Intuitive Surgical, Inc.
Health Care · Health Care Equipment
7M procedures/yr, ~17% YoY procedure growth). Razor-and-blade flywheel: each placement locks in recurring instrument + service revenue for 7-10 years. Physical-AI proxy - da Vinci 5 (launched 2026) adds 10,000x compute, force feedback, and a digital surgery data stack that compounds with case volume.
- Installed base CAGR 13% with ~80%+ recurring revenue mix; gross margin ~67%
- da Vinci 5 upgrade cycle: ~3,000+ Xi systems eligible, ASP step-up
- Bariatric + general surgery procedure mix expanding fastest (>20% YoY)
- Ion lung biopsy nascent ($300M+ run-rate) with similar razor-blade lock-in
- International rooms <30% of installed base - long runway in EU/Japan/China
- $MDT Hugo + $JNJ Ottava + $SYK Mako (soft tissue) competition arriving 2026-2027
- Multiples rich (~55x fwd P/E) leave no margin for procedure-growth deceleration
- China VBP and tariff pressure on system ASPs
- GLP-1 (bariatric) demand drag risk if obesity drug adoption compresses surgical volumes