Central airway obstruction (CAO) is associated with significant morbidity and increased mortality. Bronchoscopic electrosurgical and laser ablative tools have proven to be safe and effective instruments for the treatment of malignant CAO. While therapeutic modalities such as electrocautery, argon plasma coagulation (APC), and laser have been utilized for decades, additional tools including radiofrequency ablation (RFA) catheters continue to be developed for the treatment of CAO. These modalities are considered safe in the hands of experienced operators, though serious complications can occur. This review describes the use of various electrosurgical and laser therapy tools used for the treatment of malignant CAO along with the specific advantages and disadvantages of each device.