# How Intuitive Surgical makes money CXProWealth Business Lens · Intuitive Surgical (ISRG) · Q3 FY2026 Read from the 10-Q for the period 2026-07-01 to 2026-09-30, filed 2026-10-21 with the SEC (accession 0001035267-26-000071): https://www.sec.gov/Archives/edgar/data/1035267/000103526726000071/ Business Lens explains how a company earns, spends and keeps its money, from its own filings. It is insight and context, never a view on the shares, a target, or advice. Figures are raw units as filed; percentages are percentage points. ## Headline figures - Revenue: $3.0B (+21.7% on the year) - Operating income: $592.6M (operating margin 19.4%) - Net income: $522.8M (net margin 17.1%) - Gross margin: 68.4% - Free cash flow: $1.1B (36.4% of revenue) - Cash conversion (operating cash flow / net income): 2.34x - Capital expenditure: 3.7% of revenue ## Where the money goes (Q3 FY2026) - Instruments and accessories → Total revenue: $1.8B - Systems → Total revenue: $769.1M - Service → Total revenue: $482.2M - Total revenue → Total cost of revenue: $964.4M - Total revenue → Gross profit: $2.1B - Gross profit → Total operating expenses: $1.5B - Total operating expenses → Selling, general, and administrative: $633.4M - Total operating expenses → Research and development: $408.3M - Total operating expenses → Antitrust class action litigation settlement: $450.0M - Gross profit → Income from operations: $592.6M - Income from operations → Income before taxes: $592.6M - Interest and other income, net → Income before taxes: $75.8M - Income before taxes → Income tax expense: $144.0M - Income before taxes → Net income: $524.4M - Net income → Less: net income attributable to noncontrolling interest in joint venture: $1.6M - Net income → Net income attributable to Intuitive Surgical, Inc.: $522.8M ## Where the revenue comes from ### Products and services (REVENUE AND CONTRACT ACQUISITION COSTS - Revenue Disaggregated by Types and Geography (Details)) | Member | Value | Share | |---|---:|---:| | Instruments and accessories | $1.8B | 59.0% | | Systems | $769.1M | 25.2% | | Service | $482.2M | 15.8% | The members sum to total revenue. ### GeographicDistribution (REVENUE AND CONTRACT ACQUISITION COSTS - Revenue Disaggregated by Types and Geography (Details)) | Member | Value | Share | |---|---:|---:| | U.S. | $2.1B | 67.7% | | Outside of the U.S. (“OUS”) | $985.7M | 32.3% | The members sum to total revenue. ## Income statement, as filed | Line | Q3 FY2026 | Of revenue | |---|---:|---:| | Total revenue | $3.0B | 100% | | Product | $2.6B | 84.2% | | Service | $482.2M | 15.8% | | Total cost of revenue | $964.4M | 31.6% | | Product | $797.7M | 26.2% | | Service | $166.7M | 5.5% | | **Gross profit** | $2.1B | 68.4% | | Selling, general, and administrative | $633.4M | 20.8% | | Antitrust class action litigation settlement | $450.0M | 14.8% | | Research and development | $408.3M | 13.4% | | **Total operating expenses** | $1.5B | 48.9% | | **Income from operations** | $592.6M | 19.4% | | Interest and other income, net | $75.8M | 2.5% | | **Income before taxes** | $668.4M | 21.9% | | Income tax expense | $144.0M | 4.7% | | **Net income** | $524.4M | 17.2% | | Less: net income attributable to noncontrolling interest in joint venture | $1.6M | 0.1% | | Corporate Joint Venture | $1.6M | 0.1% | | **Net income attributable to Intuitive Surgical, Inc.** | $522.8M | 17.1% | | Basic (in dollars per share) | $2 | 0.0% | | Diluted (in dollars per share) | $1 | 0.0% | | Basic (in shares) | 349,000,000 | | | Diluted (in shares) | 351,600,000 | | | Unrealized gains (losses) on hedge instruments | -$13.9M | 0.5% | | Unrealized gains (losses) on available-for-sale securities | -$34.0M | 1.1% | | Foreign currency translation gains (losses) | -$17.8M | 0.6% | | Employee benefit plan adjustments | (-$300.0K) | 0.0% | | **Other comprehensive income (loss)** | -$65.4M | 2.1% | | **Total comprehensive income** | $459.0M | 15.1% | | Less: comprehensive income attributable to noncontrolling interest | $2.3M | 0.1% | | **Total comprehensive income attributable to Intuitive Surgical, Inc.** | $456.7M | 15.0% | ## History | Period | Revenue | Operating income | Net income | Operating cash flow | Capital expenditure | Free cash flow | |---|---:|---:|---:|---:|---:|---:| | FY2007 | $600.8M | $206.7M | $144.5M | $205.7M | $24.0M | $181.7M | | FY2008 | $874.9M | $310.8M | $204.3M | $278.2M | $106.0M | $172.2M | | FY2009 | $1.1B | $377.4M | $232.6M | $392.2M | $53.4M | $338.8M | | FY2010 | $1.4B | $555.2M | $381.8M | $545.8M | $96.0M | $449.8M | | FY2011 | $1.8B | $694.8M | $495.1M | $677.6M | $82.9M | $594.7M | | FY2012 | $2.2B | $878.1M | $656.6M | $814.2M | $114.2M | $700.0M | | FY2013 | $2.3B | $852.5M | $671.0M | $880.0M | $104.6M | $775.4M | | FY2014 | $2.1B | $544.8M | $418.8M | $665.1M | $105.6M | $559.5M | | FY2015 | $2.4B | $740.0M | $588.8M | $806.2M | $81.0M | $725.2M | | FY2016 | $2.7B | $949.7M | $738.3M | $1.1B | $53.9M | $1.0B | | FY2017 | $3.1B | $1.1B | $670.9M | $1.1B | $190.7M | $953.2M | | FY2018 | $3.7B | $1.2B | $1.1B | $1.2B | $187.4M | $982.2M | | FY2019 | $4.5B | $1.4B | $1.4B | $1.6B | $425.6M | $1.2B | | FY2020 | $4.4B | $1.0B | $1.1B | $1.5B | $341.5M | $1.1B | | FY2021 | $5.7B | $1.8B | $1.7B | $2.1B | $339.5M | $1.7B | | FY2022 | $6.2B | $1.6B | $1.3B | $1.5B | $532.4M | $958.4M | | FY2023 | $7.1B | $1.8B | $1.8B | $1.8B | $1.1B | $749.6M | | FY2024 | $8.4B | $2.3B | $2.3B | $2.4B | $1.1B | $1.3B | | FY2025 | $10.1B | $2.9B | $2.9B | $3.0B | $539.8M | $2.5B | Latest trend (the newest full year against the year before; a reading, not a forecast): - Revenue: +20.5% (year before +17.2%): accelerating - Operating income: +25.4% (year before +32.9%): slowing - Net income: +23.0% (year before +29.2%): slowing - Free cash flow: +91.0% (year before +73.9%): accelerating ## Operating figures stated in the filing - da Vinci procedures (quarter): 906,000 procedures (as of 2026-09-30). "Approximately 906,000 da Vinci procedures were performed during the three months ended September 30, 2026, a growth of 14% compared to approximately 797,000 da Vinci procedures for the three months ended September 30, 2025." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - da Vinci procedures (quarter): 797,000 procedures (as of 2025-09-30). "Approximately 906,000 da Vinci procedures were performed during the three months ended September 30, 2026, a growth of 14% compared to approximately 797,000 da Vinci procedures for the three months ended September 30, 2025." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - Ion procedures (quarter): 49,700 procedures (as of 2026-09-30). "Approximately 49,700 Ion procedures were performed during the three months ended September 30, 2026, a growth of 31% compared to approximately 37,900 Ion procedures for the three months ended September 30, 2025." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - Ion procedures (quarter): 37,900 procedures (as of 2025-09-30). "Approximately 49,700 Ion procedures were performed during the three months ended September 30, 2026, a growth of 31% compared to approximately 37,900 Ion procedures for the three months ended September 30, 2025." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - da Vinci systems placed (quarter): 546 systems (as of 2026-09-30). "546 da Vinci surgical systems were placed during the three months ended September 30, 2026, an increase of 28% compared to 427 systems during the three months ended September 30, 2025." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - da Vinci systems placed (quarter): 427 systems (as of 2025-09-30). "546 da Vinci surgical systems were placed during the three months ended September 30, 2026, an increase of 28% compared to 427 systems during the three months ended September 30, 2025." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - da Vinci installed base: 12,094 systems (as of 2026-09-30). "As of September 30, 2026, we had a da Vinci surgical system installed base of approximately 12,094 systems, an increase of 12% compared to an installed base of approximately 10,763 systems as of September 30, 2025." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - da Vinci installed base: 10,763 systems (as of 2025-09-30). "As of September 30, 2026, we had a da Vinci surgical system installed base of approximately 12,094 systems, an increase of 12% compared to an installed base of approximately 10,763 systems as of September 30, 2025." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - Ion systems placed (quarter): 56 systems (as of 2026-09-30). "56 Ion systems were placed during the three months ended September 30, 2026, an increase of 12% compared to 50 systems during the three months ended September 30, 2025." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - Ion installed base: 1,152 systems (as of 2026-09-30). "As of September 30, 2026, we had an Ion system installed base of approximately 1,152 systems, an increase of 21% compared to an installed base of approximately 954 systems as of September 30, 2025." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - da Vinci 5 systems placed (quarter): 315 systems (as of 2026-09-30). "During the third quarter of 2026, we placed 315 da Vinci 5 systems, compared to 240 systems in the third quarter of 2025." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - da Vinci system average selling price (quarter): $1.6M (as of 2026-09-30). "The da Vinci surgical system ASP, excluding systems placed under fixed-payment or usage-based operating lease arrangements, Ion systems, and the impact of specified-price trade-in rights, was approximately $1.61 million for the three months ended September 30, 2026, compared to approximately $1.60 million for the three months ended September 30, 2025." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - da Vinci 5 installed base: 2,023 systems (as of 2026-09-30). "As of September 30, 2026, we have an installed base of 2,023 da Vinci 5 surgical systems, of which 177 systems are located in geographic markets outside of the U.S." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) - da Vinci SP installed base: 487 systems (as of 2026-09-30). "We are in the early stages of launching our da Vinci SP surgical system, and we have an installed base of 487 da Vinci SP surgical systems as of September 30, 2026." (Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS) ## Key insights ### A $450M settlement, not the business, cut operating profit The repair settlement equals 14.8% of revenue, more than the 10.9 point fall in operating margin, while gross profit rose 25.4%. Operating income fell 22.0% to $592.6M from $759.7M a year earlier, and sat well below the $971.9M of the quarter before. The cause sits on one line: a $450M charge to settle a hospital class action over the service and repair of da Vinci instruments. The charge was larger than the quarter's research and development spending of $408.3M. Gross profit, by contrast, rose 25.4% to $2.08B on revenue up 21.7%. _(from the filing)_ The filing describes the settlement as a one-time payment with mutually agreed injunctive relief, reached without any admission of liability or wrongdoing. It still needs preliminary and final court approval, and class members may object. The charge sits in this quarter's operating expenses, with a matching liability in accrued liabilities. Net income attributable to Intuitive fell 25.8% to $522.8M. _(from the filing)_ Analysis: the core economics moved the other way. The charge alone is 14.8% of revenue, while operating margin fell 10.9 points to 19.4%, so the margin before the charge widened year on year. The dispute concerns the instrument line, which earns 59.0% of revenue, so the charge is a cost of how that line is serviced, not a sign of weaker demand. _(analysis)_ ### Each operation earns more, just before planned price cuts Instrument revenue rose 18.3% on about 906,000 procedures against 797,000, but the company plans pricing actions it expects to lower revenue per procedure. Instruments and accessories brought in $1.80B, 59.0% of revenue, up 18.3%. Da Vinci procedures rose to about 906,000 from about 797,000, and Ion procedures to about 49,700 from about 37,900. The filing attributes the gap between instrument growth and procedure growth to higher revenue per procedure from the instrument mix of the fifth-generation and single-port systems, plus faster Ion growth. _(from the filing)_ The filing then describes pricing actions from the first half of next year: more uses for a subset of core instruments on the fourth- and fifth-generation platforms, and volume-based pricing, both meant to lower the instrument cost per procedure for hospitals. It also expects price cuts in China from next quarter. Together, the company expects these to reduce instrument revenue per procedure by a few percent once fully in place. _(from the filing)_ Analysis: the mix gain and the price cut pull in opposite directions. The extended-use instruments target benign, lower-acuity cases where hospitals are most cost sensitive, which reads as a way to keep those cases on the robot. For instrument revenue to keep outgrowing procedures, the richer mix from new systems would have to outweigh a lower take per case. _(analysis)_ ### Cash flow outran profit while the settlement stays unpaid Operating cash flow was 2.34 times net income, and the $450M settlement, still accrued, equals 40.5% of the quarter's $1.11B free cash flow. Operating cash flow was $1.22B against $841.0M a year earlier, and free cash flow was $1.11B against $735.6M, or 36.4% of revenue, with capital spending at only 3.7% of revenue. Over the same period net income attributable to Intuitive fell 25.8% to $522.8M. _(from the filing)_ The settlement was charged against earnings but not yet paid. The filing records a matching liability in accrued liabilities and says the rise in those liabilities came mainly from litigation accruals recorded this quarter. _(from the filing)_ Below the operating line, interest and other income fell 20.6% to $75.8M, which the filing attributes to lower cash and investment balances after share repurchases and an acquisition, and to lower interest rates. Diluted shares fell to 351.6M from 361.8M. _(from the filing)_ Analysis: a charge that cuts profit without moving cash widens the gap between the two, so this quarter's cash is flattered in timing, not in kind. Once the court approves the settlement, the payment leaves in a later period, and at $450M it equals 40.5% of this quarter's free cash flow. _(analysis)_ ### Hospitals added robots faster than they added operations Placements rose to 546 from 427 and systems revenue grew 30.3%, while the filing reports procedures per robot up only modestly. Da Vinci placements rose to 546 from 427 a year earlier, and 315 of them, 57.7%, were the fifth-generation system. The installed base reached about 12,094 systems from about 10,763. Systems revenue rose 30.3% to $769.1M, faster than any other line, and its share of revenue rose 1.66 points to 25.2%. The filing names higher operating lease revenue and lease buyouts alongside more placements. _(from the filing)_ The filing ties the placements to demand for more capacity and to customers trading in fourth-generation robots. It reports procedures per system up only modestly, and links slower U.S. procedure growth partly to the end of enhanced ACA premium subsidies. The average selling price was about $1.61M, helped by geographic and product mix and partly offset by higher discounts. _(from the filing)_ Analysis: a placement is the start of an instrument stream, not the stream itself. Robots placed ahead of use earn instrument revenue only as procedures per system rise. If utilization stays flat, today's fast systems growth would show up later as slower instrument growth per robot, and instruments are the line that compounds. _(analysis)_ ### Competitive edge - **Every installed robot keeps selling instruments and service** Instruments at 59.0% and service at 15.8% of revenue come from about 12,094 installed robots, not from new hospital purchases. - **The new generation brings instruments only it can use** The fifth-generation system made 315 of 546 placements, and its force feedback instruments work only on it, enriching the instrument mix. - **Overhead grew far slower than revenue** Selling and administrative costs rose 10.5% against revenue growth of 21.7%, falling 2.1 points to 20.8% of revenue. ### What to watch - **Repaired instruments challenge the line earning 59.0% of revenue** The one updated risk factor covers remanufactured instruments and unauthorized service, and an appeals court revived a servicer's antitrust case this quarter. - **China combines fewer placements with national price limits** The filing reports fewer China placements than expected, domestic rivals, delayed tenders, and a national pricing framework that is prompting instrument price cuts. - **Part of the gross margin gain came from tariff refunds** Gross margin rose to 68.4% from 66.4%, and the filing names refunds of past tariffs first among the causes, with further refunds uncertain. ## Investor view **A $450M antitrust settlement over instrument repair cut operating income in a quarter when gross margin and procedures both rose** ### How it makes money Intuitive sells a surgical robot once and then earns on every operation performed with it. Instruments and accessories brought in $1.80B in the quarter, 59.0% of revenue, against $769.1M from systems and $482.2M from service. The filing explains why the instrument line repeats: the instruments "have limited lives and will either expire or wear out as they are used in surgery, at which point they need to be replaced." _(from the filing)_ The installed base is the engine. About 12,094 da Vinci systems were installed at quarter end, against about 10,763 a year earlier, and customers performed about 906,000 da Vinci procedures in the quarter, up from about 797,000. Each procedure pulls instruments, and each system usually carries a service contract; the filing says these contracts "have generally been renewed at the end of the initial contractual service periods." _(from the filing)_ The robot is often not sold outright. Hospitals can buy, take a sales-type lease, make fixed lease payments, or pay per use, where Intuitive charges for the system and service as procedures are performed. More than half of the quarter's da Vinci placements were operating leases, so part of the systems line arrives over the life of the lease rather than at placement. The filing says it prices these leases at a modest premium to a purchase. _(from the filing)_ Ion, a robotic catheter for lung biopsies, runs the same model on a smaller base: about 1,152 installed systems and about 49,700 procedures in the quarter, against about 37,900 a year earlier. The filing says the vast majority of Ion biopsies are performed in the U.S., where it estimates Ion has passed the halfway point of lung biopsy procedures, and customers are shifting from adding capacity to using existing systems more. _(from the filing)_ ### What shifted Revenue rose 21.7% to $3.05B while cost of revenue rose 14.4%, so gross margin widened 2.0 points to 68.4%. The filing attributes the product margin gain mainly to refunds of tariffs the Supreme Court ruled unlawful and to fixed overhead spread over more volume. The refunds relate to tariffs paid in earlier periods, and the filing says the amount and timing of any further refunds remain uncertain. _(from the filing)_ Systems grew fastest. Systems revenue rose 30.3% against 18.3% for instruments and accessories, so systems gained 1.66 points to 25.2% of revenue and instruments slipped 1.67 points to 59.0%. Da Vinci placements rose to 546 from 427, including 315 of the fifth-generation system, and the average selling price was about $1.61M, which the filing credits to geographic and product mix, partly offset by higher discounts. _(from the filing)_ Instrument revenue grew faster than procedure volume: up 18.3%, against about 906,000 procedures versus about 797,000 a year earlier. The filing says revenue per procedure rose on the instrument mix of the fifth-generation and single-port systems, with Ion procedure growth adding to it. Revenue from the U.S. was $2.06B, 67.7% of the total; outside the U.S. it was $985.7M, the faster-growing part. _(from the filing)_ The operating line fell for one reason. A $450M charge to settle a hospital class action over instrument repair equals 14.8% of revenue, more than the 10.9 point fall in operating margin to 19.4%. Operating income was $592.6M, down 22.0% from a year earlier and below the $971.9M of the quarter before. Net income attributable to Intuitive fell 25.8% to $522.8M. _(from the filing)_ Below the operating line, interest and other income fell 20.6% to $75.8M as cash went to share buybacks and an acquisition, and tax expense of $144.0M took 21.5% of pretax income, against 17.1% a year earlier. Diluted shares fell to 351.6M from 361.8M, so diluted earnings per share of $1.49, against $1.95, fell less than net income. _(from the filing)_ ### Risks in the filing The one risk factor this report updates is about third parties. They offer remanufactured or unauthorized instruments, including instruments remanufactured for use "beyond their labeled useful life," and service the robots without authorization. The company says this could reduce revenue, raise patient safety risk and bring negative publicity, and that laws regulating how third parties interact with its systems could also hurt its business. _(from the filing)_ Litigation runs on several fronts. The $450M class action settlement still needs preliminary and final court approval and could face objections from class members. An appeals court reversed Intuitive's trial win against an instrument servicer, and the company says it cannot estimate any loss from that case. Product liability suits continue, and the company says a loss beyond what it has accrued is reasonably possible but cannot be estimated. _(from the filing)_ Trade and supply are named directly. Most instruments are made in Mexico, most endoscopes in Germany, and some materials come from China, all exposed to changing tariffs. The filing flags possible Chinese export limits on rare earth elements and magnets, longer lead times and price swings for memory chips and circuit boards, and reliance on sole- and single-source suppliers. _(from the filing)_ Demand depends on hospitals and payers. The filing names hospital budgets squeezed by inflation and interest costs, delayed capital spending, limits on what hospitals in China may charge for robotic surgery, government quotas and tenders there, procedure reimbursement decisions in Japan, and the expiry of enhanced ACA premium subsidies in the U.S. _(from the filing)_ Two of these risks are already in the numbers. Litigation shows as the settlement charge, larger than the quarter's research and development spending. Trade shows in cost of revenue, where refunds of past tariffs this quarter outweighed new tariff costs. The pricing and remanufacturing risks are not visible yet: instrument revenue still grew faster than procedures. _(analysis)_ ## Founder view: mechanisms ### Each robot sells instruments for years The robot is the entry point; the money is in what each operation consumes. Instruments are engineered with a set number of uses, so every procedure on an installed system creates demand that grows as surgeons do more cases. The system sale decides who supplies the hospital for years, and a service contract sits alongside it. Revenue then tracks surgical activity rather than the hospital's capital budget. _(analysis)_ ### Leasing lowers the hospital's entry price Intuitive uses its own balance sheet to let hospitals take a robot without paying for it up front: fixed lease payments, or a charge per procedure. It gives up revenue at placement in exchange for faster adoption, a larger base, and pricing set at a modest premium to a purchase. Per-use pricing also matches the hospital's cost to the reimbursement it earns from each case. _(analysis)_ ### Build capacity in lumps, then grow into it Intuitive spends heavily on factories, imaging and field capacity in waves, then lets revenue catch up. During the build, capital spending and depreciation weigh on free cash flow. Once volume fills the capacity, fixed overhead spreads over more units, and selling and administrative costs grow slower than revenue. _(analysis)_ ### New generations reset the base and the mix Each new robot generation brings features that need new instruments. The fifth-generation system adds force feedback instruments that work only on it, and the single-port system has its own instrument set. Upgrading customers trade in older systems, and each upgraded robot then draws a richer instrument mix per procedure. Research spending funds the next reset. _(analysis)_ ## Member research Signed-in members read, on the page: what Intuitive Surgical's numbers depend on from here, and the playbook behind each mechanism (what needs scale, what transfers, how to test it, the metric that would show it). ## Sources - Intuitive Surgical 10-Q for the period to 2026-09-30: https://www.sec.gov/Archives/edgar/data/1035267/000103526726000071/ (2026-10-21) Methodology business-lens-1.0 · schema 1.2.0 · run business-lens-2026-11-02 · as of 2026-11-02