An apparatus to treat a patient, the apparatus comprises a carrier having a proximal end and a distal end, an optical fiber to couple to a light source, a fluid delivery element comprising a nozzle having an orifice on the distal end, and an alignment structure to align the optical fiber with the orifice. A distance extends between the alignment structure and the orifice, such that the light beam emitted from the optical fiber diverges so as to allow energy transmission and fluid flow through the orifice. In some embodiments, the apparatus to ablate tissue comprises a source of pressurized fluid, and the nozzle is coupled to the source of pressurized fluid to release a fluid stream.
