The paper presents the description of a high-power waveguide single-mode CO2 laser generating 800 W average beam power and up to 1 kW peak power at pulse duration from 2 to 100 ms. The diffusion-cooled active medium is excited by a capacitive AC discharge of sound frequency. The advantages of the laser are: high (>10%) technical efficiency, upgraded stability of beam parameters at the cost of the use of waveguide generation mode, extremely low (<1 nl/h) consumption of lasing mixture and possibility of operation in quasi-sealed-off regime; design simplicity, compactness and low cost. As an example of application of various capabilities of these lasers, a description of the developed medical system `Genom-4' used in the transmyocardial revascularization (TMR) procedure is presented. The system is equipped with devices which are necessary both to conducting biophysical experiments and to performing operations under clinical conditions; among them are computer control system, cardiograph for synchronization of laser pulse with ECG of the heart under operation, remote articulated mirror manipulator with optical hand-piece for performing operations. The results of biophysical experiments on drilling channels in organic materials and biological tissues in vitro, as well as the results of operations on patients, are presented. Verification of a possible negative influence of shock waves, which can be generated in biotissues during the TMR procedure, has been studied. It has been shown that the pressure excess due to laser action is lower than one bar. Thus, no destruction of biotissues surrounding the channel should be caused. The autodyne Doppler spectroscopy diagnostics of specifying the moment of keyhole punching in myocardium has been discussed. Other possible applications of the system for drilling deep channels in liver, lungs, etc. are mentioned.