Intuitive Surgical has outperformed the broader market over the last five years, but the landscape is shifting. The main growth driver going forward is the rollout of the da Vinci 5 system, which was cleared in 2024. Since they make most of their revenue from instruments and accessories, expanding the installed base is key. Competition is getting real though. Medtronic received FDA clearance for its Hugo system last year and is running trials for more indications. J&J is also inching closer to approval for their Ottava system. Despite the new pressure, the bull case is that the robotic surgery market is still underpenetrated and ISRG has a wide moat. High switching costs for hospitals mean existing customers likely won't leave, making the stock a decent hold for the next few years.