The Real Reason Intuitive Surgical Keeps Winning: A Cash Machine Hiding in Plain Sight

Key Points

Intuitive Surgical makes the da Vinci surgical robot.

The company was one of the first in the surgical robotics market and has a large installed base.

The company's real flywheel isn't selling robots.

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Shares of Intuitive Surgical (NASDAQ: ISRG) have risen roughly 580% over the past decade. That's incredible when you consider that the S&P 500 index (SNPINDEX: ^GSPC) rose 240% over that same span. What makes Intuitive Surgical so attractive is the opportunity it is leaning into with its da Vinci surgical robots. But investors need to think beyond the actual sale of robots to fully understand just how powerful a business Intuitive Surgical has built. Here's what you need to know.

Surgical robots are selling like hot cakes

Surgical robots improve patient outcomes, making the technology highly attractive to both practitioners and patients. That is the core of the story about Intuitive Surgical, an industry pioneer. It currently has 11,395 of its surgical robots being used around the world.

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Demand for its robots is very strong. It placed 431 da Vinci systems in the first quarter of 2026, up from 367 a year earlier. Its total installed base increased in size by 12% year over year. Without question, strong demand for its surgical robots is a key growth driver for Intuitive Surgical. But there's an interesting twist to consider when you examine the company's earnings statement. Only 23% of the medical device maker's revenues came from the sale of da Vinci robots.

Another important statistic to watch

Before getting to the source of the rest of Intuitive Surgical's revenues, there's another metric the company reports that is vital to monitor. The number of surgeries performed with a da Vinci robot increased 17% year over year in the first quarter of 2026. That's much higher than the 12% increase in the number of da Vinci robots and shows strong demand for surgeries performed with the company's robots.

That fact leads to the real flywheel you should be monitoring with Intuitive Surgical. Every time a surgery is performed, many of the products and instruments used have to be replaced. The more a robot is used, the more likely it is to need servicing. And as the list of surgeries a da Vinci can perform increases, the list of additional accessories needed grows. Simply put, this high-tech healthcare company's most important business is actually selling parts (instruments and accessories) and services.

To put some numbers on that, services make up around 15% of the company's top line. Instruments and accessories, meanwhile, are a huge 60% of the business. If you own or are considering buying Intuitive Surgical, you need to look beyond the da Vinci robots it is selling to fully understand the company.

Yes, the more robots it sells, the better. And the more surgeries that are performed with a da Vinci, the better, too. But both of those support Intuitive Surgical's real growth driver: its sale of parts and services. What's really special about parts and services revenues, however, is that they are annuity-like in nature. The sale of a new da Vinci robot is a one-time event, but the parts and service revenues that follow will continue until that surgical robot is no longer in use. So the more da Vinci systems that get sold, the larger the parts and services flywheel grows.

Wall Street isn't ignorant of Intuitive Surgical's growth story

As noted, Intuitive Surgical's stock has risen dramatically over the past decade. The price-to-earnings ratio is a lofty 58x today. It is only appropriate for more aggressive growth investors. That said, it keeps winning because it has built a cash-generating machine through the parts and services it sells to support its da Vinci surgical robots. So don't get caught up focusing only on the robots; they aren't the real growth story here.

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Reuben Gregg Brewer has no position in any of the stocks mentioned. The Motley Fool has positions in and recommends Intuitive Surgical. The Motley Fool recommends the following options: long January 2028 $520 calls on Intuitive Surgical and short January 2028 $530 calls on Intuitive Surgical. The Motley Fool has a disclosure policy.

The views and opinions expressed herein are the views and opinions of the author and do not necessarily reflect those of Nasdaq, Inc.