Welcome to the annual meeting for Intuitive Surgical. Our host for today's call is Craig Barratt, Chair of the Board. I will now turn the call over to your host. Mr. Barratt, you may begin.
Good afternoon, everyone. I am Craig Barratt, Chair of the Board of Directors of Intuitive. I welcome you to the 2025 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 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.
If I ask you to stand up briefly as I introduce you, in addition to myself, our Directors are Joseph Beery, a director since 2020; Louis Chu, a Director since 2024; Dr. Gary Guthart, Chief Executive Officer Intuitive and a director since 2009; Amal Johnson, a Director since 2010; Sreelakshmi Kolli , a Director since 2023; Dr. Amy Ladd, a director since 2019, Keith Leonard, a Director since 2016, Jami Dover Nachtsheim, a Director since 2017, Dr. Monica Reed, a Director since 2021, Dave Rosa, President of Intuitive and a Director since 2024, and Mark Rubash, a Director since 2007. Other officers and members of the management team of the company, online or in person with us today, are Jamie Samath, Executive Vice President, Chief Financial Officer, and Enterprise Technology Leader, Gary Loeb, Executive Vice President and Chief Legal and Compliance Officer, Dan Connolly, Vice President Investor Relations, and Corey Balliet, Vice President Corporate Law, Governance, and Corporate Secretary.
I would also like to introduce Kris Veaco, Principal at Veaco Group and Inspector of Election, and Christian Gurtner, Partner at PricewaterhouseCoopers LLP, the company's independent registered public accounting firm. Mr. Balliet will act as Secretary of this meeting.
Let me begin with a brief overview 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 of the meeting: consideration of the proposals described in our proxy statement. After the conclusion of the formal business, Dr. Guthart 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 3:03 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 March 3, 2025, 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 portal, our web portal, for any stockholder wishing to inspect it.
The stockholder list shows that, as of the record date, there were 358,274,567 shares of common stock outstanding and entitled to vote at this meeting. I also have an affidavit certifying that, commencing on March 18, 2025, either a notice of internet availability of the proxy materials or the proxy materials themselves were sent by email or by the United States Mail to all stockholders of record at the close of business on March 3, 2025. Kris Veaco, who's 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 this 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 3:05 P.M., and the polls are open for voting on all matters to be presented. The polls will be closed for 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 2026 annual meeting of stockholders: Dr. Craig Barratt, Mr. Joseph Beery, Mr. Louis Chu, Dr. Gary Guthart, Ms. Amal Johnson, Ms. Sreelakshmi Kolli , Dr. Amy Ladd, Mr. Keith Leonard, Ms. Jami Dover Nachtsheim, Dr. Monica Reed, and Mr. David Rosa. 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 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 ending December 31, 2025. The Board of Directors recommends that the 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, 2025. 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 stockholders vote for the amendment and restatement of the amended and restated 2010 incentive award plan. The fifth item of business is the consideration of the stockholder proposal purportedly to improve the executive compensation program. 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 Mr. Jing Zhao, recommending that the company improve the executive compensation program to include the CEO pay ratio factor. At this time, a chair recognizes Mr. Zhao for a period of two minutes. The time will begin as soon as the representative starts speaking. Please go ahead.
Good afternoon, fellow shareholders. Since we all have read my proposal, there's no need to repeat the content. I would like to express my disagreement with the board's operating statement. First, our executive compensation program methodology is structurally flawed. I was trained as an expert in social research methodology, so I know how easily to abuse the same data to make up different result numbers as our proxy statement shows. For example, there's no need to invent five categories of compensation: salary, stock award, option award, non-equity incentive plan compensation, or other compensation to make the 10% complicated and misleading. Second, there's no need to hire an outside firm to say what the board wanted to hear because all outside parties manipulate the data. To increase the compensation assumed from all companies' compensation result.
Third, my proposal will bring the stable, simple methodology with the certainty and the clarity to determine the CEO pay ratio. Furthermore, in general, according to Wall Street Journal, April 23, 2025, the whales have gotten richer and control record shares of American wealth. This is not sustainable for our economy, and it's not sustainable for our corporation. Thank you very much.
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. The sixth and final item of business is the consideration of the stockholder proposal titled "Shareholder Approval Requirement for Excessive Golden Parachutes." 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 Mr. John Chevedden, requesting that the Board of Directors seek shareholder approval of new or renewed golden parachutes for our named executive officers. At this time, the chair recognizes Mr. Chevedden for a period of two minutes. This time will begin as soon as the representative starts speaking.
Hello, this is John Chevedden. Proposal six, shareholder approval requirement for excessive golden parachutes. Shareholders requests that the Board of Directors seek shareholder approval of any senior manager's new or renewed pay package that provides for termination payments with an estimated value exceeding 2.99 times the sum of the executive's base salary plus target short-term bonus. This proposal only applies to the named executive officers. This provision shall at least be included in the governance guidelines of the company. The board shall retain the option to seek shareholder approval after material terms are agreed upon. Unfortunately, many companies only limit cash golden parachutes to the 2.99 figure, which means that there's no limit on non-cash golden parachutes for which shareholders have no voting power. This proposal is relevant even if there are current golden parachute limits. The limit on golden parachutes is like a speed limit.
A speed limit by itself does not guarantee that the speed limit will never be exceeded. Like this proposal, the rules associated with the speed limit provide consequences if the limit is exceeded. With this proposal, the consequences are a non-binding shareholder vote is required for unreasonably rich golden parachutes. This proposal places no limit on long-term equity pay or any other type pay. This proposal thus has no impact on the ability to attract executive talent and does not discourage the use of long-term equity pay because it places no limit on golden parachutes. It simply requires that overly rich golden parachutes be subject to a non-binding shareholder vote at a shareholder meeting already scheduled for other matters. This proposal is relevant because the annual state and executive pay vote does not have a separate section for approving or rejecting golden parachutes.
This proposal received between 51% and 65% support at FedEx, Spirit AeroSystems, Alaska Air, and Pfizer. This proposal is more important at Intuitive Surgical since Intuitive Surgical ranks seven in regard to executive pay with 10 being the worst possible score.
Mr. Chevedden, for two minutes.
Please vote yes. Shareholder approval requirement for excessive golden parachutes, proposal six.
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 these six proposals, either in person? 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 the internet and who do not wish to change their vote do not need to take any further action.
Only stockholders of record on March 3, 2025, or their proxy holders are eligible to vote at this meeting. We are now going to take a short pause to allow for our stockholders who have not yet voted to do so. The polls are about to close. The time is 3:16 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 for the board to the Board of Directors: Dr. Craig Barratt, Mr. Joseph Beery, Mr. Louis Chu, Dr. Gary Guthart, Ms. Amal Johnson, Ms. Sreelakshmi Kolli , Dr. Amy Ladd, Mr. Keith Leonard, Ms. Jami Dover Nachtsheim, Dr. Monica Reed, and Mr. David Rosa. Each is hereby elected to the Board of Directors to serve until the 2026 annual meeting of stockholders.
In addition, the Inspector of Election's 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, 2025, 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 stockholder proposal purportedly to improve the executive compensation program is rejected. The stockholder proposal titled "Shareholder Approval Requirement for Excessive Golden Parachutes" 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 the meeting. This meeting is adjourned at 3:18 P.M. Now I will turn it over to Dr. Guthart for a presentation on our business. Gary.
Thank you, Craig.
How many folks are Intuitive folks?
All right.
Welcome to our shareholders. Great to see the two of you.
Thanks to him.
We appreciate that. That's great. Pardon me, I'm just going to do a couple of things here, and then we'll get to it. First, before I get into the presentation, I want to take a moment to acknowledge one of our long-serving board members for whom this is their last shareholder meeting. That's Mark Rubash. Mark, as you heard earlier, joined the board in 2007. He has had a storied career around the Valley and has been chair of our audit committee for many years, preceding our current chair, Louis. Also outstanding. I just wanted to acknowledge all of Mark's contributions. He is highly disciplined. He is deeply insightful, and he has brought a lot of value to this community of all of ours. If we could acknowledge Mark, that would help.
Before I get into the presentation itself, note that the following discussion contains forward-looking statements and the company's actual results may differ materially from those discussed here. Additional information concerning factors that could cause a difference can be found in the company's annual report on Form 10-K for the fiscal year ended December 31, 2024, as updated on the company's other filings page and our SEC documentation. You can find it on our investor website. With that, I'll take you into a little bit of how we think about the business, and then I'm interested to answer your questions, and I'll ask our leadership team to join me in that. It's easy to come to shareholder meetings and earnings calls and things like that and start talking about market sizes and earnings and tariffs and those kinds of things.
Let's start with why we're here, what the company is about. For us, we really start looking at where are there really difficult problems in healthcare. We have a team that looks from the bottom of the human being's feet to the top of your head and asks the question, "Where are outcomes not very good? And what could a technology-enabled ecosystem, which is what we view ourselves as, where could that make a difference in people's lives in a substantial way? Not a 3% change. Can we make something substantively better?" I'm just going to give you three examples of which there are tens. There's nothing particularly special about these three, just that they're easy stories to tell quickly. First one, lung cancer.
You have seen our Ion product line in the market do really well, and it's about earlier definitive diagnosis of lung cancer through biopsy. That's what it's about. It turns out that for the average American walking around with lung cancer, it could have been detected. It was detectable for about a year before they had it detected. This is the number one cancer killer in the United States. People are walking around with it. Somebody somewhere could have found it, and it was not found. It was growing in their body for years before that detection limit. That's what Ion is about. Ion, the technology is a computer-controlled catheter that can reach deeply into your body with high precision. That's the technology.
What it really is, is a lung cancer finder that pulls forward the detection of lung cancer when, if you do something about it, somebody's long-term outcome is substantially better, and their course of treatment, their experience of that course of treatment is substantially better. Does that make sense? We start there. You do that well, then, okay, we have a product line and we can bring it to market. Turning to another one, endometriosis in women. Endometriosis is typically causing pain and symptoms. It's symptomatic for five years in the U.S. before a woman is definitively diagnosed and even longer before there's treatment. Somebody is suffering from the disease for five years prior to diagnosis. I think that's crazy. It bothers me. It's actually upsetting. I find that upsetting. Another example, mitral valve repair and replacement.
In the United States, for the average person who needs a mitral valve replacement or repair surgery, if they undergo surgery, the mortality is on average 7% in the first year. After that surgery, seven will have passed. I think these are patients who need care, and that's a sobering, bothersome statistic. This is where we start, and there's a whole set of pages of other things, but that's the top of the tree. What that drives for us in priorities, this is a prioritized list. I think this list was first written for the company, and I suspect it was 1999, it was about then. I think Lonnie, when he came in, he joined in 1997. I think he wrote this list 1998 or 1999. He said, "It's in priority order. The first thing is to make sure we deliver value for patients.
We're not healthcare providers, so how do we do that? We got to make sure that the healthcare provider, that's the physician, in this case, the surgeon, gets value out of our products. Patient value, that's about outcomes and dignity and respect the patient journey. Surgeon value, that's about helping surgeons get to repeatable great outcomes in products that they can learn how to use well and in a company that they can depend upon. Surgeons don't buy our products, and patients don't buy our products. Hospitals do. Hospitals are the first place we get revenue, and what's a hospital want? They want to treat their patient community. They have a mission to care for their catchment area, and they need a return on investment. They need an ROI, otherwise they can't keep doing it. Where's hospital revenue come from? Insurance companies, payers.
Sometimes the government is the insurer. And what do they want? They want the lowest total cost to treat per patient episode. They want to be able to make sure they can offer good care at an affordable price. None of this happens without human beings. It's not automated. It's not about to be automated. And AI isn't about to take all our jobs, just so you know. What does that mean? That means that we need an employee population that is mission-driven, that is committed to this, that is highly engaged and highly competent. Finally, we are all shareholders, and we want our employees to be shareholders. Shareholders on the list, and what do we expect there? We want an outstanding risk-adjusted return for our shareholders.
We're on the list, but they're on the list last, and it's because if you don't do the things above, you'll destroy the value. We keep in mind the prioritized list, and we use it as an active decision-making tool, not a poster. Our customers, what do our customers want? In their words, this is their language, and we have adopted their language to make sure that we're highly aligned with them, and they want the quintuple aim. If you're a providing group or a hospital, what are you after? You want to make sure that you're providing great outcomes for your patient population. You want to have great patient experiences. They measure themselves against this. Turns out it's really hard to work in healthcare. Several of our hardworking board members work on this side of the fence. They are in hospitals.
That is a hard job, whether it's administration or surgery or nursing or anesthesia. These are complex environments, and we want to make sure that we help that care team experience, that they want to use our products. If we have great products they don't want to use them, we have made a mistake. You want to lower the total cost to treat per patient episode. That isn't just the cost of the object we sell them, the total value that we bring, right? Total cost of ownership. Finally, we want to make sure that everybody has access to great care. In the last couple of years, we've looked at that really carefully. Sometimes you might think, "Well, maybe that's a state-by-state thing.
Maybe great care is about whether you're in the red state or blue state, and that's not great. Maybe you say, "No, no, no. Maybe it's about cities. In this city, you're going to get great care, and you're in that city, maybe you don't get great care." That's not true either. If you look at the data, it's zip code by zip code. You can be four miles apart from two different hospitals, and they will offer you two different standards of care. We can make a difference in that. In fact, we have. If you look at the data that's starting to come through, it looks really exciting. That is what is ahead of our mission. That precedes our mission and our vision. You can look this up.
I will not read them to you, but these are powerful for us, and they are aligned. The motives that I've described prior are the things that inform the mission and vision, and they are alive for us. These are living things in our minds, in our hearts. Just some statistics. Now we're finally into a shareholder meeting. Gosh, Gary, you made me listen to all that. Okay, let's get into it. Trailing 12 months, I'm sorry, in 2024, just about 2.7 million procedures performed by customers using our products. There are now the total database, a little more than 17 million, almost 18 million procedures performed in lifetime. Bigger than we were, but smaller than we'll be. The opportunity is substantially bigger going forward than it is looking in the rearview mirror. There are now over 11,000 of our platforms operating in clinical environments somewhere.
The publication, the clinical validation peer-reviewed publications, the arrival rates are more than 4,000 per year. We do invest in clinical trials. Our investments, we think that's important, represent less than 5% of that total 4,000. Almost all of this is done independently of Intuitive. I think that's powerful. I think that's a really powerful statement. The peer-reviewed database is extremely large. Just looking back at 2024, this is one of our disciplines, is to talk about what we set out to achieve and then to do an honest assessment, an honest report card. How did we do? Every year has its positives and its challenges. The objectives, we wanted to make sure that we expanded our indications and launched our new platforms, including da Vinci 5. It goes fast, but remember at the beginning of 2024, we had not launched.
It's about a year ago that we launched, which is terrific. We continue to want to help our customers use our products. We want to help enable and support adoption in different procedures in different countries. We want to make sure that we are focusing on the quality of our products, our supply chains, and to manage our gross margin, particularly on our new products. Supply chain is probably something none of us thought a lot about 10 years ago. It's something that you cannot go 10 minutes without thinking about today between COVID and now tariffs. We want to increase our productivity. We want to be a highly productive organization in those parts of our company that are benefiting from our scale growth. As we become more efficient, that frees money, and that money can be used to reinvest in the business, particularly focused on innovation and growth.
Every year has its challenges. There have been environmental uncertainty in China over multiple issues. It has only increased in the last several months. The rise of GLP-1 drugs has changed the surgery market for bariatric surgery. We understand that. I think for patients, that's a wonderful choice. That has decreased the amount of bariatric surgery that has happened. It has continued to decrease through the year. At some point, we think it'll bottom out. It'll even out. We haven't seen that yet. We think these things are actually complementary. We don't think GLP-1s will make surgery go away forever. It's changing the care pathway for patients, and it takes a little while for that all to work its way through. We've had some healthcare worker strikes around the world, and we've had a durable one in Korea. That was difficult in 2024.
They're still on strike, but it's become more manageable for the Intuitive side of the business in 2025. We've had strength in U.S. general surgery. Adoption by general surgeons here has been great. Da Vinci 5 launched really nicely. The executives who represent those teams are in the row from Dave, Mark Brosius in the back, Chris Carlson in that big hand in it. This is a great product. The response has been fantastic. Our operations team's response to bring it to market has been wonderful. Our U.S. capital performance has been really good. Our commercial teams have done a great job placing systems. We've seen a lot of demand for our product here. It's been wonderful. We continue to expand our platforms on an SP around the world, and that takes regulatory clearances. It takes operational work to make that happen. It takes go-to-market and market-enablement work to do it.
Teams have done a really nice job. When you combine those things, we've had really strong financial performance. That starts at the top. People want to use our products. Our teams can execute well. Our finance teams do a great job supporting the business, and that falls through to the bottom line. We've done well. Just a quick touch-in on Q1, just updating on what the past year was. 17% year-over-year growth rate. That does not account for some days' difference between the prior year. If you did day-equilibrated, it's a little higher than that, Jamie. Is that right?
18 and a half, yes.
Yeah. We had fewer working days in Q1 because of the leap year in the prior year. We are doing fine. I think the procedure growth side has been good. Revenue up 19% year-over-year is strong.
Install-based growth of 15% is good on a 17% procedure growth rate. 15% install-based growth is great. Gross margins have been not perfect for some reasons that we will talk about, but okay. Our guidance is 15-17%. I think we, Dan, we ticked up the bottom end of that guidance and earnings group at the earnings call. And our investment guidance stays unchanged. So far, I've touched on the highlights already. You've seen it, and so far, so good. We just got our clearance for a stapler and SP. We're starting to see nice momentum in procedure growth and SP. I think we had shared the earnings, the procedure growth on earnings for SP. It was how much?
She did. Yeah, 94%.
94%. Almost a doubling year-over-year, which is really good. You're starting to see SP take wing.
The SP stapler will help us further upgrade. This is what the procedure trend looks like. A nice up and to the right chart, no surprise there. You can see in the different colors the segment, general surgery versus urology versus gynecology. You can see that general surgery is becoming the largest of the single segments, but healthy businesses across the segments. If you look at what's outgoing, what are your high growers? 17% overall. We're having growth beyond urology outside the U.S. We're seeing multidisciplinary use outside the U.S. That's great. That means that we think that adoption paradigms we see in the U.S. can start to take hold in other places, other countries. General surgery, while it's big, is also growing faster than the average. It's both big and fast-growing.
We also have strong growth, you'll see in a minute, in after-hours procedures. This has been the revenue trend. The thing to point out here, nice growth up and to the right. The thing to point out here is how much is recurring. Recurring is utilization. That's instruments and accessories. It's also in our service contracts, and it's in our leasing portfolio. True? Yes. That means we have reasonably predictable sources of revenue. What I like about recurring revenue is you have to earn it every day. Capital, you go out, you sell it. In recurring revenue, that's used through customer satisfaction and ongoing utilization. That's been powerful for us. This is what the capital trends look like. Capital can be lumpier than utilization. Capital budgets can come and go. Economic stresses can put pressure on capital. We see that in the U.K.
We see it in Germany, where different political things going on inside health ministries can put constraints on capital. You see it being lumpier, but a good year last year in what our install-based growth has been. We often look at how existing customers want to build their business. It is an indication that somebody who owns a system already and buys their second or third is a vote of confidence. When you buy your first one, it is often a pilot. Is this something that is going to bring the value I expect it to bring? When you buy your second, third, or your seventh, you know exactly the value it brings because you can analyze it in your own hands. I think that has been powerful. What you see on the left chart is the number of integrated delivery networks.
This is corporate ownership groups of hospitals that own 20 or more within their group. These are highly sophisticated businesses that can analyze the performance of robotic surgery in their own hands. You are seeing that grow nicely over time. It was 8% in the first quarter. If you ask an individual building, if our building right here was a hospital, how many individual hospital buildings have seven or more da Vincis in them? You have to walk to the eighth OR before you find one without da Vinci in it. That has been growing at almost 50% a year. This is this idea of standardization. We are bringing a lot of value. Our existing customers want to keep building capacity. We think that is a good indicator of satisfaction. We have had a really wonderful da Vinci 5 first launch. This was a limited launch. That is to do two things.
We want to make sure we learn from those first experiences. We want to be able to stabilize things like software. We want to help our supply chain come up to speed. This was, I'd say, exceeded our expectations. In the first, this is through Q1 of 2025, we have almost 510 systems, 509 out. 64,000 procedures have been done, slightly more than that. Over 41 different types of procedures on those products and over 4,000 different surgeons using it. As a limited launch, it's been wonderful. We have been talking to you for the last several years about supplying the globe at industrial scale. What does industrial scale mean? Why do we say those words? What it says now is that we are fully embedded in surgical practice. We have Dr. Reed on our board, who's a physician leader at a hospital.
If you say, "Hey, you're going to do a significant fraction of your surgical procedures on a da Vinci, it better work," and you can't stock out, your supplies have to be there on time, we have to be predictable for you, quality has to be great, you don't want to be recalling things every 10 minutes. This is what industrial scale means. We want to do that around the globe. I think we're present now in 70 countries, Jamie. That's what we're talking about, being an outstanding supplier at industrial scale across 70 countries. It's easy to say. Mark and his team can attest that it's hard to do. We have done a beautiful job putting factories where they ought to be, increasing factory automation, bringing our IT systems and enterprise software up to levels that allow us to drive and track.
Mark has done a wonderful job driving the logistics systems in our company to be able to get things where they ought to be at a good price and to handle the trade shocks that have been going on. That is what we have been doing. This is the kind of thing that is a duck traveling across the pond. It can look calm on top. The legs are turning underneath. This has been really good. We measure independently. We anonymously go out and ask our customers what they think of us. We use a thing called Net Promoter Score. We want to do this routinely. The way this works is you talk to folks, and it indexes on who would recommend your product and your company as one to work with, I am sorry. An outstanding score is above 70. That is world-class.
The big brands you know of are above 70. We're running at 75. Down just a tick from the prior year. Launch years tend to do that. Tends to generate a tiny bit of stress. That we're still at 75 in a big launch year is good. Dave has been a passionate leader of this. Make sure that our customers communicate with us how we're doing in their words and their terms. We track this and drive it. Why is that? We have products that do what they say. We are able to deliver on our claims. Our training is world-class. Our teams are highly respected and solutions-oriented. If we have a problem up to it, we acknowledge it and we deal with it. I think we are viewed as quick and transparent when there's an issue.
I think these are things that build trust, and we continue to drive them. What are we doing into 2025? We want to get to full launch of DV5. That's incorporating our learnings, some of the new hardware, some of the new software, and to continue to stress our supply chain and manufacturing capability. I think we're doing pretty well in that regard. We want to continue to focus on procedure enablement by country. Some of the things you've seen before, and that's training, commercial enablement, market access, new clearances. We need to keep working on industrial scale. We are not finished. That's positioning our capabilities in various countries around the world and bringing our factory capabilities and some of our IT capabilities as it relates to manufacturing up to snuff. We really want to reach digital excellence. We have built digital products into our pipelines.
DV5 rests on a digital foundation, and we really want to drive excellence and leadership in our digital backend. With that, thank you for your attention. We'll, as a leadership team, take your questions. Yes, sir.
I noticed you didn't mention the word tariffs. You talked about challenges, something not obvious in China. Do you want to modify any of your equipment to get it into China with the current situation? Example, the new financial and the fact that with some of the companies, they have to break down $5.5 billion because they modified their products that could only be sold in China, and then the Trump administration didn't allow them to do it. You don't have any of that kind of problem?
I'm going to turn it to Jamie. Yeah.
I think the particular example you're referring to was in part an export control on that particular product. That particular product, once it was kind of downspecced by the export control and the inventory they had, couldn't be sold into China. For us, we have no such export restrictions. We do have 125% tariffs for products that we manufacture in the U.S. that are imported into China for sale to Chinese customers. That's a significant financial impact for us. On the last earnings call, we said the totality of all tariffs is about a 1.7% of revenue impact for us this year.
Okay, but for da Vinci 5, you didn't hear any problem with terms of leading edge with China or the Trump administration?
The da Vinci 5 currently is not cleared to be sold in China. It's not applicable.
There's nothing that I'm aware of yet that would prevent that should we get da Vinci 5 cleared in China, but it's not cleared at this point. Thank you. Any other questions in the room? We do have a couple of questions coming in online. One is related to tariffs, which we just touched on. There was a second part of that. Jamie, what's being done to minimize the impact on tariffs? That's the first question from an unnamed shareholder. Yeah, maybe principles by which we'll respond to the trade environment. I think what we're looking to do first is let the trade environment settle, let it stabilize because it is kind of moving up and down and changing quite frequently. We don't want to be responding to every headline and every change and then having to backtrack. We've got to let things stabilize.
Concurrently with that, because it'll settle at some point, we have a set of workstreams where we're evaluating what we might do with respect to how our supply chain operates, what our workflows are, other sets of things that might mitigate the impact of tariffs. Really the question for us is when it settles, what is the durable impact in the medium and longer term, and then that allows us to decide what we would do already to discuss the specifics of what that might be.
Second question from an individual shareholder, Eric Marks, asking broadly, how is Intuitive leveraging artificial intelligence and data analytics to improve surgical outcomes and drive value for hospitals and providers?
Yeah, I like that question. Let's just demystify AI a little bit. Think of it, I want you to think of it as a layer cake.
At the base layer, it's the one that folks don't, it's not exciting, but it's super important. It's exciting to me, but maybe not for many, many others. The biggest thing around AI capability is access to high-quality, meaningful data that is cybersecure, privacy compliant, and differentiated. I'm a math major. I'm a math PhD. The math here is a commodity. The math is generally undifferentiated. What differentiates something that's going to matter to people is going to be, do you have good data sources? Have you built the trust in the pipes to get that data? That is the first thing we are working on. We have been the Internet of Things with hospitals. We've been cloud-connected to our hospitals for over 15 years. It wasn't something we woke up yesterday and said, "Hey, this is going to be important." That is exciting.
When we brought DV5 to market, these robotic systems are natural data collectors. DV5 has more sensors of more types than prior systems did, which gives us enormous insight into what's happening. The first thing is good data. On top of that, you want to go through and curate the data and start asking questions of it. You can do little things. Who are fast surgeons? Who are slow surgeons? If I have a hospital group and there are 50 hospitals in my hospital group, what are well-functioning, high-turnover, successful robotics programs, and which ones are struggling? What are the differences? We do that work all the time. We call it Custom Hospital Analytics. I think that we have those contracts with roughly 1,000 of our US customers.
We routinely sit down, look at the data with them together, and ask questions about how can we help you optimize your experience. It's a highly successful program. It's been fantastic. We've probably been running CHA today for four or five years, give or take. That's an everyday thing. It's not our future. It's our today. Kind of think of that as big data analysis, big data analytics. The next thing on top of that is you start saying, "Well, how about if I have synchronized real-time data?" I'm watching what's going on in surgery, and I link it to preoperative electronic medical records at a hospital, post-operative patient course. You make that cybersecure and privacy compliant, make sure all that stuff is done right.
You can ask the question, "Okay, if a patient is coming through the health system in a particular way, and then they meet Dr. Guthart in the operating room, and Dr. Guthart operates in this way, what's likely to create a good outcome long-term?" Patients are highly complex, and surgery is highly complex, and surgeon variance is highly complex. Asking that of one surgeon, one patient is really tough. If you ask that question of thousands of surgeons and millions of patients, you can start to see trends. This is the place where people start moving towards self-driving car analogies. Can I look at a lot of data and start inferring what is good surgery? We are working with academic medical centers, with researchers, clinical researchers on this type of research. In fact, da Vinci 5 will accelerate that research.
What they're showing is that indeed, there are certain parts of procedures that are highly sensitive to predict outcome, and that certain kinds of surgical technique are more likely to be correlated to better outcome. They are peer-reviewing those. They're publishing them. It is creating now a database that's being externally examined that starts looking at, "What can you start determining what are predictive capabilities in surgery?" We can also start adding data to the surgeon learning pathway. Think of that as a digital coach. You have your Apple Watch. It tracks your behaviors, and then it starts giving you suggestions or a nudge. "Hey, Gary, it'd be good for you to keep walking, and you didn't get your steps in today, and you might consider the following." If you start having this kind of data, you can imagine a digital coach for care teams.
We're starting to explore that, and we're in the early stages. The early stages of that, with some of the clinical data we're seeing, is that that set of digital nudges starts to work. It looks pretty interesting. It's early. Don't bank anything on that yet, and it needs to be validated. It's just telling you an anecdote. That's the next one. Wait a minute. You're going to ask the next question, which is, "When do we get to automated surgery that I don't need a surgeon?" That's the next one coming. That's the layer cake. Good data, followed by big data analysis, followed by an assessment of, "Can we infer what good surgery is?" You need those three layers of the layer cake. Finally, the top layer is, if you know what good surgery looks like.
Remember, these systems actually can follow a trajectory. They can perform a task. Right now, the surgeon guides that task, but you can automate subtasks. That is a possible thing. Once you know what good surgery is, you can consider automating subtasks. That will take a while. Do not expect that tomorrow. Subtask automation in some places is going to happen relatively quickly. In other places, it would take a long time. It will be a stack that is built that way. Sorry, that was a long answer. I am not interested in this subject at all. Did not even have to check my notes. Anything else?
Y eah, thank you, Gary. Our last relevant question for the session, also from Eric Marks, an individual shareholder. What are the company's capital allocation priorities over the next two to three years?
They remain consistent with how we've described that over many years, actually. First, organic investment in the business, and that's because we see significant opportunity in robotics to make a difference for patients in accordance with actually the priorities that you laid out in that earlier slide. Second, we look for opportunities to get technology from outside the company. Think of that as smaller tuck-in acquisition, IP arrangements. That's where we look for differentiated technology that we don't have or opportunities to accelerate the growth of our business. Third, we do look to return excess cash to shareholders over time, but we look to do that opportunistically when we think there's a difference between where the market has the company valued and where we think the long-term value of the company is.
A number of questions right now.
All right. Thank you so much.
That'll conclude our meeting. I'd like to thank all our Intuitive staff. Nothing at Intuitive happens without the hard work of all the staff who are here and outside these walls. Thank you so much.
This now concludes the meeting. Thank you for joining, and have a pleasant day. The host has ended this call. Goodbye.