Handheld and endoscopic optical‐sectioning microscopes are being developed for noninvasive screening and intraoperative consultation. Imaging a large extent of tissue is often desired, but miniature in vivo microscopes tend to suffer from limited fields of view. To extend the imaging field during clinical use, we have developed a real‐time video mosaicking method, which allows users to efficiently survey larger areas of tissue. Here, we modified a previous post‐processing mosaicking method so that real‐time mosaicking is possible at >30 frames/second when using a device that outputs images that are 400 × 400 pixels in size. Unlike other real‐time mosaicking methods, our strategy can accommodate image rotations and deformations that often occur during clinical use of a handheld microscope. We perform a feasibility study to demonstrate that the use of real‐time mosaicking is necessary to enable efficient sampling of a desired imaging field when using a handheld dual‐axis confocal microscope.