<p>Laser bone ablation has emerged as a promising alternative to conventional mechanical osteotomy, offering advantages including high precision, minimal collateral damage, non-contact operation, and compatibility with intelligent and robotic surgical systems. However, compared to conventional mechanical tools, its relatively lower ablation efficiency prolongs surgical duration and increases associated risks, thereby hindering its clinical application. This review systematically examines recent advances and effective strategies for improving the efficiency of laser bone ablation. A comprehensive analysis is carried out on the optical and structural properties of bone, laser-tissue interaction mechanisms, and the distinctive ablation characteristics of various laser systems to explore optimization direction for laser osteotomy procedures. The investigation discusses critical factors influencing ablation efficiency, including laser parameters, target bone quality, cooling methodologies, and monitoring techniques. For each laser type, the review provides evidence-based optimization protocols designed to achieve an optimal balance between maximal tissue removal efficiency and minimal collateral damage. Finally, the review summarizes the current optimization challenges faced by laser bone ablation systems, including systematic experiments in various bone quality scenarios, the development of multimodal real-time monitoring, intelligent feedback systems, and specialized hardware components, such as optical fibers. Integrating these solutions will improve laser bone ablation efficiency and clinical outcomes, potentially transforming conventional orthopedic surgical approaches.</p>