机器人支气管镜检查在小型外围肺结节的导航成功中表现出高水平，但诊断产量明显较低。基于针头共聚焦激光内窥镜（nCLE），可以在针尖实时显微成像。我们旨在评估实时nCLE引导下针头重定位的可行性、安全性和应用于小型外围肺结节机器人支气管镜检查中的效用。怀疑患有外围肺癌的患者进行了透视和辅助机器人支气管镜检查。通过辅助机器人支气管镜检查确定肺结节位置后，进行了目标区域的nCLE成像。使用nCLE恶性和气道/肺实质标准来确定最佳取样位置。如果可视化气道，就会进行活检针重定位。确定工具进入肺结节后，针头通过和活检在同一位置进行。共纳入20名患者（最终诊断n = 17（肺）癌症），肺结节的中位数大小为14.5毫米（8-28毫米范围）。未发生并发症。 20名患者中，有19名患者获得了优质nCLE视频。在9名患者（45％）中，实时nCLE成像显示针头定位不当，进行了重定位。重定位后，nCLE成像在19/20名患者中提供了工具进入肺结节的确认。随后进行的ROSE检查显示，9名患者（45％）的代表性物质，总体诊断率为80％（16/20）。其中出现nCLE成像恶性但病理学不充分的3名患者中，有两名在随访期间被诊断出患有恶性肿瘤。机器人支气管镜下的nCLE成像是可行且安全的。在难以接触的小型肺结节中，nCLE成像提供了额外的实时反馈，以便优化取样位置和诊断产量。© 2022亚太呼吸学会。

Robotic bronchoscopy has demonstrated high navigational success in small peripheral lung nodules but the diagnostic yield is discrepantly lower. Needle based confocal laser endomicroscopy (nCLE) enables real-time microscopic imaging at the needle tip. We aim to assess feasibility, safety and needle repositioning based on real-time nCLE-guidance during robotic bronchoscopy in small peripheral lung nodules.Patients with suspected peripheral lung cancer underwent fluoroscopy and radial EBUS assisted robotic bronchoscopy. After radial EBUS nodule identification, nCLE-imaging of the target area was performed. nCLE-malignancy and airway/lung parenchyma criteria were used to identify the optimal sampling location. In case airway was visualized, repositioning of the biopsy needle was performed. After nCLE tool-in-nodule confirmation, needle passes and biopsies were performed at the same location.Twenty patients were included (final diagnosis n = 17 (lung) cancer) with a median lung nodule size of 14.5 mm (range 8-28 mm). No complications occurred. In 19/20 patients, good quality nCLE-videos were obtained. In 9 patients (45%), real-time nCLE-imaging revealed inadequate positioning of the needle and repositioning was performed. After repositioning, nCLE-imaging provided tool-in-nodule-confirmation in 19/20 patients. Subsequent ROSE demonstrated representative material in 9/20 patients (45%) and overall diagnostic yield was 80% (16/20). Of the three patients with malignant nCLE-imaging but inadequate pathology, two were diagnosed with malignancy during follow-up.Robotic bronchoscopic nCLE-imaging is feasible and safe. nCLE-imaging in small, difficult-to-access lung nodules provided additional real-time feedback on the correct needle positioning with the potential to optimize the sampling location and diagnostic yield.© 2022 Asian Pacific Society of Respirology.