Procept Biorobotics Charts Growth Amid Profit Pressures

Procept Biorobotics Corp. ((PRCT)) has held its Q1 earnings call. Read on for the main highlights of the call.

Procept Biorobotics’ latest earnings call struck a cautiously upbeat note, with management highlighting strong revenue and procedure growth alongside steady margin gains and important clinical wins. At the same time, executives acknowledged rising losses, heavier operating expenses and tariff headwinds, while emphasizing that many commercial and productivity benefits will materialize more meaningfully in late 2026.

Revenue Growth

Procept opened 2026 with total revenue of $83.1 million in the first quarter, up 20% year over year and signaling solid demand for its Aquablation platform. Management framed this as a strong start that supports its confidence in delivering high‑20s to low‑30s percentage growth for the full year.

Procedure Momentum

The company reported about 12,200 U.S. procedures in Q1, representing roughly 30% growth from a year ago as adoption expanded across hospitals and health systems. Management expects procedure growth to accelerate in the back half, reiterating guidance for 60,000–64,000 U.S. procedures in 2026, or about 39%–48% growth over 2025.

System Sales and Pricing Strength

Procept sold 49 U.S. Hydros systems in the quarter, including two replacements, and achieved a record new‑system average selling price near $485,000. That figure marked a 14% increase versus Q4 and drove U.S. system revenue to $23.4 million, up 25% year over year, though management now models the rest of the year at a more conservative $450,000–$460,000.

Consumable Performance

On the consumables side, handpiece ASP rose to about $3,500, up 5% sequentially and 10% year over year, underscoring healthy pricing power in the recurring revenue stream. U.S. handpiece and consumable revenue reached $43 million, a 13% increase, and management reiterated its expectation of roughly one handpiece per procedure for the full year.

Gross Margin Improvement

Gross margin improved to 65% in Q1, up from 61% in Q4 2025 and slightly above the prior‑year level, putting the company squarely within its targeted range. Management reiterated full‑year gross margin guidance around 65% and expects modest sequential improvement, even after absorbing higher tariffs.

International Progress

International revenue climbed to $11.1 million, a 25% year‑over‑year increase that underscores growing global traction for Aquablation. The quarter also marked the first Hydros launch in the U.K., where Procept sold seven systems at ASPs above $400,000 and saw rapid uptake within the National Health Service.

Clinical and Regulatory Milestones

Procept scored notable clinical and regulatory wins that should support future adoption and pricing. The European Association of Urology upgraded Aquablation to a strong recommendation as a surgical alternative for benign prostatic hyperplasia, and the company secured FDA clearance for its second‑generation FirstAssist AI software, enhancing the system’s capabilities.

WATER IV Trial Progress

Enrollment in the WATER IV clinical trial is nearing completion, with full enrollment anticipated by the end of May. Management plans to present the primary endpoint at a major urology meeting in spring 2027, and a positive readout could significantly broaden indications and expand the addressable market.

Balance Sheet Strength

The company ended the quarter with $249 million in cash, cash equivalents and restricted cash, offering a solid buffer to fund commercialization and ongoing trials. This liquidity position gives management room to continue investing in sales infrastructure and clinical programs despite current operating losses.

GAAP Losses and EBITDA Pressure

Despite strong top‑line trends, profitability remains a concern, with Q1 net loss widening to $31.6 million from $24.7 million a year earlier. Adjusted EBITDA loss also increased to $18.1 million from $15.8 million, highlighting that higher scale has not yet translated into bottom‑line leverage.

Rising Operating Expenses

Total operating expenses increased to $86.6 million, up from $71.6 million in the prior‑year quarter, as the company ramped commercial teams, innovation efforts and funding for the WATER IV trial. Management framed these higher costs as strategic investments that should support long‑term growth but acknowledged they are weighing on near‑term earnings.

Short‑Term Commercial Disruption

A commercial realignment, including a shift to an integrated regional structure and creation of launch teams, caused some disruption in the quarter. Executives said this transition contributed to softer‑than‑planned procedure growth in Q1 but expressed confidence that performance will normalize and improve in the second half of 2026.

Handpiece to Procedure Ratio Slippage

Handpieces sold represented roughly 95% of procedures, falling slightly short of the targeted one‑to‑one ratio that underpins revenue efficiency. Management attributed this to recent inventory rightsizing and transitional buying behavior and expects the ratio to normalize over the course of the year.

Tariff Headwind

Tariffs represent another emerging headwind, with Procept projecting $5 million to $6 million in tariff expense for 2026 versus $1.3 million last year. While gross margin guidance already incorporates this burden, it still dampens the upside from operational improvements and could pressure profitability if not offset by pricing or scale.

Conservative Near‑Term Guidance

Management adopted a cautious tone on near‑term expectations, especially following prior organizational changes and a previous quarter’s shortfall. The company guided Q2 revenue to $91–$95 million, implying 15%–20% growth but a midpoint slightly below consensus estimates, signaling prudence despite strong Q1 pricing metrics.

ASP Sustainability Uncertainty

Executives also warned that the record Q1 system ASP may not fully persist, as pricing depends on customer mix between large integrated delivery networks and single‑site accounts. They plan to monitor trends through Q2 before revisiting assumptions, suggesting investors should not extrapolate first‑quarter ASP strength in a straight line.

Back‑Loaded Benefit Realization

Several key initiatives, including launch teams, marketing pilots and a replacement program, are expected to deliver most of their impact in the back half of 2026. That timing leaves near‑term numbers more vulnerable to execution risk, but it also sets the stage for a stronger finish if ramp‑up proceeds as planned.

Forward‑Looking Guidance

Looking ahead, Procept reaffirmed full‑year 2026 revenue guidance of $390–$410 million, implying about 27%–33% growth, and expects international sales of $50–$51 million with total U.S. procedures of 60,000–64,000. The company is guiding to a roughly 65% gross margin, a full‑year adjusted EBITDA loss of $30 million to $17 million and positive adjusted EBITDA in the fourth quarter, while forecasting new U.S. system pricing of $450,000–$460,000 and a handpiece ASP near $3,500.

Procept Biorobotics’ earnings call painted a picture of a company balancing strong growth and expanding clinical validation against near‑term cost pressure and operational transitions. For investors, the key takeaways are robust procedure and revenue momentum, improving margins and a solid cash position, offset by widening losses and execution risk as management works toward its goal of turning EBITDA positive by year‑end 2026.