Pulmonary nodules at the periphery of the lung were historically diagnosed via transthoracic needle aspiration due to poor outcomes with bronchoscopy. The development of navigational techniques has allowed bronchoscopists to successfully access these lesions, with advantages of a significantly lower risk of pneumothorax and the ability to stage nonsmall cell lung cancer during the same procedure and anesthesia event. The first iteration of this technology was virtual bronchoscopy, essentially reconstructing a three-dimensional map of the airways from a high-resolution CT scan and building a preprocedural roadmap to be followed during the procedure. The advent of electromagnetic navigation allowed for real-time monitoring of the position of the bronchoscope within the airways along the preplanned pathway with a virtual view of the airway tree demonstrating a roadmap to follow that updates in real time as the bronchoscope is advanced. Subsequent advances have included the development of robotic bronchoscopy and the addition of real-time external imaging to better confirm the location of the target and bronchoscope/sampling instruments intraprocedurally. The safety and efficacy of navigational bronchoscopy has been demonstrated with an increasingly robust literature basis, but additional studies are needed to help determine the most optimal approach among available tools and technologies.