Mid-infrared 6.45 μm laser scalpel has potential application in high precision medicine fields, with advantage of high ablation rate and minimal collateral damage in biological tissue. The collateral damage at this wavelength amounts to several μm which is comparable to the cell size, i.e. close to the optimum value. The laser ablation mechanisms, minimally invasive surgical applications, and laser sources for 6.45 μm laser in China and foreign countries are reviewed, and the development of the research is forecasted.