Intuitive Surgical, Inc.

Intuitive Surgical, Inc. designs, manufactures, and services the da Vinci surgical systems and the Ion endoluminal system — the leading platforms for robotic-assisted minimally invasive surgery — and reported $10.06 billion of revenue in fiscal 2025, with roughly 11,710 da Vinci systems installed worldwide at mid-2026.

This is a story about an extraordinary annuity meeting the arithmetic of its own success. Intuitive owns the soft-tissue surgical robotics market it largely created, and the economics are the envy of medical technology: a system sale is the beginning of a decade-long stream of disposable instruments and service contracts, the recurring lines now produce three-quarters of revenue, and the whole thing converts to cash at a rate most industrials never see. The question the file turns on is not whether Intuitive is a good business — it plainly is — but whether the growth that the stock has always been priced for survives the next five years. U.S. da Vinci procedure growth has slid from 16% to 12% across four quarters, management's full-year guide points to the low-to-mid teens, and the company is doing something it has rarely had to do: defending an annuity against its own customers' cost pressure and against competitors that finally look real.

So the report is organized around a single tension. On one side sits the upgrade cycle to da Vinci 5, a second platform in Ion, a still-enormous pool of unoperated patients, and net cash of $8.63 billion to fund the whole thing without borrowing. On the other sits a decelerating U.S. core, a China business that has collapsed to almost nothing, tariffs that cost roughly 100 basis points of margin, a chronic decline in bariatric procedures, and an Extended Use Program that will deliberately lower the revenue Intuitive earns from each instrument. Whether the first list outruns the second is the entire investment case.