Good afternoon, everyone. I am Craig Barrett, Chair of the Board of Directors of Intuitive. I welcome you to the 2024 Annual Meeting of Stockholders. We are again hosting our annual meeting both virtually and in person to be more inclusive and reach a greater number of our stockholders. Before I call the meeting to order, I would like to introduce to you the other members of the Board of Directors, as well as the management team members who are present in person with us today. In addition to myself, our directors are, and if you could put your hand up, Joseph Beery, an Intuitive director since 2020. Amal Johnson, an Intuitive director since 2010. Sreelakshmi Kolli, an Intuitive director since 2023. Dr. Amy Ladd, an Intuitive director since 2019.
Keith Leonard, an Intuitive director since 2016. Dr. Alan Levy, an Intuitive director since 2000. Jami Dover Nachtsheim, an Intuitive director since 2017, and Dr. Monica Reed, an Intuitive director since 2021. Dr. Gary Guthart, Chief Executive Officer, Intuitive, and a director since 2009, is participating virtually. Dr. Don Kania, a director since 2018, and Mark Rubash, a director since 2007, are not able to join us today. In addition, Lewis Chew, Lewis, thank you, is a nominee for election to the company's board of directors and is present in person.
Other officers and members of the management team of the company, online or in person with us today are: Dave Rosa, President; Jamie Samath, Senior Vice President and Chief Financial Officer; Gary Loeb, Senior Vice President, General Counsel, Chief Compliance Officer, and Secretary; Brian King, Vice President, Treasurer, and Head of Investor Relations; and Kara Balliet, Vice President, Corporate Law and Governance, in the rear. I would also like to introduce Kris Veaco , Principal at Veaco Group and the Inspector of Election, and Jeff Mollenhauer, PricewaterhouseCoopers, LLP, the company's independent registered public accounting firm. Mr. Loeb will act as secretary of the meeting. Let me begin with a brief review of the agenda for today's meeting. We will start by taking care of some housekeeping items, and then we will move to the formal business for the meeting: consideration of the proposals described in our proxy statement.
After the conclusion of the formal business, Mr. Samath will provide an overview of recent company highlights, and we will have time for appropriate questions. Only stockholders may ask questions, which must either be submitted in the designated field on the web portal or made in person only after such stockholder raises his or her hand and is recognized by the chair of the meeting. Out of consideration for others, please limit yourself to two questions. If you encounter any difficulties submitting questions on the web portal during the meeting, please call the technical support number that is posted on the virtual shareholder meeting login page, or otherwise refer to the proxy statement for additional information on how to reach our support team. The time is 3:04 P.M. Pacific Time. The meeting will now come to order.
I have confirmed with Computershare that we have a complete list of the stockholders of record of the company's capital stock on February 29, 2024, the record date for this meeting. That list of stockholders and the number of shares held by each such stockholder as of the record date, is posted on the meeting web portal for any stockholder wishing to inspect it. The stockholder list shows that as of the record date, there were 354,448,735 shares of common stock outstanding and entitled to vote at this meeting.
I also have an affidavit certifying that commencing on March 8th, 2024, either (1) a notice of internet availability of the proxy materials, or (2) the proxy materials themselves were sent either by email or by United States mail to all stockholders of record at the close of business on February 29, 2024. Kris Veaco has been appointed to act as Inspector of Election at this meeting. Ms. Veaco has taken and subscribed the customary oath of office to execute her duties with strict impartiality, which will be filed with the records of the meeting. Her function is to decide the qualification of voters, accept their votes, and when voting on all matters is completed, to tally the votes cast as to each matter.
I'm informed by the Inspector of Election that based on the number of proxies received to date, a quorum is present, and the meeting will proceed. Accordingly, I hereby declare this meeting to be duly constituted for the transaction of all business. We will now proceed with the formal business of the meeting. There are six proposals to be considered by the stockholders at this meeting, which are listed in our proxy statement. It is now 3:36 P.M., and the polls are open for voting on all matters to be presented. The polls will be closed to voting after we go through the matters to be voted upon.... The first item of business is the election of 11 directors nominated by the board of directors. The following individuals have been nominated to the board of directors to serve until the 2025 annual meeting of stockholders: Dr.
Craig Barrett, Mr. Joseph Beery, Mr. Lewis Chew, Dr. Gary Guthart, Ms. Amal Johnson, Ms. Sreelakshmi Kolli, Dr. Amy Ladd, Mr. Keith Leonard, Ms. Jami Dover Nachtsheim, Dr. Monica Reed, and Mr. Mark Rubash. The board of directors recommends that stockholders vote for the election of each of the nominees. No other nominations complying with the nomination procedures in the company's amended and restated bylaws have been received, and the nominations are closed. The second item of business is the approval on an advisory basis of the compensation of the company's named executive officers, as disclosed in the compensation discussion and analysis, compensation tables, and narrative discussion of the proxy statement for this annual meeting. The board of directors recommends that the stockholders vote on an advisory basis for the approval of the compensation of the company's named executive officers.
The third item of business is the ratification of the appointment of PricewaterhouseCoopers, LLP, as the company's independent registered public accounting firm for the fiscal year ended December 31, 2024. The board of directors recommends that stockholders vote for the ratification of the appointment of PricewaterhouseCoopers, LLP, as the company's independent registered public accounting firm for the fiscal year ending December 31, 2024. The fourth item of business is the amendment and restatement of the amended and restated 2010 incentive award plan, as disclosed in the exhibits of the proxy statement for this annual meeting. The board of directors recommends that the stockholders vote for the amendment and restatement of the amended and restated 2010 incentive award plan.
The fifth item of business is the amendment and restatement of the amended and restated 2000 employee stock purchase plan, as disclosed in the exhibits of the proxy statement for this annual meeting. The board of directors recommends that the stockholders vote for the amendment and restatement of the amended and restated 2000 employee stock purchase plan. The sixth and final item of business is the consideration of the stockholder proposal regarding a racial and gender pay gap report. A representative of the proponent may present the proposal. As per the rules of conduct for this meeting, the representative will be granted two minutes to introduce the proposal. The proposal has been submitted by Ms. Myra K.
Young, requesting that the company report annually on an unadjusted, median, and adjusted pay gaps across race and gender, globally and or by country, where appropriate, including associated policy, reputational, competitive, and operational risks, and risks related to recruiting and retaining diverse talent. The requested report may be prepared at reasonable cost, omitting proprietary information, litigation strategy, and legal compliance information. At this time, the chair recognizes James McRitchie, the representative of Ms. Young, for a period of two minutes. The time will begin as soon as the representative starts speaking.
Thanks. This is Jim McRitchie, presenting proposal number six on behalf of longtime stockholder, Myra K. Young. Thanks for holding a hybrid meeting and letting me present our proposal virtually. Please also hold off closing the polls until about two minutes after my presentation, so that shareholders can vote. This proposal seeks transparent disclosure of racial and gender pay gaps. White women won't reach pay equity in the United States until 2059. Black and Latina women will take up to another 150 years at the current rate. There are two types of pay gap disclosure. They measure different things. Intuitive reports statistically adjusted gaps, but not unadjusted median pay gaps, which address structural bias against women and minorities who may face discrimination regarding job opportunities and pay. Why is this information important? Companies with fair pay and equal opportunity attract and retain top talent.
83% of younger employees track a company's commitment to fairness. 70% would switch jobs to work for a fairer company. Diverse leadership correlates with better risk management, higher profit managers, margins, stronger return on equity, and better stock performance. These are objectives all stockholders can agree on. The European Union will soon require all companies to list or to disclose median pay gap, gaps publicly. Why? Because these disclosures move companies in the right direction. Fairness benefits stockholders, employees, the company, and our whole society. Please vote for proposal number six, the Racial and Gender Pay Gap Report proposal. Thank you.
Thank you. The board of directors recommends a vote against this proposal for the reasons set forth in the proxy statement for this annual meeting. Are there any questions on any of the six proposals? Seeing none, we'll now move on to voting on the proposals. Voting is by proxy, written ballot, or online on the web portal. Any stockholder who has not yet voted or who wishes to change their vote may do so, if attending online, by clicking on the voting button on the web portal and following the instructions there, or if attending in person, by submitting your written ballot to the Inspector of Election and registering your name with her. Stockholders who have sent in proxies or voted via telephone or internet and who do not want to change their vote, do not need to take any further action.
Only stockholders of record on February 29, 2024, or their proxy holders are eligible to vote at this meeting. We are now gonna take a short pause to allow for any stockholders who have not yet voted to do so. The polls are about to close. The time is 3:14 P.M., and the polls are now closed for voting. We have been informed by the Inspector of Election that the preliminary vote report shows that there were sufficient votes for the election of each of the nominees to the board of directors: Dr. Craig Barrett, Mr. Joseph Beery, Mr. Lewis Chew, Dr. Gary Guthart, Ms. Amal Johnson, Ms. Sreelakshmi Kolli, Dr. Amy Ladd, Mr. Keith Leonard, Ms. Jami Dover Nachtsheim, Dr. Monica Reed, and Mr.
Mark Rubash, and each is hereby elected to the board of directors to serve until the 2025 annual meeting of stockholders. In addition, the Inspector of Elections preliminary vote report for each of the other proposals is as follows: The proposal to approve the compensation of the named executive officers on an advisory basis has received sufficient affirmative votes and is approved. The proposal to ratify the appointment of PricewaterhouseCoopers, LLP, as the independent registered public accounting firm for the fiscal year ending December 31, 2024, has received sufficient affirmative votes and is approved. The proposal to approve the amendment and restatement of the amended and restated 2010 incentive award plan has received sufficient affirmative votes and is approved. The proposal to approve the amendment and restatement of the amended and restated 2000 employee stock purchase plan has received sufficient affirmative votes and is approved.
The stockholder proposal regarding a racial and gender pay gap report is rejected. The Inspector of Election will prepare a final report that will be included as part of the record of this meeting. We will be reporting the final vote results in a Form 8-K, which will be filed with the U.S. Securities and Exchange Commission within the next four business days. This concludes the formal portion of our meeting. This meeting is adjourned at 3:17 P.M. Now, I will turn it over to Mr. Samath for a presentation on our business. Jamie?
Welcome, everybody. It's great to see everybody that's in person. Hopefully, you can all hear me at the back. Gary Guthart, our CEO, would normally make this presentation. Gary's actually in Europe, and we felt like it would be more appropriate to have a live presenter, so you have me for this cycle. Before I begin my view on the company's business, as with most presentations, the following discussions contain forward-looking statements, and the company's actual results may differ materially from those discussed here. Additional information concerning factors that could cause such a difference can be found in the company's annual report on Form 10-K, the fiscal year ended December 31st, 2023, as updated by the company's other filings with the Securities and Exchange Commission. Let's get into the presentation.
This slide actually describes how the company thinks about creation of value in the company. And this chart is integrated into actually how the company operates. It's a core part, actually, of also our culture, and it's in priority order. So first and foremost, we think about: How do we create value for our patients? That's core to our mission, and it's the development of advanced, differentiated technology that, in the end, makes a difference for patients and patient care. And then we think about: How do we create value for surgeons who use our products routinely? How do we make it easy for them to use? How do we make it efficient? How do we listen to their feedback and create value for them in their practice?
Of course, we care about the hospitals that actually then employ the surgeons and treat the patients, and they have financial constraints. So we think about the economic objectives of our hospital customers, and we look to align our value that we create for them economically also. Payers are the source of revenue for hospitals, and of course, they also care about clinical quality, so they are also an entity that we look to create value for. Our employees do tremendous work for the company. They're actually the ones that work on this value creation, particularly the products and technologies that are used by surgeons and benefit patients. We look for our employees to operate actually as owner operates, so that there's some alignment with investors.
If we do everything in this stack appropriately, we do it consistent with everything I just described, that will lead to the creation of value for our shareholders. We think that as you create value at the top of the stack, it drifts down through the rest of the stack. This is important grounding in terms of how the company thinks about creation of value and how we operationalize it in the company. This is actually a framework that was developed by the American Medical Association some time ago, and it's a way for healthcare systems and hospitals to think about how they prioritize their own strategy and how they operate.
The company, Intuitive, has integrated that into our own strategy, and it affects many of the things we do, for example, how we do product development. So what you can see here in this quadruple aim is that we look to improve clinical outcomes over time. We look for a better patient experience, and that's not just clinical outcomes, but their experience in going through the office visits, to the surgeon they see, to how they're prepped, and how they actually recover and leave hospital. The people that actually take care of patients, we also look for a great experience for them. What's the nature of the work they do? How efficient is it? How much autonomy do they have?
And finally, and of course, particularly, where you have high healthcare costs relative to GDP, we look for lowering total cost to treat the patient episode routinely over time. That also allows us to get access to an increasing number of patients, particularly as we look globally. So this, this framework, commonly understood by customers and integrated into how the company operates and thinks about its business and how we engage with customers in terms of the language with which we use. We look to create value for our customers in their language, with their objectives. And so this is our mission and vision, and many employees of the company are deeply connected to the mission that gives them a sense of higher purpose. And again, the mission is really that we develop, invent technology that, in the hands of surgeons, allows them to heal without any constraints.
The complementary vision then is that you can treat patients early, effectively, and let them get back to their lives and what matters most to them in their lives. And that drives us every day, and that's a significant motivation for a number of many, most of the employees of the company. So just to look back at some numbers, the top section here is the numbers from last year, and you can see at the bottom then, cumulatively, over the history of the company, what we've done. And so I'll look at the bottom for a second. Cumulatively, almost 15 million soft tissue surgery procedures. Obviously, that's a significant experience set for the company.
Evidence and data matters to the company, and you can see we've accumulated over 38,000 scientific publications with respect to the benefits of robotic-assisted surgery, da Vinci in particular. You see the size of the installed base across our three platforms, 9,400 systems in the installed base, and you can see above how many of them came from last year. That gives us a certain scale and presence that we can use in terms of a feedback loop in terms of how we operate, what goes through our development pipelines, how we interact with customers. We think it's important, an important discipline for us to describe: What did we say a year ago with respect to our objectives, and how did we do?
You can see on the left then what did we lay out last year in terms of the key areas of focus for us. We'd like to acknowledge what was challenging, where could we have done better, and what were sources of strength for us. So the environment in China has been challenging. There are pricing dynamics there. There are obviously geopolitical issues that you can see broadly in the news. We've seen increasing domestic competition in China, and so that's been relatively, relatively dynamic for us and presented a number of challenges as we've operated there. We don't have yet visibility as to how that's going to settle out.
Last year, what we saw was some pressure, particularly in our newer product areas, for kind of yield performance, scrap, and the absolute gross margins that we were seeing in some of our new products. That's been an area of focus for us and will be for several years. We're seeing progress in terms of the action commitments for the relative views of May, but it's going to take us some time. You'll see when we get to 2024 commentary, that will be a continuing area of focus for us. Back in Q2, we started to describe how GLP-1s weight loss drugs were having an impact on bariatric surgery in the U.S. We've seen growth rates in bariatric surgery then moderate since that time. In Q1, this quarter just passed, bariatric surgical growth for us was about flat.
We think the total surgical market for bariatrics was down 12%-15%, and it's too early at this point to say how that will settle out, given there's lots to kind of see through in terms of further invention in GLP-1s and what will happen as patients kind of continue to be on that for extended periods of time. So we'll see how that settles out. From time to time in Ion, a newer platform for us, this is our endoluminal platform that we use for biopsy for lung cancer. We've had some supply constraints, and we've been working through those. Actually, last quarter, Q4, we held back some system placements because of the supply constraints in our catheter in particular.
We didn't want to place those systems and then not be able to actually provide those customers who just bought that system adequate I&A to start doing procedures. We had some catch up in Q1. We're not out of the woods yet in terms of stabilizing that supply, but the teams are making good progress. In terms of areas of strength, U.S. general surgery has been a growth driver for us for several years. Stems actually back from when we originally launched Xi in 2014, but that's been a driver of growth for us. Europe and Japan, Japan's performance has been nice, and what we're starting to see is growth beyond urology in many of our international markets.
Up until recently, for the longest time, urology was really the key driver for us in international markets, and you're starting to see da Vinci now move into the next set of categories, and we saw that in Europe and Japan, Japan. We got a clearance for Ion in Korea and Europe last year, and we got clearance for SP in Japan and Europe. Japan last quarter, Europe this quarter. And so now we've moved into launch phase for both those platforms in each of those countries, and it's exciting to have that expansion and see how those products do in the markets. And obviously, that gives us incremental ability to drive the top line. I know U.S. system placements were strong last year, and again, that's tied to procedure growth in some sense.
The procedure growth that we saw last year drove the need for expanded capacity in many international markets. So snapshot on Q1 results, you can see in the middle column, where we guided on the earnings call last quarter. You can see that procedure growth is 14-17, a little bit of leverage relative to procedure growth on our investment guidance or our spending guidance. So I really wanted to go through the milestones on the right. There's some relatively significant milestones for the company. So we got our fifth-generation platform cleared in the U.S. in the middle of March, and the reaction to that, early days, has been really strong. We had the opportunity to have our version of Macworld and attend the SAGES conference last week, and the reaction has been overwhelming so far.
Obviously, we have to work through that launch over, over the next year or two. We got Europe SP cleared in Europe in January. We placed eight systems in Q1 in Europe for SP, and I think the teams there are really excited around the areas of differentiation for, for SP. Ion got cleared in China in Q1 by NMPA, which is the regulatory body there. Clearance in China is a long regulatory timeline and a lot of effort, but, lung cancer incidence rate in China is almost half of the global burden, and so, a large opportunity for Ion there to improve outcomes in terms of biopsying lung cancer and doing so at an earlier stage. And as I mentioned, we improved some of the supply constraints, particularly the catheter in Q1. We have to continue that through the rest of the year.
So over an extended period, you can see our procedure growth in the dark blue is general surgery. You can see that's been an increasing contributor to procedure growth. As a reminder, in 2023, with that 22% procedure growth, that was above our longer-term historical averages and reflected, to some extent, some patients that had deferred care during the pandemic that kind of got treated as electives in 2023. And so the guidance we have then for 2024, in some ways reflects a tough comparison to the inflated 2023 procedure performance. But guidance 14%-17% procedure growth for 2024. And if you look at sources of growth, where do you see differentiated growth in our soft tissue surgery business?
You can see at the top there, outside of urology, that next set of procedure curves in our international business grew at 35%, well above the average of 22% last year. And again, that's where we're now starting to see early-stage adoption in hysterectomy, in colorectal, in thoracic, this next set of cancer procedures, and some early-stage growth internationally in benign procedures, which is brilliant. And then general surgery in the U.S. at 25%, you can see that's a big portion of the total stack, but that is also appreciated from a growth perspective. Just one point on our revenue trend. We have been, with intention, increasing the proportion of our revenue that's recurring revenue. That basically means revenue we earn that happens as customers use our products. So you can see back in 2016, that was 71% of revenue.
This last quarter is 86% of revenue, and we think that better matches our performance with usage of our products, and therefore, we align our interests with the, with the interests of our customers. It also gives us greater financial predictability and stability. On the left is system placements, and you'll see in the light blue this kind of decreasing proportion that are trading. And that's because we've been coming towards the end of an Xi trading cycle. Xi is our third-generation system, and da Vinci 5 is too early to kind of trigger the next trading cycle. We have to move into broad launch before you can see that. Broad launch won't be before next year. And so you can see that that's affected total system placements.
But in dark blue, that's where we're placing systems at either new customers or existing customers who are expanding capacity. And you can see then the impact of that on the right with the install base. And actually, install base growth in 2023 accelerated from the prior year. We grew that 14%. This is a, I think, a really interesting chart. So what it shows is the phases that a customer goes through with respect to adoption of robotic-assisted surgery or da Vinci surgery. On the left, integrated networks, companies that have many, many hospitals in their network. So for our IDNs, how many of them have 20 or more da Vinci systems across their network? And you can see how that's trended over time, and in Q1, the number of them grew by 30%.
And if you look on the right, then in the four walls of an individual hospital, how many of those individual hospitals have seven or more da Vinci systems in those four walls? And you can see that grew by 52%. And this is where we see many of our customers moving from. They're operationalizing their robotics program, so they're standardizing now on robotic-assisted surgery. And it's a function of their understanding of the clinical benefits and the fact that it's economically attractive because you get low complication rates, because you have lower length of stay. And those things, as you look at total cost to treat, not just direct costs, provide an economic return. And as part of that, then that reflects engagements we have with customers on working with them on their own data and assessing the efficacy of their program, again, clinically and economically.
Ion, we introduced in 2019. It's our endoluminal system. First indication is biopsies for lung cancer, which is the cancer that has the greatest mortality rates. You can see our installed base on the top, 604, that's up 60% from a year ago, driven by procedure growth, which is up 90% from a year ago. We're only cleared, this only reflects systems and procedures done in the U.S., although we did place four systems in Q1 in the U.K. after the clearance in Europe. But if you look at what drives that growth, that performance, it's really grounded in the architecture of the product and the associated clinical benefits relative to alternatives.
Our single-port system, 201 systems in the installed base, that's up 55% from a year ago. You can see procedure growth, 60%. That's actually an acceleration in growth from the prior quarter. At the bottom in the teal color, you can see we now have broad clearance across a broad set of procedures in Korea, Japan, and Europe. Japan and Europe are recent clearances. In the U.S., we have to go indication by indication, in terms of getting clearances with the FDA. But whilst that's not at the same degree in terms of installed base size as, as Ion, it's progressing nicely, and that's a platform that's highly leveraged. The surgeon console and vision tower are the same as Xi, part of the fourth-generation family and, and within our da Vinci business.
So as part of how we operate, we do look externally, we do talk to our customers, and we ask the question: "What's important to you?" And obviously, we've been, if you look at the last four years, through a difficult period with the pandemic. And so this is what customers are telling us are the most important priorities for them. And we obviously ask that question so that we can ensure that how we're operating matches their priorities. Staffing continues to be a significant challenge. Obviously, it was very difficult during the pandemic. But it continues to be a challenge, both finding and keeping staffing at hospitals. Operating margins at hospitals generally are quite low for that industry and have not recovered yet back to pre-pandemic levels.
We see, we all see what's happened with opioid, opioid addiction in the U.S. and the extent to which that's impacted healthcare outcomes across the U.S. And so one of the value propositions of da Vinci surgery is, with it being minimally invasive, you need less pain medication. And so each of these are areas we believe that we have the, the ability to help our customers, and these are the top four things that they're describing to us. And so the question is: how can we help? And, and at the kind of highest level, we can, of course, use R&D, use ingenuity to improve our products and their capabilities to improve patient outcomes. But we can also help surgeons both become robotic surgeons more quickly and narrow the variability of performance, and that's part of our strategy.
If you look at then raising our capability, of course, in March, we had da Vinci 5 cleared in the U.S., and we think this is transformative in terms of how surgery is performed, and I want to describe that for a second. Compute power is up significantly. That enables many of the features in the system, but it also creates the foundation for how we can add to the ecosystem over time. There are digital capabilities that we can add over the coming years that continue to enhance the capability of the system. If you look at the actual control of the system by a surgeon and the precision by which it operates, that's a significant improvement in terms of inertia, smoothness, and control.
The imaging system, which has always been an area we've got strong positive feedback from customers, has improved once again. The color is much better. When you use Firefly, it's improved significantly, and we think it matters with respect to what the surgeon will see as they perform surgery. Something that we've heard very strongly in the initial use of the product, early feedback from the customer, there's a whole set of features, integrated installation, guided tool exchange, a whole set of features that make a real difference to how long it takes to do a case, and minutes actually matter in a procedure. Within that, we're giving the surgeon greater autonomy in terms of how they control the system. They don't have to ask somebody else in the room to actually press the button or make the change in configuration.
They can do it themselves from how we've changed the user, user interface and the level of integration. And that can make a real difference then to what's the cost of the program, how many staff do you need in the room, how many procedures can you do in a day? The surgeon console has significantly improved the ergonomic capability. The industrial design of that console is fantastic and has also received really good feedback so far. And then something that we think could be a game changer, we want to collect evidence to support that, is the force feedback capability, where now a surgeon can feel force as they're retracting tissue, as they're suturing. And not only can they feel it as they do the procedure and use the instrument, but we can measure it. And they...
We have an AI companion tool that they have access to with da Vinci 5, where they can see the forces being applied in every step of the procedure. That level of data gives us opportunities over time to help realize what could be a benefit to patient outcomes. If you can do gentler surgery, you can get better outcomes, and force will be key to doing gentler surgery. So on the other side, then, how do we help new surgeons become robotically trained more quickly? How do we reduce variability? And here it's around what we call data science. And we use the framing data science or the use of the word science because we want it to be evidence-based. We're very much an evidence-based company or science-based company.
And if you look at, kind of the set of capabilities in our ecosystem, each one of these that you see here, at using Hub to capture video, capturing how much force is applied during the procedure, each one of those become data sets to which we can do advanced analytics, machine learning, that you can bring together to bring advantages to, to our surgeons. And so there's a real advantage in having curated data that has integrity, that is relevant to then it serve as a basis for these highly capable machine learning and AI engineers to do both analytics and generate insights for our customers. And we think there's real potential here. And of course, we've done 15 million procedures.
Not all of those feed right into what I just described, but we have a substantial lead in terms of our experience set in soft tissue surgery. Much of that is in our data sets, and obviously, we'll expand upon that with use of da Vinci 5 and the additional sensors and data sets that will be collected. And the objective here then is to create this positive loop or this virtuous data loop. As you collect data, you can generate insights that allows your surgeons to change what they actually do so that they can improve, and that creates an additional loop. As they take action, you measure whether they improve, and it creates this loop here. And Case Insights, which comes with da Vinci 5, is our first foray into doing this.
It's a product where you can provide surgeons objective performance indicators on what they're doing in a particular procedure at a certain step and compare it to an expert surgeon. And that can then point them to our skill simulator to do simulation exercises to help them improve how they're doing on that performance, objective performance indicator. That's an early example of the potential in this world. And so ultimately, the objective of many of our digital capabilities is what's listed here. We want to improve outcome. We want to have a better, more effective care team that supports the surgeon and be more efficient in surgery. No matter the company's success or position in the marketplace, we will never lose sight of the customer.
We routinely measure how our customers view Intuitive, our products, how we operate, how we interact with them. We've been doing this for several years. It's a blinded survey done by an independent party. Above 70 is world-class. If you look at the last three surveys, we've slightly improved each time, and we are deeply committed to ensuring that that's how customers continue to see us. Lastly, our priorities for this year. Innovation is key to our success. We have a number of new products that have been cleared, that are in the launch phase, and we want those launches to go well. We want customers to realize the benefits of the value that we're bringing to the markets. We have a set of growth objectives.
Those are focused at a procedure and country level, and obviously, we want to achieve those objectives. We have an objective to improve gross margin over time. A companion to that is great product quality, which we think is important to the customer experience. And finally, as we grow, we're going to look to leverage a subset of functions in the company because they have the opportunity to benefit from economies of scale. And with that, I think we will invite any questions.
Thank you, Jamie. Before we actually open it up for questions, Gary Guthart, who's traveling internationally on business, I think, would like to make a couple of comments. So if the technology works, Gary, if you can, jump in.
Yeah. Can you hear me, Craig? Thank you.
Yes, we can. Please go ahead.
Yeah. I think it's important to pause for a minute and to acknowledge the distinguished service of a couple of our board members who are at their last shareholder meeting with us, and that's Don Kania and Alan Levy. They are great leaders, and we are blessed and grateful for their service. So I know Alan's in the room with you today. If you see him, please shake his hand. And what a joy it has been to work with him over this period. It's really been fantastic, and likewise, Don. And I think I heard in the hubbub, as people walking into the room, Lonnie Smith's name or his voice. So if Lonnie's there, I think he is. Speaking of great leaders, another great leader. And Lonnie, are you there?
Yes.
Fantastic. Anyway, before we get to the Q&A, and I think Jamie and Dave will do a fantastic job answering your questions, and I'm here if they want to call on me. I think it's worthwhile recognizing the contributions of those great people. Thank you.
Thanks. Yeah. So let me turn it back over to Jamie and Dave. And of course, the whole board is here for any questions. So let's open it up for questions live, and then we'll also turn online. Please use the chat box for questions if you're remote. Can we get a microphone, please?
Harold Kellman, a longtime stockholder. Every year I go to ASCO, and this last year, it was really strange in that they have new terms, financial toxicity. The FDA, if you're not a drug company, which is good, but if you're a drug company and have expensive drugs, they go out of their way to not approve it. Now, you have a product which costs $1.5 million, which doesn't increase in price, which is good, but are you seeing any kind of feedback with this so-called financial toxicity, where the FDA doesn't want to have, to have to pay increased costs like the drug companies?
Jamie, a comment.
Thank you. I'll let Dave supplement my answer, but I have not seen that come up at all in any of our internal conversations. Maybe you have it from the field perspective, Dave, but I have not seen that come up at all.
No, I haven't. And it turns out that the FDA or Medicare, you know, the payers don't really pay more, and sometimes they pay less. And so there's not a differentiated reimbursement-
...for robotic surgery done by da Vinci as compared to minimally invasive surgery with manual instruments or laparoscopy. So really the core here is actually saving money for the healthcare system because of the better outcomes, mostly.
Thank you. Additional questions live?
There was a slide with the number of units and the number of procedures per year. It averaged out to something like 30-some-odd a year. Is that consistent, and is that good, bad, or indifferent? What do you think about that?
I am not remembering the slide. So for da Vinci global average-
Well, not the da Vinci, obviously, the Ion, I think it was the chart you had.
Yeah, yeah. Ion runs around 135 procedures per system per year. So it is quite a bit below da Vinci. It basically reflects two things. One, where it is in its life cycle being much earlier in terms of the launch period, and you've got a number of customers that are ramping. And then it, it's a one indication product at this point versus da Vinci, that let's say, runs at 320 procedures per system per year. So you have multiple specialties running on, let's say, the Xi, versus today, it's just lung cancer biopsy for Ion. There are customers that have utilization much higher than that.
That largely reflects the nature of the institution, how many patients they're seeing, are they specialized, and are they having patients kind of sent to them from a larger distance to that facility because they're specialized? But I would expect over time, the utilization for Ion to climb, and it has been consistently over time.
Thank you. Any additional in-person questions? Let's turn online to see if there are any online questions.
No questions that have been submitted online.
Okay, so no online submitted questions. Last call for questions. Well, thank you, everyone. We'd like to conclude the meeting. We'd like to invite our in-person visitors and investors, shareholders to meet back at the lobby, and I think we'll have a small, short demo that folks are welcome to attend, so as an optional part of the meeting. So thank you very much, and we look forward to seeing you next year. Thank you.
This now concludes the meeting. Thank you for joining, and have a pleasant rest of your day.