A tissue removal device comprising: a handpiece enclosing a handpiece interior and having a proximal handpiece opening and a distal handpiece opening; a vacuum conduit (144, 152) extending from the proximal handpiece opening and through the handpiece interior and the distal handpiece opening, and terminating at an open distal conduit end disposed outside the handpiece at a distance from the distal handpiece opening; a valve mechanism (156, 1056, 1256, 1556) communicating with the vacuum conduit (144, 152) and configured to control vacuum pressure in the vacuum conduit, wherein the vacuum conduit includes a rigid conduit section extending from the valve mechanism (156, 105 6, 1256, 1556) to the distal conduit end; and a vacuum control device (112, 180) communicating with the valve mechanism (156, 1056, 1256, 1556) and including pulse rate control circuitry configured to actuate the valve mechanism between an open state and a closed state to induce vacuum pulses in the vacuum conduit at a controllable pulse rate to generate vacuum pulses; wherein the vacuum control device (112, 180) further includes vacuum-mode switching circuitry (116, 118) configured to switch the valve mechanism (156, 1056, 1256, 1556) between a continuous-vacuum mode and a pulsed vacuum mode, and wherein the vacuum control device (112, 180) is configured to activate a vacuum pulsing device to alternate the valve mechanism between the open and closed states to generate the vacuum pulses for a pulsing operation effective for breaking up tissue, wherein the magnitude and duration of the vacuum pulses produces a sequence of discrete impacts for fragmentation of the tissue and thereafter for collection of the tissue into the vacuum conduit. a handpiece enclosing a handpiece interior and having a proximal handpiece opening and a distal handpiece opening; a vacuum conduit (144, 152) extending from the proximal handpiece opening and through the handpiece interior and the distal handpiece opening, and terminating at an open distal conduit end disposed outside the handpiece at a distance from the distal handpiece opening; a valve mechanism (156, 1056, 1256, 1556) communicating with the vacuum conduit (144, 152) and configured to control vacuum pressure in the vacuum conduit, wherein the vacuum conduit includes a rigid conduit section extending from the valve mechanism (156, 105 6, 1256, 1556) to the distal conduit end; and a vacuum control device (112, 180) communicating with the valve mechanism (156, 1056, 1256, 1556) and including pulse rate control circuitry configured to actuate the valve mechanism between an open state and a closed state to induce vacuum pulses in the vacuum conduit at a controllable pulse rate to generate vacuum pulses; wherein the vacuum control device (112, 180) further includes vacuum-mode switching circuitry (116, 118) configured to switch the valve mechanism (156, 1056, 1256, 1556) between a continuous-vacuum mode and a pulsed vacuum mode, and wherein the vacuum control device (112, 180) is configured to activate a vacuum pulsing device to alternate the valve mechanism between the open and closed states to generate the vacuum pulses for a pulsing operation effective for breaking up tissue, wherein the magnitude and duration of the vacuum pulses produces a sequence of discrete impacts for fragmentation of the tissue and thereafter for collection of the tissue into the vacuum conduit.