Intuitive Surgical reported adjusted earnings per share of $2.53 for the fourth quarter of 2025, surpassing the consensus estimate of $2.26 by 12%. Revenue rose 19% year over year to $2.87 billion, outpacing the analyst expectation of $2.75 billion. Procedure volume was a key driver, with da Vinci procedures up 17% and Ion procedures jumping 44% compared with the prior-year period. System placements also expanded, with 532 da Vinci units added during the quarter versus 493 a year earlier, lifting the installed base to 11,106 systems globally.

Intuitive Surgical’s growth in Asia remained below internal forecasts, as procedure volumes in Japan continued to lag. Reimbursement guidelines for additional robotic procedures await final approval, with new rates expected to take effect in June 2026. In China, local competitors secured a larger share of provincial tenders by offering lower-priced systems, eroding Intuitive’s market penetration. Management highlighted that pricing has become a critical factor in tender awards, cutting into both system sales and recurring revenue potential in the region.

Ion system placements fell sharply in Q4, with 42 units delivered compared to 69 in the same quarter of 2024, marking a 39% decline. While U.S. customers increased utilization by 11% year over year, management attributed the drop in new installations to a strategic shift toward maximizing throughput on existing systems. The decline raises concerns about the pace at which the company can scale its newest technology, which had previously shown strong sequential growth since its launch.

For fiscal 2026, Intuitive Surgical projects da Vinci procedure growth of 13% to 15%, down from the 18% achieved in 2025. The company also expects a non-GAAP gross margin of 67% to 68%, factoring in a roughly 1.2 percentage point headwind from tariffs. Despite the moderated outlook, management pointed to a long-term opportunity in an annual addressable market of approximately 20 million soft-tissue procedures. A November 2025 study published in the Annals of Surgery found that robotic-assisted operations reduce the likelihood of subsequent open surgery by 50% compared with laparoscopy, underscoring the technology’s potential to capture additional share over the coming years.