For the first part of the presentation, participants will be in listen-only mode. During the questions-and-answers session, participants are able to ask questions by dialing pound key 5 on their telephone keypad. Now I will hand the conference over to the speakers, CEO Gisli Hennermark and CFO Anna Ahlberg. Please go ahead.
Good morning everyone and welcome to the Surgical Science Q4 2023 call. My name is Gisli Hennermark, I'm the CEO of the company, and I will start this call off with a few general comments, and then Anna Ahlberg, CFO, will go through some of the details, and then we will open up for questions. So 2023 Q4, we had a decrease in our total revenue compared to the same period last year, compared to the same period in 2022. What we saw in the fourth quarter was that the typical, what we call end-of-year deals, when hospitals are using their budgets, that they've been waiting or saving during the year, did not do so in 2023. It was a tough year for many hospitals, and more so in the United States, which is an important market for us.
When our customers were planning to do their end-of-year purchases, the budget was simply not there because it had already been spent. And this is not so strange looking at it in the rearview mirror. Most of these budgets were set in fall of 2022, and then inflation and cost increases ate away a lot of those budgets, making the environment difficult for the hospitals. We also noted that the Chinese market, which we commented on in our Q3 report where we saw some bright signs, and I actually travel quite a lot to China. I was there two times last year. We have an office there, so we have our own people on the ground.
But we noted that it was a change during the fourth quarter where the government, to our surprise, announced that they will continue the anti-corruption campaign specifically targeted towards hospitals and teaching institutions within hospitals. This puts a dampening effect on the market because no one wants to be subject to those kinds of investigations. The need is still very strong there. We expect the market to come back, and our best guess currently is that that market will start bouncing back mid-2024. And I must add also that this comment is not attributable to Industry OEM, where we see a strong growth and lots of opportunities also in the Chinese market. Moving on, looking at more of the bright side of our Q4 report is the continued strong growth in license revenue. We ended the year with a total of SEK 278 million in license revenue.
So these are the royalties that the surgical robotics companies are paying us to utilize our technology, and that's up more than 50%. So it's a very strong tailwind and strong development. Also, the fourth quarter had a growth of about 20%, and you can see it there on the slide on your screen if you're in front of your computers where you see it quarter by quarter. Looking a bit at the market, we follow very closely the utilization of surgical robots, and we saw market leader Intuitive post their quarterly report about a month ago, and they had all-time high utilization rates. So procedural growth, how much you use the surgical robots, continues to grow very strongly. This is extremely important to us because it means more surgeons are needed, which in turn means that you need to do more training and more use of our simulation technology.
We also note that the new entrants that are competing with the market leader in this business typically have lower utilization rates. One important part of bridging and getting utilization rates up is to work with education and training and with simulation. Another interesting observation is that—and this is true particularly for Europe where we have a regulatory environment where there are many robotic platforms, robotic surgery platforms that are approved—we note that the hospitals are really embracing simulation because these robots, they are not like driving a car, meaning that in between them, they work differently of how you control them. So you need to train on each one of these robots in order to perform surgery in a patient-safe manner. We're really seeing hospitals embracing simulation and appreciating the fact that the simulation is the same from one vendor to another.
So we feel that we are moving our positions forward in our being the de facto gold standard for simulation for robotic surgery. And we keep on investing in technology. So we have advanced our core technology, meaning that we can do applications for our customers that we weren't able to do before. And we're also helping our customers utilize the simulation in different contexts. We call these product extensions, meaning that the sort of core console simulation can be used also ahead of the surgeon even coming and sitting at the surgical robot for the first time, for example, through head-mounted display. These are VR headsets that we can utilize off-the-shelf hardware with our software. About a month ago, the market leader Intuitive announced that they have now made a submission to the FDA in the United States for a next-generation da Vinci called the da Vinci 5.
Without making any comments whatsoever about the actual capability of da Vinci 5, I can note that generally speaking, this is very good news for Surgical Science because when a new robot comes to market, it typically has some features that are different, and that requires more training, and simulation is part of that training. It also typically has capabilities that over time means that the surgical robotic company can expand into new indications, and when doing so, it again puts a demand for more simulation. So generally speaking, this is good news for Surgical Science. Of course, in the very short term, it can have some market dynamics that some customers may want to hold off a bit and get more information about what the new da Vinci 5 will actually have in terms of capabilities.
But this is, again, speaking historically, what we've seen when Intuitive launched their latest da Vinci called the da Vinci Xi. And what is different today is also that there are many more customers that are leasing the robots, so it means increased flexibility for them to upgrade at a future point of time. Our profit margin in Q4 was disappointing and not where we are used to having our profit margin. But actually, looking a bit more closely at that profit margin, the big effect was the currency effect on our receivables, like accounts receivables, because they need to be revalued at 31st of December, which happened to be a low point for the US dollar versus the Swedish krona. Actually, that effect was about SEK 15 million, representing then 6 percentage points.
So that's the difference between the actual 17% profit margin on an EBIT level to a more normal mid-20s profit margin, 23% in this example. And I will provide details on this matter. We have our largest office in Tel Aviv, in Israel, and throughout the fourth quarter, we all know that Israel was at war. I was there the last time in December working with the team. And even if war means a lot of emotions and a war is a tragedy for everyone involved on all sides, I can comment that Surgical Science has not missed one single delivery or one single deadline out of the Tel Aviv office. So I'm extremely proud of how our team is pulling together there and how the whole company is working together in order to move the company forward.
So business-wise, the war has had a very marginal effect on our business. Now, finalizing my introduction here, I like to firmly restate that we have a strong belief in our 2026 goals. If we're looking at, for example, educational products that had a weak quarter in Q4, since we introduced our long-term financial goals, educational products have been well above the 10%-15% on average revenue growth that's needed in order to reach the goal. That means, sort of just mathematically, if you take our total revenues that for 2024 ended at SEK 883 million, we need a total growth of just below 20% for 2024 up until 2026. We firmly believe in this goal, and we also firmly believe in our strong position within the surgical robotic customer group that will drive license revenue and will make us reach our Adjusted EBIT goal of 40%.
Of course, looking in here into 2024, we note that there is a headwind in educational products. There is very strong demand. We know the need from the customers, but there are question marks about financing. And actually, last year, for educational products as a whole, it still grew, even if it was a very modest growth, I think like SEK 10 million. But if you look at what we had sort of against us in that year, there was the Q4 effect that sort of just didn't happen in 2023. In 2022, we had a sale to a leading US hospital chain of about SEK 70 million and then a sluggish China. In this environment, we still grew educational products, meaning there are many other markets that had very nice growth in order to adjust for this. And we feel a strong tailwind in Industry OEM.
The strategy is working. The resources that we're putting in place are generating, and we're seeing not only surgical robotics, also outside of surgical robotics, we're seeing good progress. So with those words, I say thank you, and I hand over to our CFO, Anna Ahlberg.
Yes. Hi, everyone. So Q4 was a quarter where we had strong license revenues and weaker simulator sales because of the lack of what we call the year-end Q4 effect on the hospital side, meaning sales was more on par with Q2 and Q3. In absolute numbers, we had sales of SEK 227 million, down 9%, and the same then in local currencies. As you know, we are heavily dependent on the US dollar, where we have 82% of our revenues. We have had a positive effect for quite some time from the strengthening US dollar.
It was on par for the quarter then on the sales side, but we saw a negative effect further down in the income statement, and I will get back to that in a while. Educational products was 54% of our sales for the quarter, down 20%, and more in line with Q2 and Q3 than because of the lack of the Q4 effect. We have had some great quarters for educational products with great growth up until and including Q1. We have repeatedly said that the rising inflation and downturn in the economy would affect us unless it was very short. We do see there being a greater inertia in the market, not because the demand is not there, but we do see things taking a longer time, and especially then in the U.S.
And then we have the very important China market being weak due to the anti-corruption campaign affecting the healthcare sector. For educational products, Europe was slightly above Q2 and Q3, and the same goes for South America. Industry OEM was up 9%, 46% of our sales, and again, license revenues at an all-time high level and up 20% for the quarter. That meant we showed sales of SEK 883 million for 2023, +10%, and in local currencies, +7%. Educational products then +2% and Industry OEM +24%.
Anna and Gisli also said, "After the merger with Simbionix, we had a very, very strong period for educational products, and that means that at the CAGR level, we are above our target of 10%-15% average growth per year since our financial goals were communicated." License revenues for the year were up 50%. Looking at our four different revenue streams, and also in the report, you have them divided per business area as well. We see that license revenues for the quarter was 33% of our total sales. And that meant that for 2023, our license revenues were 31% of our total sales, which was considerably higher than in 2022 when we had 23%. And this is, of course, very important for us for our financial goals, both when it comes to our sales goal and our profitability goal.
As we always emphasize, this number, the license revenues, is more lumpy between the quarters since new entrants buy their licenses more in batches. We do have today revenues from several customers within the segment. We also said that we gained new customers during 2023 within the robotics segment, even though they haven't started to generate license revenues yet. Simulator sales was 55% of our sales in Q4. If we look at full year 2023 and exclude the large US order we had of approximately SEK 68 million, the increase was 18%. Development revenues were somewhat lower for the quarter, but we do have, as Gisli also said, several exciting projects within the area. And we are starting to see that our investments that we have made in the sales organization within Industry OEM, that that is starting to pay off.
This item consists of both robotics projects as well as sales of simulators where we do software adaptations to the OEMs. Our service revenues continue to be stable and grow with our installed base. Cost and EBIT margin for the fourth quarter, our gross margin was at the highest level that we had in Q4 for 2023, was just above 71% due to both the fact that we had an increased share of license revenues, 33% versus 25% in Q4 2022. We also had a good product mix and a favorable average sales price. Sales costs increased a bit compared to Q2 and Q3. They are usually a bit higher in Q4, one factor being that sales commissions often reach a higher level. The costs were only there was only a slight increase if we compare quarter over quarter for Q4.
Sales costs were 19% of sales and admin then 9% of sales. Looking at R&D, the costs were on par with last year, and they were at 20% of sales. We activated approximately SEK 8 million, the same as last year, but lower than in Q3 than when we had SEK 12 million. We got some questions then if that level should be considered to be sort of the new level going forward. But it does depend a lot on what we work on during the quarter. And again, we are working on many good projects within the Industry OEM area, and here revenue recognition can be a bit more lumpy. The item other is usually not significant. For this quarter, however, we had a large currency effect from the weakening US dollar. The dollar went from 10.8 on September 30th to 10.0 on December 31st.
When we then revalue our operating assets and liabilities in, above all, US dollar, this was the effect of that. So it is not a realized loss, but more of a translation loss. This item also includes an IFRS 2 effect from our options programs. EBIT was then SEK 38 million, corresponding to a margin of 17%. If we exclude the SEK 15 million that we just discussed, we are at a more normal 23% EBIT margin. Organization, we were the same number of employees at the end of the year as after Q3, 260 people. We are continuing to grow the organization, especially within R&D, but also other areas. We have a good plan for this year and are growing with cost control.
Down to the right, you can see the split between the countries where we have approximately half of our staff in Israel and then one quarter each in Sweden and the US, respectively. Adjusted EBIT, where we have our financial goal of 40% in 2026, which corresponds to EBIT adjusted for amortizations on acquisition-related items such as customer contracts and technology. For Q4, this number was SEK 44 million, a margin of 19%. For the full year, we had Adjusted EBIT of SEK 240 million. That was a margin of 24%, approximately one percentage point above 2022. Finance net and taxes, finance net for the quarter was SEK 80 million, and SEK 70 million of these came from the effect of the Mimic earnout.
Going into the quarter, we had $7.8 million in our balance sheet, which was attributable to 2023, which was the last year of this continuing consideration that was in the deal when we acquired Mimic in 2021. $6.7 million of these will not be paid out, and they are in the finance net. And then $1.1 million will be paid out to the former shareholders of Mimic.
This item is then still in the balance sheet as a short-term liability. And after it has been paid out during the spring, there is nothing left referring to the Mimic acquisition or the contingent consideration, the earnouts. Other items in the finance net, interest on bank balances, approximately SEK 4 million, revaluation of internal loans, SEK 7 million, and then a smaller amount attributable to IFRS 16. Taxes for the quarter were SEK 20 million and for the full year, SEK 34 million.
Our taxes paid are affected by the fact that we have no carry-forwards in Sweden and the U.S. That means then that not all of the tax expense in the income statement will be paid. Some is booked towards deferred tax assets because of these NOLs. Going into 2024, we have NOLs left in the U.S. in Mimic. Net result for the quarter was SEK 98 million, and for the full year, SEK 234 million, approximately 26%. Cash flow from operating activities, it was SEK 40 million for the quarter. A negative change in working capital, minus SEK 15 million. Inventory and accounts receivables decreased. However, other current receivables increased. For the full year, we see that inventory has increased due to the fact that we have more production, while accounts receivables have decreased.
This is the most important item that we work with in our cash management, accounts receivable, more important than the inventory level, and especially then in the U.S., since that is a direct market. I'm very happy with the development we've had. You see the gray line there with the decreasing trend, accounts receivable as a percentage of rolling 12-month sales. We see it decreasing also for Q4, but I think we are pretty much where we want to be with that now. It's more a question of continuing to do this good work on the AR side. Cash flow from investing activities was -SEK 12 million. That is minor investments in development costs. From financing activities, it was +SEK 9 million, an IFRS 16 effect. And that meant that we ended the year with SEK 634 million in our bank accounts.
That was +SEK 28 million for the quarter and just above SEK 200 million +4% 2023.
All right. Thank you, Anna. Ending the address here after numbers to the left and right with a picture, a couple of photos from reality. A couple of weeks ago, we had our annual sales and partner meeting. We had it in Budapest this year. We were about 120 people from all over the world, literally all over the world, meeting up. They were Surgical Science people, our internal staff. But the majority are our distributors, our sales partners within educational products. This community is strong. I'm really proud of the sales network we have and our sales organization helping them get customers, their needs met with simulation, but also the service and support organization that can help customers with this broad portfolio of simulators for medical specialties. We also had the technical training.
It's such a vibrant, amazing community that keeps on growing and that is ready to sell new products. We really feel, after the various acquisitions we made, that our strategy of being a simulation company with a broad product portfolio is really working. With that, I would like to hand over for any questions. Thank you.
If you wish to ask a question, please dial pound key 5 on your telephone keypad to enter the queue. If you wish to withdraw your question, please dial pound key 6 on your telephone keypad. The next question comes from Simon Larsson from Danske Bank. Please go ahead.
Hi, Gisli and Anna. I'm filling in for Victor today. A few questions from my end, please. So maybe, Gisli, you're highlighting some short-term dynamics here in the robotic markets as a potential challenge going into this year. I guess the da Vinci 5 launch is maybe a thing for the back half of this year or beginning of next. Should we expect this to hamper the license growth in coming quarters in any way, or that some customers might wait for that launch to invest? Or how should we think about this?
Like I spoke about earlier, there can be some wait-and-see effect. If you look at what Intuitive said during their earnings call in January, a month ago, they said that they expect trading volumes to be somewhat lower. But they also highlighted the fact that many customers now have the lease option. So if you are curious about da Vinci 5, you can always go with a da Vinci Xi while waiting a da Vinci 5. So it's a little bit hard to know how it will pan out in the short term. But I think you have to go back and look at the really key metrics. And that is procedural growth, Simon. If you look at the 22% procedural growth Intuitive published in Q4, that is a really, really strong number. And I think they're guiding for next year between 13%-16%.
That means more surgeons are performing robotic surgery. They need more training, and they need more surgeons combined with the new entrants. But we pointed out because it can have a short-term effect, but I can't quantify it, if that makes sense.
Yeah. No, but that's very clear, I think. And yeah, I mean, 13%-16% growth for procedures, I mean, that's quite strong, actually, so. And maybe the second question, you also brought up budget constraints a bit. I saw there was some news out this morning around China implementing volume-based procurements here in 2024 to try to cut prices on larger CapEx items such as laparoscopic robots. At the same time, both HCA and Tenet seem to guide quite strongly CapEx-wise here in 2024. So yes, if you can paint the picture, what you're seeing around budget constraints here during the year.
Yeah. I mean, we see the need, Simon. We see the need. We see customers' plans. But what we experienced in the rearview mirror was really that budgets ran out in 2023. And it's a bit. I mean, it's always easier to be logical in the rearview mirror, but it makes sense. They made the budgets sometimes in 2022. They got them approved. And in 2023, there was a lot of cost increases, and hospitals really felt the pain. It's a bit difficult to say what will happen with budgets in 2024, but I know they've made budgets for 2024. And then if inflation starts coming down, I think that will also help us a lot. And then it's very big differences also from market to market. I commented on China, where we really saw the signs. I mean, I was there during the fall.
I saw the signs that things are easing up. Then we were a bit surprised that the current anti-corruption campaign now is announced to continue to the midpoint of 2024. It also has big differences from market to market. The need is really strong, and that is what makes us positive overall for the adoption of medical simulation.
Yeah. Perfect. Thanks so much. And the final one from my end. So on the dynamic around the license sales in the quarter, I know we've been talking about this before, Gisli. When a new customer starts selling the robot, they tend to order in bulks or licenses in bulks for the simulation. Did you have any of those bulk orders here in the quarter, or was it more rather broad-based demand for licenses?
Yeah. Again, we have license revenues now from several customers, meaning several more defined as new entrants. Since they are purchasing in bulks, as you say, or batches, that will always be an effect in sort of each quarter. It can vary, of course. If several buy their batches in one quarter and maybe less in the next, then that effect is larger, of course. It depends on when these batches come in, so to speak.
Yeah. Okay. I see. Perfect. Okay. Thanks so much.
Thank you.
And continuing maybe on that note before we take the next question, we have some written questions as well, and also around the license revenues and what is recurring or not and what the model looks like. So for the license revenues, we have one part that is more perpetual tied to the actual robot. When a robot is being sold with our simulation package on it, we get money for that. But then we also have a recurring part. We have not stated the percentage or the split between the two different ones. What we said when we acquired Simbionix was that for their contract with Intuitive, the larger part was recurring. And recurring can be both on installed base or based on usage. So with that, I think we can take the next question.
The next question comes from Ulrik Trattner from Carnegie. Please go ahead.
Great. Thank you very much. Hi, Gisli. Hi, Anna. A few questions on my end. I'll start off with the stricter budgets in Q4 and what you're seeing there in terms of restrictions from release of the full budgets into Q4. Since you mentioned inflation, but you also feel that hospitals in general have been kept on a sort of tighter leash when it comes to releasing their budgets for Q4. Is this mainly a U.S. thing? Because I do note that we're seeing decline in all geographies, and we can take away China with anti-corruption. But do you see this as a general theme for Q4?
It's a general theme for Q4, Ulrik. I mentioned the United States because it's such an important market for us. It's also a direct sales market where we have a larger margin contribution, also larger cost, of course, because we have our own direct salespeople. But it was felt everywhere. I mean, hospitals were under pressure last year. That, I think, goes as a general comment across the line. But despite that, like Anna mentioned, we grew in Europe, for example, Q over Q in educational products. Yeah, that's what I can say about the budget squeeze.
Okay. Do you expect this to turn more positive in Q1? If I remember it correctly, you have quite tough comps on the educational side with orders from Q4 being spilled over into Q1 due to the sort of high demand that we were seeing. I know sort of if they can't release their full budgets for Q4, is there someone waiting until Q1 for buying? What's your gut feeling here?
Yeah. I mean, I can't give any forecasts. We don't give any forecasts. But we did comment in our Q1 report in 2023 that we had an unusually large backlog from Q4, meaning in 2022, we couldn't deliver everything the customers wanted to buy. So we had SEK 17 million that spilled over into Q1 2023. But it will be really interesting to see because, I mean, we see the demand. We know that a lot of customers want to buy. Now, if they went to their purchasing office and said, "I want to buy this simulator," and they got a no in Q4, will it mean that they get a yes in Q1 to a larger extent? Or will it mean that the finance department will say, "It looks good, but hold off, and there will be a larger Q4 effect in 2024"? It remains to be seen.
I don't have any forecast on the short-term impact or dynamics. But I do know that the underlying demand is there. It's strong. We have a good position as a company.
Great. And if we stay on geographical growth here, and you mentioned that you delivered on a large deal in Romania Q2 and Q3 this year. And as well as we went back in the quarterly report, you mentioned a larger deal in Pakistan. Do you feel that we should take this into consideration for 2024, or is this just normal operations on your end, and you're expecting to be able to meet these orders with new orders for the full year 2024?
Yeah. This is more in line with normal operations. We always have, I mean, different-size deliveries. As you know, there might be one large order in one country in one quarter, and then there might not be any sales to that country for a few quarters. Then something else comes up. It's more to comment on where we had the deals for that specific quarters within educational products, even though it tends to be more linear in its growth. Within that, we have deals that can look very different and in different countries. The deal that we comment on is the large U.S. deal, of course, because that was something sort of extraordinary. It was a very large deal that we also had to announce. Usually, we don't announce deals, even though they might be of different sizes.
Great. Perhaps we can switch to FX because you are heavily tilted to the US dollar in terms of sales and as well as receivable, and that's quite obvious here in Q4. But you're also heavily tilted towards the US dollar and the Israeli shekel in terms of your cost base. Can you give us some indication on the FX effect on operational expenses here in Q4? I'm guessing you had some favorable effects.
Yes. On the cost side, as you say, and you saw it in the report, we have approximately 50% of our cost base in shekels. And we do purchase a lot of things for our production locally. And then, of course, the costs for our employees, etc., in the countries where we are. So we mentioned the negative effect of SEK 15 million on the revaluation of the balance sheet. But then, yes, the shekel depreciated somewhat against the US dollar. I mean, it's calculated in several steps, but meaning then that there might be a slight positive effect on the other part of the costs, but nothing major. The largest part is on the sales side, which we always then also, of course, disclose the percentage excluding FX effects.
Great. So do you have a switch to Intuitive's new system? It's a more advanced system with more functionalities. Are you including more advanced simulation and adjusting prices?
I cannot make any comments regarding that, Ulrik. We are bound by strict NDA and confidentiality agreements as a company. Actually, I'm personally bound also with that particular client. So I cannot comment on that.
Okay. Last question on my end, Mimic. You have three years of continued considerations on sales targets, and they've been lowered. The outcome has been lowered each year. Were expectations set extremely high, or have Mimic underperformed, or how should we read into this?
We are extremely satisfied with the acquisition of Mimic Technologies and the team we have in Seattle. They're a valuable part of our company, and we are very pleased with how it's been planned out. Now, when you discuss with the now former owner about price for the asset, it's very natural that the view diverges quite substantially. I'm no big fan of earnouts because it can quickly put in incentives that are not aligned within the company. But in this case, it was actually very easy to define an earnout based on already delivered content at negotiated prices over a three-year period. It's just natural in my mind that what the former owners thought about the development was very different than what we thought.
As a result, we have paid out not the maximum earnout, but an earnout that is hopefully something good for the former Mimic shareholders. Overall, we're very pleased with the acquisition and the position that it has put us in.
Okay. That's great. That's all on my end. Thanks for taking my question.
Thank you.
Thanks, Ulrik.
The next question comes from Christian Lee from Pareto Securities . Please go ahead.
Yes. Thank you. Good morning. You expressed some hopes of China returning to normal volumes in the second half of this year. Could you please elaborate on what you base your view on? Have you seen any signs of demand picking up despite the ongoing anti-corruption campaign?
I base that on, A, what the authorities are communicating, B, what our own staff since many years in our China office in Shenzhen are saying, and number three, what I experienced being there on the ground. I was there two times last year, and I spoke to a lot of people. When I was there in the fall, we really felt things easing up. These sort of policies, they usually start and end in Beijing. We saw the beginning of the end, but then somehow it tightened up again towards the end of last year. This is why we clearly state that in this quarterly report because it's different than what we said in Q3. However, the underlying demand is still huge there. It's not like we're making zero business. It's just not at the normal level.
I can also mention that we are making good progress with Chinese med-device companies because they are serious. They are good. They're investing in their products, and they want world-class simulation. And then they turn to Surgical Science. So my comments in these aspects are purely on the educational product side.
Okay. Excellent. Thank you. Since there are several market challenges such as restrained hospital budgets, the timing of China's bounce back, and perhaps the short-term dynamics in the robotics market, how good is your visibility for 2024? Given that you had only 7% organic growth in 2023, how can you be sure that you can grow by a CAGR of 20% until 2026?
Well, what I feel very confident about, Christian, is that when we summarize 2026, Surgical Science has reached its goals of SEK 1.5 billion in turnover and 40% Adjusted EBIT. And that I base on us growing on average 10%-15% within educational products and Industry OEM having a larger part of license revenues that are progressive towards the end of that period. And I think overall, we feel that we are in a very good and comfortable position to reach that. And when you talk about challenges, yes, there are challenges. But we are a company that is used to challenges. This is what we face every day.
In the sort of more-than-usual challenges in educational products last year, if you think about it, $70 million on the large order to U.S.-leading hospital chain, X number of millions in China that was very sluggish, the economic headwind, and no Q4 effect. I mean, all those orders in December that just sort of all of a sudden, customer calls and says, "Hey, this quote that I've had sitting on my desk for a while, can you put a new date on it because I will get money now?" It didn't happen. If you add all those effects up, it's a big sort of number to recuperate, which we did, plus another SEK 10 million. We actually still grew a little bit in 2023 in educational products.
We are above our 10%-15% on average growth for the period since we set our new financial goals. I hope that helps. Maybe Anna has a comment as well.
Yeah. No, just adding to that because we have a written question on that same note asking how we will grow towards 2026 and between the years. And that is not any guidance that we've ever given, that it will be a certain percentage each year, etc. We've said 10%-15% average for educational products. And again, Industry OEM should grow more, but also progressive towards the end of the period. So just emphasizing that.
You can also look, Christian, on the surgical robotics side. We have approximately 15 surgical robotics companies that have our software embedded on their platforms. And still, the majority has not even sort of come to market yet. There are only a few of them that have come to market, and there are several that are in various stages of regulatory approval processes. So we are keeping a strict view on our 2026 goals that we will accomplish. We are growing the company in a very planned and structured way with a good control of costs, even if we had a dip in profitability in Q4 on an EBIT level attributable then to primarily FX effects.
Okay. Perfect. And my final question, your growth assessment for Industry OEM based on the estimated number of robotic systems coming out on the market, increasing attachment rate, or the discussions with your OEM customers regarding the need for simulation? And clarification would be helpful. Thank you.
Yeah. Our main focus is that we have a large share of the surgical robotic market for simulation. Within that market, you have several different players. Some of these players will do better than expected, and some will do worse than expected. It doesn't affect us for our long-term financial goals because what's important for us is that the market overall growth grows. And actually, I can maybe intervene also a question here in the chat because there was someone asking, "How is the fact that new players are entering the surgical robotic market affecting demand for simulation? Does each robot have a different simulation specified for the robot?" And it's like this. Every robot has some unique features in how it's controlled. I mean, we all know how to drive a car. It's a steering wheel. But for surgical robots, the UIDs, user input devices, are different.
So you control them in a different way. We embed very much the same simulation software onto the consoles, and then we do some customization in connecting that simulation with the API and the kinematics of the robot. But the experience when you do a Surgical Science simulated exercise or a simulated procedure is very much the same. So this is where we get the scalability, and this is where we invest money so we can do even more things with simulation. So I just intervened a question there in the chat.
Yeah. We have some more on the same topic. Just when we expect new customers to generate license revenues, the business model is that we get development revenues during the development phase. Our customers enter into their regulatory approval process phase. Then when the robot has been approved and is starting to be sold, that is when we start to get license revenues. So it depends, of course, on when the robot is approved. We don't comment on our specific customers' timelines on that. As you know, we have several large OEMs as our customers, and they have talked about timelines for their robots. So we refer to that. There is also a question on the attach rate per robotic company. That means then that when a robot is being sold with our simulation package on it, that is the attach rate.
That is true for Intuitive. However, for many of the new entrants, they are heavily dependent on being able to show how to introduce the new robot in a patient-safe way. The customers expect there to be simulation on it. So for example, CMR Surgical has stated there, it's not a choice. It's not something you purchase on top of the robot. It's included. Yes. I think we can go for the next.
There are no more questions at this time. So I hand the conference back to the speakers for any written questions or closing comments.
I do think that we have addressed most of the written questions. I'm looking through the list here. Yes, we have. If no further questions, I think we will end this just on time, a couple of minutes early before lunch. Starting a meeting on time is respect. Ending it before time is love. Thank you very much, and take care.
Thanks. Bye.