Intuitive Surgical [ISRG]
Built 27 July 2026. Revised under investment-memo v1.4.0. Every entry has a date, a specific observable, and an explicit upgrade/downgrade threshold.
Dates marked (est.) are estimated from the company's historical reporting cadence, not confirmed by the company. ISRG reported Q3 2025 on 21 October 2025 and Q4 2025 on 22 January 2026; the estimates below follow that pattern.
Price $361.80. Nothing on this calendar has resolved since it was built, because the calendar was built one trading day ago. Recorded here so the next refresh has a dated baseline rather than a re-derivation.
| Item | Status as of 28 Jul 2026 | Evidence |
|---|---|---|
| Q2 2026 print (16 Jul) | RESOLVED — pre-dates the calendar, now formally scored. Beat on revenue (+2.4% vs consensus) and clean EPS (+8.7% ex the $0.08 IEEPA refund); FY2026 procedure guide held at 13.5–15.5% but verbally trimmed to "closer to the midpoint"; gross-margin guide raised to 68.0–69.0%; opex guide narrowed to 11–13%. Market reaction −14.15% (−13.16% abnormal). | 8-K Ex-99.1, 16 Jul 2026; Alpaca SIP |
| C1 · Q3 2026 earnings, ~20 Oct 2026 | Pending. Unchanged as the decisive event: carries the extended-use quantification, the XiR ASP (not committed), Q3 ASC/XiR placements, and the procedure-growth print. | — |
| C2 · FY2027 initial guidance, ~late Jan 2027 | Pending. | — |
| C-U3 · "JURA" programme | No change. NCT07259759 still the only trace; status COMPLETED 31 Oct 2025, last updated 29 Apr 2026. Zero transcript mentions across 14 quarters. | ClinicalTrials.gov, re-pulled 28 Jul 2026 |
| Vector C trigger — a GI/endoluminal ClinicalTrials.gov registration | NOT FIRED. All 88 Intuitive-sponsored studies re-pulled; every colorectal/colon study is transabdominal. NCT07346066 (IS-001) still under condition "Ureter Injury" and still NOT_YET_RECRUITING four months past its stated 31-Mar-2026 start. | ClinicalTrials.gov API v2, 28 Jul 2026 |
| Vector C trigger — a GI/endoluminal FDA 510(k) | NOT FIRED. Latest Intuitive clearance is K261249 (Universal Seal, 14 Jul 2026). openFDA index last updated 20 Jul 2026 — the final eight days are not covered. | openFDA 510(k) API, 28 Jul 2026 |
| Price conversion trigger $310 | NOT FIRED. 52-week low $328.57 intraday on 23 Jul — within 5.6%, then reversed. Spot is 16.7% above. | Alpaca SIP |
| the dissolved duration-variant test (old Gate 2B) variant route (3 conditions) | 0 of 3 fired. No call has occurred; consensus snapshot byte-identical to 27 Jul. | Alpha Vantage |
| All nine invalidation triggers | None fired. Two re-verified on fresh data: da Vinci placements +18.5% YoY (threshold: below +8%); bariatric mentions at 2.5/10k, near series low (GLP-1 spread threshold). |
8-K Ex-99.1; transcript series |
C-N1 · Bylaw amendment / governance — 8-K filed 27 July 2026, event 23 July 2026 (Item 5.03). The board amended and restated the bylaws to add advance-notice and proxy-contest frictions (a 67%-solicitation requirement to have nominee votes counted under universal proxy; synthetic-equity, holding-period and intent disclosure; a cap on the number of nominees; a non-white proxy card requirement; special-meeting record-date mechanics) and to move non-election actions to a majority of votes cast. Observable to watch: any Schedule 13D or 13D/A filing on ISRG. Threshold: a 13D filing by an activist would make the timing (adopted on the exact session of the 52-week low) materially more informative and would open a value-unlock path the memo does not currently model. Absent a 13D, treat this as routine post-universal-proxy modernisation. No 13D exists as of 28 July 2026. This item moves no Criteria.
Next scheduled refresh trigger: Q3 2026 earnings, ~20 October 2026. Interim checkable items (free, monthly): ClinicalTrials.gov GI/endoluminal registrations, openFDA clearances, the $310 price level, and any 13D.
The most information-dense event in the horizon. Four separate things resolve here.
| Observable | Threshold → action |
|---|---|
| Extended-use programme quantification — management explicitly promised this ("we will provide additional quantification on our next earnings call") | Disclosed FY2027 I&A revenue impact better than −1% → UPGRADE (removes the main the dissolved variant-vs-consensus test (old Gate 2) counter-argument). Worse than −2% → DOWNGRADE; cut base case toward $320 and raise bear weight to 40% |
| Worldwide da Vinci procedure growth vs the 13.5–15.5% FY guide, against what management called a "tougher comp in the US in Q3" | ≥ 15% → UPGRADE, bull weight to 30%. 12–15% → neutral, thesis on track. < 12% → DOWNGRADE, the deceleration is running ahead of guidance |
| US system utilisation growth (was +3% in Q2 and +3% for FY2025) | ≥ +5% → UPGRADE — genuine depth, not just fleet. ≤ +1% → DOWNGRADE — growth is 100% fleet expansion and the mature-indication pool is full |
| da Vinci placements (Q3 2025 base: 1,721 FY; Q2 2026 was 468, +18.5%) | > +15% YoY → competitive share intact. < +8% YoY → first hard evidence of placement-share loss → DOWNGRADE |
| XiR average selling price (NEW, v1.4.0 — the highest-value single disclosure in the horizon). Management has explicitly withheld it: "we haven't said yet what the XiR price range is likely to be... we'll let you model." | Disclosed at ≥ ~$650k → the dissolved duration-variant test (old Gate 2B) leg 4 becomes satisfiable; Vector D moves from "not modellable" to "modellable" and the Consensus Criteria gap becomes measurable on its own merits, independent of the price level. Disclosed below ~$500k → the ASC channel is volume without economics → Vector D is downgraded to immaterial. Still withheld → the Consensus Criteria stays blank on this line, which blocks nothing |
| ASC placements (NEW). Q2 2026 was 27, "significantly higher than our history," 20 of them XiR | > 27 for a second consecutive quarter → the channel is established; raise bull weight. < 27 → Q2 was a one-off and Vector D is killed |
| XiR unit placements (NEW). FY2025 42 → Q1 2026 34 → Q2 2026 64 (vs 10 a year earlier) | > 64 → the ramp compounds. < 64 → the trade-in-financed value tier is not scaling |
Why this matters more than the EPS print: ISRG has beaten consensus EPS by 18.7% and 11.9% in the last two quarters and the stock fell anyway. The EPS line is not what is being debated.
The single most decisive scheduled event, and the anchor of the stated time horizon.
| Observable | Threshold → action |
|---|---|
| FY2027 da Vinci procedure growth guidance | ≥ 13% → UPGRADE; validates the base case and the bull weight rises. 11–13% → base case confirmed, no change. < 11% → DOWNGRADE. < 10% → the long-bias is invalidated entirely and the name moves to Avoid |
| FY2027 non-GAAP gross margin guidance (FY2026 guide: 68.0–69.0% incl. 1.0pt tariff) | ≥ 69% → UPGRADE. < 67.5% → DOWNGRADE — tariffs and/or competitive pricing biting |
| FY2027 non-GAAP opex growth guidance (FY2026: 11–13%) | < 11% with revenue growth ≥ 12% → genuine operating leverage; the abandoned the dissolved variant-vs-consensus test (old Gate 2) variant partially revives |
Recall the 2026 guidance path for calibration: initial guide (Jan 2026) 13–15% procedures / 67–68% GM / 11–15% opex → raised to 13.5–15.5% / 67.5–68.5% / 11–14% (April) → 13.5–15.5% "closer to the midpoint" / 68.0–69.0% / 11–13% (July). Management has raised gross margin twice and tightened opex twice while holding procedures. That pattern is the thing to watch for continuation or breakage.
Filed 3 June 2026. 510(k) review typically runs 3–9 months, so decisions plausibly land Q4 2026 – Q2 2027; FDA does not pre-announce dates.
This is the first real test of ISRG's placement share, because general surgery and gynaecology are where ISRG's volume growth actually lives — unlike urology, where Hugo was cleared in December 2025 and where da Vinci is most entrenched. Threshold: clearance alone is not actionable. The actionable observable is the next two quarters of ISRG placements after clearance. Placement growth holding above +12% through two post-clearance quarters → UPGRADE (share durability demonstrated in the contested categories). Below +8% → DOWNGRADE.
De Novo granted 22 July 2026 for upper-abdomen general surgery; US inguinal hernia trial ongoing. Threshold: watch for J&J disclosing OTTAVA system placements or an installed-base figure on its quarterly calls. Authorisation is not commercialisation — J&J must still build a field force, surgeon training programme and instrument supply chain, which historically takes 4–8 quarters. First disclosed placement numbers are the observable.
Distalmotion raised $150m explicitly to attack ambulatory surgery centres, and holds three US authorisations (gallbladder, hysterectomy, hernia). Threshold: any ISRG disclosure of an ASC-specific product, pricing programme or placement category — that would be management conceding the channel is contested. Conversely, evidence of benign general surgery and gynaecology migrating to ASCs without an ISRG offering is a structural downgrade.
Thresholds: (a) da Vinci 5 mainland China clearance via the green channel → UPGRADE, restores ISRG's current-generation platform to its second-largest strategic market; (b) robotic consumables named in a centralised VBP tender → material DOWNGRADE to the I&A price-per-procedure assumption; (c) management describing tender activity as recovering → modest upgrade. ISRG does not disclose China separately, so this is tracked through call commentary only — a real limitation.
ISRG won at trial on 28 January 2025; SIS appealed. Consolidated class actions (Larkin, Franciscan/King County, Kaleida) remain live. Threshold: an adverse Ninth Circuit ruling attacks the legal basis of the instrument-servicing razor-blade model directly → immediate DOWNGRADE and a re-underwrite of the I&A margin assumption. A ruling affirming Intuitive removes a tail risk.
First quarter with the extended-use programme actually in effect. Observable: I&A revenue per da Vinci procedure versus the ~$1,830 Q2 2026 baseline. A decline of more than ~4% → DOWNGRADE.
US bariatric is already declining high single digits. Threshold: management attributing a decline to GLP-1s in any second category (cholecystectomy is the most obesity-correlated candidate) → DOWNGRADE, because it converts a contained substitution into a broadening one.
FY2025 placements 195, −28% vs 271 in FY2024; H1 2026 tracking 107. Threshold: FY2026 placements below 195 → the Ion capital stall is confirmed as structural, not a 2024 pull-forward. Above 220 → recovering.
1.0pt of revenue guided impact for 2026; instruments manufactured largely in Mexico, endoscopes largely in Germany. Q2 2026 included a $36m IEEPA refund for prior periods — non-recurring, and it flattered the 70.0% non-GAAP gross margin to a clean 68.7%. Threshold: any change to US–Mexico tariff treatment.
The Task 5 decision converts on price — or, new in v1.4.0, on the the dissolved duration-variant test (old Gate 2B) evidence bar being cleared:
| Trigger | Level | Action |
|---|---|---|
| Conversion to Long | ≤ $310 | E[R] +14.8%; initiate 1.0% of book in equity. Optionally via the pre-authorised 20-Nov-2026 $320 cash-secured put (bid $13.92, effective basis $306.08) |
| Hurdle breakeven | $340 | E[R] = 4.6%. Watch, do not act — no margin of safety |
| the dissolved duration-variant test (old Gate 2B) conversion (price-independent) | any price | All three of: XiR ASP disclosed ≥ ~$650k and ASC placements > 27 for a second consecutive quarter and a consensus FY2028 revenue revision > 2% not attributable to FX/M&A/guidance → the dissolved duration-variant test (old Gate 2B) passes and this becomes a Long candidate on the variant, not on the entry price |
| Re-rate away | ≥ $420 | E[R] < −10%; remove from watchlist as unattainable, revisit only on a numbers upgrade |
| Hard invalidation of long-bias | any price | FY2027 procedure growth guided < 10% → Avoid, regardless of price |
Note the deliberate tension, stated rather than hidden: the momentum Criteria would prefer to see the downtrend crack before buying, but at the price where the trend repairs (~$406, the 50-day MA) E[R] is −11.9%. The resolution adopted is to convert on price rather than on trend, accepting that $310 would likely be reached in a continuing downtrend. That is a deliberate choice to prioritise Valuation Criteria over Momentum Criteria, and the $310 level was set ~7% below the current 52-week low partly so that reaching it implies capitulation rather than a slow grind — which is the closest available approximation to satisfying both. v1.4.0 adds a second, price-independent route: if the XiR ASP and ASC run-rate resolve favourably, the dissolved duration-variant test (old Gate 2B) passes and the position converts on the variant rather than on the entry price. That is a materially better outcome than waiting for a drawdown, and it is why the Q3 2026 call now matters more than it did.
These come out of the corpora that sit outside the filings. All are free and checkable without waiting for an earnings call, which is the point — they resolve before the disclosed numbers do.
Currently zero, across all 37 Intuitive-sponsored studies started 2022+. Query:
clinicaltrials.gov/api/v2/studies?query.spons=Intuitive%20Surgical.
| Observable | Threshold → action |
|---|---|
| First Intuitive-sponsored trial with a GI/endoluminal/colorectal-endoscopy condition | Appears → the GI vector becomes sizeable for the first time; re-run the dissolved duration-variant test (old Gate 2B) leg 1 immediately. This is the single best leading indicator in the whole workup and it precedes every other GI signal |
| Still zero by Q2 2027 | GI remains a research programme, not a pipeline asset. No change to the thesis |
Submitted ~Q2 2026 for a "foundational noncommercial next-generation flexible robotic endoscope system for use
in the gastrointestinal tract." Checkable at api.fda.gov/device/510k.json?search=applicant:"Intuitive Surgical".
| Observable | Threshold → action |
|---|---|
| Cleared | The base rate from Ion is instructive: FDA clearance 2019 → 8 publications that year → 52 by 2025. Literature follows clearance by 1–2 years and revenue by 3–5. Clearance starts a clock, it does not create revenue |
| Not cleared / withdrawn | Vector C is dead for this cycle |
NCT07259759, "JURA Study – Observational First-in-human Feasibility Study," condition Imaging, n=20,
COMPLETED 2025-10-31. The word "JURA" appears zero times in fourteen quarters of transcripts and in no
filing examined. A completed first-in-human study means a working device exists and has been used in patients.
| Observable | Threshold → action |
|---|---|
| Management names JURA, or an imaging/visualisation platform, on any call | Immediate re-scope — a fifth platform would change the TAM build |
| A second JURA registry entry, or a 510(k) under that name | Same |
Deliberately not sized. An imaging platform of unknown scope cannot be valued from a one-line registry summary, and doing so would be exactly the narrative-manufacturing this framework rejects.
The independent adoption proxy, and it leads procedure volume. Baselines set 27 July 2026 (2026 is partial):
| Term | 2024 | 2025 | 2026 (partial) | Threshold → action |
|---|---|---|---|---|
| "robotic bronchoscopy" | 32 | 52 | 57 | Full-year 2026 < 52 → the Ion clinical inflection is stalling |
| "shape-sensing robotic-assisted bronchoscopy" | 13 | 20 | 27 | Full-year 2026 < 20 → same |
| "robotic cardiac surgery" | 34 | 46 | 30 | Full-year 2026 > 60 → cardiac is inflecting; upgrade Vector B |
| "endoluminal robotic surgery" | 2 | 1 | 0 | Any year > 10 → the GI field is becoming real |
Ongoing maintenance of this calendar and the thesis passes to the plugin skills equity-research:catalyst-calendar
and equity-research:thesis-tracker. The next scheduled review is C1, Q3 2026 earnings (~20 October 2026),
which per Task 8 should be an incremental refresh against this memo's provenance manifest — including the PEAD
check (surprise versus pre-print consensus, revision direction, and whether the stance is with or against the
expected drift) — not a full re-underwrite.