Handle mechanism providing unlimited roll

Devices having a handle that provides unlimited roll to an end-effector at the distal end of the device. For example, described herein are medical devices that have an elongate tool frame, an end-effector, and a handle that includes: a first portion, a second portion that rolls relative to the first portion, a push rod within the first portion connected to a control input, and a shuttle body within the second portion that rotates with the second portion but is axially driven by the push rod when the user actuates the control input. The device may include a proximal wrist/forearm attachment allowing one or more degrees of freedom in pitch, yaw or roll about the user's arm. The handle may articulate relative to the tool frame, and this articulation may be transmitted to the end-effector. The end-effector may be a jaw assembly.