ISRG Expands Installed Base, But Is Utilization Keeping Pace?

Intuitive Surgical ISRG continues to expand its global dominance in robotic-assisted surgery with a 15% year-over-year increase in da Vinci system installations, bringing its global installed base to more than 10,000 units. In the first quarter of 2025, the company placed 367 da Vinci systems — including 147 of the next-gen da Vinci 5 — amid strong U.S. demand. However, installations outside the country remained unchanged year over year, reflecting healthcare budget constraints in markets like Germany, Japan and the United Kingdom.

While Intuitive Surgical's recurring revenues, now 85% of the total revenues, remain robust, a critical metric — utilization — reveals a key tension. Overall, procedures grew 17% year over year, yet average system utilization rose just 2% across the multiport platforms. SP and Ion platforms posted stronger utilization increases of 26% and 5% respectively, supported by focused adoption strategies and new clearances.

The limited growth in core platform utilization raises questions about the ROI of hospitals post-installation, particularly in constrained capital environments. Management acknowledged this dynamic, noting efforts to drive training, site enablement, and digital adoption to boost throughput. Additionally, da Vinci 5’s Force Feedback and case insight tools, though early in rollout, are beginning to demonstrate measurable value in clinical outcomes and surgeon proficiency.

ISRG’s installed base expansion remains strong, especially in the United States. However, modest system utilization growth suggests that procedural ramp-up may lag deployments in some markets. Long-term growth will require more than system placements; it hinges on improving per-system productivity, proving clinical differentiation, and navigating financial headwinds that may shift hospital ROI expectations.

Competitive Snapshot

Stryker SYK reported record-breaking Mako installations in the first quarter of 2025, both in the United States and globally, driven by sustained momentum in orthopedics and increased procedural demand. The new Mako 4 SmartRobotics system, launched this year, features a smaller OR footprint and improved integration with its latest Q Guidance system, streamlining setup and intraoperative workflows. Management cited high utilization rates for installed units globally, particularly in knee and hip procedures, where Mako continues to drive share gains.

The company also noted progress toward launching Mako Spine later in 2025 and Mako Shoulder in early 2026, expanding its robotic footprint across specialties. With a strong capital order book and robust procedural volume, Stryker expects the Mako franchise to be a key contributor to its 8.5-9.5% organic growth target.

Zimmer Biomet’s ZBH ROSA robotics platform saw ongoing adoption in knee procedures, but results were more muted. While ROSA volume-based placements contributed to a mix shift versus outright sales, ROSA was mentioned as central to ZBH’s robotic strategy in 2025.

The company emphasized the growing uptake of cementless knee and hip implants, including the Oxford Partial Cementless Knee, which complements robotic workflows. Though specific ROSA installation figures weren’t disclosed, the system remains integral to ZBH’s ASC and digitization strategy. Management cited increased commercial focus and expanded surgical capabilities as key growth drivers, but acknowledged tariffs and ongoing pressure on operating margins as near-term headwinds.

ISRG’s Price Performance, Valuation and Estimates

Shares of ISRG have gained 2.4% in the year-to-date period against the industry’s decline of 7.7%.

From a valuation standpoint, Intuitive Surgical trades at a forward price-to-earnings ratio of 64.35, above the industry average. But, it is still lower than its five-year median of 72.21. ISRG carries a Value Score of D.

The Zacks Consensus Estimate for Intuitive Surgical’s 2025 earnings implies a 6.8% rise from the year-ago period’s level.

The stock currently carries a Zacks Rank #2 (Buy). 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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