Intuitive Surgical — Q1 2026 Earnings Preview
Reports April 21, 2026 (AMC) · Prepared April 6, 2026
Earnings Date
Apr 21, 2026
After Market Close
Consensus Revenue
$2.61B
+15.8% YoY
Consensus EPS
$2.08
+14.9% YoY
Procedure Growth Guide
13–15%
FY2026 — conservatively set
Price
$452.07
Down ~25% from $603.88 high
Market Cap
~$161B
52-Wk Range: $425–$604
GM Guide FY2026
67–68%
vs. 67.6% FY2025 actual
Beat Rate L8Q
8 / 8
Avg EPS surprise +18.2%
Executive Summary
ISRG reports Q1 2026 on April 21 after market close. The stock is trading near its 52-week low
($425) at $452, down ~25% from the $603 high, reflecting deceleration concerns and tariff headwinds.
The core question: is the 13–15% procedure growth guidance conservative (as ISRG's history suggests),
or does it signal real deceleration? FY2025 started at 13–16% guide and delivered 18%.
Against headwinds (ACA subsidies, Medicaid, China competition, Japan capital, GLP-1 risk), da Vinci 5
momentum remains strong: 303 dV5 placements in Q4, 870 for FY2025. January 2026 saw FDA cardiac
clearance (new $2B+ TAM). Consensus at $2.61B revenue / $2.08 EPS is notably below ISRG's recent
beat cadence (+18.2% avg EPS surprise). The razor/razorblade model strengthens with recurring
revenue at 81% of Q4 total.
Key Debates for Q1:
- Is 13–15% procedure guide conservative? (FY2025: started 13–16%, delivered 18%)
- da Vinci 5 international ramp — can placements sustain the Q4 pace OUS?
- Tariff impact: 120 bps gross margin headwind guided for FY2026 (vs. ~65 bps in FY2025)
- China competitive intensity and tender win rates
- MIA+ digital subscription renewals starting Q2 2026 — early signals?
Last Earnings: Q4 2025 (Reported January 22, 2026)
| Metric | Actual | Estimate | Surprise |
|---|---|---|---|
| Revenue | $2,866.2M | $2,750M | +4.2% |
| Non-GAAP EPS | $2.53 | $2.26 | +12.0% |
| Da Vinci Procedure Growth | 18% | — | — |
| System Placements | 532 | — | incl. 303 dV5 |
| Ion Procedures | ~40,200 | — | +44% YoY |
| Stock Reaction | +0.6% AH | — | Focus on FY2026 13–15% guide |
FY2026 Guidance & Q1 Estimates
FY2026 Management Guidance
| Metric | Guide | Notes |
|---|---|---|
| Da Vinci Procedure Growth | 13–15% | vs. 18% actual FY2025 |
| Pro Forma Gross Margin | 67–68% | Tariff ~1.2% headwind |
| Pro Forma OpEx Growth | 11–15% | Italy/Spain/Portugal going direct |
| SBC Expense | $890–920M | |
| Other Income | $355–375M | Mostly interest income |
| Pro Forma Tax Rate | 22–23% | ~100 bps headwind YoY |
Q1 2026 Consensus vs. Year-Ago
| Metric | Q1 2026E | Q1 2025 | YoY |
|---|---|---|---|
| Revenue | $2,610M | $2,253.4M | +15.8% |
| GAAP EPS | $2.08 | $1.92 | +8.3% |
| Non-GAAP EPS | ~$2.08 | $1.81 | +14.9% |
| Da Vinci Proc Growth | ~14% | 17% | Deceleration |
Historical Quarterly Metrics (8 Quarters)
| Segment ($M) | Q1'24 | Q2'24 | Q3'24 | Q4'24 | Q1'25 | Q2'25 | Q3'25 | Q4'25 |
|---|---|---|---|---|---|---|---|---|
| I&A Revenue | $1,158.9 | $1,244.4 | $1,264.2 | $1,411.5 | $1,367.7 | $1,474.1 | $1,518.8 | $1,658.3 |
| Systems Revenue | $418.2 | $448.2 | $445.0 | $654.6 | $522.7 | $574.7 | $590.4 | $785.9 |
| Services Revenue | $313.5 | $317.3 | $328.9 | $347.4 | $363.0 | $391.2 | $395.9 | $422.0 |
| Total Revenue | $1,890.6 | $2,009.9 | $2,038.1 | $2,413.5 | $2,253.4 | $2,440.0 | $2,505.1 | $2,866.2 |
| Non-GAAP EPS | $1.50 | $1.78 | $1.84 | $2.21 | $1.81 | $2.19 | $2.40 | $2.53 |
| Proc Growth % | 16% | 17% | 18% | 18% | 17% | 17% | 20% | 18% |
Procedure Growth Guidance History — The Conservative Pattern
ISRG has a consistent track record of guiding conservatively on procedure growth at the start of
the year, then raising throughout. FY2025 started at 13–16%, was raised 3 times, and delivered 18%.
FY2026 begins with the same 13–15% starting guide — likely conservative.
| Period | Low Guide | High Guide | Actual | Note |
|---|---|---|---|---|
| FY2025 Initial (Q4'24) | 13% | 16% | — | — |
| FY2025 Raise 1 (Q1'25) | 15% | 17% | — | — |
| FY2025 Raise 2 (Q2'25) | 15.5% | 17% | — | — |
| FY2025 Raise 3 (Q3'25) | 17% | 17.5% | — | — |
| FY2025 Actual | — | — | 18% | Beat high end by 50bps |
| FY2026 Initial (Q4'25) | 13% | 15% | TBD | Same conservative starting point |
Beat / Miss Track Record — 8 / 8 Consecutive Beats
| Quarter | EPS Actual | EPS Est. | EPS Surp. | Rev Actual | Rev Est. | Rev Surp. |
|---|---|---|---|---|---|---|
| Q1 2024 | $1.50 | $1.42 | +5.6% | $1,890.6M | $1,853M | +2.0% |
| Q2 2024 | $1.78 | $1.65 | +7.9% | $2,009.9M | $1,971M | +2.0% |
| Q3 2024 | $1.84 | $1.63 | +12.9% | $2,038.1M | $1,890M | +7.8% |
| Q4 2024 | $2.21 | $1.82 | +21.4% | $2,413.5M | $2,212M | +9.1% |
| Q1 2025 | $1.81 | $1.65 | +9.7% | $2,253.4M | $2,196M | +2.6% |
| Q2 2025 | $2.19 | $1.77 | +23.7% | $2,440.0M | $2,292M | +6.5% |
| Q3 2025 | $2.40 | $1.58 | +51.9% | $2,505.1M | $2,281M | +9.8% |
| Q4 2025 | $2.53 | $2.26 | +12.0% | $2,866.2M | $2,750M | +4.2% |
Average EPS surprise: +18.2%. Average revenue surprise: +5.5%.
Key Catalysts
Positive Catalysts
- da Vinci 5 international ramp (only 58 OUS placements in FY2025 — massive acceleration expected)
- Cardiac FDA clearance (Jan 2026) — opens $2B+ TAM; Force Feedback cardiac instruments later in 2026
- Conservative guide pattern — FY2025 started 13–16%, delivered 18%
- MIA+ digital subscription renewals starting Q2 2026 — new recurring revenue stream
- ASC expansion via XiR — 70% of opportunity within existing IDN footprint
- Single-Port: procedures +87% FY2025; NSM, thoracic, colorectal clearances broaden platform
Risks
- Procedure growth deceleration even if conservative — 13–15% vs. 17–18% run rate
- Tariff escalation: 120 bps GM headwind guided; further actions could widen
- China: local competitors gaining; tender win ratios declined in Q4
- Japan capital pressure: placements dropped from 43 (Q4'24) to 10–15 in recent quarters
- J&J Ottava FDA review underway — commercial launch expected 2027
- Tax rate step-up: 22–23% vs. 21% FY2025 (~100 bps EPS headwind)
Key Questions for April 21
1.
Is Q1 procedure growth tracking above the 13–15% guide midpoint?
2.
da Vinci 5 placements: how many OUS? Is the international ramp accelerating?
3.
Cardiac procedures: how many dV5 cardiac cases performed in Q1? Rollout cadence?
4.
Force Feedback instruments: what is the supply timeline for cardiac tools?
5.
China: tender win rate update — recovering or still declining?
6.
Tariff impact: any change to the 120 bps FY2026 gross margin headwind?
7.
MIA+ subscriptions: any early data on renewal rates or pricing?
8.
FY2026 guidance: any upward bias on the procedure growth guide?
Source: Daloopa, Intuitive Surgical IR, Barchart, MedTech Dive, Seeking Alpha