Intuitive Surgical 2026年第二季度业绩疲软，维持卖出评级并下调目标价至324美元

United States Medical Supplies&Devices Choppy 2Q; maintain SELL and lowerPT to $324 ImronZafar Research Analyst+1-212-250-3676Pito Chickering While2QWWproceduregrowthof +15%cameinmoreorless inlinewith consensus,USvolumegrowth of+12%fell shortof expectations even despitehaving been tempered post HCA's preannouncement earlierthis week,whichshowedweakinpatientandoutpatientsurgeryvolumes.WhileHCAattributedthisweaknessmainlyto AcApremiumsubsidycuts,wesubsequentlygotmorereassuringresultsandcommentaryfrombothJ&JandAbbott-withneithercitinganymeaningfulhittotheirprocedurevolume-sensitivebusinessesfromthesecuts(and UNH remarking this morning that utilization held fairly steady in 2Q) -precipitating a reliefrallyformedtech stocks. Research Analyst+1-917-635-9954KieranRyan Research Analyst+1-212-250-6879 Ben ShaverResearch Associate+1-212-250-9926 However,this week's roller-coaster ride now promises to continue post-isRG'sresults,withmanagementpositingthatACAsubsidycutsdroveslower-than-expectedUSdaVincivolumegrowthbasedonanobservedsequentialdecelerationacross several major elective/deferrable robotic surgery categories includingbenignhysterectomy,cholecystectomy,andherniarepair.Given this dynamic,procedure guidance was maintained,withfull-yearWWvolume growthtrendingtowardthe midpointofthe+13.5%to+15.5%range.Thislack of procedure upsideis notable and will likely disappoint investors,given the company's long andconsistent history of beating and raising.We lower our full-year U and Wwproceduregrowthforecasts to+12.1% (down 110bps)+14.9%(down 30bps)respectively. Onsystems,grossplacementscomfortablybetteredconsensus(468vs.446),reflecting continued healthy Us demand for dv5.However, net installed basegrowth has clearly slowedoverthepast few quarters,andwe continuetomodelfurtherdeceleration goingforward.Notably,installations within the Asc channelare gaining nice momentum,thankstolaunch ofXiRinto this more cost-sensitivechannel,whichshouldhelpdrivehighertechnologyadoptionforsimplercasesthatareincreasinglybeingperformedinthis site ofcare. International installations were in line,though continued weakness in Chinaplacements is highlynoteworthy,giventhatthismarkethadpreviouslybeenakeydriverofOUSsystemsandproceduregrowth.Whilethecompanyhadplaced55-60unitsinChinaineachofthepastfewyears,onlytwosystemswereinstalledin2Q and just six YTD vs 29 in 1H25, as the da Vinci tender win rate continues to Medical Supplies &DevicesIntuitive Surgical procedureside,whileChinatechnologyadoptionhadbeenmeaningfullyaccretiveisnowresultingindeceleratingproceduregrowthascapacityutilizationmaxesout.In India,while2Qvolumes were notablystrong,our recentchecks withlargeIndianhospital systems point to continued installed base share gains by lower-costsystems made in India and China. We will be meeting with several Asiancompetitorsnextweekat SRStobetterunderstand the competitivelandscape inthese two key OUS robotic surgery markets. dv5 did receive Indian regulatoryapproval earlier this week,though we foresee fairly limited uptake of the premium-priced robot in this highly cost-sensitive market. begin launching Extended Use round two in the first half of 2027,which will enablecustomers to perform more surgeries per instrumentforahandful of high-volumedevices.Thecompanydidnotprovidemuchadditionaldetailonthecall,suchasthenumber of instruments impactedoradditionalnumberofusesperunit,making itimpossibleto quantify thefinancial impacton the all-important I&A revenue-per-procedure line in2027and beyond.Butbased onthefirstroundofExtended Usein2021,whichnegativelyimpactedrevenueperprocedureby~7%itisfairtoassumethatthis round will likewise exertmeaningful pressureonthiskey model inputoverthe next couple of years.Management'sstrategic rationale hereisthatthelowerprice point will drive higher adoption of robotic surgery,with which we concur-thoughourstrong suspicionisthatthiswasalsoadefensivemovetohelpmitigatethe impact from lower-cost remanufactured instruments and as more surgicalrobots are commercially launched in the Us over the next couple of years.Regardless,bottom line is that launch of Extended Use round two will exert ameaningful hit to top-line growth in 2027-28. Onremanufactured instruments,whilemanagementcontinuestodownplaythisrisk factor to its crown-jewel I&A business,our checks continue to confirmsignificant interest and growing adoption by hospitals,given the sizable discountvs.de novo instruments.In speaking with several major robotics programs,including HCA, Intuitive's largest US customer, adoption of the remanufacturedmonopolarscissors,thelargestl&ASKUat~14%ofsegmentsales,continuestoincrease-andwhichweestimatehasnowcaptured~5%-7%shareofthisproductcategory.As severaladditional remanufactured instruments receiveFDAapprovaland launchincoming quarters,we believe this will increasingly start to weigh onIntuitive'stopline,specifically1&Aperprocedure,in2027andespecially2028. Hence,withthedeepmoatthathasheretoforesurroundedthel&Asegment-andj