{
  "@context": "https://frontierpicks.com/schemas/dossier.v1.json",
  "ticker": "ISRG",
  "name": "Intuitive Surgical, Inc.",
  "url": "https://frontierpicks.com/dossiers/ISRG/",
  "json_url": "https://frontierpicks.com/dossiers/ISRG.json",
  "status": "WATCHLIST",
  "current_conviction": "LOW",
  "archetype": {
    "code": "a1",
    "n": 1
  },
  "current_thesis": "Intuitive Surgical's shares look more likely to lag the S&P 500 because US procedure growth slowed to 10% and instrument revenue per procedure is set to fall 3%–5% from 2027. The mid-January 2027 preliminary procedure count will show whether US growth steadies.",
  "invalidation_trigger": "A daily close above $485.49, over the 2026-11-04 post-earnings high close of $482.10, which would show the shares leading the S&P 500. Preliminary fourth-quarter US da Vinci procedure growth above the third quarter's 10% would also prove the call wrong.",
  "catalyst_date": null,
  "portfolio": null,
  "pick": null,
  "themes": [
    "medtech-diagnostics"
  ],
  "tags": [],
  "sources": [],
  "caveats": [],
  "source_links": [
    {
      "title": "SEC EDGAR",
      "url": "https://www.sec.gov/Archives/edgar/data/0001035267/000103526726000067/q326ex-991earningsrelease.htm",
      "date": null
    },
    {
      "title": "Intuitive Surgical Inc (ISRG) Stock Down 3.4% -- Now Undervalued? GF Score: 96/100",
      "url": "https://www.gurufocus.com/news/9182320/intuitive-surgical-inc-isrg-stock-down-34-now-undervalued-gf-score-96100",
      "date": "2026-11-06"
    },
    {
      "title": "Intuitive Surgical Inc (ISRG) Stock Up 9.4% and Still Undervalued -- GF Score: 93/100",
      "url": "https://www.gurufocus.com/news/9171635/intuitive-surgical-inc-isrg-stock-up-94-and-still-undervalued-gf-score-93100",
      "date": "2026-11-04"
    },
    {
      "title": "Intuitive Surgical Surges 5.4%, Adding ~$9 Billion in One Session",
      "url": "https://247wallst.com/cards/intuitive-surgical-isrg-price-swing-01m6m2dskea20wpp19vmdr83an",
      "date": null
    },
    {
      "title": "Intuitive Announces Preliminary Fourth Quarter and Full Year 2025 Results",
      "url": "https://www.nasdaq.com/press-release/intuitive-announces-preliminary-fourth-quarter-and-full-year-2025-results-2026-01-14",
      "date": "2026-01-14"
    },
    {
      "title": "Intuitive Announces Fourth Quarter Earnings",
      "url": "https://www.nasdaq.com/press-release/intuitive-announces-fourth-quarter-earnings-2026-01-22",
      "date": "2026-01-22"
    }
  ],
  "evidence": [
    {
      "claim": "Third-quarter 2026 revenue was $3.05 billion, up 22% from $2.51 billion; non-GAAP diluted EPS was $3.00 against $2.40, and GAAP EPS was $1.49 against $1.95.",
      "source": "Q3 2026 earnings release (Form 8-K exhibit 99.1)",
      "as_of": "2026-10-20"
    },
    {
      "claim": "US da Vinci procedure growth was 10% in Q3 2026, down from 12% in Q2; da Vinci growth outside the US was 20%.",
      "source": "Reuters, 2026-10-20",
      "as_of": "2026-10-20"
    },
    {
      "claim": "The company placed 546 da Vinci systems in Q3 2026, including 315 da Vinci 5 units, against 427 and 240 a year earlier; the installed base reached 12,094.",
      "source": "Q3 2026 earnings release (Form 8-K exhibit 99.1)",
      "as_of": "2026-09-30"
    },
    {
      "claim": "2026 guidance was narrowed to 14%–15% worldwide da Vinci procedure growth; non-GAAP gross margin guidance was raised to 68.7%–69.3%.",
      "source": "Q3 2026 earnings release (Form 8-K exhibit 99.1)",
      "as_of": "2026-10-20"
    },
    {
      "claim": "The CFO said da Vinci instruments and accessories revenue per procedure should fall about 3%–5% at constant mix as Extended Use Program 2.0 rolls out from the first half of 2027.",
      "source": "Q3 2026 earnings call",
      "as_of": "2026-10-20"
    },
    {
      "claim": "BofA Securities raised its price target to $500 from $470 and BMO Capital kept a $518 target; HSBC's target is $392 and Evercore ISI's is $375.",
      "source": "fiscal.ai, 2026-10-28, 2026-11-04 and 2026-11-10",
      "as_of": "2026-11-10"
    },
    {
      "claim": "Director Gary Guthart sold 10,000 shares at $457.34 on 2026-11-04 and chief legal officer Gary Loeb sold 400 shares at $458.15 on 2026-11-10, both under Rule 10b5-1 plans.",
      "source": "SEC Form 4 filings, 2026-11-05 and 2026-11-12",
      "as_of": "2026-11-10"
    },
    {
      "claim": "Intuitive appointed Humana executive Aaron Martin to its board of directors, effective January 1, 2027.",
      "source": "Company announcement via fiscal.ai",
      "as_of": "2026-11-02"
    }
  ],
  "view_changes": [],
  "frame": null,
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    "sector": "Healthcare",
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      "close_date": "2026-11-13",
      "latest_quarter": "2026-09-30",
      "figures": {
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        "gross_margin": {
          "status": "ok",
          "quarters": [
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            }
          ]
        },
        "operating_margin": {
          "status": "ok",
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              "pct": 19.4
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            }
          ]
        },
        "pretax_income": {
          "status": "ok",
          "end": "2026-09-30",
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          "value_musd": 668.4
        },
        "net_income": {
          "status": "ok",
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          "filed": "2026-10-21",
          "four_quarters_end": "2026-09-30",
          "value_musd": 522.8,
          "four_quarters_musd": 2957.2
        },
        "operating_cash_flow": {
          "status": "ok",
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        "capital_spending": {
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          "value_musd": 491.5
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        "free_cash_flow": {
          "status": "ok",
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          "value_musd": 3598
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        "diluted_share_change": {
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          "end": "2026-09-30",
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        "debt": {
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        "equity": {
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      "days_to_cover": 4,
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  "body_markdown": "## Current Thesis\n\nIntuitive Surgical's shares look more likely to lag the S&P 500 than lead it over the next three months. US da Vinci procedure growth slowed to 10% in the third quarter of 2026, and management plans a cut of about 3%–5% in instrument revenue per procedure from 2027. The preliminary fourth-quarter procedure count, expected in mid-January 2027, will show whether US growth steadies.\n\nThe rating is Low because neither problem has been tested by new operating data. The company has published no new results since its 2026-10-20 report and the 10-Q filed on 2026-10-21. Since then the news has been analyst targets, a board appointment and routine insider sales.\n\nThe price reflects a recovery that is already well under way. The shares closed at $449.53 on 2026-11-11, up 12.0% over three months and above both the 50-day and 200-day moving averages. GuruFocus put the forward price-to-earnings ratio at 36.3 on 2026-11-06. That multiple assumes mid-teens procedure growth carries through the 2027 pricing cut, which is the point the January figures will test.\n\n## Bull Case\n\n- **Revenue growth accelerated to 22%.** Third-quarter revenue rose 22% to $3.05 billion from $2.51 billion (company 8-K, 2026-10-20). Non-GAAP earnings per share (EPS) was $3.00, against $2.40 a year earlier.\n- **System placements reached a new pace.** The company placed 546 da Vinci systems in the third quarter, up from 427 a year earlier, including 315 da Vinci 5 units against 240 (company 8-K, 2026-10-20). The installed base reached 12,094 systems on 2026-09-30.\n- **Growth outside the US stays strong.** Procedure growth outside the US was 20% in the third quarter (Reuters, 2026-10-20). Apollo Hospitals in Bengaluru, India, introduced the da Vinci 5 system (fiscal.ai, 2026-10-29).\n- **Gross margin guidance went up.** Full-year 2026 non-GAAP gross margin guidance rose to 68.7%–69.3% (company 8-K, 2026-10-20).\n- **Bullish analysts lifted or held targets.** BofA Securities raised its target to $500 from $470 and BMO Capital kept a $518 target, both on 2026-11-10 (fiscal.ai). Rothschild & Co Redburn raised its target to $560 on 2026-10-23 and Barclays to $500 on 2026-10-22 (fiscal.ai).\n- **Buybacks are large.** Intuitive repurchased 7.8 million shares for $2.94 billion in the third quarter (company 8-K, 2026-10-20).\n\n## Bear Case\n\n- **US procedure growth slowed for a second quarter.** US da Vinci procedures grew 10% in the third quarter, down from 12% in the second (Reuters, 2026-10-20). Management said it is watching lower Affordable Care Act enrollment and changes to Medicaid eligibility.\n- **Instrument revenue per procedure will fall.** Chief financial officer Jamie Samath said da Vinci instruments and accessories revenue per procedure should fall about 3%–5% at constant mix as Extended Use Program 2.0 rolls out from the first half of 2027 (Q3 call, 2026-10-20). RBC Capital Markets said on 2026-10-22 that these pricing actions put 2027 procedure momentum at risk.\n- **The margin target sits below today's margin.** Samath put the long-term operating margin range at 35%–40%, against a current 41%–42% (Q3 call, 2026-10-20). GAAP EPS fell to $1.49 from $1.95 after a $450 million antitrust settlement charge (company 8-K, 2026-10-20).\n- **Cautious analysts hold low targets.** Evercore ISI cut its target to $375 from $385 on 2026-10-28, and HSBC moved its target to $392 from $391 on 2026-11-04 (fiscal.ai). Both sit below the 2026-11-11 close of $449.53.\n- **Insiders keep selling into the rally.** Director Gary Guthart sold 10,000 shares at $457.34 on 2026-11-04, director Craig Barratt sold 1,150 shares at $460.00 the same day, and chief legal officer Gary Loeb sold 400 shares at $458.15 on 2026-11-10 (SEC Form 4 filings). All sales were under pre-arranged Rule 10b5-1 plans; controller Fredrik Widman also exercised options and sold 5,448 shares at $436.06 on 2026-10-30.\n\n## Setup & Price Structure\n\nThe shares closed at $449.53 on 2026-11-11, 25.6% below the 52-week intraday high of $603.88 set on 2026-01-07. The 52-week closing low was $332.02 on 2026-07-23. The 3-month change is 12.0%, measured from a $401.27 close on 2026-08-13.\n\nThe last close sits above the 50-day moving average of $414.76 and the 200-day moving average of $430.11 (adjusted daily closes, as of 2026-11-11). The 200-day average is the nearer level beneath the price. A close back under it would put the shares below their longer-term trend again.\n\nThe post-earnings high close is $482.10 on 2026-11-04, after a 9.4% one-day rise (GuruFocus, 2026-11-04). The shares then fell on four of the next five sessions to $449.53. A close above that high would show buyers taking the shares past their post-earnings peak despite the open questions on US growth and pricing.\n\nNo earnings date is scheduled before January 2027, so no company report is likely to reprice the shares in the next 30 days. GuruFocus put the trailing price-to-earnings ratio at 54.8 on 2026-11-06.\n\n## Catalyst Calendar\n\n- **~2027-01-12 (est.):** Preliminary fourth-quarter 2026 procedure and system placement figures. It is the first reading of US da Vinci growth after the 10% third quarter, and shows whether the slowdown came from a hard comparison or weaker demand.\n- **~2027-01-22 (est.):** Fourth-quarter 2026 report with 2027 guidance. It sets 2027 procedure, gross margin and operating expense guidance, and shows how much the instrument pricing changes cost in margin.\n- **~2027-03-31 (est.):** Possible start of the US Extended Use Program 2.0 rollout in the first half of 2027, pending regulatory clearance. It starts the planned 3%–5% cut in da Vinci instruments and accessories revenue per procedure in the company's largest market.\n\n## What Would Change Our Mind\n\nA daily close above $485.49, over the 2026-11-04 post-earnings high close of $482.10, which would show the shares leading the S&P 500. Preliminary fourth-quarter US da Vinci procedure growth above the third quarter's 10% would also prove the call wrong.\n\n## Correlation Notes\n\nThe shares trade with large-cap medical device stocks and with US hospital spending and insurance-coverage policy, because US procedures drive most recurring instrument revenue. The 9.4% rise on 2026-11-04 came with no confirmed company catalyst (24/7 Wall St.), so sector flows can move the shares sharply between reports. Competition from Johnson & Johnson's Ottava robot is a slower, company-specific factor. It would show up first in US system placements, which were 335 in the third quarter (company 8-K, 2026-10-20).",
  "first_seen": "2026-11-10",
  "last_analyzed": "2026-11-12T16:28:25+00:00",
  "last_synthesized": "2026-11-12",
  "date_modified": "2026-11-12",
  "license": "Content © FrontierPicks. Cite the canonical URL."
}