Ion, and the Second FranchiseNarrow moat

Intuitive Surgical (ISRG) — moat facet

Procedures grew 51% while placements fell 28% — a platform being used harder by the hospitals that have it.

Ion is Intuitive's attempt to prove the model transfers, and so far it is working.

Ion, 2024 and 2025~95kProcedures 2024 (000)144.1kProcedures 2025 (000)271Placements 2024195Placements 2025Installed base 995 to 1,096. Procedures grew about 51%; placements fell 28%.
A platform being used much harder by the hospitals that have it, and adopted more slowly by the ones that do not.

Cleared by the FDA in 2019, Ion is a flexible, robotic-assisted, catheter-based platform whose first indication is minimally invasive biopsy in the lung1. It uses an ultra-thin catheter articulating 180 degrees in all directions with real-time shape-sensing navigation, reaching lesions deep in the peripheral lung that are otherwise difficult to sample — which matters because early diagnosis is where lung-cancer survival is decided.

The commercial shape is identical to da Vinci. A capital system, then a stream of consumables: the catheter, the peripheral vision probe and Flexision biopsy needles2. The installed base reached approximately 995 systems at the end of 2025 and 1,096 by mid-2026, up 24% and 21%3; procedures grew 51% in 2025 to about 144,100 and 36% in the June 2026 quarter4.

Regulatory expansion is under way — NMPA clearance in China in March 2024 with first placements that year, Korea in September 2023, European certification in March 20235 — and in October 2025 the FDA cleared a software release introducing artificial intelligence "across Ion's entire navigational workflow" with new imaging capabilities6.

Two cautions. Placements fell 28% in 2025, to 195 from 2717, while procedures grew 51% — the installed base is being used much harder rather than expanded, which is good for economics and a warning about the pace of new adoption. And the consumable economics were cut by a regulator: catheter uses were extended from five to eight by the FDA in April 2024 and in Europe in February 20258.

Track Ion procedures per system, which is rising fast. That is the number that says whether a second franchise is being built or a first one is being extended.

Moat trajectory: Holding steady

Ion procedures grew 51% to 144,100 while placements fell 28% to a base of 1,096. The franchise is deepening with its adopters and spreading more slowly to everyone else — a wash.

The number that tests this moat
Reported
Ion procedures
144,100, up 51%, on a base of 1,096 systems

Procedures grew 51% while placements fell 28%. A platform being used much harder by the hospitals that have it, and adopted more slowly by the ones that do not.

Source: Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 ↗
⚠ Threats to the moat
⚠ THREAT 01
Ion Placements Fell 28% in the Year Its Procedures Grew 51%
A second franchise being used harder by its adopters and adopted more slowly by everyone else.
References
  1. ReportedCleared by the FDA in 2019, Ion is a flexible, robotic-assisted, catheter-based platform whose first indication is minimally invasive biopsy in the lung.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 1 Business (the da Vinci and Ion platforms, instruments with a use count enforced in the instrument itself, training pathways and SimNow, enabling technologies, manufacturing sites, employees by function, and the seasonality of benign procedures) — FY2025 · publ. February 3, 2026 · source ↗
  2. ReportedA capital system, then a stream of consumables: the catheter, the peripheral vision probe and Flexision biopsy needles.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 1 Business (the da Vinci and Ion platforms, instruments with a use count enforced in the instrument itself, training pathways and SimNow, enabling technologies, manufacturing sites, employees by function, and the seasonality of benign procedures) — FY2025 · publ. February 3, 2026 · source ↗
  3. ReportedThe installed base reached approximately 995 systems at the end of 2025 and 1,096 by mid-2026, up 24% and 21%; procedures grew 51% in 2025 to about 144,100 and 36% in the June 2026 quarter.
    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 ↗
  4. ReportedThe installed base reached approximately 995 systems at the end of 2025 and 1,096 by mid-2026, up 24% and 21%; procedures grew 51% in 2025 to about 144,100 and 36% in the June 2026 quarter.
    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. ReportedRegulatory expansion is under way — NMPA clearance in China in March 2024 with first placements that year, Korea in September 2023, European certification in March 2023 — and in October 2025 the FDA cleared a software release introducing...
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 1 Business (the da Vinci and Ion platforms, instruments with a use count enforced in the instrument itself, training pathways and SimNow, enabling technologies, manufacturing sites, employees by function, and the seasonality of benign procedures) — FY2025 · publ. February 3, 2026 · source ↗
  6. ReportedRegulatory expansion is under way — NMPA clearance in China in March 2024 with first placements that year, Korea in September 2023, European certification in March 2023 — and in October 2025 the FDA cleared a software release introducing...
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 1 Business (the da Vinci and Ion platforms, instruments with a use count enforced in the instrument itself, training pathways and SimNow, enabling technologies, manufacturing sites, employees by function, and the seasonality of benign procedures) — FY2025 · publ. February 3, 2026 · source ↗
  7. ReportedPlacements fell 28% in 2025, to 195 from 271, while procedures grew 51% — the installed base is being used much harder rather than expanded, which is good for economics and a warning about the pace of new adoption.
    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 ↗
  8. ReportedAnd the consumable economics were cut by a regulator: catheter uses were extended from five to eight by the FDA in April 2024 and in Europe in February 2025.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 1 Business: competition, intellectual property and government regulation (the fourteen named competitors, more than 5,600 patents in force and 2,500 pending, Class II devices cleared under section 510(k) on substantial equivalence, special controls, field actions and recalls) — FY2025 · publ. February 3, 2026 · source ↗
Sources
Generated September 23, 2026