Health

Can ISRG maintain its premium valuation amid slower procedure growth?

Zacks.com · Jul 22, 2026 15:06 · 3 min read

Intuitive Surgical ISRG continues to command a valuation premium over the medical technology industry, though that premium has narrowed significantly. The stock currently trades at 9.89X forward 12-month sales, its lowest level in the past 18 months compared with a historical median of 15.89X, while the industry trades at 3.77X. The compressed multiple reflects investor concerns over moderating U.S. procedure growth, but the company's latest...

Intuitive Surgical ISRG continues to command a valuation premium over the medical technology industry, though that premium has narrowed significantly. The stock currently trades at 9.89X forward 12-month sales, its lowest level in the past 18 months compared with a historical median of 15.89X, while the industry trades at 3.77X. The compressed multiple reflects investor concerns over moderating U.S. procedure growth, but the company's latest results suggest its long-term competitive advantages remain intact.

The key overhang is slowing procedure growth. U.S. da Vinci procedures rose 12% in the second quarter, below recent trends, as management cited deferred benign surgeries due to changes in ACA premium subsidies and the law of large numbers. However, the company maintained its full-year procedure growth guidance of 13.5-15.5%, expecting results near the midpoint, indicating confidence that deferred demand will eventually return.

Meanwhile, profitability continues to strengthen. Second-quarter adjusted gross margin expanded 30 basis points (bps) to 70% and adjusted operating margin expanded 330 bps to 42%, supported by product cost reductions, operating leverage and robust adoption of da Vinci 5. Management also raised its full-year gross margin outlook by 50 bps to 68-69%, highlighting the ability of the business to offset inflationary pressures through scale and manufacturing efficiencies.

Beyond procedures, Intuitive Surgical is widening its competitive moat through software and ecosystem expansion. The company rolled out the first wave of more than 100 planned da Vinci 5 software updates, renewed its My Intuitive+ AI-enabled digital platform without customer opt-outs and continues to invest heavily in AI and workflow automation. Product innovation remains robust with continued momentum in SP and Ion, expansion of XiR into cost-sensitive markets, development of a next-generation GI robotic platform and new cardiac-specific technologies.

Geographic diversification also provides an important growth lever. While China remains challenging, strong momentum in Europe, India, Japan and other international markets, coupled with favorable reimbursement changes and broader robotic adoption, supports long-term expansion. Investments in new indications, higher-value software offerings and next-generation robotics reinforce Intuitive Surgical's durable growth profile. Although near-term procedure moderation may keep valuation multiples below historical peaks, the company's innovation engine, recurring revenue model and expanding global footprint justify its continued premium over industry peers.

Peer Updates

Glaukos GKOS continues to command a premium valuation, trading at 12.54X forward sales, well above its five-year median of 9.9X and the industry's 3.77X, reflecting investors' confidence in its ability to create entirely new ophthalmology markets. The first quarter reinforced this narrative with 41% revenue growth, driven by rapid adoption of iDose TR, a raised full-year revenue outlook and the commercial launch of Epioxa. Management believes Epioxa can become another transformational growth platform. Beyond these launches, an expanding clinical pipeline, growing reimbursement support, international glaucoma expansion and a disciplined focus on operating leverage strengthen the long-term investment case. While execution risks around Epioxa reimbursement and competitive pressures remain, sustained innovation, multiple growth drivers and a diversified ophthalmology portfolio support Glaukos' ability to justify its premium valuation over time.

IDEXX Laboratories IDXXtrades at 8.81x forward sales, below its five-year median of 10.14x but still well above the industry's 3.77x, reflecting its durable competitive advantages in veterinary diagnostics. The first quarter demonstrated why investors continue to assign a premium, as the company delivered 14% reported revenue growth, expanded operating margins and raised full-year guidance despite declining clinic visits. Growth continues to be driven by higher diagnostics utilization, premium instrument placements, expanding recurring revenues, cloud-based software adoption and AI-enabled innovations such as inVue Dx and Cancer Dx. High customer retention, increasing international penetration and continued software integration further reinforce recurring revenue visibility. Although softer wellness visits remain a near-term headwind, IDEXX's innovation-led ecosystem, pricing power and expanding diagnostics penetration position the company to sustain a premium valuation relative to peers over the long run.

ISRG’s Price Performance, Valuation and Estimates

Shares of ISRG have lost 38.2% so far this year compared with a 16.3% decline for the industry.

Image Source: Zacks Investment Research

From a valuation standpoint, Intuitive Surgical trades at a forward price-to-sales of 9.89X, above the industry average. It is trading close to its five-year low of 9.66X. ISRG carries a Value Score of D.