Intuitive Surgical Inc. (ISRG-Q)

EPS of $1.81 beat estimates of $1.72; revenue of $2.25B beat estimates of $2.18B. EBITDA of $771M missed estimates of $864M. It was a good quarter, with revenue up 19% and earnings up 21%. The company did lower guidance a bit, but this was due to tariffs, which could be delayed, or reprieved, and should not be permanent (maybe) and should not be a big surprise.  Intuitive Surgical's cut to gross-margin guidance due to tariffs may overshadow the 1Q beat and higher procedure-volume outlook. Management expects a 170-bp hit in 2025, split roughly between China and imports from other countries, particularly Mexico, with the impact expanding throughout the year. Guidance for procedure growth rose to 15-17% for the year from 13-16%, driven by strong utilization in Europe. US bariatric-procedure volume continues to face pressure from the use of GLP-1 weight-loss drugs, declining mid-single-digits in the quarter. Further pressure could come from the emergence of oral versions of the drugs. Intuitive placed 367 systems in 1Q, slightly below expectations, yet roughly in line with 4Q-1Q seasonality seen last year. Of those placed, 147 were da Vinci 5s. Very good growth overall is expected over the next two years, despite these issues. The company now has $9B cash and generating $2.4B cash annually. The long term thesis and moat here have not really changed, and any good news on tariffs would be positive for the stock, which has actually held up OK in this market considering its high valuation (up 26% in a year, down 8% YTD). The conference call did not add much in the way of detail, but other than tariffs the tone was positive. We would be OK buying this still, in the context of overall market volatility and with a 3+ year holding period.
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Primarily US-based. Main customers are hospitals, so there can be funding concerns. Long-term, very good secular growth in robotic surgery. Tends to trade at very high multiple. When rates are high, as they have been, hospitals pause on the more costly budget items.

In the healthcare sector, but not really a defensive the way pharma is.

The market didn't like their last quarter and this sold off, but is still trading at a high 58x PE. Wait until tomorrow after the close when they report.

We would look at P/E (61X, vs 3-year 72X), P/CF (72 vs 70X) and earnings growth (18% vs 30%). Overall growth rates have slowed as the company gets bigger, but free cash flow has surged anf the company has $4B net cash. The stock is down 6% YTD. We think $475 would look good. 
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It is the front runner in robotic surgeries and its new launching is doing well. The market should double in the next period of time and it is a great long term investment. They have premiums on their option strategies.

Is up 55% over the year, though -4% today after earnings and 12% so far this year. They pre-announced strong topline numbers of 25% revenue growth as global Da Vinci procedures grew 18%--and they sell consumables for the Da Vinci system, so more revenues to come. They guided 13-16% DV growth this year--strong numbers. And yet they disappointed investors last night, because of the full-year forecast of 67-68% gross margin, down from last year's 69.1% and below estimates. Also, they signaled rising costs over last year, which the reaction is overblown and misguided. After all, demand for the system is durable and every US company is facing headwinds from the strong USD and potential impact from new Trump tariffs (Mexico makes some of their products). Also, their higher expenses are building the company, which is good.

It is one of our favourite growth companies and we will have a hard time specifically being negative here. Of course, in a TFSA one cannot utilize losses, so that's an added risk to an 'expensive' stock. There are some small competitrors, and new US policies towards cutting healthcare costs could impact sentiment towards the stock. The stock can decline. It went down 21% in 2022, 16% in 2013, 20% in 2010, 52% in 2008, 18% in 2006 and 39% in 2002. Most of these declines were economically-related. Of course, over that same period the stock rose more than 26,000%, with triple-digit gains in 2004 and 2005. 
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EPS of $1.84 beat estimates of $1.64; revenue of $2.04B beat estimates of $2.00B. Intuitive Surgical's 3Q earnings show strong momentum in the adoption of its latest surgical robotic technology and margin expansion, with further potential upside as utilization expands. The quarter's 18% procedure growth beat estimates for 17.1%, with gains in the installed base and system utilization easily compensating for bariatric procedure declines. The 379 da Vinci placements in 3Q, including 110 of the new Da Vinci 5 robots, surpassed estimates. This trend makes Intuitive's procedural volume growth guidance of 16-17% look conservative as it only raised the low end of the range. Operating margin of 37% exceeded analyst estimates of 34.8%, with management citing operating leverage as it updated its 2024 operating expense growth outlook to 10-12% year-over-year, from 10-13% previously. Things continue to look very good here. 
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The beat top and bottom, crushing earnings today--and they can still run higher when they use AI with their Da Vinci surgical products.

Considering it is nearly a global monopoly, we would be comfortable at 5%. 
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The GLP-1 weight loss companies are really in the sweet spot. For example for LLY, a very large holding for him, the opportunity for them is a very large marketplace. Getting approval for a broader range of uses. 

He also owns ISRG, which will help with the cost of healthcare, a very big growth opportunity. He owns MCK too.

Those 3 names together make up a 5% weight for him, which is underweight the market.

Last week, it reported a great quarter, its shares reversing a sell off earlier this month. Revenues are 14% YOY, non-GAAP EPS 25% YOY and beat revenues. They raised their guidance and cut their operating expenses outlook. Surgeries have been increasing along with use of ISRG's surgical equipment, such as up 22% outside the US and 14% in the US. Caveat: it trades at 70x PE, but it's always been high, in early 2021 at 85x forward and averages 58x PE. They've beaten the last 6 quarters. He believes in it. Buy on pullback, typically in August -September.

Last year, non-emergency medical procedures finally caught up after Covid and are now at higher than average levels. ISRG makes surgical robots for minimally invasive procedures. It's rallied 52% since October's lows. They recently pre-announced a blow-out quarter.

Their story is about the hardware, but going forward it will be about improving software. It's outperformed healthcare peers. It's a core holding for those who believe in applying tech to healthcare.