Bronchoscopic Transparenchymal Nodule Access (BTPNA) is an innovative technique in interventional pulmonology, offering a minimally invasive approach to diagnosing and treating peripheral pulmonary nodules (PPNs). By integrating bronchoscopic navigation system, BTPNA overcomes the limitations of traditional bronchoscopy and transthoracic needle aspiration. This method has demonstrated high diagnostic yields, particularly in nodules that lack a bronchus sign, and significantly reduces complications like pneumothorax. BTPNA’s utility extends beyond diagnosis, enabling therapeutic interventions like ablation and recanalization of obstructed airways. Despite its advantages, BTPNA requires specialized skills and equipment, and relative complex process, which may limit its widespread adoption. However, ongoing technological advancements are likely to simplify the procedure and broaden its application, potentially making BTPNA a standard practice in the management of PPNs. This chapter discusses the principles, applications, procedures, complications, and future prospects of BTPNA in the context of pulmonary disease management.