Intuitive Surgical (ISRG)
Market Price (4/29/2026): $464.5 | Market Cap: $164.9 BilSector: Health Care | Industry: Health Care Equipment
Intuitive Surgical (ISRG)
Market Price (4/29/2026): $464.5Market Cap: $164.9 BilSector: Health CareIndustry: Health Care Equipment
Investment Highlights Why It Matters Detailed financial logic regarding cash flow yields vs trend-riding momentum.
Attractive operating marginsOp Mgn LTMOperating Margin = Operating Income / Revenue Reflects profitability before taxes and before impact of capital structure (interest payments). is 30% Attractive cash flow generationCFO/Rev LTMCash Flow from Operations / Revenue (Sales), Last Twelve Months (LTM) is 32%, FCF/Rev LTMFree Cash Flow / Revenue (Sales), Last Twelve Months (LTM) is 27%, CFO LTM is 3.4 Bil, FCF LTM is 2.8 Bil Stock buyback supportStock Buyback 3Y Total is 3.5 Bil Low stock price volatilityVol 12M is 29% Megatrend and thematic driversMegatrends include Automation & Robotics, Precision Medicine, Digital Health & Telemedicine, and Aging Population & Chronic Disease. Show more. | Weak multi-year price returns2Y Excs Rtn is -17%, 3Y Excs Rtn is -17% | Expensive valuation multiplesP/EBITPrice/EBIT or Price/(Operating Income) ratio is 51x, P/CFOPrice/(Cash Flow from Operations). CFO is cash before capital expenditures. is 49x, P/EPrice/Earnings or Price/(Net Income) is 56x Yield minus risk free rate is negativeERPEquity Risk Premium (ERP) = Total Yield - Risk Free Rate, Reflects the premium above risk free assets offered by the investment. is -2.5% Key risksISRG key risks include [1] intensifying competition from rival robotic surgery platforms threatening its dominant market share and [2] sales vulnerability to constrained hospital budgets given the high capital cost of its da Vinci systems. |
| Attractive operating marginsOp Mgn LTMOperating Margin = Operating Income / Revenue Reflects profitability before taxes and before impact of capital structure (interest payments). is 30% |
| Attractive cash flow generationCFO/Rev LTMCash Flow from Operations / Revenue (Sales), Last Twelve Months (LTM) is 32%, FCF/Rev LTMFree Cash Flow / Revenue (Sales), Last Twelve Months (LTM) is 27%, CFO LTM is 3.4 Bil, FCF LTM is 2.8 Bil |
| Stock buyback supportStock Buyback 3Y Total is 3.5 Bil |
| Low stock price volatilityVol 12M is 29% |
| Megatrend and thematic driversMegatrends include Automation & Robotics, Precision Medicine, Digital Health & Telemedicine, and Aging Population & Chronic Disease. Show more. |
| Weak multi-year price returns2Y Excs Rtn is -17%, 3Y Excs Rtn is -17% |
| Expensive valuation multiplesP/EBITPrice/EBIT or Price/(Operating Income) ratio is 51x, P/CFOPrice/(Cash Flow from Operations). CFO is cash before capital expenditures. is 49x, P/EPrice/Earnings or Price/(Net Income) is 56x |
| Yield minus risk free rate is negativeERPEquity Risk Premium (ERP) = Total Yield - Risk Free Rate, Reflects the premium above risk free assets offered by the investment. is -2.5% |
| Key risksISRG key risks include [1] intensifying competition from rival robotic surgery platforms threatening its dominant market share and [2] sales vulnerability to constrained hospital budgets given the high capital cost of its da Vinci systems. |
Qualitative Assessment
AI Analysis | Feedback
1. 2026 Procedure Growth Guidance Below Analyst Expectations.
Intuitive Surgical's initial guidance for 13% to 15% growth in worldwide da Vinci procedures for 2026 fell short of the 15.2% growth anticipated by analysts, marking the slowest projected rate since 2020. This outlook, announced with preliminary Q4 2025 results on January 14, 2026, and reiterated in the full Q4 earnings report on January 22, 2026, tempered investor expectations for future growth.
2. Regulatory Concerns and FDA Action.
The U.S. Food and Drug Administration (FDA) issued an early alert on March 18, 2026, highlighting issues related to certain curved-tip staplers, including reports of injuries and one death, which led to a recall recommendation. This regulatory scrutiny and the associated safety risks generated investor caution and contributed to downward pressure on the stock.
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Stock Movement Drivers
Fundamental Drivers
The -17.6% change in ISRG stock from 12/31/2025 to 4/28/2026 was primarily driven by a -24.4% change in the company's P/E Multiple.| (LTM values as of) | 12312025 | 4282026 | Change |
|---|---|---|---|
| Stock Price ($) | 566.36 | 466.64 | -17.6% |
| Change Contribution By: | |||
| Total Revenues ($ Mil) | 9,612 | 10,582 | 10.1% |
| Net Income Margin (%) | 28.6% | 28.2% | -1.5% |
| P/E Multiple | 73.5 | 55.6 | -24.4% |
| Shares Outstanding (Mil) | 357 | 355 | 0.5% |
| Cumulative Contribution | -17.6% |
Market Drivers
12/31/2025 to 4/28/2026| Return | Correlation | |
|---|---|---|
| ISRG | -17.6% | |
| Market (SPY) | 5.2% | 59.3% |
| Sector (XLV) | -6.7% | 44.9% |
Fundamental Drivers
The 4.3% change in ISRG stock from 9/30/2025 to 4/28/2026 was primarily driven by a 15.7% change in the company's Total Revenues ($ Mil).| (LTM values as of) | 9302025 | 4282026 | Change |
|---|---|---|---|
| Stock Price ($) | 447.23 | 466.64 | 4.3% |
| Change Contribution By: | |||
| Total Revenues ($ Mil) | 9,145 | 10,582 | 15.7% |
| Net Income Margin (%) | 28.5% | 28.2% | -1.3% |
| P/E Multiple | 61.5 | 55.6 | -9.6% |
| Shares Outstanding (Mil) | 358 | 355 | 1.0% |
| Cumulative Contribution | 4.3% |
Market Drivers
9/30/2025 to 4/28/2026| Return | Correlation | |
|---|---|---|
| ISRG | 4.3% | |
| Market (SPY) | 8.0% | 44.3% |
| Sector (XLV) | 4.2% | 37.0% |
Fundamental Drivers
The -5.8% change in ISRG stock from 3/31/2025 to 4/28/2026 was primarily driven by a -26.9% change in the company's P/E Multiple.| (LTM values as of) | 3312025 | 4282026 | Change |
|---|---|---|---|
| Stock Price ($) | 495.27 | 466.64 | -5.8% |
| Change Contribution By: | |||
| Total Revenues ($ Mil) | 8,352 | 10,582 | 26.7% |
| Net Income Margin (%) | 27.8% | 28.2% | 1.2% |
| P/E Multiple | 76.0 | 55.6 | -26.9% |
| Shares Outstanding (Mil) | 356 | 355 | 0.4% |
| Cumulative Contribution | -5.8% |
Market Drivers
3/31/2025 to 4/28/2026| Return | Correlation | |
|---|---|---|
| ISRG | -5.8% | |
| Market (SPY) | 29.3% | 63.0% |
| Sector (XLV) | 0.3% | 49.8% |
Fundamental Drivers
The 82.7% change in ISRG stock from 3/31/2023 to 4/28/2026 was primarily driven by a 70.1% change in the company's Total Revenues ($ Mil).| (LTM values as of) | 3312023 | 4282026 | Change |
|---|---|---|---|
| Stock Price ($) | 255.47 | 466.64 | 82.7% |
| Change Contribution By: | |||
| Total Revenues ($ Mil) | 6,222 | 10,582 | 70.1% |
| Net Income Margin (%) | 21.3% | 28.2% | 32.5% |
| P/E Multiple | 67.9 | 55.6 | -18.1% |
| Shares Outstanding (Mil) | 351 | 355 | -1.0% |
| Cumulative Contribution | 82.7% |
Market Drivers
3/31/2023 to 4/28/2026| Return | Correlation | |
|---|---|---|
| ISRG | 82.7% | |
| Market (SPY) | 81.5% | 58.1% |
| Sector (XLV) | 16.8% | 44.3% |
Price Returns Compared
| 2021 | 2022 | 2023 | 2024 | 2025 | 2026 | Total [1] | |
|---|---|---|---|---|---|---|---|
| Returns | |||||||
| ISRG Return | 32% | -26% | 27% | 55% | 9% | -17% | 73% |
| Peers Return | 1% | -3% | -1% | 12% | 12% | 0% | 21% |
| S&P 500 Return | 27% | -19% | 24% | 23% | 16% | 5% | 91% |
Monthly Win Rates [3] | |||||||
| ISRG Win Rate | 58% | 42% | 50% | 67% | 50% | 25% | |
| Peers Win Rate | 52% | 55% | 48% | 50% | 52% | 55% | |
| S&P 500 Win Rate | 75% | 42% | 67% | 75% | 67% | 50% | |
Max Drawdowns [4] | |||||||
| ISRG Max Drawdown | -16% | -49% | -15% | -5% | -18% | -20% | |
| Peers Max Drawdown | -11% | -21% | -17% | -7% | -12% | -6% | |
| S&P 500 Max Drawdown | -1% | -25% | -1% | -2% | -15% | -7% | |
[1] Cumulative total returns since the beginning of 2021
[2] Peers: MDT, JNJ, SYK, ZBH, GMED. See ISRG Returns vs. Peers.
[3] Win Rate = % of calendar months in which monthly returns were positive
[4] Max drawdown represents maximum peak-to-trough decline within a year
[5] 2026 data is for the year up to 4/28/2026 (YTD)
How Low Can It Go
| Event | ISRG | S&P 500 |
|---|---|---|
| 2022 Inflation Shock | ||
| % Loss | -49.9% | -25.4% |
| % Gain to Breakeven | 99.6% | 34.1% |
| Time to Breakeven | 461 days | 464 days |
| 2020 Covid Pandemic | ||
| % Loss | -40.5% | -33.9% |
| % Gain to Breakeven | 68.1% | 51.3% |
| Time to Breakeven | 116 days | 148 days |
| 2018 Correction | ||
| % Loss | -24.3% | -19.8% |
| % Gain to Breakeven | 32.2% | 24.7% |
| Time to Breakeven | 87 days | 120 days |
| 2008 Global Financial Crisis | ||
| % Loss | -75.9% | -56.8% |
| % Gain to Breakeven | 314.7% | 131.3% |
| Time to Breakeven | 364 days | 1,480 days |
Compare to MDT, JNJ, SYK, ZBH, GMED
In The Past
Intuitive Surgical's stock fell -49.9% during the 2022 Inflation Shock from a high on 11/8/2021. A -49.9% loss requires a 99.6% gain to breakeven.
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About Intuitive Surgical (ISRG)
AI Analysis | Feedback
Here are 1-3 brief analogies for Intuitive Surgical (ISRG):
The Apple of robotic surgery.
The Tesla of surgical technology.
AI Analysis | Feedback
- da Vinci Surgical System: A robotic surgical system designed for complex, minimally invasive surgical procedures.
- Ion endoluminal system: A diagnostic system enabling minimally invasive biopsies in the lung.
- Surgical Instruments & Accessories: A suite of stapling, energy, and core instrumentation used with its surgical systems.
- Customer Support & Maintenance: Comprehensive services including installation, repair, maintenance, and ongoing support for its medical systems.
- Learning Pathways: Educational programs and training designed to support healthcare providers in using its technology effectively.
- Integrated Digital Capabilities: Digital offerings providing connected insights to optimize hospital program performance.
AI Analysis | Feedback
Intuitive Surgical (ISRG) sells primarily to other companies and institutions within the healthcare sector. Its major customers can be categorized as:
- Healthcare Systems and Hospitals
- Ambulatory Surgery Centers
- Other Healthcare Providers (e.g., specialized clinics)
These customers acquire the da Vinci Surgical System, Ion endoluminal system, associated instrumentation, and ongoing services to deliver minimally invasive care to their patients.
AI Analysis | Feedback
nullAI Analysis | Feedback
David J. Rosa, Chief Executive Officer and Member of the Board of Directors
David J. Rosa joined Intuitive Surgical in March 1996 as its ninth employee. He has held various leadership positions within the company, including in engineering, clinical and product development, marketing, regulatory and quality affairs, and the commercial organization. Rosa is credited with founding Intuitive’s first clinical engineering and endoluminal groups, which led to the development and commercialization of the da Vinci SP and Ion robotic systems. Prior to becoming CEO, effective July 1, 2025, he served as President, Chief Strategy and Growth Officer, Executive Vice President and Chief Business Officer, Executive Vice President and Chief Commercial Officer, Executive Vice President and Chief Scientific Officer, Senior Vice President, Scientific Affairs, and Senior Vice President, Emerging Procedures and Technology. Before joining Intuitive, he contributed to the development of trans-esophageal transducers for Acuson Corporation. He serves on the board of directors' compensation committee for Kardium, a private company, and as chairman of the board of the joint venture between Intuitive Surgical and Fosun Pharma. Rosa holds multiple patents.
Jamie E. Samath, Executive Vice President, Chief Financial Officer and Enterprise Technology Leader
Jamie E. Samath joined Intuitive Surgical in April 2013 as Vice President and Corporate Controller, and he became the Chief Financial Officer on January 1, 2022. Prior to his tenure at Intuitive, Samath held senior finance roles at Atmel Corporation, where he served as Vice President Finance and Corporate Controller, and Principal Accounting Officer from October 2011 to April 2013. Before Atmel, he worked at National Semiconductor Corporation from 1991 to 2011 in various finance capacities, including Principal Accounting Officer and Corporate Controller from 2005 to 2011. National Semiconductor was acquired by Texas Instruments in 2011. Samath also serves as an independent director at KLA Corp.
Gary S. Guthart, PhD, Executive Chair of the Board of Directors
Gary S. Guthart joined Intuitive Surgical in 1996 as part of the first engineering team. He served as the company's Chief Executive Officer from 2010 until July 1, 2025, when he transitioned to Executive Chair of the Board of Directors. His previous roles at Intuitive include Vice President of Engineering, Senior Vice President of Product Operations, and President and Chief Operating Officer. Before joining Intuitive, Guthart was a key member of the team developing foundational technology for computer-enhanced surgery at SRI International. He also gained scientific experience at NASA. Guthart is also on the Board of Directors for Illumina.
Brian E. Miller, PhD, Executive Vice President & Chief Digital Officer
Brian E. Miller, PhD, leads Intuitive Surgical's digital and artificial intelligence (AI) strategy. He joined Intuitive in 2003 as part of the merger with Computer Motion, where he developed software for early robotic surgical systems like AESOP and ZEUS. During his time at Intuitive, Miller has been instrumental in key innovations in robotic surgical systems and surgeon simulation capabilities, holding patents for technologies such as tele-robotic motion control, 3D telestration, adaptive video streaming, video content searching, and virtual reality simulation for surgeon training. His career at Intuitive has included roles such as director of engineering, simulation & networking; director of advanced development; vice president, system engineering; and senior vice president and general manager of Systems, Imaging, and Digital.
Myriam J. Curet, MD, FACS, Executive Vice President and Chief Medical Officer
Myriam J. Curet, MD, FACS, joined Intuitive Surgical as Chief Medical Advisor in 2005 or 2006, initially on a part-time basis. She was promoted to Senior Vice President & CMO in 2014 and Executive Vice President & CMO in 2017. In her role, she has been responsible for developing clinical evidence, physician education, and managing reimbursement and regulatory activities. Dr. Curet earned her M.D. from Harvard Medical School and completed her general surgery residency at the University of Chicago. She served with the Indian Health Service for four years and completed a surgical endoscopy fellowship at the University of New Mexico, where she was a faculty member for six years. In 2000, she joined the Stanford University Department of Surgery and has served as a Clinical Professor of Surgery at Stanford University School of Medicine for over 20 years, with a part-time clinical appointment at the Palo Alto Veteran’s Administration Medical Center. She also sits on the boards of Stereotaxis and Inspire Medical Systems.
AI Analysis | Feedback
Intuitive Surgical (ISRG) faces several key risks to its business, primarily stemming from intensifying competition, ongoing regulatory and legal challenges, and macroeconomic factors impacting healthcare spending. * Intensifying Competition: Intuitive Surgical, while maintaining a dominant position, is experiencing increased competition in the surgical robotics market. Major medical device companies like Medtronic with its Hugo system and Johnson & Johnson with Ottava are entering the field, leading to potential market share erosion, pricing pressures, and slower placements of its da Vinci systems, particularly in cost-sensitive and emerging markets. Specialized competitors, such as Stryker's Mako system in orthopedics, also pose a threat in specific surgical segments. * Regulatory and Legal Risks: The company faces ongoing scrutiny and potential liabilities related to product safety, regulatory compliance, and allegations of inadequate surgeon training. There have been numerous lawsuits concerning complications, injuries, and even deaths associated with the da Vinci surgical system. Intuitive Surgical has also received FDA warning letters in the past regarding its recall and design processes. Additionally, cybersecurity threats and breaches impacting IT systems introduce further regulatory and operational risks. * Macroeconomic and Healthcare Policy/Spending Risks: External factors such as changes in healthcare policies, uncertainty in hospital capital expenditure budgets, and international trade tariffs can significantly impact Intuitive Surgical's financial performance. Tariffs, in particular, have been explicitly cited as headwinds contributing to pressure on gross margins. Broad shifts in healthcare spending and reimbursement models can also challenge the company's traditional capital sales approach for its systems.AI Analysis | Feedback
The clear emerging threats to Intuitive Surgical (ISRG) are:
- The active global launch and increasing market presence of Medtronic's Hugo RAS System, which directly competes with Intuitive's da Vinci Surgical System in multi-specialty robot-assisted surgery.
- The growing adoption and international expansion of CMR Surgical's Versius System, another direct competitor offering a modular robot-assisted surgical platform.
- The established market presence of Johnson & Johnson's Monarch Platform, which directly competes with Intuitive's Ion endoluminal system for robotic-assisted bronchoscopy in lung diagnostics.
- The resulting increase in competitive intensity, which is expected to lead to greater pricing pressure on Intuitive Surgical's systems, instruments, accessories, and services.
AI Analysis | Feedback
Intuitive Surgical, Inc. (ISRG) operates in several significant addressable markets for its main products, the da Vinci Surgical System and the Ion endoluminal system.
da Vinci Surgical System (Robotic-Assisted Surgery)
The da Vinci Surgical System addresses the global robotic-assisted surgery market and the broader minimally invasive surgery market. Several estimates highlight the substantial size and growth of this market:
- The global robotic surgery market is projected to increase from USD 8.28 billion in 2025 to USD 16.40 billion by 2032, at a compound annual growth rate (CAGR) of 10.25%.
- Another projection estimates the global robotic surgery market size to be USD 13.79 billion in 2025, growing to approximately USD 63.73 billion by 2035, with a CAGR of 16.54%.
- The global surgical robots market was estimated at USD 4.31 billion in 2024 and is projected to reach USD 9.60 billion by 2033, growing at a CAGR of 9.3%.
- North America held the largest share of the global surgical robots market, accounting for 50.90% in 2024.
- Intuitive Surgical estimates its total addressable market (TAM) for soft tissue surgical procedures at 6 million, with a long-term global TAM of 20 million procedures. The company's management currently defines the "line of sight" TAM for da Vinci at 9 million operations.
- A recent FDA clearance for the da Vinci 5 in certain cardiac procedures, including mitral valve repair, is estimated to expand the total addressable market by approximately 160,000 procedures annually.
- The broader global minimally invasive surgery market, which includes robotic-assisted surgery, was valued at USD 486.72 billion in 2024 and is projected to reach USD 946.50 billion by 2033. Within this, robotic-assisted surgery held a leading market share in 2024, specifically capturing 33.57% of the method segment.
Ion Endoluminal System (Minimally Invasive Biopsies in the Lung)
The Ion endoluminal system targets the global lung biopsy systems market, which is characterized by various projections:
- The global lung biopsy systems market size was over USD 5.03 billion in 2025 and is projected to reach USD 20.89 billion by 2035, growing at a CAGR of approximately 15.3%. In 2026, the market size is evaluated at USD 5.72 billion.
- Another estimate indicates the lung biopsy systems market is projected to grow from USD 3.0 billion in 2025 to USD 7.4 billion by 2035, with a CAGR of 9.4%.
- The global lung biopsy systems market is expected to grow from USD 3.3 billion in 2026 to USD 5.4 billion by 2033, with a CAGR of 5.9%.
- North America is expected to hold the largest revenue share of 42% in the lung biopsy systems market by 2035.
- Analysts estimate that the Ion platform has penetrated 4.7% of the bronchoscopy market.
AI Analysis | Feedback
Intuitive Surgical (ISRG) is anticipated to drive future revenue growth over the next 2-3 years through several key strategies and market trends: * Accelerating Adoption and Placement of the da Vinci 5 Platform: The company's next-generation da Vinci 5 system, featuring advanced capabilities like force feedback technology, is a significant driver. Strong placements and positive feedback in late 2025 are expected to continue ramping up in 2026, indicating an ongoing upgrade cycle within hospitals seeking enhanced surgical precision and patient outcomes. * Growth in Procedure Volumes and Expansion into New Clinical Areas: Overall procedure growth across da Vinci, Ion, and SP platforms remains the foundation of Intuitive Surgical's revenue model. Specifically, new FDA clearances, such as for the da Vinci 5 in certain cardiac procedures (e.g., mitral valve repair), are expected to significantly expand the total addressable market by approximately 160,000 procedures annually. Continued growth in general surgery and thoracic procedures also contributes to this driver. * International Market Expansion: Intuitive Surgical is strategically focused on expanding its global footprint. International da Vinci procedures demonstrated strong growth in 2025 and are projected to continue their upward trajectory, particularly in regions like Europe and Asia. Strategic acquisitions of distribution businesses in countries such as Italy, Spain, and Portugal, coupled with potential reimbursement for additional robotic procedures in Japan by mid-2026, are set to enhance the company's competitiveness and drive sustained international growth. * Increased Utilization of the Ion Endoluminal System: The Ion endoluminal system, which facilitates minimally invasive lung biopsies, is a key growth area outside of traditional surgery. Despite some fluctuations in system placements, Ion procedure volumes have shown robust growth (e.g., 44-51% in 2025), indicating increasing utilization of the installed base and extending Intuitive's commercial offerings into diagnostic procedures. * Recurring Revenue from Instruments, Accessories, and Services: A substantial portion of Intuitive Surgical's revenue comes from the sale of instruments, accessories, and services, which scales directly with the utilization of its installed systems. As the installed base of da Vinci and Ion systems continues to grow and procedure volumes increase, the recurring revenue stream is expected to expand, providing a stable and predictable component of overall revenue growth. Additionally, the expansion into U.S. ambulatory surgery centers (ASCs) and the offering of refurbished da Vinci XiR systems present a long-term opportunity to broaden access to da Vinci surgery, further supporting recurring revenue growth.AI Analysis | Feedback
Share Repurchases
- On May 1, 2025, Intuitive Surgical's Board authorized an increase in its stock repurchase program to $4 billion.
- The company repurchased 4 million shares for $1.92 billion in Q3 2025.
- Intuitive Surgical executed $3.023 billion in share repurchases during fiscal years 2022 and 2023.
Share Issuance
- Intuitive Surgical's shares outstanding increased by 0.19% to 0.363 billion in 2025 from 2024, and by 1.29% to 0.362 billion in 2024 from 2023.
- In May 2025, shareholders approved an amendment to the 2010 Incentive Award Plan, increasing the number of shares reserved for issuance by 5 million, from 115.35 million to 120.35 million.
- As of June 30, 2025, approximately 22.1 million shares were reserved for future issuance under the company's stock plans.
Outbound Investments
- On March 2, 2026, Intuitive Surgical completed the acquisition of the da Vinci and Ion distribution business operated by ab medica, Abex, Excelencia Robótica, and their affiliates, expanding its direct operations in Europe.
Capital Expenditures
- Intuitive Surgical's capital expenditures averaged $717.4 million annually for fiscal years ending December 2021 to 2025.
- Capital expenditures reached a peak of $1.111 billion in December 2024.
- The company's capital expenditures rose to $1.11 billion in FY2024, primarily focused on expanding manufacturing capacity and developing new technologies.
Latest Trefis Analyses
Trade Ideas
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| Date | Ticker | Company | Category | Trade Strategy | 6M Fwd Rtn | 12M Fwd Rtn | 12M Max DD |
|---|---|---|---|---|---|---|---|
| 03312026 | PGNY | Progyny | Dip Buy | DB | FCF Yield | Low D/EDip Buy with High Free Cash Flow YieldBuying dips for companies with significant free cash flow yield (FCF / Market Cap) and reasonable debt / market cap | 0.0% | 0.0% | 0.0% |
| 03272026 | CNC | Centene | Dip Buy | DB | FCF Yield | Low D/EDip Buy with High Free Cash Flow YieldBuying dips for companies with significant free cash flow yield (FCF / Market Cap) and reasonable debt / market cap | 2.3% | 2.3% | -0.6% |
| 03272026 | OSCR | Oscar Health | Dip Buy | DB | FCF Yield | Low D/EDip Buy with High Free Cash Flow YieldBuying dips for companies with significant free cash flow yield (FCF / Market Cap) and reasonable debt / market cap | 3.0% | 3.0% | -2.6% |
| 03202026 | WAT | Waters | Monopoly | MY | Getting CheaperMonopoly-Like with P/S DeclineLarge cap with monopoly-like margins or cash flow generation and getting cheaper based on P/S multiple | -0.4% | -0.4% | -3.3% |
| 03202026 | GILD | Gilead Sciences | Quality | Q | Momentum | UpsideQuality Stocks with Momentum and UpsideBuying quality stocks with strong momentum but still having room to run | 1.6% | 1.6% | -2.2% |
| 03062026 | ISRG | Intuitive Surgical | Monopoly | MY | Getting CheaperMonopoly-Like with P/S DeclineLarge cap with monopoly-like margins or cash flow generation and getting cheaper based on P/S multiple | -6.0% | -6.0% | -7.7% |
| 09052025 | ISRG | Intuitive Surgical | Monopoly | MY | Getting CheaperMonopoly-Like with P/S DeclineLarge cap with monopoly-like margins or cash flow generation and getting cheaper based on P/S multiple | 5.0% | -1.3% | -8.0% |
| 10312022 | ISRG | Intuitive Surgical | Monopoly | MY | Getting CheaperMonopoly-Like with P/S DeclineLarge cap with monopoly-like margins or cash flow generation and getting cheaper based on P/S multiple | 22.9% | 6.4% | -8.8% |
| 04302022 | ISRG | Intuitive Surgical | Monopoly | MY | Getting CheaperMonopoly-Like with P/S DeclineLarge cap with monopoly-like margins or cash flow generation and getting cheaper based on P/S multiple | 2.0% | 25.9% | -23.5% |
| 03312020 | ISRG | Intuitive Surgical | Monopoly | MY | Getting CheaperMonopoly-Like with P/S DeclineLarge cap with monopoly-like margins or cash flow generation and getting cheaper based on P/S multiple | 39.9% | 49.2% | -7.5% |
| 08312019 | ISRG | Intuitive Surgical | Monopoly | MY | Getting CheaperMonopoly-Like with P/S DeclineLarge cap with monopoly-like margins or cash flow generation and getting cheaper based on P/S multiple | 4.4% | 42.2% | -28.1% |
Research & Analysis
Invest in Strategies
Wealth Management
Peer Comparisons
| Peers to compare with: |
Financials
| Median | |
|---|---|
| Name | |
| Mkt Price | 159.26 |
| Mkt Cap | 114.0 |
| Rev LTM | 17,849 |
| Op Inc LTM | 4,141 |
| FCF LTM | 3,559 |
| FCF 3Y Avg | 2,680 |
| CFO LTM | 4,202 |
| CFO 3Y Avg | 3,466 |
Growth & Margins
| Median | |
|---|---|
| Name | |
| Rev Chg LTM | 9.5% |
| Rev Chg 3Y Avg | 8.3% |
| Rev Chg Q | 11.2% |
| QoQ Delta Rev Chg LTM | 2.9% |
| Op Inc Chg LTM | 15.9% |
| Op Inc Chg 3Y Avg | 11.7% |
| Op Mgn LTM | 19.4% |
| Op Mgn 3Y Avg | 19.3% |
| QoQ Delta Op Mgn LTM | 0.1% |
| CFO/Rev LTM | 22.2% |
| CFO/Rev 3Y Avg | 20.7% |
| FCF/Rev LTM | 17.7% |
| FCF/Rev 3Y Avg | 16.0% |
Valuation
| Median | |
|---|---|
| Name | |
| Mkt Cap | 114.0 |
| P/S | 4.5 |
| P/Op Inc | 22.0 |
| P/EBIT | 21.9 |
| P/E | 24.6 |
| P/CFO | 20.1 |
| Total Yield | 4.9% |
| Dividend Yield | 1.1% |
| FCF Yield 3Y Avg | 3.9% |
| D/E | 0.1 |
| Net D/E | 0.1 |
Returns
| Median | |
|---|---|
| Name | |
| 1M Rtn | -3.6% |
| 3M Rtn | -6.3% |
| 6M Rtn | -12.4% |
| 12M Rtn | -4.3% |
| 3Y Rtn | 31.3% |
| 1M Excs Rtn | -15.6% |
| 3M Excs Rtn | -8.6% |
| 6M Excs Rtn | -18.0% |
| 12M Excs Rtn | -33.7% |
| 3Y Excs Rtn | -41.6% |
Comparison Analyses
Price Behavior
| Market Price | $466.64 | |
| Market Cap ($ Bil) | 165.7 | |
| First Trading Date | 06/16/2000 | |
| Distance from 52W High | -21.3% | |
| 50 Days | 200 Days | |
| DMA Price | $477.47 | $501.02 |
| DMA Trend | down | down |
| Distance from DMA | -2.3% | -6.9% |
| 3M | 1YR | |
| Volatility | 29.1% | 29.5% |
| Downside Capture | 1.04 | 0.61 |
| Upside Capture | 90.34 | 65.11 |
| Correlation (SPY) | 62.2% | 42.7% |
| 1M | 2M | 3M | 6M | 1Y | 3Y | |
|---|---|---|---|---|---|---|
| Beta | 0.70 | 1.11 | 1.05 | 1.02 | 1.13 | 1.17 |
| Up Beta | 2.37 | 1.24 | 1.47 | 1.35 | 1.41 | 1.31 |
| Down Beta | 0.52 | 1.00 | 0.56 | 0.85 | 1.05 | 1.15 |
| Up Capture | 40% | 116% | 82% | 120% | 69% | 138% |
| Bmk +ve Days | 7 | 16 | 27 | 65 | 139 | 424 |
| Stock +ve Days | 9 | 20 | 25 | 57 | 122 | 401 |
| Down Capture | 85% | 111% | 144% | 93% | 100% | 102% |
| Bmk -ve Days | 12 | 23 | 33 | 58 | 110 | 323 |
| Stock -ve Days | 13 | 22 | 38 | 69 | 129 | 349 |
[1] Upside and downside betas calculated using positive and negative benchmark daily returns respectively
Based On 1-Year Data
| Annualized Return | Annualized Volatility | Sharpe Ratio | Correlation with ISRG | |
|---|---|---|---|---|
| ISRG | -8.4% | 29.5% | -0.30 | - |
| Sector ETF (XLV) | 6.1% | 15.8% | 0.18 | 36.1% |
| Equity (SPY) | 31.5% | 12.5% | 1.92 | 42.8% |
| Gold (GLD) | 38.6% | 27.2% | 1.18 | 3.1% |
| Commodities (DBC) | 45.9% | 18.0% | 1.95 | -6.6% |
| Real Estate (VNQ) | 14.4% | 13.4% | 0.75 | 23.6% |
| Bitcoin (BTCUSD) | -19.0% | 42.1% | -0.39 | 19.3% |
Smart multi-asset allocation framework can stack odds in your favor. Learn How
Based On 5-Year Data
| Annualized Return | Annualized Volatility | Sharpe Ratio | Correlation with ISRG | |
|---|---|---|---|---|
| ISRG | 9.7% | 32.9% | 0.34 | - |
| Sector ETF (XLV) | 4.8% | 14.6% | 0.15 | 55.3% |
| Equity (SPY) | 12.9% | 17.1% | 0.59 | 65.9% |
| Gold (GLD) | 20.2% | 17.8% | 0.92 | 9.6% |
| Commodities (DBC) | 14.8% | 19.1% | 0.63 | 8.6% |
| Real Estate (VNQ) | 3.4% | 18.8% | 0.09 | 47.1% |
| Bitcoin (BTCUSD) | 7.3% | 56.2% | 0.35 | 26.3% |
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Based On 10-Year Data
| Annualized Return | Annualized Volatility | Sharpe Ratio | Correlation with ISRG | |
|---|---|---|---|---|
| ISRG | 21.2% | 32.2% | 0.67 | - |
| Sector ETF (XLV) | 9.2% | 16.5% | 0.45 | 62.9% |
| Equity (SPY) | 14.9% | 17.9% | 0.71 | 69.1% |
| Gold (GLD) | 13.4% | 15.9% | 0.70 | 8.5% |
| Commodities (DBC) | 9.9% | 17.7% | 0.46 | 18.8% |
| Real Estate (VNQ) | 5.4% | 20.7% | 0.23 | 49.9% |
| Bitcoin (BTCUSD) | 67.8% | 66.9% | 1.07 | 16.7% |
Smart multi-asset allocation framework can stack odds in your favor. Learn How
Returns Analyses
Earnings Returns History
Expand for More| Forward Returns | |||
|---|---|---|---|
| Earnings Date | 1D Returns | 5D Returns | 21D Returns |
| 4/21/2026 | 7.2% | 3.4% | |
| 1/14/2026 | -2.7% | -6.8% | -14.8% |
| 10/21/2025 | 13.9% | 17.9% | 22.0% |
| 7/22/2025 | -1.8% | -2.8% | -6.0% |
| 4/22/2025 | 1.9% | 7.6% | 14.3% |
| 1/15/2025 | 7.7% | 13.3% | 9.7% |
| 10/17/2024 | 10.0% | 8.0% | 11.4% |
| 7/18/2024 | 9.3% | 5.0% | 15.1% |
| ... | |||
| SUMMARY STATS | |||
| # Positive | 15 | 17 | 18 |
| # Negative | 10 | 8 | 6 |
| Median Positive | 7.7% | 5.0% | 9.6% |
| Median Negative | -2.5% | -6.2% | -12.8% |
| Max Positive | 13.9% | 22.8% | 35.8% |
| Max Negative | -14.3% | -17.4% | -25.6% |
SEC Filings
Expand for More| Report Date | Filing Date | Filing |
|---|---|---|
| 03/31/2026 | 04/22/2026 | 10-Q |
| 12/31/2025 | 02/03/2026 | 10-K |
| 09/30/2025 | 10/22/2025 | 10-Q |
| 06/30/2025 | 07/23/2025 | 10-Q |
| 03/31/2025 | 04/23/2025 | 10-Q |
| 12/31/2024 | 01/31/2025 | 10-K |
| 09/30/2024 | 10/18/2024 | 10-Q |
| 06/30/2024 | 07/19/2024 | 10-Q |
| 03/31/2024 | 04/19/2024 | 10-Q |
| 12/31/2023 | 01/31/2024 | 10-K |
| 09/30/2023 | 10/20/2023 | 10-Q |
| 06/30/2023 | 07/24/2023 | 10-Q |
| 03/31/2023 | 04/20/2023 | 10-Q |
| 12/31/2022 | 02/10/2023 | 10-K |
| 09/30/2022 | 10/21/2022 | 10-Q |
| 06/30/2022 | 07/22/2022 | 10-Q |
Recent Forward Guidance [BETA]
Latest: Q1 2026 Earnings Reported 4/21/2026
| Forward Guidance | Guidance Change | ||||||
|---|---|---|---|---|---|---|---|
| Metric | Low | Mid | High | % Chg | % Delta | Change | Prior |
| 2026 Worldwide da Vinci procedure growth | 13.5% | 14.5% | 15.5% | 3.6% | 0.5% | Raised | Guidance: 14.0% for 2026 |
| 2026 Non-GAAP gross profit margin | 67.5% | 68.0% | 68.5% | 0.7% | 0.5% | Raised | Guidance: 67.5% for 2026 |
| 2026 Non-GAAP operating expense growth | 11.0% | 12.5% | 14.0% | -3.8% | -0.5% | Lowered | Guidance: 13.0% for 2026 |
Prior: Q4 2025 Earnings Reported 1/22/2026
| Forward Guidance | Guidance Change | ||||||
|---|---|---|---|---|---|---|---|
| Metric | Low | Mid | High | % Chg | % Delta | Change | Prior |
| 2026 Worldwide da Vinci procedure growth | 13.0% | 14.0% | 15.0% | -22.2% | -4.0% | Lowered | Actual: 18.0% for 2025 |
| 2026 Non-GAAP gross profit margin | 67.0% | 67.5% | 68.0% | -0.2% | -0.1% | Lowered | Actual: 67.6% for 2025 |
| 2026 Non-GAAP operating expense growth | 11.0% | 13.0% | 15.0% | 8.3% | 1.0% | Higher New | Actual: 12.0% for 2025 |
Insider Activity
Expand for More| # | Owner | Title | Holding | Action | Filing Date | Price | Shares | Transacted Value | Value of Held Shares | Form |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Brosius, Mark | SVP & Chief Mfg and Supply Cha | Direct | Sell | 3102026 | 485.01 | 645 | 312,831 | 782,321 | Form |
| 2 | Brosius, Mark | SVP & Chief Mfg and Supply Cha | Direct | Sell | 3102026 | 490.19 | 648 | 317,643 | 1,106,849 | Form |
| 3 | Brosius, Mark | SVP & Chief Mfg and Supply Cha | Direct | Sell | 3052026 | 495.20 | 648 | 320,890 | 1,439,051 | Form |
| 4 | Brosius, Mark | SVP & Chief Mfg and Supply Cha | Direct | Sell | 3052026 | 498.68 | 2,362 | 1,177,883 | 1,772,310 | Form |
| 5 | Brosius, Mark | SVP & Chief Mfg and Supply Cha | Direct | Sell | 3052026 | 488.10 | 648 | 316,289 | 2,887,600 | Form |
ISRG Trade Sentinel
ACCUMULATE (Score 7-8)
CONVICTION RATIONALE
The score of 7 (Accumulate) is driven by the company's elite quality, widening competitive moat, and a strong, visible product cycle with the da Vinci 5. The business fundamentals are superb, justifying the premium valuation. While competitive and macro risks are present, they are not yet impacting the company's powerful ecosystem. The risk/reward is moderately favorable, making it a core holding to accumulate on any pullbacks.
STOCK ARCHETYPE
Type B: 'Quality Compounder / Stalwart'Intuitive Surgical exhibits the core traits of a 'Stalwart': dominant market leadership, a strong competitive moat based on switching costs, consistent mid-teens growth, high and stable margins, and a powerful recurring revenue model (76% of total). The investment thesis hinges on earnings consistency and capital efficiency, not hyper-growth, making it a classic Quality Compounder.
INVESTMENT THESIS
The primary driver for upside is the ongoing product cycle fueled by the new, higher-priced da Vinci 5 system, which is accelerating system placement growth and lifting average selling prices (ASPs). This is complemented by the rapid, high-growth adoption of the Ion diagnostic platform for lung biopsies, which expands the company's addressable market and diversifies its recurring revenue streams.
- The da Vinci 5 system accounted for over half of new placements in Q1 2026, indicating strong demand and a successful launch.
- System ASP for purchased da Vinci systems increased to $1.7M in Q1 2026 from $1.6M in the prior year.
- Ion procedure volume grew 39% YoY in Q1 2026, demonstrating successful expansion into a new market segment.
- Overall da Vinci procedure growth remains robust at 16% YoY, feeding the core recurring revenue engine.
PRIMARY RISK
The primary risk is a dual threat of increased competition from well-capitalized MedTech peers (Medtronic, Johnson & Johnson) and heightened pricing pressure from hospital CFOs facing tight capital budgets. Competitors are launching 'good enough', potentially lower-cost systems, while hospitals are increasingly focused on Total Cost of Ownership (TCO), which could erode ISRG's market share and pricing power over time.
- Medtronic's Hugo RAS system received its first major US clearance in late 2025 and J&J submitted its Ottava system to the FDA in early 2026.
- Hospital operating margins dropped to a 12-month low in January 2026, increasing pressure on capital expenditure budgets.
- Management cited 'domestic competition and policy-driven pricing pressure' in China as a key challenge on the Q1 2026 earnings call.
| KPI | Threshold | Rationale |
|---|---|---|
| Worldwide da Vinci Procedure Growth YoY | Maintain >14% | This is the core driver of high-margin recurring instrument revenue. A drop below the guided range would signal a material slowdown in demand or competitive intrusion. |
| da Vinci 5 as % of Total System Placements | >55% | This leading indicator signals the success of the new product cycle, which drives higher ASPs, expands the technology moat, and secures the next wave of recurring revenue. |
| Instruments & Accessories Revenue Growth vs. Procedure Growth | Revenue growth must meet or exceed procedure growth | This measures pricing power. If revenue growth lags procedure growth, it indicates pricing pressure from competitors or hospital systems, a key tenet of the bear case. |
Product Cycle Strength vs. Competitive & Macro Pressure
BULL VIEW
The da Vinci 5 is driving an upgrade cycle, increasing ASPs and widening the moat. Ion growth diversifies revenue, sustaining mid-teens growth despite competition.
CORE TENSION
Can the da Vinci 5 upgrade cycle and Ion platform expansion overcome the dual threats of new, lower-cost competitors (MDT, JNJ) and hospital capital budget constraints?
PREVAILING SENTIMENT
Q1 2026 results show the Bull case is currently winning: da Vinci 5 accounted for over half of new placements, system ASP increased, and procedure growth was a robust 16% YoY.
BEAR VIEW
Competitors will gain share in routine procedures, forcing price concessions. Hospital capex freezes will delay system placements, slowing future recurring revenue growth.
| Timeline | Event & Metric To Watch |
|---|---|
Anytime (Review Ongoing) | FDA Decision on J&J's Ottava System Watch: Binary outcome: FDA De Novo classification granted or denied. A grant would officially shift the competitive landscape from a duopoly threat to a three-player market. |
Late July 2026 | Q2 2026 Earnings Call Watch: Watch for da Vinci procedure growth vs. 13.5-15.5% guide and da Vinci 5 as % of placements vs. Q1's >50% baseline. Any deceleration signals competitive/macro impact. |
Late October 2026 | Q3 2026 Earnings Call Watch: Focus on management's initial FY2027 procedure growth outlook and commentary on hospital capital spending trends heading into budget season. |
Next 6 Months (Ongoing) | China VBP Policy Announcement Watch: Headline: Formal inclusion of robotic surgery instruments into a national Volume-Based Procurement (VBP) tender, which would signal significant pricing pressure. |
| Date | Event | Stock Impact |
|---|---|---|
Oct 21, 2025 | Q3 2025 Earnings Release Details: Reported Q3 worldwide procedure growth of approximately 20% YoY, significantly beating analyst expectations and signaling strong underlying demand. | Surged +13.9% $462.74 -> $527.03 |
Jan 07, 2026 | Competitor Milestone: J&J Submits Ottava to FDA Details: Johnson & Johnson announced it submitted its Ottava robotic surgical system to the FDA for review, marking a major step for a key competitor entering the market. | Changed Little (-0.1%) $592.85 -> $592.27 |
Jan 22, 2026 | Q4 2025 Earnings Release Details: Reported strong Q4 results with da Vinci procedures growing 17% YoY and 532 systems placed. The results showed continued robust growth heading into the new year. | Flat (-0.3%) $525.81 -> $523.99 |
Feb 17, 2026 | Competitor Milestone: Medtronic's First U.S. Hugo Procedure Details: Medtronic announced the first U.S. commercial procedure with its competing Hugo RAS system, a notable step in the increasingly competitive landscape. Market reaction was minimal. | Muted (-0.2%) $500.76 -> $499.53 |
Mar 13, 2026 | FDA Safety Communication on Stapler Recall Details: The FDA highlighted a company-initiated recall for a da Vinci stapler reload associated with one death. Despite the negative news, the stock saw a positive move. | Rose significantly by 2.4% $472.16 -> $483.46 |
Apr 21, 2026 | Q1 2026 Earnings Release Details: Reported 16% YoY da Vinci procedure growth and strong da Vinci 5 adoption. Despite beating estimates, the stock fell amid concerns of slight growth deceleration from prior quarters. | Fell notably by -3.1% $465.60 -> $451.29 |
Position Sizing
4% - 6%
NORMAL
The stock has moderate, compressing volatility. While business quality is elite with high visibility, the Neutral sentiment reflects a premium valuation colliding with tangible competitive risks, warranting a Normal allocation.
Diversification Alternatives
SYK
INDUSTRYStryker offers exposure to MedTech capital cycles but is more diversified across orthopedics (Mako robot) and MedSurg, with less concentration risk to a single platform.
ALGN
INDUSTRYAlign offers a different high-margin, tech-driven business model in healthcare, focused on consumer-driven orthodontics, avoiding hospital capex and reimbursement risks.
Intuitive Surgical is evolving from a single-product surgical robot company into a multi-platform, data-enabled ecosystem for minimally invasive care, driven by the new da Vinci 5 platform and rapid growth in its Ion diagnostic system.
Filter all news through the lens of procedure volume growth and the adoption rate of new platforms (da Vinci 5, Ion), as these are the primary drivers of the high-margin recurring revenue model.
Worldwide procedure growth exceeding 15% YoY; da Vinci 5 system placements accelerating as a percentage of total placements; Ion procedure growth >30% YoY; expansion of cleared indications for new systems.
Sustained deceleration in procedure growth below management guidance (13.5%-15.5%); significant system placement push-outs due to hospital capital budget constraints; market share gains by named competitors (Medtronic's Hugo, J&J's Ottava) in key surgical areas; pricing pressure in major markets like China.
Single-quarter fluctuations in bariatric surgery volumes due to GLP-1 drugs (hedged by growth in other areas like general surgery); minor changes in the mix of leased vs. purchased systems (customer preference, not a demand signal); isolated competitive announcements without evidence of significant market traction.
Repricing Catalyst
The successful launch and rapid adoption of the da Vinci 5 system, which accounted for over half of new placements in Q1 2026, is driving a new upgrade cycle and increasing system ASPs. This, combined with >35% growth in the newer Ion platform, expands the company's addressable market from surgery into diagnostics, sustaining a long-term, high-margin recurring revenue growth trajectory.
Surgical Instruments & Accessories
$6.8B TTM (61% of Total) · 68% MarginWhat It Is
Proprietary disposable instruments (e.g., EndoWrist) and accessories for da Vinci and Ion systems, used during surgical and diagnostic procedures.
Who Pays & How
Hospitals pay per-procedure for instruments. They are locked into the da Vinci ecosystem due to high surgeon training costs (thousands of hours), significant capital investment in the systems, and the establishment of dedicated robotic surgery programs.
Competition
Robotic Systems (Capital)
$2.6B TTM (24% of Total) · 68% MarginWhat It Is
da Vinci surgical systems (da Vinci 5, Xi, SP) and Ion endoluminal systems for robotic-assisted bronchoscopy.
Who Pays & How
Hospitals and surgical centers pay via direct purchase or operating lease to acquire the core robotic platform, enabling them to offer minimally invasive procedures, attract top surgical talent, and improve patient outcomes.
Competition
System Services
$1.7B TTM (15% of Total) · 68% MarginWhat It Is
Service and maintenance contracts for the installed base of da Vinci and Ion systems.
Who Pays & How
Hospitals with installed systems pay recurring service fees to ensure system uptime, maintenance, and support, which is critical for operating room scheduling and patient care.
Competition
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