Three Million Procedures a YearNarrow moat

Intuitive Surgical (ISRG) — moat facet

Every recurring dollar is a function of this number, and it is now growing more slowly for reasons that have nothing to do with robots.

Approximately 3,153,000 da Vinci procedures were performed in 2025, up 18% on 2,683,000 in 2024 and 2,286,000 in 20231. Ion added approximately 144,100, up 51%.

2025 procedures by region and category (thousands)1,250US generalsurgery468US gynecology201US urology507OUS urology334OUS generalsurgery181OUS gynaecology1,141,000 of the 3,153,000 total were performed outside the United States.
The mix abroad is the mirror of the mix at home: international adoption is still in the urology phase America has left behind.

The composition tells the strategic story better than the total. In the United States, general surgery was 1,250,000 procedures against gynecology's 468,000 and urology's 201,000. Outside the United States the order is different — urology 507,000, general surgery 334,000, gynecology 181,000 — because adoption began with prostatectomy and is following the same path a decade behind.

General surgery is where the growth is and where the argument is hardest. United States general surgery grew 18% in 2025, driven by cholecystectomy, hernia repair, appendectomy and colorectal procedures2. Those are high-volume, largely benign operations that laparoscopy already does well, which is why Intuitive itself writes that the extent of further robotic adoption in cholecystectomy "remains unclear."

The geography is shifting too. Procedures outside the United States grew 23% in 2025 against 15% domestically, with particular strength in South Korea and India3, and OUS was 1,141,000 of the 3,153,000 total. Intuitive says it expects OUS procedures and revenue to become a greater share of the business over time.

Count total da Vinci procedures, not revenue. Every recurring dollar in this company is a function of that number, and management's guidance for 2026 — 13.5% to 15.5% growth, nearer the midpoint4 — is the most important forecast it publishes.

Moat trajectory: Narrowing

3,153,000 procedures, up 18% for the full year — but U.S. growth fell from 14% to 12% inside a single quarter on an insurance coverage change, and 2026 guidance is 13.5% to 15.5%. The number is still growing and the rate of growth is not.

The number that tests this moat
Reported
U.S. da Vinci procedure growth
12% in the June 2026 quarter, from 14% in the March quarter

Two percentage points, one quarter, and 39% off the share price. The softening was concentrated in deferrable categories, which is the tell that this is coverage rather than competition.

Source: Intuitive Surgical Q2 2026 earnings call, July 16, 2026 ↗
⚠ Threats to the moat
⚠ THREAT 01
The Growth Is Concentrating Where the Case Is Weakest
The fastest-growing categories have the smallest clinical edge, the same instrument cost, and the highest sensitivity to insurance.
References
  1. ReportedApproximately 3,153,000 da Vinci procedures were performed in 2025, up 18% on 2,683,000 in 2024 and 2,286,000 in 2023.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 7 MD&A, business and operating highlights (3,153,000 da Vinci procedures up 18%, 1,721 placements, an installed base of 11,106, utilisation up about 3%, 870 da Vinci 5 placements, Ion procedures and placements, procedures by region and category, and revenue denominated in foreign currencies) — FY2025 · publ. February 3, 2026 · source ↗
  2. ReportedUnited States general surgery grew 18% in 2025, driven by cholecystectomy, hernia repair, appendectomy and colorectal procedures.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 1 Business (the da Vinci and Ion platforms, instruments with a use count enforced in the instrument itself, training pathways and SimNow, enabling technologies, manufacturing sites, employees by function, and the seasonality of benign procedures) — FY2025 · publ. February 3, 2026 · source ↗
  3. ReportedProcedures outside the United States grew 23% in 2025 against 15% domestically, with particular strength in South Korea and India, and OUS was 1,141,000 of the 3,153,000 total.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 7 MD&A, business and operating highlights (3,153,000 da Vinci procedures up 18%, 1,721 placements, an installed base of 11,106, utilisation up about 3%, 870 da Vinci 5 placements, Ion procedures and placements, procedures by region and category, and revenue denominated in foreign currencies) — FY2025 · publ. February 3, 2026 · source ↗
  4. ReportedEvery recurring dollar in this company is a function of that number, and management's guidance for 2026 — 13.5% to 15.5% growth, nearer the midpoint — is the most important forecast it publishes.
    Intuitive Surgical Q2 2026 earnings call - the Extended Use Program raising permitted uses on selected EndoWrist instruments from the first half of 2027, US da Vinci procedure growth of 12% against 14% attributed to the expiry of enhanced Affordable Care Act premium subsidies, full-year guidance of 13.5% to 15.5% nearer the midpoint, gross-margin guidance raised to 68-69%, and Japanese placements of 25 against 15 — Q2 2026 · publ. July 16, 2026 · source ↗
Sources
Generated September 23, 2026