With some art tools, gcc cross-tools, a few emulators and an eprom programmer. I explain it more in depth here:
video.aviI was thinking about coming up with a concept first and then some conceptual art. Make a programmer-cart or find an eprom programmer or romulator. Draw some pixel-art and make any level-editors that would be necessary and make the levels. Then putting together some music and putting everything together. Polishing-- lots of polishing. Testing and of course all the while testing. and then eventually making a manual and box-art. Then selling it/making it freely available for download. I think it would probably take a year to make something really good