Intuitive Surgical’s (ISRG Quick QuoteISRG - Free Report) business in China has shown pressure points as geopolitics and industrial policy increasingly shape capital purchasing. Management acknowledged that tenders are slow, but the competition remains healthy, even as clinicians continue to prefer da Vinci on technological grounds. The company also noted that several local provinces are preferring local players to win, underscoring structural favoritism toward domestic vendors and persistent pricing pressure on both capital systems and instruments and accessories (I&A).

These headwinds are already evident in placements. In the third quarter of 2025, China accounted for 13 da Vinci systems, down slightly year over year, as management described the market as “constrained and competitive.” At the JPMorgan Healthcare Conference, leadership reiterated that the company continues to face challenges with pricing and other robotic competitors entering the market in China, flagging competitive intensity as a key variable in 2026 guidance.

Despite this, ISRG retains meaningful advantages. First, its global scale supports portfolio segmentation to address cost sensitivity — most notably via refurbished Xi systems — allowing the company to lower entry barriers. Second, utilization-driven economics remain central, with management emphasizing per-procedure value over upfront price, leveraging training, service, and digital tools to raise throughput and sustain customer ROI. Finally, the breadth of ISRG’s installed base and evidence engine (tens of thousands of peer-reviewed publications) reinforces physician preference, which remains a differentiator even in policy-tilted markets.

Peer Updates

Apart from ISRG, the majority of U.S.-based robotic surgery device-makers, including Stryker (SYK Quick QuoteSYK - Free Report) and Globus Medical (GMED Quick QuoteGMED - Free Report) , are facing rising competition from upcoming local players in China. Moreover, the Chinese policy to prioritize high???end, domestically pioneered surgical robots implicitly tilts the playing field toward local players.

Stryker has pushed Mako SmartRobotics into broader commercial rollouts while targeting growth in Asia, including China, where the company highlights product launches and feature upgrades to broaden indications and adoption. Stryker’s management stressed continued investment in Mako’s global commercialization and new-generation systems to improve OR throughput and surgeon adoption. At the same time, China’s orthopedic-robot market is rapidly maturing and increasingly led by domestic suppliers, producing intense price and tender competition that may compress capital and I&A margins for premium entrants like Stryker. Expect Stryker to lean on refurbished or segmented offerings and service economics to defend share.

Globus Medical has accelerated internationalization of its Excelsius ecosystem — most recently expanding navigation and imaging integrations with launches such as ExcelsiusHub — while pursuing growth outside the United States, including China. The company emphasizes technology depth, including robotic guidance, navigation and workflow to win hospital programs. However, Chinese spine and navigation suppliers are scaling quickly, eroding pricing power in that market. As China concentrates domestic capability in surgical navigation and robot-assisted spine solutions, Globus Medical will need to rely on clinical evidence, channel partnerships and portfolio bundling to protect ExcelsiusGPS uptake amid rising local competition.