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Intuitive Surgical Just Proved the Growth Engine Still Runs
Author: Leo Miller. Article Posted: 1/23/2026.
Article Highlights
- Intuitive Surgical’s Q4 2025 results beat on both revenue and EPS, reinforcing confidence in its robotics‑assisted surgery leadership despite a deceleration in procedure growth.
- Guidance for 2026 shows steady procedural demand and gross margins, with investment in R&D and new platforms (Ion, da Vinci SP) supporting long‑term growth prospects.
- Tariff headwinds and a high valuation present near‑term risks, but investor resilience and market trust underpin sustained growth expectations.
Robotic-assisted surgery stalwart Intuitive Surgical (NASDAQ: ISRG) impressed investors with its Q3 2025 earnings report in October 2025. Shares jumped nearly 14% on the news, marking the healthcare stock's largest single-day post-earnings gain in recent memory.
On Jan. 22, the company reported its Q4 2025 results. While the release didn't generate the same level of fanfare as the prior quarter, markets reacted positively: the stock was up roughly 1.4% in after-hours trading. Despite a lofty valuation, Intuitive still presents a constructive long-term outlook with a growth engine that appears capable of continuing to run.
Intuitive Beats on Revenue and EPS by a Solid Margin
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Watch the free 2026 AI Investing Playbook now.In Q4, Intuitive posted revenue of $2.87 billion, up 19% year over year and well above estimates of $2.72 billion (13% growth). The company's adjusted earnings per share (EPS) beat was even more notable: adjusted EPS came in at $2.53, an increase of just over 14%, versus analysts' expectations of $2.25, which implied under 2% growth.
Growth in da Vinci procedures is a key metric for the company because more procedures typically lead to higher sales of disposable instruments—an important source of recurring revenue that usually represents the majority of total sales. In Q4, da Vinci procedure volume rose 17%, consistent with the company's historical range over the past two years but a slight deceleration from the 19% growth recorded the prior quarter. For the full year, da Vinci procedures increased 18%.
Intuitive Provides Solid Guidance, but Growth May Decelerate
Looking into 2026, Intuitive expects da Vinci procedure growth of 14% at the midpoint. The company does not provide an explicit revenue-growth forecast tied to those procedures, but revenue growth often tracks procedure trends. Management expects gross margin of 67%–68% in 2026, effectively in line with its 2025 gross margin of 67.7%.
Intuitive also expects operating expenses to rise at a slightly faster pace in 2026 than in 2025, which could lead to some operating-margin compression if revenue growth slows alongside procedure growth. Management attributes the accelerated expense growth primarily to early-stage research and development efforts. While that could be dilutive in the near term, it supports the company's long-term prospects by funding new devices and platform development.
Developing new growth drivers is critical to sustaining Intuitive's high valuation. The company's Ion and da Vinci SP platforms illustrate that capability: procedures for those systems rose 78% and 51%, respectively, during the quarter.
Markets Look Past Intuitive's Tariff Guidance, Mitigating a Key Headwind
Investors also appeared unfazed by Intuitive's tariff-related guidance. For 2026, management expects tariffs to reduce gross margins by about 1.2%, materially higher than the roughly 65-basis-point impact in 2025. Shares holding up despite that outlook is encouraging, given that tariff concerns weighed on the stock throughout much of 2025. With a clearer picture of tariff exposure, uncertainty has fallen, which should bolster investor confidence in the company's path forward.
Intuitive Surgical is not inexpensive, trading at a forward price-to-earnings (P/E) ratio near 56x. But as an established leader in robot-assisted surgery, it has built substantial trust within the healthcare industry. That reputation should help as the company pursues new markets, giving it an advantage over aspiring competitors and making sustained growth a realistic possibility. Still, Intuitive must keep innovating and expanding approved indications to sustain growth rates that justify its current valuation and support further stock appreciation.
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