Abstract: A medical laser delivery system is disclosed which includes a laser generating a high power, pulsed, treatment beam. The beam is coupled to an optical fiber which is placed adjacent to a tissue site immersed in a fluid medium. The wavelength of the laser light and the energy of the pulses is selected so that the fluid medium will be quickly vaporized creating a vapor bubble around the end of the fiber. The end surface of the fiber is angled in a manner such that after the vapor bubble is formed, the laser output will be totally internally reflected at the end surface and be redirected out of the side of the fiber.