Biopsy instruments can diagnose peripheral pulmonary lesions, but they must be precisely advanced through the bronchus to the target lesions by selecting the correct route among branching bronchi. Thinner bronchoscopes can navigate more peripheral bronchi while allowing direct visualization of bronchial branches, making the use of an ultrathin bronchoscope for diagnosing peripheral lesions a reasonable approach. Technological advances have led to the development of thinner bronchoscopes with larger working channels and improved visual quality compared to earlier models. Additionally, miniaturized biopsy instruments (e.g., cryoprobes and biopsy needles) and guidance devices (e.g., radial probe endobronchial ultrasound) that can be used through the working channel of ultrathin bronchoscopes have been introduced. Several randomized studies have demonstrated that ultrathin bronchoscopy offers superior diagnostic performance compared to larger bronchoscopes for small peripheral pulmonary lesions. The integration of multimodality and multiinstrumental ultrathin bronchoscopy significantly enhances the diagnostic yield for these lesions.