Ablative therapies in gynecologic malignancies can be divided into two broad categories: direct (surgical or intraoperative) and image-guided. In advanced-stage ovarian and endometrial cancers, the primary treatment is surgery, with the goal of removing all visible tumors. It is important to note that neoadjuvant chemotherapy has been used with increasing frequency if upfront resection of tumor is not deemed feasible, or if the patient is not a surgical candidate. Direct ablative techniques are useful and have become standard tools in both upfront and interval debulking surgeries. The most commonly used techniques (argon beam coagulator, cavitron ultrasonic surgical aspirator, and thermal plasma surgery) will be reviewed. The use of image-guided therapies (radiofrequency ablation, cryotherapy, and embolization) in gynecologic cancers is limited and has been reported mostly in the palliative setting for recurrent disease. Radiofrequency ablation is occasionally used for tumors metastatic to the liver, although there is no evidence showing a benefit to this practice. Embolization of pelvic vessels is commonly used in the palliative treatment of advanced, recurrent pelvic malignancies presenting with genitourinary or gastrointestinal bleeding. Intraoperative ultrasound has been used to facilitate the identification of suspicious lymph nodes, assess myometrial invasion, and diagnose adnexal masses. Unfortunately, the results have been disappointing overall, and intraoperative ultrasound remains investigational. The use of magnetic resonance-guided high-intensity frequency ultrasound technology is still investigational in the setting of gynecologic malignancies.