From Hospitals to ASCs: Will Refurbished Xi Systems Broaden ISRG's Reach?

Intuitive Surgical’s ISRG third-quarter 2025 results reveal an ongoing evolution in the company’s market-access strategy — the emergence of refurbished da Vinci Xi systems as a new bridge into cost-sensitive geographies and ambulatory surgery centers (ASCs). With 20 refurbished Xis already sold and many hospitals redeploying older units internally, Intuitive Surgical is quietly constructing a tiered portfolio that could meaningfully expand its footprint without materially lowering price integrity on its flagship da Vinci 5.

The catalyst for adoption of refurbished Xi is the da Vinci 5 upgrade cycle. As U.S. health systems trade in older Xis (141 trade-ins occurred in third-quarter alone) for da Vinci 5, Intuitive Surgical gains a reliable stream of lightly used inventory. These systems, once refurbished, become economically viable for ambulatory environments and emerging markets where capital budgets remain tight.

CEO David Rosa underscored that refurbished Xis will be “an important component” of serving cost-sensitive buyers, both domestically and internationally, while CFO Jamie Samath noted strong enthusiasm among regional leaders who now have more pricing and capability segmentation to work with.

This matters because affordability is now one of the biggest barriers to expanding robotic-assisted surgery beyond tertiary centers. In the United States, ASCs face sharply lower reimbursement — “a fraction” of hospital outpatient rates, Samath observed — making full-price robotic adoption challenging. Capital, far more than instrumentation cost or sterilization logistics, remains the gating factor.

Here, refurbished Xis offer an entry point — familiar workflows, interoperable instruments and aligned training environments with hospitals’ da Vinci 5 units. That continuity allows surgeons to shift cases across sites of care without friction, enabling IDNs to decant lower-acuity procedures into outpatient settings while maximizing utilization of premium systems.

Internationally, refurbished units provide a strategic lever for markets constrained by government budgets or competitive pricing pressure, including China, Japan and parts of Europe. As Intuitive Surgical introduces da Vinci 5 into these regions, refurbished Xis can anchor broader market penetration, seeding procedural adoption before hospitals step up to higher-end platforms.

With a multi-tier portfolio, Intuitive Surgical is quietly adapting to a more price-sensitive global landscape and positioning refurbished Xis as a durable growth engine in the years ahead.

Peer Update

Zimmer Biomet ZBH is depending heavily on its robotics strategy to drive ROSA adoption as it works to reaccelerate growth. ZBH emphasized repeatedly that ROSA is central to its differentiated “customer-centric technology suite,” pairing non-CT-based robotics with navigation tools like OrthoGrid to meet diverse surgeon needs.

In the third quarter, ZBH highlighted its strongest robotics capital quarter in over a year, with U.S. ROSA accounts performing over half of knee implants robotically, up 400 bps year to date. ZBH expects upcoming enhancements, such as ROSA with OptimiZe, featuring a simplified UI and kinematic alignment, to deepen penetration across ASCs and competitive accounts.

Stereotaxis STXS is making significant progress with its GenesisX robotic surgery platform, a next-generation solution designed to expand access to robotic electrophysiology procedures. In the second quarter of 2025, Stereotaxis’ GenesisX secured CE Mark approval in Europe, and the first commercial system was manufactured, with FDA clearance expected later this year.

Initial hospital installations are planned in Europe in 2025, followed by a full U.S. and EU launch in 2026. GenesisX is engineered to avoid costly lab construction, lowering barriers to adoption. With second-quarter operating expenses steady at $6 million, Stereotaxis plans disciplined reinvestment in salesforce expansion and catheter-driven recurring revenues to support commercialization.

ISRG’s Price Performance, Valuation and Estimates

Shares of ISRG have gained 10.9% in the year-to-date period compared to 4.5% rise for the industry.

From a valuation standpoint, Intuitive Surgical trades at a forward price-to-earnings ratio of 61.19, above the industry average. But, it is still lower than its five-year median of 71.53. ISRG carries a Value Score of F.

The Zacks Consensus Estimate for Intuitive Surgical’s 2025 earnings implies a 17.3% rise from the year-ago period’s level.

The stock currently carries a Zacks Rank #3 (Hold). You can see the complete list of today’s Zacks #1 Rank (Strong Buy) stocks here.

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This article originally published on Zacks Investment Research (zacks.com).

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