Fernando Muslera saved the third and fourth Ghanaian penalty kicks, and when Sebastián Abreu chipped-in Uruguay's fourth goal with the fifth kick of the shootout, Uruguay was into the semifinals of the 2010 World Cup.
The teams finished extra time drawn 1-1, with neither team scoring in the bonus thirty after Sulley Muntari and Diego Forlan goals in regulation.
Forlan and Asamoah Gyan (who missed a penalty kick at the end of extra time that would have sent Ghana to the final four) opened with successful tries, with Mauricio Victorino and Stephen Appiah making it 2-2.
After Andres Scotti beat Richard Kingson to give Uruguay a 3-2 lead, John Mensah and Maxi Pereria missed kicks, giving Ghana a chance to pull even with Dominic Adiyiah's try. The 20-year-old striker's shot was saved by Muslera, making Sebastián Abreu's kick potentially decisive.
"El Loco" chipped a ball into the middle of goal, his shot arching over the goal line as Richard Kingson landed to the goal's right, putting Uruguay into the semifinals for the first time since 1970.
Team - Kick Taker - Kick Result - Standing
Uruguay - Diego Forlan - Converted into right of goal (Kingson guessed incorrectly) - 1-0, Uruguay
Ghana - Asamoah Gyan - Coverted into the upper right of goal (Muslera guessed correctly) - 1-1
Uruguay - Mauricio Victorino - Converted into the upper left of goal (Kingson guessed correctly) - 2-1, Uruguay
Ghana - Stephen Appiah - Converted into the upper left of goal (Muslera guessed correctly) - 2-2
Uruguay - Andres Scotti - Converted into the center of goal (Kingson guessed incorrectly) - 3-2, Uruguay
Ghana - John Mensah - Saved by Muslera to the right of goal - 3-2, Uruguay
Uruguay - Maxi Pereira - Missed over goal - 3-2, Uruguay
Ghana - Dominic Adiyiah - Saved by Muslera to the right of goal - 3-2, Uruguay
Uruguay - Sebastián Abreu - Chipped into middle of goal (Kingson guessed incorrectly) - 4-2 Uruguay wins