Prompt debridement of burns and early grafting increase survival rates while reducing morbidity and length of hospitalization. Among the debridement methods, hydrosurgery is gaining popularity during the last decade. This review aims to review all available clinical evidence regarding the efficacy, safety, and cost-effectiveness of the hydrosurgical management of burns. This is a systematic review based on a MEDLINE and Scopus databases search of articles in English from 2015 to October 2016. The terms “hydrosurgery,” “hydrodebridement,” “hydroscalpels,” “water jet surgery,” and “Versajet” were used in combination and with the terms “acute wound” and “burns.” Retrieval of included studies and critical appraisal of data were assessed following the PRISMA structure. There is good but limited evidence regarding the efficacy and safety of the method (level of evidence I–II). No significant differences compared to the conventional surgical debridement are yet documented by currently available literature. There is fair and limited evidence (level III) concerning the cost-effectiveness of the method. Although there is increasing evidence on the safety, efficacy, and cost-effectiveness of hydrosurgery in burns, large-scale prospective randomized control trials with long-term follow-up are necessary to establish the superiority of the method over conventional surgical debridement in terms of selectivity of removed tissues, reduced necessity for dressings and reoperations, healing time, engraftment, and scar quality. All cost-influencing dynamics of this per se expensive modality need to be thoroughly analyzed to resolve its cost-saving potential.