Intuitive Surgical (ISRG) 10-Q20 Oct 232023 Q3 Quarterly reportFinancial data

Company Profile

Cover Page

Cover Page - shares	9 Months Ended
Cover Page - shares	Sep. 30, 2023	Oct. 16, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
Document Transition Report	false
Entity File Number	000-30713
Entity Registrant Name	Intuitive Surgical, Inc.
State or Other Jurisdiction of Incorporation or Organization	DE
I.R.S. Employer Identification No.	77-0416458
Entity Address, Address Line One	1020 Kifer Road
Entity Address, City or Town	Sunnyvale
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	94086
City Area Code	408
Local Phone Number	523-2100
Title of each class	Common Stock, par value $0.001 per share
Trading Symbol(s)	ISRG
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		352,071,592
Entity Central Index Key	0001035267
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3
Amendment Flag	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 3,602	$ 1,581.2
Short-term investments	2,873.7	2,536.7
Accounts receivable, net	962.7	942.1
Inventory	1,147.5	893.2
Prepaids and other current assets	317	299.8
Total current assets	8,902.9	6,253
Property, plant, and equipment, net	3,077	2,374.2
Long-term investments	1,044.9	2,623.6
Deferred tax assets	701.4	664.6
Intangible and other assets, net	638.4	710.1
Goodwill	348.1	348.5
Total assets	14,712.7	12,974
Current liabilities:
Accounts payable	196.2	147
Accrued compensation and employee benefits	374.8	401.6
Deferred revenue	394.8	397.3
Other accrued liabilities	710.6	476.2
Total current liabilities	1,676.4	1,422.1
Other long-term liabilities	412.8	439.3
Total liabilities	2,089.2	1,861.4
Contingencies (Note 8)
Stockholders’ equity:
Preferred stock, 2.5 shares authorized, $0.001 par value, issuable in series; zero shares issued and outstanding as of September 30, 2023, and December 31, 2022	0	0
Common stock, 600.0 shares authorized, $0.001 par value, 352.0 shares and 350.0 shares issued and outstanding as of September 30, 2023, and December 31, 2022, respectively	0.4	0.4
Additional paid-in capital	8,385.9	7,703.9
Retained earnings	4,209.2	3,500.1
Accumulated other comprehensive loss	(56.5)	(162.5)
Total Intuitive Surgical, Inc. stockholders’ equity	12,539	11,041.9
Noncontrolling interest in joint venture	84.5	70.7
Total stockholders’ equity	12,623.5	11,112.6
Total liabilities and stockholders’ equity	$ 14,712.7	$ 12,974

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - $ / shares	Sep. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Preferred stock, shares authorized (in shares)	2,500,000	2,500,000
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, shares authorized (in shares)	600,000,000	600,000,000
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares issued (in shares)	352,000,000	350,000,000
Common stock, shares outstanding (in shares)	352,000,000	350,000,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) shares in Millions, $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenue:
Total revenue	$ 1,743.7	$ 1,557.4	$ 5,195.8	$ 4,567.2
Cost of revenue:
Total cost of revenue	576.5	505.3	1,743.7	1,482.1
Gross profit	1,167.2	1,052.1	3,452.1	3,085.1
Operating expenses:
Selling, general and administrative	452	436.1	1,396.8	1,245.6
Research and development	249.4	217.1	738.7	634.9
Total operating expenses	701.4	653.2	2,135.5	1,880.5
Income from operations	465.8	398.9	1,316.6	1,204.6
Interest and other income, net	56.2	3.9	126.4	7.5
Income before taxes	522	402.8	1,443	1,212.1
Income tax expense	102.2	78.1	236.4	204.4
Net income	419.8	324.7	1,206.6	1,007.7
Less: net income attributable to noncontrolling interest in joint venture	4.1	0.7	14.8	10.3
Net income attributable to Intuitive Surgical, Inc.	$ 415.7	$ 324	$ 1,191.8	$ 997.4
Net income per share attributable to Intuitive Surgical, Inc.:
Basic (in dollars per share)	$ 1.18	$ 0.91	$ 3.40	$ 2.79
Diluted (in dollars per share)	$ 1.16	$ 0.90	$ 3.34	$ 2.74
Shares used in computing net income per share attributable to Intuitive Surgical, Inc.:
Basic (in shares)	351.7	355.3	351	357.2
Diluted (in shares)	358.2	360.5	357.1	363.7
Other comprehensive income (loss), net of tax:
Unrealized gains on hedge instruments	$ 4.3	$ 2.3	$ 12.8	$ 7.7
Unrealized gains (losses) on available-for-sale securities	25.6	(37.3)	76.3	(161.4)
Foreign currency translation gains (losses)	(6.8)	(10)	15.9	(12)
Prior service cost for employee benefit plans	0	0.1	0	0.2
Other comprehensive income (loss)	23.1	(44.9)	105	(165.5)
Total comprehensive income	442.9	279.8	1,311.6	842.2
Less: comprehensive income (loss) attributable to noncontrolling interest	3.9	(0.8)	13.8	8.2
Total comprehensive income attributable to Intuitive Surgical, Inc.	439	280.6	1,297.8	834
Corporate Joint Venture
Operating expenses:
Less: net income attributable to noncontrolling interest in joint venture	4.1	0.7	14.8	10.3
Product
Revenue:
Total revenue	1,450.8	1,297.5	4,332.4	3,806.3
Cost of revenue:
Total cost of revenue	489.5	421.6	1,480.5	1,239.9
Service
Revenue:
Total revenue	292.9	259.9	863.4	760.9
Cost of revenue:
Total cost of revenue	$ 87	$ 83.7	$ 263.2	$ 242.2

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Operating activities:
Net income	$ 1,206.6	$ 1,007.7
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and loss on disposal of property, plant, and equipment	283.5	239.4
Amortization of intangible assets	15.1	20.2
Gain on sale of business	0	(3.8)
Loss on investments, accretion of discounts, and amortization of premiums on investments, net	14.7	43.4
Deferred income taxes	(61)	(102)
Share-based compensation expense	442.4	385.6
Amortization of contract acquisition assets	22.6	20.7
Changes in operating assets and liabilities, net of effects of acquisitions:
Accounts receivable	(19.7)	(67.2)
Inventory	(528.2)	(419.1)
Prepaids and other assets	37.5	(96.8)
Accounts payable	27.7	26.3
Accrued compensation and employee benefits	(26.8)	(41.9)
Deferred revenue	(1)	(21.2)
Other liabilities	172.1	61.6
Net cash provided by operating activities	1,585.5	1,052.9
Investing activities:
Purchase of investments	(820.2)	(1,393.6)
Proceeds from sales of investments	47.7	59.6
Proceeds from maturities of investments	2,092.4	2,536.3
Purchase of property, plant, and equipment	(628.7)	(393.2)
Acquisition of businesses, net of cash, and intellectual property and other investing activities	(7.1)	(13.1)
Net cash provided by investing activities	684.1	796
Financing activities:
Proceeds from issuance of common stock relating to employee stock plans	252.2	188.6
Taxes paid related to net share settlement of equity awards	(155.4)	(187.3)
Repurchase of common stock	(350)	(1,606.6)
Payment of deferred purchase consideration	(2.9)	(3.5)
Net cash used in financing activities	(256.1)	(1,608.8)
Effect of exchange rate changes on cash, cash equivalents, and restricted cash	8.7	7.9
Net increase in cash, cash equivalents, and restricted cash	2,022.2	248
Cash, cash equivalents, and restricted cash, beginning of period	1,600.7	1,306
Cash, cash equivalents, and restricted cash, end of period	$ 3,622.9	$ 1,554

DESCRIPTION OF THE BUSINESS

DESCRIPTION OF THE BUSINESS	9 Months Ended
DESCRIPTION OF THE BUSINESS	Sep. 30, 2023
Accounting Policies [Abstract]
DESCRIPTION OF THE BUSINESS	DESCRIPTION OF THE BUSINESS Intuitive Surgical, Inc. (“Intuitive” or the “Company”) develops, manufactures, and markets da Vinci ® surgical systems and the Ion ® endoluminal system. The Company’s products and related services enable physicians and healthcare providers to improve the quality of and access to minimally invasive care. The da Vinci surgical system consists of a surgeon console or consoles, a patient-side cart, and a high-performance vision system. The Ion endoluminal system consists of a system cart, a controller, a catheter, and a vision probe. Both systems use software, instruments, and accessories.

SUMMARY OF SIGNIFICANT ACCOUNTI

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	9 Months Ended
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	Sep. 30, 2023
Accounting Policies [Abstract]
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Presentation In the opinion of management, the accompanying unaudited Condensed Consolidated Financial Statements (“Financial Statements”) of Intuitive Surgical, Inc. and its wholly and majority-owned subsidiaries have been prepared on a consistent basis with the audited Consolidated Financial Statements for the fiscal year ended December 31, 2022, and include all adjustments, consisting of only normal, recurring adjustments, necessary to fairly state the information set forth herein. The Financial Statements have been prepared in accordance with the rules and regulations of the Securities and Exchange Commission (“SEC”) and, therefore, omit certain information and footnote disclosure necessary to present the Financial Statements in accordance with United States (“U.S.”) generally accepted accounting principles (“GAAP”). These Financial Statements should be read in conjunction with the audited Consolidated Financial Statements and notes thereto included in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2022, which was filed with the SEC on February 10, 2023. The results of operations for the first nine months of 2023 are not necessarily indicative of the results to be expected for the entire fiscal year or any future periods. The Financial Statements include the results and balances of the Company’s majority-owned joint ventures, Intuitive Surgical-Fosun Medical Technology (Shanghai) Co., Ltd. and Intuitive Surgical-Fosun (HongKong) Co., Ltd. (collectively, the “Joint Venture”), with Shanghai Fosun Pharmaceutical (Group) Co., Ltd. (“Fosun Pharma”). The Company holds a controlling financial interest in the Joint Venture, and the noncontrolling interest is reflected as a separate component of the consolidated stockholders’ equity. The noncontrolling interest’s share of the earnings in the Joint Venture is presented separately in the Condensed Consolidated Statements of Comprehensive Income. Risks and Uncertainties The Company’s future results of operations and liquidity could be materially adversely affected by macroeconomic and geopolitical factors in the U.S. and globally, including the supply chain environment, inflationary pressure, higher interest rates, instability in the global financial markets, significant disruptions in the commodities’ markets as a result of the conflict between Russia and Ukraine and the conflict in Israel, labor shortages, the introduction of or changes in tariffs, trade barriers, or regulatory requirements, and uncertain or reduced demand, as well as the impact of any initiatives or programs that the Company may undertake to address financial and operational challenges faced by its customers. While the supply chain challenges facing the Company have shown signs of improvement during the first three quarters of 2023, relative to 2022, certain semiconductor materials, specialty metals, and polymers continue to face supply constraints due to various factors, including limited labor availability, equipment shortages, capacity limitations among sub-tier suppliers, and difficulties in sourcing raw materials and component parts to meet demand requirements. Additionally, prices of such materials remain elevated due to increased demand and production-related cost inflation. With higher interest rates, access to credit may become more difficult, and any insolvency of the Company’s key suppliers, including sole-sourced and single-sourced suppliers, may exacerbate current supply chain challenges. Also, liquidity concerns in the broader financial services industry could result in delayed access or loss of access to the Company’s key suppliers’ uninsured deposits or loss of their ability to draw on existing credit facilities involving a troubled or failed financial institution. The Company is actively engaged in activities to seek to mitigate the impact of any supply chain disruptions on the Company’s operations. Such global shortages in important components have resulted in, and will continue to cause, inflationary cost pressure in the Company’s supply chain. To date, these supply chain challenges have not materially impacted the Company’s results of operations or ability to deliver products and services to its customers. However, supply constraints with certain materials, many of which may be unavoidable, could delay the timing of our product deliveries, which could result in deferred or canceled procedures. Additionally, if inflationary pressures in component costs persist, the Company may not be able to quickly or easily adjust pricing, reduce costs, or implement countermeasures. Additionally, there is continued uncertainty surrounding the impact of any monetary policy changes taken by the U.S. Federal Reserve and other central banks to address the structural risks associated with inflation. Fluctuations in labor availability globally, including labor shortages and staff burnout and attrition, could also impact the Company’s ability to hire and retain personnel critical to its manufacturing, logistics, and commercial operations. The Company is also highly dependent on the principal members of its management and scientific staff. The loss of critical members of the Company’s team, or its inability to attract and retain qualified personnel, could significantly harm its operations, business, and ability to compete. Many hospitals continue to experience challenges with staffing and cost pressures that could affect their ability to provide patient care; however, the staffing challenges have shown signs of improvement during the third quarter of 2023, relative to the first two quarters of 2023 and to the prior year. Additionally, hospitals are facing significant financial pressure as supply chain constraints and inflation drive up operating costs, higher interest rates make access to credit more expensive, unrealized losses decrease available cash reserves, and fiscal stimulus programs enacted during the COVID-19 pandemic wind down. Hospitals may also be adversely affected by the liquidity concerns in the broader financial services industry that could result in delayed access or loss of access to uninsured deposits or loss of their ability to draw on existing credit facilities involving a troubled or failed financial institution. To the extent macroeconomic conditions remain challenging, it is likely that hospitals’ spend on capital equipment will be adversely impacted. In addition, as competition progresses in various markets, longer selling cycles and pricing pressures are likely to result. As of the date of issuance of these Financial Statements, the extent to which these macroeconomic factors may materially adversely affect the Company’s financial condition, liquidity, or results of operations is uncertain. The Company maintains the majority of its cash and cash equivalents in accounts with major U.S. and multi-national financial institutions, and our deposits exceed insured limits. Market conditions could impact the viability of these institutions. To date, these market conditions and liquidity concerns have not impacted our results of operations. However, in the event of the failure of any of the financial institutions where we maintain our cash and cash equivalents, there can be no assurance that we would be able to access uninsured funds in a timely manner or at all. Any inability to access or delay in accessing these funds could adversely affect our business and financial position. The Company is also subject to additional risks and uncertainties due to the ongoing COVID-19 pandemic. When COVID-19 infection rates have spiked in a particular region in the past, procedure volumes were often negatively impacted and the diagnoses of new conditions and their related treatments were sometimes deferred. The extent of the impact on the Company’s business is highly uncertain and difficult to predict. The Company’s customers may divert resources to treat COVID-19 patients and defer some elective surgical procedures, both of which may impact the Company’s customers’ ability to meet their obligations, including to the Company. The severity of the impact of the COVID-19 pandemic on the Company’s business will depend on a number of factors, including, but not limited to, the duration and severity of the pandemic and the extent and severity of the impact on the Company’s customers, all of which are uncertain and cannot be predicted. Recently Adopted Accounting Pronouncements Troubled Debt Restructurings and Vintage Disclosures In March 2022, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2022-02, Financial Instruments-Credit Losses (Topic 326): Troubled Debt Restructurings and Vintage Disclosures (“ASU 2022-02”), which eliminates the accounting guidance for troubled debt restructurings by creditors while enhancing disclosure requirements for certain loan refinancings and restructurings by creditors when a borrower is experiencing financial difficulty. Additionally, the standard requires disclosure of current-period gross write-offs by year of origination for financing receivables and net investments in leases within the scope of Subtopic ASC 326-20, Financial Instruments-Credit Losses-Measured at Amortized Cost . The Company adopted ASU 2022-02 on January 1, 2023, on a prospective basis. There was no impact of the adoption of ASU 2022-02 on the Company’s Financial Statements in the three and nine months ended September 30, 2023. Recently Issued Accounting Pronouncements The Company continues to monitor new accounting pronouncements issued by the FASB and does not believe any accounting pronouncements issued through the date of this report will have a material impact on the Company’s Financial Statements. Significant Accounting Policies There have been no new or material changes to the significant accounting policies discussed in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2022, that are of significance, or potential significance, to the Company.

FINANCIAL INSTRUMENTS

FINANCIAL INSTRUMENTS	9 Months Ended
FINANCIAL INSTRUMENTS	Sep. 30, 2023
Investments, All Other Investments [Abstract]
FINANCIAL INSTRUMENTS	FINANCIAL INSTRUMENTS Cash, Cash Equivalents, and Investments The following tables summarize the Company’s cash and available-for-sale debt securities’ amortized cost, gross unrealized gains, gross unrealized losses, allowance for credit loss, and fair value by significant investment category reported as cash and cash equivalents, short-term investments, or long-term investments as of September 30, 2023, and December 31, 2022 (in millions): Reported as: Amortized Gross Gross Allowance for Credit Loss Fair Cash and Short- Long- September 30, 2023 Cash $ 474.3 $ — $ — $ — $ 474.3 $ 474.3 $ — $ — Level 1: Money market funds 2,967.8 — — — 2,967.8 2,967.8 — — U.S. treasuries 2,324.2 0.2 (43.9) — 2,280.5 159.9 1,660.5 460.1 Subtotal 5,292.0 0.2 (43.9) — 5,248.3 3,127.7 1,660.5 460.1 Level 2: Corporate debt securities 1,353.9 — (42.3) (1.1) 1,310.5 — 914.7 395.8 U.S. government agencies 400.4 — (11.2) — 389.2 — 214.2 175.0 Municipal securities 101.4 — (3.1) — 98.3 — 84.3 14.0 Subtotal 1,855.7 — (56.6) (1.1) 1,798.0 — 1,213.2 584.8 Total assets measured at fair value $ 7,622.0 $ 0.2 $ (100.5) $ (1.1) $ 7,520.6 $ 3,602.0 $ 2,873.7 $ 1,044.9 Reported as: Amortized Gross Gross Allowance for Credit Loss Fair Cash and Short- Long- December 31, 2022 Cash $ 497.2 $ — $ — $ — $ 497.2 $ 497.2 $ — $ — Level 1: Money market funds 1,084.0 — — — 1,084.0 1,084.0 — — U.S. treasuries 2,715.2 — (96.6) — 2,618.6 — 1,542.4 1,076.2 Subtotal 3,799.2 — (96.6) — 3,702.6 1,084.0 1,542.4 1,076.2 Level 2: Commercial paper 20.0 — — — 20.0 — 20.0 — Corporate debt securities 2,022.0 — (76.0) (1.1) 1,944.9 — 651.8 1,293.1 U.S. government agencies 447.2 — (19.9) — 427.3 — 247.8 179.5 Municipal securities 155.5 — (6.0) — 149.5 — 74.7 74.8 Subtotal 2,644.7 — (101.9) (1.1) 2,541.7 — 994.3 1,547.4 Total assets measured at fair value $ 6,941.1 $ — $ (198.5) $ (1.1) $ 6,741.5 $ 1,581.2 $ 2,536.7 $ 2,623.6 The following table summarizes the contractual maturities of the Company’s cash equivalents and available-for-sale debt securities (excluding money market funds), as of September 30, 2023 (in millions): Amortized Fair Mature in less than one year $ 3,084.2 $ 3,033.6 Mature in one to five years 1,095.7 1,044.9 Total $ 4,179.9 $ 4,078.5 Actual maturities may differ from contractual maturities, because certain borrowers have the right to call or prepay certain obligations. Gross realized gains and losses recognized on the sale of investments were immaterial for the periods presented. As of September 30, 2023, and December 31, 2022, net unrealized losses on available-for-sale debt securities, net of tax, of $77.9 million and $154.2 million, respectively, were included in accumulated other comprehensive loss in the accompanying Consolidated Balance Sheets. The following tables present the breakdown of the available-for-sale debt securities with unrealized losses as of September 30, 2023, and December 31, 2022 (in millions): September 30, 2023 Unrealized losses less than 12 months Unrealized losses 12 months or greater Total Fair Unrealized Fair Unrealized Fair Unrealized U.S. treasuries $ 458.8 $ (0.4) $ 1,427.5 $ (43.5) $ 1,886.3 $ (43.9) Corporate debt securities 54.0 (0.1) 1,248.8 (42.2) 1,302.8 (42.3) U.S. government agencies 114.6 (0.2) 274.6 (11.0) 389.2 (11.2) Municipal securities — — 82.3 (3.1) 82.3 (3.1) Total $ 627.4 $ (0.7) $ 3,033.2 $ (99.8) $ 3,660.6 $ (100.5) December 31, 2022 Unrealized losses less than 12 months Unrealized losses 12 months or greater Total Fair Unrealized Fair Unrealized Fair Unrealized U.S. treasuries $ 731.7 $ (26.0) $ 1,886.9 $ (70.6) $ 2,618.6 $ (96.6) Corporate debt securities 631.4 (17.6) 1,221.9 (58.4) 1,853.3 (76.0) U.S. government agencies 102.7 (4.4) 324.6 (15.5) 427.3 (19.9) Municipal securities 44.6 (1.1) 104.9 (4.9) 149.5 (6.0) Total $ 1,510.4 $ (49.1) $ 3,538.3 $ (149.4) $ 5,048.7 $ (198.5) The Company’s investments may consist of U.S. government money market funds, U.S. treasury and U.S. government agency securities, high-quality corporate notes and bonds, commercial paper, non-U.S. government agency securities, and taxable and tax-exempt municipal notes. The Company regularly reviews its investments and evaluates the current expected credit loss by considering factors such as historical experience, market data, financial condition and near-term prospects of the investee, the extent of any losses related to the credit of the issuer, and the expected cash flows from the security. The Company segments its portfolio based on the underlying risk profiles of the securities and has a zero-loss expectation for U.S. treasury and U.S. government agency securities. The basis for this assumption is that these securities have consistently high credit ratings by rating agencies, have a long history with no credit losses, are explicitly guaranteed by a sovereign entity, which can print its own currency, and are denominated in a currency that is routinely held by central banks, used in international commerce, and commonly viewed as a reserve currency. Equity Investments The Company holds equity investments with readily determinable fair values and equity investments without readily determinable fair values. The Company generally recognizes equity investments that do not have readily determinable fair values at cost minus impairment, if any, plus or minus changes resulting from observable price changes in orderly transactions for the identical or a similar investment of the same issuer. The following table is a summary of the activity related to equity investments (in millions): Reported as: December 31, 2022 Carrying Value Changes in Fair Value (1) Purchases / Sales / Other (2) September 30, 2023 Carrying Value Prepaids and other current assets Intangible and other assets, net Equity investments with readily determinable value (Level 1) $ 4.3 $ (0.4) $ (3.9) $ — $ — $ — Equity investments without readily determinable value (Level 2) $ 59.1 $ (5.6) $ 20.0 $ 73.5 $ — $ 73.5 (1) Recorded in interest and other income, net. (2) Other includes foreign currency translation gains/(losses). Foreign Currency Derivatives The objective of the Company’s hedging program is to mitigate the impact of changes in currency exchange rates on net cash flow from foreign currency-denominated sales, expenses, intercompany balances, and other monetary assets or liabilities denominated in currencies other than the U.S. dollar (“USD”). The terms of the Company’s derivative contracts are generally thirteen months or shorter. The derivative assets and liabilities are measured using Level 2 fair value inputs. Cash Flow Hedges The Company enters into currency forward contracts as cash flow hedges to hedge certain forecasted revenue transactions denominated in currencies other than the USD, primarily the Euro (“EUR”), the British Pound (“GBP”), the Japanese Yen (“JPY”), the Korean Won (“KRW”), and the New Taiwan Dollar (“TWD”). The Company also enters into currency forward contracts as cash flow hedges to hedge certain forecasted expense transactions denominated in EUR and the Swiss Franc (“CHF”). For these derivatives, the Company reports the unrealized after-tax gain or loss from the hedge as a component of accumulated other comprehensive loss in stockholders’ equity and reclassifies the amount into earnings in the same period in which the hedged transaction affects earnings. The amounts reclassified to revenue and expenses related to the hedged transactions and the ineffective portions of cash flow hedges were not material for the periods presented. Other Derivatives Not Designated as Hedging Instruments Other derivatives not designated as hedging instruments consist primarily of forward contracts that the Company uses to hedge intercompany balances and other monetary assets or liabilities denominated in currencies other than the USD, primarily the EUR, GBP, JPY, KRW, CHF, TWD, Indian Rupee (“INR”), Mexican Peso (“MXN”), Chinese Yuan (“CNY”), Canadian Dollar (“CAD”), and Swedish Kronor (“SEK”). These derivative instruments are used to hedge against balance sheet foreign currency exposures. The related gains and losses were as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Recognized gains in interest and other income, net $ 10.4 $ 17.9 $ 21.8 $ 46.6 Foreign exchange losses related to balance sheet re-measurement $ (13.1) $ (30.5) $ (24.0) $ (69.4) The notional amounts for derivative instruments provide one measure of the transaction volume. Total gross notional amounts (in USD) for outstanding derivatives and the aggregate gross fair value at the end of each period were as follows (in millions): Derivatives Designated as Hedging Instruments Derivatives Not Designated as Hedging Instruments September 30, December 31, September 30, December 31, Notional amounts: Forward contracts $ 262.2 $ 188.4 $ 618.0 $ 496.3 Gross fair value recorded in: Prepaids and other current assets $ 12.8 $ 1.8 $ 9.3 $ 4.3 Other accrued liabilities $ 1.7 $ 5.3 $ 2.5 $ 4.2

BALANCE SHEET DETAILS AND OTHER

BALANCE SHEET DETAILS AND OTHER FINANCIAL INFORMATION	9 Months Ended
BALANCE SHEET DETAILS AND OTHER FINANCIAL INFORMATION	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BALANCE SHEET DETAILS AND OTHER FINANCIAL INFORMATION	BALANCE SHEET DETAILS AND OTHER FINANCIAL INFORMATION Balance Sheet Details The following tables provide details of selected balance sheet line items (in millions): As of Accounts receivable, net September 30, December 31, Trade accounts receivable, net $ 879.6 $ 864.9 Unbilled accounts receivable and other 98.4 91.7 Sales returns and allowances (15.3) (14.5) Total accounts receivable, net $ 962.7 $ 942.1 As of Inventory September 30, December 31, Raw materials $ 420.3 $ 382.9 Work-in-process 150.1 159.9 Finished goods 577.1 350.4 Total inventory $ 1,147.5 $ 893.2 As of Prepaids and other current assets September 30, December 31, Net investment in sales-type leases – short-term $ 134.4 $ 131.2 Other prepaids and other current assets 182.6 168.6 Total prepaids and other current assets $ 317.0 $ 299.8 As of September 30, December 31, Property, plant, and equipment, net Land $ 389.5 $ 388.6 Building and building/leasehold improvements 900.9 866.5 Machinery and equipment 654.7 566.4 Operating lease assets – Intuitive System Leasing 1,052.9 806.4 Computer and office equipment 145.6 134.7 Capitalized software 250.8 240.9 Construction-in-process 1,150.8 608.6 Gross property, plant, and equipment 4,545.2 3,612.1 Less: Accumulated depreciation* (1,468.2) (1,237.9) Total property, plant, and equipment, net $ 3,077.0 $ 2,374.2 *Accumulated depreciation associated with operating lease assets – Intuitive System Leasing $ (395.7) $ (285.8) As of Other accrued liabilities – short-term September 30, December 31, Income and other taxes payable $ 342.8 $ 96.1 Accrued construction-related capital expenditures 106.0 50.3 Litigation-related accruals 1.6 23.0 Other accrued liabilities 260.2 306.8 Total other accrued liabilities – short-term $ 710.6 $ 476.2 As of Other long-term liabilities September 30, December 31, Income taxes – long-term $ 264.1 $ 288.0 Deferred revenue – long-term 42.5 41.0 Other long-term liabilities 106.2 110.3 Total other long-term liabilities $ 412.8 $ 439.3 Supplemental Cash Flow Information The following table provides supplemental non-cash investing and financing activities (in millions): Nine Months Ended September 30, 2023 2022 Equipment transfers, including operating lease assets, from inventory to property, plant, and equipment $ 303.8 $ 189.0 Acquisition of property, plant, and equipment in accounts payable and accrued liabilities $ 135.2 $ 91.4

REVENUE AND CONTRACT ACQUISITIO

REVENUE AND CONTRACT ACQUISITION COSTS	9 Months Ended
REVENUE AND CONTRACT ACQUISITION COSTS	Sep. 30, 2023
Revenue from Contract with Customer [Abstract]
REVENUE AND CONTRACT ACQUISITION COSTS	REVENUE AND CONTRACT ACQUISITION COSTS The following table presents revenue disaggregated by type and geography (in millions): Three Months Ended September 30, Nine Months Ended September 30, U.S. 2023 2022 2023 2022 Instruments and accessories $ 775.7 $ 643.3 $ 2,240.4 $ 1,819.0 Systems 216.0 264.7 627.6 731.0 Services 188.5 175.0 564.6 508.9 Total U.S. revenue $ 1,180.2 $ 1,083.0 $ 3,432.6 $ 3,058.9 Outside of U.S. (“OUS”) Instruments and accessories $ 295.7 $ 228.3 $ 892.5 $ 758.2 Systems 163.4 161.2 571.9 498.1 Services 104.4 84.9 298.8 252.0 Total OUS revenue $ 563.5 $ 474.4 $ 1,763.2 $ 1,508.3 Total Instruments and accessories $ 1,071.4 $ 871.6 $ 3,132.9 $ 2,577.2 Systems 379.4 425.9 1,199.5 1,229.1 Services 292.9 259.9 863.4 760.9 Total revenue $ 1,743.7 $ 1,557.4 $ 5,195.8 $ 4,567.2 Remaining Performance Obligations The transaction price allocated to remaining performance obligations relates to amounts allocated to products and services for which revenue has not yet been recognized. A significant portion of these performance obligations relate to service obligations in the Company’s system sale and lease arrangements that will be satisfied and recognized as revenue in future periods. The transaction price allocated to the remaining performance obligations was $2.13 billion as of September 30, 2023. The remaining performance obligations are expected to be satisfied over the term of the system sale, lease, and service arrangements. Approximately 43% of the remaining performance obligations are expected to be recognized in the next 12 months with the remainder recognized thereafter over the term of the system sale, lease, and service arrangements, which are generally up to 5 years. Contract Assets and Liabilities The following information summarizes the Company’s contract assets and liabilities (in millions): As of September 30, 2023 December 31, 2022 Contract assets $ 22.7 $ 45.0 Deferred revenue $ 437.3 $ 438.3 The Company invoices its customers based on the billing schedules in its sales arrangements. Payments are generally due 30 to 60 days from the date of invoice. Contract assets for the periods presented primarily represent the difference between the revenue that was recognized based on the relative standalone selling price of the related performance obligations satisfied and the contractual billing terms in the arrangements. Deferred revenue for the periods presented primarily relates to service contracts where the service fees are billed up-front, generally quarterly or annually, prior to those services having been performed. The associated deferred revenue is generally recognized over the term of the service period. The Company did not have any significant impairment losses on its contract assets for the periods presented. Intuitive System Leasing The following table presents product revenue from Intuitive System Leasing arrangements (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Sales-type lease revenue $ 19.2 $ 29.6 $ 54.5 $ 115.3 Operating lease revenue* $ 127.1 $ 97.5 $ 361.8 $ 273.7 *Variable lease revenue relating to usage-based arrangements included within operating lease revenue $ 54.2 $ 35.5 $ 153.4 $ 94.0 Trade Accounts Receivable The allowance for doubtful accounts is based on the Company’s assessment of the collectibility of customer accounts. The Company regularly reviews the allowance by considering factors such as historical experience, credit quality, the age of the accounts receivable balances, and current economic conditions that may affect a customer’s ability to pay. For the three and nine months ended September 30, 2023, and 2022, bad debt expense was not material.

LEASES

LEASES	9 Months Ended
LEASES	Sep. 30, 2023
Leases [Abstract]
LEASES	LEASES Lessor Information related to Intuitive System Leasing Sales-type Leases. Lease receivables relating to sales-type lease arrangements are presented on the Condensed Consolidated Balance Sheets as follows (in millions): As of September 30, 2023 December 31, 2022 Gross lease receivables $ 395.1 $ 449.4 Unearned income (13.0) (14.4) Subtotal 382.1 435.0 Allowance for credit loss (2.7) (3.0) Net investment in sales-type leases $ 379.4 $ 432.0 Reported as: Prepaids and other current assets $ 134.4 $ 131.2 Intangible and other assets, net 245.0 300.8 Net investment in sales-type leases $ 379.4 $ 432.0 Contractual maturities of gross lease receivables as of September 30, 2023, are as follows (in millions): Fiscal Year Amount Remainder of 2023 $ 34.5 2024 135.9 2025 107.2 2026 69.3 2027 37.0 2028 and thereafter 11.2 Total $ 395.1 The Company enters into sales-type leases with certain qualified customers to purchase its systems. Sales-type leases have terms that generally range from 24 to 84 months and are usually collateralized by a security interest in the underlying assets. The allowance for loan loss is based on the Company’s assessment of current expected lifetime losses on lease receivables. The Company regularly reviews the allowance by considering factors such as historical experience, credit quality, age of the lease receivable balances, and current economic conditions that may affect a customer’s ability to pay. Lease receivables are considered past due 90 days after invoice. The Company manages the credit risk in the net investment in sales-type leases using a number of factors, including, but not limited to the following: size of operations; profitability, liquidity, and debt ratios; payment history; and past due amounts. The Company also uses credit scores obtained from external providers as a key indicator for the purposes of determining credit quality. The following table summarizes the amortized cost basis by year of origination and by credit quality for the net investment in sales-type leases as of September 30, 2023 (in millions): 2023 2022 2021 2020 2019 Prior Net Investment Credit Rating: High $ 34.7 $ 71.1 $ 63.7 $ 25.6 $ 7.2 $ 0.5 $ 202.8 Moderate 21.7 58.8 50.1 27.9 6.9 2.0 167.4 Low — 6.7 4.3 0.9 — — 11.9 Total $ 56.4 $ 136.6 $ 118.1 $ 54.4 $ 14.1 $ 2.5 $ 382.1

GOODWILL AND INTANGIBLE ASSETS

GOODWILL AND INTANGIBLE ASSETS	9 Months Ended
GOODWILL AND INTANGIBLE ASSETS	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
GOODWILL AND INTANGIBLE ASSETS	GOODWILL AND INTANGIBLE ASSETS Acquisitions There were no material acquisitions in the nine months ended September 30, 2023, and 2022. Goodwill The following table summarizes the changes in the carrying amount of goodwill (in millions): Amount Balance as of December 31, 2022 $ 348.5 Acquisition activity — Translation and other (0.4) Balance as of September 30, 2023 $ 348.1 Intangible Assets The following table summarizes the components of gross intangible assets, accumulated amortization, and net intangible assets balances as of September 30, 2023, and December 31, 2022 (in millions): September 30, 2023 December 31, 2022 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount Patents and developed technology $ 204.3 $ (175.1) $ 29.2 $ 199.1 $ (167.4) $ 31.7 Distribution rights and others 10.7 (8.7) 2.0 11.0 (7.4) 3.6 Customer relationships 31.7 (21.1) 10.6 32.6 (18.1) 14.5 Total intangible assets $ 246.7 $ (204.9) $ 41.8 $ 242.7 $ (192.9) $ 49.8 The estimated future amortization expense related to intangible assets as of September 30, 2023, is as follows (in millions): Fiscal Year Amount Remainder of 2023 $ 5.0 2024 16.5 2025 11.6 2026 5.0 2027 2.5 2028 and thereafter 1.2 Total $ 41.8 The preceding expected amortization expense is an estimate. Actual amounts of amortization expense may differ from estimated amounts due to additional intangible asset acquisitions, measurement-period adjustments to intangible assets, changes in foreign currency exchange rates, impairments of intangible assets, accelerated amortization of intangible assets, and other events.

CONTINGENCIES

CONTINGENCIES	9 Months Ended
CONTINGENCIES	Sep. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
CONTINGENCIES	CONTINGENCIES From time to time, the Company is involved in a variety of claims, lawsuits, investigations, and proceedings relating to securities laws, product liability, intellectual property, commercial, insurance, contract disputes, employment, and other matters. Certain of these lawsuits and claims are described in further detail below. It is not possible to predict what the outcome of these matters will be, and the Company cannot guarantee that any resolution will be reached on commercially reasonable terms, if at all. A liability and related charge to earnings are recorded in the Financial Statements for legal contingencies when the loss is considered probable and the amount can be reasonably estimated. The assessment is re-evaluated each accounting period and is based on all available information, including the impact of negotiations, settlements, rulings, advice of legal counsel, and other information and events pertaining to each case. Nevertheless, it is possible that additional future legal costs (including settlements, judgments, legal fees, and other related defense costs) could have a material adverse effect on the Company’s business, financial condition, or future results of operations. Product Liability Litigation The Company is currently named as a defendant in a number of individual product liability lawsuits filed in various state and federal courts. The plaintiffs generally allege that they or a family member underwent surgical procedures that utilized the da Vinci surgical system and sustained a variety of personal injuries and, in some cases, death as a result of such surgery. Several of the filed cases have trial dates in the next 12 months. The cases raise a variety of allegations including, to varying degrees, that plaintiffs’ injuries resulted from purported defects in the da Vinci surgical system and/or failure on the Company’s part to provide adequate training resources to the healthcare professionals who performed plaintiffs’ surgeries. The cases further allege that the Company failed to adequately disclose and/or misrepresented the potential risks and/or benefits of the da Vinci surgical system. Plaintiffs also assert a variety of causes of action, including, for example, strict liability based on purported design defects, negligence, fraud, breach of express and implied warranties, unjust enrichment, and loss of consortium. Plaintiffs seek recovery for alleged personal injuries and, in many cases, punitive damages. The Company disputes these allegations and is defending against these claims. The Company’s estimate of the anticipated cost of resolving the pending cases is based on negotiations with attorneys for the claimants. The final outcome of the pending lawsuits and claims, and others that might arise, is dependent on many variables that are difficult to predict, and the ultimate cost associated with these product liability lawsuits and claims may be materially different than the amount of the current estimate and accruals and could have a material adverse effect on the Company’s business, financial condition, or future results of operations. Although there is a reasonable possibility that a loss in excess of the amount recognized exists, the Company is unable to estimate the possible loss or range of loss in excess of the amount recognized at this time. Patent Litigation On June 30, 2017, Ethicon LLC, Ethicon Endo-Surgery, Inc., and Ethicon US LLC (collectively, “Ethicon”) filed a complaint for patent infringement against the Company in the U.S. District Court for the District of Delaware. The complaint, which was served on the Company on July 12, 2017, alleges that the Company’s EndoWrist Stapler instruments infringe several of Ethicon’s patents. Ethicon asserts infringement of U.S. Patent Nos. 9,585,658 (“’658”); 8,479,969 (“’969”); 9,113,874 (“’874”); 8,998,058 (“’058”); 8,991,677 (“’677”); 9,084,601 (“’601”); and 8,616,431 (“’431”). A claim construction hearing occurred on October 1, 2018, and the Court issued a scheduling order on December 28, 2018. On March 20, 2019, the Court granted the Company’s Motion to Stay pending an Inter Partes Review to be held at the Patent Trademark and Appeals Board (“PTAB”) to review patentability of six of the seven patents noted above and vacated the trial date. On August 1, 2019, the Court granted the parties’ joint stipulation to modify the stay in light of Ethicon’s U.S. International Trade Commission (“USITC”) complaint against Intuitive involving U.S. Patent Nos. 8,479,969 and 9,113,874. The PTAB has issued final written decisions finding the asserted claims of Patent Nos. ’658, ’058, ’677, ’601, and ’431 unpatentable. On October 3, 2023, Ethicon confirmed that it would not further appeal the decisions by the USITC in that proceeding that claim 24 of the ’969 Patent and claim 19 of the ’874 Patent were not infringed by the asserted Intuitive products and that those patents were invalid. On October 4, 2023, the parties filed a Joint Status Report in the district court in which Ethicon stated that it was prepared to proceed in this case with respect to its allegations that the accused EndoWrist Stapler instruments infringe asserted claim 24 of the ’969 Patent and asserted claim 20 of the ’874 Patent. On August 27, 2018, Ethicon filed a second complaint for patent infringement against the Company in the U.S. District Court for the District of Delaware. The complaint alleges that the Company’s SureForm 60 Staplers infringe five of Ethicon’s patents. Ethicon asserts infringement of U.S. Patent Nos. 9,884,369 (“’369”); 7,490,749 (“’749”); 8,602,288 (“’288”); 8,602,287 (“’287”); and 9,326,770(“’658”). The Company filed an answer denying all claims. On March 19, 2019, Ethicon filed a Motion for Leave to File a First Amended Complaint, removing allegations related to U.S. Patent No. 9,326,770 and adding allegations related to U.S. Patent Nos. 9,844,379 (“’379”) and 8,479,969. On July 17, 2019, the Court entered an order denying the amendment, without prejudice, and granting the parties’ joint stipulation to stay the case in its entirety in light of the USITC investigation involving U.S. Patent Nos. 9,844,369 and 7,490,749. The PTAB has issued final written decisions finding the asserted claims of Patent Nos. ’749, ’288, ’287, and ’379 unpatentable. On October 3, 2023, Ethicon confirmed that it would not further appeal the final written decision by the ITC that found, inter alia , that the asserted claim of the ’969 Patent was invalid and not infringed by the accused product. On October 4, 2023, the parties filed a Joint Status Report notifying the district court that asserted claims 22 and 23 of the ’369 Patent are the only asserted claims that remain at issue in this case and that the parties would meet and confer to discuss the activities that remain and to allow Ethicon to determine whether it will pursue the case. Based on currently available information, the Company is unable to make a reasonable estimate of loss or range of losses, if any, arising from these matters. On October 19, 2022, a jury rendered a verdict against the Company awarding $10 million in damages to Rex Medical, L.P. in a patent infringement lawsuit. On September 20, 2023, the court granted the Company’s post-trial motion and reduced the damages to Rex Medical L.P. to nominal damages of $1. On October 18, 2023, Rex Medical filed a notice of appeal to the United States Court of Appeals for the Federal Circuit. Based on currently available information, the Company does not believe that any losses arising from this matter would be material. Commercial Litigation On May 10, 2021, Surgical Instrument Service Company, Inc. (“SIS”) filed a complaint in the Northern District of California Court alleging anti-trust claims against the Company relating to EndoWrist service, maintenance, and repair processes. The Court granted in part and denied in part the Company’s Motion to Dismiss, and discovery has commenced. The Company filed an answer denying the anti-trust allegations and filed counterclaims against SIS. The counterclaims allege that SIS violated the Federal Lanham Act, California’s Unfair Competition Law, and California’s False Advertising Law and that SIS is also liable to the Company for Unfair Competition and Tortious Interference with Contract. The parties have filed summary judgment and Daubert motions, and the court held a hearing on these motions on September 7, 2023. Based on currently available information, the Company is unable to make a reasonable estimate of loss or range of losses, if any, arising from this matter. Three class action complaints were filed against the Company in the Northern District of California Court alleging anti-trust allegations relating to the service and repair of certain instruments manufactured by the Company. A complaint by Larkin Community Hospital was filed on May 20, 2021, a complaint by Franciscan Alliance, Inc. and King County Public Hospital District No. 1 was filed on July 6, 2021, and a complaint by Kaleida Health was filed on July 8, 2021. The Court has consolidated the Franciscan Alliance, Inc. and King County Public Hospital District No. 1 and Kaleida Health cases with the Larkin Community Hospital case, which is now captioned on the Larkin docket as “In Re: da Vinci Surgical Robot Antitrust Litigation.” A Consolidated Amended Class Action Complaint has been filed on behalf of each plaintiff named in the earlier-filed cases. On January 14, 2022, Kaleida Health voluntarily dismissed itself as a party to this case. On January 18, 2022, the Company filed an answer against the plaintiffs in this matter, and discovery has commenced. The parties have filed summary judgment and Daubert motions, and the court held a hearing on these motions on September 7, 2023. Based on currently available information, the Company is unable to make a reasonable estimate of loss or range of losses, if any, arising from this matter.

STOCKHOLDERS' EQUITY

STOCKHOLDERS' EQUITY	9 Months Ended
STOCKHOLDERS' EQUITY	Sep. 30, 2023
Equity [Abstract]
STOCKHOLDERS' EQUITY	STOCKHOLDERS’ EQUITY Stockholders’ Equity The following tables present the changes in stockholders’ equity (in millions): Three Months Ended September 30, 2023 Common Stock Additional Paid-In Capital Retained Earnings Accumulated Other Comprehensive Income (Loss) Total Intuitive Surgical, Inc. Stockholders’ Equity Noncontrolling Interest in Joint Venture Total Stockholders’ Equity Shares Amount Beginning balance 351.3 $ 0.4 $ 8,150.8 $ 3,807.7 $ (79.8) $ 11,879.1 $ 80.6 $ 11,959.7 Issuance of common stock through employee stock plans 0.7 — 77.4 — — 77.4 — 77.4 Shares withheld related to net share settlement of equity awards — — (0.6) (14.2) — (14.8) — (14.8) Share-based compensation expense related to employee stock plans — — 158.3 — — 158.3 — 158.3 Net income attributable to Intuitive Surgical, Inc. — — — 415.7 — 415.7 — 415.7 Other comprehensive income (loss) — — — — 23.3 23.3 (0.2) 23.1 Net income attributable to noncontrolling interest in joint venture — — — — — — 4.1 4.1 Ending balance 352.0 $ 0.4 $ 8,385.9 $ 4,209.2 $ (56.5) $ 12,539.0 $ 84.5 $ 12,623.5 Three Months Ended September 30, 2022 Common Stock Additional Retained Accumulated Total Intuitive Surgical, Inc. Stockholders’ Equity Noncontrolling Interest in Joint Venture Total Stockholders’ Equity Shares Amount Beginning balance 357.1 $ 0.4 $ 7,484.0 $ 4,682.8 $ (144.2) $ 12,023.0 $ 59.4 $ 12,082.4 Issuance of common stock through employee stock plans 0.9 — 82.0 — — 82.0 — 82.0 Shares withheld related to net share settlement of equity awards (0.1) — (0.4) (7.9) — (8.3) — (8.3) Share-based compensation expense related to employee stock plans — — 138.1 — — 138.1 — 138.1 Repurchase and retirement of common stock (4.6) — (18.9) (981.1) — (1,000.0) — (1,000.0) Net income attributable to Intuitive Surgical, Inc. — — — 324.0 — 324.0 — 324.0 Other comprehensive income (loss) — — — — (43.4) (43.4) (1.5) (44.9) Net income attributable to noncontrolling interest in joint venture — — — — — — 0.7 0.7 Ending balance 353.3 $ 0.4 $ 7,684.8 $ 4,017.8 $ (187.6) $ 11,515.4 $ 58.6 $ 11,574.0 Nine Months Ended September 30, 2023 Common Stock Additional Paid-In Capital Retained Earnings Accumulated Other Comprehensive Income (Loss) Total Intuitive Surgical, Inc. Stockholders’ Equity Noncontrolling Interest in Joint Venture Total Stockholders’ Equity Shares Amount Beginning balance 350.0 $ 0.4 $ 7,703.9 $ 3,500.1 $ (162.5) $ 11,041.9 $ 70.7 $ 11,112.6 Issuance of common stock through employee stock plans 4.1 — 252.2 — — 252.2 — 252.2 Shares withheld related to net share settlement of equity awards (0.6) — (6.9) (148.5) — (155.4) — (155.4) Share-based compensation expense related to employee stock plans — — 452.5 — — 452.5 — 452.5 Repurchase and retirement of common stock (1.5) — (15.8) (334.2) — (350.0) — (350.0) Net income attributable to Intuitive Surgical, Inc. — — — 1,191.8 — 1,191.8 — 1,191.8 Other comprehensive income (loss) — — — — 106.0 106.0 (1.0) 105.0 Net income attributable to noncontrolling interest in joint venture — — — — — — 14.8 14.8 Ending balance 352.0 $ 0.4 $ 8,385.9 $ 4,209.2 $ (56.5) $ 12,539.0 $ 84.5 $ 12,623.5 Nine Months Ended September 30, 2022 Common Stock Additional Paid-In Capital Retained Earnings Accumulated Other Comprehensive Income (Loss) Total Intuitive Surgical, Inc. Stockholders’ Equity Noncontrolling Interest in Joint Venture Total Stockholders’ Equity Shares Amount Beginning balance 357.7 $ 0.4 $ 7,164.0 $ 4,760.9 $ (24.2) $ 11,901.1 $ 50.4 $ 11,951.5 Issuance of common stock through employee stock plans 3.5 — 188.6 — — 188.6 — 188.6 Shares withheld related to net share settlement of equity awards (0.7) — (7.1) (180.2) — (187.3) — (187.3) Share-based compensation expense related to employee stock plans — — 385.6 — — 385.6 — 385.6 Repurchase and retirement of common stock (7.2) — (46.3) (1,560.3) — (1,606.6) — (1,606.6) Net income attributable to Intuitive Surgical, Inc. — — — 997.4 — 997.4 — 997.4 Other comprehensive income (loss) — — — — (163.4) (163.4) (2.1) (165.5) Net income attributable to noncontrolling interest in joint venture — — — — — — 10.3 10.3 Ending balance 353.3 $ 0.4 $ 7,684.8 $ 4,017.8 $ (187.6) $ 11,515.4 $ 58.6 $ 11,574.0 Stock Repurchase Program The Company’s Board of Directors (the “Board”) has authorized an aggregate of $10.0 billion of funding for the Company’s common stock repurchase program (the “Repurchase Program”) since its establishment in March 2009. The most recent authorization occurred in July 2022, when the Board increased the authorized amount available under the Repurchase Program to $3.5 billion, including amounts remaining under previous authorization. As of September 30, 2023, the remaining amount of share repurchases authorized by the Board under the Repurchase Program was approximately $1.1 billion. The following table summarizes stock repurchase activities (in millions, except per share amounts): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Shares repurchased — 4.6 1.5 7.2 Average price per share $ — $ 217.5 $ 238.1 $ 222.4 Value of shares repurchased $ — $ 1,000.0 $ 350.0 $ 1,606.6 In August 2022, the Company entered into an accelerated share repurchase program (the “ASR Program”) with Goldman, Sachs & Co. (“Goldman”) to repurchase $1.0 billion of the Company’s common stock. In September 2022, the ASR Program was completed and, in total, 4.6 million shares were repurchased at an average price per share of $217.52. The total cost of the ASR Program was reflected as a reduction to equity in the Condensed Consolidated Balance Sheets. As a provision of the Inflation Reduction Act enacted in the U.S. during 2022, the Company is subject to an excise tax on corporate stock repurchases, which is assessed as one percent of the fair market value of net stock repurchases after December 31, 2022. As of September 30, 2023, no excise tax was accrued, as the aggregate fair market value of the Company’s stock issuances exceeded the fair market value of stock repurchases. Accumulated Other Comprehensive Loss, Net of Tax, Attributable to Intuitive Surgical, Inc. The components of accumulated other comprehensive loss, net of tax, attributable to Intuitive Surgical, Inc. are as follows (in millions): Three Months Ended September 30, 2023 Gains (Losses) Unrealized Gains Foreign Employee Benefit Plans Total Beginning balance $ 5.6 $ (103.5) $ 16.9 $ 1.2 $ (79.8) Other comprehensive income (loss) before reclassifications 2.0 25.6 (6.6) — 21.0 Amounts reclassified from accumulated other comprehensive income (loss) 2.3 — — — 2.3 Net current-period other comprehensive income (loss) 4.3 25.6 (6.6) — 23.3 Ending balance $ 9.9 $ (77.9) $ 10.3 $ 1.2 $ (56.5) Three Months Ended September 30, 2022 Gains (Losses) Unrealized Gains Foreign Employee Benefit Plans Total Beginning balance $ 9.9 $ (140.1) $ (9.3) $ (4.7) $ (144.2) Other comprehensive income (loss) before reclassifications (5.7) (37.3) (8.5) — (51.5) Amounts reclassified from accumulated other comprehensive income (loss) 8.0 — — 0.1 8.1 Net current-period other comprehensive income (loss) 2.3 (37.3) (8.5) 0.1 (43.4) Ending balance $ 12.2 $ (177.4) $ (17.8) $ (4.6) $ (187.6) Nine Months Ended September 30, 2023 Gains (Losses) on Hedge Instruments Unrealized Gains Foreign Currency Translation Gains (Losses) Employee Benefit Plans Total Beginning balance $ (2.9) $ (154.2) $ (6.6) $ 1.2 $ (162.5) Other comprehensive income (loss) before reclassifications 12.6 76.5 16.9 — 106.0 Amounts reclassified from accumulated other comprehensive income (loss) 0.2 (0.2) — — — Net current-period other comprehensive income (loss) 12.8 76.3 16.9 — 106.0 Ending balance $ 9.9 $ (77.9) $ 10.3 $ 1.2 $ (56.5) Nine Months Ended September 30, 2022 Gains (Losses) on Hedge Instruments Unrealized Gains Foreign Currency Translation Gains (Losses) Employee Benefit Plans Total Beginning balance $ 4.5 $ (16.0) $ (7.9) $ (4.8) $ (24.2) Other comprehensive income (loss) before reclassifications (11.0) (161.4) (9.9) — (182.3) Amounts reclassified from accumulated other comprehensive income (loss) 18.7 — — 0.2 18.9 Net current-period other comprehensive income (loss) 7.7 (161.4) (9.9) 0.2 (163.4) Ending balance $ 12.2 $ (177.4) $ (17.8) $ (4.6) $ (187.6) The tax impacts for amounts recognized in other comprehensive income (loss) before reclassifications were as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, Available-for-sale securities 2023 2022 2023 2022 Income tax benefit (expense) for net gains (losses) recorded in other comprehensive income (loss) $ (7.4) $ 10.8 $ (22.0) $ 46.1 The tax impacts for amounts recognized in other comprehensive income (loss) before reclassifications for hedge instruments, foreign currency translation, and employee benefit plans for the three and nine months ended September 30, 2023, and 2022, were not material to the Company’s Financial Statements. The tax impacts for amounts reclassified from accumulated other comprehensive loss relating to hedge instruments, available-for-sale securities, foreign currency translation, and employee benefit plans for the three and nine months ended September 30, 2023, and 2022, were not material to the Company’s Financial Statements.

SHARE-BASED COMPENSATION

SHARE-BASED COMPENSATION	9 Months Ended
SHARE-BASED COMPENSATION	Sep. 30, 2023
Share-Based Payment Arrangement [Abstract]
SHARE-BASED COMPENSATION	SHARE-BASED COMPENSATION As of September 30, 2023, the total number of shares of common stock reserved for issuance under the 2010 Incentive Award Plan was 110,350,000. Approximately 20.6 million shares were reserved for future issuance under the Company’s stock plans, and a maximum of approximately 8.9 million of these shares can be awarded as restricted stock units (“RSUs”). Restricted Stock Units A summary of RSU activity under all stock plans for the nine months ended September 30, 2023, is presented as follows (in millions, except per share amounts): Shares Weighted-Average Unvested balance as of December 31, 2022 4.6 $ 241.47 RSUs granted 2.4 $ 235.57 RSUs vested (1.8) $ 222.84 RSUs forfeited (0.2) $ 246.83 Unvested balance as of September 30, 2023 5.0 $ 244.89 Stock Options A summary of stock option activity under all stock plans for the nine months ended September 30, 2023, is presented as follows (in millions, except per share amounts): Stock Options Outstanding Number Weighted-Average Balance as of December 31, 2022 10.8 $ 144.86 Options granted 1.4 $ 267.32 Options exercised (1.9) $ 80.91 Options forfeited/expired (0.1) $ 259.12 Balance as of September 30, 2023 10.2 $ 171.54 As of September 30, 2023, options to purchase an aggregate of 7.9 million shares of common stock were exercisable at a weighted-average price of $144.89 per share. Performance Stock Units In 2022, the Company began granting performance stock units (“PSUs”) to officers and other key employees subject to three-year cliff vesting and pre-established, quantitative goals. Whether any PSUs vest, and the amount that do vest, is tied to completion of service over three years and the achievement of three equally-weighted, quantitative goals that directly align with or help drive the Company’s strategy and long-term total shareholder return. The 2022 PSU grant metrics are focused on relative total shareholder return (“TSR”), year-over-year da Vinci procedure growth for 2023, and two-year compound annual da Vinci procedure growth for 2024. The 2023 PSU grant metrics are focused on relative TSR, da Vinci and Ion procedure growth in 2024 compared to 2022, and da Vinci and Ion procedure growth in 2025 compared to 2022. The TSR metric is considered a market condition, and the expense is determined at the grant date. The procedure growth metrics are considered performance conditions, and the expense is recorded based on the forecasted performance, which is reassessed each reporting period based on the probability of achieving the performance conditions. The number of shares earned at the end of the three-year period will vary, based on actual performance, from 0% to 125% of the target number of PSUs granted. PSUs are subject to forfeiture if employment terminates prior to the vesting date. PSUs are not considered issued or outstanding shares of the Company. The Company calculates the fair value for each component of the PSUs individually. The fair value for the component with the TSR metric was determined using Monte Carlo simulation. The fair value per share for the components with the procedure growth metrics is equal to the closing stock price on the grant date. A summary of PSU activity for the nine months ended September 30, 2023, is presented as follows (in millions, except per share amounts): Shares Weighted-Average Unvested balance as of December 31, 2022 0.1 $ 299.32 Granted 0.1 $ 240.45 Vested — $ — Performance change — $ — Forfeited — $ 235.84 Unvested balance as of September 30, 2023 0.2 $ 259.60 Employee Stock Purchase Plan Under the Employee Stock Purchase Plan (“ESPP”), employees purchased approximately 0.5 million shares for $104.5 million and approximately 0.4 million shares for $87.9 million during the nine months ended September 30, 2023, and 2022, respectively. Share-based Compensation Expense The following table summarizes share-based compensation expense for the three and nine months ended September 30, 2023, and 2022 (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Cost of sales – products (before capitalization) $ 24.7 $ 22.0 $ 70.4 $ 61.0 Amounts capitalized into inventory (1) (23.2) — (63.1) — Amounts recognized in income for amounts previously capitalized in inventory 21.1 — 53.0 — Cost of sales – products $ 22.6 $ 22.0 $ 60.3 $ 61.0 Cost of sales – services 7.3 6.3 21.3 17.7 Total cost of sales 29.9 28.3 81.6 78.7 Selling, general, and administrative 71.9 68.0 206.6 191.0 Research and development 55.3 42.3 157.7 117.6 Share-based compensation expense before income taxes 157.1 138.6 445.9 387.3 Income tax benefit 28.7 26.9 85.2 75.0 Share-based compensation expense after income taxes $ 128.4 $ 111.7 $ 360.7 $ 312.3 (1) Share-based compensation expense subject to capitalization into inventory was not material during the three and nine months ended September 30, 2022, and, therefore, not recorded. The Company commenced capitalization of share-based compensation expense into inventory during the quarter ended December 31, 2022, on a prospective basis. The Black-Scholes-Merton option pricing model is used to estimate the fair value of stock options granted under the Company’s share-based compensation plans and the rights to acquire stock granted under the ESPP. The weighted-average estimated fair values of stock options and the rights to acquire stock under the ESPP, as well as the weighted-average assumptions used in calculating the fair values of stock options and the rights to acquire stock under the ESPP that were granted during the three and nine months ended September 30, 2023, and 2022, were as follows: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Stock Options Risk-free interest rate 4.5% 3.4% 4.6% 2.5% Expected term (in years) 2.9 3.0 3.2 3.2 Expected volatility 32% 42% 33% 38% Fair value at grant date $82.63 $66.00 $77.41 $73.51 ESPP Risk-free interest rate 5.2% 2.9% 5.0% 2.1% Expected term (in years) 1.2 1.2 1.2 1.2 Expected volatility 31% 40% 33% 39% Fair value at grant date $98.96 $75.01 $89.42 $80.61

INCOME TAXES

INCOME TAXES	9 Months Ended
INCOME TAXES	Sep. 30, 2023
Income Tax Disclosure [Abstract]
INCOME TAXES	INCOME TAXESIncome tax expense for the three months ended September 30, 2023, was $102.2 million, or 19.6% of income before taxes, compared to $78.1 million, or 19.4% of income before taxes, for the three months ended September 30, 2022. Income tax expense for the nine months ended September 30, 2023, was $236.4 million, or 16.4% of income before taxes, compared to $204.4 million, or 16.9% of income before taxes, for the nine months ended September 30, 2022. The effective tax rates for the three and nine months ended September 30, 2023, and 2022, differed from the U.S. federal statutory rate of 21% primarily due to the tax benefits associated with employee equity plans, the effect of income earned by certain overseas entities being taxed at rates lower than the federal statutory rate, and the federal research and development credit benefit, partially offset by U.S. tax on foreign earnings and state income taxes (net of the federal benefit). The provision for income taxes for the three months ended September 30, 2023, and 2022, included excess tax benefits associated with employee equity plans of $22.0 million and $18.1 million, respectively, which reduced the Company’s effective tax rate by 4.2 and 4.5 percentage points, respectively. The Company files federal, state, and foreign income tax returns in many U.S. and OUS jurisdictions. Years before 2016 are closed for the significant jurisdictions. Certain of the Company’s unrecognized tax benefits could change due to activities of various tax authorities, including evolving interpretations of existing tax laws in the jurisdictions in which the Company operates, potential assessment of additional tax, possible settlement of audits, or through normal expiration of various statutes of limitations, which could affect the Company’s effective tax rate in the period in which they change. Due to the uncertainty related to the timing and potential outcome of audits, the Company cannot estimate the range of reasonably possible changes in unrecognized tax benefits that may occur in the next 12 months. The Company is subject to the examination of its income tax returns by the Internal Revenue Service and other tax authorities. The outcome of these audits cannot be predicted with certainty. The Company’s management regularly assesses the likelihood of adverse outcomes resulting from these examinations to determine the adequacy of the Company’s provision for income taxes. If any issues addressed in the Company’s tax audits are resolved in a manner not consistent with management’s expectations, the Company could be required to adjust its provision for income taxes in the period such resolution occurs.

NET INCOME PER SHARE

NET INCOME PER SHARE	9 Months Ended
NET INCOME PER SHARE	Sep. 30, 2023
Earnings Per Share [Abstract]
NET INCOME PER SHARE	NET INCOME PER SHARE The following table presents the computation of basic and diluted net income per share attributable to Intuitive Surgical, Inc. (in millions, except per share amounts): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Numerator: Net income attributable to Intuitive Surgical, Inc. $ 415.7 $ 324.0 $ 1,191.8 $ 997.4 Denominator: Weighted-average shares outstanding used in basic calculation 351.7 355.3 351.0 357.2 Add: dilutive effect of potential common shares 6.5 5.2 6.1 6.5 Weighted-average shares outstanding used in diluted calculation 358.2 360.5 357.1 363.7 Net income per share attributable to Intuitive Surgical, Inc.: Basic $ 1.18 $ 0.91 $ 3.40 $ 2.79 Diluted $ 1.16 $ 0.90 $ 3.34 $ 2.74

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Millions	3 Months Ended		9 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Millions	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Pay vs Performance Disclosure
Net income attributable to Intuitive Surgical, Inc.	$ 415.7	$ 324	$ 1,191.8	$ 997.4

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended	9 Months Ended
Insider Trading Arrangements	Sep. 30, 2023 shares	Sep. 30, 2023 shares
Trading Arrangements, by Individual
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
Myriam J. Curet, M.D., F.A.C.S. [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		On August 11, 2023, Myriam J. Curet, M.D., F.A.C.S., the Company’s Chief Medical Officer, adopted a Rule 10b5-1 trading plan. Ms. Curet’s trading plan provides for the potential sale of up to 27,077 shares of the Company’s common stock, including the potential exercise and sale of up to 21,273 shares of the Company’s common stock subject to stock options, until August 12, 2024. This trading plan was entered into during an open insider trading window and is intended to satisfy the affirmative defense of Rule 10b5-1(c) under the Securities Exchange Act of 1934, as amended, and the Company’s policies regarding transactions in the Company’s securities.
Name	Myriam J. Curet, M.D., F.A.C.S.
Title	Chief Medical Officer
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	August 11, 2023
Arrangement Duration	367 days
Myriam J. Curet, M.D., F.A.C.S. Trading Arrangement, Common Stock [Member] \| Myriam J. Curet, M.D., F.A.C.S. [Member]
Trading Arrangements, by Individual
Aggregate Available	27,077	27,077
Myriam J. Curet, M.D., F.A.C.S. Trading Arrangement, Stock Options [Member] \| Myriam J. Curet, M.D., F.A.C.S. [Member]
Trading Arrangements, by Individual
Aggregate Available	21,273	21,273

SUMMARY OF SIGNIFICANT ACCOUN_2

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)	9 Months Ended
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)	Sep. 30, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation In the opinion of management, the accompanying unaudited Condensed Consolidated Financial Statements (“Financial Statements”) of Intuitive Surgical, Inc. and its wholly and majority-owned subsidiaries have been prepared on a consistent basis with the audited Consolidated Financial Statements for the fiscal year ended December 31, 2022, and include all adjustments, consisting of only normal, recurring adjustments, necessary to fairly state the information set forth herein. The Financial Statements have been prepared in accordance with the rules and regulations of the Securities and Exchange Commission (“SEC”) and, therefore, omit certain information and footnote disclosure necessary to present the Financial Statements in accordance with United States (“U.S.”) generally accepted accounting principles (“GAAP”). These Financial Statements should be read in conjunction with the audited Consolidated Financial Statements and notes thereto included in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2022, which was filed with the SEC on February 10, 2023. The results of operations for the first nine months of 2023 are not necessarily indicative of the results to be expected for the entire fiscal year or any future periods.
Consolidation and Joint Ventures	The Financial Statements include the results and balances of the Company’s majority-owned joint ventures, Intuitive Surgical-Fosun Medical Technology (Shanghai) Co., Ltd. and Intuitive Surgical-Fosun (HongKong) Co., Ltd. (collectively, the “Joint Venture”), with Shanghai Fosun Pharmaceutical (Group) Co., Ltd. (“Fosun Pharma”). The Company holds a controlling financial interest in the Joint Venture, and the noncontrolling interest is reflected as a separate component of the consolidated stockholders’ equity. The noncontrolling interest’s share of the earnings in the Joint Venture is presented separately in the Condensed Consolidated Statements of Comprehensive Income.
Recently Adopted Accounting Pronouncements and Recently Issued Accounting Pronouncements	Recently Adopted Accounting Pronouncements Troubled Debt Restructurings and Vintage Disclosures In March 2022, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2022-02, Financial Instruments-Credit Losses (Topic 326): Troubled Debt Restructurings and Vintage Disclosures (“ASU 2022-02”), which eliminates the accounting guidance for troubled debt restructurings by creditors while enhancing disclosure requirements for certain loan refinancings and restructurings by creditors when a borrower is experiencing financial difficulty. Additionally, the standard requires disclosure of current-period gross write-offs by year of origination for financing receivables and net investments in leases within the scope of Subtopic ASC 326-20, Financial Instruments-Credit Losses-Measured at Amortized Cost . The Company adopted ASU 2022-02 on January 1, 2023, on a prospective basis. There was no impact of the adoption of ASU 2022-02 on the Company’s Financial Statements in the three and nine months ended September 30, 2023. Recently Issued Accounting Pronouncements The Company continues to monitor new accounting pronouncements issued by the FASB and does not believe any accounting pronouncements issued through the date of this report will have a material impact on the Company’s Financial Statements. Significant Accounting Policies There have been no new or material changes to the significant accounting policies discussed in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2022, that are of significance, or potential significance, to the Company.

FINANCIAL INSTRUMENTS (Tables)

FINANCIAL INSTRUMENTS (Tables)	9 Months Ended
FINANCIAL INSTRUMENTS (Tables)	Sep. 30, 2023
Investments, All Other Investments [Abstract]
Debt Securities, Available-for-sale	The following tables summarize the Company’s cash and available-for-sale debt securities’ amortized cost, gross unrealized gains, gross unrealized losses, allowance for credit loss, and fair value by significant investment category reported as cash and cash equivalents, short-term investments, or long-term investments as of September 30, 2023, and December 31, 2022 (in millions): Reported as: Amortized Gross Gross Allowance for Credit Loss Fair Cash and Short- Long- September 30, 2023 Cash $ 474.3 $ — $ — $ — $ 474.3 $ 474.3 $ — $ — Level 1: Money market funds 2,967.8 — — — 2,967.8 2,967.8 — — U.S. treasuries 2,324.2 0.2 (43.9) — 2,280.5 159.9 1,660.5 460.1 Subtotal 5,292.0 0.2 (43.9) — 5,248.3 3,127.7 1,660.5 460.1 Level 2: Corporate debt securities 1,353.9 — (42.3) (1.1) 1,310.5 — 914.7 395.8 U.S. government agencies 400.4 — (11.2) — 389.2 — 214.2 175.0 Municipal securities 101.4 — (3.1) — 98.3 — 84.3 14.0 Subtotal 1,855.7 — (56.6) (1.1) 1,798.0 — 1,213.2 584.8 Total assets measured at fair value $ 7,622.0 $ 0.2 $ (100.5) $ (1.1) $ 7,520.6 $ 3,602.0 $ 2,873.7 $ 1,044.9 Reported as: Amortized Gross Gross Allowance for Credit Loss Fair Cash and Short- Long- December 31, 2022 Cash $ 497.2 $ — $ — $ — $ 497.2 $ 497.2 $ — $ — Level 1: Money market funds 1,084.0 — — — 1,084.0 1,084.0 — — U.S. treasuries 2,715.2 — (96.6) — 2,618.6 — 1,542.4 1,076.2 Subtotal 3,799.2 — (96.6) — 3,702.6 1,084.0 1,542.4 1,076.2 Level 2: Commercial paper 20.0 — — — 20.0 — 20.0 — Corporate debt securities 2,022.0 — (76.0) (1.1) 1,944.9 — 651.8 1,293.1 U.S. government agencies 447.2 — (19.9) — 427.3 — 247.8 179.5 Municipal securities 155.5 — (6.0) — 149.5 — 74.7 74.8 Subtotal 2,644.7 — (101.9) (1.1) 2,541.7 — 994.3 1,547.4 Total assets measured at fair value $ 6,941.1 $ — $ (198.5) $ (1.1) $ 6,741.5 $ 1,581.2 $ 2,536.7 $ 2,623.6
Summary of Contractual Maturities of Cash Equivalents and Available-For-Sale Investments	The following table summarizes the contractual maturities of the Company’s cash equivalents and available-for-sale debt securities (excluding money market funds), as of September 30, 2023 (in millions): Amortized Fair Mature in less than one year $ 3,084.2 $ 3,033.6 Mature in one to five years 1,095.7 1,044.9 Total $ 4,179.9 $ 4,078.5
Schedule of Unrealized Loss on Investments	The following tables present the breakdown of the available-for-sale debt securities with unrealized losses as of September 30, 2023, and December 31, 2022 (in millions): September 30, 2023 Unrealized losses less than 12 months Unrealized losses 12 months or greater Total Fair Unrealized Fair Unrealized Fair Unrealized U.S. treasuries $ 458.8 $ (0.4) $ 1,427.5 $ (43.5) $ 1,886.3 $ (43.9) Corporate debt securities 54.0 (0.1) 1,248.8 (42.2) 1,302.8 (42.3) U.S. government agencies 114.6 (0.2) 274.6 (11.0) 389.2 (11.2) Municipal securities — — 82.3 (3.1) 82.3 (3.1) Total $ 627.4 $ (0.7) $ 3,033.2 $ (99.8) $ 3,660.6 $ (100.5) December 31, 2022 Unrealized losses less than 12 months Unrealized losses 12 months or greater Total Fair Unrealized Fair Unrealized Fair Unrealized U.S. treasuries $ 731.7 $ (26.0) $ 1,886.9 $ (70.6) $ 2,618.6 $ (96.6) Corporate debt securities 631.4 (17.6) 1,221.9 (58.4) 1,853.3 (76.0) U.S. government agencies 102.7 (4.4) 324.6 (15.5) 427.3 (19.9) Municipal securities 44.6 (1.1) 104.9 (4.9) 149.5 (6.0) Total $ 1,510.4 $ (49.1) $ 3,538.3 $ (149.4) $ 5,048.7 $ (198.5)
Summary of Equity Investment Activity	The following table is a summary of the activity related to equity investments (in millions): Reported as: December 31, 2022 Carrying Value Changes in Fair Value (1) Purchases / Sales / Other (2) September 30, 2023 Carrying Value Prepaids and other current assets Intangible and other assets, net Equity investments with readily determinable value (Level 1) $ 4.3 $ (0.4) $ (3.9) $ — $ — $ — Equity investments without readily determinable value (Level 2) $ 59.1 $ (5.6) $ 20.0 $ 73.5 $ — $ 73.5 (1) Recorded in interest and other income, net. (2) Other includes foreign currency translation gains/(losses).
Derivatives Not Designated as Hedging Instruments	These derivative instruments are used to hedge against balance sheet foreign currency exposures. The related gains and losses were as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Recognized gains in interest and other income, net $ 10.4 $ 17.9 $ 21.8 $ 46.6 Foreign exchange losses related to balance sheet re-measurement $ (13.1) $ (30.5) $ (24.0) $ (69.4)
Gross Notional Amounts for Derivatives and Aggregate Gross Fair Value Outstanding	Total gross notional amounts (in USD) for outstanding derivatives and the aggregate gross fair value at the end of each period were as follows (in millions): Derivatives Designated as Hedging Instruments Derivatives Not Designated as Hedging Instruments September 30, December 31, September 30, December 31, Notional amounts: Forward contracts $ 262.2 $ 188.4 $ 618.0 $ 496.3 Gross fair value recorded in: Prepaids and other current assets $ 12.8 $ 1.8 $ 9.3 $ 4.3 Other accrued liabilities $ 1.7 $ 5.3 $ 2.5 $ 4.2

BALANCE SHEET DETAILS AND OTH_2

BALANCE SHEET DETAILS AND OTHER FINANCIAL INFORMATION (Tables)	9 Months Ended
	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Accounts Receivable, Net	As of Accounts receivable, net September 30, December 31, Trade accounts receivable, net $ 879.6 $ 864.9 Unbilled accounts receivable and other 98.4 91.7 Sales returns and allowances (15.3) (14.5) Total accounts receivable, net $ 962.7 $ 942.1
Inventory	As of Inventory September 30, December 31, Raw materials $ 420.3 $ 382.9 Work-in-process 150.1 159.9 Finished goods 577.1 350.4 Total inventory $ 1,147.5 $ 893.2
Prepaids and Other Current Assets	As of Prepaids and other current assets September 30, December 31, Net investment in sales-type leases – short-term $ 134.4 $ 131.2 Other prepaids and other current assets 182.6 168.6 Total prepaids and other current assets $ 317.0 $ 299.8
Property, Plant, and Equipment, Net	As of September 30, December 31, Property, plant, and equipment, net Land $ 389.5 $ 388.6 Building and building/leasehold improvements 900.9 866.5 Machinery and equipment 654.7 566.4 Operating lease assets – Intuitive System Leasing 1,052.9 806.4 Computer and office equipment 145.6 134.7 Capitalized software 250.8 240.9 Construction-in-process 1,150.8 608.6 Gross property, plant, and equipment 4,545.2 3,612.1 Less: Accumulated depreciation* (1,468.2) (1,237.9) Total property, plant, and equipment, net $ 3,077.0 $ 2,374.2 *Accumulated depreciation associated with operating lease assets – Intuitive System Leasing $ (395.7) $ (285.8)
Other Accrued Liabilities - Short-term	As of Other accrued liabilities – short-term September 30, December 31, Income and other taxes payable $ 342.8 $ 96.1 Accrued construction-related capital expenditures 106.0 50.3 Litigation-related accruals 1.6 23.0 Other accrued liabilities 260.2 306.8 Total other accrued liabilities – short-term $ 710.6 $ 476.2
Other Long-term Liabilities	As of Other long-term liabilities September 30, December 31, Income taxes – long-term $ 264.1 $ 288.0 Deferred revenue – long-term 42.5 41.0 Other long-term liabilities 106.2 110.3 Total other long-term liabilities $ 412.8 $ 439.3
Supplemental Cash Flow Information	The following table provides supplemental non-cash investing and financing activities (in millions): Nine Months Ended September 30, 2023 2022 Equipment transfers, including operating lease assets, from inventory to property, plant, and equipment $ 303.8 $ 189.0 Acquisition of property, plant, and equipment in accounts payable and accrued liabilities $ 135.2 $ 91.4

REVENUE AND CONTRACT ACQUISIT_2

REVENUE AND CONTRACT ACQUISITION COSTS (Tables)	9 Months Ended
REVENUE AND CONTRACT ACQUISITION COSTS (Tables)	Sep. 30, 2023
Revenue from Contract with Customer [Abstract]
Revenue Disaggregated by Types and Geography	The following table presents revenue disaggregated by type and geography (in millions): Three Months Ended September 30, Nine Months Ended September 30, U.S. 2023 2022 2023 2022 Instruments and accessories $ 775.7 $ 643.3 $ 2,240.4 $ 1,819.0 Systems 216.0 264.7 627.6 731.0 Services 188.5 175.0 564.6 508.9 Total U.S. revenue $ 1,180.2 $ 1,083.0 $ 3,432.6 $ 3,058.9 Outside of U.S. (“OUS”) Instruments and accessories $ 295.7 $ 228.3 $ 892.5 $ 758.2 Systems 163.4 161.2 571.9 498.1 Services 104.4 84.9 298.8 252.0 Total OUS revenue $ 563.5 $ 474.4 $ 1,763.2 $ 1,508.3 Total Instruments and accessories $ 1,071.4 $ 871.6 $ 3,132.9 $ 2,577.2 Systems 379.4 425.9 1,199.5 1,229.1 Services 292.9 259.9 863.4 760.9 Total revenue $ 1,743.7 $ 1,557.4 $ 5,195.8 $ 4,567.2
Summary of Contract Assets and Liabilities	The following information summarizes the Company’s contract assets and liabilities (in millions): As of September 30, 2023 December 31, 2022 Contract assets $ 22.7 $ 45.0 Deferred revenue $ 437.3 $ 438.3
Sales-type Lease Revenue	The following table presents product revenue from Intuitive System Leasing arrangements (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Sales-type lease revenue $ 19.2 $ 29.6 $ 54.5 $ 115.3 Operating lease revenue* $ 127.1 $ 97.5 $ 361.8 $ 273.7 *Variable lease revenue relating to usage-based arrangements included within operating lease revenue $ 54.2 $ 35.5 $ 153.4 $ 94.0
Operating Lease Revenue	The following table presents product revenue from Intuitive System Leasing arrangements (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Sales-type lease revenue $ 19.2 $ 29.6 $ 54.5 $ 115.3 Operating lease revenue* $ 127.1 $ 97.5 $ 361.8 $ 273.7 *Variable lease revenue relating to usage-based arrangements included within operating lease revenue $ 54.2 $ 35.5 $ 153.4 $ 94.0

LEASES (Tables)

LEASES (Tables)	9 Months Ended
LEASES (Tables)	Sep. 30, 2023
Leases [Abstract]
Schedule of Lease Receivables	Lease receivables relating to sales-type lease arrangements are presented on the Condensed Consolidated Balance Sheets as follows (in millions): As of September 30, 2023 December 31, 2022 Gross lease receivables $ 395.1 $ 449.4 Unearned income (13.0) (14.4) Subtotal 382.1 435.0 Allowance for credit loss (2.7) (3.0) Net investment in sales-type leases $ 379.4 $ 432.0 Reported as: Prepaids and other current assets $ 134.4 $ 131.2 Intangible and other assets, net 245.0 300.8 Net investment in sales-type leases $ 379.4 $ 432.0
Schedule of Contractual Maturities of Gross Lease Receivables	Contractual maturities of gross lease receivables as of September 30, 2023, are as follows (in millions): Fiscal Year Amount Remainder of 2023 $ 34.5 2024 135.9 2025 107.2 2026 69.3 2027 37.0 2028 and thereafter 11.2 Total $ 395.1
Amortized Cost Basis by Year of Origination and Credit Quality Indicator	The following table summarizes the amortized cost basis by year of origination and by credit quality for the net investment in sales-type leases as of September 30, 2023 (in millions): 2023 2022 2021 2020 2019 Prior Net Investment Credit Rating: High $ 34.7 $ 71.1 $ 63.7 $ 25.6 $ 7.2 $ 0.5 $ 202.8 Moderate 21.7 58.8 50.1 27.9 6.9 2.0 167.4 Low — 6.7 4.3 0.9 — — 11.9 Total $ 56.4 $ 136.6 $ 118.1 $ 54.4 $ 14.1 $ 2.5 $ 382.1

GOODWILL AND INTANGIBLE ASSETS

GOODWILL AND INTANGIBLE ASSETS (Tables)	9 Months Ended
GOODWILL AND INTANGIBLE ASSETS (Tables)	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Summary of Changes in Goodwill	The following table summarizes the changes in the carrying amount of goodwill (in millions): Amount Balance as of December 31, 2022 $ 348.5 Acquisition activity — Translation and other (0.4) Balance as of September 30, 2023 $ 348.1
Schedule of Intangible Assets	The following table summarizes the components of gross intangible assets, accumulated amortization, and net intangible assets balances as of September 30, 2023, and December 31, 2022 (in millions): September 30, 2023 December 31, 2022 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount Patents and developed technology $ 204.3 $ (175.1) $ 29.2 $ 199.1 $ (167.4) $ 31.7 Distribution rights and others 10.7 (8.7) 2.0 11.0 (7.4) 3.6 Customer relationships 31.7 (21.1) 10.6 32.6 (18.1) 14.5 Total intangible assets $ 246.7 $ (204.9) $ 41.8 $ 242.7 $ (192.9) $ 49.8
Schedule Of Estimated Future Amortization Expense Of Intangible Assets	The estimated future amortization expense related to intangible assets as of September 30, 2023, is as follows (in millions): Fiscal Year Amount Remainder of 2023 $ 5.0 2024 16.5 2025 11.6 2026 5.0 2027 2.5 2028 and thereafter 1.2 Total $ 41.8

STOCKHOLDERS' EQUITY (Tables)

STOCKHOLDERS' EQUITY (Tables)	9 Months Ended
STOCKHOLDERS' EQUITY (Tables)	Sep. 30, 2023
Equity [Abstract]
Schedule of Stockholders Equity	The following tables present the changes in stockholders’ equity (in millions): Three Months Ended September 30, 2023 Common Stock Additional Paid-In Capital Retained Earnings Accumulated Other Comprehensive Income (Loss) Total Intuitive Surgical, Inc. Stockholders’ Equity Noncontrolling Interest in Joint Venture Total Stockholders’ Equity Shares Amount Beginning balance 351.3 $ 0.4 $ 8,150.8 $ 3,807.7 $ (79.8) $ 11,879.1 $ 80.6 $ 11,959.7 Issuance of common stock through employee stock plans 0.7 — 77.4 — — 77.4 — 77.4 Shares withheld related to net share settlement of equity awards — — (0.6) (14.2) — (14.8) — (14.8) Share-based compensation expense related to employee stock plans — — 158.3 — — 158.3 — 158.3 Net income attributable to Intuitive Surgical, Inc. — — — 415.7 — 415.7 — 415.7 Other comprehensive income (loss) — — — — 23.3 23.3 (0.2) 23.1 Net income attributable to noncontrolling interest in joint venture — — — — — — 4.1 4.1 Ending balance 352.0 $ 0.4 $ 8,385.9 $ 4,209.2 $ (56.5) $ 12,539.0 $ 84.5 $ 12,623.5 Three Months Ended September 30, 2022 Common Stock Additional Retained Accumulated Total Intuitive Surgical, Inc. Stockholders’ Equity Noncontrolling Interest in Joint Venture Total Stockholders’ Equity Shares Amount Beginning balance 357.1 $ 0.4 $ 7,484.0 $ 4,682.8 $ (144.2) $ 12,023.0 $ 59.4 $ 12,082.4 Issuance of common stock through employee stock plans 0.9 — 82.0 — — 82.0 — 82.0 Shares withheld related to net share settlement of equity awards (0.1) — (0.4) (7.9) — (8.3) — (8.3) Share-based compensation expense related to employee stock plans — — 138.1 — — 138.1 — 138.1 Repurchase and retirement of common stock (4.6) — (18.9) (981.1) — (1,000.0) — (1,000.0) Net income attributable to Intuitive Surgical, Inc. — — — 324.0 — 324.0 — 324.0 Other comprehensive income (loss) — — — — (43.4) (43.4) (1.5) (44.9) Net income attributable to noncontrolling interest in joint venture — — — — — — 0.7 0.7 Ending balance 353.3 $ 0.4 $ 7,684.8 $ 4,017.8 $ (187.6) $ 11,515.4 $ 58.6 $ 11,574.0 Nine Months Ended September 30, 2023 Common Stock Additional Paid-In Capital Retained Earnings Accumulated Other Comprehensive Income (Loss) Total Intuitive Surgical, Inc. Stockholders’ Equity Noncontrolling Interest in Joint Venture Total Stockholders’ Equity Shares Amount Beginning balance 350.0 $ 0.4 $ 7,703.9 $ 3,500.1 $ (162.5) $ 11,041.9 $ 70.7 $ 11,112.6 Issuance of common stock through employee stock plans 4.1 — 252.2 — — 252.2 — 252.2 Shares withheld related to net share settlement of equity awards (0.6) — (6.9) (148.5) — (155.4) — (155.4) Share-based compensation expense related to employee stock plans — — 452.5 — — 452.5 — 452.5 Repurchase and retirement of common stock (1.5) — (15.8) (334.2) — (350.0) — (350.0) Net income attributable to Intuitive Surgical, Inc. — — — 1,191.8 — 1,191.8 — 1,191.8 Other comprehensive income (loss) — — — — 106.0 106.0 (1.0) 105.0 Net income attributable to noncontrolling interest in joint venture — — — — — — 14.8 14.8 Ending balance 352.0 $ 0.4 $ 8,385.9 $ 4,209.2 $ (56.5) $ 12,539.0 $ 84.5 $ 12,623.5 Nine Months Ended September 30, 2022 Common Stock Additional Paid-In Capital Retained Earnings Accumulated Other Comprehensive Income (Loss) Total Intuitive Surgical, Inc. Stockholders’ Equity Noncontrolling Interest in Joint Venture Total Stockholders’ Equity Shares Amount Beginning balance 357.7 $ 0.4 $ 7,164.0 $ 4,760.9 $ (24.2) $ 11,901.1 $ 50.4 $ 11,951.5 Issuance of common stock through employee stock plans 3.5 — 188.6 — — 188.6 — 188.6 Shares withheld related to net share settlement of equity awards (0.7) — (7.1) (180.2) — (187.3) — (187.3) Share-based compensation expense related to employee stock plans — — 385.6 — — 385.6 — 385.6 Repurchase and retirement of common stock (7.2) — (46.3) (1,560.3) — (1,606.6) — (1,606.6) Net income attributable to Intuitive Surgical, Inc. — — — 997.4 — 997.4 — 997.4 Other comprehensive income (loss) — — — — (163.4) (163.4) (2.1) (165.5) Net income attributable to noncontrolling interest in joint venture — — — — — — 10.3 10.3 Ending balance 353.3 $ 0.4 $ 7,684.8 $ 4,017.8 $ (187.6) $ 11,515.4 $ 58.6 $ 11,574.0
Schedule of Share Repurchase Activities	The following table summarizes stock repurchase activities (in millions, except per share amounts): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Shares repurchased — 4.6 1.5 7.2 Average price per share $ — $ 217.5 $ 238.1 $ 222.4 Value of shares repurchased $ — $ 1,000.0 $ 350.0 $ 1,606.6
Components of Accumulated Other Comprehensive Income, Net of Tax	The components of accumulated other comprehensive loss, net of tax, attributable to Intuitive Surgical, Inc. are as follows (in millions): Three Months Ended September 30, 2023 Gains (Losses) Unrealized Gains Foreign Employee Benefit Plans Total Beginning balance $ 5.6 $ (103.5) $ 16.9 $ 1.2 $ (79.8) Other comprehensive income (loss) before reclassifications 2.0 25.6 (6.6) — 21.0 Amounts reclassified from accumulated other comprehensive income (loss) 2.3 — — — 2.3 Net current-period other comprehensive income (loss) 4.3 25.6 (6.6) — 23.3 Ending balance $ 9.9 $ (77.9) $ 10.3 $ 1.2 $ (56.5) Three Months Ended September 30, 2022 Gains (Losses) Unrealized Gains Foreign Employee Benefit Plans Total Beginning balance $ 9.9 $ (140.1) $ (9.3) $ (4.7) $ (144.2) Other comprehensive income (loss) before reclassifications (5.7) (37.3) (8.5) — (51.5) Amounts reclassified from accumulated other comprehensive income (loss) 8.0 — — 0.1 8.1 Net current-period other comprehensive income (loss) 2.3 (37.3) (8.5) 0.1 (43.4) Ending balance $ 12.2 $ (177.4) $ (17.8) $ (4.6) $ (187.6) Nine Months Ended September 30, 2023 Gains (Losses) on Hedge Instruments Unrealized Gains Foreign Currency Translation Gains (Losses) Employee Benefit Plans Total Beginning balance $ (2.9) $ (154.2) $ (6.6) $ 1.2 $ (162.5) Other comprehensive income (loss) before reclassifications 12.6 76.5 16.9 — 106.0 Amounts reclassified from accumulated other comprehensive income (loss) 0.2 (0.2) — — — Net current-period other comprehensive income (loss) 12.8 76.3 16.9 — 106.0 Ending balance $ 9.9 $ (77.9) $ 10.3 $ 1.2 $ (56.5) Nine Months Ended September 30, 2022 Gains (Losses) on Hedge Instruments Unrealized Gains Foreign Currency Translation Gains (Losses) Employee Benefit Plans Total Beginning balance $ 4.5 $ (16.0) $ (7.9) $ (4.8) $ (24.2) Other comprehensive income (loss) before reclassifications (11.0) (161.4) (9.9) — (182.3) Amounts reclassified from accumulated other comprehensive income (loss) 18.7 — — 0.2 18.9 Net current-period other comprehensive income (loss) 7.7 (161.4) (9.9) 0.2 (163.4) Ending balance $ 12.2 $ (177.4) $ (17.8) $ (4.6) $ (187.6)
Schedule of Amounts Recognized in Other Comprehensive Income (Loss)	The tax impacts for amounts recognized in other comprehensive income (loss) before reclassifications were as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, Available-for-sale securities 2023 2022 2023 2022 Income tax benefit (expense) for net gains (losses) recorded in other comprehensive income (loss) $ (7.4) $ 10.8 $ (22.0) $ 46.1

SHARE-BASED COMPENSATION (Table

SHARE-BASED COMPENSATION (Tables)	9 Months Ended
SHARE-BASED COMPENSATION (Tables)	Sep. 30, 2023
Share-Based Payment Arrangement [Abstract]
Summary of RSU Activity	A summary of RSU activity under all stock plans for the nine months ended September 30, 2023, is presented as follows (in millions, except per share amounts): Shares Weighted-Average Unvested balance as of December 31, 2022 4.6 $ 241.47 RSUs granted 2.4 $ 235.57 RSUs vested (1.8) $ 222.84 RSUs forfeited (0.2) $ 246.83 Unvested balance as of September 30, 2023 5.0 $ 244.89
Summary of Stock Option Activity Under All Stock Plans	A summary of stock option activity under all stock plans for the nine months ended September 30, 2023, is presented as follows (in millions, except per share amounts): Stock Options Outstanding Number Weighted-Average Balance as of December 31, 2022 10.8 $ 144.86 Options granted 1.4 $ 267.32 Options exercised (1.9) $ 80.91 Options forfeited/expired (0.1) $ 259.12 Balance as of September 30, 2023 10.2 $ 171.54
Share-Based Payment Arrangement, Performance Shares, Activity	A summary of PSU activity for the nine months ended September 30, 2023, is presented as follows (in millions, except per share amounts): Shares Weighted-Average Unvested balance as of December 31, 2022 0.1 $ 299.32 Granted 0.1 $ 240.45 Vested — $ — Performance change — $ — Forfeited — $ 235.84 Unvested balance as of September 30, 2023 0.2 $ 259.60
Summary of Share-Based Compensation Expense	The following table summarizes share-based compensation expense for the three and nine months ended September 30, 2023, and 2022 (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Cost of sales – products (before capitalization) $ 24.7 $ 22.0 $ 70.4 $ 61.0 Amounts capitalized into inventory (1) (23.2) — (63.1) — Amounts recognized in income for amounts previously capitalized in inventory 21.1 — 53.0 — Cost of sales – products $ 22.6 $ 22.0 $ 60.3 $ 61.0 Cost of sales – services 7.3 6.3 21.3 17.7 Total cost of sales 29.9 28.3 81.6 78.7 Selling, general, and administrative 71.9 68.0 206.6 191.0 Research and development 55.3 42.3 157.7 117.6 Share-based compensation expense before income taxes 157.1 138.6 445.9 387.3 Income tax benefit 28.7 26.9 85.2 75.0 Share-based compensation expense after income taxes $ 128.4 $ 111.7 $ 360.7 $ 312.3 (1) Share-based compensation expense subject to capitalization into inventory was not material during the three and nine months ended September 30, 2022, and, therefore, not recorded. The Company commenced capitalization of share-based compensation expense into inventory during the quarter ended December 31, 2022, on a prospective basis.
Schedule of Estimated Fair Value of the Option Using Black-Scholes Option Pricing Model, Weighted Average Assumptions	The weighted-average estimated fair values of stock options and the rights to acquire stock under the ESPP, as well as the weighted-average assumptions used in calculating the fair values of stock options and the rights to acquire stock under the ESPP that were granted during the three and nine months ended September 30, 2023, and 2022, were as follows: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Stock Options Risk-free interest rate 4.5% 3.4% 4.6% 2.5% Expected term (in years) 2.9 3.0 3.2 3.2 Expected volatility 32% 42% 33% 38% Fair value at grant date $82.63 $66.00 $77.41 $73.51 ESPP Risk-free interest rate 5.2% 2.9% 5.0% 2.1% Expected term (in years) 1.2 1.2 1.2 1.2 Expected volatility 31% 40% 33% 39% Fair value at grant date $98.96 $75.01 $89.42 $80.61

NET INCOME PER SHARE (Tables)

NET INCOME PER SHARE (Tables)	9 Months Ended
NET INCOME PER SHARE (Tables)	Sep. 30, 2023
Earnings Per Share [Abstract]
Computation of Basic and Diluted Net Income Per Share	The following table presents the computation of basic and diluted net income per share attributable to Intuitive Surgical, Inc. (in millions, except per share amounts): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Numerator: Net income attributable to Intuitive Surgical, Inc. $ 415.7 $ 324.0 $ 1,191.8 $ 997.4 Denominator: Weighted-average shares outstanding used in basic calculation 351.7 355.3 351.0 357.2 Add: dilutive effect of potential common shares 6.5 5.2 6.1 6.5 Weighted-average shares outstanding used in diluted calculation 358.2 360.5 357.1 363.7 Net income per share attributable to Intuitive Surgical, Inc.: Basic $ 1.18 $ 0.91 $ 3.40 $ 2.79 Diluted $ 1.16 $ 0.90 $ 3.34 $ 2.74

FINANCIAL INSTRUMENTS - Summary

FINANCIAL INSTRUMENTS - Summary of Cash and Available-For-Sale Securities (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Debt Securities, Available-for-sale [Line Items]
Cash and cash equivalents	$ 3,602	$ 1,581.2
Total	4,179.9
Gross Unrealized Gains	0.2	0
Gross Unrealized Losses	(100.5)	(198.5)
Allowance for Credit Loss	(1.1)	(1.1)
Fair Value	4,078.5
Short- term Investments	2,873.7	2,536.7
Long- term Investments	1,044.9	2,623.6
Total assets measured at fair value, amortized cost	7,622	6,941.1
Total assets measured at fair value, fair value	7,520.6	6,741.5
Cash
Debt Securities, Available-for-sale [Line Items]
Cash and cash equivalents	474.3	497.2
Fair Value	474.3	497.2
Level 1
Debt Securities, Available-for-sale [Line Items]
Cash and cash equivalents	3,127.7	1,084
Total	5,292	3,799.2
Gross Unrealized Gains	0.2	0
Gross Unrealized Losses	(43.9)	(96.6)
Allowance for Credit Loss	0	0
Fair Value	5,248.3	3,702.6
Short- term Investments	1,660.5	1,542.4
Long- term Investments	460.1	1,076.2
Level 1 \| Money market funds
Debt Securities, Available-for-sale [Line Items]
Cash and cash equivalents	2,967.8	1,084
Fair Value	2,967.8	1,084
Short- term Investments	0	0
Long- term Investments	0	0
Level 1 \| U.S. treasuries
Debt Securities, Available-for-sale [Line Items]
Cash and cash equivalents	159.9	0
Total	2,324.2	2,715.2
Gross Unrealized Gains	0.2	0
Gross Unrealized Losses	(43.9)	(96.6)
Allowance for Credit Loss	0	0
Fair Value	2,280.5	2,618.6
Short- term Investments	1,660.5	1,542.4
Long- term Investments	460.1	1,076.2
Level 2
Debt Securities, Available-for-sale [Line Items]
Cash and cash equivalents	0	0
Total	1,855.7	2,644.7
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(56.6)	(101.9)
Allowance for Credit Loss	(1.1)	(1.1)
Fair Value	1,798	2,541.7
Short- term Investments	1,213.2	994.3
Long- term Investments	584.8	1,547.4
Level 2 \| Commercial paper
Debt Securities, Available-for-sale [Line Items]
Cash and cash equivalents		0
Total		20
Gross Unrealized Gains		0
Gross Unrealized Losses		0
Allowance for Credit Loss		0
Fair Value		20
Short- term Investments		20
Long- term Investments		0
Level 2 \| Corporate debt securities
Debt Securities, Available-for-sale [Line Items]
Cash and cash equivalents	0	0
Total	1,353.9	2,022
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(42.3)	(76)
Allowance for Credit Loss	(1.1)	(1.1)
Fair Value	1,310.5	1,944.9
Short- term Investments	914.7	651.8
Long- term Investments	395.8	1,293.1
Level 2 \| U.S. government agencies
Debt Securities, Available-for-sale [Line Items]
Cash and cash equivalents	0	0
Total	400.4	447.2
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(11.2)	(19.9)
Allowance for Credit Loss	0	0
Fair Value	389.2	427.3
Short- term Investments	214.2	247.8
Long- term Investments	175	179.5
Level 2 \| Municipal securities
Debt Securities, Available-for-sale [Line Items]
Cash and cash equivalents	0	0
Total	101.4	155.5
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(3.1)	(6)
Allowance for Credit Loss	0	0
Fair Value	98.3	149.5
Short- term Investments	84.3	74.7
Long- term Investments	$ 14	$ 74.8

FINANCIAL INSTRUMENTS - Summa_2

FINANCIAL INSTRUMENTS - Summary of Contractual Maturities of Cash Equivalents and Available-For-Sale Investments (Details) $ in Millions	Sep. 30, 2023 USD ($)
Amortized Cost
Mature in less than one year	$ 3,084.2
Mature in one to five years	1,095.7
Total	4,179.9
Fair Value
Mature in less than one year	3,033.6
Mature in one to five years	1,044.9
Total	$ 4,078.5

FINANCIAL INSTRUMENTS - Narrati

FINANCIAL INSTRUMENTS - Narrative (Details) - USD ($)	3 Months Ended	6 Months Ended	9 Months Ended	12 Months Ended
FINANCIAL INSTRUMENTS - Narrative (Details) - USD ($)	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2023	Dec. 31, 2022
Debt and Equity Securities, FV-NI [Line Items]
Gross realized gains (losses)		$ 0	$ 0
Net unrealized losses on AFS debt securities, net of tax			77,900,000	$ 154,200,000
Level 1
Debt and Equity Securities, FV-NI [Line Items]
Decreases in fair value on equity investments			(400,000)
Level 2
Debt and Equity Securities, FV-NI [Line Items]
Changes in fair value on equity investments that lack readily determinable market values	$ 0		$ (5,600,000)

FINANCIAL INSTRUMENTS - Availab

FINANCIAL INSTRUMENTS - Available-for-Sale Debt Securities in a Continuous Unrealized Loss Position (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Debt Securities, Available-for-sale [Line Items]
Unrealized losses less than 12 months, fair value	$ 627.4	$ 1,510.4
Unrealized losses less than 12 months, gross unrealized losses	(0.7)	(49.1)
Unrealized losses more than 12 months, fair value	3,033.2	3,538.3
Unrealized losses more than 12 months, gross unrealized losses	(99.8)	(149.4)
Total unrealized losses, fair value	3,660.6	5,048.7
Total unrealized losses, gross unrealized losses	(100.5)	(198.5)
U.S. treasuries
Debt Securities, Available-for-sale [Line Items]
Unrealized losses less than 12 months, fair value	458.8	731.7
Unrealized losses less than 12 months, gross unrealized losses	(0.4)	(26)
Unrealized losses more than 12 months, fair value	1,427.5	1,886.9
Unrealized losses more than 12 months, gross unrealized losses	(43.5)	(70.6)
Total unrealized losses, fair value	1,886.3	2,618.6
Total unrealized losses, gross unrealized losses	(43.9)	(96.6)
Corporate debt securities
Debt Securities, Available-for-sale [Line Items]
Unrealized losses less than 12 months, fair value	54	631.4
Unrealized losses less than 12 months, gross unrealized losses	(0.1)	(17.6)
Unrealized losses more than 12 months, fair value	1,248.8	1,221.9
Unrealized losses more than 12 months, gross unrealized losses	(42.2)	(58.4)
Total unrealized losses, fair value	1,302.8	1,853.3
Total unrealized losses, gross unrealized losses	(42.3)	(76)
U.S. government agencies
Debt Securities, Available-for-sale [Line Items]
Unrealized losses less than 12 months, fair value	114.6	102.7
Unrealized losses less than 12 months, gross unrealized losses	(0.2)	(4.4)
Unrealized losses more than 12 months, fair value	274.6	324.6
Unrealized losses more than 12 months, gross unrealized losses	(11)	(15.5)
Total unrealized losses, fair value	389.2	427.3
Total unrealized losses, gross unrealized losses	(11.2)	(19.9)
Municipal securities
Debt Securities, Available-for-sale [Line Items]
Unrealized losses less than 12 months, fair value	0	44.6
Unrealized losses less than 12 months, gross unrealized losses	0	(1.1)
Unrealized losses more than 12 months, fair value	82.3	104.9
Unrealized losses more than 12 months, gross unrealized losses	(3.1)	(4.9)
Total unrealized losses, fair value	82.3	149.5
Total unrealized losses, gross unrealized losses	$ (3.1)	$ (6)

FINANCIAL INSTRUMENTS - Summa_3

FINANCIAL INSTRUMENTS - Summary of Equity Investment Activity (Details) - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2023
Level 1
Fair Value, Level 1 [Abstract]
Beginning balance, carrying value		$ 4.3
Changes in fair value		(0.4)
Purchases / Sales / Other		(3.9)
Ending balance, carrying value	$ 0	0
Level 2
Fair Value, Level 2 [Abstract]
Beginning balance, carrying value		59.1
Changes in Fair Value	0	(5.6)
Purchases / Sales / Other		20
Ending balance, carrying value	73.5	73.5
Prepaids and other current assets \| Level 1
Fair Value, Level 1 [Abstract]
Ending balance, carrying value	0	0
Prepaids and other current assets \| Level 2
Fair Value, Level 2 [Abstract]
Ending balance, carrying value	0	0
Intangible and other assets, net \| Level 1
Fair Value, Level 1 [Abstract]
Ending balance, carrying value	0	0
Intangible and other assets, net \| Level 2
Fair Value, Level 2 [Abstract]
Ending balance, carrying value	$ 73.5	$ 73.5

FINANCIAL INSTRUMENTS - Derivat

FINANCIAL INSTRUMENTS - Derivative Instruments Used to Hedge against Balance Sheet Foreign Currency Exposures (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Foreign exchange losses related to balance sheet re-measurement	$ (13.1)	$ (30.5)	$ (24)	$ (69.4)
Forward contracts \| Derivatives Not Designated as Hedging Instruments
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Recognized gains in interest and other income, net	$ 10.4	$ 17.9	$ 21.8	$ 46.6

FINANCIAL INSTRUMENTS - Gross N

FINANCIAL INSTRUMENTS - Gross Notional Amounts for Outstanding Derivatives (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Derivatives Designated as Hedging Instruments \| Prepaids and other current assets
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Notional amounts of outstanding currency forward contracts	$ 12.8	$ 1.8
Derivatives Designated as Hedging Instruments \| Other accrued liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Notional amounts of outstanding currency forward contracts	1.7	5.3
Derivatives Not Designated as Hedging Instruments \| Prepaids and other current assets
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Notional amounts of outstanding currency forward contracts	9.3	4.3
Derivatives Not Designated as Hedging Instruments \| Other accrued liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Notional amounts of outstanding currency forward contracts	2.5	4.2
Forward contracts \| Derivatives Designated as Hedging Instruments
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Notional amounts of outstanding currency forward contracts	262.2	188.4
Forward contracts \| Derivatives Not Designated as Hedging Instruments
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Notional amounts of outstanding currency forward contracts	$ 618	$ 496.3

BALANCE SHEET DETAILS AND OTH_3

BALANCE SHEET DETAILS AND OTHER FINANCIAL INFORMATION - Accounts Receivable, Net (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Trade accounts receivable, net	$ 879.6	$ 864.9
Unbilled accounts receivable and other	98.4	91.7
Sales returns and allowances	(15.3)	(14.5)
Accounts receivable, net	$ 962.7	$ 942.1

BALANCE SHEET DETAILS AND OTH_4

BALANCE SHEET DETAILS AND OTHER FINANCIAL INFORMATION - Inventory (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Raw materials	$ 420.3	$ 382.9
Work-in-process	150.1	159.9
Finished goods	577.1	350.4
Total inventory	$ 1,147.5	$ 893.2

BALANCE SHEET DETAILS AND OTH_5

BALANCE SHEET DETAILS AND OTHER FINANCIAL INFORMATION - Prepaids and Other Current Assets (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Net investment in sales-type leases – short-term	$ 134.4	$ 131.2
Other prepaids and other current assets	182.6	168.6
Total prepaids and other current assets	$ 317	$ 299.8

BALANCE SHEET DETAILS AND OTH_6

BALANCE SHEET DETAILS AND OTHER FINANCIAL INFORMATION - Property, Plant, and Equipment, Net (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Land	$ 389.5	$ 388.6
Building and building/leasehold improvements	900.9	866.5
Machinery and equipment	654.7	566.4
Operating lease assets – Intuitive System Leasing	1,052.9	806.4
Computer and office equipment	145.6	134.7
Capitalized software	250.8	240.9
Construction-in-process	1,150.8	608.6
Gross property, plant, and equipment	4,545.2	3,612.1
Less: Accumulated depreciation	(1,468.2)	(1,237.9)
Total property, plant, and equipment, net	3,077	2,374.2
Accumulated depreciation associated with operating lease assets – Intuitive System Leasing	$ (395.7)	$ (285.8)

BALANCE SHEET DETAILS AND OTH_7

BALANCE SHEET DETAILS AND OTHER FINANCIAL INFORMATION - Other Accrued Liabilities - Short-term (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Income and other taxes payable	$ 342.8	$ 96.1
Accrued construction-related capital expenditures	106	50.3
Litigation-related accruals	1.6	23
Other accrued liabilities	260.2	306.8
Total other accrued liabilities – short-term	$ 710.6	$ 476.2

BALANCE SHEET DETAILS AND OTH_8

BALANCE SHEET DETAILS AND OTHER FINANCIAL INFORMATION - Other Long-term Liabilities (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Income taxes – long-term	$ 264.1	$ 288
Deferred revenue – long-term	42.5	41
Other long-term liabilities	106.2	110.3
Total other long-term liabilities	$ 412.8	$ 439.3

BALANCE SHEET DETAILS AND OTH_9

BALANCE SHEET DETAILS AND OTHER FINANCIAL INFORMATION - Supplemental Cash Flow Information (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Equipment transfers, including operating lease assets, from inventory to property, plant, and equipment	$ 303.8	$ 189
Acquisition of property, plant, and equipment in accounts payable and accrued liabilities	$ 135.2	$ 91.4

REVENUE AND CONTRACT ACQUISIT_3

REVENUE AND CONTRACT ACQUISITION COSTS - Revenue Disaggregated by Types and Geography (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Disaggregation of Revenue [Line Items]
Total revenue	$ 1,743.7	$ 1,557.4	$ 5,195.8	$ 4,567.2
Instruments and accessories
Disaggregation of Revenue [Line Items]
Total revenue	1,071.4	871.6	3,132.9	2,577.2
Systems
Disaggregation of Revenue [Line Items]
Total revenue	379.4	425.9	1,199.5	1,229.1
Services
Disaggregation of Revenue [Line Items]
Total revenue	292.9	259.9	863.4	760.9
U.S.
Disaggregation of Revenue [Line Items]
Total revenue	1,180.2	1,083	3,432.6	3,058.9
U.S. \| Instruments and accessories
Disaggregation of Revenue [Line Items]
Total revenue	775.7	643.3	2,240.4	1,819
U.S. \| Systems
Disaggregation of Revenue [Line Items]
Total revenue	216	264.7	627.6	731
U.S. \| Services
Disaggregation of Revenue [Line Items]
Total revenue	188.5	175	564.6	508.9
Outside of U.S. (“OUS”)
Disaggregation of Revenue [Line Items]
Total revenue	563.5	474.4	1,763.2	1,508.3
Outside of U.S. (“OUS”) \| Instruments and accessories
Disaggregation of Revenue [Line Items]
Total revenue	295.7	228.3	892.5	758.2
Outside of U.S. (“OUS”) \| Systems
Disaggregation of Revenue [Line Items]
Total revenue	163.4	161.2	571.9	498.1
Outside of U.S. (“OUS”) \| Services
Disaggregation of Revenue [Line Items]
Total revenue	$ 104.4	$ 84.9	$ 298.8	$ 252

REVENUE AND CONTRACT ACQUISIT_4

REVENUE AND CONTRACT ACQUISITION COSTS - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue recognized	$ 75	$ 73	$ 372	$ 352
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-10-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Price allocated to remaining performance obligations	$ 2,130		$ 2,130
Remaining performance obligations, percent	43%		43%
Remaining performance obligations, expected timing of satisfaction, period	5 years		5 years

REVENUE AND CONTRACT ACQUISIT_5

REVENUE AND CONTRACT ACQUISITION COSTS - Summary of Contract Assets and Liabilities (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Revenue from Contract with Customer [Abstract]
Contract assets	$ 22.7	$ 45
Deferred revenue	$ 437.3	$ 438.3

REVENUE AND CONTRACT ACQUISIT_6

REVENUE AND CONTRACT ACQUISITION COSTS - Sales-type and Operating Lease Revenue (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Deferred Revenue Arrangement [Line Items]
Sales-type lease revenue	$ 19.2	$ 29.6	$ 54.5	$ 115.3
Operating lease revenue	127.1	97.5	361.8	273.7
Variable Lease Revenue, Usage-Based Arrangements
Deferred Revenue Arrangement [Line Items]
Operating lease revenue	$ 54.2	$ 35.5	$ 153.4	$ 94

LEASES - Lease Receivables (Det

LEASES - Lease Receivables (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Capital Leased Assets [Line Items]
Gross lease receivables	$ 395.1	$ 449.4
Unearned income	(13)	(14.4)
Subtotal	382.1	435
Allowance for credit loss	(2.7)	(3)
Sales-type lease, lease receivable	379.4	432
Prepaids and other current assets
Capital Leased Assets [Line Items]
Sales-type lease, lease receivable	134.4	131.2
Intangible and other assets, net
Capital Leased Assets [Line Items]
Sales-type lease, lease receivable	$ 245	$ 300.8

LEASES - Schedule of Contractua

LEASES - Schedule of Contractual Maturities of Gross Lease Receivables (Details) $ in Millions	Sep. 30, 2023 USD ($)
Leases [Abstract]
Remainder of 2023	$ 34.5
2024	135.9
2025	107.2
2026	69.3
2027	37
2028 and thereafter	11.2
Total	$ 395.1

LEASES - Additional Information

LEASES - Additional Information (Details)	Sep. 30, 2023
Minimum
Lessee, Lease, Description [Line Items]
Sales-type leases terms	24 months
Maximum
Lessee, Lease, Description [Line Items]
Sales-type leases terms	84 months

LEASES - Credit Quality Indicat

LEASES - Credit Quality Indicator (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Sales-type Lease, Net Investment in Lease, Credit Quality Indicator [Line Items]
2023	$ 56.4
2022	136.6
2021	118.1
2020	54.4
2019	14.1
Prior	2.5
Subtotal	382.1	$ 435
High
Sales-type Lease, Net Investment in Lease, Credit Quality Indicator [Line Items]
2023	34.7
2022	71.1
2021	63.7
2020	25.6
2019	7.2
Prior	0.5
Subtotal	202.8
Moderate
Sales-type Lease, Net Investment in Lease, Credit Quality Indicator [Line Items]
2023	21.7
2022	58.8
2021	50.1
2020	27.9
2019	6.9
Prior	2
Subtotal	167.4
Low
Sales-type Lease, Net Investment in Lease, Credit Quality Indicator [Line Items]
2023	0
2022	6.7
2021	4.3
2020	0.9
2019	0
Prior	0
Subtotal	$ 11.9

GOODWILL AND INTANGIBLE ASSET_2

GOODWILL AND INTANGIBLE ASSETS - Schedule of Summary of Changes in Goodwill (Details) $ in Millions	9 Months Ended
	Sep. 30, 2023 USD ($)
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 348.5
Acquisition activity	0
Translation and other	(0.4)
Goodwill, ending balance	$ 348.1

GOODWILL AND INTANGIBLE ASSET_3

GOODWILL AND INTANGIBLE ASSETS - Schedule of Intangible Assets (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 246.7	$ 242.7
Accumulated Amortization	(204.9)	(192.9)
Net Carrying Amount	41.8	49.8
Patents and developed technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	204.3	199.1
Accumulated Amortization	(175.1)	(167.4)
Net Carrying Amount	29.2	31.7
Distribution rights and others
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	10.7	11
Accumulated Amortization	(8.7)	(7.4)
Net Carrying Amount	2	3.6
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	31.7	32.6
Accumulated Amortization	(21.1)	(18.1)
Net Carrying Amount	$ 10.6	$ 14.5

GOODWILL AND INTANGIBLE ASSET_4

GOODWILL AND INTANGIBLE ASSETS - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of intangible assets	$ 5.1	$ 7.9	$ 15.1	$ 20.2

GOODWILL AND INTANGIBLE ASSET_5

GOODWILL AND INTANGIBLE ASSETS - Schedule Of Estimated Future Amortization Expense Of Intangible Assets (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Remainder of 2023	$ 5
2024	16.5
2025	11.6
2026	5
2027	2.5
2028 and thereafter	1.2
Net Carrying Amount	$ 41.8	$ 49.8

CONTINGENCIES (Details)

CONTINGENCIES (Details) - USD ($)	Sep. 20, 2023	Oct. 19, 2022
Rex Medical, L.P.
Other Commitments [Line Items]
Loss contingency, damages awarded	$ 1	$ 10,000,000

STOCKHOLDERS' EQUITY - Schedule

STOCKHOLDERS' EQUITY - Schedule of Stockholders Equity (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance (in shares)			350,000,000
Beginning balance	$ 11,959.7	$ 12,082.4	$ 11,112.6	$ 11,951.5
Issuance of common stock through employee stock plans	77.4	82	252.2	188.6
Shares withheld related to net share settlement of equity awards	(14.8)	(8.3)	(155.4)	(187.3)
Share-based compensation expense related to employee stock plans	158.3	138.1	452.5	385.6
Repurchase and retirement of common stock		(1,000)	(350)	(1,606.6)
Net income attributable to Intuitive Surgical, Inc.	415.7	324	1,191.8	997.4
Other comprehensive income (loss)	23.1	(44.9)	105	(165.5)
Net income attributable to noncontrolling interest in joint venture	$ 4.1	0.7	$ 14.8	10.3
Ending balance (in shares)	352,000,000		352,000,000
Ending balance	$ 12,623.5	11,574	$ 12,623.5	11,574
Total Intuitive Surgical, Inc. Stockholders’ Equity
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance	11,879.1	12,023	11,041.9	11,901.1
Issuance of common stock through employee stock plans	77.4	82	252.2	188.6
Shares withheld related to net share settlement of equity awards	(14.8)	(8.3)	(155.4)	(187.3)
Share-based compensation expense related to employee stock plans	158.3	138.1	452.5	385.6
Repurchase and retirement of common stock		(1,000)	(350)	(1,606.6)
Net income attributable to Intuitive Surgical, Inc.	415.7	324	1,191.8	997.4
Other comprehensive income (loss)	23.3	(43.4)	106	(163.4)
Ending balance	$ 12,539	$ 11,515.4	$ 12,539	$ 11,515.4
Common Stock
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance (in shares)	351,300,000	357,100,000	350,000,000	357,700,000
Beginning balance	$ 0.4	$ 0.4	$ 0.4	$ 0.4
Issuance of common stock through employee stock plans (in shares)	700,000	900,000	4,100,000	3,500,000
Shares withheld related to net share settlement of equity awards (in shares)		(100,000)	(600,000)	(700,000)
Repurchase and retirement of common stock (in shares)		(4,600,000)	(1,500,000)	(7,200,000)
Ending balance (in shares)	352,000,000	353,300,000	352,000,000	353,300,000
Ending balance	$ 0.4	$ 0.4	$ 0.4	$ 0.4
Additional Paid-In Capital
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance	8,150.8	7,484	7,703.9	7,164
Issuance of common stock through employee stock plans	77.4	82	252.2	188.6
Shares withheld related to net share settlement of equity awards	(0.6)	(0.4)	(6.9)	(7.1)
Share-based compensation expense related to employee stock plans	158.3	138.1	452.5	385.6
Repurchase and retirement of common stock		(18.9)	(15.8)	(46.3)
Ending balance	8,385.9	7,684.8	8,385.9	7,684.8
Retained Earnings
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance	3,807.7	4,682.8	3,500.1	4,760.9
Shares withheld related to net share settlement of equity awards	(14.2)	(7.9)	(148.5)	(180.2)
Repurchase and retirement of common stock		(981.1)	(334.2)	(1,560.3)
Net income attributable to Intuitive Surgical, Inc.	415.7	324	1,191.8	997.4
Ending balance	4,209.2	4,017.8	4,209.2	4,017.8
Accumulated Other Comprehensive Income (Loss)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance	(79.8)	(144.2)	(162.5)	(24.2)
Other comprehensive income (loss)	23.3	(43.4)	106	(163.4)
Ending balance	(56.5)	(187.6)	(56.5)	(187.6)
Noncontrolling Interest in Joint Venture
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance	80.6	59.4	70.7	50.4
Other comprehensive income (loss)	(0.2)	(1.5)	(1)	(2.1)
Net income attributable to noncontrolling interest in joint venture	4.1	0.7	14.8	10.3
Ending balance	$ 84.5	$ 58.6	$ 84.5	$ 58.6

STOCKHOLDERS' EQUITY - Stock Re

STOCKHOLDERS' EQUITY - Stock Repurchase Program (Details) - USD ($) $ / shares in Units, shares in Millions, $ in Billions	2 Months Ended	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Aug. 31, 2022	Jul. 20, 2022
Common Stock
Equity, Class of Treasury Stock [Line Items]
Shares repurchased (in shares)			4.6	1.5	7.2
Repurchase Program \| Common Stock
Equity, Class of Treasury Stock [Line Items]
Amount of share repurchases authorized		$ 10		$ 10
Remaining amount of share repurchases authorized		$ 1.1		$ 1.1			$ 3.5
Shares repurchased (in shares)		0	4.6	1.5	7.2
August Accelerated Share Repurchase Program
Equity, Class of Treasury Stock [Line Items]
Amount of share repurchases authorized						$ 1
Shares repurchased (in shares)	4.6
Final average price per share paid (in dollars per share)	$ 217.52

STOCKHOLDERS' EQUITY - Schedu_2

STOCKHOLDERS' EQUITY - Schedule of Share Repurchase Activities (Details) - USD ($) $ / shares in Units, shares in Millions, $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Equity, Class of Treasury Stock [Line Items]
Value of shares repurchased		$ 1,000	$ 350	$ 1,606.6
Common Stock
Equity, Class of Treasury Stock [Line Items]
Shares repurchased (in shares)		4.6	1.5	7.2
Common Stock \| Repurchase Program
Equity, Class of Treasury Stock [Line Items]
Shares repurchased (in shares)	0	4.6	1.5	7.2
Average price per share (in dollars per share)	$ 0	$ 217.5	$ 238.1	$ 222.4
Value of shares repurchased	$ 0	$ 1,000	$ 350	$ 1,606.6

STOCKHOLDERS' EQUITY - Componen

STOCKHOLDERS' EQUITY - Components of Accumulated Other Comprehensive Income, Net of Tax (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance	$ (79.8)	$ (144.2)	$ (162.5)	$ (24.2)
Other comprehensive income (loss) before reclassifications	21	(51.5)	106	(182.3)
Amounts reclassified from accumulated other comprehensive income (loss)	2.3	8.1	0	18.9
Net current-period other comprehensive income (loss)	23.3	(43.4)	106	(163.4)
Ending balance	(56.5)	(187.6)	(56.5)	(187.6)
Gains (Losses) on Hedge Instruments
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance	5.6	9.9	(2.9)	4.5
Other comprehensive income (loss) before reclassifications	2	(5.7)	12.6	(11)
Amounts reclassified from accumulated other comprehensive income (loss)	2.3	8	0.2	18.7
Net current-period other comprehensive income (loss)	4.3	2.3	12.8	7.7
Ending balance	9.9	12.2	9.9	12.2
Unrealized Gains (Losses) on Available-for-Sale Securities
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance	(103.5)	(140.1)	(154.2)	(16)
Other comprehensive income (loss) before reclassifications	25.6	(37.3)	76.5	(161.4)
Amounts reclassified from accumulated other comprehensive income (loss)	0	0	(0.2)	0
Net current-period other comprehensive income (loss)	25.6	(37.3)	76.3	(161.4)
Ending balance	(77.9)	(177.4)	(77.9)	(177.4)
Foreign Currency Translation Gains (Losses)
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance	16.9	(9.3)	(6.6)	(7.9)
Other comprehensive income (loss) before reclassifications	(6.6)	(8.5)	16.9	(9.9)
Amounts reclassified from accumulated other comprehensive income (loss)	0	0	0	0
Net current-period other comprehensive income (loss)	(6.6)	(8.5)	16.9	(9.9)
Ending balance	10.3	(17.8)	10.3	(17.8)
Employee Benefit Plans
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance	1.2	(4.7)	1.2	(4.8)
Other comprehensive income (loss) before reclassifications	0	0	0	0
Amounts reclassified from accumulated other comprehensive income (loss)	0	0.1	0	0.2
Net current-period other comprehensive income (loss)	0	0.1	0	0.2
Ending balance	$ 1.2	$ (4.6)	$ 1.2	$ (4.6)

STOCKHOLDERS' EQUITY - Other Co

STOCKHOLDERS' EQUITY - Other Comprehensive Income (Loss) (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Text Block [Abstract]
Income tax benefit (expense) for net gains (losses) recorded in other comprehensive income (loss)	$ (7.4)	$ 10.8	$ (22)	$ 46.1

SHARE-BASED COMPENSATION - Addi

SHARE-BASED COMPENSATION - Additional Information (Details) - USD ($) $ / shares in Units, $ in Millions	9 Months Ended		12 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options exercisable, number of shares	7,900,000
Options exercisable, weighted-average exercise price (usd per share)	$ 144.89
Employee Stock Purchase Plan, number of shares purchased by employees	500,000	400,000
Employee Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Employee Stock Purchase Plan, value of shares purchased by employees	$ 104.5	$ 87.9
Performance Share Units (PSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			3 years
Performance Share Units (PSUs) \| Share-Based Payment Arrangement, Tranche One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting percentage	33%
Performance Share Units (PSUs) \| Share-Based Payment Arrangement, Tranche Two
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting percentage	33%
Performance Share Units (PSUs) \| Share-Based Payment Arrangement, Tranche Three
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting percentage	33%
Performance Share Units (PSUs) \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of awards vested			0%
Performance Share Units (PSUs) \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of awards vested			125%
2010 Incentive Award Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for issuance	110,350,000
Number of shares reserved for future issuance	20,600,000
2010 Incentive Award Plan \| Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares reserved for future issuance	8,900,000

SHARE-BASED COMPENSATION - Summ

SHARE-BASED COMPENSATION - Summary of RSU and PSU Activity (Details) shares in Millions	9 Months Ended
	Sep. 30, 2023 $ / shares shares
Restricted Stock Units (RSUs)
Shares
Unvested beginning balance (in shares) \| shares	4.6
Granted (in shares) \| shares	2.4
Vested (in shares) \| shares	(1.8)
Forfeited (in shares) \| shares	(0.2)
Unvested ending balance (in shares) \| shares	5
Weighted-Average Grant-Date Fair Value
Unvested beginning balance (usd per share) \| $ / shares	$ 241.47
Granted (usd per share) \| $ / shares	235.57
Vested (usd per share) \| $ / shares	222.84
Forfeited (usd per share) \| $ / shares	246.83
Unvested ending balance (usd per share) \| $ / shares	$ 244.89
Performance Share Units (PSUs)
Shares
Unvested beginning balance (in shares) \| shares	0.1
Granted (in shares) \| shares	0.1
Vested (in shares) \| shares	0
Performance change (in shares) \| shares	0
Forfeited (in shares) \| shares	0
Unvested ending balance (in shares) \| shares	0.2
Weighted-Average Grant-Date Fair Value
Unvested beginning balance (usd per share) \| $ / shares	$ 299.32
Granted (usd per share) \| $ / shares	240.45
Vested (usd per share) \| $ / shares	0
Performance change (usd per share) \| $ / shares	0
Forfeited (usd per share) \| $ / shares	235.84
Unvested ending balance (usd per share) \| $ / shares	$ 259.60

SHARE-BASED COMPENSATION - Su_2

SHARE-BASED COMPENSATION - Summary of Stock Option Activity Under All Stock Plans (Details) shares in Millions	9 Months Ended
	Sep. 30, 2023 $ / shares shares
Number Outstanding
Beginning balance (in shares) \| shares	10.8
Options granted (in shares) \| shares	1.4
Options exercised (in shares) \| shares	(1.9)
Options forfeited/expired (in shares) \| shares	(0.1)
Ending balance (in shares) \| shares	10.2
Weighted-Average Exercise Price Per Share
Beginning balance, Weighted Average Exercise Price Per Share \| $ / shares	$ 144.86
Options granted, Weighted Average Exercise Price Per Share \| $ / shares	267.32
Options exercised, Weighted Average Exercise Price Per Share \| $ / shares	80.91
Options forfeited/expired, Weighted Average Exercise Price Per Share \| $ / shares	259.12
Ending balance, Weighted Average Exercise Price Per Share \| $ / shares	$ 171.54

SHARE-BASED COMPENSATION - Stoc

SHARE-BASED COMPENSATION - Stock-Based Compensation Expense (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense before income taxes	$ 157.1	$ 138.6	$ 445.9	$ 387.3
Income tax benefit	28.7	26.9	85.2	75
Share-based compensation expense after income taxes	128.4	111.7	360.7	312.3
Cost of sales – products \| Cost of sales – products (before capitalization)
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense before income taxes	24.7	22	70.4	61
Cost of sales – products \| Amounts capitalized into inventory
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense before income taxes	(23.2)	0	(63.1)	0
Cost of sales – products \| Amounts recognized in income for amounts previously capitalized in inventory
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense before income taxes	21.1	0	53	0
Total cost of sales
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense before income taxes	29.9	28.3	81.6	78.7
Total cost of sales \| Cost of sales – products
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense before income taxes	22.6	22	60.3	61
Total cost of sales \| Cost of sales – services
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense before income taxes	7.3	6.3	21.3	17.7
Selling, general, and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense before income taxes	71.9	68	206.6	191
Research and development
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense before income taxes	$ 55.3	$ 42.3	$ 157.7	$ 117.6

SHARE-BASED COMPENSATION - Sche

SHARE-BASED COMPENSATION - Schedule of Estimated Fair Value of Option Using Black-Scholes Option Pricing Model, Weighted Average Assumptions (Details) - $ / shares	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	4.50%	3.40%	4.60%	2.50%
Expected term (in years)	2 years 10 months 24 days	3 years	3 years 2 months 12 days	3 years 2 months 12 days
Expected volatility (percent)	32%	42%	33%	38%
Weighted average fair value at grant date (usd per share)	$ 82.63	$ 66	$ 77.41	$ 73.51
ESPP
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	5.20%	2.90%	5%	2.10%
Expected term (in years)	1 year 2 months 12 days	1 year 2 months 12 days	1 year 2 months 12 days	1 year 2 months 12 days
Expected volatility (percent)	31%	40%	33%	39%
Weighted average fair value at grant date (usd per share)	$ 98.96	$ 75.01	$ 89.42	$ 80.61

INCOME TAXES - Additional Infor

INCOME TAXES - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Income Tax Disclosure [Abstract]
Income tax expense	$ 102.2	$ 78.1	$ 236.4	$ 204.4
Income tax expense, percentage of pre-tax income	19.60%	19.40%	16.40%	16.90%
Excess tax benefits associated with employee equity plans	$ 22	$ 18.1	$ 86.2	$ 80.4
Excess tax benefits associated with employee equity plans (in percent)	4.20%	4.50%	6%	6.60%

NET INCOME PER SHARE - Computat

NET INCOME PER SHARE - Computation of Basic and Diluted Net Income Per Share (Details) - USD ($) $ / shares in Units, shares in Millions, $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Numerator:
Net income attributable to Intuitive Surgical, Inc.	$ 415.7	$ 324	$ 1,191.8	$ 997.4
Denominator:
Weighted-average shares outstanding used in basic calculation (in shares)	351.7	355.3	351	357.2
Add: dilutive effect of potential common shares (in shares)	6.5	5.2	6.1	6.5
Weighted-average shares outstanding used in diluted calculation (in shares)	358.2	360.5	357.1	363.7
Net income per share attributable to Intuitive Surgical, Inc.:
Basic (in dollars per share)	$ 1.18	$ 0.91	$ 3.40	$ 2.79
Diluted (in dollars per share)	$ 1.16	$ 0.90	$ 3.34	$ 2.74

NET INCOME PER SHARE - Addition

NET INCOME PER SHARE - Additional Information (Details) - shares shares in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Earnings Per Share [Abstract]
Employee stock options excluded from computation of diluted net income per share	1.4	4.7	1.9	3.7