Ramos almost put them ahead after just four minutes but his thunderous header was brilliantly saved by Maarten Stekelenburg.
The most important shot on target was the one by Michael Krohn-Dehli that sailed through the legs of Dutch keeper Maarten Stekelenburg.
After Giovanni van Bronckhorst's spectacular opener, Uruguay were gifted an equaliser when goalkeeper Maarten Stekelenburg failed to deal with Diego Forlan's long-range shot.
Miroslav Stoch took a leaf out of Robben's book by cutting inside onto his right foot and shooting but Netherlands keeper Maarten Stekelenburg tipped over.
Seconds later Marek Hamsik toe-poked forward for Vittek, who showed none of the composure he demonstrated to score twice against Italy by firing straight at Stekelenburg.
In extra-time, Spain pressed forward with yet more urgency and Fabregas was put through by Iniesta only for goalkeeper Maarten Stekelenburg to deny him with a smart save.
Andres Iniesta, Spanish offensive midfielder, caught a break, and after receiving the ball in the box took a shot to the second post, beating Dutch goalkeeper Maarten Stekelenburg.
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Stekelenburg had a clear view of Forlan's swerving strike from 25 yards out and got a hand to the ball, but was still unable to keep it out.
United have recently been linked with a number of goalkeepers, including Gianluigi Buffon of Juventus and Ajax's Martin Stekelenburg, who are seen as potential replacements for Van der Sar.
But the game quickly got bogged down in midfield and there were few chances to speak of until Forlan brought a much better stop from Stekelenburg with a dipping free-kick.
And by the end of the first half Japan had relative control, with towering Brazilian-born defender Tulio heading just wide before Matsui lashed a decent volley straight at goalkeeper Maarten Stekelenburg.
Slovakia's final touch in this World Cup was a positive one as Vittek stroked home a penalty for his fourth and final goal of the tournament after Stekelenburg had tripped the striker.
There was the deliberate handball on the line in a 2010 World Cup quarterfinal to deny Ghana a clear goal he received a red card for that and was jokingly called "the best goalkeeper of the tournament" by the Netherlands goalkeeper Maarten Stekelenburg.
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