✦ Twenty-Three Percent Outside AmericaNarrow moat

Intuitive Surgical (ISRG) — the future bets

One Japanese reimbursement decision took quarterly placements from 15 to 25 — the mirror image of what Washington did.

The growth Intuitive is losing in the United States is being more than replaced abroad, and the gap is widening.

2025 procedure growth, and the mix behind it+23%Outside the US (%)+15%United States (%)507kOUS urology (000)334kOUS general surgery (000)1,141,000 of 3,153,000 procedures were performed outside the United States.
The growth being lost at home is more than replaced abroad, and the mix there is the urology-led one America has already left behind.

Outside-the-United-States da Vinci procedures grew approximately 23% in 2025 against 15% domestically, reaching 1,141,000 of the 3,153,000 total1. In the June 2026 quarter the divergence was starker: 20% OUS against 12% in the United States2. Intuitive says it has been investing in OUS markets, that its OUS procedures "have grown faster in proportion to U.S. procedures", and that it expects OUS to make up a greater share of the business in the long term3.

The composition abroad is different too, and healthier by the argument set out elsewhere in this file. OUS urology was 507,000 procedures against general surgery's 334,000 — the reverse of the domestic mix — because international adoption is following the same path the United States took, starting with the procedures where robotics wins most clearly.

The named strength is in South Korea and India4, with Europe and Asia both growing 20% in the June quarter and particular performance in India, Italy, Taiwan and the United Kingdom5.

And the mechanism is reimbursement, which is why this belongs among the bets rather than the certainties. Japan expanded reimbursement for multiple robotic procedures on 1 June 2026 — the largest category inguinal hernia — and added utilisation incentives; Japanese system placements went from 15 in the prior-year quarter to 25. One ministry decision, one quarter, a two-thirds increase.

The offsetting exposure is currency and price. Revenue denominated in foreign currencies was approximately 24% of the total in 20256, and international revenue per procedure is lower than domestic — 32% of revenue from 36% of procedures7.

Watch the OUS share of procedures rather than of revenue. It was 36% in 2025 and rising, and it is the only part of the volume equation currently compounding at the rate the valuation was built on.

Moat trajectory: Widening

A Japanese reimbursement decision took quarterly placements there from 15 to 25, India and Korea keep growing, and Europe is now served directly in three more countries. The one market moving the other way is China, and that is a ministry's decision.

The number that tests this moat
Reported
Procedure growth outside the United States
About 23% in 2025, against 15% domestically

The growth Intuitive is losing at home is being more than replaced abroad. Watch the OUS share of procedures — 36% and rising — rather than of revenue, because international revenue per procedure is lower.

Source: Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 ↗
References
  1. ReportedOutside-the-United-States da Vinci procedures grew approximately 23% in 2025 against 15% domestically, reaching 1,141,000 of the 3,153,000 total.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 7 MD&A, business and operating highlights (3,153,000 da Vinci procedures up 18%, 1,721 placements, an installed base of 11,106, utilisation up about 3%, 870 da Vinci 5 placements, Ion procedures and placements, procedures by region and category, and revenue denominated in foreign currencies) — FY2025 · publ. February 3, 2026 · source ↗
  2. ReportedIn the June 2026 quarter the divergence was starker: 20% OUS against 12% in the United States.
    Intuitive Surgical Form 10-Q, quarter ended June 30, 2026 (installed base 11,710 da Vinci systems up 12%, 468 placements of which 246 were da Vinci 5, the operating-lease share, the distributor acquisitions in Italy, Spain and Portugal, cash and investments of $8.63 billion, and the factors expected to affect future placements) — Q2 2026 and the first six months · publ. July 21, 2026 · source ↗
  3. Reportedprocedures", and that it expects OUS to make up a greater share of the business in the long term.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 7 MD&A, business and operating highlights (3,153,000 da Vinci procedures up 18%, 1,721 placements, an installed base of 11,106, utilisation up about 3%, 870 da Vinci 5 placements, Ion procedures and placements, procedures by region and category, and revenue denominated in foreign currencies) — FY2025 · publ. February 3, 2026 · source ↗
  4. ReportedThe named strength is in South Korea and India, with Europe and Asia both growing 20% in the June quarter and particular performance in India, Italy, Taiwan and the United Kingdom.
    Intuitive Surgical Form 10-Q, quarter ended June 30, 2026 (installed base 11,710 da Vinci systems up 12%, 468 placements of which 246 were da Vinci 5, the operating-lease share, the distributor acquisitions in Italy, Spain and Portugal, cash and investments of $8.63 billion, and the factors expected to affect future placements) — Q2 2026 and the first six months · publ. July 21, 2026 · source ↗
  5. ReportedThe named strength is in South Korea and India, with Europe and Asia both growing 20% in the June quarter and particular performance in India, Italy, Taiwan and the United Kingdom.
    Intuitive Surgical Form 10-Q, quarter ended June 30, 2026 (installed base 11,710 da Vinci systems up 12%, 468 placements of which 246 were da Vinci 5, the operating-lease share, the distributor acquisitions in Italy, Spain and Portugal, cash and investments of $8.63 billion, and the factors expected to affect future placements) — Q2 2026 and the first six months · publ. July 21, 2026 · source ↗
  6. ReportedRevenue denominated in foreign currencies was approximately 24% of the total in 2025, and international revenue per procedure is lower than domestic — 32% of revenue from 36% of procedures.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 7 MD&A, business and operating highlights (3,153,000 da Vinci procedures up 18%, 1,721 placements, an installed base of 11,106, utilisation up about 3%, 870 da Vinci 5 placements, Ion procedures and placements, procedures by region and category, and revenue denominated in foreign currencies) — FY2025 · publ. February 3, 2026 · source ↗
  7. Moat Explorer calcRevenue denominated in foreign currencies was approximately 24% of the total in 2025, and international revenue per procedure is lower than domestic — 32% of revenue from 36% of procedures.
    Moat Explorer calculation - arithmetic on figures reported in Intuitive's Form 10-K and Form 10-Q: instruments and accessories of $6,018.9M over 3,153,000 da Vinci plus 144,100 Ion procedures ($1,825 a procedure), service revenue of $1,572.1M over the installed base (about $134,000 a system), variable lease revenue of $531M over 1,810 usage-based systems (about $293,000), procedures over the average installed base (about 300 a system), each revenue line as a share of the $10,064.7M total, and US general surgery as a share of US procedures — FY2025 · publ. September 2026 · source ↗
Sources
Generated September 23, 2026