Eighteen Hundred Dollars a ProcedureNarrow moat

Intuitive Surgical (ISRG) — moat facet

The toll per case, protected not by an argument but by the absence of anyone else who can make the instruments.

Divide instruments and accessories revenue of $6,018.9 million by roughly 3.30 million da Vinci and Ion procedures and you get about $1,825 per procedure1. That is the toll, and its size relative to the alternatives is the whole commercial argument.

The toll, per operation$1,825instruments andaccessories per procedure3.30Mda Vinci and Ionprocedures in 2025$6,018.9Mthe line it adds up toDerived: $6,018.9M divided by 3,153,000 da Vinci plus 144,100 Ion procedures.
Not protected by an argument about value. Protected because nobody else can make the instrument that fits.

It is not small. A conventional laparoscopic case uses instruments costing a fraction of that, which is why Intuitive's marketing has always been about total cost of care rather than device cost — the argument that shorter stays, fewer complications and faster recovery pay for the difference. The company frames it as the fourth aim of its "Quintuple Aim": to "help lower the total cost of care per patient episode when compared with existing treatment alternatives, providing a return on investment for hospitals and healthcare systems and value for payers"2.

Whether that argument holds varies sharply by procedure, and Intuitive says so. On cholecystectomy — one of the largest contributors to recent United States growth — the 10-K notes that "given the already very high level of laparoscopic techniques used in cholecystectomy procedures, it remains unclear to what extent robotic-assisted surgery using da Vinci may continue to be adopted"3. That is unusually frank about the ceiling in a category the company is currently growing into.

What protects the price is not the argument but the absence of an alternative supplier. Instruments are wristed, chip-controlled, procedure-specific and made only by Intuitive; a hospital that wants a da Vinci case has exactly one place to buy the instruments for it.

Watch instruments and accessories revenue growth against procedure growth: 19% against 18% in 20254, 18% against 15% in the June 2026 quarter. Roughly matched is healthy. Consumables growing materially slower than procedures means either mix is moving to cheaper cases or the toll per case is falling.

Moat trajectory: Narrowing

Instruments and accessories revenue per procedure has been drifting down for several years on mix, and the Extended Use Program will push it further. Intuitive's guidance is for the absolute number to grow on volume, not for the rate to hold.

The number that tests this moat
Moat Explorer calc
Instrument and accessory revenue per procedure
About $1,825 across 3,297,100 procedures

This is the toll, and it is the number the Extended Use Program lowers on purpose. Intuitive guides the absolute line to grow on volume; it has not said the rate will hold.

How it's calculated: $6,018.9M of instruments and accessories revenue divided by 3,153,000 da Vinci plus 144,100 Ion procedures, all as reported in the fiscal 2025 Form 10-K.
Source: Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 ↗
⚠ Threats to the moat
⚠ THREAT 01
The Cost Argument Weakens Where Laparoscopy Is Already Good
Intuitive concedes the point on cholecystectomy in its own filing, and cholecystectomy is where the growth is.
References
  1. Moat Explorer calcDivide instruments and accessories revenue of $6,018.9 million by roughly 3.30 million da Vinci and Ion procedures and you get about $1,825 per procedure.
    Moat Explorer calculation - arithmetic on figures reported in Intuitive's Form 10-K and Form 10-Q: instruments and accessories of $6,018.9M over 3,153,000 da Vinci plus 144,100 Ion procedures ($1,825 a procedure), service revenue of $1,572.1M over the installed base (about $134,000 a system), variable lease revenue of $531M over 1,810 usage-based systems (about $293,000), procedures over the average installed base (about 300 a system), each revenue line as a share of the $10,064.7M total, and US general surgery as a share of US procedures — FY2025 · publ. September 2026 · source ↗
  2. ReportedThe company frames it as the fourth aim of its "Quintuple Aim": to "help lower the total cost of care per patient episode when compared with existing treatment alternatives, providing a return on investment for hospitals and healthcare...
    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. ReportedOn cholecystectomy — one of the largest contributors to recent United States growth — the 10-K notes that "given the already very high level of laparoscopic techniques used in cholecystectomy procedures, it remains unclear to what extent...
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 7 MD&A, results of operations (instruments and accessories $6,018.9M, systems $2,473.7M, service $1,572.1M, recurring revenue $8,465.3M, gross margin 66.0%, operating income $2,945.5M, average selling price, lease revenue recognition, and the discussion of procedure categories) — FY2025 · publ. February 3, 2026 · source ↗
  4. ReportedWatch instruments and accessories revenue growth against procedure growth: 19% against 18% in 2025, 18% against 15% in the June 2026 quarter.
    Intuitive Surgical Form 10-Q, quarter ended June 30, 2026 (installed base 11,710 da Vinci systems up 12%, 468 placements of which 246 were da Vinci 5, the operating-lease share, the distributor acquisitions in Italy, Spain and Portugal, cash and investments of $8.63 billion, and the factors expected to affect future placements) — Q2 2026 and the first six months · publ. July 21, 2026 · source ↗
Sources
Generated September 23, 2026