Intuitive passes $10 billion in revenue as da Vinci 5 takes half of its robot shipments, but guides procedure growth lower

Surgeons performed 3.153 million operations with Intuitive's da Vinci robots in 2025, and for the first time more than half of the da Vinci systems the company shipped in a year were its newest model. Intuitive said on January 22, 2026 that full-year revenue rose about 21% to $10.06 billion, the first time the Sunnyvale, California company has crossed $10 billion, and that da Vinci 5 accounted for 870 of the 1,721 da Vinci systems it placed.

The same release carried a brake. Intuitive told investors it expects da Vinci procedures to grow 13% to 15% in 2026, against about 18% in 2025, and guided its non-GAAP gross margin to between 67% and 68% of revenue, including an estimated tariff cost of 1.2% of revenue. For the world's largest surgical robot maker the question is whether an upgrade cycle and a shift to pay-per-use leasing can keep earnings compounding as procedure growth slows and the first serious rivals reach American operating rooms. The numbers point to an answer, though not an unqualified one.

A $10 billion year carried by instruments, not robots

Fourth-quarter revenue rose 19% to $2.87 billion from $2.41 billion, the company said. Instruments and accessories, the disposable and reusable tools consumed in each operation, grew 17% to $1.66 billion, which Intuitive attributed to roughly 17% growth in da Vinci procedures and 44% growth in procedures on Ion, its robotic lung biopsy system. Systems revenue reached $786 million against $655 million, and services $422.0 million against $347.4 million. For the full year, the preliminary release dated January 14 put instruments and accessories at about $6.02 billion, up 19%, and systems at about $2.47 billion. Roughly six of every ten dollars Intuitive earns therefore come from the procedure, not the machine.

Profit kept pace. Fourth-quarter GAAP net income was $795 million, or $2.21 per diluted share, and non-GAAP net income $914 million, or $2.53. Full-year GAAP net income reached $2.86 billion, or $7.87 per share, and non-GAAP net income $3.24 billion, or $8.93. Intuitive ended the year with $9.03 billion in cash, cash equivalents and investments. Margins, however, slipped. By our calculation from the release's tables, fourth-quarter non-GAAP gross margin was 67.8%, down from 69.5% a year earlier, and GAAP gross margin 66.4% against 68.0%.

Placements show where the growth came from. Intuitive placed 532 da Vinci systems in the fourth quarter, up from 493, and 250 of them went out under operating leases, 150 of those on usage-based terms where the hospital pays as it operates. Over 2025 it placed 1,721 da Vinci systems, up from 1,526. A Form 8-K filed on January 14 breaks the year down as 987 systems in the United States and 734 abroad, of which 342 went to Europe, 269 to Asia and 123 to other markets. The installed base reached 11,106 da Vinci systems on December 31, up 12%. Ion added 195 systems over the year, but only 42 in the fourth quarter against 69 a year earlier, taking its installed base to 995.

Why da Vinci 5 matters more than the procedure count

da Vinci 5 is Intuitive's fifth-generation multiport platform. The company says it carries 10,000 times the computing power of earlier da Vinci systems and records more than 1,000 data points per second during surgery, which feeds the analytics products it sells to hospitals. Its share of placements rose from 23.7% in 2024 (362 of 1,526) to 50.6% in 2025 (870 of 1,721), and to 57.0% in the fourth quarter (303 of 532). In practice that means hospitals are now replacing older consoles as often as they are adding new capacity, which keeps systems revenue rising even as procedure growth cools.

The platform also gained new indications. On January 26, 2026, four days after the results, Intuitive said the US Food and Drug Administration had cleared da Vinci 5 for nine cardiac procedures, including mitral valve repair and replacement, tricuspid valve repair, internal mammary artery mobilization for bypass surgery, and closure of atrial septal defects, patent foramen ovale and the left atrial appendage. The clearance covers instruments without force feedback, and a limited number of US sites will start programmes through 2026. Intuitive counts more than 140,000 robotic-assisted cardiac procedures performed with its systems across 51 countries. Chief Executive Dave Rosa said opening the chest brings significant pain, a high risk of complications and long recovery times.

Rivals are arriving, led by Medtronic and a Shanghai challenger

The competitive picture changed within weeks of the results. Medtronic, which received FDA clearance for its Hugo system in urology in December 2025, said its first US commercial Hugo operation, a prostatectomy, took place at Cleveland Clinic on February 17, 2026, and that Hugo is available in more than 35 countries. It plans to extend Hugo to gynecology and general surgery. In China, MicroPort MedBot reported 2025 revenue of RMB551.1 million, up 114%, with about 73% earned outside China, a gross margin of 48.4% and more than 100 new orders for its Toumai robot in 2025. Smaller challengers include Medicaroid's hinotori in Japan, backed by Kawasaki Heavy Industries and Sysmex, and meere company's Revo-i in Korea.

The scale gap remains wide. Dividing 3.153 million da Vinci procedures by the 11,106 systems installed at year-end gives about 284 operations per robot per year, a utilisation figure no rival discloses. Usage-based leases, which made up 28.2% of fourth-quarter placements (150 of 532), let Intuitive meet hospitals that balk at capital budgets on the same terms a challenger would offer, while keeping the instrument stream that funds its research.

The risks sit in the supply chain and the growth rate. Intuitive makes most instruments and accessories in Mexico and endoscopes in Germany, imports certain materials from China, and warned in its release that the ultimate effect of tariffs could be material. Leasing defers revenue that a sale would book upfront. And a slowdown to 13% to 15% procedure growth leaves less room to absorb margin pressure.

The next tests are Intuitive's first-quarter 2026 report, the pace at which US hospitals start da Vinci 5 cardiac programmes through 2026, and whether Medtronic wins FDA clearance to take Hugo beyond urology.