a medical technology company focused on the design, manufacture and service of robotic-assisted surgical systems. The company is best known for its da Vinci surgical systems, which enable minimally invasive procedures by translating a surgeon’s hand movements into finer, scaled motions of small instruments inside the patient. Intuitive’s business centers on supplying hospitals and surgical centers with systems, instruments and related technologies that aim to improve precision, visualization and control in the operating room.
In addition to its core surgical platforms, Intuitive markets a portfolio of reusable and disposable instruments, accessories, and proprietary software, and provides training, servicing and clinical support to its customers.
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