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We investigated the mechanisms of material ejection in Q-switched Er:YAG laser tissue ablation (70-ns pulse duration) where moderate and large radiant exposures are associated with large volumetric energy densities in the target material. For water, an initial phase of non-equilibrium surface vaporization is followed by an explosive vaporization of the superficial liquid volume from a supercritical state. The ablation of deeper layers with lower peak temperatures proceeds as phase explosion. For mechanically strong tissues, non-equilibrium surface vaporization is followed by a vapour explosion coupled with thermal dissociation of the biomolecules into volatile products. In deeper layers, ablation proceeds as confined boiling with mechanical tearing of the tissue matrix by the vapour pressure. The recoil stress induced at a radiant exposure of 5.4 J/cm2 is in the order of 500-900 MPa. For water and soft tissues such as liver, the recoil causes a powerful secondary material expulsion. For stronger tissues such as skin, no secondary expulsion was observed even though the recoil stress largely exceeds the static tensile strength of the tissue. Recoil-induced material expulsion results in an increase of both ablation efficiency and mechanical side effects of ablation. Theoretical modelling of the succession of phase transitions in nanosecond-laser tissue ablation and of recoil-induced material expulsion remain a major challenge for future work. [ABSTRACT FROM AUTHOR]