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Intuitive Surgical Just Proved the Growth Engine Still Runs
Reported by Leo Miller. Originally Published: 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) blew investors away with its Q3 2025 earnings report in October 2025. Shares closed up 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 earlier report, the market reacted positively: the stock rose roughly 1.4% in after-hours trading. Despite a lofty valuation, Intuitive's long-term outlook remains constructive, and the company appears positioned to keep its growth engine running.
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In Q4, Intuitive posted revenue of $2.87 billion, a 19% increase that comfortably exceeded consensus of $2.72 billion (13% growth). The beat on adjusted earnings per share (EPS) was especially notable: adjusted EPS came in at $2.53, up just over 14%, versus analyst expectations of $2.25 (under 2% growth).
Growth in da Vinci procedures is one of the company's key performance indicators. More procedures drive demand for the company's disposable instruments, which are an important source of recurring revenue and typically account for the majority of total sales.
Da Vinci procedure volume grew 17% in the quarter, a solid result and consistent with Intuitive's historical range over the past two years. That said, it was a slight deceleration from the 19% growth reported in the prior quarter — a standout figure the firm hadn't exceeded since 2023. For the full year, da Vinci procedures rose 18%.
Intuitive Provides Solid Guidance, but Growth May Decelerate
For 2026, the company expects da Vinci procedure growth of about 14% at the midpoint. Intuitive does not tie its revenue guidance directly to a single procedure metric, but revenue growth often trends with da Vinci procedure growth. The company forecasts a 2026 gross margin of 67%–68%, essentially in line with 2025's 67.7% gross margin.
Intuitive also expects operating expenses to rise slightly faster in 2026 than in 2025, which could press operating margins if revenue growth slows in step with da Vinci procedure growth. Management attributes a portion of the higher expense growth to early-stage research and development investments.
While these investments may pressure near-term margins, they support Intuitive's long-term outlook. Sustaining growth will depend heavily on developing new devices and platforms and securing approvals to expand current applications. Services such as the Ion and da Vinci SP platforms illustrate the company's ability to create new growth drivers: procedures for these devices increased 78% and 51%, respectively, during the quarter.
Markets Look Past Intuitive's Tariff Guidance, Mitigating a Key Headwind
Investors also seemed unbothered by the company's tariff-related guidance. Intuitive expects tariffs to reduce 2026 gross margins by about 1.2%, compared with roughly a 65-basis-point headwind in 2025 (see transcript). Shares holding up despite a larger tariff impact is encouraging: tariff concerns weighed on the stock through much of 2025, and clearer visibility into that exposure has reduced uncertainty for investors.
Intuitive is not a cheap stock, trading at a forward price-to-earnings (P/E) near 56x. But as an established leader in robotic-assisted surgery, it has earned trust across the healthcare ecosystem. That credibility should help it enter new markets and fend off aspiring competitors, making sustained growth a realistic possibility. Still, the company must continue innovating to sustain the growth rates that justify its current valuation and support further gains in the stock price.
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