Surgery: Sutures, Staplers and ScaleNarrow moat

Johnson & Johnson (JNJ) — moat facet

J&J's surgery business sold $10.0 billion in 2023 and $10.1 billion in 2025; scale holds the position but does not grow it.

Surgery is the largest part of J&J's device business, and the least exciting. The franchise sold $10,137 million in 2025, up 3.0%1: advanced surgery, which includes endocutters, energy devices and biosurgery, $4,577 million, and general surgery, largely wound closure, $5,560 million2. In 2023 the same franchise sold $10,037 million3, so two years added 1.0% in total4.

Surgery sales, 2023 and 2025 ($M)4,671Advanced 20234,577Advanced 20255,366General 20235,560General 2025J&J Form 10-K FY2025
Wound closure grew, advanced surgery slipped.

The moat is breadth and presence in every operating room. Hospitals buy sutures, staplers and haemostats in volume under contracts, and a supplier that can fill the whole list has an advantage. General surgery growth in 2025 was driven by technology penetration and upgrades within the wound closure portfolio5.

That advantage does not produce pricing power. Advanced surgery growth was partially offset by China volume-based procurement across all platforms and competitive pressures in energy and endocutters6. J&J started a restructuring of the Surgery franchise in 2025 to exit certain non-strategic product lines, with $114 million of charges in the first half of 20267.

In the second quarter of 2026 Surgery grew 3.9% to $2,653 million, general surgery 5.2% and advanced 2.2%8. The new Ottava robot, covered on the Competitors page, is J&J's attempt to put a growth engine into this franchise.

The robot is the attempt to change that. Ottava received FDA de novo authorisation in July 2026 for multiple general-surgery procedures9, and J&J's group chair of medtech surgery said that what defined the last 25 years of surgery will not define the next 2510. A surgery franchise tied to a robot would sell instruments with each procedure, turning a commodity supply relationship into a platform relationship. That is several years away.

The restructuring is meant to make the franchise smaller and better. J&J said the Surgery program would simplify and focus operations by exiting certain non-strategic product lines and optimizing select sites, and expects it to be substantially completed by the end of fiscal 202611.

Surgery is a narrow moat of scale in a business that grows at the pace of surgery volumes. Its operational growth decides it: below 2% for a year would mean the restructuring and China tendering are eroding the scale advantage faster than new products renew it.

Moat trajectory: Holding steady

Growth of 3.0% in 2025 and 3.9% in the latest quarter.

The number that tests this moat
Reported
Surgery franchise sales growth, latest quarter
+3.9%, $2,653M (Q2 2026)

The largest MedTech franchise's pace; below 2% for a year would show tendering eroding scale.

Source: Johnson & Johnson Q2 2026 financial schedules ↗
⚠ Threats to the moat
⚠ THREAT 01
Chinese Tenders Reach Every Platform
Chinese tenders turned J&J's advanced-surgery sales outside America into a price auction.
References
  1. ReportedThe franchise sold $10,137 million in 2025, up 3.0%: advanced surgery, which includes endocutters, energy devices and biosurgery, $4,577 million, and general surgery, largely wound closure, $5,560 million.
    Johnson & Johnson Form 10-K for fiscal 2025 (year ended 28 December 2025) - Item 7 MD&A: MedTech segment and franchise sales analysis. — FY2025 · publ. 11 February 2026 · source ↗
  2. ReportedThe franchise sold $10,137 million in 2025, up 3.0%: advanced surgery, which includes endocutters, energy devices and biosurgery, $4,577 million, and general surgery, largely wound closure, $5,560 million.
    Johnson & Johnson Form 10-K for fiscal 2025 (year ended 28 December 2025) - Item 7 MD&A: MedTech segment and franchise sales analysis. — FY2025 · publ. 11 February 2026 · source ↗
  3. ReportedIn 2023 the same franchise sold $10,037 million, so two years added 1.0% in total.
    Johnson & Johnson Form 10-K for fiscal 2025 (year ended 28 December 2025) - Item 7 MD&A: consolidated sales, volume and price, geography, the three wholesalers, rebate accruals, costs, R&D and liquidity. — FY2025 · publ. 11 February 2026 · source ↗
  4. Moat Explorer calcIn 2023 the same franchise sold $10,037 million, so two years added 1.0% in total.
    Moat Explorer calculation from Johnson & Johnson's reported figures ($ millions unless stated). Darzalex royalty: 2,400 / 14,351 = 16.7%. Stelara 2023-2025: 10,858 - 6,078 = 4,780 lost; Tremfya 5,155 - 3,147 = 2,008 gained, 2,008 / 4,780 = 42%. Growth 2023-2025: Darzalex 14,351 - 9,744 = 4,607; Carvykti 1,887 - 500 = 1,387; Erleada 3,574 - 2,387 = 1,187; Spravato 1,696 - 689 = 1,007; five products 4,607 + 2,008 + 1,387 + 1,187 + 1,007 = 10,196. Myeloma medicines Q2 2026: 4,207 + 657 + 260 + 174 = 5,298; 5,298 / 25,310 = 20.9%. Simponi and Opsumit 2025: 2,668 + 2,325 = 4,993. Abiomed: 3,700 / 1,751 = 2.1 times; 1,751 x 1.171^5 = 3,850 by 2030. Shockwave: 12,600 / 1,146 = 11.0 times. Caplyta: 361 x 4 = 1,444 a year; 14,500 / 1,444 = 10.0 times. Acquisitions: 15,146 + 17,541 = 32,687. Goodwill and intangibles: 48,772 + 50,403 = 99,175; 99,175 / 199,210 = 49.8%. Free cash flow 2025: 24,530 - 4,832 = 19,698. Cash uses 2025: 12,381 + 5,953 + 17,541 = 35,875. Capex 4,832 / 94,193 = 5.1%. Surgery: 10,137 / 10,037 - 1 = 1.0%. Electrophysiology: 5,634 / 33,792 = 16.7%. MedTech share of sales: 33,792 / 94,193 = 35.9%; Innovative Medicine 60,401 / 94,193 = 64.1%. Segment income 2025: 22,266 + 4,113 = 26,379; Innovative Medicine 22,266 / 26,379 = 84.4%; MedTech 4,113 / 26,379 = 15.6%. Gross margin 63,937 / 94,193 = 67.9%. MedTech rebates: 6,446 / 33,792 = 19.1%; 5,955 / 31,857 = 18.7%. Return on identifiable assets: Innovative Medicine 22,266 / 78,057 = 28.5%; MedTech 4,113 / 86,482 = 4.8%. Cost of products sold / segment sales 2025: Innovative Medicine 15,646 / 60,401 = 25.9%; MedTech 14,549 / 33,792 = 43.1%. Q2 2026 segment margins: Innovative Medicine 6,249 / 16,384 = 38.1%; MedTech 1,177 / 8,926 = 13.2%. Growth 2023-2025: sales 94,193 / 85,159 - 1 = 10.6%; operating cash flow 24,530 / 22,791 - 1 = 7.6%; dividends 12,381 / 11,770 - 1 = 5.2%. Dividends per share 5.14 / 2.95 - 1 = 74%. Payout 2025: 12,381 / 26,804 = 46%; 12,381 / 26,215 = 47%; 12,381 / 19,698 = 63%. Diluted shares 2,429.4 / 2,812.9 - 1 = -13.6%; Kenvue exchange 190.96 / 2,674.0 = 7.1%. Firefly and Sail initial payments: 1,000 + 785 = 1,785. Consumer sales 2015-2022: (14,953 / 13,507)^(1/7) - 1 = 1.5% a year. Wholesalers: 21.8 + 15.5 + 11.1 = 48.4 (2025); 20.5 + 15.6 + 12.3 = 48.4 (2024); 18.2 + 15.1 + 14.2 = 47.5 (2023); largest 21.8 - 18.2 = 3.6 points. Innovative Medicine rebates: 56,819 / 60,401 = 94.1% (2025); 47,523 / 54,759 = 86.8% (2023); 56,819 / 47,523 - 1 = 19.6%; net sales 60,401 / 54,759 - 1 = 10.3%. Top three products: 15.0 + 6.5 + 5.5 = 27.0% of revenue. United States share: 53,752 / 94,193 = 57.1% (2025); 14,533 / 25,310 = 57.4% (Q2 2026). MedTech excluding orthopaedics: (33,792 - 9,258) / (31,857 - 9,158) - 1 = 8.1%. Talc: 5,500 / 76,000 claims = about $72,000 per claim; 5.5 - 3.7 = 1.8 billion. Valuation: 348.19 / 24.242 = 14.4 times (end-2024 market value over 2024 adjusted net earnings); 652.05 / 348.19 - 1 = 87%; 270.57 / 11.04 = 24.5 times; 11.04 / 10.79 - 1 = 2.3%; 277.91 / 270.57 - 1 = 2.7%. Innovative Medicine history: (60,401 / 31,430)^(1/10) - 1 = 6.8% a year; Pharmaceutical pre-tax margins 11,734 / 31,430 = 37.3% (2015), 12,827 / 33,464 = 38.3% (2016), 8,816 / 42,198 = 20.9% (2019); restated growth 52,563 / 51,680 - 1 = 1.7% (2022), 54,759 / 52,563 - 1 = 4.2% (2023), 56,964 / 54,759 - 1 = 4.0% (2024). Additional: 2015 mix 31,430 / 70,074 = 45%; dividend 5.36 / 11.04 = 49%; buybacks 4,253 / 5,953 = 71%; vision 5,468 / 33,792 = 16%; Innovative Medicine international 60,401 - 36,344 = 24,057 against 54,759 - 31,169 = 23,590 (2.0%); United States 36,344 / 31,169 - 1 = 16.6%; myeloma four-product growth 2023-2025 4,607 + 1,387 + (670 - 395) + (463 - 63) = 6,669 of oncology growth 25,380 - 17,661 = 7,719, 86%; Darzalex international 1,772 / 4,207 = 42%; equity gap 99,175 - 81,544 = 17,631; Abiomed 440 x 4 = 1,760; amortisation MedTech 0.5 / 1.3 = 38%; MedTech H1 2026 segment income 2,416 / 2,625 - 1 = -8.0%, SM&A 5,975 / 5,518 - 1 = 8.3%, R&D 1,492 / 1,324 - 1 = 12.7%, cost of products sold 7,438 / 6,964 - 1 = 6.8%, margins 2,416 / 17,562 = 13.8% and 2,625 / 16,561 = 15.9%; Innovative Medicine H1 2026 11,566 / 10,762 - 1 = 7.5%, 11,566 / 31,810 = 36.4%; dividends / operating cash flow 12,381 / 24,530 = 50%; receivables 17,178 - 14,842 = 2,336, inventories 14,191 - 12,444 = 1,747; Q2 2026 dividend 3,227 x 4 = 12,908, one cent x 4 x 2,408M shares = $96M; diluted shares 2,663.9 / 2,812.9 - 1 = -5.3%; MedTech United States 17,408 / 33,792 = 52%; international sales 94,193 - 53,752 = 40,441; oncology share of Innovative Medicine 25,380 / 60,401 = 42.0%; Darzalex sales increase 14,351 - 11,670 = 2,681, royalty increase 2,400 - 2,000 = 400, 400 / 2,681 = 15%; newer myeloma medicines Q2 2026 657 + 260 + 174 = 1,091, 1,091 / 4,207 = 26%; Shockwave international 67 / 335 = 20%; amortisation 2,492 x 2 = 4,984 a year, 4,984 / 26,215 = 19%; US long-lived assets 89,392 - 70,670 = 18,722; surgery international Q2 2026 1,559 / 2,653 = 59%; net interest 1,056 - 971 = 85; dividends per share 5.14 / 4.70 - 1 = 9.4%; MedTech rebates 6,446 / 5,955 - 1 = 8.2%; trailing sales 94,193 - 45,636 + 49,372 = 97,929; net earnings 26,804 - 16,536 + 10,769 = 21,037. MedTech history: (33,792 / 25,137)^(1/10) - 1 = 3.0% a year; Medical Devices 6,826 / 25,137 = 27.2% (2015), 5,392 / 26,592 = 20.3% (2017); restated 4,208 / 27,060 = 15.6% (2021), 4,447 / 27,427 = 16.2% (2022); growth 27,427 / 27,060 - 1 = 1.4% (2022), 30,400 / 27,427 - 1 = 10.8% (2023), 31,857 / 30,400 - 1 = 4.8% (2024) - product and franchise growth. — 2015-2026 · publ. September 2026 · source ↗
    Method: Arithmetic on figures reported in J&J's Forms 10-K, 10-Q, results releases and market data; operands shown in the source line.
  5. ReportedGeneral surgery growth in 2025 was driven by technology penetration and upgrades within the wound closure portfolio.
    Johnson & Johnson Form 10-K for fiscal 2025 (year ended 28 December 2025) - Item 7 MD&A: MedTech segment and franchise sales analysis. — FY2025 · publ. 11 February 2026 · source ↗
  6. ReportedAdvanced surgery growth was partially offset by China volume-based procurement across all platforms and competitive pressures in energy and endocutters.
    Johnson & Johnson Form 10-K for fiscal 2025 (year ended 28 December 2025) - Item 7 MD&A: MedTech segment and franchise sales analysis. — FY2025 · publ. 11 February 2026 · source ↗
  7. ReportedJ&J started a restructuring of the Surgery franchise in 2025 to exit certain non-strategic product lines, with $114 million of charges in the first half of 2026.
    Johnson & Johnson second-quarter 2026 supplementary sales data, statement of earnings and non-GAAP reconciliation, Form 8-K exhibit 99.2 - statement of earnings and non-GAAP reconciliation. — Q2 2026 · publ. 15 July 2026 · source ↗
  8. ReportedIn the second quarter of 2026 Surgery grew 3.9% to $2,653 million, general surgery 5.2% and advanced 2.2%.
    Johnson & Johnson second-quarter 2026 supplementary sales data, statement of earnings and non-GAAP reconciliation, Form 8-K exhibit 99.2 - MedTech segment and franchise sales by region. — Q2 2026 · publ. 15 July 2026 · source ↗
  9. ReportedOttava received FDA de novo authorisation in July 2026 for multiple general-surgery procedures, and J&J's group chair of medtech surgery said that what defined the last 25 years of surgery will not define the next 25.
    MedTech Dive, J&J gets FDA authorization for Ottava robot, teeing up competition with Intuitive. — July 2026 · publ. 22 July 2026 · source ↗
  10. ReportedOttava received FDA de novo authorisation in July 2026 for multiple general-surgery procedures, and J&J's group chair of medtech surgery said that what defined the last 25 years of surgery will not define the next 25.
    MedTech Dive, J&J gets FDA authorization for Ottava robot, teeing up competition with Intuitive. — July 2026 · publ. 22 July 2026 · source ↗
  11. ReportedJ&J said the Surgery program would simplify and focus operations by exiting certain non-strategic product lines and optimizing select sites, and expects it to be substantially completed by the end of fiscal 2026.
    Johnson & Johnson second-quarter 2026 supplementary sales data, statement of earnings and non-GAAP reconciliation, Form 8-K exhibit 99.2 - MedTech segment and franchise sales by region. — Q2 2026 · publ. 15 July 2026 · source ↗
Sources
Generated September 24, 2026