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Call sheet · Q1'26

Intuitive Surgical (ISRG)

Q1'26 earnings call · held 2026-04-21 · compared with the Q4'25 call · management-credibility review
11/12
Disclosure score
2 medium, 4 low flags
Financial quality
Bottom line
The sleeper story is dV5 achieving Xi margin parity ahead of schedule - this manufacturing milestone will drive significant gross margin expansion as mix shifts. While 17% procedure growth looks solid, the geographic divergence is worsening with China and Japan both below corporate average growth due to structural, not cyclical factors. Force Feedback supply constraints are the binding constraint limiting adoption of their most differentiated technology. Management's candid assessment: 'We continue to believe we are in the early stages of this journey' despite 3M procedures annually. My view changes if China win rates stabilize above 50% or Force Feedback attachment rates exceed 30% by year-end.

The 30-second version

  • SLEEPER STORY: dV5 margin profile achieved Xi parity a full quarter earlier than expected
  • 17% procedure growth masks geographical divergence that's getting worse
  • Force Feedback launch being throttled by supply constraints they're not quantifying

What changed this quarter

MetricQ4'25Q1'26Change
Revenue$2.87B (+19% YoY)$2.77B (+23% YoY)+400 bps acceleration despite $100M sequential decline
Procedure Growth18% total procedures17% total procedures100 bps deceleration
dV Procedure Growth17%16%100 bps deceleration
Operating Margin37%39%+200 bps expansion
Gross Margin67.8%67.8%Flat despite mix headwinds
System Placements532 dV systems431 dV systems100 system decline, -19%
I&A Revenue Growth17%23%+600 bps acceleration
I&A RPP~$1,850~$1,880+$30 per procedure
U.S. Utilization Growth3%4%+100 bps acceleration
Cash Position$9.0B$8.0B$1B decline from buybacks

Accountability tracked

7 new promises made4 narrative shifts flagged6 prior promises scored
Inside the full report
The complete write-up covers the full promise ledger with kept/missed calls, disclosure-quality scoring, the metrics-vanished check, verification items, and the questions to ask next quarter.
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Scores, kept-promise rates, and flags on this site reflect the author's opinion, applying a stated methodology to statements management made on public earnings calls. Informational and educational purposes only - not investment advice, a recommendation, or an offer to buy or sell any security. Sources believed reliable but not guaranteed; the author may hold positions in the securities discussed.

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