Medical devices, methods and systems for treating tissue are provided. An exemplary system comprises a fluid from a fluid source, a surgical device which provides energy and the fluid to the tissue and a control mechanism which changes a flow rate of fluid provided from the surgical device and changes a rate of energy provided from the surgical device. The fluid flow rate changes between at least two non-zero flow rates and the energy rate changes between at least two non-zero energy rates. An exemplary method comprises providing a fluid from a fluid source, providing a surgical device which provides energy and the fluid to the tissue, and changing a flow rate of fluid provided from the surgical device with a change in a rate of energy provided from the surgical device. Exemplary devices comprise a tip portion configured to provide energy and a fluid to a tissue.