Operator
Ladies and gentlemen, thank you for standing by. Welcome to the Intuitive Surgical Q4 2015 earnings release conference call. At this time, all participants are in a listen-only mode. Later we will conduct a question-and-answer session and instructions will be given at that time. [Operator Instructions]. As a reminder, today’s teleconference is being recorded.
And I would now like to turn the conference over to the Senior Director of Finance, Investor Relations for Intuitive Surgical, Mr. Calvin Darling. Please go ahead, sir 
Calvin Darling
Thank you. Good afternoon and welcome to Intuitive Surgical’s fourth quarter earnings conference call. With me today, we have Gary Guthart, our President and CEO, Marshall Mohr, our Chief Financial Officer and Patrick Clingan, Senior Director of Finance.
Before we begin, I would like to inform you that comments mentioned on today’s call may be deemed to contain forward-looking statements. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties.
These risks and uncertainties are described in detail in the company’s Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 5, 2015 and 10-Q, filed on October 21, 2015. These filings can be found through our website or at the SEC’s EDGAR database. Prospective investors are cautioned not to place undue reliance on such forward-looking statements.
Please note that this conference call will be available for audio replay on our website at intuitivesurgical.com, on the Audio Archives section under our Investor Relations page. In addition, today’s press release and supplementary financial data tables have been posted to our website.
Today’s format will consist of providing you with our highlights of our fourth quarter results as described in our press release announced earlier today, followed by a question-and-answer session. Gary will present the quarter’s business and operational highlights, Marshall will provide a review of our fourth quarter financial results, Patrick will discuss marketing and clinical highlights, then I will provide our financial outlook for 2016 and finally we will host a question-and-answer session.
With that, I will turn it over to Gary.
Gary Guthart
Good afternoon and thank you for joining us on the call today. 2015 was a good year for Intuitive with increased use of our products around the globe and solid operational execution. Our focus in 2015 was to drive adoption of our platform in general surgery, expand our da Vinci Xi Surgical System product line, increase our organizational capability and performance in international markets and improve contribution margins for our newly launched products. Themes that emerged at the close of 2014 continued into 2015 with strong performance in general surgery and international procedure growth.
Full-year global procedure growth was approximately 14%, led by growth in general surgery, growth in the use of da Vinci surgical systems outside the United States and strength in urology. U.S. general surgery growth was approximately 31% for the year made up of strong growth in inguinal hernia repair, ventral hernia repair and colorectal surgery, use of single site in cholecystectomy and hysterectomy declined for the year. Outside of the United States, procedure growth was strong, rising approximately 26% over procedures in 2014. Patrick will review procedure trends in greater detail later in the call.
Looking at trends in capital sales for the year, capital placements increased in 2015 to 492 from 431 placements in 2014. Customer interest and acceptance of our latest platform da Vinci Xi has been positive with Xi making up the majority of placements for the year. In 2015, we shipped 298 systems in the United States, 90 in Europe, 77 in Asia and 27 in other global markets. Our operations teams remain focused on optimizing our manufacturing, design and supply chains for our newer products. Progress in the back half of 2015 has been solid with steady improvements in reducing product costs for our new systems and advanced instruments. We expect our product cost to continue to improve in 2016 and 2017 as a result of these efforts.
As we have said before, our offerings make up an ecosystem designed to encompass our customers’ needs in building and running outstanding robotic surgery programs. 2015 was a year which we focused on enabling our ecosystem with new product launches globally. We launched our da Vinci Xi system with a core set of instruments, vessel sealer and Firefly Fluorescence Imaging in 2014. We broadened access to our Xi system with international regulatory clearances through the year. We also added our 45 millimeter Xi stapler in Q1 as well as Harmonic Curved Shears and a second set of instruments in Q2 of 2015. We submitted our 510(k) for our 30 millimeter stapler for Xi, single site instrument kit for Xi as well as other Xi accessories in the second half of 2015. I am pleased to report that we obtained FDA clearance for integrated Xi table motion this month.
In addition to products, our surgeon customers can choose from dozens of training courses provided by academic surgeons as well as courses designed for assistance and other operating room staff. Our customers own over 1,400 surgical simulators and over 600 dual consoles to assist them in technology training. In addition, our teams have provided detailed analytic and operational support for customers seeking to optimize and benchmark their programs relative to international norms. We believe the combination of these products and services are important to fully enable our customers.
Looking back at the full year of 2015, our operating performance is summarized as follows. Worldwide procedures grew by approximately 14%. We shipped 492 da Vinci surgical systems in the year, up from 431 in 2014. Total revenue was $2.4 billion, up 12% from 2014 and up 15% on a constant currency basis. Recurring revenue grew to $1.7 billion, up 11% and comprising 70% of total revenue. We generated $946 million in pro forma operating profit, up 16% from last year. Pro forma net income was $731 million, up 20% from 2014 and we repurchased 366,000 shares at an average price of $502 per share during 2015.
Turning to our operating performance for the fourth quarter. Procedures grew approximately 15% over the fourth quarter of last year. We shipped 158 da Vinci surgical systems, up from 137 in the fourth quarter of 2014. Total pro forma revenue for the quarter was $677 million, up 13% from prior year. Instrument and accessory revenue increased to $326 million, up 16%. We generated a pro forma operating profit of $293 million in the quarter, up 28% from the fourth quarter of last year and pro forma net income was $224 million, up 22% from Q4 of 2014.
As we look to the future, we passionately believe that robotic assisted surgery is in its infancy in application and technology. As we have improved our cost and supply chains for new products, we anticipate increasing our investments in key areas that will enable and drive the future of robotic assisted surgery. These include product investments in advanced imaging, advanced instrumentation and next generation robotics. We will also continue to invest in procedure, product and program analytics, international market development and economic and clinical validation.
Looking to 2016, our priorities are as follows. First, we will focus on the expanded use of da Vinci in general and thoracic surgery, particularly colorectal surgery and hernia repair. Second, we will work to advance our ecosystem, including expanding our Xi line and taking our Sp product line into initial clinical use. Third, we will drive our organizational capabilities in markets in Europe and Asia. And finally, we will continue to assist our customers in their efforts to maximize the comprehensive value of their programs.
I will now turn the call over to Marshall who will review financial highlights.