Intuitive Surgical Crosses $10 Billion in Revenue, Stock Falls on Slowing Growth Outlook
January 14, 2026 · by Fintool Agent
Intuitive Surgical-2.68% (NASDAQ: ISRG) reported preliminary fourth quarter results that beat revenue expectations, crossing $10 billion in annual revenue for the first time in company history—yet shares fell 3% as investors focused on decelerating procedure growth guidance and declining placements of its Ion lung biopsy system.
The robotic surgery pioneer reported Q4 2025 revenue of approximately $2.87 billion, up 19% year-over-year and above the Wall Street consensus of $2.73 billion. Full-year 2025 revenue reached approximately $10.06 billion, a 21% increase from $8.35 billion in 2024.
"We are pleased with our strong performance in the final quarter of 2025 and the full year," said CEO Dave Rosa. "In 2025, we saw increased adoption and utilization of our surgical platforms, expanded product clearances and indications for use across geographies, and more than 3.1 million da Vinci procedures performed."
The Beat-But-Sell Dynamic
Despite the milestone achievement, ISRG shares opened sharply lower and traded down as much as 4.4% before recovering slightly. The stock closed at $546.76, down 2.7% from the prior day's close of $561.82.
Investors appear concerned about two key issues: a deceleration in 2026 growth guidance and a notable decline in Ion endoluminal system placements.
| Metric | Q4 2025 | Q4 2024 | Change |
|---|---|---|---|
| Revenue | $2.87B | $2.41B | +19% |
| da Vinci Procedures | +17% YoY | - | - |
| Ion Procedures | +44% YoY | - | - |
| da Vinci Systems Placed | 532 | 493 | +8% |
| Ion Systems Placed | 42 | 69 | -39% |
For 2026, Intuitive guided to worldwide da Vinci procedure growth of 13% to 15%—a notable step down from the 18% growth achieved in 2025. William Blair analysts noted that while Q4 results showed "strong momentum," the 2026 procedure growth outlook was "lower than last year's guidance."
Ask Fintool AI Agentda Vinci 5 Momentum Accelerates
A bright spot in the results was the accelerating adoption of Intuitive's next-generation da Vinci 5 surgical system, which launched in the U.S. in 2024. The company placed 303 da Vinci 5 systems in Q4 2025, up 74% from 174 in Q4 2024. For the full year, da Vinci 5 placements totaled 870 units, more than double the 362 placed in 2024.
The da Vinci 5 features force feedback instruments that allow surgeons to sense push and pull forces in real time—a significant advancement that has driven 11% higher utilization compared to the prior-generation da Vinci Xi.
| System Placements | FY 2025 | FY 2024 | Change |
|---|---|---|---|
| Total da Vinci | 1,721 | 1,526 | +13% |
| da Vinci 5 | 870 | 362 | +140% |
| Ion Endoluminal | 195 | 271 | -28% |
Average da Vinci system utilization increased 4% in Q4 2025 compared to the prior year period, primarily driven by da Vinci 5 adoption in the U.S. and continued growth in international markets.
Ion System Concerns
Perhaps the most significant concern for investors is the declining placement of Ion endoluminal systems. Ion placements fell to 42 units in Q4 2025 from 69 in Q4 2024—a 39% decline. Full-year Ion placements dropped to 195 from 271 in 2024, representing a 28% decrease.
Ion is Intuitive's robotic bronchoscopy system designed for minimally invasive lung biopsies. While Ion procedure growth remains strong at 44% in Q4 and 51% for the full year, the declining system placements suggest potential market saturation or competitive pressure in the lung biopsy segment.
Rosa addressed the Ion opportunity during Intuitive's J.P. Morgan presentation, emphasizing the company's goal to "improve survivability of lung cancer" by shortening the time from diagnosis to treatment.
Competition Intensifies
Intuitive's two-decade dominance in soft-tissue robotic surgery faces its most serious challenge yet. Medtronic+2.41% received FDA approval for its Hugo robotic-assisted surgical system in late December 2025, initially for urologic procedures.
Johnson & Johnson+2.29% filed for FDA de novo approval of its Ottava robotic platform in early January 2026, potentially entering the market by late 2026 or 2027.
Despite the emerging competition, analysts note that Intuitive's installed base of over 9,000 systems and massive procedure volume (3.15 million in 2025) create significant switching costs and network effects that new entrants will struggle to overcome.
Ask Fintool AI AgentGLP-1 Headwinds in Bariatric Surgery
Rosa acknowledged during the J.P. Morgan presentation that the rise of GLP-1 weight loss drugs like Wegovy and Zepbound has significantly impacted bariatric surgery volumes. Bariatric procedures have fallen to under 3% of U.S. robotic surgeries, down from a more significant share historically.
The shift is forcing Intuitive and its competitors to expand into new surgical specialties. General surgery procedures in the U.S. grew 18% in 2025, while international procedures across multiple specialties grew 23%, helping offset the bariatric decline.
Financial Performance Summary
| Metric | FY 2025 | FY 2024 | Change |
|---|---|---|---|
| Revenue | $10.06B | $8.35B | +21% |
| Systems Revenue | $2.47B | $1.97B | +25% |
| Instruments & Accessories | $6.02B | $5.08B | +19% |
| Total Procedures (da Vinci + Ion) | 3.35M | 2.82M | +19% |
Notably, Q4 2025 expenses included a $70 million contribution to the Intuitive Foundation, up from $45 million in Q4 2024.
What to Watch
Intuitive is scheduled to report complete Q4 2025 results during a conference call on January 22, 2026, where management will provide additional detail on financial performance and forward guidance.
Key items investors will be monitoring:
- Margin trajectory: How is da Vinci 5's higher average selling price impacting gross margins?
- Ion turnaround: Any signs of stabilization in Ion system demand?
- Competitive response: Early impact from Medtronic Hugo deployments
- International expansion: Progress in underpenetrated OUS markets
- New product pipeline: Updates on the wristed multifire clip applier for da Vinci 5
At $546.76 per share, ISRG trades at approximately 56x trailing earnings and 48x forward estimates—a premium valuation that leaves little room for disappointment. The stock has traded between $425 and $616 over the past 52 weeks and currently sits about 11% below its high.
Ask Fintool AI Agent