devices having a cable that provides an unlimited roll end-effector to a distal end of the device. for example, are described herein medical devices having an elongate tool body, the end effector, and a handle which includes: a first portion, a second portion which rolls against the first portion of a push rod within the first portion connected to a control input and a shuttle body within the second portion which rotates with the second portion but is axially actuated by the push rod when the user activates the control input. The device may include a proximal fixation wrist / forearm allowing one or more degrees of freedom in pitch, yaw or roll around the user's arm. the handle may be pivotable relative to the tool structure, and this joint may be transmitted to the end effector. the end effector can be a set of claws.