By Joseph Walker and Tess Stynes 

Intuitive Surgical Inc. declined to estimate its expectations for sales in 2014, citing "limited visibility" into how the federal health-care overhaul will affect its business this year.

The decision to not issue sales guidance followed on what Chief Executive Gary Guthart called a "challenging year" in 2013, during which sales of the company's hallmark da Vinci surgical robots declined for the first time and the company's share price fell by 22%.

The Sunnyvale, Calif., company said it expected the number of procedures performed with its robots to grow 9% to 12% this year, compared with a 16% increase in 2013. The company said it expects it will sell fewer of the da Vinci robots in 2014 than last year.

Shares of Intuitive Surgical fell 4.4% to $419.33 in after-hours Nasdaq trading on Thursday.

Intuitive's formal presentation of its fourth-quarter results Thursday followed its initial disclosure of the results last week at the JP Morgan Healthcare Conference. In the fourth quarter of 2013, earnings fell 5% on lower sales of the company's da Vinci robotic surgical systems. Intuitive Surgical reported a net profit of $166.2 million, or $4.28 a share, compared with $174.9 million, or $4.25 a share, a year earlier. Analysts polled by Thomson Reuters expected per-share profit of $3.83.

Revenue in the fourth quarter decreased 5.4% to $576.2 million, matching the company's recent estimates. Sales of the da Vinci systems fell 23% to $204.6 million as the number of systems sold dropped to 138 from 175 a year earlier.

The company has continued to face challenges from customer concerns about the safety and cost effectiveness of its da Vinci robots, in addition to slower growth in gynecology procedures and lower hospital spending related to the U.S. health-care policy overhaul.

"Trends that emerged in the second quarter of 2013 continued through the balance of the year, including revenue uncertainties for United States customers due to pressure on gynecologic surgery broadly, the implementation of the Affordable Care Act, and confusion surrounding the public debate regarding some da Vinci procedures," Mr. Guthart said.

Sales of instruments and accessories increased 5.7% to $268.2 million, mostly owing to the 12% growth in procedures on machines that da Vinci already has sold.

Write to Joseph Walker at joseph.walker@wsj.com and Tess Stynes at tess.stynes@wsj.com

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