Eastern Democratic Republic of Congo (DRC) and Burundi are an endemic zone of giant goiters that are a significant public health challenge there. Thyroidectomies were performed only occasionally with a complication rate approaching 50 %. In 2012, in collaboration with the NGO 2nd Chance and local hospitals, we initiated a training program for local general surgeons to reintroduce a safe practice of thyroid surgery. The program was ongoing for 10 years and is still running.

We retrospectively assessed the outcomes of patients enrolled in the program between 2013 and 2023 in Eastern DRC and Burundi. The progression of the participating surgeons was evaluated. Data were collected from patient records and mission reports.

We conducted 38 teaching missions between 2013 and 2023 during which 559 patients underwent thyroid surgery. The short-term follow-up rate was nearly 100% and the long term 36%. The complications included : hematoma requiring reintervention (2.4%), recurrent nerve palsy (1.6%), wound infection (2.75%). Out of 29 local surgeons enrolled in the program,14 are now certified as independent operators and 4 have the status of trainers.

Although the surgery was performed in a rural environment with limited resources on goiters weighing up to 2 kilos, the complication rate was acceptable. The missions permitted to create a network of independent endocrine surgeons.The skills are being diffused now autonomously by local actors, maintaining the surgical expertise in the long term. This project demonstrates the feasibility of performing and teaching a complex procedure in an unstable socio-economic context in a limited resources setting.