A doctor can use fine instruments which are also passed into the abdomen through another small incision in the skin.

http://www.patient.co.uk/health/laparoscopy-and-laparoscopic-surgery

What is laparoscopic surgery?

In addition simply to looking inside, a doctor can use fine instruments which are also passed into the abdomen through another small incision in the skin. These instruments are used to cut, trim, biopsy, grab, etc, inside the abdomen. This laparoscopic surgery is sometimes called 'keyhole surgery' or 'minimally invasive surgery'.