Every new procedure on an existing machine is growth without a sale

When a surgical system is approved or adopted for new kinds of procedures, every machine already installed becomes more useful. Growth arrives through utilisation, with no new machine sold and no new hospital persuaded.

The installed base gets busier

A machine in a theatre is a fixed asset for the hospital. More procedures on it make it a better investment and generate more disposables and service revenue for the manufacturer. New indications turn existing customers into growth.

It also strengthens the case for the next purchase, because a busier machine is the best argument for a second one.

What I'm watching

• Procedures per installed system
• Adoption in newer surgical specialties
• Placements into hospitals that already have a system

Where I stand

Long, on utilisation growth that needs no new customers. It is the least visible and most profitable form of growth this business has.

What would change my mind

Utilisation flattening while placements continue. That would mean machines are being bought faster than they are being used, and the growth would be borrowed from the future.