Intuitive Surgical (NASDAQ:ISRG) pre-announced preliminary fourth-quarter results last week, leaving little room for big surprises in Thursday's full earnings report.

The final report confirmed Intuitive Surgical's estimated $576 million in total revenue, a 5% year-over-year decline. Also as expected, sales of instruments and accessories for the da Vinci robotic surgery system increased 6% and accounted for 46.5% of total revenues.

GAAP earnings for the quarter came in at $4.28 per diluted share, slightly below the year-ago quarter. This metric was not pre-announced, and the average analyst projection pointed at a much lower $3.83 per share.

Intuitive sold 138 da Vinci systems in the quarter, 21% below the year-ago period's 175 systems. The decline was driven by hospitals setting conservative budgets as they adjust to the new Obamacare health insurance system. Machine sales are increasing abroad, particularly in the Japanese market.

"For 2014, we are focused on expanding use of da Vinci in general surgery, particularly colorectal surgery and single-incision surgery," said CEO Gary Guthart. Europe and Japan are Intuitive's main target markets for international growth this year.

In after-hours trading, Intuitive Surgical's shares initially jumped as much as 3.1% higher on the earnings surprise, but reversed course to trade down 4.3% at the time of writing as the analyst call started.