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The scope handle is held in the left hand with the umbilical cable that connects to the video processor resting between the thumb and index finger (Figure 6.8) and extending on the outside of the forearm. The base of the scope handle is held between the palm and the fourth and fifth digit. The left elbow is bent in a comfortable position to allow the arm to carry the weight of the scope for long periods of time. The right hand holds the shaft of the scope and is kept within 20–30 cm from the anal opening to allow maximum control of the shaft. The shoulders would be in a comfortable position and the height of the bed should be at a level that allows the endoscopist to stand with the hips and back straight to avoid overuse of the back muscles. In this position, the right elbow should also be bent at roughly 90°. Trainees need to be instructed early on how to correctly set the height of the bed, proper posture, and position of the arms. Improper posture or form can lead to muscle fatigue and chronic musculoskeletal problems over an endoscopist's career [7].